Monday, August 09, 2010

Homeless in Portland

Here's a very interesting story from Portland, Oregon where housing and services for the homeless are "indexed" on the basis of need and, I would add, community impact. The story highlights differences in opinion and approach as to how to best address the needs of chronically homeless persons across the nation, as well as in a city like Portland.

Old Town project sorts out who should get 130 apartments
By Peter Korn
The Portland Tribune, Aug 5, 2010

Construction has started on the $49 million Resource Access Center, which will provide housing for 130 homeless people and include an overnight shelter and a daytime facility.

Sometime this autumn, the people who work in Portland’s safety-net medical clinics and social service agencies will be filling out new assessment forms for every homeless patient or client they see. These forms will be graded and ranked, and will provide housing officials with a list of the 260 most vulnerable homeless people in the city.

The assessments are part of an ambitious, first-of-its-kind Portland housing project in Old Town. The challenge is to find 130 homeless people most likely to die or become victims of abuse if left homeless, and to provide them with apartments in one building – the $49 million Resource Access Center, that should be completed in the spring. The building will house other services for the homeless, including an overnight shelter and a daytime facility.

But the 130 apartments will be the most experimental part of the access center. Most of the residents will suffer from mental illness and addiction and diseases such as cirrhosis and kidney failure. They will be among the most hard-core homeless, many unwilling or unable to accept help in the past.

Housing officials say it will cost the city and the Housing Authority of Portland quite a bit of money to manage the residents in the access center apartments. But if the experiment works to stabilize the lives of its tenants, they say, it will save millions of dollars because these are the homeless people who, when left on the street, require the most in unpaid hospital care, as well as in police, jail and court costs.

The access center apartments will represent the single largest housing development for the homeless ever built in Portland. It was not an easy matter to choose who, among the estimated 1,600 homeless people in Portland, would get those apartments, says Margaret Van Vliet, director of the Portland Housing Bureau.
“There will be thousands of people who don’t get served,” Van Vliet says. “It is the ‘Sophie’s Choice.’ ”

The city could have targeted homeless veterans or held a lottery or even operated the building as the housing authority runs the rest of its public housing projects – on a first-come, first-served basis.

But targeting the most vulnerable among the homeless, a relatively new idea gaining popularity among housing officials in many cities, makes sense, Van Vliet says. Other programs provide housing vouchers for homeless veterans, and options for homeless families and abused women.

“It’s a humanitarian crisis,” Van Vliet says. “Let’s serve the people who aren’t getting served in any other part of the system. Nobody else is going to get to this population.”

And the policy could make good financial sense.

The access center apartments and the city’s vulnerability index are modeled on pioneering work done in Seattle by that city’s Downtown Emergency Service Center, a nonprofit dedicated to homeless housing.

Bill Hobson, executive director of the service center, says one of those models is the 1811 East Lake Project, a building opened to late-stage, chronic alcoholic homeless people who were given 75 apartments. Seattle, like Portland, follows a Housing First policy (see sidebar), which means residents were not required to stop drinking in order to keep their rent-free apartments.

“It pissed off the Western Hemisphere when we did this,” Hobson says.

It cost his agency an extra $100,000 a year to run those 75 apartments, Hobson says. Staff on the site included nurses familiar with mental health and addiction issues who could be ready for emergencies, and could assist tenants in getting health care.

Yet, during two years, according to Hobson, 1811 East Lake saved more than $4 million in jail, shelter, detox and emergency medical care costs. He says it works to target public housing for the most vulnerable.

“The most vulnerable people are racking up an awful lot of taxpayer-funded crisis services,” Hobson says. “It’s a more prudent use of the public purse.”

If similar savings are realized through the access center, Van Vliet says, she’d like to find a way that the housing bureau gets more than credit, but gets some of the money back. Long-term, she’d like to see a system put in place so that hospitals, for instance, would analyze how much money they were saved and send some of that money to the housing bureau to subsidize management of the apartment buildings.

Van Vliet acknowledges that both the population in the apartments and the apartments’ location as part of the access center could present unique problems.

“We want to set this up for success,” she says. “It’s a lot of fragile people in a single building. Nobody’s really done this.”

That means more staff, say Jacob Fox, assistant housing director of the housing bureau. “These are people who are not good rules followers,” he says.

The housing authority plans to have one staff member for every seven building residents, says Rachael Duke, the agency’s assistant director of residential services. Most public housing buildings have one staff member for every 30 residents.

The 130 apartments will cost the housing authority about $975,000 annually to run, most of which will come from federal funds. The city has dedicated $500,000 a year in operating costs for the apartments.

Becky Kanis, director of a nationwide project to find and house the 100,000 most vulnerable homeless people in the country, says the housing authority might be surprised at how demand for their housing management team drops after a while.

Kanis works for Common Ground, a New York City nonprofit that pioneered the idea of the vulnerability index by assessing all the homeless in Times Square, and eventually luring all but one of the most vulnerable into public housing apartments.

Common Ground operates buildings that house more than 3,000 formerly homeless New York residents, Kanis says. Most of those tenants were hard to place in traditional public housing, she says, because they were labeled “bad tenants” – bothersome to neighbors and requiring a great deal of intervention by social workers.

For the first six months in Common Ground apartments, the tenants did use 30 percent more service hours from building management staff, Kanis says. But after that, most stabilized their lives and didn’t require the help of case managers much at all.

“People who have been on the streets forever are pretty darn self-sufficient people,” Kanis says. “They’ve figured out how to survive on the streets; going to chemo appointments they can deal with.”

Common Ground’s buildings differ from the proposed access center’s plan in one significant aspect. Kanis says Common Ground never dedicates one building to those who score highest on the vulnerability index. Instead, the New York agency combines the most vulnerable of the homeless with a more typical low-income population of renters.

“We always blend, so it doesn’t have an institutional feel,” Kanis says.

The housing authority’s early plans were for a full block access center with between 150 and 200 apartments and Duke says in that scenario, a less uniform tenant population was planned. When city financing was cut and the access center became a half-block project, the number of apartment units was nearly halved, and the decision was made to focus on the most vulnerable of Portland’s homeless.

Major James Sloan, Portland-area coordinator for the Salvation Army, says the city’s decision to find the most vulnerable to house could potentially lead to another problem. Sloan says the Salvation Army tries to house people who have come forward wanting a place to stay and a place to change their lives.

“There needs to be effort on their part,” Sloan says. “This is a gift to 130 people and I don’t begrudge them that, but it feels like there should be some matching of effort.”

Portland's decision to house the most vulnerable of the chronically homeless means many of the tenants in the Resource Access Center's apartments will have drug and alcohol addiction problems.

Years ago, that would have meant the new residents of the access center would have had to commit to being clean and sober or risk being kicked out. Not anymore.

The access center is a partnership between the city and the Housing Authority of Portland. The city follows a Housing First model, which concedes that most alcoholics, for instance, cannot commit to abstinence even when confronted with a potential loss of housing. And getting homeless alcoholics and addicts stability in their lives, in the form of permanent housing, can be the foundation that helps them change their lives.

One thing tenants at the Resource Access Center won't be allowed to do is smoke. The Housing Authority has a strict rule making all its buildings smoke free.

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