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The St Louis Contrarian

Providing Independent and Intelligent Insight on St. Louis Public Policy Issues

Archive for the category “homelessness”

St. Patricks Center

I wanted to write today about the amazing work being accomplished by St. Patricks Center, the largest provider of homeless services in Missouri. I am privileged to offer some help as a volunteer to the organization.

St Patricks of course provides a men’s shelter and meals. More important they provide a whole network of social, housing, and supportive services to help end homelessness. They operate permanent housing communities and provide a whole range of supportive services. Their facility even provides a job incubator.

The Executive Director of St. Patricks Center is Laurie Phillips who is a remarkably talented and caring person. St. Louis is luckily to have this organization. Written by Paul Dribin

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Homelessness in St. Louis

Activists in St. Louis have mounted demonstrations against the Mayor and other city officials over the issues of homelessness. They have criticized the city for not making more homeless beds available and doing a better job of housing the homeless population. A poster child for this action has been a homeless man who died in a portapot before Christmas.

That gentleman’s story is symptomatic of the homeless problem. This individual had refused help from his family and from workers in an office building near his portapot. He consistently refused help; most likely having a mental health problem. I don’t know of any way the city could have managed this situation.

I work closely with the homeless issue in St. Louis. I help serve lunch every week at Biddle House. When the Larry Rice facility was shut we did not notice an upswing in people coming in for lunch. Where did his alleged population go? Also, as pointed out by the city, if there is an overflow in shelters churches step in and house people.

I don’t believe there are people sleeping on the streets who could not be admitted to shelters. I also believe if we built ten more shelters they would be full. The issue is complicated, but homelessness is a more fluid situation than most people understand. The answer to the problem is permanent supportive housing. Written by Paul Dribin

Homelessness as Part of a Housing Continuum

In the housing world it seems for the most part that people deal either with affordable housing and homelessness. One develops and manages projects and the other provides services for homeless people. I have discovered that really affordable housing is one continuum with chronic homelessness where poverty and mental illness interact. Other people are periodically homeless due to circumstances such as job loss or divorce; these people are acutely homeless. Finally many other people on the continuum lack affordable housing and suffer from the results. They tend to pay too much of their income for housing, live in substandard housing, or double up. All of these folks need both housing support and social services to a greater or lesser degree. Housing practitioners would do well to view both housing and homelessness this way. Often our view of these issues get nuanced by our day to day work and funding sources. Written by Paul Dribin

The Ghost of Larry Rice

The Reverend Larry Rice has been a controversial figure in St. Louis. For years he ran a homeless shelter and refused to cooperate with authorities, did not allow inspections, made religious conversion a requirement for admission, allegedly housed many more people than he was licensed for, and required residents of his facility to work for free on his farm. He also owns a radio station. Reverend Rice was a constant thorn in the nose of the establishment.

I argue that even more important, his work was a hinderance to homeless people improving their lives. I have a friend who is a former homeless person who said Rice actually enable homeless behavior and got in the way of people looking and preparing for jobs. I help serve lunch at Biddle House which is affiliated with St. Patrick’s Center. When Reverend Rice’s facility was finally shut by the city, we expected to find many more people coming for lunch. Actually, we did not. Our conclusion is that Reverend Rice never had nearly as many people living in his facility as he claimed. Rice has tended to be a popular figure with liberals because he thumbs his nose as the establishment. That support was a big mistake. Written by Paul Dribin

Health Care and Housing

More research is showing that good health outcomes are dependent on decent housing. We know that people who live in-substandard housing are more likely to have health problems, more frequently get admitted to emergency rooms. Excessive hospital stays for uninsured people drive up health care costs significantly. Hospitals are beginning to partner with housing professionals to find decent housing for frequent fliers to hospitals. I hope this starts to happen in St. Louis. Written by Paul Dribin

Designing a More Inclusive City

A way for St. Louis to prosper is to be as welcoming and inclusive as possible. An article I just read in the New Yok Times describes how often through subtle measures we exclude people. An example the author cited was the lack of comfortable seating in public spaces. These measures of course by themselves are not game changers but are part of an overall package that make cities appealing. Written by a Paul Dribin

Homelessness in St. Louis

I have some interesting news about the status of homelessness in St. Louis. Earlier this year a major shelter led by Reverend Larry Rice was shut down. For years he snubbed his nose at the establishment, housed more people than code allowed, and didn’t let the city inspect the place.

When the news of the shutdown became known, many in the community predicted dire consequences. What would happen to the clients?

After the dust has settled I have learned that all the occupants were easily rehoused. St. Patricks Center rehoused people who wanted it in their facility. I help serve lunch at Biddle Place associated with St. Patricks. We anticipated many more people for meals after Rice’s facility was closed. Interestingly, this didn’t happen.

I have two conclusions, Either Reverend Rice did not house as many people as he said, or some of those people did not need the level of services provided by St. Patricks. Written by Paul Dribin

Homeless Prevention

An article in How Housing Matters makes an important point about homelessness in cities such as St. Louis. That article demonstrates the most successful approach to combating homelessness is a housing first model. This approach requires building affordable supportive housing for homeless people, housing them, and providing supportive services at the same time.

An interesting point about the St. Louis homeless situation. Biddle House run by St. Patrick’s Center serves anyone who wants it 3 meals a day, 7 days a week. When the Larry Rice shelter closed, people at Biddle prepared for more clients. They never came. We suspect Larry never had as many clients as he claimed. Written by Paul Dribin

Here is the copy of the article from How Housing Matters:

What Cities Can Do to Combat Homelessness

August 03, 2017

by Steven Brown

The most recent Annual Homeless Assessment Report to Congress points out the number of people experiencing homelessness has fallen every year since 2010, representing a 13.7 percent drop between 2010 and 2016. Homelessness fell even more dramatically among certain subpopulations over the same period. Chronic homelessness fell 27 percent, veterans homelessness was cut by nearly half and was eliminated in dozens of places across the country, and homelessness among families with children decreased 23 percent.

Though the number of people experiencing homelessness has declined nationally, many large cities have experienced increases in their homeless populations. Since 2010, homelessness increased slightly more than 1 percent. In many of these cities, the number of people in shelters has decreased while the number of people on the street has gone up dramatically. In Los Angeles, the number of people experiencing homelessness went up more than 33 percent in the past two years and increased more than 42 percent for people outside of shelter. In New York City, homelessness spiked 39 percent in the past year. Chicago, Denver, Seattle, and several other large cities saw similar increases.

Despite the trends, many cities—including Atlanta, Cleveland, and New Orleans—experienced significant declines in homelessness. What are these cities doing well? Houston is a prime example. After a peak in homelessness in 2011, Houston adopted a Housing First model for addressing homelessness. Officials and homelessness providers in the areas developed the Houston/Harris County Continuum of Care in 2012 and worked with local agencies to create The Way Home, an action plan with goals to address area homelessness. The goals of The Way Home are to

create a system to identify the chronically homeless and match them to appropriate affordable housing,
coordinate a service system to support long-term housing stability, and
create enough permanent housing to meet the demand.
Before The Way Home, area service providers and nonprofits were an uncoordinated “tangle of services,” but the city worked to coordinate local efforts, including adopting the Homeless Management Information System to match people to appropriate, stable housing within 30 days of system entry and assessment. The city redirected over $100 million in federal, state, and local funding, with help from local businesses, to build and maintain over 2,500 additional permanent supportive housing units with wraparound services. Since the introduction of The Way Home, homelessness in Houston, Harris, and Fort Bend counties has fallen 60 percent, and their Continuum of Care was recently recognized as one of 50 in the country that has effectively ended veterans homelessness.

The gains Houston has made toward ending homelessness through a Housing First approach and coordinated entry are laudable and impressive. Other cities have tried or are trying similar approaches, yet still struggle with a steady or growing homeless population.

One additional reason the gains may have been more effective in Houston is their more accessible housing market. According to US Department of Housing and Urban Development data, the fair market rent for a one-bedroom rental in Harris County stayed flat between 2011 ($767 a month) and 2016 ($773), and the most recent Census Bureau data for the county show an 8.9 percent vacancy in rental housing. Atlanta, Cleveland, and New Orleans have also used a Housing First approach and seen their homeless populations fall, and so have other cities with comparably lower rents and slower rental growth.

Compare this with Seattle and King County, which saw a 25 percent increase in fair market rent for one-bedroom rentals (2011: $977, 2016: $1,225) and has a rental vacancy rate of 3.4 percent. Decreasing housing affordability in an area can make it more difficult for people on the margins to stay in their homes and can prevent people in shelters or permanent supportive housing from jumping into private market housing.

But cities, including many coastal ones, with rising rents and rising populations experiencing homelessness can still fight the rising tide. Boston has experienced recent spikes in homelessness, but is in a state that has a right-to-shelter law. Even though the number of people and the length of stay in emergency shelters is increasing, the number of people “on the street” is among the lowest in the country, and the area is seeing declines in people returning to shelter. Though emergency shelter can have challenges (e.g., turnover, privacy, safety), shelters have the advantage of staff who can help coordinate services and transitions to more stable housing. Boston’s challenge, and the challenge of other cities in a similar position, is to build a better bridge between shelter and self-supported housing.

While homelessness is down in much of the country, many cities still struggle. Cities that have brought down their populations have done so through a Housing First approach, a tight coordination between public, nonprofit, and private stakeholders, and a clear path for permanent and stable housing. Houston’s Housing First, integrated Homeless Management Information System model, and close coordination between agencies have led to an end of veterans homelessness and a nearly 50 percent reduction in homelessness overall. Although rents haven’t risen there as quickly, the approach shows that getting people into permanent supportive housing may be the best solution. The Family Options Study showed that of transitional housing, rapid re-housing, and vouchers, vouchers proved the best option for helping homeless families achieve residential stability, and other studies have shown that rapid re-housing can work in certain contexts.

The best way for cities to help their homeless populations is to house them and support them with services to help them find stable employment, health care, and child care services. Though this may be challenging for cities with limited affordable units and rising rents, these are the steps that must be taken to support these most vulnerable of populations.

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Chesterfield Mobile Home Park

I attended a meeting today of some good citizens who are attempting to find a solution to save the residents of a mobile home park in Chesterfield who could be facing eviction.

The park has been located in Chesterfield since before that community was incorporated. There are presently about 130 families living there, who may own or rent their mobile home and all rent their spaces. They pay $350 a month in rent.

A developer has come forth who has apparently reached agreement with the park owner to sell the property for the construction of apartments. The tenants who are on month to month leases are naturally worried.

We are working to oppose the zoning change necessary for this transaction and come up with an alternative development proposal which would leave the existing low income residents in place.

Issues Affecting Housing and Healthcare

Here is an article from the Housing Matters website that discusses the positives and negatives of trying to link housing with healthcare services.

The Future of Integrated Health and Housing Programs

June 14, 2017

by Josh Leopold, Brenda C. Spillman, Eva H. Allen

Americans spend more on health care, but have lower life expectancies and worse health outcomes than any other developed country. This disparity arises partly from a lack of attention to social determinants of health, which include income, education, and housing.

States, localities, and organizations throughout the country have taken advantage of opportunities created by the Affordable Care Act (ACA) and other health system delivery and payment reforms to improve health outcomes by integrating housing and health care.

But the prospects of ACA repeal and the president’s proposed budget for fiscal year 2018 threaten to reverse recent progress in collaborations between housing and health care providers. Deep cuts to the US Department of Housing and Urban Development (HUD) and Medicaid could make it harder for states to provide basic care to low-income people and leave fewer resources to improve outcomes through integrated health care and housing.

How can housing support health?

Lack of housing makes it hard for vulnerable people (such as the elderly and those with disabilities or experiencing homelessness) to manage chronic health conditions, leads to reliance on emergency rooms for health care and emergency shelter, and contributes to poor health outcomes and reduced life expectancy.

Supportive housing combines a rental subsidy with case management and has been shown to reduce health care spending and improve health outcomes for people experiencing chronic homelessness. In subsidized housing, health care and social services available on-site can help people stay healthy enough to remain at home and avoid hospitalizations and nursing home admissions.

How can housing and health care providers collaborate?

Several ACA provisions aimed to improve care coordination and shift the health care system to value-based payments, where providers have more flexibility in the services they provide, but also are more accountable for improving patient outcomes. Value-based payments are intended to motivate health care providers to take a “whole-person” approach that includes addressing social determinants of health.

The Urban Institute conducted a review of nearly 40 state and local health and housing initiatives. By encouraging cross-sector collaboration, using community resources strategically, and taking advantage of health reform opportunities, many states and communities integrated health care with housing and other services to improve vulnerable populations’ health and well-being.

Three initiatives were particularly promising:

New York State’s Medicaid Redesign Team used state savings generated by Medicaid system reforms to pay for housing for high-needs populations, including construction of new affordable housing units, rental assistance, and supportive services to residents. The state recently committed an additional $1 billion to develop 6,000 new units of supportive housing in the next five years as part of a larger commitment to build 20,000 supportive units over the next 15 years.
Houston’s Integrated Care for the Chronically Homeless initiative paired housing vouchers from HUD with health care and case management services funded by the Medicaid Delivery System Reform Incentive Payment program to serve people experiencing homelessness who have chronic physical and mental health conditions and are high users of costly medical services. Early program results show reductions in participants’ preventable emergency department use, improved mental health functioning, and reduced depression rates.
Housing with Services in Portland, Oregon, brought together several organizations, from nonprofit service providers to Portland’s housing authority to the largest Medicaid health insurer, to coordinate health care and social services for low-income seniors and people with disabilities living in federally subsidized housing. Evaluation results indicate that program participants were more likely than those not connected to the program to use preventive and mental health services, had better access to long-term services and supports, and experienced less food insecurity.
What are barriers to these collaborations?

Although many health and housing partnerships have developed or been strengthened since the ACA’s passage, several obstacles limit the reach of such partnerships, a problem that budget cuts will only exacerbate. In interviews, local leaders and national experts frequently cited the widespread shortage of affordable housing as an obstacle to creating and sustaining housing and health care collaborations. Federal Medicaid funds can sometimes be used for housing-related services, but cannot pay for room and board. Some state Medicaid agencies, hospital networks, and health insurance plans have invested in rental assistance and affordable housing development, but they remain the exceptions.

Competing priorities, restrictions on the use of health care funding for nonclinical services, and lack of housing-related expertise make it unlikely that the health care sector will become a significant funder of new affordable housing. One policy expert said advocates have been overly focused on “trying to find ways that Medicare and Medicaid should fund housing that we eliminated at the HUD level.”

Proposed budget cuts would hamper efforts to integrate housing and health care

The proposed budget aims to cut HUD by $7.4 billion and eliminate the Housing Production Trust Fund and Community Development Block Grants. In addition, the proposal to cut the corporate tax rate from 35 percent to 15 percent has already made affordable housing development more difficult. The proposed cut has reduced investment in Low-Income Housing Tax Credits, the primary funding source for affordable housing, because investors are less motivated to buy the credits to offset their income taxes.

In this environment, housing providers may focus on stemming losses rather than supporting new collaborations. The vulnerability of housing and health partnerships to changes in federal funding was demonstrated recently, when HUD advised the Houston Housing Authority to stop issuing new vouchers for the remainder of the year because of an anticipated budget shortfall.

The budget also calls for reductions in federal Medicaid spending, that, coupled with reductions proposed in the House-passed health plan, would cut Medicaid spending 47 percent over 10 years.

These proposals could slow or reverse the momentum for housing and health care integration. Given the promise of housing and health collaboration for the nation’s most vulnerable populations, further reducing the stock of affordable housing and supportive services could thwart progress in improving their health care outcomes and quality of life.

An earlier version of this post was published on Urban Wire, the blog for the Urban Institute.

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TAGS: Health, housing, Budget
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