The Down Side of Permanent Supportive Housing

It was a jarring set of articles that appeared in the Cleveland Plain Dealer this week.  On the same day, that homeless social service providers were proclaiming victory over long term homeless by the year 2020 in Cleveland, there was the discovery of the death of two homeless people in the snow.  If only the two had lived to 2020, there problems would have been solved!  How can anyone say that they are within two years of solving long term homelessness on the day that two of our friends are found dead on the streets?  I view this in much the same way as I read the October headline from Russia proclaiming that they will defeat ISIS and declare victory in Syria by the end of 2017.  Both are propaganda efforts to bolster an embattled public leader with no basis in reality.

Then on Friday December 15, WCPN-FM with a couple of Cleveland.com executives on the panel took up the public relations effort by proclaiming how great these Permanent Supportive Housing units are in the community never mentioning the deaths on the streets.  How much would you wanna bet that if these properties were being proposed in Shaker, Pepper Pike or near one of these reporters homes they would be screaming about how they are untested, unproven, too great a risk and will destroy the neighborhoods?

I put together this on the weekend and then Mike McIntyre and the Sound of Ideas on Monday December 18 featured about 20 minutes on this same topic.  Mike tried to provide a much better presentation of the issues compared to the cheer-leading done by the Plain Dealer and the Friday news roundup.  He still only featured three advocates of the program who had benefited from this policy in Enterprise Community Partners, FrontLine's CEO and the main funder in the Sisters of Charity Foundation without any skeptic.  All three are really good people, but they are pushing a concept that they do not seem to recognize that there are winners and losers with Permanent Supportive Housing.  The winners are the agencies that hooked their wagon to this experiment and the 20% of the homeless population and the losers are the rest of the homeless population and the majority of homeless service providers who are struggling to stay in business.  The million dollar question is on balance is the community better off with Permanent Supportive Housing?

McIntyre asked good questions, but did not get good answers from these guests who were selling a product.  Mark McDermott saying we don't want to pit providers against each other may be a hope it is certainly not the reality with 450 shelter beds disappearing over the last 10 years  They treated Ann from Lakewood who was housing her disabled adult children nicely with their words, but in reality they were saying, "You are on your own until you have had enough of them and force them out of your house and they survive outside for one year."  Basically, this $130 million dollar collaborative is busy serving 800 people in the community and does not have the money or time to serve the 30,000 people who need their support services, housing assistance and a pillow inside on a cold night. In my opinion, these programs saved hundreds of lives and we at least built some housing in the community, but the advocates have over-sold Housing First as some utopia solution to homelessness.

A quick run down on the virtues mentioned in the PD article and the two WCPN radio shows:

• They do not require people to cure themselves before participating. This is a huge improvement over previous shelter/housing program policies.
• In Cleveland, they are beautiful units that are an asset in any community. (How to compare these PSH units to 9,000 abandoned properties in Cleveland?)
• They set a goal back in 2002-4 to build 1,000 units to end long term homeless, and they are on track for this goal. 
• They identify these statistics which appear to show how successful they have been. (There is no academic or even media scrutiny of these stats).
• It was mentioned to be good social policy "to get them off the streets." (They are us!)
• One positive in the PD story was that they did not use the offensive phrase "chronically homeless" like it was a disease.  Joe Frolik could not avoid using this offensive language.
• All the services come to you in these apartments to stabilize the individual in order to move the formerly disabled individual into permanent housing without all the services.
• Frolik mentioned that this was based on research out of Philadelphia and was pushed extensively by the GW Bush administration with the "compassionate conservatism" propaganda. This "research" claimed that 20% of the population were using 70% of the resources for homeless people.  
• The economics work because the $131 million we spent saves the community $6-7 million a year. Just for clarification it will take 18 years to get the money we spent back on the money we spent to date, which will not include the on-going maintenance and social service cost.  So, in reality, the public will never re-coup the money we spent on these housing programs.  
• Chris Quinn believes that this is the replacement of the closed down asylums from the 1970s, but he also said that this was "solving of homelessness" forgetting the qualifier "solving long term homelessness." 
• The moderator of the WCPN, Rick Jackson, mentioned Councilman Matt Zone championing that this is a model in the United States and is highly successful "a feather in our cap."
• Mark McDermott of Enterprise mentioned that we need an overall affordable housing strategy, but did not mention that we are no closer to that and in fact we have lost ground over the previous two federal administrations.
• The State of Ohio has come on board to help invest in this strategy identified by Frolik as a "remarkable programs that has had bi-partisan support."
• The County was given much praise for all the funds and work they are doing to serve the population on the Monday WCPN program both with HousingFirst and the shelters.
• These are safe places with 24 hours of services and security to monitor who comes and goes within the buildings.  (Something which the better shelters also have by the way.)

I will give the other side of the story below.  I wish the media would not just accept the research, and statistics without question.  Where is the push back and the skepticism?

"Once upon a time you dressed so fine
Threw the bums a dime in your prime, didn't you?
People call, say, "Beware doll you're bound to fall"
You thought they were all kiddin' you

You used to laugh about everybody that was hangin' out
Now you don't talk so loud
Now you don't seem so proud
About having to be scrounging your next meal

How does it feel?
How does it feel?
To be without a home
Like a complete unknown
Like a rolling stone"
    by Bob Dylan

Here are the points that you never hear in this public relations campaign to push Permanent Supportive Housing:

• In my opinion, the research out of Philadelphia was flawed by arriving at a solution and then trying to build stats around that outcome.  In addition, the researcher in Philly benefited from this research by then becoming a consultant for cities to implement this strategy.
• The statistics are based on a one day count that takes place in one of the coldest weeks of the year in Cleveland.  It is tough counting people outside, and much easier to count people inside while sleeping in a shelter bed.  We lost 450 shelter beds over the last 10 years in Cleveland making it more difficult to count homeless people.  Besides these barriers to counting, there is also the reality that can one day be extrapolated to an entire year?  As an example, let's say the average temperature on January 23 was 22 degrees in 2017 while it was 17 degrees on January 23, 2016 does that mean that we have a 5 degree rise in temperature for the year 2016 compared to 2017?  It is absurd to compare one day to mean anything other than the number of homeless on one day.  It is useless information and should not be used for any purpose other than recycling. This is especially true when so many beds are closing every year.  It was not like these beds were sitting empty and these beds were wasted in our community.    
• Anyone who looks at this objectively has to see that this was a way to cut funding during the Bush Administration.  It was not like they came up with a good idea and found new money to experiment with this housing options.  When this started 80% of the dollars went to emergency and transitional programs in our community.  Now, 80% of our funds goes to Permanent Supportive Housing and only 20% goes to emergency services.  Transitional Housing was eliminated and the federal funds remained the same except one year of stimulus funding.
• These are people who are in housing and yet we are spending homeless dollars on these programs.  We lost 450 shelter beds over the last 10 years which makes it very difficult to serve the emergency needs of a family locally.  Remember, the PSH program is only for long term and disabled single adult individuals which are only 20% of the total population.  Our only strategy for serving homeless people caters to only a small number of the population.  The 80% are told to go find their own solutions or wait 5 years on an affordable housing waiting list. 
• The 1,000 unit goal is still not realized, but that had no basis in fact. It was pulled out of the air and did not take into account the assault on affordable housing during the time of constructing these units.  It also did not take into account the foreclosure crisis or the elimination of emergency services.   The Bush Administration while championing Housing First was at the same time starving the beast by trying to play games with affordable housing funding.  We have not created affordable housing for decades except for PSH and senior housing while we lost units because of age and financing.  The Obama administration was digging out from the recession and then faced sequestration which only added to the loss of housing for low income Americans. 
• Remember, this housing in Cleveland is largely for single adults with a disability.  It is not for families or even couples.  If you stay on a couch or with family or in a motel, you are not considered homeless. 
• There was mention that only two other cities had solved long term homeless which is a good talking point, but in reality is just spin.  No city has or will solve long term homelessness, because in spending all of its money on the problem they have created families, young people and other populations who became long term homeless during the time we were building all this housing.  There is no doubt that this has contributed to a decrease in the number of people who sleep outside, but they should not oversell their accomplishments.  There were plenty of other things that contributed to a decline in the number of people who sleep outside including some amazing people like Jim Schlecht and Toni Johnson working on this issue.  It is not just the buildings get built and poof there is magic the population declines. 
• It is not true that this is unique to Cleveland or that we are doing this better than other communities.  We are following the Dennis Culhane playbook because we are paying a lot of money to his Philadelphia consulting company to follow that playbook. 
• It is great that all these services come to these facilities to offer help, but the same was true of transitional housing and that was much cheaper for the community.  The average transitional shelter bed turned over twice a year, while the 700 units of PSH are housing and do not turn over.  These are great programs, but should have funded these projects with all new money to add to our tools of serving the homeless population.  Instead, we eliminated many programs to fund the HousingFirst initiative.  
• We also had no idea that we would create new sectors of homelessness because we are focusing all of our money on one very limited population.  There are families that are spending more and more time on the streets.  There are more seniors facing homelessness and we have had to do all kinds of contortions to be able to serve homeless youth that we finally recognized as being a problem.  
• During the time of building HousingFirst units, we have made it much more difficult to be defined as a homeless person. How do you prove that you have lived in 45 different street corners/abandoned buildings/couches and doorways over the last three years?  Now you have to accumulate 1 year of homelessness over the last year in order to qualify.  Also, any time spent in a basement couch does not count as homeless.  While the school district is struggling with huge numbers of families, the County is proclaiming success with the Housing First.  It is like they are throwing paper towels out to the homeless population with this story.  
• How can every other system be stressed under the pressure of the opioid overdose epidemic except the homeless system which is on the verge of solving long term homelessness?  
• The economics of this strategy does not work.  I believe that the community saves even more than the $6 to $7 million mentioned on the radio, but they are not saving homeless dollars.  The money saved is in the criminal justice system, mental health centers, and the emergency room.  The homeless shelters and social services will not see a dollar of those funds.  The MetroHealth system will not say, thanks for your help with housing Joe Smith who has been sleeping in the Flats for 10 years, here is the $50,000 that we spent on him last year.  
• Another economics problem is that the long term homeless are typically not using many shelter resources in the community.  For the most part, those outside and not using shelter resources, and so their moving inside does not free up a shelter bed or many homeless resources.  The long term homeless are not using the meal programs or the social services. 
• Overall, the system for homeless people is more fractured, more confusing, and less accessible before the HousingFirst initiative was created.  We have not reduced the number of people who die on the streets.  We have not reduced the overall homeless population.  We have not reduced the number of poor people in the community, and we have not stabilized the affordable housing market.  We have built 800 units of housing and placed 800 people who have huge barriers to living independently inside.  We should have done built these apartments years ago, and we should have used non-homeless money.  Think about how far ahead we would be as a community if we were able to provide for the emergency needs of families and the disabled people sleeping in Ann from Lakewood's house along with helping people who have multiple barriers to homelessness.  

by Brian Davis