By Lynn Graebner
California Health Report
Linda Goytil is an attractive, clean-cut gregarious 63-year-old with a warm smile and sparkling blue eyes. She looks frail, but no one would suspect she’s homeless. Since March she’s been living in her van in Santa Cruz, struggling with a rapid loss of body mass which doctors can’t explain. She’s got severe osteoporosis, diverticulitis, chronic obstructive pulmonary disease, high blood pressure and three surgical fusions of her spine and neck. She now uses a walker.
On top of all that lies a tremendous amount of emotional trauma.
“To be homeless is a shock to me,” said Goytil, who took care of both her parents until they were 92, nursing them through Parkinson’s disease, dementia and congestive heart failure.
A new community campaign called 180/180 in Santa Cruz County has identified Goytil as part of a group of about 155 medically vulnerable chronically homeless people who are at risk of dying on the street.
“We’re audaciously and shamelessly saying these people need to be housed, and whatever it takes, we’re going to do it. Business as usual has failed these people,” said Monica Martinez, executive director of the Santa Cruz Homeless Services Center.
County and city agencies, outreach providers, businesses, faith-based and civic organizations and citizens have joined together in this local participation in a national campaign called 100,000 Homes. It’s aiming to find permanent housing with supportive medical, mental health, substance abuse and other services for 100,000 medically vulnerable and chronically homeless people by July of 2014.
The Santa Cruz 180/180 campaign has committed to housing 180 of them, to help them turn their lives around and avoid joining the 24 homeless who died on the county’s streets last year at the average age of 49.
Key to the strategy is a tool called the vulnerability index, which is used by communities nationwide to rank homeless by their mortality risk. Each community conducts a registry week. So during the week of May 7, between 4 and 6 a.m., about 100 Santa Cruz County community volunteers dispersed through the county encountering more than 500 people and completing 325 surveys with names, locations, photos and information about their health and living circumstances.
They identified 155 of them, as medically vulnerable with a high mortality risk, based on nine risk factors. For instance, 37 of the 155 have had a combined total of 67 hospitalizations in the past year at an estimated cost of $569,500, the survey results show.
Supporters of permanent supportive housing say housing people and providing them with medical and other services is cheaper than paying for the medical services, jail time, law enforcement, emergency room visits and ambulance rides when problems escalate.
There have been more than 60 studies done on the cost effectiveness of permanent supportive housing, said Philip Kramer, project manager for the Santa Cruz 180/180 project.
A 2009 Los Angeles study called Where We Sleep reported that the average monthly public costs for people in supportive housing were five times less, than for homeless general relief recipients, $605 verses $2,897.
“Resources are getting spent either way. We could keep spending on a catch by catch can emergency basis or we could do it smarter,” Kramer said.
John Dietz, a retired aerospace executive and county resident, saw on television the call to action for volunteers to help survey homeless in Santa Cruz and he signed up.
“It’s a noble cause,” he said. He admits he wouldn’t have thought so in the past, not until he spent 20 years helping a family member overcome homelessness.
“I was searching for an infrastructure that would have helped him and it wasn’t there,” Dietz said.
“Most people would be shocked at how many systems are set up to try and help the homeless and how little they know about each other,” said Jake Maguire, a spokesman for the 100,000 Homes campaign. “If you get those folks working together, the rate at which housing people becomes possible shoots up dramatically. It’s a systems failure,” he said.
But is 100,000 homes possible by July 2014? So far 146 communities have joined up and more than 18,400 formerly homeless have been housed. That’s a far cry from 100,000, but Maguire said the nation is gearing up and on track.
“This time last year 100 people a month were getting housed, now it’s 800 to 1,000 a month,” he said.
Los Angeles County tackled its systems failure in 2007 with “Project 50,” a pilot to permanently house 50 of Skid Row’s most chronic homeless. The county hired Common Ground, now Community Solutions, a national nonprofit helping communities end homelessness and parent to the 100,000 Homes Campaign. And 24 government, nonprofit and business organizations cooperated on the project.
Project 50 was very controversial at first because it didn’t make homeless people get a job or get off drugs, Maguire said.
“It’s a program that kind of freaks people out,” he said. “But it saved the county a quarter of a million dollars.”
A report released in June on the cost effectiveness of Project 50 showed that between 2008 and 2010 the program cost the county $3.05 million and saved $3.28 million in incarceration, medical services and other costs, a $238,700 savings. Eighteen months after housing the Project 50 group more than 86 percent of them remained housed, the report states. And 18 communities in L.A. have now joined the 100,000 Homes campaign.
Connecting people to existing resources is one of the challenges for communities. Eight months ago Santa Cruz County got 50 housing assistance vouchers from the U.S. Department of Housing and Urban Development Veterans Affairs Supportive Housing program (HUD-VASH vouchers). About half of those are still available, Martinez said.
Kramer encountered a homeless man over 70 who didn’t think he qualified for a VASH voucher because he wasn’t in the military that long. It turns out he does qualify, Kramer said.
Helping make those connections to existing resources is where volunteers come in. 180/180 has a housing navigator team helping people with paperwork, transportation to government offices, finding landlords who accept government housing vouchers and helping clients get cleaned up and equipped with household necessities.
Another source of housing for this population are section 8 vouchers, funded through HUD and issued by the local Housing Authority of Santa Cruz County. On July 25, 2012 the Housing Authority Board of Commissioners voted to create waiting list preferences capped at 40 vouchers for the medically vulnerable homeless and 12 vouchers for disabled persons transitioning from institutions. If the 180/180 campaign and other efforts to house the homeless are successful, those caps could be raised, said Housing Authority Director Ken Cole.
Cole said his agency is very interested in the concerns the 180/180 campaign has raised, but that it has to be careful not to negatively affect any other population it serves which could result in an investigation by the HUD Office of Fair Housing and Equal Opportunity.
“I think there are other Housing Authorities that are doing things they don’t have the authority to do,” he said. “There are just a lot of ways you can go wrong spending public money.”
Cole, however, personally supports 180/180. This effort, he said, is really a return to how things used to be done. Housing Authorities came about out of the Great Depression around the same time the public health system evolved, he said.
“Housing and health used to be together,” Cole said. “You couldn’t help anyone if they didn’t have housing.”
Kramer seconds that sentiment. “What they find is that when someone moves into permanent supportive housing, they start improving their lives by themselves,” he said. “They now have something to lose.”