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Wednesday, June 14, 2006 | Sandy Moore lives in a castle at 13th Street and Market in downtown San Diego.
That’s what she calls it – my castle – the one-room apartment that’s barely big enough to turn her wheelchair in. On a shelf above her sink sits a neatly arranged row of spices for cooking with. There’s a bowl of fruit on the spotless countertop and a glint of pride in Moore’s eye as she surveys the small world she inhabits.
It’s that sense of pride that is the nucleus of a nationwide movement to change the way that the homeless are provided for and looked after. San Diego is the latest city to unveil plans to overhaul its homeless services to put new focus on the few chronic cases that experts say place the most strain on public services and public funds.
For the last 20 years, San Diego, like most cities in the United States, has been caring for its burgeoning homeless population in a way that Philip Mangano, the Bush administration’s homeless services czar, calls serving people “endlessly.”
“Now, we’re interested in ending homelessness,” Mangano said in an interview.
Mangano is the point man for a radical shift in the way the nation’s homelessness problem is being approached. That shift is a movement away from the traditional “two-hots-and-a-cot” approach – where homeless people are offered two hot meals and a bed for the night at shelters and then sent on their way. The strategy that Mangano and his team are implementing across the country focuses on the small proportion of so-called “chronic homeless” cases who, research has shown, cost society far more combined than the larger homeless population. The chronic homeless are those who are regularly homeless and have a disabling condition.
The local plan is to provide permanent supportive housing and services for the chronically homeless and to prevent families and individuals from becoming homeless in the first place. The idea is to save money that would be spent on services in the long-run by investing in the short-term to house and treat chronically homeless people.
In some ways, San Diego was the birthplace of this new movement.
A 1998 study by the University of California, San Diego Medical Center followed 15 chronically homeless men for a period of 18 months. It found that the total cost of treating those men in the hospital’s emergency room was $1,476,113. That was just those men’s medical bills, and all 15 were still homeless by the end of the study. One man had visited the emergency room 87 times.
The theory – that a small proportion of the homeless population is responsible for most of the costs associated with caring for and treating the homeless – has become the basis for more than 200 action plans drawn up by communities around the United States. San Diego County’s plan, “The Plan to End Chronic Homelessness in San Diego,” was just unveiled. It represents, some experts say, a revolution in the way the city and county deal with homelessness, and aims to end chronic homelessness in San Diego by 2012.
“The solution to chronic homelessness is more complex than simply providing more housing and supportive services. Addressing the problem means changing the way the current system operates,” reads the report’s executive summary.
Mangano, the executive director of the Interagency Council on Homelessness, a body set up in 1987 to guide the federal government’s policy on homelessness, puts it another way. He said that, until recently, San Diego’s approach to tackling the homelessness issue was about as misguided as most cities in the country.
“Einstein told us that the definition of insanity is to keep doing the same thing over and over and over again expecting different results. Well, San Diego wasn’t alone. It was the same across the entire country; we were wishing and hoping and lighting candles that things would magically happen on the 15th time we did something, and of course, it never happened.”
In 2003, Mangano visited San Diego and essentially challenged the city and the local business community to come up with an action plan to fight chronic homelessness. For the last two years, local bigwigs and homeless advocates have collaborated in an effort to do exactly that. The team is called the Leadership Council and is headed by developer Dene Oliver, of Oliver McMillan, Inc.
Hannah Cohen is a consultant who was brought in by the United Way to bring together the group to produce the initial action plan for the city. She said that about 13 percent of San Diego’s homeless population is chronically homeless, and that this group consumes about 60 percent of the resources available to treat people on the streets.
It is this core group of repeat offenders who are the hardest to treat, Cohen said. Drug and alcohol abuse problems and mental health issues make it difficult for this element of society to ever really come back into the fold of the mainstream, she said.
“They are not well and they are the hardest. A lot of them have been on the streets for so long that they don’t realize that there’s still a chance for them,” Cohen said.
Cohen said the Leadership Council has developed a strategy for the city that specifically focuses this “neglected part of the continuum of care.” That strategy, which is contained in the group’s draft plan, focuses on two main elements: Providing permanent supportive housing for the chronically homeless, coupled with comprehensive support services, and preventing families and individuals from becoming homeless in the first place.
That means providing a constant, safe place for people like Sandy Moore to sleep and to take a breather from a harsh life on the streets.
Moore, who was placed in her apartment three months ago as part of a pilot program run by Alpha Project for the Homeless, is disabled and takes a variety of medication for depression and mental illness. Prior to getting help from the pilot project, she said she lived on the streets more often than under a roof.
She said her husband, who she hasn’t seen for 18 months, is an alcoholic who used to pick fights with the landlords of the cheap apartments where they would stay for a few weeks at a time. The couple got a bad name for themselves, and she couldn’t find anyone who would rent to her, even if she had the money to spend.
Moore said her tiny apartment has been a Godsend. She has an income from Social Security that covers the $461 a month she pays for the rent and phone bill, and has just enough left over to pay for food, her medication, and other bills.
“I don’t have to let nothing go,” she said with a sense of pride. “I’m able to put back so much weekly that I’m able to maintain my laundry. I don’t ever have to worry about having clean clothes again, or where I’m going to wash my clothes next.”
Moore said the security that a stable environment offers her has allowed her to reclaim her place in society. She no longer worries that a crack addict will steal her wheelchair during the night, as she once did, or that her husband will get drunk and get her into trouble.
While programs like those used to house and treat people like Moore are costly, experts said the long-term benefits to the overall community make them more than worthwhile.
Steve Escoboza, president and CEO of the Hospital Association of San Diego and Imperial Counties, and a member of the Leadership Council, said there is plenty of evidence that the plan being put forward will be cost-effective.
“Certainly the cost of providing supportive housing, from all the studies we’ve seen, outweighs the cost in the long-haul for people who have reoccurring disorders,” he said.
“If you can find a place where you can house these folks and you can break down, through components, what is their condition – it’s getting to the nub of the problem in a way that we can’t do when they’re on the streets,” he added.
Sharon Johnson, manager of the city of San Diego’s Homeless Services Program, said the beauty of focusing on the small number of people in the city who are most likely to stay on the streets for prolonged periods of time, is that there are already a number of proven case studies around the nation that have shown positive results.
“It’s a real shift in the paradigm nationally,” she said.
Though San Diego has a number of hurdles to overcome when it comes to implementing the chronic homelessness plan, Escoboza said the key to success is to introduce the new approach incrementally. By focusing on a few hundred of the worst cases of homelessness in town, San Diego can build some successes that it can then point to in order to expand the supportive housing program countywide, Escoboza said, and he’s hopeful that the city and the county are taking the right track.
“I have a degree of optimism that I haven’t felt before that we’re going to accomplish something,” he said.
On Wednesday, the Leadership Committee presents its draft plan to the Committee on Public Safety and Neighborhood Services. They hope to take the plan to the full City Council later this year.