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The math is supposed to be simple.
Thirty-four of the most frequent homeless users of San Diego’s emergency services cost taxpayers and hospitals $4.3 million in responses to 911 calls and other public safety needs in 2010. Take those same people, put them in a house, give them preventative medical care and access to round-the-clock case workers, and the costs drop to $2.2 million in 2013.
That’s a savings to the public of more than $2 million last year.
This was the promise of Project 25, a much-heralded, three-year pilot program funded by the local chapter of the United Way to help some of the most chronic users of San Diego’s emergency services. The idea was that if you take these people off the streets, you can give them a better life and save a lot of money in the process.
Project 25’s data show that the program worked. But now its three years of United Way funding are up, and Project 25’s leaders haven’t found anyone willing to pay to extend it. Most of the program’s employees are moving to other jobs and the money will officially run out in June.
Marc Stevenson, the head of Project 25, said it would be a shame if the program went away. Local emergency medical officials have identified another 25 mega-users of the health care system who would benefit from the same approach. They won’t get the help they need, and the community won’t get the savings, unless Stevenson can find the roughly $930,000 it costs to run the program each year. (Project 25’s savings numbers include this up-front cost.)
Here’s a look at how Project 25 cut the number of arrests, ambulance rides and other uses of emergency services of its 34 participants in 2010 compared with last year:
Given the numbers, Stevenson didn’t expect that finding more funding would be so difficult. I spoke with Stevenson, a social worker who works for St. Vincent de Paul Village, about what the program did and whether it has a future.
What’s been the biggest surprise that you’ve had?
That it worked. (Laughs)
The biggest surprise was over $2 million in savings and this was after the cost of what it took to provide the service. Watching these folks stay in housing and watching them stay connected to supportive services that we offer them, which basically is a fine blend of clinical and nonclinical approaches. There’s a lot of nonclinical things that go on in their lives that are really important to address when you want somebody to stay in housing. Their house has to feel like a home.
What do you mean by that?
If you take somebody off the street and you put them in a house and they came in with nothing and they still have nothing in the home, they don’t feel much different than when they were on the street. I mean it’s nice to have a toilet and a shower, but basically what we witnessed in the beginning of the program is that some of our folks had a tendency to kind of all of a sudden set up their homeless camp right there in the living room.
United Way provided us with enough to make sure they’re comfortable in their homes. We’re talking a bed, kitchen table, chairs, that kind of thing.
Can you give me a concrete example of someone who was helped through this program?
I have a guy that we engaged. He used to sit on the corner of 10th and B. He sat there wrapped in a blanket. We started providing health services. The doctor used to go visit him right there. It took us four months to really engage with him and get him on board with what we were trying to do. We finally got him to agree to go into housing. Once we got him into housing, it didn’t go well for him. He actually kind of freaked out, the four walls were getting into him and he ended up exiting that housing. But we stuck with him on the streets. We got him to go along with getting back into housing.
The issues that came up once we got him in housing is, what was going to prevent him from staying in housing? If he were to become over-intoxicated in the same matter he might have on the streets, that could present problems. Does he have anything to sustain himself? He had no income, or anything at all. Did he take proper care of his hygiene so that he wouldn’t get complaints from other neighbors? Does he know how to be a good tenant and a good neighbor? All of these things were the things we started working on once he was in housing.
We used to take him to his doctor’s appointment and instead of anticipating a crisis, we set up a weekly appointment in the clinic with him since he had a lot of health stuff going on. We would take him to that appointment, we would show up at his door. We knew that he wouldn’t go if we just gave him the appointment card.
Now he’s created a relationship with the doctor and now he goes to the doctor on his own. To watch that growth over time, and this took almost every bit of that three years to get to that point.
In that story there seems to have been a lot of hands-on, day-to-day work. Did you think it was going to be that way at the outset?
These are crisis-oriented folks. If you aren’t set up to address crisis, then you’re probably not going to make a big impact on folks like this.
You told me a story of someone who this has helped. Do you have a story of someone this hasn’t helped?
It depends on how you look at it. I’ve got some clients that haven’t changed a whole bunch from when I first got them in the project. They’re difficult to engage. They really value being able to do things on their own and therefore their recycle route is more important than meeting with us. We have to chase them around sometimes. And they still basically act in some ways like a homeless person yet they come home to their apartment at night.
Somebody from the outside may come in and look at that and say, “Well you haven’t done much with these folks.” In some ways, you may be right. But you know what, these folks haven’t hit the hospital in I don’t know how long. They’ve been maintaining housing for going on three years right now and nobody has been able to engage them before this.
What’s the current funding situation?
It’s been really interesting. With the data that we have on what we’ve been able to accomplish with this group, I think all of us thought that this is going to be no problem. We had raw, exact data. Not just client reports or surveys or something. Since the savings were incredible, we thought this was going to be a slam dunk.
When we started approaching the hospitals, they were very, very interested in what we were doing. But when it came down to funding, there’s a lot of fears around funding a social service agency in the community. One of those fears may be that other social service agencies will come and feel like the hospitals are responsible for that too. There’s a little bit of politics around those approaches.
We did have a commitment from one of the hospitals to provide a portion. One of our ideas was that if the other hospitals were on board, and those equal portions were put in then we can continue to serve another 25 of these folks that are costing so much money.
We have a lot of irons in the fire. We’ve presented about this project across the community. Anybody that’s ever heard about it has expressed huge interest in the outcomes and what it was that we’re doing.
I know that over the last year two years, there has been a lot of discussion at the city about permanent or year-round funding for the shelters and the tents and things like that. But Project 25 hasn’t really been as much of a part of that discussion. Why?
We have approached the city. We have approached the county. They’re well aware of Project 25 and what it is that we do here. I think there’s been some conversations about potentially accessing county funding to provide a housing-first approach. But these conversations don’t seem to get to where they need to be. Either they’re not falling on the right ears or their focus seems to be turned toward other things that are happening in the community.
If this saves money for everyone involved, why does it seem to be so hard to find people to fund it?
It’s hard to say.
I think right now the biggest problem is not that people aren’t willing to fund this. It’s that a single agency is probably nervous about being the one to fund the whole thing. Our idea is if we can get the major hospitals together to provide a piece of it, the health plans together to provide a piece of it, that collaboratively it wouldn’t be a big impact on what they were spending, but we could still make a huge impact on what these costs are happening with these mega-users of the emergency services. Trying to get everybody on the same page and at the same table has been difficult for us. We’re definitely open to ways and support in being able to make that happen.
What happens to the people currently in the program?
Ethically, we are responsible for the well-being of the people that we serve. There’s no way that our agency would try to let these folks fall back onto the streets. St. Vincent de Paul Village will do whatever it can to make sure that continued services are provided to these folks.
We don’t have any funding to take any more people. This is not a cheap project, but this is not a cheap group. They take an excessive amount of attention, an excessive amount of work.
So we’ll have a whole (other) set of 25 people out here that will never experience that and another over $2 million that’s just going to get spent because the lights go out.
This interview has been lightly edited for length and clarity.