Jess sends on this article about a controversial Seattle program which gives homeless alcoholics a place to live — and allows them to drink in their rooms.
These are the “unsympathetic homeless” who beg, drink, urinate and vomit in public — and they are probably the most difficult to get off the streets, said Bill Hobson, executive director of the Downtown Emergency Service Center, the nonprofit group that owns 1811 Eastlake.
In 2003, the public spent $50,000, on average, for each of 40 homeless alcoholics found most often at the jail, the sobering center and the public Harborview Medical Center, said Amnon Shoenfeld, director of King County’s division of mental health and chemical abuse.
Mr. Hobson’s group expected the annual cost for each new resident of 1811 Eastlake to be $13,000, or a total of $950,000. It cost $11.2 million to build and is paid for entirely by the City of Seattle and county, state and federal governments.
There was an article in the New Yorker a while back about this problem: The fact that the chronically homeless cost local and state governments thousands of dollars in hospital bills, jail time, etc, and that alcohol is a serious addiction that many of them simply cannot ween themselves of.
“We came up with three names that were some of our chronic inebriates in the downtown area, that got arrested the most often,” O’Bryan said. “We tracked those three individuals through just one of our two hospitals. One of the guys had been in jail previously, so he’d only been on the streets for six months. In those six months, he had accumulated a bill of a hundred thousand dollars—and that’s at the smaller of the two hospitals near downtown Reno. It’s pretty reasonable to assume that the other hospital had an even larger bill. Another individual came from Portland and had been in Reno for three months. In those three months, he had accumulated a bill for sixty-five thousand dollars. The third individual actually had some periods of being sober, and had accumulated a bill of fifty thousand.”
The first of those people was Murray Barr, and Johns and O’Bryan realized that if you totted up all his hospital bills for the ten years that he had been on the streets—as well as substance-abuse-treatment costs, doctors’ fees, and other expenses—Murray Barr probably ran up a medical bill as large as anyone in the state of Nevada.
“It cost us one million dollars not to do something about Murray,” O’Bryan said.
The current plan — hospitalize them, jail them, maybe get them into a short-term treatment program, put them back out on the streets when they’re “cured,” then watch them sink back into alcoholism and homelessness — isn’t working. So the Seattle plan is ground-breaking, since it deals with the problem of homelessness directly by giving people homes. From the NYTimes article:
A third of the residents, including Mr. Littlebear, are American Indian; an estimated 20 percent are military veterans. The average age is 45. Most receive state or federal disability payments, and all residents pay 30 percent of their income as rent under HUD’s guideline for low-income housing.
Alcoholism in American Indian communities is a big problem; as is the general lack of support for veterans in this country (what happens to “supporting the troops” once they come back?). The Times article focuses heavily on the alcohol issue, and unfortunately isn’t able to do the whole issue the kind of justice that the New Yorker is able to (longer word limits and more flexible deadlines generally allow New Yorker articles to be better-researched and more in-depth than newspaper articles — if you don’t subscribe to the magazine or read it online, I’d recommend it). The New Yorker article does a great job of challenging a lot of our perceptions about the homeless, and what can be done to help them:
In the nineteen-eighties, when homelessness first surfaced as a national issue, the assumption was that the problem fit a normal distribution: that the vast majority of the homeless were in the same state of semi-permanent distress. It was an assumption that bred despair: if there were so many homeless, with so many problems, what could be done to help them? Then, fifteen years ago, a young Boston College graduate student named Dennis Culhane lived in a shelter in Philadelphia for seven weeks as part of the research for his dissertation. A few months later he went back, and was surprised to discover that he couldn’t find any of the people he had recently spent so much time with. “It made me realize that most of these people were getting on with their own lives,” he said.
Culhane then put together a database—the first of its kind—to track who was coming in and out of the shelter system. What he discovered profoundly changed the way homelessness is understood. Homelessness doesn’t have a normal distribution, it turned out. It has a power-law distribution. “We found that eighty per cent of the homeless were in and out really quickly,” he said. “In Philadelphia, the most common length of time that someone is homeless is one day. And the second most common length is two days. And they never come back. Anyone who ever has to stay in a shelter involuntarily knows that all you think about is how to make sure you never come back.”
The next ten per cent were what Culhane calls episodic users. They would come for three weeks at a time, and return periodically, particularly in the winter. They were quite young, and they were often heavy drug users. It was the last ten per cent—the group at the farthest edge of the curve—that interested Culhane the most. They were the chronically homeless, who lived in the shelters, sometimes for years at a time. They were older. Many were mentally ill or physically disabled, and when we think about homelessness as a social problem—the people sleeping on the sidewalk, aggressively panhandling, lying drunk in doorways, huddled on subway grates and under bridges—it’s this group that we have in mind. In the early nineteen-nineties, Culhane’s database suggested that New York City had a quarter of a million people who were homeless at some point in the previous half decade —which was a surprisingly high number. But only about twenty-five hundred were chronically homeless.
It turns out, furthermore, that this group costs the health-care and social-services systems far more than anyone had ever anticipated. Culhane estimates that in New York at least sixty-two million dollars was being spent annually to shelter just those twenty-five hundred hard-core homeless. “It costs twenty-four thousand dollars a year for one of these shelter beds,” Culhane said. “We’re talking about a cot eighteen inches away from the next cot.” Boston Health Care for the Homeless Program, a leading service group for the homeless in Boston, recently tracked the medical expenses of a hundred and nineteen chronically homeless people. In the course of five years, thirty-three people died and seven more were sent to nursing homes, and the group still accounted for 18,834 emergency-room visits—at a minimum cost of a thousand dollars a visit. The University of California, San Diego Medical Center followed fifteen chronically homeless inebriates and found that over eighteen months those fifteen people were treated at the hospital’s emergency room four hundred and seventeen times, and ran up bills that averaged a hundred thousand dollars each. One person—San Diego’s counterpart to Murray Barr—came to the emergency room eighty-seven times.
And so treating all homeless people the same way is ridiculous. Homelessness is caused by a wide variety of factors, and can touch the lives of all kinds of people. But the stereotypical homeless person — the one who is a drug and/or alcohol user and who is chronically homeless — is a rarity among the total number of homeless people.
The New Yorker article also gets into the moral complexities of programs like the one in Seattle (here, they reference a similar program in Denver):
This is what is so perplexing about power-law homeless policy. From an economic perspective the approach makes perfect sense. But from a moral perspective it doesn’t seem fair. Thousands of people in the Denver area no doubt live day to day, work two or three jobs, and are eminently deserving of a helping hand—and no one offers them the key to a new apartment. Yet that’s just what the guy screaming obscenities and swigging Dr. Tich gets. When the welfare mom’s time on public assistance runs out, we cut her off. Yet when the homeless man trashes his apartment we give him another. Social benefits are supposed to have some kind of moral justification. We give them to widows and disabled veterans and poor mothers with small children. Giving the homeless guy passed out on the sidewalk an apartment has a different rationale. It’s simply about efficiency.
Which makes it a tough problem. It appeals to economic conservatives because it’s efficient and it saves a lot of money. And it has some appeal for social liberals, who want to see homelessness end. But for all the people in between, and even for many social liberals and economic conservatives, it does seem a little unfair, for all the reasons that the author lays out. Resources are limited, and many of us would rather see the low-income family be able to get food stamps than the drunk guy on the corner be given a brand-new apartment.
It’s important to keep in mind, though, that this isn’t necessarily an either-or situation, and that a comprehensive view of human rights and social justice attempts to help all people. Further, politicians aren’t weighing this homelessness program against welfare programs. It’s true that resources are limited, but pitting social programs against each other isn’t the answer. If we’re going to advocate for cutting spending somewhere, there are plenty of places to start — and most of them don’t involve programs that help the poor.
Is the Seattle proposal a perfect one? Far from it. It’s been heavily criticized for not requiring apartment residents to stay sober. But would requiring sobriety be effective? I’m hesitant to throw a whole lot of support behind it, largely because the Times article wasn’t clear on how much help the residents will be getting from medical professionals and social service workers. But it does seem to be a step in the right direction — or at least an interesting effort, that will hopefully have some positive results.
And do read the whole New Yorker article if you have time.
Thoughts?