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What works: Housing plus support

ShelterCare addresses homelessness with a comprehensive approach

This editorial was originally published on April 2, 2017. Reprinted with the permission of The Register-Guard.

The solution to homelessness is obvious: Housing. Less obvious is the fact that housing, while necessary, is often not sufficient. Many people need various kinds of support to find housing, to keep them in housing once they find it, or to help them avoid losing their housing in the first place.

ShelterCare has been providing supported housing in Lane County since 1970, and offers a model for an approach that can get people off the streets and into housing, where with the right kinds of treatment and support they can achieve stability and independence.

The non-profit agency has a half-dozen programs tailored for specific segments of the homeless population, such as people with persistent mental illness, people with traumatic brain injuries and homeless people needing care after a period of hospitalization. It also works with homeless people who fit no specific category or who need one-time assistance to pull them back from the brink of homelessness.

These can be difficult populations to work with. Their illnesses and disabilities may be severe. Their history as tenants may be checkered or non-existent. One year on the streets takes the physical toll of two years in housing, says Don Gulbrandsen, ShelterCare’s development director. All other problems are aggravated by the mental stresses of homelessness, which include isolation, anxiety and the atrophy of social skills.

ShelterCare serves about 1,250 of these people each year, and provides supported housing for 375 — housing plus health care coordination, skills training, peer counseling, individual and group therapy, supported employment and more. The people receiving these services are taken from a waiting list maintained by Lane County that places those with the most urgent physical and mental vulnerabilities at the top.

Finding these people once they become eligible for ShelterCare’s services can be hard — they’ve often learned to make themselves invisible. They may need help obtaining some form of identification. ShelterCare works mainly with private landlords to provide housing, and persuading landlords to take a chance on tenants with sketchy backgrounds or a history of behavioral problems requires persistent effort.

In some cases ShelterCare will sign the lease, providing landlords assurance that the rent will be paid and that problems with tenants will be addressed. Executive director Susan Ban says her agency has developed good relations with many landlords and property management agencies. The continuing support provided by ShelterCare is undoubtedly a key to maintaining those relations. Some formerly homeless tenants’ needs can be unexpected: Ban and Gulbrandsen tell of tenants who had to be taught to use quiet indoor voices so as not to disturb neighbors, or who had never learned to live with hot and cold running water.

ShelterCare can also step in when a one-time financial crisis — often related to an illness — threatens to result in a loss of housing. Gulbrandsen recalls one unemployed father who had found a job that required him to report for work wearing steel-toed boots, but if he bought the $350 boots he would not be able to pay the rent. ShelterCare bought the boots. More homelessness prevention efforts will be funded by a new three-year, $325,000 grant from the Kaiser Permanente health care system for an eviction intervention program run by ShelterCare in partnership with other agencies.

All this costs quite a lot of money. ShelterCare has an annual budget of $7.3 million, with about half coming from program revenues and the rest from federal, state and local governments, donations and grants. The revenues flow partly from people in supported housing who qualify for various kinds of public assistance — Medicaid, housing subsidies, veterans’ benefits and others.

Yet ShelterCare has compiled information showing that its services actually save money. It costs nearly $20,000 a year to maintain a person in supported housing. A homeless person costs nearly $30,000 a year — housing expenses go down, but the cost of health care goes way up, as do expenses for law enforcement services and incarceration.

These are ShelterCare’s figures, but they are corroborated by studies supporting an emerging consensus that a failure to house the homeless costs more than providing supported housing. The effects of homelessness on the health care system alone are so significant that insurance companies are starting to think of housing as something for which a prescription might be written, just like medicine.

Ban and Gulbrandsen agree with others who work with homeless people that Lane County urgently needs more affordable housing. They also agree with the somewhat less widely accepted idea that a “low-barrier” homeless shelter would be helpful, one that would provide a bed to anyone who needs it. They warn that such a shelter would be expensive — robust security would be essential, and unless it had a strong social-service component the shelter would be no more than a warehouse.

Lane County also needs something like the Royal Avenue Shelter, which was a 19-bed center providing short-term treatment to people with mental health crises, Ban and Gulbrandsen say. ShelterCare was forced to close Royal Avenue in 2014 after shifts in state funding. Without such a shelter, people with mental illnesses are often one crisis away from the hospital or the streets.

And Ban and Gulbrandsen say the CAHOOTS crisis intervention program provides a service so valuable that it ought to be expanded.

Such new or strengthened strands in the social safety net would reduce the costs of homelessness — but the real benefit would not be financial. Ban speaks of what happens to people when they are “reinstilled with hope,” when they are “given permission to blossom.” The real benefit would come in the form of a recovery of human potential that is now being wasted.

Editor’s note: This editorial is part of a Register-Guard project focusing on productive responses to homelessness.

Reprinted with the permission of The Register-Guard. Originally published on April 2, 2017.

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