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Special Reports - Sheltered in Shadows

Friday, Sep. 14, 2007

In Search of a Home

Bush plan aims to end homelessness in 10 years

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Mick Matthews and his girlfriend, Marlene, Terry and Linda Cool, Steve Harris and Mad Dog — they're not just homeless, they're the chronic homeless and they're very, very expensive.

So expensive, in fact, they've caught the attention of the Bush administration.

The chronic homeless — those who've been on the street a year or more or several times in as many years — make up only about 10 percent of the homeless population, but they consume more than 50 percent of the federal, state and local dollars dedicated to fight homelessness. The White House has realized that whether or not the county wants to pay for homelessness, the country pays for homelessness.

President Bush revived the U.S. Interagency Council on Homelessness in 2002 after six dormant years and set its new director, Philip Mangano, on an aggressive tack — to end homelessness in 10years.

"The president's initiative calls on us to 'end,' that's the specific verb, 'end' homelessness. He literally changed the verb when he asked us to end homelessness, not manage it," Mangano said during a phone interview. "The president was specific."

Since the 1980s, vast networks of soup kitchens, shelters and emergency intervention services have met the homeless at their most dire points of need — when starving, freezing or rushed to the emergency room.

The University of California at San Diego followed 15 homeless people through that network. They watched the homeless bounce between mental health providers, emergency rooms, police involvements, before judges, through short jail stays and ultimately back to the street. The cost: $3 million in 18months, or $200,000 per person.

"We could have rented ocean-side condos and concierges to attend to their every whim, and it would have been a less expensive venture," Mangano said. "And these studies are being done all across the country, and the results are basically the same."

The Boston Health Care for the Homeless Program recently tracked 119 chronically homeless for five years. They had more than 18,000 emergency room visits at an average cost of $1,000 per visit.

John Gilbert, director of physician relations and marketing at Emanuel Medical Center in Turlock, said the bare-bones cost for an emergency room visit is roughly $400 and does not include treatment costs.

By their best estimates, Mick, Marlene — which is not her real name — Terry and Linda Cool said they've visited the ER 14 times in the last year. That was before Mick suffered a second stroke Saturday, landing him at Emanuel for a few days. At the conservative estimate of $400 a trip, that's $5,600 and does not include treatment costs for ailments such as open gashes, infections, bronchitis and pneumonia. And it's just the tip of the iceberg. In the past 10 months, Emanuel has spent $17.8 million in unpaid treatment costs for people without insurance.

But perhaps the most disturbing part of all the research was that after the thousands were spent on emergency care, the homeless were no better off.

They were in the same condition at the end of the treatment as they were when they started. They were still on the street. Still in a shelter. Still drinking. Still not taking their psychiatric medication. Still hoping for a food handout.

The matrix of soup kitchens, emergency rooms, acute care psychiatric hospitals and drug rehabilitations simply manages the symptoms of homelessness.

"The central antidote to homelessness is housing, permanent housing," Mangano said. "What we've come to understand is that permanent, supportive housing costs less to the community than people randomly ricocheting through expensive heath care and law enforcement systems."