Travis County's Patient No. 1 lives behind a cloak of anonymity, provided both by official practice and a particular set of life circumstances. Chances are you will never meet Patient No. 1, but you're deeply invested in Patient No. 1. In calendar year 2010, Patient No. 1 absorbed $75,407.41 worth of emergency medical care, and you paid for it. Patient No. 1 does not have a home, let alone any sort of insurance coverage. Instead, Patient No. 1 depends on care from local emergency rooms or, every once in a while, the county jail. Patient No. 1 is a poster patient, and a metaphor twice over – the wandering personification of a national problem, and the living, breathing argument for its solution.
So what is Austin to do with Patient No. 1 – and, for that matter, with the portion of the homeless population that isn't Patient No. 1: the single moms who live in cars, the gentrification-ousted renters, the whole tragic mess of homelessness?
To get at it, Austin could well turn to existing, successful models for inspiration. The city of Miami designed a solution that includes a business-community-backed (i.e., well-funded), comprehensive approach that offers a significant portion of the city's homeless population real ways to get off the street. Since its 1993 inception, the effort there has reduced the city's homeless population from 8,000 to just 1,000 "street" homeless. Three Austin City Council members, high-ranking city administration officials, and a host of advocates from such organizations as the Downtown Austin Alliance and Foundation Communities have been to Miami to see the solution up close. Some version of this program could find its way to Central Texas.
Closer to home, San Antonio officials built a sprawling, 15-building, 37-acre campus that surrounds transitioning homeless with a variety of on-site services. Austin policymakers say the city doesn't have the space to provide a San Antonio-style campus, and besides, it might be seen as a segregationist solution. Yet, the San Antonio method serves nearly 1,000 down-on-their-luck citizens and sleeps up to 500 a night. By comparison, the Austin Resource Center for the Homeless sleeps only 100.
None of this is to say that there aren't substantial efforts in Austin to help Patient No. 1. Indeed, the city has more than a fistful of existing advocacy and outreach organizations already doing the hard work. But there is no overarching plan – a funny situation for a town so devoted to planning. Worse, when the city went to its own voters on Nov. 6 for $78.3 million in bond funds to support affordable housing in the region – a key portion of any comprehensive approach to the homelessness issue – the voters declined. It was a significant, and somewhat surprising, blow.
The election has thereby complicated the obvious question: What's next?
According to the website of a private partner in Miami/Dade County's program, the Florida version of the story reads like a Dickensian rich-man-makes-good fantasy, complete with a bit of deus ex machina provided by a court order. The story starts with a quote from Alvah Chapman, a former publisher of The Miami Herald: "In 1991, when I left my Knight-Ridder office and drove south, I was appalled by the sea of humanity that was living under the expressways in conditions that would have been a disgrace to a third world nation."
Chapman, according to the South Florida Sun-Sentinel, pushed Florida's then-Gov. Lawton Chiles to create the Governor's Commission on the Homeless in 1992, and to appoint Chapman to it. The Sun-Sentinel – a competitor of Chapman's Herald – says that the effort was "jolted" into place by an American Civil Liberties Union lawsuit accusing Miami-Dade of "a pattern of unconstitutional treatment of the homeless." Obviously, the program needed funding – and by 1993, Florida jurisdictions were granted the authority to impose a 1% food and beverage tax and direct a significant portion to homelessness-combating programs. Miami-Dade would be the only region in the state to take the opportunity.
Miami-Dade began to see an impressive turnaround in its homeless population. By 1997, even the Sun-Sentinel had called the progress "striking." In 1998, the program was recognized as a national best practice. The Miami model found success – at least in the Chapman program – in a comprehensive approach that offers the region's homeless sleeping accommodations at facilities that also boast social and medical services and offer meals and job training, as well as mental health support.
The plan includes a strong outreach program – nicknamed the Green Shirt effort, for the color of the tops worn by its workers – that aims to get homeless Miamians quickly off the street. The Green Shirts carry a list of available services and the ability to immediately direct individuals to the appropriate place.
Some observers argue that Miami's numbers, especially the initial 8,000 estimate, aren't quite accurate, but no one questions the visible success of the Chapman effort. Still, it's not quite fair to compare Miami to Austin. Even if Austin had a comprehensive outreach program like Miami's, the city still wouldn't have enough empty beds, caseworkers, or housing to answer the need. Ann Howard, executive director of the Ending Community Homelessness Coalition, says, "The Chapman Center, which does a great job, is not a shelter for folks with mental illness. They are at a different shelter in Miami. ... They've culled out who's going to the Chapman."
She continues: "It's not the right comparison if we're worried about what's going on Downtown in Austin, Texas."
The beginning of San Antonio's program reads a lot like Chapman's call to power. According to the private nonprofit Haven for Hope's website, local "business and civic leader" Bill Greehey – chairman of NuStar Energy – saw a documentary on San Antonio's homeless population in 2005. Five years later, Greehey, in partnership with local politicos, opened a massive campus that Haven for Hope claims is "the largest, most comprehensive Homeless Transformation Campus" in the United States. In addition to beds, the facility contains treatment options for addiction and mental illness, job training, and chapel services. According to a January 2012 report prepared by the facility, "The Haven for Hope campus increases the effectiveness of 78 nonprofit service providers [40 housed on-site], who are now able to collaborate."
Haven for Hope is a centralized facility, something that critics might dismiss as a ghetto of poverty separated from the rest of the city. It's still a bit early to evaluate Haven's success, but its approach seems persuasive. "Studies show that up to 80% of people who become homeless can quickly regain self-sufficiency if they receive supportive services such as those found at Haven for Hope," continues the 2012 report. "Following best practices based on thorough research on homelessness and substance abuse, the campus provides holistic treatment by combining: Housing, Food, Health, Job/Employment, Education, Financial, Social Support Services, Case Management, Spiritual and Targeted Population Services within a single campus."
In two years, Haven for Hope has found work for 700 of its clients and permanent housing for nearly 900. According to spokeswoman Evita Mendiola, Haven's early success stems from its ability to avoid the predictable barriers for a homeless population, thanks to the on-site services that let Haven residents access social services without having to worry about how to get to them.
Bill Brice, security and maintenance director for the Downtown Austin Alliance, notes one problem with the San Antonio approach that might also be an issue for Austin. Though the program has been successful in moving people off the streets into temporary shelter, the logical next step has been somewhat elusive. "They are recognizing that they don't necessarily have the [permanent housing] units to move those people into," Brice says.
There are certainly lessons for Austin in each of these programs. Foundation Communities is one of the Austin success stories, and Executive Director Walter Moreau says that some of the success of the Miami and San Antonio programs is due to the simple fact that those efforts provide reserved beds. "You have a reserved spot that you don't have to leave in the morning," he says. That's not the case for Austin's emergency shelter, the Austin Resource Center for the Homeless, where some of the most acutely needy turn.
In the first place, the ARCH is primarily a first-come, first-served emergency shelter and is not equipped to serve as a centralized intake facility for the chronically homeless. According to Howard, only a fraction of the population that visits the ARCH receives case management services – the kind that help direct an individual through the sometimes byzantine world of federal, state, and local social support services.[page]
Mayor Pro Tem Sheryl Cole has visited both Miami and San Antonio in search of best practices to bring home. She suggests that the city governments in those places have formed extensive partnerships. "Both cities have a model – a new model – that I think is probably one of the most critical aspects of what we need to implement here," she says. "It involves a collaboration between the government sector, the faith-based community, social services, and the business community.
"In Austin, at this stage," Cole continues, "the government sector is taking a primary role in trying to address the issue. ... But we do not want to do that alone, and we do not think we can do that alone. We have to have the other prongs of the model at the table."
Much of the solution comes down to money. Miami-Dade reeled in millions of dollars in federal funding, thanks to its considerable local match. It can also depend on $14 million annually from the food and beverage tax. San Antonio, by contrast, is subject to the same lack of state social services funding we are – but managed to give just over $7 million to Haven for Hope alone in fiscal year 2012. San Antonio's Department of Human Services funded a raft of community programs to the tune of $36.1 million from the city's general fund.
The city of Austin can provide only a fraction of its already severely diced $25 million in social services funds to address homelessness. Private investment did help establish such efforts as the ARCH, but Council Member Mike Martinez isn't sure that's an adequate precedent. "We've got to get the right partners at the table," he says. "You can't go to the business community every time and say, 'Hey, we need you to pony up some money and help us solve this.' We've already tried that, and it hasn't worked. They stepped up heavily for the ARCH and helped fund that and embraced it being Downtown, and it's done good – it's done a lot of good things – but it certainly didn't solve our issues."
Proposition 15 was supposed to help. On Nov. 6, the city of Austin asked its voters to approve $78.3 million in bonds for rental housing and affordable ownership opportunities for low- to moderate-income residents and Austinites with special needs who are working toward self-sufficiency. It wasn't the annual $95 million infusion that helps fund Miami's programs, but it would have been a substantial investment.
The citizens of Austin said no.
There's been plenty of speculation, including in this paper, about why Prop. 15 failed. Martinez suggests it was insufficient education. "It's not that [Austinites are] opposed to it. ... They just want to know where we are going to stick all of these units," he says. "Obviously, we'd love to have a road map, but ... when the opportunity arises and a property becomes available that's cheap and can have a big impact, you have to be ready and capable of moving on it quickly, and sometimes it may not be according to the plan."
Whatever the explanation, the defeat of Prop. 15 was a considerable blow to the overall effort to diminish homelessness. And there's a paradox embedded in the problem that makes the failure of Prop. 15 even more frustrating: There is strong evidence that an investment in permanent supportive housing, though expensive up front, is ultimately cheaper than doing nothing. And that calculation brings us back to Patient No. 1.
Patient No. 1 is a member of what social scientists call "a cohort," a group of individuals who share a set of measurable experiences. Patient No. 1's cohort is the top 20 most frequent users of emergency care in Travis County. They are all homeless and dependent on city services to address their complicated sets of needs. This means hospital emergency room visits, frequent contact with Emergency Medical Services, and mental health or detox care courtesy of Travis County Central Booking. The cumulative costs are daunting – in 2010 alone, almost $800,000 spent on just 20 people – and make investments in permanent solutions seem economical by comparison.
There are also, says ECHO, hospital costs for those members of the homeless population who need more attention than can be provided by EMS. ECHO puts that figure at over $1.5 million in emergency room costs and $1.4 million in other hospital fees. The DAA's Brice succinctly summarizes the situation: "We're spending millions and millions of dollars to not solve the problem."
It also means that despite the substantial start-up costs, investing in permanent supportive housing could save the city (and the county, and the taxpayers) a lot of money.
While much of Austin was preoccupied with Formula One weekend (for or against), the city's veterans consultant, Allen Bergeron, was engaged in a different sort of civic enterprise. In September, Mayor Lee Leffingwell and the Veterans Affairs Office – with help from state and federal programs – kicked off a furniture donation program designed to provide furnishings to veterans and their families who are transitioning to new housing. In about a month, the participating organizations and their sponsors had collected enough household goods to furnish dwellings for seven vets. It was a relatively small effort that, nonetheless, had a large impact (as Bergeron puts it, a program might get a vet into housing, but it can't keep him or her from sleeping on the floor) and was accomplished quickly and efficiently. "We have a warehouse full of furniture," says Bergeron – in theory, the seed of several more furnished homes.
Key players in local efforts to combat homelessness – including those both at City Hall and on the front lines – argue that what's on the ground now could benefit from better focus. A broadly accessible, centralized, and comprehensive database of services would be a good start; more case managers would be helpful, too. But they insist that there is already quite a bit of service infrastructure. "We have so many of the same components at work that other cities have," says Brice. "It's just a matter of coming to grips with how all of these parts come together."
A close-up of such efforts as Bergeron's is encouraging. In addition to the furniture drive, the city Veterans Affairs Office has also organized an arrangement whereby local faith organizations step in to watch children of single female veterans while they take care of necessary activities like job interviews. Bergeron is also partnering with the U.S. VETS in an arrangement that he hopes will acquire more permanent, full-time transitional housing for vets over the next six months or so.
Bergeron and his staff are employing a broad range of programs to get homeless veterans into long-term housing by providing the wraparound support that is required to do the job. And he's doing it at a very low cost. His department relies on partnerships – federal, state, faith-based, private, whatever – to get things done. The office's basic operations are funded by a federal grant.
Although it might not seem so to the casual observer, there are in fact fewer homeless in Austin than in other U.S. cities; that means the problem should be relatively more solvable here than in, say, New York or Los Angeles or even Houston. Bergeron estimates Austin's homeless veteran population at 150 to 200; if the citywide figure is something that can be tackled, Bergeron's focus is even more manageable, and the progress made by the Veterans Affairs Office illustrates that a lot can be accomplished for not much funding.
Indeed, the pieces of a solution may be in place, but the funding most certainly isn't. Cole does not mince words about the stakes. "The homeless issue has been called the last major civil rights issue," she says. "Now as you see ... the public order initiatives with many cities throughout the country, with large amounts of the homeless population, you're seeing a crackdown, sometimes, on their civil liberties." In recent months, the Austin Police Department has responded to a rising incidence of homeless-related crime – both as victims and perpetrators – with its own public order initiative, to a mixed public response (see "Downtown Stopgap"). But neither APD Chief Art Acevedo nor social services advocates consider such responses permanent or sufficient solutions.
If we do nothing more, says Cole, "I don't think [homelessness] will go away, especially as we decrease our safety net." Unless the city finds a way to fill that gap, the line will continue to form behind Patient No. 1.
Correction: The cutline on the first image of this feature previously misidentified the Austin Resource Center for the Homeless and has since been corrected.
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