Project: Homeless | Coordinated approaches save millions of dollars

bmusgrave@herald-leader.comNovember 23, 2013 

While Lexington has debated and studied how to address homelessness and increase affordable housing for years, other cities and counties have implemented coordinated approaches to address aspects of homelessness.

Some are seeing system-wide results that Lexington is not.

The Mayor's Commission on Homelessness released a 100-page report in January that included a host of recommendations that have not yet been implemented. One key overarching recommendation is to increase collaboration between service providers, the city and other partners to develop coordinated approaches to homeless.

Louisville and Dayton, Ohio — which have similar numbers of homeless people — have developed targeted approaches to go after the most costly users of homeless services — the chronically homeless.

And initial data shows that they could be saving millions system-wide that Lexington is not.

Chronically homeless people are a small portion of the homeless population that cost the most to serve. A study in Hawaii showed 1,751 homeless adults were responsible for 564 hospitalizations, costing $4 million. They also spend more time in jail for petty offenses. A University of Texas two-year study found that each homeless person costs taxpayers $14,480 a year, mostly because of jail costs.

A study in Los Angeles found that placing just four chronically homeless people in permanent housing saved the city more than $80,000 per year in lower emergency room, jail and other costs.

Montgomery County and Dayton officials developed a 10-year plan in 2006 to address homelessness that set out specific goals for the community, including adding 750 permanent housing units that offered support services such as case workers and mental health professionals. Three years from its 10-year goal, it has developed 598 units, or 80 percent of its goal. The community has seen a dramatic drop in the number of chronically homeless people, said Joyce Probst MacAlpine, assistant director of Montgomery County's Housing and Homeless Solutions, a county office. In 2006, 127 people were identified as chronically homeless in its annual point-in-time counts reported to the U.S. Department of Housing and Urban Development. In 2012, that number fell to 48.

Those people who have received services have stayed in their homes.

"It's a different group of people than in 2006," Probst MacAlpine said of the people considered chronically homeless in 2012. Addressing the issue

Louisville Coalition for the Homeless, a nonprofit coalition started more than 25 years ago, started a push for more permanent housing units in October 2012 as part of a national campaign to add 100,000 permanent housing units nationwide. To date, service providers in Louisville have been able to house 120 people who were once chronically homeless, many of whom have lived outside for years.

"It's really impactful because that population is so hard to serve. It just saves you so much money when you get them off the street," said Natalie Harris, the executive director of the coalition, which includes more than 30 service providers.

The number of chronically homeless people who live outside has now dropped from 59 people in 2012 to 29 people in 2013, Harris said.

Lexington's chronically homeless population has remained stubbornly around 188 and 190 for several years, according to annual counts reported to HUD.

In addition, the University of Louisville hospital has targeted frequent emergency room users, called "super utilizers" for a new program that has gained national attention. Many, but not all, of the people who are in the program are homeless.

The program began in September 2012, and it is estimated to have saved U of L more than $700,000 to date in fewer emergency room visits, said Tom Walton of U of L. The hospital looks at reasons behind a person's frequent emergency room visits, digs deep into the person's background and then develops a plan with a host of service providers to get that person services they need.

One homeless man had more than 330 emergency room visits over a little less than two years and racked up a bill more that was more than $500,000. U of L paid for the man to go to in-patient drug and alcohol treatment in Northern Kentucky. They found him a primary care physician and other doctors through Phoenix Family Health Care for the Homeless. More important, they found the man a home. The total cost was a little more than $6,000.

His use is now down 90 percent, said Barbara DiMercurio, Director of Nursing, Emergency Services for University of Louisville Hospital.

Walton said it's difficult to determine how much the program costs because DiMercurio and one other staffer coordinate the program as part of their current jobs.

Louisville and Dayton also have something that Lexington does not: a coordinated point of entry for people entering homelessness.

The Louisville coalition recently launched a phone number for people to call if they needed a bed for the night. It is developing an assessment tool to determine the best place for someone who is homeless to go.

Montgomery County first developed its assessment tool in 2010. It allows more coordination between service providers and more data collection of the people who are entering the system. Moreover, it creates consistency within the system, said Probst Macalpine.

"We looked at the people being served in the shelter; we saw that there was a group of people that were never exiting," Probst MacAlpine said. "We also didn't have a good idea of what people actually needed. All we knew is what our providers provided."

Dayton is able to show providers the wait list for certain services such as transitional housing. That was not available before, she said.

Probst MacAlpine said the single point of entry and new assessment tool has resulted in some big successes.

"In the first six months, we housed someone who had lived outside for 10 years," Probst MacAlpine said. "She's still housed three years later."

Coordinating efforts

David Christiansen, executive director of Central Kentucky Housing and Homeless Initiative, said Lexington has not been able to implement the systemwide changes that Louisville and Dayton have because it does not have the money to do so. Christiansen receives only a small stipend from the Kentucky Housing Corporation to coordinate the HUD application for federal homeless money. The Louisville homeless coalition receives some money through federal grants and has a staff of six.

"We made the decision not to compete with providers for those dollars," Christiansen said. "But we now have these mandates from HUD (single point of entry, community-wide assessment tools) but no funding for them," he said.

One of the recommendations of the Lexington Mayor's Commission on Homelessness is to create an Office of Homeless Intervention and Prevention to help better coordinate services. The office has been created, but a director will not be hired until spring.

If the city hires a coordinator for homeless services, Christiansen said, that person could help with coordination and data collection. But he said one of the key reasons they kept some parts of the homeless service delivery system separate from the government is so they could advocate for the homeless.

"We are a voice for the homeless and the providers that's outside of city control," Christiansen said.

Shaye Rabold, a senior advisor to Mayor Jim Gray, said the new director of Office of Homeless Intervention and Prevention, could be key to making the city a better partner with service providers.

"We don't want this to become separate from the service providers," Rabold said.

Maj. Debra Ashcraft of the Salvation Army of Central Kentucky, which serves homeless women and children, said she thinks the service providers already "do a really good job working together."

Janice James, administrative deputy director at the Hope Center, said better data collection and focusing on the chronically homeless that live outside is something the community needs to focus on, but she is not convinced that Lexington needs a single point of entry or an assessment tool.

"I would like to see the benefit for the citywide assessment tool and see if it really works," James said

Debra Hensley, co-chairwoman of the Mayor's Commission on Homeless, said communities that succeed in addressing homelessness need buy-in from every facet of the community.

"It takes the government, the faith community, the provider community, the whole community," Hensley said.

Beth Musgrave: (859) 231-3205. Twitter: @HLCityhall.

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