How do we save tax payer's dollars? We provide housing for the most vulnerable and most expensive homeless people.
How do we figure that out? By using a vulnerability index.
The Vulnerability Index is a tool for identifying individuals at risk of dying on the street and prioritizing them for housing. Dr. Jim O’Connell of Boston’s Healthcare for the Homeless conducted the original research on the health conditions of the homeless. He identified eight markers that place the street homeless at a heightened risk of mortality:
- More than three hospitalizations or emergency room visits in a year
- More than three emergency room visits in the previous three months
- Aged 60 or older
- Cirrhosis of the liver
- End-stage renal disease
- History of frostbite, immersion foot, or hypothermia
- Tri-morbidity: co-occurring psychiatric, substance abuse, and chronic medical conditions
How does that help? Once people have homes, we can provide the wrap-around, supportive services needed to help them become healthier.
When someone is living on the street, it is much harder to get the services needed. Yes, the same services are available to someone without a home as someone who has a home but access and ability to obtain these services are much harder.
Perhaps someone has a mental issue. They would need a bus pass to get to their mental health provider. Because of their mental health issue, they may qualify for disability. However, because they're on the street, they have no place to receive that check, which could allow them to purchase their bus passes. Since they can't get to their appointments on a regular basis, they also cannot take the medication needed to manage the mental illness. Even if they have the medication, they have no place to store it. Living on the street also makes it challenging to have a set schedule of when, where, or how to take the medication.
The great thing about Housing First is that it offers people a home. It offers stability. It offers services...often right in the building. Many of the barriers are removed simply by housing people and partnering with services to offer some on site. Health can improve because a person now has a place to cook. They have an address where they can receive a check...which may come from tax dollars, but becomes a preventative solution to much bigger, reactive solutions like tax payers paying for 9-1-1 calls and ER visits when they were on the street. It allows them a place to bathe, which then allows people to look for jobs. It allows the mental health stability...sometimes from simply getting off of a stressful street corner...but also because those mental health services are often provided in the building.
Housing First is not a completely do-it-yourself model. There is usually a team of people on-site who help neighbors get connected with the resources they need. They help encourage some to take their medications. They help others look for jobs. Still others, they walk beside as they face their fears of untreated health issues that have developed during their time on the streets.
I'll admit, there is a part of me that is skeptical about paying for housing and services for someone who seemingly doesn't do anything for it. However, the more I get into my job as Director of Community Life at a Housing First model, permanent supportive housing program, the more I realize Tsemberis (founder of Housing First) really was right in his discovery. Not only do people change and improve, we are actually paying LESS to help them move in that direction. It's a win/win for all of us.
You can join the 100,000 Homes movement here.