Six years ago, Waldon Adams escaped from a nursing home with a catheter in his arm to score some crack. He was homeless and had AIDS, which was causing a host of health complications, most recently the heart condition that had landed him in the nursing home. He’d been in and out of hospitals, psychiatric wards, and housing programs that kept expelling him on suspicion of drug use.
Next month, Adams will celebrate six years of sobriety. He’ll also run his 13th marathon; he credits running for providing stability in his once-unmoored life.
What happened in between? Adams got a type of housing that wouldn’t kick him out. The increasingly popular “housing first” model places homeless residents into housing without any prerequisites. There’s no need to pass a drug test, or get treated for mental health issues. Housing comes first; treatment comes later.
Adams credits the “lack of barriers” in his permanent supportive housing for getting him back on his feet. His apartment may have saved his life. It also saved the District a lot of money.
“People started talking about the cost to the District government, and I felt so bad,” Adams said this morning on a panel at the John A. Wilson Building about how to end chronic homelessness. “I didn’t realize I was causing all this damage. That’s how I became an advocate.”
According to an analysis of medical and housing data by the Advisory Board Company for the homeless services nonprofit Miriam’s Kitchen, the 414 most vulnerable chronically homeless individuals in D.C. cost the city an average of $40,843 a year in emergency services. By contrast, permanent supportive housing costs just $22,500 a year.
“Managing chronic homelessness is very costly,” said Adam Rocap, chief program officer at Miriam’s Kitchen, on the panel. “Ending chronic homelessness is not only important for human reasons, but it makes financial sense.”
Chronically homeless individuals are defined as those who have been homeless for a year or more, or at least four times in the past three years, and have at least one chronic health condition. There are about 1,800 chronically homeless individuals and 133 chronically homeless families in the District on a given night, according to the Way Home Campaign, which advocates to end chronic homelessness in D.C. three-quarters of the individuals are men, 60 percent suffer from mental illness, and 80 percent suffer from substance abuse.
Rocap presented a case study of a 51-year-old chronically homeless individual he called Ricky, who has schizophrenia and often goes to the emergency room for a warm place to spend the night. In one year, Ricky took an ambulance to the hospital 134 times, had four inpatient stays, and used mental health crisis services 12 times. That amounts to $208,908 in medical costs. This month, Ricky moved into permanent supportive housing—-housing for homeless residents with substantial support needs, as opposed to rapid rehousing for families who simply need rent assistance—-at a cost of just $22,500 a year, which should dramatically reduce his emergency-services costs.
“I’ve been in every hospital in this city, several times,” said Adams. “I’ve had several tours of St. Elizabeths, the way people have tours in Vietnam.”
“There are big costs to doing nothing,” At-Large Councilmember Elissa Silverman said this morning, “in terms of lives and people not reaching their potential.”
Deputy Mayor for Health and Human Services Brenda Donald took issue with the frequent mention of “the cost of doing nothing,” which was also the name of the event. “We are not doing nothing,” she said, “but we know we have to do so much more.”
The Way Home Campaign urges the city to make an up-front investment to end chronic homelessness, so as to reap much larger savings over the long term, in addition to providing stability to the people who get housing. The campaign recommends a $12 million investment in permanent supportive housing to house at least 621 residents and a $5 million investment in rapid rehousing to house 330 individuals, in addition to other investments. The group also wants to move all permanent supportive housing units into the city’s new coordinated entry system to give equal access to all homeless individuals in need, as opposed to the more patchwork system that prevails now.
The push to spend money now in order to avoid the need for costly services later mirrors an effort that has so far fallen short for homeless families. In trying to move homeless families from shelter into housing, city officials emphasized last year that shelter is considerably more expensive than permanent supportive housing or rapid rehousing. But with families flooding the shelter system last winter and this winter, the city’s been unable to get ahead of the curve and move families into housing as quickly as desired. According to the Department of Human Services, it costs the city $156 per night to house a family at the D.C. General shelter. The city has declined to reveal what it’s spending on motel rooms for the hundreds of families it’s putting up there for lack of space at D.C. General.
“We can’t really end homelessness,” said At-Large Councilmember David Grosso at today’s panel. “But we can reduce the number of minutes and says that someone is homeless to as little as possible.”
Adams is training to run next month’s Rock ‘n’ Roll Marathon. He used to get frustrated when people asked him if he won his races. But now he has a better answer.
“Yeah, I won, because there was no one else with AIDS and a 32-year crack history and permanent supportive housing who ran that race,” said Adams, 52. “So yeah, I won.”
Photo by Aaron Wiener