Sunday, July 8, 2012

180/180 ~~ House Our Worst-Case Neglected Homeless Folks, Those Who Have Given Up, Medically Ill-served, Hiding in Bushes

our most vulnerable homeless people

deserve shelter and safety ~

180/180 campaign aims to address the price of homelessness

Of an estimated 2,700 homeless people living on the streets of Santa Cruz County, just 10 to 15 percent of them—the “medically vulnerable”—account for 70 percent of the costs incurred by countywide services.

The newly implemented 180/180 campaign aims to save lives and money by permanently housing that population.

news1-1Medically vulnerable homeless (people) are a subset identified within the “chronically homeless” population, which accounts for about 33 percent of all homeless people in the county. The chronically homeless are identified as having been homeless for a year or more or having four or more episodes of homelessness in three years.

In May, 180/180 volunteers surveyed 325 homeless people in Santa Cruz County and identified 155 of them as medically vulnerable or as being at risk of premature death, says Philip Kramer, the campaign's project manager.
Thirty-seven of those medically vulnerable homeless individuals—those who suffer from at least one serious physical, mental or substance abuse problem—had a combined total of 67 hospital admissions in the past year, Kramer says. The average hospital admission cost is $8,500. Multiplying that figure by 67 and then dividing the total by 37, shows that each of those chronically homeless people cost the county $15,392 in hospital bills alone.
By providing the 180 most vulnerable homeless people with housing, the campaign plans to help those who are the most at risk of death, as well as minimize the expenses incurred by the county in responding to their emergencies.

“It's a win-win,” Kramer says. “If this appeals to your sense of compassion, then great. But these are also the people who need to go to the hospital the most, who are getting picked up by the police and using emergency services, so it makes good fiscal sense. They're not only the hardest cases, they're also the most expensive.”

The 180/180 campaign is one of 136 similar programs being conducted across the country. Helping to facilitate all of the campaigns is the parent organization, 100,000 Homes, whose goal is to house 100,000 chronically homeless Americans by July 2014.

Kramer says there have been more than 60 studies done nationwide over the years that evaluate the cost effectiveness of permanent supportive housing relative to general relief emergency services.

In a 180/180 study based on 2008 figures, the average monthly public costs for chronically homeless people in supportive housing is $605. The study found that the monthly cost for those people when left on the streets is $2,897.
The last figure factors in a homeless person's dependence on paramedics, ambulance rides, shelter beds and food stamps as well as their inevitable contacts with police, nights in jail and getting processed through the court system.

The average cost for an ambulance response and transport is $2,400, according to Christine Sippl, of the Homeless Persons Health Project. The cost of a county jail booking is $119 plus $98 per bed night.
She says the average cost per admission at a hospital in the Western United States is $8,500, but can be significantly higher for medically vulnerable people who suffer from complex illnesses that require expensive treatments and longer-term stays.

Jake Maguire, communications director for 100,000 Homes, refers to Los Angeles County's homeless housing campaign, Project 50, which has been active for five years.

According to a June 8 Los Angeles Times article, Project 50 ultimately housed 133 chronically homeless people, 85 percent of whom are still in their housing. Those housed soon stopped requiring as many visits to the ER, stopped being arrested and began seeking treatment for addiction, Maguire says.
Medical costs for the Project 50 participants in L.A. fell 68 percent in the first year, according to the Los Angeles Times article.
Between 2008 and 2010, the program cost the county $3.045 million but generated $3.284 million in estimated savings, yielding a net savings of $238,700.

“One chronically homeless person can cost [a] county $40,000 to $50,000 over the course of a year,” Maguire says.
Housing them and providing supportive services to prevent emergencies is a more systematic way to manage health, he says.
“What happens is they [the homeless] end up getting services for preventive care instead of going to the ER, and that's a much cheaper way to manage a person's heath,” Maguire says. “Help them routinely rather than wait for a crisis to flare up.”

Monica Martinez, the director of the Homeless Services Center in Santa Cruz, says this is “counter intuitive to what many people think should be done for the homeless.”

“We're investing money in these people no matter what,” she says. “We're either going to invest in smart solutions that help them live a higher quality and hopefully longer life, or we're going to, by default, invest in our emergency resources to act as the social safety net for this population.”
The next stage for 180/180 is to initiate the housing process, Kramer says.
The first wave of homeless people the campaign plans to house is veterans, 24 of whom were contacted during the survey week. Veterans are at the top of the list because they are eligible for a special type of veterans' housing voucher, called VASH, that is currently available through the U.S. Department of Veterans Affairs (VA), Kramer says.

For non-veterans in the second wave, the campaign will use Section 8 housing vouchers, which supplement housing costs for low-income individuals and families.

There are 4,200 Section 8 housing vouchers available in Santa Cruz County through the Housing Authority, but they have only about a 1 percent turnover rate, making about 40 available each month, Kramer says.

The 180/180 campaign requested three weeks ago that the Housing Authority set a preference for chronically homeless individuals, arguing that they have less opportunity to access the vouchers due to their circumstances, he says. They hope to have two or three set aside each month.
180/180 appealed to the County Board of Supervisors, who sent a letter to the Housing Authority supporting the priority list of Section 8 housing vouchers, Kramer says.

Kramer says they made a similar request to the VA for priority VASH vouchers.
The first group of 180/180 participants will be housed in apartments scattered throughout the county, Martinez says. Part of the campaign's work will be to reach out to landlords who accept Section 8 vouchers as well as contact landlords who may not have considered it in the past.

Kramer hopes that sharing the financial results will cause many people to view solutions to the homeless problem in a new light.

“We're showing that it makes more sense for a community to pick someone who's really sick up off the streets and get them out of the emergency room, out of the ambulance, and put them in an apartment and give them supportive services,” he says.

Ardella Davies knows firsthand how housing can turn a person’s life around. Davies lived on the streets for nine years while struggling with diabetes and a methamphetamine addiction. In September 2011, she was given an apartment at the Nuevo Sol complex in Santa Cruz. She received the housing through Project Home Base, which is managed by the Santa Cruz County Homeless Persons’ Health Project in collaboration with County Mental Health and Substance Abuse Services. Since moving in, she says her health has improved greatly. She says being able to cook proper food in her kitchen and having a bed has changed her life.

"You have a place to put your head,” Davies says. “You have facilities to cook. You have your basic needs. Everyone needs housing.”

Photo caption: Ardella Davies was homeless for nine years, during which time she was coping with diabetes and an addiction to methamphetamine. Since moving into the Nuevo Sol apartment complex in Santa Cruz last September, she says her health has improved greatly.

Comments (2)Add Comment
written by Phil Kramer, July 06, 2012
Much of 180/180's success and legacy will be in forming improved working methods and streamlined processes. Both the VA and Housing Authority, cited in this article, have worked closely with 180/180 to make this happen, and we are grateful. Many 100k homes communities have cut in half the time it takes to identify, qualify and house a vulnerable homeless person. We can do the same here in Santa Cruz County, thus saving time and money. To learn more go to
written by Phil Kramer, July 06, 2012

This article does a good job covering the cost-effectiveness of Permanent Supportive Housing (PSH). Put simply, it is less of a drain on the public purse to house a medically vulnerable homeless person than to have them accessing expensive emergency services. And, as cited, Ms. Davies is one such person who has turned their life around with PSH - we know it works, but with only 199 units administered across the County it's not enough. We need to expand this successful program. To learn more and find out how to involved go to


  1. Both Good Times and S.C. Weekly had puffpiece articles on this latest "house the worst out of sight, while continuing to criminalize the majority" approach.

    There's nothing wrong with providing "Housing First"--which this seems to be an extension of.

    But when it's only intended for a fraction of the population with no emergency decriminalization of sleep or campgrounds for the rest, it sounds to me like another fund magnate, similar to the notorious "end homelessness in 10 years" crap that spewed out of the Continuum of Care.

    Sorry, Phil.

    Linda--this sounds like another distraction and copout--the specialty of Mayor Lane.

  2. Robert,
    I've posted your comment here, but the downside of doing so is, everyone gets to read my response to you as well.

    Your logic is inadequate to justify your statements. It seems like you're saying, essentially, that if I were to offer some dude who crosses my path an apple, and you were watching, you would object to my offer as not being good enough because I don't have an apple for you and anyone else within hearing? Or you'd block the apple, yourself, because you know that an orange would be more vital in that moment.

    I disagree. This is exactly like when Mike Rotkin says, "The OTHER homeless (people) are obviously capable of hiding in the bushes, why can't so-n-so?

    I cannot support anyone, regardless their belief systems or other status, who thinks withholding help should be avoided because it's not enough help.

    This 180/180 Campaign has enough impediments; including its dependence on regular people in neighborhoods, especially landlords. If ordinary people don't rise up out of their complacancy and misplaced fears, 180/180 can't happen here. Which means that group of people, already suffering longterm and dying prematurely, largely hiding from abusers, will also die prematurely.Yes, it relies on a maximizing or better leveraging of certain governmental systems. But only in direct proportion to a requisite expansion of individuals who want to substantially "help out" somehow. Your comparisons are vaguely governmental (ke Mayor Lane, C of C noted). You can mislead people with this kind of broken logic and guessing. There are plenty of detractors. Please consider your words and purpose. If there is something fundamentally wrong with this project, what is, it really? Why on earth would you be AGAINST getting people off the streets who've been there a long time and can't even take care of themselves without both help and housing?

  3. I agree with Linda, something should be done for the people who we can help. Also of concern is that people on SSI may fall through the cracks even further when the govt stops issuing paper checks in March 2013. Many of these people (outside the range of the homeless services center with their mail drop) don't have legit mailing addresses that a debit card or checking account statement could be mailed to to facilitate them getting their SSI money if they are homeless.

  4. to Anonymous, yr right to be concerned. what happens most often when a person can't provide both a secure snail mail or email address to the federal government, they will stop getting their checks and they will be offered/assigned/required to get a rustee. That designee can pay her/himself from the person's survival funds, and sometimes can rip the disabled person off outright (tho' risky to the ripper) Pas the word along: we ALL need friends. Those of us who are down because disabled, but who've had doctors and such confirming it and the patience of Job, sometimes get SSI, and it can truly help. Nonetheless, just like you need doctors if you are disabled or permanently hurt and unable to work enough to support yourself; similarly, you need friends you can trust with your money if you have certain status scars. If you've had to move a lot or are homeless, if you have had a mental health jacket in the past, a lot of other reasons -- be prepared to suddenly have to find someone you can trust who has some sense, in case something comnes up where you can't yourself. (tense changes? sorry -quitting time)


Please leave a comment. Comments which are abusive, libelous, threatening, or otherwise objectionable may be removed by the editor. Comments which remain posted may or may not reflect the views of the editor. I welcome your comments, suggestions, critiques, and updates.