Not Enough Support

Developers and services providers can’t do it alone — and it’s most cost effective if they don’t
The-Homefront-Supportive-Housing-Fall-2019
Stephanie Hoffman, center, talks with Open Doors’ staff members.

© 2019 NowKalamazoo/Brian K. Powers

It works. It is cost effective. Even some local private developers want to take part.

It’s called supportive housing and just as with Kalamazoo County’s affordable housing options, there’s just not enough of it.

While the lack of a home technically makes one homeless, for someone caught in such a crisis, there’s more than a key to a front door needed to keep them off the streets.

“When we think about the housing crisis, it is not just the bricks and mortar. Other barriers exist that keep people out of housing,” Stephanie Hoffman, executive director of the shelter and housing non profit Open Doors Kalamazoo, told The Homefront.

There’s the lack of available housing, for sure, Hoffman says, as evidenced by months-long waiting lists in the county. It’s especially acute for someone working a minimum wage job or someone with an old eviction or criminal record. They may have a low credit score working against them or lost their job so income has dried up. Perhaps their health care costs were more than they could pay or physical or mental health setbacks like addiction have upended their goals in life. Maybe they don’t have a car and they can’t find a home that is close enough to a bus line as well as work and social services providers that they need to keep on track.

Open Doors accounts for all of that when helping a tenant in one of the hundreds of rental units scattered across 23 buildings in the county that the nonprofit owns and manages, she says.

“We really believe in the humanity of our shelter guests and our residents,” Hoffman says. “The main thing is they stay in housing, they can continue to go to work, and continue the household plan.”

The practical definition of “supportive housing” — basically, packaging a safe home with the support and services tailored to an individual’s situation that exposed them to homelessness in the first place — often depends on how the tactician in a community’s fight against homelessness deploys it, as well as government requirements if a housing program utilizes taxpayer funds.

This can range from a social worker or representative of a service provider clocking a minimum number of hours at an apartment complex to as intense as having a caseworker or mentor living on site.

“We need [more] permanent supportive housing” in the community, Hoffman says. “In order to address generational poverty and eliminating it, housing has to be the foundation of that. Without a home, families and individuals cannot succeed and thrive.”

The services, tailored to an individual’s need, are geared for what a person needs to remain out of homelessness beyond the physical shelter. Done right, supportive housing addresses the trauma that created the conditions of homelessness in the first place.

A 2017 report by the National Alliance to End Homelessness found communities with permanent supportive housing reduce the use of publicly funded crisis services, including jails, hospitalizations, and emergency departments. One study in the report showed providing permanent supportive housing resulted in a 30% drop in chronic homelessness over the course of seven years. A “chronically homeless person costs the taxpayers an average of $35,578 per year,” and those costs drop nearly 50% when people experiencing homelessness are placed in supportive housing.

“Study after study has shown that supportive housing not only resolves homelessness and increases housing stability, but also improves health and lowers public costs by reducing the use of publicly-funded crisis services, including shelters, hospitals, psychiatric centers, jails, and prisons,” the U.S. Interagency Council on Homelessness (USICH) says.

“It’s absolutely been scientifically quantifiable that permanent supportive housing works. It is the cheaper way toward homeless alleviation,” Ben Leverette, the Continuum of Care director at the Kalamazoo office of the Local Initiative Support Corporation (LISC), told The Homefront.

Lighting a FUSE

Bronson Healthcare thought so.

In 2016, it launched a pilot project called Frequent User System Engagement (FUSE) where it and partners targeted a very specific — and very expensive to serve — demographic of the homeless population: those who frequent hospital emergency rooms due to chronic pain and who also rely on other societal safety nets to address a variety of physical, behavioral or mental health ailments, all of which are exacerbated without a home.

“This population includes some of our most vulnerable citizens,” says Michelle Smith, clinical nurse leader at Bronson Methodist Hospital.

“Many lack the physical or cognitive ability, for various reasons, to maintain housing,” Smith says, so they go to the E.R. for “hunger, pain, assault or injuries, and frostbite” as well as medical issues that would be best addressed by a primary care physician or a mental healthcare specialist. Sometimes it is too late and routine, unmet needs spiral into a crisis that walks into an E.R.

“Many also have regular contact with police, jails, court systems, ambulance teams, shelters, and other community agencies,” Smith says. In other words: costs upon unnecessary costs directly and indirectly related to the basics of a homelessness crisis.

Bronson partnered with the Kalamazoo County Housing Commission, Kalamazoo Community Mental Health (now Integrated Services of Kalamazoo) and the social service provider Interact to give a dozen people their own personal residences and swaddled them with services from medical care to substance abuse counseling and mental health services to assistance with Social Security benefits — all within their own homes.

In the 12 months prior to enrolling in Project FUSE there were 124 emergency room visits by the first 11 people in the program. A year after joining the program, that number fell to 50 visits, corresponding to a nearly 60% reduction in costs to the emergency department from $52,065 to $20,475. There was a 28% drop in the participants’ overall medical costs as well during that timeframe.

Lessons From Elsewhere

Bronson is not alone. In 2017, the Rand Corporation studied a similar program implemented by the Los Angeles County Department of Health Services called Housing For Health and found it was a more efficient use of anti-homelessness funds: costs to public services dropped by 60% over a year.
“Overall, the cost reductions more than covered the year’s worth of supportive housing costs, as we observed a net cost savings of 20%,” the Rand study concluded.

Supportive housing models are “ultimately a little bit of money in the short term that saves oodles and oodles,” Julie Rogers, chairperson of the Kalamazoo County Commission, told The Homefront. “Not only is it the right thing to do but it is a cost effective way of managing.”

There are lessons to be learned beyond the healthcare paradigm. A 2015 USICH strategic plan is full of successes of permanent supportive housing projects including reduced costs on municipal public services budgets and engagement of child welfare and criminal justice systems.

“We have to be good learners, good at experiencing and creating different systems that meet unique needs,” Terry Morrow, Bronson’s vice president for development and community health, told The Homefront.

Bronson’s FUSE program included collaboration with a number of local service providers and supporters. Open Doors, which accepts very little in government funding, relies on individual, business, church and foundation donors, as well as discounted rent from tenants, to fund 96% of its operations.

Obstacles to Development

Meanwhile, local developers say they face significant obstacles to participate while new state and federal public housing has been eliminated.

There’s a reputational issue there — developers from outside the community receive the Low Income Housing Tax Credit and other incentives to build affordable and supportive housing according to the letter of the laws and regulations that govern the work, but not necessarily the spirit.

“These out-of-state developers are salivating,” says Leverette, who suggests community leaders could see more construction and better service delivery if they empowered local developers and incentivized a focus on services that meet the needs of the end user. “To truly get fast development you need that whole community complement to that of having property managers who manage successful programs.”

Jon Durham of NOMI Developers says working through the tax incentives and other requirements that the Michigan State Housing Development Authority sets out that make an affordable housing project viable is time consuming but doable. Then comes everything else to make it viable for a tenant.

There’s the “treasure hunt” of getting memorandums of understanding signed with accredited service providers, and then finding state-approved management companies that Durham trusts will execute the services that make up supportive housing beyond just a few hours a day of social work hours — thus, a gap between what’s required of a developer and what Durham says he feels needs to happen for it to be successful.

NOMI is currently building an affordable housing project in the Northside neighborhood and working through an 80-unit permanent supportive housing project on Burdick Street on the edge of downtown Kalamazoo that includes extensive outreach to prospective tenants and bespoke services once they are given a key to a unit.

“We’re trying,” Durham told The Homefront, “but there are still enormous barriers and all these intertwined, complicated webs of relationships that make it really hard to get it built as quickly as possible and in the numbers that we need. It’s not happening.”

Addiction Not Being Addressed

One particular demographic that is lacking intensive assistance are those suffering from the opioid epidemic.

“That’s a missing piece of the puzzle to the housing situation in Kalamazoo,” Durham says.

Matt Hollander of Hollander Development Corp. says a permanent supportive housing project for recovering addicts was killed last year due to NIMBY (not in my back yard) objections from Edison neighborhood residents which, along with long-term funding for services, are “the two big ones” that impede permanent supportive housing projects.

Hollander’s current project in Kalamazoo isn’t technically a supportive housing project, though it does pull on those threads. The Creamery project on the corner of Portage and Lake streets will have 48 low-income units as well as a 24-hour daycare operated by the YWCA.

“The issue is not building apartments, it is coming up with long-term solid financing to cover services and all of the treatment providers” to come into the building, such as case workers, social workers, employment outreach, job training, Hollander told The Homefront. “That costs money, and a lot of the way the system works is subject to appropriations at the local, state or federal level. It is not easy to set up a solid, long-term financing stream for those services. You need to make sure you have 15-20 year stream of money coming in to support that. That’s a huge challenge.”

And it is likely to become more challenging. Leverette says there’s a need for another 4,000–4,500 units of affordable housing throughout Kalamazoo County, and that’s on top of a need for as many as 3,000 units to handle the expected non-income-dependent demand as economic growth continues.

“We need to structure a plan, if we truly want to grow,” he says. “We need somewhere to put people.”

Stories in this issue:

From The Publisher

In Search of a Strategy

The Struggle

Those Facing the Most Risk:

Tears of Relief

We Can Do It Too

Not Enough Support

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