Friday, February 13, 2009

The Least Of These

Amid all of the stories of the national financial meltdown and California's budget problems (both of which are linked in a rather complicated skein), sometimes the story of what governments are actually supposed to do gets lost. I almost overlooked this column by Steve Lopez in the Los Angeles Time which illustrates my point, but because I'm off work with a busted shoulder, I took the time to read the paper edition from start to finish from the last couple of days and found the gem hidden in the awful.

Here's some background. The latest estimates are that there are 70,000 homeless people in the Los Angeles area (although, given the current state of the economy, that figure might be outdated). A huge chunk of them are located in the downtown Skid Row area, and most suffer from various physical and mental ailments, including addiction, all largely untreated. They spend their time hanging out and, if they're lucky, eating at soup kitchens and sleeping in shelters. If they're not so lucky, they don't eat and they sleep on the pavement or in doorways. If the police are so inclined, they are rousted and jailed for vagrancy or for the petty crimes associated with their status. When their diabetes or schizophrenia gets out of control, they wind up in emergency rooms.

Mr. Lopez describes a pilot program initiated by the County Board of Supervisors and led by County Supervisor Zev Yaroslavsky to try to ameliorate some of these conditions.

Project 50, initiated by the L.A. County Board of Supervisors, had a bold objective: Select the 50 most hard-core, sick, chronically homeless people on skid row, give them a place to live with a raft of support services, and see what happens.

Would their lives be transformed? If so, how much would it cost taxpayers?

Nice idea. But then came the hard part. For starters, Project 50 required the collaboration of 24 city, county and nonprofit agencies, and history tells us the city and county don't often work well together. Next came the problem of which homeless people should be included. But by the end of 2007, 350 pavement dwellers had been surveyed, and the 50 most vulnerable identified.

They were, in a manner of speaking, the walking dead. Among the 50, there was cancer, liver and kidney disease and HIV/AIDS. Roughly 90% had some form of mental illness. More than half had a history of substance abuse. ...

When it came time to move them into housing in early 2008, 14 of the 50 had disappeared, and six were in prison. The outreach team searched for replacements, and between January and May of last year, 49 people were moved from skid row and housed, most of them in downtown apartments run by Skid Row Housing Trust.

The plan itself involved a multifaceted treatment program, including drug/alcohol rehab, mental health treatment, informal education on physical health issues with follow up health treatment, and most importantly, a room for each of the participants to call his or her own.

Now, nearly a year later, a report on the program has issued.

Four of the 49 are in jail or prison.

Two dropped out.

And the rest -- 88% -- are still indoors, including two people who were reunited with their families. A 50th person was recently housed but did not figure into the evaluation released last week, at the halfway point of the two-year program.

"By all accounts, it has been a success," says L.A. County Supervisor Zev Yaroslavsky, whose staff, led by Flora Gil Krisiloff, got the project started and did much of the heavy lifting along with a nonprofit called Common Ground.

Some of the participants have slipped more than once ... But for the most part the results have been remarkable. The majority of those with addiction problems have gone into rehab. All but two of the 39 diagnosed with mental illness are in treatment. Every participant has access to preventive healthcare, so hospital costs have plummeted.

The program didn't come cheap, however, not by any means. The biggest cost, of course was the initial start-up costs, which won't have to be undertaken again if the program is continued and, hopefully, expanded.

The numbers provided by Project 50 are a little squishy, in part because of one-time start-up costs and because state and federal funds were not counted into the net cost. Backers assert the net cost to the county was $892,000, or $540,000 not counting startup.

If that sounds like a lot, consider this: In the year before the program, Project 50's participants cost the county an estimated $756,000 on hospitalization and incarceration.

Those numbers can be debated, of course, given the difficulty of breaking down specific costs in large institutions. But however you calculate it, one thing is clear: For roughly the same investment of county tax dollars, the bulk of the 50 are in recovery rather than a permanent state of decline here in the homeless capital of the United States. And there could well be long-term savings.

While it is doubtful that all 49 of the project's subjects will now go forward, find jobs or go to school to get jobs, and then live independent and productive lives, some might. The rest, however, are off the streets and out of jails and the emergency rooms. That in itself is an improvement.

If one believes that one of the key responsibilities of government is to protect its citizens, all of its citizens, then this kind of program is a proper expenditure of the taxpayers' money. It deserves to be funded even if it is more costly than the alternative. It is just the right thing to do.

Unfortunately, during times like these, this is the kind of project that gets chopped right at the start of the budgetary process, unless citizens get involved enough to stop such foolishness by pointing out that we can't afford not to fund these services.



Anonymous Anonymous said...

Hope you recover soon. One of the most important aspects of such a program is the public health aspect, particularly as regards TB. Antibiotic resistant TB (TB was always difficult to fight) is common in the community you described, and this population is well known for not treating the disease when the infected are on their own. Having them in a more humane, controlled environment insures a better rate of treatment, and thus a higher level of protection for the rest of society. What I'm trying to state is that this is money well spent, something even social darwinist clowns should be able to get behind.

5:34 AM  
Blogger janinsanfran said...

Steve Lopez has consistently paid some quality attention to LA's homeless. That's meant as a compliment.

8:35 PM  

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