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The issues, impact, and solutions to ending Veteran homelessness faster, more cost effectively – Part-1 of a Series Housing “First” Ends Homelessness, it’s that simple!!!

by Terry Richards

LOS ANGELES, CA – Why is the VA spending *$9,000 per month per Veteran for its Domiciliary Residential and Rehabilitation Treatment Programs (DRRTP) and a variety of other Residential Programs “First” that only has a 47% success rate when Permanent Housing First has an 88% success rate of homeless remaining housed at five years (Tsemberis and Eisenberg 2000) and only costs on a national average about $1,500 per month per Veteran??? “A study from Los Angeles, CA home to ten percent of the entire homeless population – found that placing four chronically homeless people into permanent supportive housing saved the city more than $80,000 per year. Homelessness can be surprisingly costly for taxpayers. Fortunately, socially-responsible, cost-effective solutions exist.”

It’s not that Veterans don’t deserve the Government paying *$9,000 per month for Programs to get them off-the-street because they do deserve it. But what Veterans don’t deserve is the VA squandering money on Transitional Housing and Treatment Programs which could have been used to get them into Permanent Housing “First” which has been proven to have a substantially more positive impact to ending Veteran homelessness faster, more cost effectively. substancemisuse

In the City of Los Angeles where the average rents are about $1,700 per month (Double the National average for rent) the average HUD-VASH Section 8 Voucher being about $1179 for a single Veteran, the Average cost for Permanent Housing in round numbers would be about *$1,650 per month/*$19,800 per year per Veteran.

 The *$9,000 per month for the said Domiciliary Program costs in the City of Los Angeles would pay the cost of placing 5-homeless Veterans in to Permanent Supportive Housing for one month. This would be part of the “Solution” to ending Veteran homelessness faster and more cost effectively.

“A recent study followed the progress of the Downtown Emergency Service Center (DESC) in Seattle, WA. All the residents at this Housing First-styled residence had severe alcohol problems and varying medical and mental health conditions. When taking into account all costs – including housing costs – the participants in the 1811 Eastlake program cost $2,449 less per person per month than those who were in conventional city shelters, as described in the article from the Journal of American Medical Association.”

 In the early 2000’s the VA signed on to the “Housing First Initiative” but soon modified that “Paradigm” and that’s what got the VA in trouble with ending homelessness for Veterans faster and more cost effectively.

“Housing First ends homelessness… It’s that simple” says the Pathways Housing First Model a Worldwide “Paradigm” started in Europe that proved that “Housing First” ends homelessness. VA Domiciliary and other kinds of Residential (Transitional Housing) Rehabilitation and Treatment Programs “First” do not end homelessness, and in fact, may contribute to continued homelessness and/or recidivism rates. substancemisuse

More than 350 communities in the United States have committed to ending chronic homelessness. One nationally prominent approach, Housing First, offers early access to permanent housing without requiring completion of treatment or, for clients with addiction, proof of sobriety. 

An earlier, observational study of the Pathways intervention found that 88 percent of 241 persons entering the Pathways Housing First approach remained housed at five years, versus 47 percent of 1,600 persons who entered a variety of residential programs in New York City (Tsemberis and Eisenberg 2000), most of which did not provide permanent housing. A later study showed that more participants remained in the program when a Housing First approach was implemented by the originator (Pathways to Housing) (78.3 percent at forty-seven months) and that fewer did when the program was implemented by other agencies (57 percent at forty-seven months) (Stefancic and Tsemberis 2007).

Housing First for Homeless Persons with Active Addiction:              http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2881444/

An International Study including the United States of Successes and Failures of different kinds of Permanent and Transitional Housing Models including their Percentage rates of  success and failures and recidivism from the Pathways Housing First Model and other Models. The U.S. Studies were done in New York City, Washington, D.C., Los Angeles, and San Francisco, among others, of what Models work best. substancemisuse

What does it mean when it is said that Permanent Supportive Housing First has an 88% success rate and Transitional Housing Residential Treatment Programs First only have a *47% success rate? It means that 53% of homeless Veterans who are placed in Residential Transitional Housing Treatment Programs First rather than Permanent Supportive Housing First where they have the option of whether they want to get Treatment or not get Evicted and/or Arrested for Misconduct and/or Non-Payment of Rent or Abandon their Permanent Housing within the first 5-years due to their Mental Health and/or to their Addictions of legal and/or illegal Drugs and/or Alcohol and/or Gambling and/or Sex Addiction.

The costs of keeping the homeless homeless, whether they are Veterans or not is at least $20,000 more per year than providing them with Permanent Housing, mostly due to the homeless using un-Managed Emergency Medical Care, extra Police Patrols, Jail-time costs, Public Defender Costs, City Cleaning Crews, etc. “Emergency shelter is a costly alternative to permanent housing. While it is sometimes necessary for short-term crises, too often it serves as long-term housing. The cost of an emergency shelter bed funded by HUD’s Emergency Shelter Grants program is approximately $8,067 more than the average annual cost of a federal housing subsidy (Section 8 Housing Certificate). A recent HUD study found that the cost of providing emergency shelter to families is generally as much or more than the cost of placing them in transitional or permanent housing”.

According to Point in Time (PIT) surveys in 2012 only 25% of homeless Veterans used VA Medical Care mostly because they don’t trust the VA. This 25% figure also substantiates VA and Private Surveys completed by this Writer that 80% of homeless Veterans do not want to live in “Permanent: Housing on VA or other Government Property… They want their own Private Housing. And at least 10% of homeless Veterans have told this Writer that they would rather stay homeless then live in “Permanent” Housing on Government Property (Emphasis on “Permanent”) with or without curfews, inspections, substance abuse testing, and unable to have overnight guests and general lack of privacy.

It is this Writer’s opinion that the West Los Angeles VA Domiciliary be used only as “Bridge-Housing” rather than for Treatment Programs until other “Bridge-Housing can be built, and let each Veteran decide whether they want outpatient treatment for any of their addictions or mental health issues until Permanent Housing becomes available for them as Secretary McDonald has discussed in his Press Conferences. This means that 2/3 of the Medical Doctors, Psychiatrists, Psychologists, Addiction Therapists, and Administrative Staff can be cut and sent to the Main Hospital or other VA Medical Facilities in the Greater Los Angeles area where they can be utilized when our new Veterans coming home from War start enrolling in VA Healthcare, or on an Outpatient basis for those Veterans under HUD-VASH Housing who by their own decision choose Outpatient Addiction or Mental Health Treatment. And all or some of the Social Workers who were assigned to the Domiciliary can then become VASH Social Workers for all the new Veterans being placed in Permanent VA Supportive Housing. This concept should be mandated to all VA Domiciliaries Nationwide and eventually all VA Domiciliaries should be converted back to “Old Soldiers Homes” Permanent Housing for Elderly Veterans 65 and over, and Disabled Veterans who suffer from physical and/or mental health conditions who wish to live on Government Property and who need a stable and/or Assisted Living.

A 2015 Point in Time (PIT) Survey found that there were still about 4,300 homeless Veterans on the streets of Los Angeles. However, did that survey include the estimated 3,500 Veterans that are currently in Non-Profit Transitional Housing Programs around Greater Los Angeles known as Grant and Per Diems who are by Federal Law still considered homeless because these Programs are only meant to be Temporary Housing Program solutions for 2-years or less??? The statutory authority for the VA Homeless Providers Grant and Per Diem Program extends only to a veteran who is homeless as that term is defined in section 103(a) of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11302(a)).                                                                                 http://www.gpo.gov/fdsys/pkg/USCODE-2013-title42/html/USCODE-2013-title42-chap119-subchapI-sec11302.htm

VA Pays the above Non-Profits a per diem of $43.32 a day = about $1,314 per month. For another $200-$300 per month these homeless Veterans could be placed in Permanent Supportive Housing which would be the solution to ending Veteran homelessness faster and the most cost effective.

Sadly, some of these Non-Profits who receive Funds in the form of Grants and Per Diem from the VA and Private Fundraising Events, keeping Veterans Homeless in Transitional Housing is nothing but a money making Scam to bank big salaries and pensions, and hidden bonuses for their friends and relatives they hire as well, and to buy or lease late model cars for their higher Management. As a Fundraising ploy some of these Non-Profits cleverly and underhandedly claim they have a 90% success rate for Addictions Rehabilitation meaning they have “Cured” the Addictions of 90% of its Graduates which contradicts all homeless Addiction studies of only a 47% success rate over the first 5-years after being placed in Permanent Housing Second after Treatment. What they actually and really mean but don’t say is that 90% of the Veterans who go through their Residential Treatment Programs Graduate the Programs. But what they also don’t say is that some of those same Veterans who Graduated the first time come back again, and again, and Graduate their Programs again, and again, as well as other VA Funded Programs 3 or 5 or 10, times or more over a 10 to 20 year period.

Instead of paying Non-Profits about $1,314 per month for Temporary Transitional Housing “First” with or without Treatment Programs for homeless Veterans that don’t work as well as Permanent “Housing First”, Congress should appropriate more funds for HUD-VASH Section 8 Permanent Supportive Housing Vouchers and/or for HUD Single Room Occupancies (SRO) as well as renovating and building new construction for Public Housing for the estimated remaining 43,000+ homeless Veterans.

But Congress and the VA should also keep in mind with the ending of the Afghanistan and Iraq Wars and its physical and mental health issues that come with the territory immediately but also latently, that an unknown percent of these War Veterans will also end up homeless. So there needs to be a special funding system set in place by Congress where the VA can extract whatever money it needs immediately for these new homeless Veterans, many whom commit suicide because they are homeless or at risk of becoming homeless.

Keep in mind that a large percentage of Veterans that are provided Permanent Housing continue more or less with their substance abuse of alcohol or drugs of their choice but not to the extent where they create problems that require that they be “evicted”. So “recidivism” under the Permanent Housing First Program means that *14% of Veterans who relapsed and returned to their addictions and/or their mental health issues became acute to the point that the landlord had to “evict” them for Misconduct or for not paying their 30% of the rent or they abandoned their Permanent Housing on their own and went back to living on-the-street or at another Grant Per Diem Transitional Housing Program.

According to over 150 homeless Veterans at the West Los Angeles VA Domiciliary (“DRRTP”) with whom this Writer informally had conversations over the last 3-years revealed that about 50% of them were Court Ordered to this Program as part of their release agreement from Prison and pursuant to California’s Proposition 36. The other 50% of these Veterans entered this Program voluntarily because they relapsed and/or were imminently “at-risk” of becoming homeless. They were imminently “at-risk” of becoming homeless from their HUD-VASH or their own Permanent Housing due to eviction for non-payment of rent or misconduct, or being asked to leave from a friend or relative’s home who did not want them there any longer, or they had been homeless for months or years and just wanted to get-off- the-streets for 90-180 days and into the Domiciliary’s Program and hopefully be placed in Permanent HUD-VASH Section 8 or other Section 8 Permanent Housing or Affordable Housing. About 10% of these Veterans did not want Permanent Housing at all and said they would rather return to living on-the-street.

Furthermore, and of interest, is that about 50% of all the above same Veterans have attended this same Domiciliary Treatment Program an average of 6-times over the last 15-years and also attended other VA Funded “per diem” Treatment Programs an average of another 3-times (The Maximum permitted at no cost to the Veteran). One Veteran told me this was his 14th time at the VA’s West Los Angeles “DRRTP”. And about 75% of the Court Ordered Veterans also told me that they had been to State of California Addiction Programs an average of 3-times while they were still in Prison or as part of their release agreement.

In Los Angeles Hundreds of Veterans who Graduate these Treatment First Programs and who are in “Recovery”, and who are not provided with Permanent Housing because there are not enough HUD-VASH Section 8 or Single Room Occupancy Vouchers left over from the Fiscal Year, or they don’t qualify because they were not homeless long-enough under the HUD-VASH Regulations, are sent to Grand and Per Diems at Hotels in the drug and alcohol infested “skid-row” in downtown Los Angeles for up to 2-years where they are expected to maintain “Sobriety” or “Good Mental Health” in an environment that is obviously a “trigger” for relapse/recidivism. These Hotels in Fiscal Year 2014 are paid from VA Funds a “per diem” of $43.32 per day/$1,314 per month/$15,768 per year which could be used to place these Veterans into Permanent Housing.

Take the case of the Veterans Home of California West Los Angeles that states in writing that it cost them $95 per diem/per day or $2889 per month/$34,668 per year to provide Homeless Veterans with shelter, medical care, and 3-meals per day. So the VA pays them $15,768 per year in “per diem” which leaves a balance of $18,900 of which in part will be picked up by the Veteran if he or she has countable income the Calvet Home will charge them *$47.5% of their countable income, and the rest is picked up by the State of California from Federal Funds or Tax Revenue. $34,668 would virtually pay the rent for 3-Single Homeless Veterans in Permanent Housing for a year when you add the 30% of the rent that Veterans with income have to pay under HUD-VASH Section 8 Choice Housing Voucher Regulations.                                                     *(Pursuant to the Grant and Per Diem “Final Ruling” the Calvets Home is only permitted to charge a maximum of 30% of a Veterans countable income but somehow they are getting away with charging *47.5%)

All of the above lends credence that all resources would be best spent for Permanent Housing First.

Finally, The VA and HUD should offer Special Expedited Portability of HUD-VASH Vouchers to homeless Veterans to find housing in areas that have been hit hard by the economy and people leaving certain cities and states to find work and the landlords are unable to fill their Apartments and Condominiums even after lowering the rent or the price. Moreover, the VA should Air Free Public Service Messages (which Broadcasters are required to air under FCC Regulations) on National and Local TV and Radio Stations to prospective Landlords who do not know about HUD-VASH and the Tax-Credits that go along with it, no less the filling of their Vacancies.

RELATED STORIES

Veterans Thrive at Hope at Pinellas Hope, and Who are the homeless, hungry and needy in America? https://vnsla.files.wordpress.com/2013/08/whoarethehomelesshungryneedypart1-3.pdf

http://www.endhomelessness.org/pages/cost_of_homelessness

Copies sent to President Obama, select Congressman Ted Lieu, CA Governor Jerry Brown, CA Lieutenant Governor Gavin Newsom, select Members of the California State Legislature, select Delegates to the California Democratic Party, Los Angeles Mayor Eric Garcetti, and Robert A. McDonald the new Secretary of Veterans Affairs whom this Writer believes by all his actions to date is the most sincere and qualified person the VA has ever had to get the job done.

  *Based upon costs which include 3-meals per day + snacks, Classes, Books, and an estimated 100 VA Employees which include Medical Doctors, Nurse Practitioners, Registered Nurses, Pharmacists, Psychologists, Social Workers, Addiction Therapists, Nutritionists, Recreation Therapists, Peer Support Specialists, Business Management Office (BMO), Food Workers, Chief and Assistant Chiefs of the Domiciliary and other Administrators, and Clerical Staff, etc. Since the VA gave me the run-around in providing the cost, the $9,000 per month/$300 per day figure came from at the West Los Angeles Domiciliary Substance Abuse Therapist. This figure sounds accurate because the Veterans Home of California West Los Angeles published costs for their Temporary Housing Program (THP) is $95 per day/$2,850 per month without any Treatment Programs and only has about 20-employees directly related to THP and the VA Domiciliary has Treatment Programs and about 90 employees directly related to their Treatment Programs.

*Based upon HUD-VASH Choice Voucher issued by the Housing Authority City of Los Angeles (HACLA) averaging $1,179 per month for a Single Veteran, 1-VASH Social Worker, Managed Medical Care by the VA, Food Stamps, Gas and/or Electric Assistance, and Administrative Costs minus the Veteran’s average Contributions for Rent. Subtract about $200 per less per month for Rent in Los Angeles County outside of the City of Los Angeles. Subtract $329 per month for the average rent in the United States which is about $850 per month.

*(Pursuant to the Grant and Per Diem “Final Ruling” the Calvets Home is only permitted to charge a maximum of 30% of a Veterans countable income but somehow they are getting away with charging 47.5%)

References

  • Salit S.A., Kuhn E.M., Hartz A.J., Vu J.M., Mosso A.L. Hospitalization costs associated with homelessness in New York City. New England Journal of Medicine 1998; 338: 1734-1740.

  • Martell J.V., Seitz R.S., Harada J.K., Kobayashi J., Sasaki V.K., Wong C. Hospitalization in an urban homeless population: the Honolulu Urban Homeless Project. Annals of Internal Medicine 1992; 116:299-303.

  • Rosenheck, R., Bassuk, E., Salomon, A., Special Populations of Homeless Americans, Practical Lessons: The 1998 National Symposium on Homelessness Research, US Department of Housing and Urban Development, US Department of Health and Human Services, August, 1999.

  • From the website of the National Law Center on Homelessness and Poverty, May 8, 2000.

  • Diamond, Pamela and Steven B. Schneed, Lives in the Shadows: Some of the Costs and Consequences of a “Non-System” of Care. Hogg Foundation for Mental Health, University of Texas, Austin, TX, 1991. 6Slevin, Peter, Life After Prison: Lack of Services Has High Price. The Washington Post, April 24, 2000.

  • Office of Policy Development and Research, U.S. Department of Housing and Urban Development, Evaluation of the Emergency Shelter Grants Program, Volume 1: Findings September 1994. p 91.

  • Abt Assocaites, et al, Costs Associated With First-Time Homelessness For Families and Individuals, U.S. Department of Housing and Urban Development, March 23, 2010.

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