Posted tagged ‘Homelessness’

Should doctors write job prescriptions?

April 25, 2017

Last month, news of Hawaii’s homeless challenge gained national attention on HBO’s Vice News (Hawaii News Now, 3/30/17). The 5-minute segment spotlights that “Hawaii legislators are debating whether to classify homelessness as an illness and housing as a treatment. (via HBO).” This Vice News report is not the kind of attention that Hawaii wants, but maybe it’s the attention that Hawaii needs.

Correspondent Caroline Modarressy-Tehrani interviewed four people to get their perspectives on the proposal to redefine homelessness as a medical condition. Gary Grinker, who is chronically homeless and has a heart condition; he visited the emergency room 241 times in 2016, costing taxpayers $1.2 million in healthcare. Senator Josh Green, who introduced a bill to redefine chronic homelessness as a disease and allow doctors to write prescriptions for housing. Representative Bob McDermott, who believes that Hawaii has “turned the safety net into a hammock.” And Dr. Daniel Cheng, an emergency room doctor at Queen’s Medical Center, which handles two-thirds of all homeless encounters in Hawaii.

I had three successive reactions to the news report.

First, doctors’ first responsibility is to take care of patients’ physical and mental health. A “prescription” for housing would probably involve time filling out forms and coordinating with social workers – time that doctors need to help patients.

Second, having a home may not make people more responsible for their health or reduce emergency room visits. It may even exacerbate health conditions, if people have health emergencies in their home and are unable or unwilling to seek help.

Third, if a solution to rising healthcare costs and chronic disease were housing, we would have more people living in shelters and healthier people at home. But in Hawaii, an alarming 82% of adults have at least one chronic disease or condition and 53% have two or more chronic diseases (heart disease, heart attack, stroke, diabetes, asthma, disability, cancer, chronic obstructive pulmonary disease, high blood pressure, high blood cholesterol, or obesity), according to the Department of Health’s “Chronic Disease Disparities Report 2011: Social Determinants.”

Instead of a “prescription” for housing, maybe doctors should write a “prescription” for a job.  Research shows that employment increases health status and healthy people are more likely to work, according to a Lead Center Policy Brief, “The Impact of Employment on the Health Status and Health Care Costs of Working-age People with Disabilities” (2015).

“Work is at the very core of contemporary life for most people, providing financial security, personal identity, and an opportunity to make a meaningful contribution to community life,” according to the National Alliance for the Mentally Ill (NAMI) factsheet, “Facts about mental illness and work” (1999).

A job gives people dignity as well as a paycheck. Doctors can assess a person’s physical and mental ability to work, and offer a referral to an employer – who could assess their skills, experience, and trustworthiness.

Do you think that we can reduce healthcare costs by prescribing housing? Could having a job help people be healthier?


Homelessness in Hawaii

October 25, 2016

No Room in Paradise

Last week I watched the 90-minute documentary, “No Room In Paradise” (2016) on Hawaii News Now. Filmmakers Anthony Aalto and Mike Hinchey of Green Island Films followed Justin Phillips, homeless outreach field manager for the Institute of Human Services (IHS), as he visited homeless communities around Oahu. The documentary showed the many faces of the homeless, including minimum-wage earners who can’t afford a home to single-mothers, substance-abusers and the mentally ill, Micronesians, veterans, newly-released prisoners, and tent city residents.

After watching the documentary, I was saddened and thoughtful. It made me appreciate everything that I have. My 10-year old son was subdued. I commented that we are lucky to have a home and pointed out how using drugs can destroy lives.

Here are some observations and ideas that I hope will spark discussions:

* Touch is important. We all need human contact. Justin constantly reached out and touched people on the shoulder, showing that he cares and that he is not afraid to touch them. He looks at them directly and turns his body towards them to show that he is listening.

* Family matters — community. In the film, a substance-abuser went back to her family on the mainland, and a single mother who had a subsidized apartment was lonely for the homeless camp community. This made me question whether giving someone their own home is really the answer for everyone. Instead of finding single-family apartments, maybe we could match two compatible families. For example, two single mothers could share an apartment, providing each other with friendship, support, security, and childcare assistance. A case manager could help the families come up with a co-housing agreement that covers “house rules” and chores.

* Family matters — marriage. In the film, a woman was pregnant, homeless, and already caring for other children. However, I can’t remember any mention of a father for the children, a husband, or a boyfriend. Public assistance programs seem to discourage marriage, but marriage is important for mental health and financial stability, especially when there are children. Maybe we could encourage marriage by 1) offering a one-time, one-year only tax credit for couples with one or more children who get married; and 2) following it up with a one-time, one-year only tax credit for couples who are still married after five years.

* Make current housing available. People complain that we are not building enough new, affordable housing. An alternate solution is to make the housing we do have more available for Hawaii residents. While I hate to advocate for any tax increase, maybe we need to impose an exorbitantly high tax on non-resident purchases of homes or apartments. This would discourage out-of-state and international buyers from buying residences in Hawaii, either as part-time homes or investments, and free those homes for Hawaii residents. It wouldn’t cost government anything, and the money from the tax could be designated for the affordable housing fund.

Have you ever been homeless? Do you know anyone who is homeless or on the verge of homelessness? What can we do to make a difference?

Job+housing ideas for Hawaii

August 2, 2016

Job+housing Ideas

In Hawaii, we don’t only have a housing problem. We have a jobs-and-housing problem. It’s not enough to find people affordable housing. People need jobs so that they can afford their affordable housing.

Unfortunately, most of our public assistance programs address either job training or homelessness, but not both. The Hawaii Department of Labor and Industrial Relations has over 1500 job training programs from 42 “eligible training providers” (ETPs). The Hawaii Department of Human Services coordinates 22 agencies, 13 emergency shelters, and 32 traditional shelters across the state. We have rent subsidies, public housing, and weekly “cleanups” to clear public sidewalks.

I believe that we need more programs to assist with housing and employment. I thought about Hawaii’s current job market (tourism), Hawaii’s recent history (plantations), and Hawaii’s isolated geography. Here are 3 off-the-cuff ideas that combine jobs and housing.

Hotel room and board program. In Hawaii, tourism is one of our largest industries, employing over 150,000 people in 2010, according to the Hawaii Tourism Authority. We could create new property tax categories to allow hotels and resorts to set aside a limited number of rooms for employees. Hotels could pay a lower wage in return for providing a room, or receive a small tax credit by offering rooms to employees at subsidized rates. Hotels could even set aside an entire floor for employees, who could apply for a room by showing financial hardship.

Public parks caretakers. In Honolulu alone, the Department of Parks and Recreation (DPR) manages 290 named parks on 5,200 acres of land, employing over 1,800 people. To help maintain the parks and deter vandalism, the DPR could create a “Park Caretaker” program for larger staffed parks. Similar to a plantation community, one or two families could live in caretaker cabins, as long as at least one member of the household is employed by the park.

Job relocation program. Hawaii is an expensive place to live and the job market is limited. Sometimes we have to make the hard decision to move to cities where there are jobs and companies are desperate for qualified workers. A job relation program could help people find jobs in other states with larger job markets and more affordable housing. We could help individuals with resume writing, job applications, interviews, business attire, moving expenses, finding a first apartment, and even enrolling in schools. Teams of 2-5 individuals or families could even go through the job relocation program together, moving to the same city at the same time, perhaps initially living as roommates. They would become a built-in support network for advice, friendship, and even emergency babysitting.

What housing programs you consider successful in Hawaii? Do you think that Hawaii is doing a good job of addressing the affordable housing issue? Is it government’s responsibility to find homes for everyone?

A mash-up idea about homelessness

November 3, 2015

Homeless Voucher Program

Homelessness in Hawaii is not a “crisis.” A natural disaster is a crisis; it is a sudden, unexpected, singular event that has specific responses – we can send aid, help the wounded, and rebuild. By calling homelessness a “crisis,” we expect the one solution (or set of solutions) to “fix” the problem, and we expect it to go away.

Homelessness is a part of everyday life. It is an on-going struggle, like care for the elderly, affordable health care, and aging infrastructure. It needs prompt and constant attention, not a one-time, expensive relief program. There will always be people who are homeless, sometimes temporarily, sometimes because of bad decisions, sometimes by choice. Our cities, our state, churches, and nonprofits are doing what they can, with programs to bus people to shelters, to find them housing, to provide “wrap-around” services, to support landlords. There is no one program that will end homelessness.

That said, I want to suggest a strange, quirky, two-part mash-up idea to help with homelessness, inspired by existing programs: senior homes and school vouchers. It’s not based on any surveys, studies, or research; I don’t know whether this could even work.

Here is my two-part mash-up suggestion:

Part I: Care homes for the homeless. Inspired by care homes and hospice… we could set up a business model for people to open part of their home as a care home for the homeless. Each care home would provide 4 basic services: three meals a day (breakfast, a sack lunch, and dinner); a bed, bunk, or room at night (or during the day if someone works a night shift); daily access to a shower; and a storage locker for belongings. This could incentivize the creation of homes for the homeless, using a familiar business model that people already understand. Instead of a few large homeless shelters, we could have many smaller, close-knit homeless care homes.

Larger providers, like shelters, churches, and YMCA-like organizations, could also provide 1 additional service: an enclosed room or fenced lawn for pets; and office space for 4 additional services, to be provided by government and nonprofit agencies: day care for toddler children and children who are on school breaks; medical and pharmacy services; job training and counseling; and English language tutoring, interpretation, and translation services.

Part II: Homeless care vouchers.  Inspired by school vouchers that give parents school choice … we could create homeless care vouchers that could be redeemed at a care home that has space for them. Instead of applying for multiple social services (food stamps, supplemental aid, welfare, and housing vouchers), homeless individuals and families would be issued a single voucher each month. They would be able to choose the best provider, location, and range of services that fit their needs. They would be part of a small group who could support and trust each other. They would have access to more nutritious meals.

Providers would benefit from a voucher program. There would be guaranteed payment from the state for their services. They would also have an incentive to provide good care and compete with other providers for vouchers. Effective and courteous providers would receive more vouchers; less effective providers would improve or go out of business.

There could be benefits for local government and taxpayers as well. State and city aid programs could be consolidated. There could be more accountability with a voucher program, since EBT cards can be abused or re-sold.

Vouchers could also be adjusted with higher amounts for care providers who accept alcoholics, drug users, and the mentally ill (like Housing First, there would be no requirement to seek counseling before being admitted to a care home).

How else can we change the way we think about homelessness? Are there other existing programs that we could adapt to help the homeless?

Cleanliness, community, and closets for the homeless

August 13, 2013

Last month, Honolulu City Councilman Joey Manahan introduced Resolution 13-116, asking that the city study the feasibility of opening hygiene centers in Honolulu for the homeless. The nonprofit Urban Rest Stop in Seattle, Washington, which offers toilet, shower, and laundry services 24-hours a day, is held up as model to follow.

I thought hygiene centers would be a good idea when I first read about it. But the more I thought about them, the more I questioned it. It’s a big investment in land, building, and staff, but the resolution is based entirely on one human services program in Seattle.

When looking at legislation, there are three basic questions to ask: 1. Is it constitutional? On this issue, yes. The bigger questions are: 2. Can we afford it and 3. Does it solve the problem?

* Can we afford it? According to a KITV news article, Manahan says that the Urban Rest Stop spends $600,000 a year for each of its facilities. It’s paid for by the US Department of Housing and Urban Development, the City, and private donors. I don’t think we can rely on the federal government for funding, and I don’t think the City can afford to run hygiene centers, in addition to shelters and other programs.

* Does it solve the problem?Honolulu already operates 13 homeless shelter programs and numerous aid programs. Would the homeless people who currently avoid shelters use a hygiene center? Would people want to use public parks and playgrounds if a hygiene center is on the grounds? Would enough people use the center to justify the 24-hour staffing that we need to prevent vandalism and illegal activity? While a hygiene center would help homeless people who have a job or who are seriously looking for a job, it would not reduce the number of tents and shopping carts on the streets.

I agree with Manahan’s approach: we should consider the needs of the homeless, and try to address them. But I think we also need to fit our solutions with existing programs and budgets. Here are a few ideas:

Homeless people don’t have easy and welcome access to restrooms and showers.
* Drive mobile hygiene trucks. Instead of building and staffing a permanent hygiene center, we could test this concept with a mobile hygiene truck. Okay, it’s not an existing service, but the idea works for food (Meals on Wheels) and books (Hawaii Bookmobile). And social service workers already drive out to meet clients. This would offer an additional service, and the mobile staff can help them get into a shelter. Could we convert old buses or container boxes? Is the water hookup even possible?
* Open the YMCA and Hawaii hostels for special hours. Can the nonprofit YMCA have special open-house hours for homeless people to use the showers and restrooms, even if they are not living in YMCA housing? Could the city contract with hostels for similar open house hours?

Homeless people are disconnected from the community.
* Get family members and friends involved. Can we start a program to get family members, childhood friends, and former co-workers to help? These relatives and acquaintances could work with a social worker get homeless people into shelters and take turns keeping in touch with them.
* Recruit churches, civic groups, and nonprofits. Can churches, civic groups, and nonprofit organizations adopt a homeless person living in their neighborhood? Can we create a Big Brothers, Big Sisters type of mentor-assistance program?

Homeless people do not have a safe place to store their belongings.
* Build storage lockers. Can we install storage lockers in public places, such as police stations, staffed public parks, the State Capitol building grounds, and municipal buildings? Can we ask businesses to report the theft of their shopping carts?

Do you think that hygiene centers would be an effective way to help the homeless? Are there better ways to aid the homeless? What types of assistance programs should be a priority in Hawaii?

The future of affordable housing

October 25, 2011

The deadline for submitting your comments about the Oahu General Plan is November 30, 2011, and I hope that you’ve taken a moment to think about Oahu’s future. Affordable housing is just one of the eleven key planning issues covered by the Plan.

The Affordable Housing Trend Report starts with the assumption that “affordable housing is a pressing need for the county.” It highlights several issues affecting affordable housing: the aging population, transit-oriented development, gentrification, densification, the conversion of affordable housing to market-rate housing, and green building.

In a statement of the obvious, the report reveals, “While sometimes linked to mental illness, drug use, and outside factors, the availability of affordable housing can prevent homelessness” (page 13).

But the most surprising thing about the report isn’t the trends and key issues; it’s a chart on page 12 that illustrates “The Flow of Subsidies from Public Agencies to Private Entities.” This Institutional Structure chart highlights six federal government programs, eight Hawaii programs, and four Honolulu programs that funnel taxpayer money to developers and property managers, all with the goal of making housing affordable in Hawaii. There are five voucher programs, three block grant programs, tax credits, tax-exempt bonds, two investment programs, and public housing. Despite similar goals and the duplication of services, the report warns, “interagency cooperation may prove difficult” (page 11).

Why is it “difficult” for the various agencies to work together? Why can’t we combine affordable housing programs and reduce the duplication of services?

Affordable housing is an issue for states and counties. Aside from military housing, I don’t understand why the federal government is involved in affordable housing at all. Right away, we could eliminate six programs and vastly scale down the size of the Department of Housing and Urban Development.

At the state and county level, the state should be responsible for any affordable housing tax credits, block grants, and funding for affordable housing projects; while the county should be responsible for building and maintaining affordable housing units.

After reading through the report, I have to wonder: what is government’s role in affordable housing? How many years is government expected to provide affordable housing? Why doesn’t the General Plan address the personal responsibility for housing?

Think about these questions, and consider some ideas for affordable housing reform:

* Affordable housing should have time-limits, such as three years for individuals and five years for families; they must agree not to have additional children. This encourages people to work hard and save money so they can move out and find a home of their own.

* Affordable housing should include an agreement to contribute to a monthly “Community Day,” one day of work to help clean and maintain the grounds and common areas, for all able adults and older children. This encourages people to have pride in their homes and helps create a sense of community.

* Affordable housing should partner elderly residents and families with young children. This gives people a way to build friendships, offer companionship, and help others.

All of these affordable housing programs are not affordable for taxpayers, and they don’t solve the problem of homelessness. How do you think we can improve the affordable housing programs we have and ensure that they don’t become generational affordable housing programs?