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'Paradigm shift' in homeless housing coming to Johnson County

'Housing First' model removes barriers for chronically homeless

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IOWA CITY — What is the cost of homelessness?

The chronic homeless — those being homeless for a year or having four stints of homelessness in the last three years — cope with a never-ending cycle of jail, detox, emergency rooms and shelters because of disabilities, mental illnesses and substance abuse.

A study of four men in Iowa City who met these criteria — chronically homeless and frequent users of the criminal justice, mental health and emergency medical systems — provided an answer. Over four and a half years, they incurred costs of $2.2 million.

“If anything, that’s a low ball,” said Crissy Canganelli, director of the Shelter House in Iowa City.

Canganelli and others are working to permanently house those whose issues have prevented them being able to use shelter services in the past. How? By removing barriers that have traditionally kept them out of a shelter — including requirements for sobriety and participating in social services.

The project is called FUSE — Housing First. FUSE stands for Frequent User System Engagement and refers to transients trapped in the cycle of jail, emergency rooms and substance abuse treatment.

If Canganelli’s plans are realized, up to 15 of these individuals would be given apartments in a yet-to-be constructed and yet-to-be financed building that would house FUSE individuals and also the chronically homeless, free of charge and without restrictions.

“‘Housing First’ is a paradigm shift,” said Canganelli. “It’s a deconstructionist approach to homelessness. Let’s get you into housing, begin to stabilize and offer the support services, but not make them a requisite to tenancy.”

Of the people to whom Shelter House provides services, Canganelli said 84 percent experience short-term homelessness. Of that population, 58 percent leave Shelter House for permanent housing, she said.

The remaining 16 percent are chronically homeless. And of those, 3 or 4 percent are frequent service users.

Those are defined as having at least two criminal justice system contacts and having used at least three agencies — like hospitals, shelters and substance abuse facilities — in three years, incurring unreimbursed costs of at least $50,000.

That population, which Canganelli estimates to be 24 to 36 people locally is who the Housing First project is targeting.

Housing First is not a new idea. Charlotte, N.C., San Diego, Minneapolis and Portland, Ore., are among the communities that have implemented Housing First projects since the concept was introduced about a decade ago.

Based on the success of those projects, the Johnson County Local Homeless Coordinating Board decided to do a study of the costs of chronic homelessness.

The study, which ended in mid-2014, identified four people who were both chronically homeless and frequent system users. Access to medical records were granted and, when combined with jail and shelter expenses, the study calculated the costs of those four men.

It found the men’s annual cost for services — jail time, medical visits and shelter — ranged from nearly $57,000 to just under $200,000 with an average annual cost of about $140,000 apiece.

A breakdown for the entire study period showed about $1.9 million went to medical and mental health costs; $150,000 to substance abuse treatment; $43,000 to housing and case management; and an estimated $73,000 to legal costs.

The study found the four men spent a total of 320 days in jail, 756 in substance abuse treatment; 650 in emergency or transitional shelter; 249 in inpatient care and 141 in supportive housing.

And, Canganelli said, the longer those men and other frequent system users remain on the street, the more costs they’ll incur.“

“If we looked at the annual costs of what we have in play now for these individuals and if we project it out the next five years, at the current rate of activity and the current rate of cost incurrence, we could estimate $2.7 million of costs related to just these four individuals,” Canganelli said. “If we leave all things the same.”

“The only change possibility is that you die,” she added.

In fact, one of the men in the study did die on the streets, she said.

What would the Housing First model look like to those who qualify?

Essentially, the initiative would put them in a furnished apartment in a secured building. Services would be offered, but would not be required. Tenants would be required to talk weekly with a case manager, but would not be required to actually do anything, Canganelli said.

“The majority will start to engage in some level of services,” she said. “As people stabilize, they will want to take better care of themselves. Some people won’t stop drinking, but they might drink less. They may start to take their medications and acknowledge they have a mental illness. They may finally believe that this doctor who is coming to the building is somebody worth listening to. ... And, it doesn’t work for everyone, but it works for the majority.”

Obviously, the building and project wouldn’t be free. But Canganelli said communities that have Housing First projects find a 40 percent reduction in costs from frequent users.

In San Diego, for instance, frequent user costs went from $4.2 million in 2010 to $1.5 million in the second year of the Housing First project’s existence.

Essentially, the Housing First project in Iowa City would be a basic apartment building. The biggest difference from a typical apartment building would be the staffed, secured entrance and offices for medical and mental health professionals and other social service providers.

Canganelli said she hopes to have 24 units.

Local architecture firm Neumann Monson is donating its services to design the building.

“Believing in the Housing First mission of helping the chronically homeless, many of which of course are military veterans, we believe we can use our talents and make a huge difference in the lives of these people that could use some help,” said firm president Kevin Monson.

Canganelli said she anticipates the project costing about $2.25 million to build. Organizers so far have received $275,000 from the city of Iowa City in the form of a Community Development Block Grant, and $50,000 from the Housing Trust Fund of Johnson County. Canganelli said fundraising hasn’t started yet, but Shelter House will start grant submissions this fall.

“If we’re looking at $2.25 million, we’re nowhere near that,” she said. “But, if I’m asked to give a timeline, I think it’d be tremendous to look at a late spring groundbreaking and before winter 2017, be able to bring people in.”

Canganelli said she also has a site in mind and a property owner interested and willing to sell, but at this time, she’s not willing to divulge the location.

The new Shelter House, completed in 2010, faced a lengthy legal battle from neighbors.

“I entirely believe in transparency and due process, but when it comes at the cost of people who are suffering, who are mentally ill, disabled, chronic substance abusers, when it comes on their backs ... I believe protection should be provided,” she said.

The project already has received a $15,000 grant from the Corporation for Supportive Housing. Canganelli and others used some of that money for a site visit to Charlotte, home of the Moore Place.

The facility is meant for the chronically homeless, not frequent system users. But Charlotte has another project for frequent system users.

John Yaeger, Housing Works director for the Urban Ministry Center, which oversees Moore Place, said the first 85 units opened in 2012. It has since added 35 units.

He estimates more than 90 percent of the tenants engage in services in an ongoing basis.

“That’s what contributes to the success of the building,” Yeager said. “With chronically homeless folks, it’s not just the apartment they need. There are reasons they’re chronically homeless.”

Services range from helping a tenant get a cellphone or find a job to helping a tenant navigate health care benefits.

Yaeger said that while the community at large initially opposed the facility, neighbors since have embraced it. A tenant is on the neighborhood association and Moore Place has adopted the street outside — cleaning it once a month.

Back in Iowa City, police Officer David Schwindt, who serves as downtown liaison officer, sees firsthand the cycle frequent system users go through. Transients who also are fighting alcoholism drink in public and get sent to jail. But before they go to jail, they often have to sober up in a hospital, he said.

Schwindt — who is on the Housing First coordinating committee — said he hopes with a safe place to live, reduced stress and access to services, those men and women will then begin to address their issues.

“We need something rather than the revolving door we have now,” he said.

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