No place like home

By Tony Staley
Compass Editor

Homelessness seems like an unsolvable problem because of the large numbers of people living on the streets or crowding shelters. But the problem might be easier to solve than we think, writes Malcolm Gladwell in The New Yorker (2/13&20).

Gladwell quotes a study Dennis Culhane did 15 years ago for his doctoral dissertation as a graduate student at Boston College. Culhane, who lived for seven weeks at a homeless shelter in Philadelphia, found that 80% of those using shelters were there only one or two nights and never came back. "Anyone who ever has to stay in a shelter involuntarily knows that all you think about is how to make sure you never come back," Culhane said.

The next 10% - episodic users - tend to be young and heavy drug users. They stay up to three weeks at a time and return periodically, usually in winter.

While we would probably always need shelters to provide short-term assistance for those two groups, the cost would be small, especially when compared to what we spend on the final 10%. These are the hard cases - the chronically homeless, some of whom live in shelters for years at a time. They are older and many are mentally ill or physically disabled. These are "the people sleeping on the sidewalk, aggressively panhandling, lying drunk in doorways, huddled on subway grates and under bridges," Gladwell wrote.

Society spends a great deal to care for that final group, Culhane found. In New York City, each cot in a homeless shelter costs $24,000 a year. But it doesn't end there. Because the people in this group are often drunk, they often fall down or get hit by cars or trucks, or fall victim to other ailments, all requiring emergency room care and even hospitalization. San Diego followed just 15 people in this group for 18 months and found they were in the emergency room 417 times for an average medical bill of $100,000 per person.

Potentially it could be less expensive to give each one an apartment and their own nurse. But an even cheaper alternative is possible. Denver has a program where these hard cases are assigned small, inexpensive apartments and a caseworker (one caseworker for every 10 clients) to monitor them.

On the whole, it's an effective and comparatively inexpensive solution. But, Gladwell writes, conservatives don't like the program because those in it are there for life because without rules and constant monitoring they're soon back on the streets. Thus it both creates and rewards dependency. Liberals don't like the idea because it's another example of cost-benefit analysis.

In the end, we're talking about human lives, the common good and the need to act out of love. That should trump all personal or political ideologies.