Emergency Solutions Grant

How Should We Spend Our ESG Dollars?

The Homeless Congress in cooperation with NEOCH, the City of Cleveland, the Cuyahoga County Office of Homeless Services, and the Bishop Cosgrove Center are hosting a meeting to discuss the new Emergency Solutions Grant funding. This is a new pool of funds that were intended to replace the stimulus funding from 2009.  It is hardly a replacement since we were given around $5 million per year for preventing homelessness in Cuyahoga County and the new allocation in 2012 will be around $600,000 to $700,000.  This is all because of the push in DC to cut, cut, cut, and cut until it hurts.  The program has been effective in serving thousands in Cleveland, but it will have to be scaled back because of funding from the federal government.

The Emergency Solutions Grant funding is distributed to Cuyahoga County and most every Continuum in the country.  In accepting these funds, the City/County must adjust their Consolidated Plan.  The Homeless Congress is having a special meeting on Tuesday February 28 at 1 p.m. at the Cosgrove Center to hear input from consumers of homeless social services about their recommendations in utilizing these prevention dollars.   The Office of Homeless Services is hosting another public meeting for social service providers and other members of the public on 

                                              Friday, March 2, 2012

                                              9:00 - 10:30 AM at

                                              the ADAMHS Board, 6th Floor

                                              2012 W. 25th St.--the old bank building kitty corner 

                                              from the West Side Market.

Parking is available on the street and at the West Side Market.  Parking is not available in the ADAMHS Board lots. Also, do not park in the depressing shopping center across the street or your call will be towed.

 

Congress passed the stimulus in 2009 to get the economy going, and with the housing crisis there was a huge pool created to prevent homeless.  There was an attempt to get this money on the street quickly, and so they dumped this money into existing programs.  Cuyahoga County received $14 million to be used between July 2009 and July 2012, and is just about out of funds.  Just for context, the program served 10,224 individuals between September 15, 2009 and December 31, 2011.  There were 2,074 families were served which is made up of 4,441 children.  Five percent of the total are veterans and 29% have some long term disability which makes it difficult to find housing.  Of the 6,800 who left the program before the end of 2011, 32% receive Social Security as their primary source of income with another 8% were receiving Social Security Disability, and 38% had some earned income but if they did not receive help they would have become homeless and had to live in a shelter. 

The program has funded legal help, mediation assistance,  the housing website, eviction prevention, rental assistance, housing search help, case management, and education of tenants of their rights when facing an eviction. We will have to figure out how to sustain these services with additional state or local dollars or figure out how to keep people out of the shelters with only about 15% of the money we had before. 

Brian

Posts reflect the opinion of those who sign the entry.

Third Health Care Forum Overview

Health Care Reform and the Consumer

This is the third and last forum in a series of health care reform hosted by UHCANN. You can find our overview here and here and here on this blog. The last healthcare forum, National Health Care Reform Begins: The Delivery of Care Story took place June, 20 at Cleveland State University. This forum addressed how reform will effect the general public as consumers.

Speakers included:
Cathy Levine- Executive Director of the Universal HealthCare Action network of Ohio (UHCAN Ohio).
Gary Hartman- Director of Care management program for Uninsured for the MetroHelath System.
Peter DeGolia- Director of the Center for Geriatric medicine of University Hospital Case Medical Center and the Executive Director of McGregor PACE (program of all inclusive care for the elderly).
Aaron Smith- Emergency Medicine Doctor and assistant Medical Director for External Affair organizational effectiveness for Kaiser Permanente.
John Begala- Executive Director of the Center for Community Solutions.
Scheduled but could not attend Greg Moody Director of the Governor’s Office of Health Transformation. Monica Juenger- Director of Stakeholder Relations replaced Greg Moody from the Governor’s Office of Health Transformation.

This forum began with a presentation from a consumer talking about her terrible experience with lack of coordination in the current medical system. Pat Morgan, as a result has been left blind in one eye due to misdiagnosis and lack of follow up. She suffered needlessly after receiving surgery for a cyst in her ear, she was released with no prescription for antibiotics; had to fight to get the prescription and received no follow up information from the doctor after she had the surgery. This resulted in a severe infection. Personally she feels having an accountable care facility as a standard for medical needs would have alleviated many of the miscommunications and misdiagnosis that she experienced. She believes that an accountable care facility would have resulted in fewer tests, fewer doctor visits, shorter illnesses and would have lowered her cost of health care.

Ms. Juenger replaced Director Moody, and featured a powerpoint presentation called Medicaid Hot Spots. This slide show is available online at the Ohio Governor’s Office of Health Transformation (search under reports on their website. Ms. Juenger’s presentation was the same information that has been provided in the news in regards to the Governor’s plans for healthcare. The high cost of Medicaid being absorbed by the few and changing long term care. 96% of Medicaid recipients are low cost, while 4% utilize over 50% of expenditures. Sighting that Ohio per capita has a rate 52% higher in nursing home care and 12% higher in hospital care, but 8% lower in home healthcare than the rest of the country.

Also covered by Ms. Juenger’s presentation was Ohio’s poor performance in national ranking in regards to overall health and delivery of health care. The following are few of the highlights. Ohio is ranked 42nd healthiest state in the nation, 44th in avoiding Medicare hospital admission for preventable conditions, 44th most affordable Medicaid for seniors (6th from last), 40th in avoiding Medicare hospital re-admissions. Another key highlight was that while Governor Kasich plan is designed to save money and improve a fragmented system in order to provide a coordinated, efficient and ultimately better care system. But with regard to seniors and persons with chronic disease the goal is to reduce hospitalization and nursing care facilities stays in order to save money while improving care. Ms. Juenger pointed out that savings will not take place immediately, but will take a few years to actually see cost going down.

Cathy Levine Executive Director of UCHAN of Ohio said it will be important for consumers and consumer advocates to insure that patient center care is effective during this transition. This means transparency in delivery of service, changes in how providers interact with patients and most importantly leadership provided by consumer and consumer advocates. Patients will need to have a better understanding of their insurance, specifically pertaining to cost and coverage. Providers should not receive funds for “volume but quality.” Many Medicaid providers are paid for specific services they provide, this often results in unnecessary test as well as duplication of tests.

Gwyn Hartman discussed the MetroHealth medical home model that the organization implemented in 2009, which is a comprehensive onsite coordination of care program and is available at six of their locations. This program mimics the key components of an accountable care facility as described in the law. She stated that the number of uninsured patients continues to grow. At this comprehensive care program, all health care members who relate to a patient come together on a daily basis to share information. Care coordinator nurses work with high risk patients beyond their stay in the physical facility. This includes communicating with patients on daily or weekly basis. Hartman gave examples such as the diabetic that a care coordinator also schedules the patient with an eye exam in order to reduce emergency room visits and encourage preventative care.

Peter DeGolia discussed the PACE program and their comprehensive care provided to dual eligible seniors. Dual eligible refers to people who qualify for both Medicaid and Medicare. Peter provided the average medical needs of a baby boomer in a year time span:

• 1 in 10 have a chronic illness
• 77% has more than one chronic illness
• On average they attend 37 different doctors appointments annually
• They see 14 different doctors
• They fill 50 different prescriptions annually

DeGolia explained that hospitals are not the safest places for senior, as they can find the transitions disorienting and are exposed to various illnesses. Home care saves an incredible amount of money for the State. He did point out the problem with those physicians and nurses who currently provide care coordination are often not properly reimbursed under the current system. Sharing a personal example of a house call, (yes, Dr. DeGalio still performs house calls!) he went to a gentleman’s house and he treated him for pneumonia. DeGalio arranged health care aids to properly treat him and followed up with the patient in his home. He stated it was the right thing to do because he knew the patient would become disorientated in the hospital and risk the quality of his overall health. For this house call related to pneumonia he was only reimbursed $250. Had he had the patient admitted he would of had a plethora of tests to confirm he had pneumonia, and it would have cost the state thousands. DeGalio saved Medicaid and or Medicare substantial amount of money, but in many cases the best interest of the patient is not taken into account when these health care decisions are made.

Aaron Smith from Kaiser Permanente said that patients at Kaiser also receive service that replicate an accountable care facility. The most distinct difference is that Kaiser is a for-profit corporation. Smith was asked by an audience member if Kaiser being a profit based agency had anything to do with their model of care he replied, “Yes,” and went on to point out that from a fiscal stand point healthier patients save money. Kaiser Permanente currently covers 600 Medicaid patients.

John Begala focused his presentation on how health insurance differs from other products we purchase. The buyer and the provider often do not know how much the service that they are receiving actually costs. The bulk of medical costs are paid by somebody else; consumers rely on someone else to make choices for them with regard to the amount of care as well as the costs of that care. Begalia stated that the affordable care act is “Marvelous” in regards to expanding Medicaid (32 million will receive coverage with ACT; specifically 16 million will receive coverage under Medicaid.) However he is concerned that policy makers in DC do not fully understand what an accountable care facility is and is doubtful about the federal government’s ability to guide the implementation of something they seem to know little about.

I will evaluate the forum in a follow up posting.
Holly Lyon
Posts reflect the opinion of those who sign the entry.

How is the Stimulus Working for Homeless People?

Homeless Prevention Dollars in Cuyahoga County

In 2009, in the wake of the housing collapse, the federal government provided millions to cities to help prevent homelessness. The feds pumped money into existing programs so that they did not have to put a bunch of dollars into creating new infrastructure. In Cuyahoga County, we received $14 million that had to spent by 2012. The money was to be used to prevent homelessness, and to quickly move people back into housing if they became homeless. The City received $9.8 million, and gave it all over to the County. This may seem counter-intuitive since the FBI has set up camp around the Ontario Ave. County headquarters, but the City Council members had to go on summer break. The City of Lakewood took their $900,000 out of the pool, and they are using those funds for eviction prevention with the assistance of Lakewood Christian Services. Cleveland Heights decided to pool their money again with the County and so gave their $750,000 to the County Office of Homeless Services for distribution.

The County came up with their own plan for how to distribute the $13 million, and sub contracted with EDEN development corporation to distribute rent money, Mental Health Services to provide case management and administer the central intake to determine eligibility. Legal Aid, CTO, CMHA, Famicos, Catholic Charities, and the Department of Aging all received funds to help people prevent evictions. The Cleveland Mediation Center handles the payments to landlords in order to prevent evictions. We were told originally that only one third of the dollars would go to staffing and 2/3 would go to direct assistance to clients. This has proven to be difficult, and additional staff are being hired to keep up with the incredible demand for help during these difficult economic times. Money was set aside to pay for Housing Cleveland website and to purchase birth certificates and identification for homeless people as well.

Officials have had to engage in a "course correction" because things are not going as planned. Too many people are eligible for the funds and thus flocked to get help for their eviction. This has only increased over the last two months since the other pool of eviction diversion funds has dried up. CEOGC received a separate allocation and blew through their money in one year helping hundreds of families from becoming homeless. Through June the County was distributing twice as much for eviction help compared to those being placed in housing to get them out of homelessness. The Cleveland Mediation Center is overseeing the money to prevent evictions way faster than expected. They were so overwhelmed that they were setting up appointments after the hearing at eviction court. This usually meant that the individual would have to relocate to a new apartment, which is certainly not ideal. Now it looks like there was so much demand that they are going to limit rental assistance to only those in subsidized housing. Some in the community are angry that these decisions are made without any community input or oversight, but that is how things go in the County.

The other piece of the program is rapid rehousing, which is currently operated out of the two main shelters in Cleveland. With eviction diversion or homeless prevention, the County can provide rent to keep a person in housing. The other side of the HPRP stimulus dollars is the rapid rehousing and the agencies administering the rehousing program help find housing and then do follow up services to make sure the person will stay in housing. Many out in the field still wonder about the wisdom of giving away money at a shelter that are already overcrowded, but that is the plan. County and steering committee members defend both sides of the program saying that it is a new experiment and never before tried on this scale. The problem is that it is also time limited and we only have 19 months left to get it right.

Cleveland Hts seems to have backed the wrong horse here. They were one of two suburbs to get their own allocation. Lakewood officials pulled their money to use within the city limits, and have been giving money out at a rapid clip to prevent evictions. In fact in 2009, they were giving more money out than the entire rest of the County. But Cleveland Hts pooled their money with Cuyahoga County and were only able to serve 32 people through June 2010. The County wide average is that those receiving help average $825 per household as part of homeless prevention/eviction diversion. This means that Lakewood has served around 350 households since October of 2009 when the program began. Cleveland Hts has served 32 households or they have used around $26,000 of their $750,000 that the federal government provided as part of the stimulus.

So, here are the numbers from October 2009 to June 30, 2010:

Total prevention dollars spent: $906,996 or 1,190 households
Total Rapid Rehousing dollars spent: $412,602 or 1,548 households served
The total number of households re-housed is 232 from the Rapid Rehousing side.

We haven't had enough time to see if people are becoming homeless again, and since there is no central access point for all shelter it might never be possible to access these numbers. We still have to see if those facing eviction in non-subsidized housing will turn to the shelters in greater numbers because there is not rental assistance money available to prevent evictions as part of the course correction. We do know that thousands have been helped, and without these dollars the shelters would be overwhelmed. But the shelters are still completely full almost every day of the last year, and we still cannot provide a bed to everyone in need. It is unfortunate that we never get to discuss, as a community, strategies to use $14 million in the best manner possible instead of decisions being made based on the abilities of staff or agencies or course corrections made at the whim of the providers.

Brian
Posts reflect the opinion of those who sign the entry.

National Homeless Issues

Photo by Cheryl Jones of the NEOCH Photo Project

Prevention Dollars and Other Updates from Around the Country

I went to DC the last week in July for the National Coalition Board meeting, and the big news was that NCH hired a new Executive Director to carry the organization forward. There will be details on their website with a reception this fall. (The new ED is not the individual in the photo above.) I wanted to put down a few things that I heard from some of the other members of the NCH Board.

The District of Columbia
There is a lot of anger toward the Mayor for shutting down one of the shelters, but he was going to be at the ribbon cutting of the national street soccer tournament. One other piece of good news is that the City Council was planning to pass a local anti-homeless hate crimes bill. Cleveland already has one, but it is a positive step for a city to recognize that homeless people are targets living on the streets. Hopefully, this is a first step toward increased monitoring and a crack down on these young people who are doing this.

Atlanta, GA
Ever since the Olympics were in Atlanta, it has been rough for homeless people. The city has taken a hostile position on the presence of homeless people downtown, and struggled to close one of the biggest shelters in the region. They have fought in court and before funders and have gone back and forth to try to kill the Metro Atlanta Task Force shelter. The city has seen the public hospitals privatized, closed many affordable housing units, and now they are working to the shelter to try and shut it down.

San Antonio, TX
There is a new program called Haven of Hope that is trying to get started. It is located on 37 acres with many warehouses and buildings for housing. This will be a massive complex that could potentially house thousands of homeless individuals. The program will work with the individuals to find gainful employment as part of their programming on housing and other issues.

Miami, FL
The big news out of Florida is the fight over sexually based offenders, and especially the 75 person camp of offenders under one of the overpasses. There is a fight between local council members who want most of the city to be off limits to offenders and the state officials who are sending offenders to live below the overpass.

Denver, CO
One of the few cities that seem to using the Homeless Prevention dollars effectively. The County gave the funds over to the large social service provider to set up a collaborative process. Every group is trying to figure out if they can meet the reporting requirements set up by HUD for these funds. Denver social service groups are filling up the green affordable rental units that were built earlier this year and they are now working on a collaboration with the public library for a supportive housing complex. The health care facility got stimulus dollars to move to electronic medical records, and they are working to try to double the size.

Montana
There is some development work going on in Billings. Montana was only given a small amount of Homeless Prevention money, and it is very difficult to figure out how to spend such a small amount of money considering the huge need.

Minnesota
There was a substantial increase in family homelessness. There is legislation pending in Minnesota to restrict the use of HMIS numbers. They are using some of the neighborhood money to try to save homes that are foreclosed on especially for refugees and rental property. They are working on repairing the tax credit program to create new affordable housing. Very few corporations were paying taxes since they did not have profits and so therefore there was not much of a pool of available credits to build housing.

South Carolina
They are having a hard time spending the Homeless Prevention dollars. The applications require collaboration, but the groups cannot hire partner agencies to actually implement a collaboration. There was a bill introduced to protect homeless people with a anti-hate crimes bill. There are a few scattered programs to use federal dollars to build affordable housing.

I also attended the Homeless Coalition meeting for the other Coalitions in Ohio. There I learned that only Southeast Ohio seems satisfied with the way that the Homeless Prevention stimulus dollars were being spent. The Three C cities (Cleveland, Columbus, Cincy) all have had one person basically decide where all this new money was going to go. Very few of the activists were happy with how these decisions were made, and do not see many potentially homeless benefiting from these funds. Toledo activists have raised a stink about the process and gone to HUD and the media to raise objections. Dayton is more in a wait and see approach to the use of these funds. The groups traditionally funded to prevent evictions were not funded and the money was divided among groups that had not traditionally provided these types of services.

Brian
Posts reflect the opinion of those who sign the entry.

A Real Chance at Reform

Prevention Could Transform the Homeless System Locally

The Obama Administration is putting $12 million dollars into the local economy to prevent homelessness. This is a huge change for all of the cities which have for 20 years dealt with homelessness as an emergency. We were basically dealing with the problem after the disaster had already struck the family. This is the same amount of money that we get every year just to renew the budgets of all the shelters, so we cannot waste the resource. Now, we have the opportunity to figure out a new path to keep people in their housing before they become homeless. So what do we need to make this happen?

1. We need transparency in the process. We must model our local programs after the federal recovery process with an RFP with broad input. We should have a clear expression for what we need. We need to clearly outline the process for securing these dollars. There must be an open process for picking the recipient without personalities or conflicts of interest.

2. We need to create something new that will transform the system. We could just put more money into all the existing programs, but where would we be after two years? We would continue to increase homelessness every year as we have done for the past 20 years, and we would still have the same number of shelters as we have today. We blow this opportunity and everyone responsible for serving homeless people should be fired.

3. We cannot construct the system around shelter. To prevent homelessness, we must respond to people's individual needs. We should not force people to have to conform to the rules of the shelter in order to get help. We should not force them to split up their family in order to get a shelter space. We have built a system that shoves people into a program that they had no say in creating, and if they reject the charity offered they are cast aside. We need to build a system around housing and not services.

The above picture is from the Homeless Memorial Day in December at St. Augustine church in Tremont.

Brian
Posts by Northeast Ohio Coalition for the Homeless staff and Board.

Good Story in the PD Today

Homeless Report Featured in the PD/WKYC

The Plain Dealer did an article about the money for federal stimulus bill and the possible uses for the prevention dollars today. WKYC also did a story on their website about our report on Tuesday. Both stories used our report on the State of Homelessness in Cleveland in their news coverage. Regarding the stimulus prevention dollars, this is a once in a lifetime opportunity. I hope that the City can put this money to good use. If you ever have the occasion to read the comments in the PD, don't do it. The people who submit comments are some of the most dense people in our city. I have never understood the anger and hatred toward homeless people. I can see that people want lazy and those who have made bad mistakes to pay, but why doom those people to the shelters, hospitals, and jails? Taxpayers pay for all these services, and so we are just sucking money out of our own wallets by pushing people into homelessness. There is no bigger drain on taxpayer money than homelessness. Put people in housing with a little bit of subsidy and the County saves thousands of dollars. With the foreclosure crisis, the bank bailouts, and the wall street issues, people are out for blood. They want to put some people in the stockades for causing all this grief in our financial markets. But homeless people seem to be the victims and not the cause of these problems in America.

Just one update for today...
The state agency distributing the foreclosure assistance money informed us today that we they will not fund our pilot project to move homeless people into foreclosed buildings. They said that they received $75 million in requests for dollars and they only had $4 million to distribute. We will keep trying, but this is a tough proposal to fund.

Brian Davis
Posts by Northeast Ohio Coalition for the Homeless staff and Board.

The OHS Mad Tea Party

If You Can't Solve Homelessness: Expand the Problem

"Alice: I've had nothing yet, so I can't take more.
The Hatter: You mean you can't take less; it's very easy to take more than nothing."

I attended the most bizarre Office of Homeless Services Advisory meeting (or Homeless Bookclub as they are affectionately known) a few weeks back. It has taken a little while to process, and I am not sure that I can explain it without sounding like I am describing Alice's Tea Party with the Hatter. First, you should be aware that there is a great deal of dispute at the national level about the definition of homelessness. There are many advocates who are happy with the Department of Housing and Urban Development, the main funders of shelters and housing in America, and their limited definition of homelessness. The National Coalition, NPACH, and NEOCH all want a more comprehensive definition of homelessness that includes those sleeping on couches, coming out of prison, and those living in motels. Most HUD funded programs are not allowed to serve those not meeting the limited HUD definition of homelessness. HUD and a number of advocates do not support this expansion, because all the alleged progress made in solving homelessness will be destroyed overnight. It is estimated that if HUD were to change the definition of homelessness in America, the numbers would certainly double and may even triple. So, we have kept the numbers down by limiting the definition of who is homeless or just not counting people in America.

The other thing to understand is that things are really bad in Cleveland for homeless people. Besides being beat and killed on the streets, I will just give you the top 10 problems I can think of facing homeless people in Cleveland:

1. There is an attack of bed bugs in the shelters--Shelters need to think about replacing all wood beds in the system with metal frames to contain the problem--Major Dollars needed!
2. Family shelters are overcrowded and it is highly likely that families will need to break apart in order to find a bed within the shelters.
3. The identification program is out of money. Without ID, a person cannot get a job, sign a lease or vote. The program purchased about $100,000 in birth certificates and state IDs over the last year and a half.
4. Programs are struggling to stay in existence. There is very little new money because we are buying expensive permanent supportive housing projects, and nearly every program is trying to figure out how to keep their doors open in tough economic times (East Side Catholic closed and DV shelter spaces closed already.)
   
5. The main shelter at 2100 Lakeside got a substantial cut, and is eliminating staff and trying to find help with their food program.
   
6. Transportation costs are soaring making it difficult for homeless people to get a bus pass to get to a job or work.
   
7. Access to health care is increasing scarce, and debt issues associated with hospital stays are on the rise.
   
8. Jobs are increasingly difficult to find, and those jobs that are available are way outside the County (off the bus line).
   
9. The foreclosure crisis is killing our city and making more and more people homeless. The worst part of this crisis is that it is reducing the stock of housing in our community. People are abandoning their houses and those houses are stripped clean and condemned. This tightens the housing market and moves everyone down the ladder eventually into shelter.
   
10. We have lost more people in this county than any other county in America except Orleans parish in Louisiana. This destroys our tax base, and reduces local government services.

These are just the top ten list of problems of the hundreds of issues. So, things are bad, and we are far behind other cities in how we address the problem. There are an incredible number of problems, and yet the Homeless Bookclub continues to meet every other month to talk about homelessness. Now, they have proposed a new strategy to address the problem: Rapid Re-housing and Homeless Prevention. This all sounds great and certainly would eliminate some of the problems if fewer people were showing up at the shelter doors. No one is, however, proposing a new funding source to pay for these services or an expansion of the definition of homelessness. The staff at OHS and the County want to begin to talk about Homeless Prevention as the silver bullet to end homelessness in Cuyahoga County. We got to see an impressive video and listen to a moderated discussion about this new exciting strategy. It was too early to talk about details according to the moderator, but the brightest minds in the County working on homelessness will spend the next six months to 10 years pushing a prevention agenda when we have not even solved the immediate crisis facing thousands of families every day.

Where are we going to find the money for this new effort? Who has the staff to do this? We have not even found how to pay for the last fad: the supportive services associated with permanent supportive housing and now we are on to the next trend to come from DC. I view this as putting a giant hole in the other side of the Titanic in order to create some buoyancy I guess. We are one of the poorest cities in the United States with a disproportionate number of homeless people, a shrinking tax base, a County budget in freefall, and many programs teetering on the edge. In the face of such adversity, we decided to look at new areas of need. II guess the theory is that if you see a problem only getting worse over 20 years, find some other problem to address. Is the Homeless Bookclub the appropriate body to look at new problem when they have not figured out how to manage homelessness? A lot of very smart people were impressed with the video, and voted to support this new initiative. In fact, there was only one who did not jump on the bandwagon. I can only go back to where we started with another quote from Lewis Carroll, "If you don't know where you are going, any road will take you there."

Brian
Posts by Northeast Ohio Coalition for the Homeless staff and Board.