In the three years before he secured his own apartment, Oscar, a Cumberland County man who had long been homeless, was admitted to local hospitals about 300 times and was among the Bridgeton area’s biggest user of EMS services. He also spent at least 80 nights in jail.
But several years later, Oscar lives in safe housing, is employed by a local landfill, and shops for groceries at a neighborhood store on Sunday mornings, according to advocates who helped settle him and dozens of other county residents. In addition, Oscar receives regular behavioral health and medical services through Inspira Health Network and other providers, largely on an outpatient basis.
The turnaround Oscar experienced is in large part a result of the Cumberland County Housing First Collaboration, a partnership that employs a highly successful model that starts with safe housing and let’s everything else — including sobriety, medical treatment and employment — follow. The group has since housed nearly 60 clients in the county with the lowest per-capita income in the state, and limited public services.
“That shows what happens when you address homelessness in a humanistic and holistic way,” said Rev. Robin Weinstein, president and CEO of the M25 Initiative, a nonprofit organization formed to coordinate support for Housing First and other social service collaborations in the area.
Weinstein had launched an emergency homeless-response program called Code Blue years earlier but was looking for a more comprehensive way to address the issue for those who don’t do well in structured housing programs, which can require residents to abstain from drugs and alcohol or hold down a job.
The toll of chronic homelessness
“Chronic homelessness takes its toll,” explained David Moore, an M25 board member and head of mental health services at Inspira. “You can’t go years of being chronically homeless without it taking a significant toll on everything. On your mental health on your physical health,” he said; studies suggest roughly two-thirds of those without regular shelter have an addiction of some form.
“Housing first is the tip of the pyramid of social services for homeless individuals,” Moore said. As an M25 partner, Inspira has provided assistance ranging from laundry services for homeless individuals to healthcare for those in Housing First and other programs.
The housing-first model has gained popularity nationwide and here in New Jersey, thanks in part to housing vouchers made available to community organizations through the state Department of Community Affairs. The Camden Coalition of Healthcare is generally credited with pioneering the model here in 2015, using DCA dollars to house more than five dozen chronically homeless individuals. That program led to a 60 percent reduction in both in-patient and emergency room visits for participants, according to the coalition.
“What we saw is when it comes to behavioral healthcare, there is a small percentage of patients that take up enormous resources — and homelessness is a big part of this problem,” said Moore, who also worked in Camden. And when a patient is discharged from the hospital without a place to go, “the care plan fails,” he said.
The DCA has distributed more than 650 vouchers since 2015 to organizations in all but a handful of counties, according to officials, as monthly subsidies to offset rental costs in private housing units of all kinds. This includes a partnership announced earlier this year with Jersey City Medical Center and Hoboken University Medical Center to provide housing — along with coordinated healthcare and other support services — to 25 individuals who are considered chronically homeless, or without a stable residence for most of the past year and who are facing ongoing health issues.
Supportive housing key to overall health
“Housing is healthcare. Permanent, stable, supportive housing is key to overall health. Here we have the opportunity to both create affordable apartments and help people stay healthy,” said Charles Richman, head of the DCA’s Housing and Mortgage Finance Agency, at the agency’s annual housing conference in October.
The movement is part of a broader effort to understand and address so-called social determinants of health, or underlying factors like poverty, access to healthy food, and threats of violence, that play a role managing and preventing diseases and in overall health.
Some healthcare providers have funded community health workers to help individuals reduce asthma triggers or fall hazards at home in an effort to avoid more serious health issues; insurance companies have launched similar initiatives, looking at the cost savings over time.
Earlier this year, the HMFA committed $12 million toward a public-private partnership with the New Jersey Hospital Association to develop affordable housing complexes in up to four communities statewide. The initiative, which involves new facilities instead of vouchers, is based on the same understanding that fuels housing-first models: that safe, appropriate housing is one of many factors that contribute to an individual’s wellness.
(Hospitals have until December 17 to apply to participate in the program, which will involve tax credits and other funding mechanisms, according to NJHMFA. Candidates must have a project site, plans, and partnerships to oversee the development, and are encouraged to contribute resources of their own.)
Benefits to individuals — and public sector
“It’s hard to focus on filling your prescriptions or buying healthy foods when you don’t have stable housing,” said NJHA president and CEO Cathy Bennett, when the program was announced in August. “We’ve seen a direct correlation between housing instability and healthcare impacts, including more frequent hospitalizations and longer hospital stays. There’s plenty of evidence that shows the profound impact of supportive housing on those healthcare challenges.”
In Cumberland County, for example, the collaboration resulted in the housing of 50 chronically homeless individuals in its first year; a year later, these residents had reduced their hospital admissions by one-third, cut ambulance usage by nearly three-quarters, and reduced incarceration rates by more than 90 percent, according to representatives of the county’s Housing First Collaboration. The problem benefits individuals — and the public sector.
“It’s so wonderful when the efficient thing is also the righteous thing,” Moore said, pointing out that individuals who are chronically homeless cost various government programs as much as $40,000 each a year in Cumberland County. “If I can house them at $12,000 a year, I save the system money.”
While the housing-first clients are given privacy and respect in their homes, they are also supported with a wide network of optional services — including help accessing furniture, towels and bedding, financial management skills, or family counseling, he said. Church groups and other organizations, like the Bridgeton High School class of 1977, have sponsored individual move-ins, with others providing everything from sheets and towels to help obtaining identification cards. The collaboration’s work is coordinated through the M25 Initiative and involves more than half a dozen social service, community and government organizations, ranging from the Cumberland County Jail to Volunteers of America Delaware Valley.
“It’s been a monumental task,” Weinstein said, “but there isn’t a barrier that hasn’t been overcome.”
Collaboration is critical
The housing-first model depends on diverse collaborations, and healthcare is a critical part, experts said. The Cumberland program involves a network of faith-based groups, social service organizations, government agencies and healthcare providers, including Inspira, which operates three hospitals and other clinical services in South Jersey.
“It was very important that people could be part of the solution, not just looking for someone else to be an answer to their prayers,” Weinstein explained. “We didn’t create new services, we just tied together existing services from what had traditionally been rival nonprofits.”
While this organization has fueled success, leaders at the Cumberland coalition said their work is far from done. Under the guidance of M25 — which refers to the Biblical verses in the Gospel of Matthew, chapter 25, and a discussion of feeding, clothing and sheltering those in need — the group has set an ambitious goal of ending homelessness entirely in Cumberland County by 2020.
And while it is hard to quantify exactly how many people meet the definition of chronically homeless in Cumberland County, the group now has a waiting list of 80 individuals — more than they have already placed in their first 18 months. “Housing first is the only answer,” Weinstein said.