Housing is Health Care

House in Richmond, Virginia 2014/Josephine Ensign

Health and Homelessness in Richmond, Virginia in the 1980s: Although I was intimidated by her when I first started working at the Richmond Street Center in 1986, I quickly came to view Sheila Crowley as a valuable mentor.

Sheila Crowley was the Executive Director of the Daily Planet (the lead agency of the Richmond Street Center) from 1984-1992. She left the Daily Planet in 1992 to work on her doctorate in social work, focusing on housing policy. As part of her doctorate, she did a yearlong housing policy fellowship on Capitol Hill. Since 1998 she has been President and CEO of the National Low Income Housing Coalition (NLIHC), based in Washington, DC. The NLIHC works on socially just national housing policy issues, public education, and research. They publish the annual Housing Wage/ Out of Reach Report, which shows side-by-side comparison of wages and rents for all U.S. counties, metropolitan areas, and states.

In my telephone conversation with Sheila several years ago, she characterized the national policy climate as “a disconnect between the response to homelessness and the response to the housing shortage.” She commented on how homelessness has become institutionalized and taken for granted, with so many more people working within the homelessness industry than when it originated in the 1980s, and with even more displacement of low income people from housing.

I had been thinking about similar things. After more than a quarter of a century working with homeless people in the U.S., it disturbs me that there are more, not less people experiencing homelessness, illness, and lack of access to basic health care. There are more specialized services for homeless people in our country than there were three decades ago: homelessness as a problem has become institutionalized. Within the federal government, the Interagency Council on Homelessness includes representatives from fifteen different federal agencies related to homelessness. Homelessness has become an industry. There are currently at least 1 million people working directly with homeless-focused agencies. Homelessness is an assumed aspect of modern American urban life, often portrayed in Hollywood movies as part of a gritty, authentic urban backdrop. I had been asking myself whether by working in the ‘homelessness industry’ I was doing more harm than good: harm in that I helped make homelessness more palatable to people experiencing homelessness, as well as to our housed community members (and yes, even to myself: a literal “I gave at the office” sort of a thing). I haven’t found an answer to my question, but I continue to think it’s an important one to ask.

Sheila gave me broad-brush characterizations of the Clinton, Bush, and Obama administrations’ approaches to housing and homelessness. Under Clinton there was emphasis placed on de-concentration of low-income housing, with the unintended consequence of a net loss of low-income housing units. The Bush administration placed emphasis on increasing home ownership rates, with some funding going to McKinney Homeless Assistance for housing programs. Obama appointed a great Housing and Urban Development (HUD) director, Shaun Donovan, and Sheila had high hopes, but at the time of our interview she felt that not much had been done. The Homelessness Prevention and Rapid Re-housing Program funded through the American Recovery and Reinvestment Act of 2009 appears to have been effective at preventing the worst of recession-related increase in homelessness, although the numbers of unsheltered and doubled-up homeless increased during the 2009-2011 time period.

Sheila and I talked about how even the term ‘homeless’ is problematic on many levels. In the U.S. there have been different official federal definitions for homeless. Until recently the Department of Housing and Urban Development only included the visible or literal homeless—those living on the streets or in emergency shelters. Other federal definitions, such as those necessary for receiving health benefits, have had broader definitions that included people temporarily doubled-up with friends or family, people living episodically in cheap hotels, and people living in cars or other places not intended for human habitation. This definition encompasses people in many different variations of being marginally or precariously housed—as I had been as a young adult. The HUD definition was amended in December 2011 to be more in line with this broader definition of homeless.

Sheila described being at a Homeless Advocates Group (HAG) national meeting recently. HAG is composed of leaders of all the major groups working on homelessness at the national level, including the NLIHC, the National Health Care for the Homeless Council, and the National Alliance to End Homelessness. She looked around the meeting room and realized that all of the leaders of the represented agencies and coalitions were now in their fifties and sixties and had gotten their start in homelessness work in the 1980s. She thought to herself, “Here we go again,” with the increase in the number of homeless, this time due to the national foreclosure crisis and effects of the prolonged recession.

She was quick to highlight success stories, communities that are pulling together coordinated responses to homelessness with a Housing First emphasis—working to maintain people in adequate affordable housing and to quickly re-house people—and a Housing Plus approach of providing supportive housing for people with mental or physical health or substance abuse issues complicating their homelessness. People cannot be healthy unless they have safe and healthy housing. She mentioned Columbus, Ohio and Worcester, Massachusetts as two examples of successful community responses, and added that my new hometown of Seattle has done pretty well with a significant decrease in the chronically homeless population. Across the country, there’s been resistance from emergency shelter providers and church-sponsored programs who see funding and support moving away from their services. But the Housing First movement has had broad bipartisan support since it cuts across different political ideologies.

When I mentioned to Sheila what now stands at the corner of Belvidere and Canal Streets where the Richmond Street Center had been (it is now a VCU college dorm building and a Starbucks), she immediately said, “The only thing I regret about the Street Center building being torn down was the elevator.” This surprised me until I remembered what a practical woman Sheila is—a common character trait of many of the social workers, as well as of public health nurses I have known. She reminded me that the city inspectors had insisted she fund and install a $30,000 elevator in the Street Center building before it could open. She hopes they were at least able to re-use the elevator for another building. She also recounted the construction of the addition on the back of the Street Center for the expanded clinic space I worked in. A sinkhole opened up in the parking lot while they were preparing the foundation. That’s when they discovered that the Street Center was built on land that had been the city dump. Sheila said she went back to where the workmen were standing around looking at the hole, rubbing their chins, exclaiming, “It’s the darndest thing,” and she responded, “Well don’t just stand there, do something about it!”

We need more people like Sheila who don’t just stand around contemplating problems, but who roll up their sleeves and try to solve them.


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