Over 60 of OC’s Sickest Homeless People to Be Housed with Health Services

JULIE LEOPO, Voice of OC Contributing Photographer

Richard Sanchez (center), director of the Orange County Health Care Agency, stands next to Paul Leon, president and CEO of The Illumination Foundation, during a discussion of the supportive housing contract on April 24, 2018.

More than 60 of Orange County’s most seriously ill homeless people are on track to move into housing with services to help them address health issues, under a new county contract approved Tuesday.

County health officials will choose the homeless people, based on assessments of their health vulnerabilities, and they will receive housing and services through a contract with The Illumination Foundation, a nonprofit that specializes in helping homeless people move from the streets into housing with on-site support services, and then into permanent housing.

The goal, officials said, is to help homeless people move off the streets, stabilize their health issues, develop positive relationships with other community members, and save public money in hospital emergency services and other costs.

Health issues will include one or more physical ailments, substance addictions, or mental illnesses, officials said. On-site staff will include case managers, mental health workers, psychiatrists, therapists, housing navigators, and peer recovery counselors who have been through experiences similar to the homeless people.

The contract was approved unanimously by the Board of Supervisors Tuesday without public discussion, though they did talk about it at their April 24 meeting.

Paul Leon, who founded and leads The Illumination Foundation, said at the April 24 meeting he’s confident more than 90 percent of the formerly homeless people in the program will remain in permanent housing a year after they start the supportive housing program. That’s based on the foundation’s track record with hundreds of formerly homeless people, he said.

“Currently we’re housing 694 individuals in permanent housing. Out of those individuals, we had about an 83 percent success rate in bringing them from the street into [a] home,” Leon told supervisors.

“I’m quite confident that [after] a year, we’ll be able to take people in with 90 percent remaining in permanent housing,” Leon said. “We’re doing that currently, with many more [formerly homeless people], and our success rate has proven that we can do that.”

The $1.6 million contract will be overseen by the county Health Care Agency, and runs for about six months, until Oct. 31. There’s an option to renew for another six months if the foundation meets performance goals of moving 36 of the people, or 60 percent of everyone, into permanent housing within the first six months.

This is the first time the county Health Care Agency has used this kind of performance criteria, said Tricia Landquist, a spokeswoman for the agency.

After an expected three or four week “ramp up,” the foundation will take about 10 people per week into supportive housing, with a minimum of 60 homeless people served by the contract.

Supportive housing is an approach in which people who have been homeless receive the health and social support services they need to stabilize their conditions and to remain housed.

Under the Illumination Foundation contract, people would be in supportive housing for a few months up to roughly a year, before they move to permanent housing.

After people move to permanent housing from the supportive housing, the goal is to bring in additional homeless people to fill their spots, so more than 60 people would be served.

Susan Price, who is charge of coordinating the county’s services for homeless people, also expressed confidence in a success rate of 90-plus percent of people remaining in housing.

“In our system of care, our retention rate [for] permanent supportive housing is 97 percent,” Price told the supervisors April 24.

Regarding Leon’s confidence, she added: “I think that with this population, sometimes permanent supportive housing can be the solution for us to have that type of success rate – over 90 percent.”

The cost per person comes out to about $26,700 for the six month initial contract period, during which the contract sets an expectation of at least 60 percent of people moving into permanent housing. A person who stays for a full year in the program – less than 10 or 20 percent of people, according to officials – would cost roughly $53,300.

The cost to the public when a chronically homeless person is on the streets of Orange County averages $100,000 per year, mostly due to hospitalization costs, according to a UC Irvine cost study released last year.

The most expensive 10 percent of chronically homeless people in Orange County cost the public $440,000 per year, on average, when they’re on the streets, the study found. The most costly 10 percent of chronically homeless people in permanent supportive housing cost the public an average of $55,000, according to the study.

The UCI study found that when chronically homeless people are placed in housing with support services, arrests drop to zero, underlying health issues improve, and people are more likely to seek and obtain employment.

The performance guarantee in the new contract was proposed by Supervisor Todd Spitzer at the April 24 meeting, when the Illumination Foundation contract first came before the board. And it seemed to catch Spitzer’s colleagues off guard.

Before the meeting started, Spitzer approached Leon in the audience and spoke with him. Then, when the item was discussed during the meeting, Spitzer said he had proposed a new contract provision to Leon.

“If he hits 90 percent [of people moved into permanent housing after a year], he keeps the money,” Spitzer said. “If he doesn’t hit 90 percent, we don’t pay a dime. Mr. Leon, would you take that deal?”

Leon didn’t hesitate, leaning into the microphone: “Yes. I definitely would take it.”

Spitzer said the foundation, which largely is funded by businesses, hospitals and non-government groups, has “vast” resources and that he has “deep respect” for Leon and the foundation.

Supervisor Andrew Do, the board chairman, said he was upset at how Spitzer worked to change the contract without consulting with him and the other supervisors.

After being told the 90-percent guarantee was first brought up by Spitzer that morning, Do said, “This is not the way we should conduct business. Alright?”

“We can change our directions, but let’s bring all of us on board,” Do said of the other supervisors. “I walk out of the room and I came back and the contract is completely different. I don’t find that funny. Okay?”

While he had issues with Spitzer’s approach, Do said he supported the foundation making that guarantee.

“If the Illumination Foundation is willing to step up and say [they] guarantee [a] 90 percent success rate, there’s no reason why we shouldn’t support it. That’s a tremendous success rate,” Do said. He called the rate “mind-blowing.”

Tuesday’s move by county supervisors reflects a shift by the county in recent months beyond a law enforcement-focused approach to homelessness, to also having health workers and services seek to address underlying mental and physical health issues, as well as addiction.

The shift came largely in response to an ongoing federal civil rights lawsuit by homeless advocates, which alleges inadequate shelter space for homeless people makes it cruel and unusual punishment to cite and arrest homeless people for camping in public.

U.S. District Judge David O. Carter currently is not preventing enforcement of anti-camping or loitering laws against homeless people, though he has warned he may do so if officials don’t find additional safe places for homeless people to sleep at night.

In the meantime, during the clearing out of homeless camps at the Santa Ana riverbed and Santa Ana City Civic Center, Carter supported county officials’ decision to have health workers take the lead in offering services to homeless people with sheriff’s deputies standing by at a distance, as opposed to having law enforcement take the lead.

Since the first hearing in the court case on Feb. 13, Do and other supervisors have focused more attention on how the county can help address homelessness through health services and housing people with serious disabilities.

At the April 24 meeting, Do asked how success would be measured with the new supportive housing contract.

“Susan, when we are talking about taking the highest acuity population and being treated by the Illumination Foundation, walk me through…how do we assess success?” Do asked Price, the county’s coordinator of homeless services.

Price answered that housing “is one component” of the intervention, the other being “wraparound services” to address issues like drug, alcohol, and mental health conditions.

“It kind of all works together. And the housing is what assists the person in stabilizing their ability to receive the care and the services that are being offered,” Price said.

“Typically you’ll have a higher success rate on the wraparound services when a person is in a housing unit, and that aspect of their care has been stabilized,” she said.

With six to seven months of services in permanent supportive housing, Price added, “a person should be able to integrate into the broader community of where they’re located. And so we’ve had some success with that in national models around the country.”

Among the ways of tracking success, she said, are how long people stay in housing and how engaged people are in addressing their health issues, such as reducing their use of drugs and alcohol, and going further in mental health treatment than if they remained on streets or in an encampment.

Leon agreed.

“Studies have shown, nationally…that if you get [homeless people] in permanent housing, and they stay for a year, that their chances of retaining permanent housing for long periods of time really increases,” he said.

Nick Gerda covers county government and Santa Ana for Voice of OC. You can contact him at ngerda@voiceofoc.org.