How would you characterize homeless people's experience of the healthcare system?

Homeless people have a disjointed experience of healthcare; there is no follow-up to the care they receive. Often they must pick where they go based on where they don't already have a bill that they can't pay. So the next doctor they see has no record or knowledge of previous encounters. There is no case history.

If a person is told, "take this medication and rest at home," well, they don't have a home. They can't do that. Meanwhile, as the huge bills pile up, they have fewer places to go for healthcare. And if they can't afford the prescription, the condition doesn't get any better, and that really complicates their stay on the streets.

Huge attempts are made to divert non-paying people to Metro. Even there, the process of completing the paperwork to be declared indigent is complicated. A health problem really has to be life-threatening to receive prompt treatment.

The follow-up for homeless people released from the hospitals is terrible. Once, a guy tried to commit suicide by setting himself on fire. He received only 24 hours of inpatient psychiatric treatment, and then he was released with four prescriptions he couldn't fill to a shelter that had no room for him. The shelters are all too familiar with people showing up in hospital gowns.

Are there any medical respite beds in town?

There are eight beds, at St. Joseph's home. And they're only for men. Nothing for women or families. We have hundreds, thousands, of empty, tax-supported nursing home beds, but only eight respite beds.

Say I'm discharging someone from the hospital, and they need somewhere to rest and recover. What can I do for them? Is there someone I can call?

Nothing. The services are just not there. And when you discharge someone to a shelter, you have to know this: the way the shelters operate, that person simply will not get rest.

Recently, the Ohio Department of Mental Health has been collecting reports on people discharged to shelters. When these statistics come out, they should be very revealing. But they will only pertain to hospital encounters that include a psychiatric diagnosis.

The real problem is that we don't consider homelessness a health problem, even though clearly it is. It shortens the life span, and causes of death are different for homeless people than they are for the general population. If we start doing a homeless death review, that might help clarify the problem. But that tells us something: we do such a horrible job of keeping track of homeless people in our city, the only avenue to determine their needs is after they die.

In the 2002 Conference of Mayors Report, Jane Campbell reported to her peers that there was no unmet need for shelter space in Cleveland. Could that be true?

Yes, in fact that was the case for twenty years, but it's changing this year. In the past, if people showed up, the shelters would put them wherever they could, even on the loading dock. That doesn't mean that every homeless person had shelter, because not everyone will come to the shelters, but everyone who did come would be accepted.

Now, that's no longer the case because of safety concerns. And the new shelter spaces that are proposed are not going to be adequate. The building they want to use for the womens' shelter only holds a hundred beds; last Saturday night at the current shelter there were a hundred and twenty-five women. Obviously, women will have to be turned away. The issue is far from settled. Under the current plan, Care Alliance will have to relocate. What will that do to them?

Jane Campbell was asked to name three things the Federal Government could do to alleviate homelessness. She responded: create a National Housing Trust Fund to produce affordable housing, expand the supply of rent subsidized housing units, and develop cooperation between HUD and HHS to link housing with services to formerly homeless residents. Any thoughts?

Yes, well, HHS does need to pony up the money for services to go along with the housing. The trust fund is a good idea for dedicating federal money to housing. As far as Section 8 rent subsidy vouchers, there are 9,000 people on the waiting list, and only as many public housing units. That list is never going to move. And Cleveland does have housing units, with a 10% vacancy rate, but they're not affordable. So the demand for subsidized units is huge.

Looking at the continuum from causes of homelessness to services for getting people out of homelessness, where should we place our priorities in addressing the problem?

First of all, separating out the causes of homelessness is really difficult. Take someone who is homeless and has substance abuse. Are they homeless because they abuse substances? Are they medicating their condition, whther it's homelessness, or another condition like mental illness that contributed to the homelessness? These answers are different for everyone. When we've looked at homelessness, the only truly common factor is a lack of family support. Family support keeps people out of homelessness who otherwise would have nowhere else to turn.

As far as preventing homelessness, we need interventions that take place before a person loses their housing. Prevention is not happening at the time of eviction, when everything doesn't have to be built up from scratch again.

What we really need is affordable housing, more so than shelters. People see all these abondoned buildings, and ask, why do we have to sleep outside? There's no money to make those structures safe. Half of Cleveland is below 150% of the poverty level, so they're not paying a lot of taxes.

Some people are syaing we should change the emphasis of Cleveland's economy from manufacturing to technology and the arts. How does the changing job market affect homelessness in your view?

Since we're only graduating 38% of our high-schoolers, Cleveland is not ready to rely on a high-tech job market. So it's hard to adjust to a changing economy when you have so many people without the skills. You're fixing the plane while you're flying it. It's hard.

Groups in other cities are trying to tie the minimum wage to the fair market rent. There is a local group working to promote a living wage. Although their living wage is about $9.00 an hour; the local housing wage is $11.00 an hour. So a living wage is not a housing wage.

What was the controversy about the last Census count of homeless people?

The way they counted homeless people was pathetic. They went out for twenty-four hours and counted people in the street. Another 24 hours for the shelters, and also for the soup kitchens. Three 24-hour periods. When they counted the public housing residents, they counted for three months to make sure they didn't miss anyone. The prisons, they spent three months.

So the count was really inadequate. People were upset about it, and the Census never did release the counts. The National Coalition for the Homeless campaigned against releasing the numbers; they were afraid some Republicans would say, look, you only have this many homeless people and you want how much money? But we actually wanted them to release them, so we would at least have some information to start with. Cleveland State did their own estimate, and that's the number we use for out-of-shelter homeless people.

What's happening with the Community Hiring Hall?

We did a trial period last summer, and now we're hoping to open in April. We don't have the location finalized yet.

Information aboutthe Community Hiring Hall can be found on NEOCH's website, under the section "NEOCH Programs"
http://www.neoch.org/