Ask the Scholar
Document scope · 1 page
Scholar
Ask about this object, its catalog metadata, its source description, or the page inventory.
For page-specific OCR and visual context, open one of the page chats.
Scholar Source Context
Document identity
localId
118568716
label
[Homeless, Health and Human Services Working Group on the]
core
doc
dtoType
document
citationUrl
pageCount
1
Source metadata
id
118568716
contentType
document
title
[Homeless, Health and Human Services Working Group on the]
citationUrl
identifierLocal
94
collections
Records of the Office of the Chief of Staff (Reagan Administration)
James Cicconi's Subject Files
thumbnailUrl
largeImageUrl
imageCount
1
hasImages
yes
source
import
hasTranscription
no
Source extras
naId
118568716
coverageEndDate
logicalDate
1985-12-31
year
1985
coverageStartDate
logicalDate
1981-01-01
year
1981
levelOfDescription
fileUnit
recordType
description
ocrSource
nara-archive
Single page context
seq
1
pageIndex
0
type
document
mediaId
4ccee1042cd3157c
ocrText
THE WHITE HOUSE
WASHINGTON
Jim -
HUMAN
THE SECRETARY OF HEALTH AND HUMAN SERVICES
STATE
WASHINGTON. D.C. 20201
USA
15 August 1984
LETTER OF TRANSMITTAL
Dear Mr. President:
It is my pleasure to forward to you my report on
ways to help the homeless. When we met on 4 April 1984, you
requested that my Department prepare such a report to provide
you with background, analysis, and options.
The HHS Working Group on the Homeless has drafted the
attached paper for your review. It describes the problem, and
summarizes what is now being done by the private sector, states,
localities, and the Federal Governement. A strategy for a
public/private partnership, focusing on those most in need --
in both the short and long term -- is outlined, and specific
options presented.
Considerable ress can be made by improving the service
system already in place, allowing for a more effective
utilization of current programs. The Federal Government can
do more to make sure the homeless receive the benefits to which
they are entitled and to provide technical and other assistance
to local groups which provide direct services. In addition, a
better partnership needs to be developed between local
communities and the states in order to improve linkages and fill
gaps among existing services.
Sincerely,
Thought
Margaret M. Heckler
Secretary
THE HOMELESS
Background, Analysis, and Options
CONTENTS
Page
I.
The Problem
A. Defining "Homelessness"
1
B. Number of Homeless Persons
1
-- Advocates
-- HUD Report
C. Increased Public Awareness
3
D. Characteristics of Homeless Persons
3
E. Reasons for Homelessness
4
-- Chronic Disabilities
- Mental Illness
- Alcohol Abuse
-- Economic Conditions
-- Personal Crises
II.
Help Now Being Provided
A. Private Sector and Voluntary Programs
7
B. Local Governments
8
C. States
9
D. Federal Government
9
-- Interagency Task Force
-- Special Emergency Programs
- Feeding Programs
- Emergency Shelter
-- Regular Programs
- Entitlements
- Block Grants
E.
Overall Assessment
11
-- Private/State and Local
Government Programs
-- Federal Programs
III.
Strategy for a Public/Private
Partnership to Aid the Homeless
A.
Overview
13
-- Goals
-- Focus
-- Responsibility
-- Federal Role
-- Implementation
B.
Immediate Actions
15
-- Outreach
-- Living Arrangements
-- Services
-- Income Support
-- Management and Coordination
-2- -
III.
Strategy for a Public/Private
Partnership to Aid the Homeless, Continued
C.
Long-Term Systems Management
16
-- Research
-- Demonstrations
-- Training
IV.
Specific Options
A.
Leadership: Initiate Action
Through Presidential Leadership
17
1.
Executive Order
2.
Religious and Philanthropic
Group Initiatives
3.
Business Initiatives for
Facilities
4.
Public Awareness
5.
International Year of Shelter
B.
Entitlements: Make Sure Entitlement
Programs Work
19
1.
Eligibility Outreach
2.
Federal Field Office Guidelines
3.
Food Stamp Transitional House
Program
4.
SSI Eligibiltiy for Shelter
Residents
5.
Section 8 Vouchers for Single
Room Occupancy Units
6.
Section 8 Vouchers for Shelters
7.
Assisted Housing for Battered
Spouses
C.
Technical Assistance: Promote
Proven Service Delivery Techniques
20
1.
Clearinghouse
2.
Workshops and Technical Assistance
3.
Family Foster Care
-3- -
IV.
Specific Options, Continued
D.
Other Resources: Provide Available
Federal Resources to Service Providers
Who Request Assistance
21
1.
HHS Homeless Task Force
Operations
2.
Food Banks and Commissaries
3.
Federal Facilities, Equipment,
and Supplies
4.
Memphis/HUD Transitional
Housing Project
5.
Extended Leases for HUD Homes
6.
Urban Homesteading Units
7.
PHS Direct Services
8.
Minimum Health and Safety
Guidelines
9.
Action Agency Volunteers
10.
Shelter Improvements and
Operations
E.
Research, Demonstrations, and
Training: Develop Basis for
Improving the Service Delivery
System
24
1.
General Research
2.
Placement Policies
3.
HHS Demonstration Program
4.
HHS/HUD Demonstration --
Housing Certificates for
the Mentally Ill
5.
Training and Retraining of
Mental Health and Related
Health Service Personnel,
and Social Service/Shelter
Providers
NUMBER OF HOMELESS
2,200,000+
RANGE OF ESTIMATES
(NOTE: ALL NUMBERS ARE ROUNDED)
1,000,000
600,000
500,000
350,000
250,000
DAILY COUNT
ANNUAL (CUMULATIVE) ADVOCATES COUNT
COUNT
CHARACTERISTICS
100
90
85
80
75
70
66
60
PERCENTAGE
60
50
50
50
50
40
40
30
30
25
20
20
15
10
0
MEN
WOMEN
MINORITIES
FAMILY
GEOGRAPHICALLY COMPLETED
GROUPS
STABLE
HIGH
SCHOOL
AVERAGE AGE 35
REASONS FOR HOMELESSNESS
80
RANGE OF ESTIMATES
MENTAL
70
ILLNESS
66
60
PERCENT OF DAILY COUNT
ALCOHOL
ABUSE
50
50
40
33
33
30
///
25
25
20
15
10
10
CHRONIC DISABILITIES
RECENT ECONOMIC
PERSONAL CRISES
65 - 75%
SETBACKS
PERCENTAGES DO NOT ADD TO 100% BECAUSE OF OVERLAP
HOMELESS BRIEFING
Background, Analysis, and Options
I. THE PROBLEM
A. DEFINING "HOMELESSNESS"
Homeless people are those who lack shelter and the financial
resources necessary to acquire it, and revert to seeking food and
shelter from public or private facilities. This definition is
intended to include anyone whose regular nighttime residence is:
O in a public or private emergency shelter;
O in the streets, parks, subways, bus terminals, railroad
stations, airports, abandoned buildings without utilities,
and other outdoor locations; or
O in temporary voucher hotels, motels, or apartments, or in
jails or hospitals with the underlying purpose of seeking
shelter.
This definition is somewhat broader than that which might be used
to design an appropriate strategic initiative to help the most
numerous, destitute and helpless of these people, the mentally
disabled and alcohol abusers. The rationale for focusing an
initiative on these latter populations is developed throughout
the remainder of this paper.
B. NUMBER OF HOMELESS PERSONS
Daily Versus Annual (Cumulative) Counts
The extent of homelessness can be measured by the total number
of persons homeless on a given night or by the cumulative number
homeless during a year. The first, the daily measure, is useful
in analyzing how many emergency shelter beds, meals, and
facilities are needed; the latter, the annual (or cumulative)
measure, is useful for analyzing how many people need help in
a given year. Both types of measure provide needed information,
but the two concepts are often not distinguished, creating
confusion about how many people are homeless.
-2-
Estimates of the Homeless by Advocates
and Service Providers
Prior to 1984, the most commonly published number of homeless
persons was 2.2 million. That number was cited in numerous news
articles and was used by the U.S. Conference of Mayors and the
New York based National Coalition for the Homeless. It was
apparently based on the conclusion reached by the Washington,
D.C.-based Community for Creative Non-Violence, and reported in
1982, that in 1980 approximately one percent of the population,
or 2.2 million people, lacked shelter; this is presumably an
annual estimate.
The HUD Report
On May 1, 1984, Secretary Pierce released a systematic national
study profiling the homeless population and emergency shelters.
According to that HUD report, the estimated daily number of
homeless persons is between 192,000 and 586,000, most probably
between 250,000 and 350,000.
The HUD report indicates that almost half of those homeless on
any given day are only episodically or temporarily without
shelter. On an annual basis--because of the large turnover--the
episodically or temporarily homeless comprise a majority of the
cumulative annual count. Taking this into consideration, one can
derive a cumulative, annual count ranging between two and three
times the daily total.
The HUD report was based on:
over 500 telephone interviews in a national sample of 60
metropolitan areas;
a national survey of 184 shelter operators;
O reviews of local studies in over 30 metropolitan areas;
o
site visits to ten cities;
O
discussions with national organizations; and
telephone interviews with State government officials in all
50 States.
Furthermore, the report was quite clear in stating that it used a
daily rather than an annual estimate of homelessness.
Nevertheless, it was immediately criticized by advocates for the
homeless in many newspaper editorials, and in Congressional hear-
ings, as a purely political document intended to deny the reality
of an obviously widespread problem and to diminish criticisms of
the Administration for not responding to it. Some commentaries,
however, dismissed any such discussion as pointless, since even
HUD's lower numbers are indicative of a serious problem.
-3-
What Number Should be Used?
All current national numbers are based on estimates, not on
actual counts. A good strategy would be to assume a broad range
and to plan accordingly. What is even more important is to know
the causes of this problem and to develop strategies for
responding to it, which are more than a quick-fix.
C. INCREASED PUBLIC AWARENESS
The homeless have been a social phenomenon since the beginning of
civilization and have certainly always been a part of America's
social history. However, the increasing number of available
shelter beds and other services in the past four to five years
implies an increase in the number of homeless, an increase in
public/community awareness, or both, which has resulted in
increased availability of food and shelters.
The issue received increased public attention in the late 1970's
and early 1980's. Congressional interest, media coverage, and
advocacy concern have certainly increased over the last several
years. Since there are no routine surveys of the homeless that
provide reliable annual estimates, it is hard to be precise about
actual trends in the size of the population, although it appears
to be increasing.
D. CHARACTERISTICS OF HOMELESS PERSONS
The most outstanding characteristic of the homeless is their
heterogeneity. Although there are differences among geographic
areas, several patterns emerge:
the homeless are in their mid-thirties, much younger than in
the past when they averaged in their mid-fifties;
about 15 to 25 percent are women, a percentage that seems to
be increasing;
about 40 to 50 percent are minorities, although racial and
ethnic composition tend to reflect that of local areas;
O
20 to 30 percent are in family groups;
O
about 50 to 60 percent remain in a single city for one or
more years, although transiency is more significant in
warmer climates; and
One-half to two-thirds have completed high school, and about
25 to 30 percent have attended college.
-4-
E. REASONS FOR HOMELESSNESS
The factors that contribute to homelessness are both structural
and individual. Structural factors include economic changes and
problems, urban reconstruction projects that lead to geographical
dislocations, and discontinuities in service provision.
Individual factors include mental and physical disabilities, and
personal crises. The structural and individual factors are
highly interactive.
Chronic Disabilities
Mental Illness
From 33 to 66 percent of the homeless in shelters are
characterized principally by mental illness, on an acute or
chronic basis, and 25 to 35 percent are former patients of mental
hospitals. Since there is a higher percentage of mentally ill
persons on the streets than in shelters, these percentages
probably represent minimum figures for strategic planning.
That such a large proportion is chronically or acutely mentally
ill is due to a number of factors:
O Deinstitutionalization: Originally, this term meant the
release of patients from the large, public, State mental
hospitals and their return to the community where they would
be cared for in more personalized settings. This was made
possible and reinforced by:
-- the introduction of new types of medications which provided
symptomatic management of seriously mentally ill patients;
-- the emergence of community mental health centers to
supplement care in private homes;
-- the availability of Federal entitlements, such as Medicaid,
Supplemental Security Income (SSI), and Social Security
Disability Insurance (SSDI) to help finance such living
arrangements and care;
-- a philosophy of care in which the large State hospitals were
perceived as dehumanizing; and
-- a sensitivity to civil rights resulting in procedural
safeguards against involuntary hospital admissions.
Concerning the latter point, a series of court cases (Wyatt
V. Stickney; O'Conner V. Donaldson; and Dixon V. Weinberger)
extended to mental health patients the "right to the least
restrictive alternative" for care. Others (Rozechi V.
Ganghan and Kaimowitz V. Michigan) extended to them the
"right to refuse treatment."
-5-
Long-term residence in a State mental hospital or other
inpatient mental institution is now the exception, with the
emphasis on providing mental health outpatient and partial
care treatment in the community, and reducing the length of
hospital stay as much as possible. State hospitals for the
mentally ill have generally adopted strict admission
policies, only admitting those with the most obvious
symptoms and dangerous behavior. Typically, State laws and
the courts have supported this policy.
As a result, while there were 559,000 persons in State
mental hospitals in 1955, there were only 125,000 in 1981.
Because of the turnover in the institutionalized population,
the number deinstitutionalized during this period is higher
than a simple subtraction of the two numbers would indicate.
This aspect of deinstitutionalization has clearly resulted
in a far greater number of chronically mentally ill persons
residing in the community today than in the past. Many of
these chronically mentally ill persons do not receive a
systematic program of community-based mental health care and
supportive services.
Moreover, many of the current mentally ill homeless did not
seek or receive treatment from either State hospitals for
the mentally ill or community-based mental health care
systems. Others were diverted from inpatient care. It is
particularly in these latter cases that "deinstitutional-
ization" may have been a contributing factor in the growth
of the mentally ill homeless population.
This latter group frequently exhibits an inability to cope
with the complexities of daily life or to understand how to
apply for entitlements or take advantage of available
services.
Many of these are younger adults who are part of the baby
boom generation, which has increased dramatically the
numbers of individuals between the ages of 18 and 35, the
age group most at risk for the onset of some serious mental
disorders such as schizophrenia.
O Availability and Organization of Community Care Programs:
Although there are many cases in which the transfer of
patients from State mental hospitals into community care has
been successful, most communities were, and still are,
unable to care for and manage the complex needs character-
istic of the chronically mentally ill in the community.
Among the reasons are the unavailability of services and the
lack of effective integration among services that are
available.
-6-
Today, deinstitutionalized mentally ill persons can be found
in a range of community settings where the availability and
accessibility of a continuum of treatment and rehabilitative
services varies greatly. Thus, many chronically mentally
ill persons do not gain the benefits from services which
could help them maintain a stable existence and obtain
adequate employment, shelter, and the like. Some have no
contact with mental health care at all; others may have been
referred for short-term assistance upon release from a
hospital, but are no longer eligible or may have dropped out
of programs. Still others may come into contact with mental
health service systems only when their illness becomes so
severe that they are hospitalized.
Gaps in the availability of appropriate residential place-
ments have forced many chronically mentally ill persons to
rely on shelters in lieu of more appropriate housing. In
fact, some researchers suggest that shelters are not serving
as transient way-stations for the homeless, but instead,
have become alternative institutions to house a large number
of mentally ill persons. They also point out that such
facilities generally do not provide the necessary treatment
and other supports needed by the chronically mentally ill
and that their personnel sorely lack training as well as
access to trained mental health personnel needed to work
with chronically mentally ill persons.
Alcohol Abuse
The alcohol abuser has traditionally been the archetypical home-
less individual. Reports indicate that persons with a primary
disability due to alcohol abuse are no longer the overwhelming
majority they were in the past; however, they still make up a
significant share, perhaps 25 to 50 percent or more of the daily
total.
Some overlap exists among alcohol abusers and the mentally
disabled. In many .instances, the symptoms of alcohol abuse may
mask underlying psychiatric disorders. The two groups may be 65
to 75 percent or more of the daily estimate of the homeless.
Loss of Single Room Occupancy Units
"Gentrification" the rehabilitation of downtown housing for new
affluent purchasers- and the demolition of low-cost residential
hotels and boarding houses in urban reconstruction projects have
both depleted the supply of single-room occupancy units which are
often the homes of very low income individuals. Between 1970 and
1980, about one million rooms--nearly one half the Nation's total
were converted to other uses or destroyed. In general, these
have not been replaced.
-7-
Economic Conditions
In early 1984, at least 35 to 40 percent of the shelter
population were believed to have suffered recent economic
setbacks, such as unemployment and eviction. However, most of
these people have been "at the margin" for some time. This
phenomenon should diminish as a result of continued economic
recovery which has already created over 6.5 million new jobs.
Personal Crises
Very few, perhaps 10 to 15 percent, of the daily homeless
population are homeless due to personal crises such as divorce,
being released from a jail or hospital with no place to go, being
stranded while traveling, domestic violence, and health-related
problems. These conditions are usually temporary rather than
chronic, and a large turnover is common among this group. Thus,
they may comprise a much larger percent of the cumulative annual
population.
II. HELP NOW BEING PROVIDED
A. PRIVATE SECTOR AND VOLUNTARY PROGRAMS
The vast majority of efforts to assist the homeless are being
undertaken by the private sector, including businesses, local,
non-profit groups, churches and synogogues, and other voluntary
organizations. Activities include:
emergency overnight shelters, many of which also serve meals;
vouchers to provide overnight lodging in hotels, apartments,
and motels;
transitional housing, where families or individuals may stay
for several weeks or months while working out their problems;
emergency feeding stations;
food pantries, which provide several days' supply of
groceries;
food banks, which collect nonmarketable food from retailers,
processors, and growers; store it; and redistribute it at
very low cost to charities, including emergency feeding
stations.
There are about 110,000 emergency shelter beds and 300 food
banks. The number of food pantries and emergency feeding
stations is not known, but they are numerous.
-8-
Such services have increased dramatically in recent years, an
indication of the upsurge in need and the response to it. Most
of the food banks have opened in the last five to ten years; 40
percent of all shelters are less than four years old.
In addition to local projects, at least one national initiative
has been sponsored by the private, voluntary sector--
The Robert Wood Johnson Foundation, the Pew Memorial Trust,
and the U.S. Conference of Mayors announced in February 1983
a $19.6 million grant program to deliver health services to
the homeless.
B. LOCAL GOVERNMENTS
Local governments, often in concert with the private sector, play
a major role in the provision of food, shelter, and other
services for the homeless. According to the HUD report, about 80
percent of the city and county governments do at least one of the
following:
O operate shelters;
o give money to private groups to operate shelters or other
services;
O
lease or rehabilitate buildings for private shelter
providers; and
O provide vouchers to homeless persons for use in
hotels/motels/apartments.
In 20 cities surveyed by the U.S. Conference of Mayors in June
1984:
O 90 percent of the cities provided funds to support emergency
services, of which:
-- 46 percent came from local revenues;
-- 46 percent from the Federal government; and
-- 8 percent from State government.
O
Cities made non-financial contributions such as
-- making available city-owned property to house private
emergency service programs;
-- organizing food drives and fundraising activities;
-- establishing emergency hotlines, and
-- undertaking activities aimed at raising public awareness of
the problems.
-9-
C. STATES
The States' primary response to the homeless has been the
allocation or targeting of such funds as the
-- Social Services Block Grant;
-- FEMA Emergency Food and Shelter Program; and the
-- Community Services Block Grant.
O
In a few instances, State funds have been appropriated to
provide either social services or shelter for the homeless.
The National Governors' Association established a Task Force
on the Homeless which issued a report in July 1983
describing the plight of the homeless and the relief
activities of various State and local governments.
D. FEDERAL GOVERNMENT
The Federal Government's response has consisted of three parts:
an interagency task force; special emergency programs; and
regular programs.
Interagency Task Force
On October 31, 1983, Secretary Heckler established an Interagency
Task Force on Food and Shelter for the Homeless to coordinate
Federal food and shelter initiatives; help local groups obtain
unused Federal buildings, food, equipment, and supplies; and
generally cut red tape for local projects seeking Federal
assistance. Its major achievements have been:
certification of 133 food banks to obtain food from 197
military commissaries; eighteen of them received 100,000
pounds of food from January to April 1984;
development of an innovative, model transitional housing
program in Memphis;
help in establishing shelter facilities in Washington, D. C.;
technical assistance to other projects such as a shelter in
Seattle and an innovative shelter financing program in
St. Louis, Missouri; and
a workshop for operators of 30 successful projects and,
based on this, the preparation of a "how-to-do-it" guide for
local groups that is now ready for dissemination to local
providers
-10-
Special Emergency Programs
USDA Emergency Feeding Programs
Since 1982 the Department of Agriculture has made available
more than $1 billion of surplus commodities to help the
needy.
O
In FY 1983, the Congress appropriated:
-- $50 million to help pay for the cost of distributing
excess foods; and
-- $75 million to purchase additional, perishable foods
specifically for emergency feeding stations.
FEMA Emergency Food and Shelter Program
Congress appropriated $140 million to the Federal Emergency
Management Agency (FEMA) in the last two years for emergency
services.
O In FY 1983, $100 million was appropriated with $50 million
going to a National Board, chaired by FEMA and consisting of
representatives of the
-- United Way
-- Salvation Army
-- National Council of Churches
-- National Conference of Catholic Charities
-- Council of Jewish Federations, -and
-- the American Red Cross.
The remaining $50 million went to the States which
distributed funds to local recipients.
Another $40 million was appropriated for the program in
FY 1984; An FY 1984 supplemental appropriation of $70
million was recently approved by the full House
Appropriations Committee.
O About one-third of the money allocated through private local
FEMA boards in FY 1983 went for shelter purposes, with the
remainder spent on emergency food assistance.
Regular Programs
Entitlements
Many of the homeless are eligible for Federal and State cash or
in-kind entitlement benefits such as:
-11-
Social Security Disability Insurance (SSDI)
Supplemental Security Income (SSI)
Aid to Families with Dependent Children (AFDC)
Food Stamps
Medicare
Medicaid
Veterans Cash and Medical Benefits
Although there is no way to assess the total dollars received by
the homeless under these programs, about 20-35 percent of the
homeless do receive some form of public assistance.
Block Grants and Other Programs
A variety of Federal programs can be used to partially support
local projects for the homeless or projects to which homeless
individuals can be referred for services. Many of these are in
the form of grants to States who determine the priorities for
their use. Among the more important are:
Community Services Block Grant
O
Community Development Block Grant
Preventive Health and Health Services Block Grant
Alcohol, Drug Abuse, and Mental Health Services Block Grant
Social Services Block Grant
Low Income Home Energy Assistance Block Grant (for utility
costs for shelters)
Primary Care Block Grant (also known as Community Health
Centers Program)
DOE Weatherization
Runaway and Homeless Youth Program
Section 8 Housing Assistance
Community Support Program
ADAMHA Research
In FY 1983, $34 million was made available for emergency services
under the Community Development Block Grant, and $65 million
through the Community Services Block Grant. Much of this went to
help the homeless. What proportion of the funds under the other
programs was used for the homeless is not known.
E. OVERALL ASSESSMENT
Private Sector, State and
Local Government Programs
On the positive side:
-- the response of State and local governments and local
groups to the plight of the homeless has been
encouraging.
-- several promising innovations are evolving:
-12-
- food banks
- connection of shelters to other social service providers
- formation of coalitions of service providers
- outreach projects
- transitional housing
o
However, additional progress can be made.
More needs to be done to support State and local government
and private efforts to:
-- provide health services, which are inaccessible to the
homeless in many locations;
-- build shelters, which are not available in some locations;
-- rehabilitate and equip some shelters which are physically
deteriorated; some may present health problems; and
-- develop longer-term treatment and support services for the
homeless mentally ill.
In addition, State and local governments need to reexamine
their judicial, mental health, medical care, and social
service systems to ensure that the homeless are not deprived
of help because of service discontinuities or inappropriate
placement policies.
Federal Programs
On the positive side:
-- the block grants have given States flexibility to respond
to the problem, and they have used it.
-- the emergency programs, especially the FEMA program, were
instrumental in helping many local projects get started.
However, there are still areas where improvements can be
made:
-- Federal efforts to provide surplus Federal property to
local groups could be more efficiently coordinated; and
-- the entitlement programs do not work for many homeless
persons:
- Most cannot receive food stamps because
a. With the exception of special congregate feeding
programs for the elderly, disabled, and abused
spouses, food stamps cannot be used for hot meals;
b. if homeless persons reside in a shelter, they are
deemed to be institutionalized and are therefore
ineligible; and
-13-
C. if they are on the streets, they have no place to
prepare food and are therefore ineligible.
- Social Security Disability Insurance is available only to
those who have work histories.
- Most homeless are single; hence, not eligible for AFDC.
- Supplemental Security Income is available to mentally
disabled persons, but they have difficulty applying for
and managing their benefits, especially since more are on
the streets than in shelters.
- Medicare is only for the aged or disabled workers.
- State Medicaid eligibility rules are often contingent
upon eligibility for AFDC or SSI, or even stricter
standards, which exclude some homeless individuals.
- Many homeless do not know how to access those programs
for which they may be eligible.
III. STRATEGY FOR A PUBLIC/PRIVATE PARTNERSHIP
TO AID THE HOMELESS
A. OVERVIEW
O Goals
-- Provide emergency care for the homeless
-- Develop linkages between shelters and service providers
-- Provide continuing care for those most in need
O Focus - Concentrate on the:
-- Mentally ill, including those with multiple
disorders
(As the service system is improved to help the mentally ill,
including those with multiple disorders, other homeless
persons will benefit as well. This will result from
improved outreach, screening, shelter, feeding, health, and
other supportive services, which will benefit the entire
homeless population.)
-14- -
O Responsibility - Collaborative Federal partnership with:
-- State & local governments
-- Private Sector
- business community
- philanthropic & voluntary organizations
O Federal Role - Support Private & Local Efforts Through:
-- Leadership
- Executive Order
- national focus/public awareness
-- Entitlements
- outreach
- remove impediments
-- Technical Assistance
- clearinghouse
- workshops
-- Other Resources
- food
- buildings
- equipment & other supplies
-- Research, Demonstrations, and Training
O Implementation - Three pronged initiative:
-- Immediate Actions:
- Intensive two year effort to match the mentally ill
and alcohol abusers with appropriate services and care
-- Long-term Systems Development and Management:
- Long-term development of service linkages and systems
management
-15-
-- National or regional meetings co-sponsored by one or
more of the groups listed below (i.e. The National
Citizens Committee for Food and Shelter for the Homeless
and/or the National Governor's Association), to coordinate
the above activities with the states and other private
sector groups, focusing on implemetation, not on the
strategy itself. Organizations to involve and/or attend:
- National Citizens Committee on Food and Shelter
for the Homeless
- National Governors' Association
- National Association of State Legislatures
- National Alliance for the Mentally Ill
- National Assn of State Mental Health Program Directors
- National Assn of State Alcohol and Drug Abuse Directors
- National Association of County Executives
- U.S. Conference of Mayors
- American Public Welfare Association
- Business Associations
- Churches, Philanthropic Groups
- Consumer Representatives
- Etc.
B. IMMEDIATE ACTIONS
FEDERAL ACTIVITIES
TO SUPPORT STATE,
LOCAL AND PRIVATE
SERVICE OBJECTIVE
EFFORTS
ANNUAL COST
OUTREACH
Help the homeless
Workshops, resource guides
$ 1 million
obtain shelter and
Representative payees
-00-
services
National Health Service Corps
-00-
Commissioned Corps Officers
-00-
Entitlement outreach
$150 million
LIVING ARRANGEMENTS
Shelters,
HUD non-marketable housing
-00-
transitional houses,
GSA surplus facilities
-00-
and group homes
supplies and equipment
-00-
Business Community initiative
-00-
Food Stamp and SSI eligibility
.....
$ 20 million
for transitional housing
residents
family foster care
workshops, resource guides
$ 1 million
regular entitlement programs
costed above
low-income housing
remove statutory limits on
public housing
single, non-elderly participants
:.
-00-
SERVICES
mental health and
religious and philanthropic
other medical care and
group initiatives
-00-
supportive services
PHS direct services
-00-
-16-
FEDERAL ACTIVITIES
TO SUPPORT STATE,
LOCAL AND PRIVATE
SERVICE OBJECTIVE
EFFORTS
ANNUAL COST
INCOME SUPPORT
cash
regular entitlement programs
costed above
food stamps
housing assistance
medical care financing
MANAGEMENT AND COORDINATION
(overarching
clearinghouse
$ .1 million
activities)
public awareness
$ .1 million
UN International Year
unknown
C. LONG TERM SYSTEMS MANAGEMENT
Longer term effort to reinforce State activities to develop
service linkages and management improvements, in collaboration
with local governments and the private sector.
RESEARCH
Cost: $1-5 million
Limited to policy relevant projects with clear application at
the local level.
services
systems and linkages
programs
epidemiology
DEMONSTRATIONS
Cost: $5-10 million
Focus on service linkages, which may include the following types
of organizations and services, depending on local circumstances:
Services and
Organizations
Support Systems
Community Mental Health Centers
O Shelter
Community Residential Facilities
O
Housing
Outpatient Clinics
Food
Veterans Administration Centers
Entitlements
Transitional Facilities
Transportation
Psychiatric Hospitals
Mental Health Services
General Hospital Psychiatric and
Health and Dental
Substance Abuse Services
Services
-17-
Food Providers
O Vocational and Social
Shelters
Habilitation and
Private Sector
Rehabilitation
Social Clubs
O Private Sector
Judicial Services
Involvement (i.e.,
Correctional Facilities
Projects with
Industry)
TRAINING
Cost: $1-5 million
Training programs to be designed by States and carried out by
service providers in cooperation with universities and the
private sector.
Trainees
Skills
Shelter Providers
Entitlements and Referral
Mental Health Volunteers
Identification of the
Mentally Ill
Mental Health, Alcohol,
Caring for the Homeless
and Drug Abuse Providers
Improve System Linkages For
Better Referral and Care
Self-Help/Homeless
Access Services and
Entitlements and Help Each
Other To Do So
Correctional & Judicial
Identification of the Mentally Ill
Appropriate Referral
IV. SPECIFIC OPTIONS
A. LEADERSHIP: INITIATE ACTION THROUGH
PRESIDENTIAL LEADERSHIP
1. Executive Order
Issue an Executive Order to direct all Federal agencies to give
top priority to and expand their current efforts on behalf of the
homeless.
A Presidential Executive Order and Task Force Charter could be
used to strengthen and publicize the commitment of the Adminis-
tration to make available surplus Federal facilities and
supplies, to cut red tape, and to assist local communities to
respond to the needs of the homeless. The order would
essentially be to carry out the actions described elsewhere in
this paper.
(No cost. )
-18-
2. Religious and Philanthropic Group Initiatives
Through the direct action of the President or through the White
House Office of Private Sector Initiatives, enlist support from
the religious and philanthropic community to design initiatives
that utilize existing networks of churches, synagogues, voluntary
agencies, and public providers to house and serve the homeless,
especially the mentally ill.
This might include:
--
having a parish "adopt" one or more mentally disabled
persons;
--
sponsoring or supervising operations of group homes;
--
training individuals to serve as representative payees and
informal caseworkers; and
--
encouraging and promoting families to provide foster care
for the mentally ill.
(No cost)
3. Business Initiative for Facilities
Through direct action of the President or through the White House
Office Private of Sector Initiatives enlist the support of
business leaders to finance the rehabilitation, equipping, and
supplying of shelters and transitional houses for all homeless
and community residences for the mentally ill.
(No cost)
4.
Public Awareness Campaign
Develop a public awareness program to educate the public, ask
for their help volunteering in shelters and soup kitchens; target
professional, business and industrial, and political leaders to
get their financial support. Provide Presidential or Secretarial
recognition of outstanding projects through awards, site visits,
speeches, etc. Solicit support of celebrities. The campaign
could be directed to the programs for the homeless in general, or
be targeted on the mentally disabled.
(Cost: $100,000)
5. International Year of Shelter
Support the U.N.'s International Year of Shelter for the Homeless
(1987), and direct the HHS Task Force to work closely-with AID
(lead agency) in submitting the United States' accomplishments,
and developing proposed projects for the homeless.
(Cost: Federal contribution to U.N. operations needs to be
determined. However, it would probably be small.)
-19-
B. ENTITLEMENTS: MAKE SURE ENTITLEMENT
PROGRAMS WORK
1. Eligibility Outreach
Extend the current SSDI and SSI outreach program now functioning
in New York City to the 50 most populated cities. Expand it to
include food stamps, AFDC, Medicare, Medicaid, and Veterans cash
and medical benefits. (Estimates suggest that from 40 to 60
percent of the male homeless are military veterans.) Train
shelter operators and clients to assist in initial screening of
potential beneficiaries. Promote the use of representative
payees to receive and manage benefit checks for those disabled
indviduals unable to manage their own finances.
Six Social Security offices are sending a field or claims
representative accompanied by a State Disability Determination
Examiner to seven shelters in New York City each week on a
rotating basis to take applications for Social Security
Disability Insurance (SSDI) and Supplemental Security Income
(SSI).
The program has been operating for more than two years, and as
a result of Secretary Heckler's personal involvement in the
outreach initiative, the rate of eligibility has climbed to over
60 percent.
(Cost: up to $150 million for entitlement payments; 10 FTE's,
and $1 million for State administrative costs.)
2. Federal Field Office Guidelines
Request each Federal agency on the Interagency Task Force to
issue guidelines to their field offices and to State and local
government and private sector grantees explaining what special
rules apply and what special steps could be taken to adapt
entitlement and other application procedures for the homeless.
(No cost)
3. Food Stamp Transitional House Program
Allow residents of all transitional houses to be eligible for
food stamps and also allow them to be used by the housing project
manager to make bulk purchases of food for communal feeding in
the transitional house.
Generally, residents of such facilities are regarded as being in
an institution and therefore ineligible for food stamps. Excep-
tions are made for residents of specialized transitional housing
with programs for alcohol abusers, abused spouses, and SSI blind
or disabled individuals. The proposal is therefore a modest
expansion of current programs.
The proposal will promote the development of transitional housing
projects.
This will require a -legislative change.
(Cost: $10 million)
-20-
4. SSI Eligibility for Shelter Residents
Extend SSI eligibility for those living in shelters from the
current three-month limit to twelve months. This will provide
continued assistance (including Medicaid eligibility) to
individuals in transitional housing programs.
This will require a legislative change.
(Cost: $10 million)
5. Section 8 Certificates for Single Room
Occupancy Units
Waive the 15 percent limitation on the amount of section 8
housing assistance funds which can be used by single (s), non-
elderly clients. This will open up more assistance to the
homeless, the majority of whom are single, non-elderly adults.
(No additional cost)
6. Section 8 Certificates/Vouchers for Shelters
Provide that, on a case-by-case basis, Section 8 vouchers for
individual units could be issued to emergency shelter providers
rather than individual families. Shelter operators could provide
short-term, emergency shelter to many families rather than long-
term assistance to a single family.
(No Cost)
7. Assisted Housing for Battered Spouses
Provide preferred status for battered spouses in assisted housing
programs.
(No additional cost)
C. TECHNICAL ASSISTANCE: PROMOTE PROVEN
SERVICE DELIVERY TECHNIQUES
1. Clearinghouse
Establish a national clearinghouse to provide communities a
network for sharing information about services for the homeless.
The system could include such information as the names of
all food banks matched with military commissaries; shelter
resources available; and model programs to feed and house
the homeless that currently exist and could be duplicated
elsewhere.
-21-
This can be done through Partnership Data Net in Washington,
D.C. which was formed in March 1984 and is supported by HUD,
HHS, DoD, private and non-profit organizations, foundations,
and community volunteer leaders. It grew out of the
President's Private Sector Initiative, and has computerized
the "Adopt-A-School" program which matches a school with a
private organization or company such as Levi Strauss and
Co.
($100,000; the Partnership Data Net has received initial funding
from HUD/HHS and DOD.)
2.
Workshops and Technical Assistance
Develop an intensive program of specialized technical assistance,
including conferences, workshops, and information networks to
State or local government agencies or private groups to promote
the development of innovative programs and systems for mental
health services.
This can be accomplished under authority of section 301 of the
PHS Act.
(Cost: Discretionary; $1-5 million. )
3. Family Foster Care
Promote the use of family foster care programs for the mentally
ill. This could be done in part through the publication (with a
dedication page with message from the Secretary) of a resource
guide already prepared by NIMH.
(No additional cost)
D. OTHER RESOURCES: PROVIDE AVAILABLE
FEDERAL RESOURCES TO SERVICE PROVIDERS
WHO REQUEST ASSISTANCE
1. HHS Homeless Task Force Operations
Provide continuing and stable staff for the Homeless Task Force
to coordinate and monitor governmentwide activities described
throughout the report. Consider establishing a permanent office
for the homeless in OS, HDS, or OCS ( the latter option only if
funds for OCS are included in the FY 1986 budget).
($350,000)
2. Food Banks -- Commissaries
Require DOD and DOT/Coast Guard Commissaries to improve the
transfer of nonmarketable food from their commissaries to local
food banks.
(Minimal administrative costs to conduct workshops, etc.)
-22-
3. Federal Facilities, Equipment, and Supplies
Organize more effectively the current efforts (e.g., through an
Executive Order) to release surplus Federal buildings, equipment,
and supplies to local groups requesting them for projects for the
homeless. In particular, obtain from HUD, GSA, DOD, and Farmers
Home Administration accurate and complete lists of available
properties, periodically updated. More aggressively advertize
the availability of all surplus property, equipment and
supplies.
(No cost; can be done by current Task Force; however, inventory
value of buildings will depend on local real estate values,
condition of facility, etc.)
4. Memphis/Hud Transitional Housing Project
Replicate the Memphis/HUD project in 10 cities in each region, a
total of 100 cities, with special emphasis on designing transi-
tional housing or group homes for the mentally ill.
(No cost; however, inventory value of buildings will depend on
local real estate values, conditions of facilities, etc.)
5. Extended Leases for HUD Homes
Extend for more than one year the one-dollar leases on nonmarket-
able but repairable homes which are made available by HUD to non-
profit organizations. Under the current program, such homes can
be leased for only one year. As a result, the non-profit organi-
zations which sponsor the transitional housing projects may be
unwilling to invest in the repairs needed to start the projects
or to make commitments to families in the final few months of
that year. This proposal would make such houses a much more
attractive resource for these projects.
(No additional cost)
6. Urban Homesteading Units
Give cities the option to sell urban homesteading units to non-
profit organizations for use as shelters, transitional houses, or
group homes for the mentally ill. Under the current program,
urban homesteading units are sold at a low price to cities by
HUD; the cities in turn sell them to individual homesteaders who
repair them.
This would require a legislative change.
(No additional cost)
-23-
7.
PHS Direct Services
Assign National Health Service Corps personnel and PHS
Commissioned Corps Officers to work in shelters, provide health
screening and referral services in shelters and mobile street
outreach teams, and provide support to networks of shelters,
perhaps working through community health centers or clinics.
(No additional cost; reprioritizing of current resources)
8. Minimum Health and Safety Guidelines
Direct the Centers for Disease Control to work with State Health
Departments to develop guidelines to address health hazards in
order to prevent epidemics and cross-infections in shelters.
(No Cost)
9. ACTION Agency Volunteers
Adapt current ACTION programs to utilize public and private
volunteers to assist the homeless; e.g., train and assign VISTA
volunteers to work with the homeless.
(Cost: $200,000)
10. Shelter Improvements and Operations
Provide Federal funding to pay for part of the cost of
rehabilitating and operating shelters.
In November 1983, Congress enacted P.L. 98-181 which authorized
$60 million for HUD to make grants for this purpose. No funds
were appropriated, however. Instead, Congress appropriated $100
million in FY 1983 and $60 million in FY 1984 to FEMA for an
emergency food and shelter program. An FY 1984 supplemental
appropriation of $60 million has been approved by the Senate and
$70 million has been approved by the full House Appropriations
Committee. The FEMA National Voluntary Board has discretion for
allocating and regulating funds, which may include rehabilitation
expenditures.
(Cost: Discretionary; $60-70 million)
-24-
E. RESEARCH, DEMONSTRATIONS, AND TRAINING:
DEVELOP A BASIS FOR IMPROVING THE SERVICE
DELIVERY SYSTEM
1. General Research
Expand HHS research activities to include projects on the
epidemiology and dynamics of homelessness and mental illness;
the characteristics of the affected population; and effective
treatment interventions, services, programs, and systems
linkages. This can be done under current HHS research
authorities.
(Cost: Discretionary amount, $1-5 million.)
2. Placement Policies
Undertake a special research project to examine State and local
government placement policies for the mentally ill to identify
the most appropriate and effective means to protect the mentally
ill from involuntary commitment while at the same time ensuring
accessibility to treatment.
(Cost: $.5 million)
3. HHS Demonstration Program
Provide additional seed money to states for innovative service
approaches and systems linkages to assist the homeless mentally
ill. Systems would be designed to include:
--
outreach programs
--
mental health and substance abuse services in overnight
shelters
--
drop-in centers
--
crisis housing
--
health and dental services
--
reconnecting with families
--
case management services
--
long-term rehabilitation, and
--
development of innovative funding sources (including
participation of the private sector and encouragement of
voluntarism).
This could be carried out through a number of the Department's
discretionary programs.
(Cost: Discretionary; $5-10 million)
4. HUD/HHS Demonstration -- Housing
Vouchers for the Mentally Ill
On a demonstration basis, starting in FY 1986, provide section 8
housing vouchers and mental health and other supportive services
to mentally ill individuals. HUD would reserve a fixed number of
-25-
vouchers and the related funds for housing assistance to those
mentally ill individuals for whom a program of supportive
services is organized and operated by a local government or non-
profit organization. HHS would provide administrative funds up
to a specified limit for organizing the supportive services. HUD
and HHS would jointly administer the program.
(Cost: Discretionary)
HUD: section 8 vouchers: $1-10 million
HHS: administrative costs: $.1-1 million
5. Training and Retraining of Mental Health and
Related Health Service Personnel, and Social
Service Providers
Provide grants to selected schools and State agencies to develop
model training programs and to train mental health and related
health service personnel and social service providers (including
shelter operators) on the special techniques for dealing with
homeless individuals who are mentally ill. Current authority is
sufficient for mental health training programs.
(Cost: Discretionary; $1-5 million)