Home Again: Only a Home Ends Homelessness
September 2009
Home Again: Only a Home Ends Homelessness 
Working With the Community to End Adult Chronic Homelessness in the Greater Worcester Area
Home Again News September 2009 
In This Issue
Interview with Dr. Jan Yost
Interview with Dr. Erik Garcia
Investing more in case management
Profile of Ellen Ryder
Dontate to Home Again
About Home Again
Quick Links
Dear Home Again supporter,
As the conversation around health care consumes the nation, it is important to remind people that chronic homelessness is also one of the country's major public health issues.
Home Again, and many other organizations and programs, are guided by knowing that adult chronic homelessness is a major public health issue that has profound negative effects on our communities.  We are driven to provide a compassionate solution that will improve the physical well-being of each individual who is chronically homeless.
In the last year or so, we have seen increasing evidence that effectively reducing chronic homelessness, through "housing first," drastically reduces the burden on the state's Medicaid system by reducing the use of emergency medical services. 
That is why organizations like the Massachusetts Housing and Shelter Alliance are working to persuade the state Medicaid system to include more coverage of case management for chronically homeless individuals in supporting housing.  A small investment by Medicaid for these services will save hundreds of thousands of dollars down the line.  If this is achieved, it will be a substantial step in health care savings for the state.
The Health Foundation of Central Massachusetts also sees chronic homelessness as a major public health issue. Early on, after reviewing the evidence and best practices from around the country, The Health Foundation chose to provide resources to Home Again because of its focus on housing first as a solution to a major public health issue facing the Worcester area. Today, we are very grateful to have the public backing of The Health Foundation of Central Massachusetts, which provided Home Again with $1.6 million in grants. 
Chronic Homelessness is also a major health issue affecting the quality of life for those who are living through it. Even though we have a great deal of experience working with chronically homeless people and their health issues, it is no less shocking or sad to us when someone in one of our programs passes away.  
"Bill" came into the Home Again program with his longtime partner "Charlene" after fifteen years of living on the street and in shelters.  He was moved to tears when he was shown the apartment that would start him and Charlene on the path to changing their lives.  But, within a year, he passed away from a heart attack.
We know that providing people with a home and access to support services can greatly improve the health of chronically homeless people. But, we also know that sometimes the toll on a person's body after years of exposure to the elements, the brutality of life on the streets, and poor medical care can not be reversed.
The small comfort we can take in his passing and that of others is that by providing Bill with housing allowed him to die with dignity, close to someone he loved, and in a place he called his home, which is something every person should have.

Brooke Doyle,
Project Director,
Home Again

  Chronic homelessness is a public health issue: An interview with Dr. Jan Yost of The Health Foundation of Central Massachusetts

 For The Health Foundation of Central Massachusetts, working to end adult chronic homelessness in the Worcester region aligns with their mission.  "We see chronic homelessness as a major public health issue," says Dr. Jan Yost, president and CEO of the Foundation.  "We use the World Health Organization's definition of what it means to be healthy, which is physical, mental and social well being, and if you are homeless, you very often don't have any of these. That is why Home Again's mission syncs perfectly with the Foundation's mission."
That mission is to improve the health of those who live or work in the Central Massachusetts region especially in underserved and vulnerable populations.  The Foundation has been a major supporter of the Home Again program from the beginning providing it with $1.6 million in grants over the last three years. Dr.Yost  maintains the view that the "housing first" approach of providing housing and supportive case management services to chronically homeless people utilized by Home Again is not only a humane way to address this serious public health issue, but one that also lowers costs to the community.
"There is a perception that the least expensive way to solve chronic homelessness is to do nothing or place people in temporary shelters.
Evidence shows that providing housing and case management substantially lowers the cost to the community and reduces the burden on Medicaid because those in permanent housing spend less time in the emergency room and often become much healthier in every way."  Dr.Yost points to recent articles in the Journal of the American Medical Association that offer evidence showing that housing first reduces Medicaid costs and is an effective tool in reducing the health issues that come with chronic homelessness.
The Health Foundation intends that its funding also contribute to improving health by advancing related public policy issues.  After reviewing evidence and best practices from other programs across the country, the Foundation understood the value of supporting housing first before it had widespread support at the state and federal level.  "I do believe that Home Again has contributed directly to the growing consensus that housing first is the most effective way to reduce chronic homelessness in Massachusetts," says Dr. Yost.
Today, Home Again has placed in permanent homes 30 of the chronically or pre-chronically homeless people who were in frequenting Worcester's People in Peril shelter.  "Home Again continues to make real progress on reducing the number of chronically homeless individuals in the Worcester area," says Dr.Yost. "That's a significant improvement in a major public health issue and we are proud to be supporting the project."


Chronic homelessness is a serious health issue for individuals: An interview with Dr. Erik Garcia

Living on the streets takes a terrible toll on the human body. Lack of consistent medical care, exposure to the elements, substance abuse, and untreated mental illness are all major health issues faced by chronically homeless people every day. 
Dr Erik Garcia has been treating chronically homeless people in Worcester for over 15 years.  He knows that chronic homelessness is a major public health issue in Worcester because he has seen first-hand the impact  that living on the streets has on the people he treats. Dr. Garcia believes that for any program to be successful in reducing chronic homeless, it must work toward improving the health of each individual.
"The most pervasive reason chronically homeless people suffer from such bad health is simply poor access to health care," says Dr. Garcia.  "It really is a matter of getting into a doctor's office regularly, and chronically homeless people just can't make that happen."
Living on the street with inconsistent health care means that chronically homeless people suffer needlessly every day of their lives.   
For years, Dr. Garcia has seen how homelessness deeply affects both the body and the mind. Treatable health issues like lung and heart disease and diabetes become irreversible if left unchecked.  Living in the elements causes frostbite and trench foot that are painful and debilitating.   Sleeping in shelters exposes one to chronic diseases and parasites.  Substance abuse takes a toll on the body and a person's mental health when there is no access to help.  And, homeless people are often victims of physical and sexual violence that can leave lasting mental and physical scars.
For all the reasons, Dr. Garcia says that the old system of "getting people sober and into a shelter" does not work because it does not solve the health issues that cause homeless people to suffer. He believes housing first programs like Home Again are a "god send" to many chronically homeless people because they provide access to consistent health care, support services and the incentive to improve their lives.
Dr. Garcia has seen some of the homeless people he has treated at the People in Peril shelter flourish once they have a home.  "Clients are just inspired to become sober when they have a home.  One client who entered Home Again's Spencer House just stopped drinking," said Dr. Garcia.  "Another client's health improved so much once she moved into her own home."
He acknowledges that the challenge for the next few years will be to figure out the best way to provide health care for housing first clients, but believes that this solution is both a compassionate and effective way to help chronically homeless people with all of their health issues.
Dr. Garcia is very well aware that providing a chronically homeless person with a home cannot erase away years of cumulative damage to a person's body.  This became quite clear with the recent death of a Home Again client from a heart attack.  But, Dr. Garcia says that housing first provided a compassionate solution to one of the biggest health issues we all face: end of life.  "Those that pass away in these programs do not die anonymously in the street.  They die in a place they call home knowing that people care for them."

The toll of chronic homelessness: Bill's" story

Life on the streets takes a profound toll on the human body that sometimes cannot be undone.  That was made clear to the Home Again community when "Bill" passed away from an apparent heart attack six months after moving into his own apartment provided by the program.
"Bill" spent 15 years out on the streets of Worcester, much of it with his companion "Charlene"  before they moved into their own apartment with the help of Home Again.
"When they first walked into the apartment, they both cried," said Home Again Supervisor Gladys Rodriguez.  "Bill was just so happy that Charlene had a home."
"Bill" enjoyed living in his apartment with Charlene and his outgoing personality made him popular among the Home Again and Community Healthlink staff.
He was such a sweet guy," said Rodriguez. "He cared about everybody, had a great spirit and was very funny. We were so sad and shocked when he passed away."
Although providing a permanent home to chronically homeless people improves their health and reduces dependence on emergency care, it cannot always counter the profound negative effects on a person's health that comes with chronic homelessness.
The Home Again community does take some solace in knowing that Bill died in a place he called home with someone he loved rather than on the streets or in a crowded shelter among strangers. 
While a having a home could not prevent Bill's death, it did provide him with a way to face one of the most important health issues: to die with dignity.
Read about who Home Again is designed to serve

Increasing Medicaid investment in case management for chronically homeless people

As the nation and the state focus heavily on health care reform and the need to lower health care costs, advocates for the chronically homeless are promoting evidence showing that providing a home and case management actually lowers the burden on state Medicaid systems.
Chronically homeless adults are the highest users of Medicaid resources because they rely so heavily on emergency health services. 
The Massachusetts Housing and Shelter Alliance (MHSA) recently released data from their Home & Healthy for Good program showing annual Medicaid costs for that program's participants, who were tracked, went from $26,124 per person before they were housed to just $8,500 after housing-  a drop of $17,624.00 in Medicaid costs per person each year. 
This huge reduction in costs is why organizations like MHSA are today working to secure more Medicaid coverage for case management for chronically homeless people in supportive housing programs like their Home & Healthy for Good Housing First program.
"Providing chronically homeless people with housing and support services drastically reduces the burden on Medicaid," says 
Joe Finn, Executive Director of the Massachusetts Housing and Shelter Alliance.  "If we can secure more Medicaid funding for case management, chronically homeless people will rely less on emergency health care, which in turn will reduce the costs to the state by hundreds of thousands of dollars each year."

Read the JAMA article that shows how providing a home and support services lowers Medicaid costs

Home Again profile: Ellen Ryder

Ellen Ryder, director of public affairs at the College of the Holy Cross, talks about what drew her to work with Home Again after returning home to Worcester.


Donate to Home Again 

Your generous support will assist Home Again in helping homeless adults take the steps needed to reclaim their lives and move away from reliance on costly emergency services, which will improve the overall quality of life for the communities in the Greater Worcester area.
Please click here to visit our online donations page.
When you make a donation, you become part of a compassionate and proven solution that is working to improve people's lives through the power of a having a place to call home.
Thank you.

About Home Again
Home Again has created and implemented a model program that will reduce the number of chronically and pre-chronically homeless adults who live on the streets, consistently use emergency shelters and rely on emergency rooms for all their medical needs.
Home Again serves chronically and pre-chronically homeless adults by providing them immediately with permanent housing, community-based support services, and a case management staff who assist with access to health care, mental health and employment services.