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Healing Chronic Homelessness

To live unhoused for any period of time can be harsh and disorienting. But to live without a home, for years on end, is a trauma that is difficult to overcome. Such long-term homelessness is often described as chronic homelessness, a circumstance that itself can be life-threatening. 

Data tracked over the last 23 years shows that people experiencing homelessness tend to die decades sooner, and in larger numbers, than people who have never experienced homelessness. In 2022, at least 91 people died while experiencing homelessness in Santa Cruz County. The average age of those who died last year was 49.

By definition, people experiencing chronic homelessness are those who have lived unhoused for a year or more, or repeatedly over the past three years, and who also suffer from a complexity of disabling health conditions, which may include long-term substance use, chronic illness, and mental health disorders. 

Santa Cruz County’s 2022 Point-in-Time (PIT) count identified 921 chronically homeless individuals, 78% of whom were living in tents, vehicles, doorways, and parks throughout the county. 

The stresses of day-to-day survival take a substantial toll, putting an already vulnerable population at even higher risk for illness, injury, and abuse-related trauma. There’s also a greater likelihood of interaction with law enforcement and emergency services. Addiction as a coping mechanism becomes a way of life, and people become increasingly socially isolated as they start to avoid family and friends.

“The longer someone is homeless, the more their health and well-being declines,”  says Joey Crottogini, Health Center Manager for the county’s Homeless Persons Health Project (HPHP). 

And the longer someone is homeless and unsheltered, adds Tom Stagg, Housing Matters’ Chief Initiatives Officer, the more difficult it becomes to help them end their homelessness.

Chronic challenges

Chronically homeless individuals are among the most numerous and visible in Santa Cruz County. But they tend to receive the fewest supportive services, notes Stagg. That’s because more programs and resources exist to help families, veterans, and youth experiencing homelessness. Waitlists for the services that do exist are long, and housing options are extremely limited.

“Providing case management for someone experiencing chronic homelessness is really time-intensive,” says Stagg. “It’s an active intervention that requires staff to dedicate a significant amount of time to support someone on a path to housing.” 

Frequent one-on-one visits, as often as daily, are the norm. This limits the number of people case managers can work with at a given time, to 15 or 20 people at most. By comparison, case managers working with other populations can work with 40 or more.

“The first key is having enough staffing,” says Stagg, of what’s needed to successfully house people experiencing chronic homelessness. The second, he explains, is being able to provide housing vouchers and rent assistance, and the third is having an adequate supply of affordable housing with landlords willing to say yes to housing someone who was homeless.

“Being able to combine those things, and having those supports continue indefinitely, is what essentially comes out to be permanent supportive housing,” he says.

There’s plenty of evidence to show that permanent supportive housing, or PSH, is one of the most effective strategies for resolving chronic homelessness. The idea is to provide behavioral health services, healthcare, and case management preferably on-site, along with housing so that people have easy access to the healthcare and peer support they need to stay housed. 

A 2020 UCSF study that followed 423 chronically homeless individuals in Santa Clara County, for example, found that 86% of those placed into permanent supportive housing remained stably housed after four years.

The challenge in Santa Cruz County is one of availability. Historically, PSH in the county has been patched together in what’s called a “scattered site” model. PSH participants are located wherever they can obtain housing and must travel to other locations to receive supportive services. Case managers must drive to multiple locations across the county to meet with PSH participants in their homes. 

A related challenge is that people who are newly housed are somewhat isolated in that  they generally lack the kind of peer support that often plays a key role in helping someone stay housed. Without that support from people who have gone through similar experiences, “it can be hard for someone to integrate into the community when they’ve been homeless for so long,” says Stagg.

PSH underway

Fortunately, on-site permanent supportive housing is becoming more of a reality in Santa Cruz County. Multi-unit residences like 801 River Street — located directly across from the Housing Matters campus — will provide a healing environment for people who require ongoing services and care as they exit homelessness. That 7-unit residence is set to open in early 2023.

Another project currently underway is Harvey West Studios, a high-density residence that will bring 120 units of PSH housing directly to the Housing Matters campus. Construction is expected to break ground this summer.

For people like 70-year-old Steve M., the units can’t be built fast enough. 

Steve’s homelessness evolved over a period of many years, beginning in San Jose in 1998 with a bankruptcy and the loss of a tech company an OEM laser manufacturer which he had helped found. Around 2000, Steve began working as an independent stage technician, helping set up equipment at trade shows around the Bay Area. From there, a series of life events recovery from brain surgery in 2008, the death of his wife, mounting debts led him to eventually move into his RV. He began self-medicating with drugs and alcohol as a way to manage his pain. After his girlfriend — who struggled with alcoholism — died, Steve was forced to sell his RV. 

“Basically, I screwed up a lot,” says Steve. That’s when he began living in a tent in San Lorenzo Park. 

Steve obtained a housing voucher through the Housing Authority of the County of Santa Cruz, but his voucher expired after a year during which he was unable to find housing.  He’s now working with Housing Matters case managers to obtain permanent supportive housing. 

“At my age, I can’t be out here anymore,” says Steve. 

The hope is that Steve, and others who are experiencing chronic homelessness, won’t have to wait much longer for a healing place to call home. 

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Claudia Graziano Burgin is a Santa Cruz-based freelance writer who specializes in writing about community issues, and for local nonprofits.