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February 2, 2007
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NOW Transcript - Show 305
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Transcript - February 2, 2007

BRANCACCIO: Welcome to NOW...on the road—or really a New York subway ride away—in the Bronx.

Come with us as we investigate a radical idea that's taking on one of the toughest problems in America. And guess what? There's evidence it's actually working.

The problem is hard-core homelessness.

The approach is a new way of thinking that's spreading from here to hundreds of cities across the country. Here's how it works - are you ready for this?: You give...a homeless person...a home.

It is fascinating to watch this play out and that's what we're about to do with the help of an agreeable man who goes by the name of Footie.

William Brangham and Karla Murthy produced our report, part of our series we're calling "ideas that work."

DOYLE: Every morning, I used to always wake up and I'd start walking. Hustle up and down the street, asking people do they—have a quarter or a dime? I can get me a loose cigarette and I can get me—Can get me my beer. And start walking. Keep on walk—I do a lot of walking.

BRANCACCIO: Edward Doyle walks everywhere. That could be why everybody calls him 'Footie'. He walks because he doesn't have a car. Or a job. Or a place to live. Its been a long time since he had a real home.

DOYLE: The last time was more than ten years ago. I was drinking too much So they put me out. That's when I was really starting—sleeping inside the park or—riding the trains.

BRANCACCIO: Beyond the alcoholism, he suffers from depression. On top of that, terrible bouts of seizures. It's not hard to see why Footie's been stuck for so long.

But Footie is about to hook into a bold new experiment that could transform his life. It's a movement that's happening in hundreds of cities around the country... We spent the last few months with him to figure out if this approach can work where nothing else has.
ACEVEDO: We don't know if he's having the seizures from the alcohol, or if he's having it from not taking his medication.

BRANCACCIO: Ralph Acevedo works at a place called the living room - another spot where Footie sometimes slept. It's a homeless drop-in center in the Bronx.. You can get a meal, take a shower, talk to a social worker. But there are no beds, so if you want to sleep, it's on a hard chair slumped against the table.

People tried to pick fights with Footie here. Even fights across the room seemed to make the seizures worse.

Acevedo's been trying for almost four years to find Footie a permanent place to live. But it never worked out.

ACEVEDO: Some places would require that he remain sober or come in sober. And that's the toughest challenge for Footie. And once they see that he has all these medical conditions because of it, they shy away from him right away

BRANCACCIO: This has been an ongoing struggle for Footie, and for tens of thousands of people like him across the country.

The long-term street homeless —those who're both mentally ill and struggling with substance abuse —have proven to be immune to the remedies society has thrown at them.

Part of the problem is that many housing programs insist that they're stable before they're given their own place.

ACEVEDO: There are appropriate placements for him. Unfortunately, you know, due to—Footie not wanting to remain sober, and come in sober, is—you know, and they never would accept him.

TSEMBERIS: So it's a—there's a bit of an irony there. That the—that the housing for the homeless, mentally ill all—you know, drug addict, requires that the person is neither mentally ill or a drugged addict—drug addict, in order to get in.

BRANCACCIO: Sam Tsemberis runs a group called Pathways to Housing. He's one of the pioneers of an innovative and controversial idea known As 'Housing First.'

TSEMBERIS: Homelessness is cured by housing. Mental illness and addiction disorder require the treatments—you know, the day—state of the art treatments that we have today for psychiatric treatment and addiction disorder. Most programs put all these things together. When you separate them, the job actually becomes easier.

BRANCACCIO: But can it really work? Can you put someone like Footie right into his own home and expect it to work out?

This Bronx Park used to be the closest thing to a home that Footie had.

BRANCACCIO: Now, isn't it cold to sleep in a park like this?

DOYLE: No. Reason why it wasn't cold to me, because I used to always—at that time, I was drinking a whole lotta wine. And wine was keeping me warm.

BRANCACCIO: Footie's life has been rough. Spent a lot of nights in the cold. He's been beaten up. He's seen so much violence around him that he says he gets nervous around anything sharp.

DOYLE: Everything started—seemed like it started going wrong for me, and I just wanted to be by myself.

BRANCACCIO: But Footie's about to get a chance to turn things around.

It started at this housing fair, where he met some people from Pathways. Straight away, they offer Something he's wanted for a good long time.

SILVER: So once you get your apartment, you can stay there forever. There's no time limit, its not like it's a program for a year and then you have to leave. We have people who've lived in their apartments for 10 years. Do you have any questions so far?

DOYLE: No, it sounds good everything you said to me

BRANCACCIO: They tell Footie they'll give him a furnished apartment. After that, they'll offer a whole bunch of services —everything from psychiatric care to dealing with his drinking —but none of that is required for him to get the home.

ACEVEDO: Footie was very excited to hear that he could be housed, and, you know, someone is gonna address his issues, especially his medical issues. Unfortunately he got so happy he took off on us, and we're in the process of trying to locate him now.

BRANCACCIO: Pathways wants to get Footie into a temporary room this very night, so they search the Bronx trying to find him...

ACEVEDO: Just keep an eye out, he's got a ski hat on. I got a bad feeling he might be intoxicated by the time we find him.

BRANCACCIO: Sure enough, when they do find him standing at a gas station, He's less than sober.

ACEVEDO: What you been drinking?

BRANCACCIO: Drunk or not, Pathways wants him in the program. Tonight will be the first bed Footie's had in who knows how long.

The search for a permanent apartment starts tomorrow.

BRANCACCIO: How can we, as taxpayers afford to give an apartment like this to a person who has this many challenges?

TSEMBERIS: Well, I would ask how could we afford not to do it. You can house people who are homeless either because it's just the right thing to do—from a humane, compassionate approach. Or you can do it because it's the smart thing to do. This is just a more efficient and humane way to take care of people. And it's much, much cheaper.

BRANCACCIO: Cheaper? This is one of the big surprises about street homelessness: you figure a blanket and a bowl of soup, maybe a shelter bed now and then, is all they cost taxpayers. Not quite.

Just take a look back at what happened to Footie during the years when he was at the living room.

AUWATER: Footie stayed here on and off for seven or eight years. And, during that time, I think, conservatively we had to call EMS for him at least 100 times.

BRANCACCIO: Remember those seizures? He'd fall down and bang his head. Those ambulance trips are not cheap

AUWATER: All the EMT guys in the Bronx know Footy. I think he's extremely well known.

FELD: Oh I remember him so well. He has been coming here many, many times.

BRANCACCIO: At Lincoln hospital, we ran into plenty of staffers who knew Footie

FELD: A lot of time he needs more than seizure care. He needs more than that. He comes with some mental issues, like depression. And one thing about him is he has no place to stay.

AUWATER: I think if you added up all the costs that were associated with his homelessness, it would be easily in the hundreds of thousands of dollars, if not more.

BRANCACCIO: A study from San Diego bears this out. Long-term homeless people were tracked for their use of emergency medical services. The cost? An average of $100,000 each in just eighteen months

TSEMBERIS: We are paying a price for it. And the price we're paying is enormous—relative to providing an apartment with support services.

BRANCACCIO: So, amid all the arguments—there's the—"hey, and it saves money" argument you're saying?

TSEMBERIS: That's right. It's cheaper.

BRANCACCIO: It's been two weeks since the Pathways team connected with Footie...

Today, they're taking him apartment shopping.

FERGUSON: This is your kitchen...

BRANCACCIO: This is supposed to be one of three units to see today.

DOYLE: I think I like this.

Yeah, you said it will be all in one month?

AMANDA: Hopefully so yeah. We'll get all the furniture picked out. And then we'll set up your utilities with you. It happens very quickly.

DOYLE: It sounds good to me. That will be my Christmas present.

CHARLES: Come Footie, come check out the kitchen...

DOYLE: It was something for me like a dream house and I never—I never—I never had a place that big before in my life. If I didn't feel like walking out in the streets, I could walk right inside there around there. 'Cause I could do a lot of walking anyway. I could walk in that living room, that living room is so big. I like that.

ACEVEDO: With this Housing First model was very reluctant at first. And I'm like, I'm like this is not gonna work. You're gonna house someone who's currently using substances, whether it be crack, heroin, marijuana, or alcohol, or any other recreational drug they can get their hands on. And you're telling them they can do whatever they want in the apartment. And I'm like you're gonna have a lot of issues with real estates and landlords having this.

BRANCACCIO: Turns out, most landlords are happy to get the regular checks Pathways promises. So that's not been a problem.

But is it fair? Normally, we ask people to do the hard work first - like getting sober. Only then you get the reward.

BRANCACCIO: So, the program that you've pioneered here gives these folks an apartment. But, you don't require that they kick drugs if they abuse drugs. You don't require that they get psychological counseling or take their meds before you give the apartment. Why not require those things?

TSEMBERIS: You don't hold the person hostage in homelessness until they're no longer a drug addict or no longer psychiatrically disabled. I mean, if your safety and survival isn't assured you can't think, "Oh, I need to go see a psychiatrist and talk about my problems." Or, "I'm going to have to take on this addiction disorder." All you're thinking of is, "Am I going to be safe? Am I going to be okay? Where can I sleep tonight?" And that just takes over. Until that's settled, which with the housing settles that right away, then you can go to the next step and think about, "What else do I want to do with my life?"

BRANCACCIO: Footie's spent nine days in this temporary room. And it's been an improvement : A bed.. Nobody fighting.. But now, it's moving day.

MCGEE: Today we're moving Footie into his apartment the one with Pathways to Housing so right now we're just taking his stuff and go shopping with him.

CHARLES: Doyle, what's this?

BRANCACCIO: His case worker discovers several packets of seizure medication...

CHARLES: That means you didn't take it last night.. hmm?
BRANCACCIO: These are pills he should have already taken... getting Footie to take his meds on time is going to be a priority for Pathways.

CHARLES: Come on Doyle, say goodbye to your little quarters

MCGEE: And as part of our move in program for all new people, we have a stipend amount of money that we give to them and we take them shopping for things, shower curtains, towels, silverware, anything you can think of in terms of moving into a new apartment. Its suprising how much stuff you need to get .. toiletries, and then we'll bring them over to the apartment and move him in. Its suprising how much stuff you need to get ..

MCGEE: You want orange scent, Footie? Or lavender?

MCGEE: And we'll bring them over to the apartment and move him in.

BRANCACCIO: This is the first time Footie has seen his place with all the new furniture.

DOYLE: Looks good. To me it do. I don't have nothing to worry about now.

BRANCACCIO: Pathways has moved over a thousand homeless people into apartments since they started in 1992. It costs about $22,000 a year to make this work, per person: about half for rent, the rest for all the support services

Pathways makes tenants contribute a third of whatever income they get. So Footie will pay about $200 a month out of his government disability check towards rent and utilities. Pathways picks up the rest.

Pathways has had a lot of success - they say 85% of their clients stay housed. But it's not always on the first try... some people trash their apartments. Others threaten their neighbors. But Pathways hangs on to those people, sometimes giving clients 2 or 3 different places in the hope the program will stick.

MCGEE: Here you go! Here's your keys.

DOYLE: Thank you.

MCGEE: You're welcome.

TSEMBERIS: Once people move in—they start to have to confront all of the difficulties of, sort of, reintegrating back into society. How to cook for themselves, again. How to—shop for themselves. For the first time, looking at their addiction. And how it's getting in the way of maybe maintaining this apartment. The harder work actually begins after people are housed. And that's what the teams are for

MCGEE: These are medication packages that are already set up, okay?

BRANCACCIO: Kyle mcgee will lead the team from pathways who'll work with Footie. Managing his seizure medication is one of the first steps.

MCGEE: Okay. So, here's one for tonight, okay? Then here's tomorrow morning and then also attached is the evening, okay? For Do you feel like some help, you know, in terms of your diet?

DOYLE: I'm just glad I be eatin'. That's all.

MCGEE: Yeah, yeah, I hear ya—I hear ya.

BRANCACCIO: Now that he finally has a roof over his head, the team will help Footie focus on what he wants the rest of his \life to look like.

DOYLE: I started being inside here So it's gonna take me—I don't know how long it's gonna take me to be satisfied with myself.

BRANCACCIO: Ralph Acevedo has come around about housing first. He's seen what it's done for his other clients, and with Footie.

ACEVEDO: You know, he—he's a little timid and maybe embarrassed to have a drink or two knowing someone's gonna come give him his medication. So he's like, "Wow, like, you know, I don't—I don't want to appear a certain way in front of these people." And I'm like—yeah, I don't believe he's telling me this. You know, like, for him to even think of something—like that, I've—in the four years I've been working with him, I've never ever got that out of Footie. So that in—in essence, that alone is a positive. 'Cause he's—acknowledging certain things about himself. and—that's—that's positive. That's so positive.

BRANCACCIO: Even as Footie Doyle comes to terms with what could be a new life, there are efforts in high places to teach other cities about programs like this one.

MANGANO: You're joined in a partnership today that literally begins in the White House and extends into the streets.

BRANCACCIO: Philip Mangano is president bush's homelessness czar. He's been evangelizing nationwide for housing first...citing its effectiveness and its cost savings.

MANGANO: That's why we have 285 mayors and county executives who have created ten-year plans to end chronic homelessness in their cities.Not to continue to manage homelessness. We've literally changed the verb of homelessness.

BRANCACCIO: Remember, though, housing first is geared towards the Footies of the world —the mentally ill, substance abusing, long-term homeless. While they're the ones we see on our streets, they're just one part of the homeless population. The majority are those you tend not to see —homeless single moms, kids, families —living in and out of shelters.

BRANCACCIO: You say very strongly that you're trying not to manage homelessness, but really to wipe it out. But aren't you really talking about a certain subset of homeless people? Not the broader population.

MANGANO: I think the intent of this administration is to end homelessness. But you need to start somewhere . We're going to start with the most vulnerable and disabled, and begin the process of ending homelessness there

BRANCACCIO: Advocates for the homeless are thrilled that housing first is getting a federal boost.

But those same people argue that the Bush administration is simultaneously neglecting that much larger population of homeless people. They say that a history of cuts to other federal programs —things like low-income housing subsidies —may actually make homelessness worse.

In fact, just this week, the new congress was fighting to undo some of those cuts.

BRANCACCIO: Does it frustrate you when you see this administration, in its budgets, cutting back money for programs like that?

MANGANO: No one has an intent, whether in Congress or in this administration, to increase homelessness, but we're still wrestling with how to best apply housing resources to get a better effect. It's only as we've concentrated resources on people experiencing chronic homelessness, to create change where change was thought to be impossible. The promise of that, is that as the numbers of people on the streets go down, that will re-moralize us to invest more in the other populations.

TSEMBERIS: This is not—a program that will end homelessness. It'll end homelessness for, you know, one person at the time. What it does demonstrate is that everybody can live in housing. That we don't need to build, you know, more hospitals or—jails or other institutions. Everyone just needs a simple, you know, decent, affordable place to live.

BRANCACCIO: So this it? This is where you live?


BRANCACCIO: The other day. I went to visit Footie in his new place.

BRANCACCIO: Well Footie, look at this. This is really cool. This is your place. Look at this. Got the living room. You're all set up.

DOYLE: Color TV.


DOYLE: Color TV there.

BRANCACCIO: So what, you can like lie in bed and watch TV?

DOYLE: Yeah.

BRANCACCIO: Oh, sweet. Look at this. Excellent

BRANCACCIO: I wanted to learn from Footie about how it felt to finally have a place, but like any proud new apartment dweller, he seemed more interested in showing off his digs.

BRANCACCIO: Does it feel like home yet to you when you come here?

DOYLE: Yeah, 'cause nobody—bothered by nobody. Nobody's gonna knock on my door or anything like that. Gonna try to come and—come to my house thinking about getting a free high or something. And it don't work that way.

BRANCACCIO: Well, that is smart, you know, not telling all these people where to find you.

DOYLE: With the coats and everything in here.

BRANCACCIO: There's no way to tell if ultimately Footie can keep it together enough to make this apartment work, long-term. But so far so good

BRANCACCIO: How about the seizures? Have you had any of these?

DOYLE: I haven't had none lately. No—I don't know how—the last time I had one

BRANCACCIO: Maybe it's the meds. Maybe it's reduced stress. Maybe it's sleeping horizontal in a bed the way god intended. Who knows. But for a guy who used to have seizures two to three times a week, it's a welcome respite.

BRANCACCIO: Do you feel differently somehow living in this kind of place?

DOYLE: Yeah. I feel differently. I feel happier, too. I'm glad I got my own place. I just be by myself. And I don't have to deal with nobody out there in the streets. I'll live happily ever after.

BRANCACCIO: That's it for NOW. From the Bronx, I'm David Brancaccio. See you next week.

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