RIGHT-SIDE UP

SEATTLE - In the 1990's Seattle's Downtown Emergency Service Center - DESC- turned the world of homeless providers and policy-makers upside down. Back then, explained King County Executive Dow Constantine, the widely-held view was that, if you were homeless, you "had to put all of life's challenges behind you before you deserve a warm, safe place to call home." Given the nature of the challenges it meant a lot of folks would never, ever be able to come in off the streets.

"Wrong approach," argued DESC. Get them off the streets and into housing first and then provide them with the supportive services they need to address those challenges. DESC took "a lot of grief"," Constantine noted, for its distinctly minority, seemingly counter-intuitive point of view.

Not anymore. Slowly and then swiftly Seattle became a Housing First kind of town. Lots of other have followed. Common sense can do that.

Just how sensible is suggested in a recent report from the King County Medical Examiner announcing that a record 169 homeless had been processed by his morgue in 2017. You can blame it in large measure on the Great Outdoors.

That's pure heresy, of course, in this part of the world. From the Olympics to the west, the Cascades to the east, after all, we have more Great Outdoors than prime has numbers. All agree that for both body and soul there's nothing could be greater than the Great Outdoors. And, even better, at trail's end, we get to go home to a shower, a bite to eat and a good night's sleep.

Not so the homeless. All day and all night in The Great Outdoors is not only dangerous, but also hazardous to one's health. You see it in the stats. "Premature death," said the University of Washington Department of Medicine (https://medicine.uw.edu/news/palliative-care-homeless), "is three to four times more likely for the homeless" than the average American. In 2014, the the average life expectancy for a King County resident was 81.4. For King County's homeless, however, the average age at death was "48 years old."

And the one of the biggest common denominators among the 169 deaths reported by the Chief Medical Examiner. "Approximately half occurred" in The Great Outdoors.

In a Housing First town like Seattle it's no wonder that health care for those living day and night on the streets runs a very, very close second. A number of years ago homeless providers like DESC teamed up with an array of the County's health providers to form a county-wide Health Care for the Homeless Network, its mission to "change the conditions that deprive our neighbors of home and health." In 2016 alone, Network partners completed over 107,000 patient visits by homeless families and individuals.

With growing numbers of unsheltered homeless living in The Great Outdoors, Network members are always looking for effective, innovative ways to do even more. Like the first-of-its-kind partnership between DESC and Harborview Medical Center unveiled at DESC's grand opening (www.seattlechannel.org/videos?videoid=x87836) of The Estelle, 91 units of permanent, low-barrier, supportive housing in the Rainier Valley neighborhood. Most notable are fifteen set-aside for Harborview Medical Center to provide on-site nursing care to "health-complicated" residents who'd otherwise be stuck in a hospital, ineligible for discharge into the Great Outdoors because, they'd have "no safe place to go." Now they do.

"This is Housing First in action," said County Executive Constantine at the opening, "bringing individuals inside to their own home, own apartment first and then offering the care and services that address the reasons that they became homeless in the first place."

Case in point? The next speaker Alex, a man in his thirties who lives in another DESC complex. Since DESC opened its doors nearly 40 years ago, it's seen, sheltered and served thousands of people like Alex. He became homeless at 18. Bi-polar and schizophrenic, he quickly took to using - and abusing - crack cocaine and alcohol. Living on the streets, he said "I was out to die." He seems in no hurry to return to them.

As he spoke Alex paused and looked at a table topped with mementoes to be presented to DESC's partners - including HUD - in the project. "Before I came up here," he said, "I asked if I could have one of those awards. They said no." No problem. After all, thanks to DESC's housing and supportive services, he continued, "I've already got my award. Life."

Turning things upside down, it appears, sometimes sets the world right-side up.

###

P.S. - A few weeks after The Estelle's grand opening, his friends and colleagues at DESC did present him with an award for the courage he displayed in sharing his story.

P.S. 2 - In the summer of 2018, Affordable Housing Finance magazine announced that The Estelle had been selected as a finalist in the "best special needs development" category for a 2018 Readers' Choice Awards. Winners are to be announced in the fall of 2018.

###