HAWAII HOMELESSNESS - Thompson / Rothman / June 18, 2017

JUSTIN PHILLIPS, INSTITUTE FOR HUMAN SERVICES: Morning guys, anybody need medical attention?  

MEGAN THOMPSON: on a Monday morning, Justin Phillips sets out with a small medical team to offer aid to Hawaii’s homeless.

JUSTIN PHILLIPS:  What’s up? You can always call me.  I’ll try to help if I can.

MEGAN THOMPSON: Phillips directs outreach for the Institute for Human Services, the state’s largest homeless services provider. His first stop -- a sidewalk encampment stretching two blocks near downtown Honolulu.  Phillips knows what it’s like to sleep on these streets.  About a decade ago, he struggled with addiction and was homeless too.

JUSTIN PHILLIPS: I come out here with an understanding  of what it means to be homeless. I come out here with an understanding of what it means to be a drug addict. I come out here with an understanding of what it means to be an alcoholic. And because I have that understanding, I'm able to relate to people in a different way.

HEATHER WAHAB, INSTITUTE FOR HUMAN SERVICES:  Looking for Amy…

MEGAN THOMPSON: At a park downtown, Phillips and his team find a woman they know well.

HEATHER WAHAB:  Hey Amy!  

JUSTIN PHILLIPS:  How much you had to drink today?

MEGAN THOMPSON: There are around 7,200 homeless in this state of 1.4 million people.  

MEGAN THOMPSON: Hawaii is known as a beautiful island paradise.  But it also has the distinction of having one of the highest per-capita rate of homelessness in the nation.

MEGAN THOMPSON: According to the most recent statistics, Hawaii’s homelessness rate is now around 505 homeless for every 100,000 residents.  By comparison, New York State had 436 per 100,000, and California, 302. Hawaii’s problem became so severe, that two years ago Governor David Ige declared a state of emergency.  

HAWAII GOVERNOR DAVID IGE:  This homelessness challenge is a crisis.

MEGAN THOMPSON: That released more funding for new housing and shelters like this one - designed specifically for families with children.

SCOTT MORISHIGE, HAWAII HOMELESSNESS COORDINATOR: We have a very tight housing market here.

MEGAN THOMPSON: State Homelessness Coordinator Scott Morishige says Hawaii’s high cost of housing is the number one cause of the problem.  Average rent for a one-bedroom apartment here is almost $1800 a month. And Hawaii ranks #1 of the 50 states in highest overall cost of living.

SCOTT MORISHIGE: We really have a shortage of affordable housing, and particularly rental housing. Part of it is because we're an island state, so we have very limited land. And there's not as much opportunity for additional development.

MEGAN THOMPSON: Two-thirds of Hawaii’s homeless live on the island of Oahu, the most populous of the state’s eight islands and home to the capital, Honolulu.  Native Hawaiians and pacific islanders who’ve migrated from places like the Marshall Islands and Micronesia make up a quarter of Hawaii’s population, but account for 40 percent of the homeless.

HEATHER WAHAB:   Hi Charles!  Can I take a peek at your legs?

MEGAN THOMPSON: The medical outreach team includes Heather Wahab, a registered nurse.  Skin wounds from living outdoors are a common problem.

HEATHER WAHAB: They hurt?

MEGAN THOMPSON: These homeless individuals represent some of the most difficult, chronic cases.  Most all of them have untreated physical and mental health issues.

CHAD KOYANAGI, INSTITUTE FOR HUMAN SERVICES: Rosie!

MEGAN THOMPSON: Psychiatrist Chad Koyanagi assesses mental illness and addictions.

CHAD KOYANAGI:  You have depression, bipolar, psychosis?

MAN: Yes.  Depression and bipolar.

CHAD KOYANAGI: Are you depressed now?

MAN:  Yes I am.

CHAD KOYANAGI: Are you hearing voices?

MAN: I’m hurting bad.  I have nothing to help me.

MEGAN THOMPSON: Homeless service provider Justin Phillips says in order for a homeless person to qualify for certain housing programs, a doctor must diagnose a disability.  But Phillips says many of the people out here can’t be relied on to make it to an appointment.

JUSTIN PHILLIPS: We know they're not gonna go to a doctor, you know? ‘My main priority is getting a beer in my system, maybe some, you know, marijuana, maybe some ice. Wanna get loaded, get good and-- you know, good and high. And then I'm ready to go do it.’ But by by that time, it's 5:00 p.m., all the doctors are closed, all the doctors' offices are closed, there's no psychiatrists.

MEGAN THOMPSON: When Honolulu’s homeless do seek out care, it’s usually at The Queen’s Medical Center, a private nonprofit hospital that handles more than 10,000 visits a year.  Daniel Cheng is the ER  medical director.

DANIEL CHENG, THE QUEEN’S MEDICAL CENTER: The top few diagnoses that we see are infectious disease, behavioral health, and substance abuse.

MEGAN THOMPSON: Many of Cheng’s homeless patients also suffer from heart disease, diabetes, and kidney disease…and lack access to regular medical care.

DANIEL CHENG: Our homeless individuals die about one-third earlier than the normal population. So we're talking a good solid 20 to 25 years lost of life. And that really strikes home. Because I think that speaks to the frustration as a physician. At the very core of what we're trying to do is quality of life.

MEGAN THOMPSON: The homeless burden Cheng’s hospital with around 10 million dollars a year in unreimbursed medical bills.  They also burden Medicaid, the government health insurance system for the poor.  About 50% of Medicaid funds are spent on so-called high-utilizers - people like the homeless who frequently visit the ER.

MEGAN THOMPSON: Cheng says he sees the same homeless patients over and over.

DANIEL CHENG: We just don't have enough time and resources to address the social issues. And they go back out to the street and they get lost into the system. And it's a very perverse and it's a very broken system.

MEGAN THOMPSON: To change that, Cheng has started a program to put social workers in the e-r to connect the homeless to food stamps, housing and other services, before they’re discharged and hard to locate again.  The hospital is also partnering with Justin Phillips’ Institute for Human Services to open homes like this one...where the seriously ill homeless can heal without taking up a more expensive hospital bed.

JOSH GREEN:  We are spending 3 trillion dollars a year on health care.

MEGAN THOMPSON: Addressing homelessness is a top priority for Hawaii state senator josh green.  Green is also a practicing ER doctor and is pushing a more radical idea  - he introduced a bill saying homelessness should be considered a medical condition, and doctors should be able to prescribe housing.

JOSH GREEN, HAWAII STATE SENATE: The moment you have someone in housing, you decrease all of the complications they have from all their other diseases.

MEGAN THOMPSON: Green says Medicaid should cover rent for the homeless.  He cites a University of Hawaii study showing that after the homeless were given housing, their medical costs decreased by 43 percent.

JOSH GREEN: We're already spending these Medicaid resources on our individuals who are really hurting. And we're spending it very inefficiently. If they get admitted to the hospital for a day, it's $4,000. If they go 100 times in the year, which is very common across Hawaii and across the country, they may spend $200,000 or $300,000 of taxpayer money.

MEGAN THOMPSON: Green’s proposal has gained national media attention…. But it hasn’t passed the Hawaii state legislature.   In the meantime he’s working with local health insurers to pilot the idea.  

SCOTT MORISHIGE: Hawaii's not necessarily waiting for legislation to go through.

MEGAN THOMPSON: State Homelessness Coordinator Scott Morishige says even without Green’s bill, the state will seek permission from the federal government to spend Medicaid dollars on helping people find and stay in housing.  Similar ideas have been looked at in New York and California.  In the meantime, the state and city have been investing in a program called Housing First, which proponents say has started to make a big difference.  The idea - which has had success in other states - is to get a homeless person into housing before doing anything else.

SCOTT MORISHIGE: Because we know the quicker you can get someone into housing and a point of stability, the more positive impact you will have for that person.

MEGAN THOMPSON: And that includes positive impacts on a person’s health.  

THOMAS LAMBERTON, HOUSING FIRST CLIENT: Come on in.

MEGAN THOMPSON: Housing First is how Thomas Lamberton, homeless for eight years, got into his apartment about two years ago.

THOMAS LAMBERTON: This is the picture of cardboard that I slept on and my backpack I used for a pillow.

MEGAN THOMPSON: As an alcoholic living on the streets of Honolulu, Lamberton had regular seizures.

MEGAN THOMPSON: Did you go to the emergency room when you were on the streets?

THOMAS LAMBERTON: Every other week at least. Well, it was constant…it's embarrassing when nurses know your first name. ‘Hey Thomas.’ It's like, ‘Whoa.’

THOMAS LAMBERTON:  This is my bedroom, and my bathroom, with a shower.

MEGAN THOMPSON: Then, a local nonprofit got Lamberton on a list for a Housing First apartment.

THOMAS LAMBERTON: I mean, I'm not drinking. That's first of all. And you know, when you're not drinking, you're gonna be healthier. And I have a place to put food in the refrigerator.

MEGAN THOMPSON: Since he moved in, Lamberton has also stopped having seizures.  He’s on Medicaid and sees a primary care doctor. And he’s been to the emergency room only twice, for minor injuries he got volunteering at the Humane Society.  

THOMAS LAMBERTON: My health is great now, because I don't have the raspberry patches on my hips and shoulders from sleeping on concrete or cardboard.

MEGAN THOMPSON: But Lamberton says his new home has restored more than just his health.

THOMAS LAMBERTON: It gave me my self-respect back that I-- don't feel like a piece of scum on the street and-- worthless to society. Basically they've helped me out immensely. And I owe them my life.

MEGAN THOMPSON: Over the last two years, the State and Honolulu have expanded Housing First by adding 400 new housing units - like this new building, opened last month.  More than 500 hundred people will be housed by the end of this year.  Advocates say Housing First has helped finally turn the tide.

BRANDEE MENINO, HOPE SERVICES HAWAII: Our homeless numbers have decreased statewide.

MEGAN THOMPSON: Last month, Hawaii announced the first decrease in its homeless population in eight years.  Down nine percent between 2016 and 2017.  They’re hoping improvements in health and medical spending will now follow.

JUSTIN PHILLIPS: You ok?

MEGAN THOMPSON Back on the streets, Justin Phillips says housing people is the ultimate goal here, too.  

JUSTIN PHILLIPS:  You ever thought about coming down to the shelter and hooking up with a social worker?

MEGAN THOMPSON:  Gaining trust to get people healthy …. And into a home.

JUSTIN PHILLIPS: We've housed a lotta people that normally wouldn't get seen by doctors, would never get housing. We've been able to house them through this process. ‘Hope, one bandage at a time,’ you know, because that's what-- really, what we're doing, you know? One relationship through one bandage, you know.

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