Housing is Healthcare Panel

Tonight I had the honor to be on a panel with ACT UP member and peer educator Cliff Williams, Chief of Staff of the Philly Dept. of Health Nan Feiler, and Representative Jim McDermott (D-Wa.) It was neat to convene all of these people to talk about federal and local solutions to the AIDS housing crisis in Philadelphia.

I just learned that the camera battery ran out before we got to me, and since my notes (see photo) are illegible even to me, I thought I'd try to recreate at least the gist of the speech so that the ideas can keep being used.

So here goes:

"I'm going to keep this short. As the med students here know, events in this room always end the same way: with homework. And that's my job for tonight. I've got homework for all of you, but most of my homework is for you, Ms. Feiler, so I hope you're taking notes.

We've heard from the politicians here tonight, and one thing that we've heard is that they can't do this alone. We need to step up and create the change we want to see. We need to push them. Well, that's what we're doing right now. Consider yourselves pushed. We need politicians to step up now, like Representative McDermott did with Representatives Pelosi and Schumer when they started HOPWA as freshmen in Congress.

Right now we don't have a champion like Representative McDermott in Philadelphia. There's no one person who is solving this crisis. And here's the reason I think that's happening. I had a slide but I'm not going to show it now, but it basically shows that the funding, the funding coming into and out of the city for AIDS housing, is like a giant plate of spaghetti. It's just this tangled mush.

You heard Ms. Feiler say that there is a historic collaboration happening at the city between all the stakeholders in AIDS housing, and I'll be those of you taking notes didn't catch all the different agencies she named. It's this alphabet soup of agencies with lots of Os and Hs and Cs and Ds, and they're all overseeing different funding.

You've got the Office of Supportive Housing who oversees the shelters and they are in charge of the Shelter + Care slots, which are for people with AIDS who have substance abuse or mental health issues. So that's a more restricted program, that comes from HUD McKinney-Vento funds and you have to meet certain requirements.

Then you have HOPWA funding, which comes in through another office, the Office of Housing and Community Development with Ms. Deborah McCulloch. The great thing about HOPWA funding, as Representative McDermott referenced, is that it's less bureaucratic that McKinney-Vento. That money can be used to help someone who is not currently homeless but is in imminent danger of becoming homeless. Or they have HIV but not an AIDS diagnosis, but if they can't get their housing stabilized they might get a lot sicker. Someone who just needs some cash to make up the difference in their rent, they can get a shallow rent subsidy* that will actually turn out to be cheaper than paying for them to end up in a shelter or sick in the hospital.

So you have this moosh, right, with two agencies overseeing the funding, and then it's a separate agency, AACO, which is under Ms. Feiler, that oversees the waiting list for people who need housing. The agencies that get the funding and do the planning aren't the ones that keep track of the need. And we don't even really know what the need is since we haven't done a needs assessment since 1996, and people with substance abuse and mental health issues who aren't actively in treatment lose their slots on the waiting list. So we aren't even keeping track of who those folks are, people with substance abuse and mental health issues who are most in need of housing.

The people who really know what the need is are the providers, who actually run the programs, and then of course the people with HIV and AIDS who are homeless. They know what the need is, but they aren't the ones who keep the waiting list, or who do the planning, or get the money.

What should be happening is that there should be one central place where someone can go and say, 'look, this is my housing situation' and we'll be able to say this is what's available, whether you just need some cash to pay the rent and keep from getting evicted, or you need an SRO to stay out of the shelter, or you need more care because you're dealing with blindness or the mental health issues from living with the virus.

What we have instead is that we don't have different kinds of housing, it just comes from whatever each provider is interested in, so we might not have the exact level of care you need, maybe it's more support than you need or it's not enough support and so we're paying more than we have to or you're ending up getting sick, back on the streets and we're paying for health care.

The city's plan needs to close that information loop. We need the people who know what the need is to maintain the list, to inform the planning, to create the housing. We're losing information and money at each step of the cycle and it's the city's job to make a plan to fix the moosh of agencies.

The other job the city needs to step up and do is figure out where to get the resources. We've heard from the politicians that the state isn't going to fund us, the federal government isn't going to fund us. They might think, 'ok, we're getting less money, we can serve less people, that means less work on this issue, I can focus on other things.' I'm sorry to say, that's wrong. Now is the time for the city to get creative and to figure out other ways to solve this crisis.

Here's the problem. We've heard that housing people with AIDS saves money, but the money that it saves isn't city money. It saves money for hospitals, for Medicare and Medicaid, for insurance companies, because people aren't getting as sick. What the city needs to do is to figure out how to realize those cost savings. It's been done before. Right here at Penn, there's a program called LIFE, Living Independently for the Elderly, and they actually get money from Medicare and Medicaid that they're saving them by supporting older folks to live independently and stay out of expensive hospitals and nursing facilities.

I know it's Republicans at the state level, but they actually like saving money. And they don't like spending money on Medicare and Medicaid. So the city needs to go to them and say look, you don't have to spend this money for Medicare and Medicaid, you can spend it in Philly, create jobs. Even Republicans like jobs.

Ms. Feiler was very smart to say we need to watch what happens with these Housing First slots at Pathways. We need to keep track of how much money we're saving in hospital bills, and we need to go to the hospitals and Medicare and Medicaid and the insurance companies with the bill and say, here's what we saved you, now you need to pay us back so we can invest it in housing and make 20 more or 40 or 60 more slots. But the city needs to be ready with that research and a plan, ready to go to the hospital with a bill for what we've saved them.

I think there are some other ways to get creative too. What we've learned from the Occupy movement is that there are better ways to tax and get revenue. There wouldn't be an Occupy movement here in Philadelphia if we were doing all we could to raise revenue. There's a big insurance company right here in Philly, Blue Cross, who's got a big chunk of land here, and I don't think they're paying their fair share of the taxes. What if we could go to them and say, 'look, we're actually saving you money for the people you insure, they're not getting sicker, instead they're getting housing. Here's how you can contribute to the public health.' We can create public-private partnerships and have them pay taxes and solve this crisis.

Speaking of paying your fair share of taxes... the very institution that we're in right now, they need to be paying their fair share. As a non-profit, Penn doesn't pay any property taxes to the city. So they own all this non-profit land. But what are they doing with it? Making lots of money off of it, and putting for-profit businesses on it. So Penn needs to pay its fair share.

Now, time for your homework assignment. Ms. Feiler already talked about the postcards that are under your chairs. We really didn't intend to imply that Deputy Mayor Schwarz doesn't care about people with AIDS or homelessness. We just do wish he were here. He's a very smart guy and a good listener and this has been an amazing conversation. So we wish he were here to be a part of it because the more heads the better.

Also, the reason for the "wish you were here" slogan is that my sweetheart, Kaytee, is a designer and she's been dying to try out this vintage postcard font, so that's why we chose that.

Anyway, we think it is important Deputy Mayor Schwarz and as many people in his office as possible hear about the AIDS housing crisis in Philadelphia, so we'd like you fill the postcards out and say what you think, based on what you heard tonight, must be included in the plan to end the AIDS housing wait list in Philadelphia. And then we'll deliver them and hopefully they will inspire our local Representative McDermott, our local champion within the government who will end this crisis.

Thank you."

*I was reminded at the end of the panel by Gary Tumolo from OHCD that only San Diego has ever effectively applied to use HOPWA funds for shallow rent subsidies, and Philadelphia applied and was denied. I wonder if Representative McDermott might be able to help us think about how to get Philadelphia approved, as part of a comprehensive AIDS housing strategy?