I came to San Diego in the early ‘70s. The beaches were clean and uncrowded. The freeways were “free ways” absent of grid lock, bumper to bumper traffic and the frustrations of commuting. As I think back, there was no “commuting” as we know it today. Housing was affordable and close to your work. Apartments were plentiful for young people, and the rents seemed to be in keeping with what one or two roommates could afford. Coronado was considered G.U. (geographically undesirable) and too far away to spend a day or an evening. Everyone with a GPA of 2.2 got into State and tuition was affordable without the necessity of crushing debt.
And homelessness? I remember only one homeless person; a gentleman who gathered cans and bottles every day from people’s discards. He kept to himself. He didn’t bother anyone, and no one bothered him. I never thought about where he showered, where he slept, what he ate or where he received his healthcare. It was an innocent time.
Today is different. The overwhelming numbers of homeless persons in San Diego County is staggering, and the sheer weight of this societal failure challenges our government’s planning and available resources.
In 1988, Family Health Centers of San Diego (FHCSD) received its first Healthcare for the Homeless grant from a new federal funding offer. Through the years of operating this program, we have watched the numbers of homeless patients grow, along with increasingly complex needs. To get a true picture of homelessness in San Diego, let’s go to the data.
Many years ago, frustrated by inadequate software packages, FHCSD developed its own EHR and patient tracking system. This system is a state-of-the-art, Meaningful Use Certified Stage #2 (ask your IT friend-they will know M/U-Stage 2!) and is an elegant solution to supporting all health care activity in a complex network as large as our organization. FHCSD screens and registers all patient activity, including demographics. Homeless people are identified as they access care, anywhere in our system. With 2017 numbers recently verified, FHCSD served over 27,000 unique homeless persons in San Diego County.
San Diego’s Point in Time (PIT) count, conducted by dedicated volunteers, identified over 9,000 homeless persons in our county. How the “counts” differ is explained by some of the program restrictions: the PIT does not count incarcerated persons. Once released through low-level offender release programs, now growing in popularity, the formerly incarcerated swell the numbers of homeless persons on the streets of our cities and county; the PIT does not capture all people living in cars, tents or recreational vehicles; the PIT volunteers do not, for reasons of safety, go into the canyons, back alleys, under freeways or other unprotected areas where large numbers of homeless persons congregate. While safety restrictions are understandable, homeless persons are not always readily seen and therefore not included in the volunteers’ count, and the PIT does not count those who are transitory or doubling up—the temporary staying with friends or acquaintances to alleviate immediate shelter needs.
Another point of validation is the US Department of Education’s numbers. The DOE counts homeless children in schools. Due to better identification, aided by electronic tracking, the DOE in the 2015-2016 school year identified over 1.36 million homeless children in our public schools—a 70% increase since the housing foreclosure crisis in 2007 and more than double the number first identified in 2003. Homeless children go home to homeless parents at night.
The Union Tribune reported in 2017 that San Diego County schools had reported almost 23,000 homeless students. FHCSD numbers are starting to seem much more believable, and perhaps, even understated.
The National Law Center on Homelessness and Poverty (NLCHP) estimates that the actual number of homeless individuals is 2.5 to 10.2 times greater than a Point in Time count. According to this study, San Diego’s homeless numbers should range from 22,500 to 91,800 persons. Given that FHCSD has a limited presence in North County, it would seem our 27,000 homeless patients, while on the low side, is more closely aligned with the range of expected homeless numbers projected by the NLCHP. North County numbers, largely unserved by FHCSD, would swell the homeless count in San Diego County to a more believable number to those of us providing daily services to this population.
The Point in Time can be relied upon to tell a part of the story of homelessness, but it is not a comprehensive depiction of the crisis and to rely solely on the PIT to inform policy design and implementation decisions is not only short-sighted, it is planning for failure. When one does not truly understand the magnitude of a societal problem, the solutions will always fall short of the goal.
It is all about the numbers…Get it right, and we can begin to plan with a strong foundation. Get it wrong, we are relegated to continue piecemeal planning that always seems to come up short.