NASW Social Work Talks - EP74: Housing Insecurity

Episode Date: July 28, 2021

We speak with Kelly Bruno, MSW, president and CEO of National Health Foundation in Los Angeles, Calif. Bruno helped to create recuperative care program in response to hospitals' illegal practice of patient dumping — the failure to make continued care arrangements when releasing homeless patients from the hospital. Visit the show notes for related resources.

Welcome to Social Work Talks. I'm Kat McDonald. The COVID-19 pandemic has deepened America's housing crisis, causing large spikes in evictions and homelessness. A government study found that as of December 2020, 11 million households were significantly overdue on their regular housing payments. With us to talk about this housing crisis is Kelly Bruno, MSW, President and CEO of National Health Foundation in Los Angeles, California. Welcome, Kelly.

Thank you. I'm excited to be here. Please tell our listeners who you are and a bit about your background and what you do now. I am currently the president and CEO of National Health Foundation. Educationally, though, I'm a very proud social worker, having gotten my bachelor's at a Pacific University here in Los Angeles and my MSW at Cal State Long Beach. and I am currently enrolled in the doctorate social work program at University of Southern California. I started my professional career in more in gerontology and I ran a nursing home

and an adult day health care and actually an intergenerational daycare but currently I'm like I said the CEO of National Health Foundation which is a non-profit here in Los Angeles and our mission is to improve the health of under-resourced communities by taking action on the social determinants of health, focusing primarily on food insecurity, built environment, education, and most prominently, housing. Most of our programs revolve around assisting our neighbors here in Los Angeles without homes in a program called Recuperative Care. So can you give our listeners an overview of the housing crisis in the United States and in California in particular? Absolutely. Well, I think there isn't a United

States citizen that exists that doesn't recognize the absolute crisis that we have with homelessness right now. And I am a firm believer that we have really misdiagnosed the problem, that we do not have a homeless problem, but instead we have a poverty problem. And that we see when you look at the vast differences between the haves and the have-nots and that gap becoming larger and larger. Social work has not identified homelessness as one of the 13 grand challenges for no reason. It is absolutely an epidemic across the country. We have issues as far as affordable housing, as far as job insecurity, all of these things play into homelessness. Unfortunately, Los Angeles, California, Los Angeles in particular, you see this crisis worse than you see it anywhere across

the nation, but it absolutely touches every part of the country. And how did we get to this point? Well, historically, I mean, we have had policies that have gone away that we had in the past. You know, we've had HUD policies, we've had housing policies that in the 80s and the 90s we spent time and money on that we have just reneged or gone backwards on. And we're now, I believe, seeing the repercussions of that. And so we're looking at a substantial housing crisis. We have people that simply cannot afford to live and they have no choice. I think, like I said before, we've misdiagnosed the problem and people often think that it's a choice and that people have fallen into homelessness because they've made some sort of choices that have resulted in this. But it has very little to do with choices. It has to do with housing policies that have been reversed, mental health services that don't exist, or our philosophy on incarceration that is just not correct.

And these things all combined together create the crisis that we see today. We need to make changes. It's a very complex problem. And the changes that need to be made across the board, housing, incarceration, poverty issues, like I said, all these things play in to the compound issue that we see today. Recently, steps have been taken by federal, state, and local lawmakers to help stem the tide. So with stimulus payments, enhanced unemployment assistance, and with forbearance and moratoriums on foreclosure an eviction. Have these steps been enough? Well, they're great for the time being. But unfortunately, they're all going to come to an end. And they really do put a bandaid on the real

problem. And the real problem is that people can't afford to live in the first place. So while it's nice to have moratoriums, and it's nice for people to get that received temporarily, life is going to quote-unquote, go back to normal. And people being one paycheck away from eviction is going to come back. So the problem hasn't been fixed. It's just, in a lot of ways, just the can's been kicked down the road a little bit. So all that's going to come back. So while it's nice and I'm happy that we did that, it's not fixing the problem at all. So a government report has found that Black and Hispanic households were more than twice as likely to report being behind on their payments than white households, especially during the pandemic. Can you talk about this disparity?

So that disparity you see across the gamut when it comes to all the issues that play into homelessness or play into poverty, housing insecurity, all of those things. And that absolutely has to do with the systemic racism that our country has been built upon. And the the disparities that exist are because of the inequities that have existed from the beginning of our country's, you know, existence. Redlining, all of those kinds of things play into what we see today. So what we see today is that our black and brown communities that are more disproportionately affected by rent hikes, more disproportionately affected by evictions, and also homelessness. I mean, here in Los Angeles, but across the country, we see our black and brown populations that are disproportionately represented when we look at those folks that are suffering from homelessness.

And that is because they just have not received the same opportunities as other folks. And therefore, those disparities have existed forever and they catch up. Right. And they can't they can't be erased by moratoriums or things of that nature. So we're going to see the effects of that indefinitely. Until we start making changes, create anti-racist policies that are going to reverse that damage, this is going to be our reality. In Los Angeles County, where you are, some 66,000 people experience homelessness every night. Tell us about the work your agency is doing in the face of this. sure well during the pandemic you know uh state of california really took an active stance on homelessness and there and i and we had two programs that were pretty prevalent you know we had um project room key and then we had project home key uh and they're kind of they're

different and their names kind of describe their difference room key is more of a temporary solution. Homekey is a long-term solution. So Project Roomkey was something that allowed us to take folks that were more at risk of COVID, which are our homeless population, and put them into vacant hotels and motels across Los Angeles in an attempt to keep them safe from spreading and contracting coronavirus. And for the most part, the effort was relatively successful. We had about 38 hotels that opened up, about 5,000 beds. They were hoping for about double that, but they did get 5,000 very worthy people off the street and kept safe.

across Los Angeles. There was a kind of a happy and a sad, you could say, response to that. You know, we're very happy because they were able to do it. Also very sad because we're thinking, you know, wow, if you were able to do this so quickly, why haven't we done this before? You know, why did it take a national pandemic for us to respond in that way? The good news that also has come from this, though, is that Project Homekey has also been voted in. And this is where both the counties and the cities, and this is, of course, a federal movement, were able to purchase hotels permanently and then transition them into permanent supportive housing. Here in Los Angeles, this was imperative because we have such a NIMBY issue here,

and not in my backyard issue. And building permanent supportive housing, despite legislatively passing laws and bonds and all this stuff to have money available, we still can't seem to get these permanent supportive housing units up and running. And so much of it has to do with every time anything is proposed that the neighbors in that community protest and so project home key has allowed the city and the county to basically purchase dilapidated or hotels that are that are minimally used in the in the um for the purpose of turning them into permanent supportive housing and they're able to do it on a by right basis and so this has been extremely successful all of those facilities are currently being used as interim housing and then it'll take about three

years to take to turn them into permanent housing and um and so it kind of it kind of you know bypasses all of the by right kind of arguments and kind of puts them into the the neighborhoods regardless um it's unfortunate that that the city and the county have to work that way but because of the crisis i personally don't see any other way national health foundation participated in both of those efforts and uh for the project room key effort we actually ran the only project room key that operated as a recuperative care or what's commonly known as medical respite so for those that aren't familiar medical respite is for folks experiencing homelessness that are exited from hospitals that still have some lingering medical issues that need to be addressed so they come to

a recuperative care to stay for three or four weeks they recover from the from that ailment and then they move on to the next the next piece of the continuum on their journey to permanent housing when we opened up the project room keys here in los angeles there was a cohort of folks in each of those facilities that really had lingering medical conditions that needed to be addressed, but there wasn't any medical personnel in those facilities. So we worked with the city and the county, and we opened one of those hotels with the purpose of being a recuperative care. So that small cohort of folks at all of those 37 facilities, instead of trying to bring medical care into each of those facilities those folks were all moved into one place and then

we were able to provide care for them under one under one roof we were supposed to be open for about 90 days and we are actually still open today 13 months later so i don't know when we'll be closing yet but we seem to keep that that train keeps to seem to keep going down the track um We're also participating in the Project Home Key effort as well, and we were just recently awarded a 43,000-square-foot building here in Los Angeles that was originally an assisted living facility, and we will be providing the first interim housing facility specifically for older folks experiencing homelessness. This is a cohort of individuals who identify as having at least one activity of daily living.

They're having difficult managing on their own. So they really don't need a nursing home, but they have skills or, sorry, they have needs that are higher than what a medical respite or recuperative care could care for. And they really are in limbo and have no place to go. And actually, Los Angeles has identified about 5,000 folks that meet this criteria. So we will be opening a 148-bed facility, hopefully by the end of the year, where those individuals who are over the age of 55, who have at least one activity of daily living that they report needing assistance with, will have a safe place to go and stay for upwards of a year, if necessary, until we can find them an appropriate facility. permanent housing location that would include the assistance and the support that they need to be successful. There are so many opportunities and just chances for collaboration with this. We're very excited. We're looking at the possibility of collaborating with a PACE model

to bring a PACE model into the facility. Clearly, a clinic will be there and all kinds of other services that are applicable to the older population. So we're hoping if everything goes well and Los Angeles complies with all the regulations here, that will be open by the end of the year. It sounds like Los Angeles has a very high population of homeless people. Could you talk about why Los Angeles? Why is the population of people experiencing homelessness so high in Los Angeles? Basically and briefly, I mean, Los Angeles has the highest homeless population because we have an incredibly high cost of living here. Just the absolute cost of getting an apartment in Los Angeles, a one-bedroom apartment is upwards of $3,000 a month, right? This is the

average in Los Angeles, which is unlivable, right? Absolutely unlivable. So that is the number one reason that you see it. The second reason you see it is that Los Angeles, unlike other parts of the country, we do not have a right to housing here in Los Angeles. Other major metropolitan cities across the country have that. New York has that, where there's a right to housing, where you have a shelter bed that the city has mandated that there be a shelter bed. The number of shelter that's the equivalent to the number of folks that are without homes. Los Angeles does not have that. And so we are in a big crisis right now trying to build those homes. In fact, there is a judge, a local judge out here in Los Angeles that's actually mandating that and pretty much suing

the city and the county to make sure that we build these interim housing beds quickly. there's a lot of um debate about that here in la because because they're being built so quickly they're not necessarily being built in my personal humble opinion in a dignified manner they call them tiny homes but they're really just eight by eight sheds that two people live in um and have you know has no plumbing and has no you know has you know i think it has an air conditioner but plumbing and shower and all that stuff are in other places so to me it's almost glorified camping but we're trying to put these places up very quickly so los angeles we're dense it costs a lot of money to live here and um and we do not have places for people to go so this just keeps

building on itself and building on itself um and so we see the biggest problem in the country i mean los angeles the last count like as you said had over 60 000 individuals that were experiencing homelessness here. We did not do a count because of COVID last year. You can't possibly imagine that we're going to have anything less than that. Despite the fact that we're housing people at record numbers, we have more people falling into homelessness than we can house on any given day. And so despite the efforts, the numbers continue to go up. There is very much a lack of coordination between the systems too. And it's also a lack of, I feel a lack of real understanding and empathy towards the people that we're serving. And that really goes into the NIMBYism that we

see and the services and the way that we're providing services and what we're building. like i just alluded to earlier uh you know for national health foundations we you know we don't build facilities or spaces that we ourselves would not live in i don't have one facility that i personally would not sleep in that i personally would not eat in that i don't feel safe in that i wouldn't bring my family to and that i wouldn't allow my family to do those same things then i cannot say that for all the other facilities or all the facilities that exist there's a very much a it's better than mentality. And when you enter and try to resolve an issue as grand as homelessness with a it's better than mentality, it doesn't work. And so we're building

spaces that are interim that people don't want to be in. We're telling them, sure, I'm giving you the shed, but you have to be here by 10 o'clock. You have to leave by nine o'clock in the morning. we're going to check your bags when you come in you can't have visitors you can't smoke here you can't play loud music we're giving them all these rules and then we are surprised when they don't want to stay and then label them as quote unquote they don't they want to be homeless they don't want to be housed this is a population that has everything taken from them it has so little choice left in their lives right all the choices have been taken from them they have so so little left and so this is all they have to let's hold on to harm reduction philosophies

low barrier facilities are the only way to care for these for for these folks we also have to be very cognizant very cognizant of um substance abuse drug use and to not stigmatize um stigmatize that with those that we serve and so many of the places that are here do that there's such an inconsistency in the philosophies on paper cat everybody says that they're all those wonderful things they all say yes you know we are harm reduction yes we treat people where they are but the reality is that's not what happens so if you are able to do that and the results are people would rather be on the street where they can make their own choices than to be in a shed where they can't.

And I don't blame them, honestly. One exciting thing that's happening in California is something called CalAIM. California, instead of having Medicaid, we have Medi-Cal, which is the same thing. We have a waiver like every state does, but this year our waiver is being revamped and that effort is called CalAIM. Our Medi-Cal waiver is going to include medical respite as a Medi-Cal reimbursed service. So we'll be the first state in the country to do that. So this is huge because it's recognizing that housing is health. It's a nine-month benefit, like I said, that folks will be able to stay in these facilities until they are permanently housed. And it's going to be a benefit that Medi-Cal is going to pay for. This is a landmark to me. This is, this is huge

because like I said, we all know that someone can come into my facility and have, you know, have had their appendix taken out or have a wound that we need to take care of. But what really needs to be taken care of is, is their permanent supportive housing status. And so for insurance to recognize that need is really, it's a landmark decision in my opinion. so you're also helping people secure access to healthy food with your organization because I imagine that food insecurity go hand in hand with housing insecurity can you talk about your work in that arena sure so we you know like I said before we deal with the social determinants of health and we look at food insecurity we look at built environment and also education and

historically, we kind of kept those things separate from our recuperative care housing efforts. We take a perspective of working within the communities that we serve, not necessarily shoulder to shoulder or hand to hand, but really providing the resources. We believe wholeheartedly and we use that word purposely that those communities we served are under-resourced because we recognize that a person's ability to be healthy is not predicated on their genetic code but it's predicated on those zip codes right and if um if zip codes were all the same that we would not have health disparities and so we take our role as bringing quite literally resources into the community and that's our job and so we do programs in high schools we do also do things

as simple as food distribution um farmers markets things of that nature but i think what's really different about what we do is the community approach that we take. And so each of our sites that we have, our recuperative care sites, have community liaisons as a part of it. And the first thing that we do is that we create a community leader group that really drives the work that we do in each community. Because who better to know what needs to happen than the people that live there? This is, I wouldn't say radical, but this is really a change in the way we do our work as opposed to us looking at research and telling people well these are the problems in your community we ask them what they think the problems in the community are and then

we work from that perspective and then they drive the um the work that we do and then they drive the outcome to the work that we do not us we again provide the resources oftentimes what that looks like is participatory budgeting where we write grants to get for example in our pico union facility. We write a grant for $100,000, and we get that grant, and we can give that $100,000 to this community action group and say, how do you think this should be spent? What do you think your community needs? As opposed to us oftentimes white-savoring ourselves into these communities and telling them what we think that they need. This is how we grow roots in communities, and this is how we feel that we see the best outcomes. And so what happens in each of those communities is

very different based on what that community means. It's very difficult oftentimes to explain that to foundations because they will, they say, oh, that sounds great, Kelly, but how many, you know, how many pieces of, you know, how many apples are you going to get out, right? How many, how many, you know, CalFresh applications are you going to complete? And we say, you know, we don't know because we're not sure that's what's going to be told us that needs to happen. So what do some of these efforts look like, right? What are some of the things that have come out of our efforts? One of them is something that's near and dear to us that's called Health Academy. And this is a program that we have in 10 local high schools that identify juniors and seniors

in that high school that are interested in health as a career option for them. And they do that exact process that I just described. They identify health disparities or health issues in their high school or surrounding neighborhood, and then come up with a solution to fix it. One of the things they most recently did was something called a share table, where they identified that the majority, if not all, of the students at the school were on free lunch programs, yet a lot of the food that was there for breakfast and lunch was being thrown away. So they created something called Share Table, which is quite literally that. It's a table that's in the cafeteria. And so after breakfast and lunch, any non-perishable items,

instead of being thrown away, are put on this table so that students throughout the day, non-meal time, can come in and grab whatever they want or need throughout the day. It reduced waste by over 75 percent in the school um but more importantly you know it allowed individual you know the students to have food accessible to them 24 hours while they're at school the whole time um the state of california that will first off i should say los angeles the city of los angeles recognized this as a best practice and moved it up to the state of california and now share tables are a best practice in high schools across the entire state of california and this is a program that was designed and created by high school students at Jefferson High School in South

Los Angeles, but not by National Health Foundation, by students at South Los Angeles High School. That's fantastic, actually. That's great. It's pretty cool. Not South, I'm sorry, at Jefferson High School. Yes, it is. I think we underestimate oftentimes sometimes what those we serve can accomplish and that they know what they need, right? Again, we don't, we can't come in with the ideas. We have to listen to those who are serving. And when you do, from our perspective, the outcomes are way better. What do lawmakers need to know? What a great question. What's a lawmaker? I think lawmakers,

oh boy i i think lawmakers need to be less afraid right um they need to be they need to remember that those without homes those with mental illness um those that are elderly or seniors they all are also their constituents um not just the people with the money and to act with empathy and understanding of what of all the people that they're serving and to have the guts to be able to do that um is um what they need to know it's okay to be wrong it's okay um it's okay to be uncomfortable right and it's okay to listen and to have to move in a direction that doesn't make those that are the richest in your communities necessarily the happiest um there's lots of lawmakers that do that you know um nuri martinez you know she's the she's

the council president here in los angeles and our our new facility is in her district and you know we had several neighbors that were a little upset about it she has not backed down you know she says these are our neighbors as well these are your neighbors and we have we have an obligation to care for them. It's inhumane for them to be living on the street. We're going to build a facility. We're not going to build a low level facility. We're going to build something that is high level that they're deserving of. And we're going to make this happen. This is the right thing to do. And we're going to move forward. There needs to be more lawmakers like that, that are willing to say that and not have to be concerned about those with the money in the district. But it can happen.

People are doing it. And I feel in Los Angeles, we're seeing a little bit of a shift in that direction. We really are. We're seeing people that are willing to say that and willing to say almost shame on you, you know, shame on us for caring more about property of our home, you know, or the value of our property than stepping over. And so it's time. And there are people stepping up. There really are. Is there anything else you'd like to add? I'm very excited to see the movement with homelessness. I'm excited to see that it is one of the 13 grand challenges of social work and that we are thinking about it a little bit out of the box. I am excited to see continued collaboration between health care, housing, even incarceration and lower incarceration rates.

I see more of a collaborative effort in this and recognizing that it isn't so simple. I hope that we continue down that road. The stigma associated with being homeless is something that is hard. It hurts my heart because it's not something that people choose. Nobody chooses it. We have to fix the systems that have created it. Thank you, Kelly. I really appreciate you coming on and talking with us about this.

I really appreciate the opportunity. Thank you so much. Listeners, you'll find related resources in the show notes, including links to eviction data from Princeton University's Eviction Lab, as well as the National Health Foundation's website. You have been listening to NASW Social Work Talks, a production of the National Association of Social Workers. We encourage you to visit NASW's website for more information about our efforts to enhance the professional growth and development of our members, to create and maintain professional standards, and to advance sound social policies.

You can learn more at www.socialworkers.org. And don't forget to subscribe to NASW Social Work Talks wherever you get your podcasts. Thanks again for joining us. We look forward to seeing you next episode. Thank you.