Health

Milwaukee program shows how stable housing can improve overall health

Elijah Edwards begins each day reading Scripture from a Bible as worn from use as his leathered hands are from years of work.

He does this from a modest apartment that helped him rebuild his life, providing a foundation to move beyond addiction and homelessness.

“I’m grateful because this is what God is doing,” Edwards said.

He moved into the apartment, after living at a shelter for 19 months, in July 2019 through the Milwaukee County Housing Division’s Housing First program.

The program, based on a national model, was introduced in Milwaukee County in 2015. It provides permanent housing to people who are homeless without any requirements, such as participation in programs, employment or sobriety. Instead, it offers optional services, such as treatment for substance abuse.

Elijah Edward starts his day with his morning devotional. In his 50’s his life began to unravel for Edwards. For a time he was living at the Milwaukee Rescue Mission. While there he learned about the Housing First Program.
Elijah Edward starts his day with his morning devotional. In his 50’s his life began to unravel for Edwards. For a time he was living at the Milwaukee Rescue Mission. While there he learned about the Housing First Program.
Angela Peterson / Milwaukee Journal Sentinel

The idea is that people need the stability of a place to live before they can make other changes in their lives.

The United House where Elijah Edward lives is an affordable supportive housing apartment building with 24 one-bedroom apartments. The building includes a community kitchen, fitness center, lounge, classroom, library and chapel.
The United House where Elijah Edward lives is an affordable supportive housing apartment building with 24 one-bedroom apartments. The building includes a community kitchen, fitness center, lounge, classroom, library and chapel.
Angela Peterson / Milwaukee Journal Sentinel

“It is not necessarily the cure-all for all the layers of the things they are going through,” said Eric Collins-Dyke, assistant administrator of supportive housing and homeless services for the Milwaukee County Housing Division. “But it is the first step to having that stability.”

People have the comfort and stability of waking up in their own bed and walking into their own kitchen.

“They have that each day, before they start the day,” Collins-Dyke said, “as opposed to the constant grind, the daily grind, of surviving on the street and all that comes with that.”

Program aims to reduce hospital visits

The majority of people who are chronically homeless have behavioral health conditions or substance abuse disorders. And the Housing First program was started with $1 million in funding from the Milwaukee County Behavioral Health Division. 

“Housing is the single greatest need in our community,” said Mike Lappen, its executive director.

Michael Lappen, executive director of the Milwaukee County Behavioral Health Division.
Michael Lappen, executive director of the Milwaukee County Behavioral Health Division.
Milwaukee Journal Sentinel

The Behavioral Health Division continues to give $1 million a year to the program. The idea is that providing housing to people will reduce emergency department visits and hospitalizations for behavioral health conditions.

The Housing First program — which costs $2 million to $3 million a year — has done that.

The program has reduced costs for state Medicaid programs by $2.1 million a year and for behavioral health services by $715,000 a year for mental health services, according to a brief by the La Follette School of Public Affairs at the University of Wisconsin–Madison.

It also has saved the judicial system money by reducing the number of homeless people who are incarcerated.

The Housing First model — which has been used in other communities — is an example of how in some cases spending on social services can save money by lowering health care and other costs.

A three-day stay in a behavioral health hospital, for instance, can cost $4,500 or more. By comparison, the cost of a housing voucher — which limits what a person pays for rent and utilities to 30% of his or her income — averaged about $800 a month, or $9,600 a year, in February 2020.

New approach to help homeless

Homelessness reached crisis levels in the 1980s, prompting a rethinking of how to combat it.

Sam Tsemberis founded Pathways to Housing in New York City in 1992, the program that inspired the Housing First model. When Tsemberis came up with the idea, he was working as the director of Project H.E.L.P. (Homeless Emergency Liaison Project) in New York City, an emergency outreach team that serves people who were homeless, mentally ill and a possible danger to themselves or others.

Before Housing First, there was no alternative for people facing such challenges. Programs required they be clean and sober before housing. His team took a different approach — to stop dictating and start listening to those they served.

“Pretty much everybody said, ‘I want a place to live.’” Tsemberis said.

His team found homeless individuals to be much more capable than other programs imagined them to be.

“All of that day-to-day, exhausting — figuring it out,” Tsemberis said. “If they can do that, of course they can do an apartment where everything is right between four walls.”

Today, this model has been replicated all over the U.S. and has been adopted in other countries, such as Canada, France and New Zealand.

Injury led to addiction, challenges

A cascade of personal issues led Edwards to the program. 

Since he was 13, Edwards has waxed and stripped floors and has done tile and grout work. He worked for a company that did remediation for water damage. His favorite job was working as a teen counselor and an assistant physical education director for what is now the Boys & Girls Club from 1970 to 1975.

Elijah Edwards, second from left, with his 12 other siblings in this 1960’s family photo.
Elijah Edwards' family, from left, standing, Mae Kirby, (sister), Viola Edwards (sister), Kathy Conley (blue, niece) and older brother Larry Edwards (green packers t-shirt), seated, Albert Edwards (brother), left, and Elijah Edwards, right.
TOP: Elijah Edwards, second from left, with his 12 siblings in this 1960’s family photo; BOTTOM: Elijah Edwards’ family, clockwise from upper left: sister Mae Kirby; sister Viola Edwards; niece Kathy Conley; brother Larry Edwards; Elijah; and brother Albert Edwards.
TOP: Elijah Edwards, second from left, with his 12 siblings in this 1960’s family photo; BOTTOM: Elijah Edwards’ family, clockwise from upper left: sister Mae Kirby; sister Viola Edwards; niece Kathy Conley; brother Larry Edwards; Elijah; and brother Albert Edwards.
LEFT: Elijah Edwards, second from left, with his 12 siblings in this 1960’s family photo; RIGHT: Elijah Edwards’ family, clockwise from upper left: sister Mae Kirby; sister Viola Edwards; niece Kathy Conley; brother Larry Edwards; Elijah; and brother Albert Edwards.
Photo courtesy of Elijah Edwards and Angela Peterson/Milwaukee Journal Sentinel

He also was an intramural basketball coach at the club.

“The exciting part was working with the kids through their hard times,” Edwards said. “Every time I see them, they always call me Coach Edwards.”

Then, in his mid-50s, his life began to unravel, starting with being injured while working and needing hip replacement surgery. He eventually ended up addicted to cocaine and living at the Rescue Mission.

Father Steven Block offers Communion to a resident at Brentwood Park Home in Franklin. Block also has a homeless ministry called St. Martin's Mission. Block was able to help Elijah Edwards get assistance through the Housing First program.
Father Steven Block offers Communion to a resident at Brentwood Park Home in Franklin. Block also has a homeless ministry called St. Martin’s Mission. Block was able to help Elijah Edwards get assistance through the Housing First program.
Angela Peterson / Milwaukee Journal Sentinel

If the weather was good, he said, he would stay in his truck and get high or drink.

A turning point came when Father Steven Block, a friend and spiritual mentor, put him in touch with an outreach worker for the Housing First program.

Block said the stability of a home provides crucial dividends to those with the challenges Edwards faced.

“I was able to help him make the transition smoothly. He knew how to get an apartment; he just didn’t have the resources to get it. And I think that goes the same with anybody who is looking for housing — it’s such a great thing to get people off the street.”

He didn’t stop smoking crack cocaine immediately after getting housing, but achieved sobriety in March 2021. And he acknowledged that getting an apartment helped move him to take that step.

“If it wasn’t for Father Block, I probably wouldn’t be where I am today,” Edwards said.

Outreach to the chronically homeless

The Housing First program has helped more than 1,600 people get into housing since it was introduced in Milwaukee County.

Everything changed with the introduction of the program, said Collins-Dyke.

Outreach workers could go to an encampment and offer housing to people, some who have been homeless for more than a decade. 

The initial response was often skepticism.

“‘OK, so what are the 9,000 hoops I have to jump through to get this?’” Collins-Dyke said. “And we were like, ‘None. There are no hoops. It’s yours.’”

The Housing First program gives priority to people who are chronically homeless — those who have been homeless for one year or had four episodes of homelessness in the past three years equaling 365 days — and who have medical and behavioral health conditions.

The Milwaukee County Housing Division contracts with Impact — the nonprofit, confidential 211 helpline and online directory of community resources for nine counties in southeastern Wisconsin — to screen people who have applied for housing and to determine who should be given priority when a housing voucher becomes available.

(The vouchers can be used for apartments that rent for up to 110% of what is determined to be the fair market rent in a city.)

The number of vouchers is limited — nationally, only one in four people eligible for vouchers receive them — but some become available on most weeks, said Emily Kenney, the director of systems change at Impact.

As a teenager, Kenney tutored children who were homeless.

“I got to know the families and the situations of the kids in my home community that were experiencing homelessness and got angry at the injustice of it all,” she said.

Kenney earned a degree in social work and then got her first job at Healthcare for the Homeless, now Outreach Community Health Centers.

Offer of housing made a difference

Kenney, too, has seen the effect of getting people into housing.

She remembers one of her first clients, a man who was always drunk. The approach at the time was to get him into treatment, and she would suggest it every time she saw him. He basically would tell her to walk away.

That changed when she could offer him an apartment in a supportive housing complex for people with behavioral health conditions.

“He sat straight up and said, ‘I didn’t know that you could offer me housing,’” Kenney said.

The man, who had been without medical care, had a cognitive disability and was almost blind from glaucoma in both his eyes. He cut down on his drinking immediately after getting an apartment and the safety of a locked door.

“He was drinking just to get through the day,” Kenney said. “He was scared and lonely.”

An estimated 800 people in Milwaukee County are living in on the street, in cars or in emergency shelters.

The Housing First model shows the potential benefits of helping people by starting with housing and meeting their basic needs, Kenney said. But people also need other services. 

Two of the most important are a steady source of income — most people who are homeless are eligible for Supplemental Security Income because of disabilities — and access to behavioral health care.

Eric Collins-Dyke, right, talks to Akeem Lawrence about getting a place to live while outside Lawrence's tent in MacArthur Square Park in downtown Milwaukee. Collins-Dyke is assistant administrator of supportive housing and homeless services for the Milwaukee County Housing Division.
Eric Collins-Dyke, right, talks to Akeem Lawrence about getting a place to live while outside Lawrence’s tent in MacArthur Square Park in downtown Milwaukee. Collins-Dyke is assistant administrator of supportive housing and homeless services for the Milwaukee County Housing Division.
Mark Hoffman / Milwaukee Journal Sentinel

The Housing First program has a staff of case managers to help people once they get into housing.

“Most of the folks we serve on the street have faced significant trauma in their lives, whether in their childhood or in their adult lives,” Collins-Dyke said, “and they deal with it on a daily basis.”

The rising cost of housing, though, means that more people could find themselves homeless in coming years.

A new jump in homelessness predicted

Dennis Culhane, a professor of social policy at the University of Pennsylvania and a national expert on homelessness, estimates that the homeless population over age 65 will triple by 2030.

They will have access to health care. Medicare and Medicaid will pay their medical bills when they seek care at an emergency department or are hospitalized. They may not have access to housing.

Dennis Culhane of the University of Pennsylvania School of Social Policy & Practice.
Dennis Culhane of the University of Pennsylvania School of Social Policy & Practice.
Candace diCarlo / University of Pennsylvania

Culhane challenges some of the projections on the potential savings from lower health care costs. But his research also has drawn attention to the high cost of shelters compared with housing vouchers.

“Building shelters isn’t the way to go to get out of this,” he said. “It’s to get people rental assistance.”

The Milwaukee County Housing Division receives support from several health insurance companies that contract with the state to manage the care of people covered by BadgerCare Plus, the state’s largest Medicaid program. It also receives money from the Milwaukee Health Care Partnership, which includes the health systems in Milwaukee County, and the United Way.

But the money available for vouchers is limited.

“The only way we can end homelessness is through housing, and the only way people can afford housing is through rental subsidies,” said James Mathy, administrator of the Milwaukee County Housing Division. “That’s really the No. 1 thing when we talk about homelessness. That is what people need — rental subsidies.”

Despite its limited funding, the Housing First program has nonetheless help change, and in some cases, maybe save lives since 2015.

Elijah Edwards at his apartment at United House. Edwards said getting an apartment helped him recover from drug addiction.
Elijah Edwards at his apartment at United House. Edwards said getting an apartment helped him recover from drug addiction.
Angela Peterson / Milwaukee Journal Sentinel
Each day begins with thanks

Edwards, who turned 65 in July, once again has a home. He works a few hours several days a week for a car wholesaler.

Edwards begins each day with his morning devotional.

His favorite passage in the Bible is Deuteronomy 1:31. It reminds him of his own time in the wilderness:

“There you saw how the Lord your God carried you, as a father carries his son, all the way you went until you reached this place.”

Vanessa Rivera reported this story while attending Marquette University and working as a research assistant to Journal Sentinel reporter Guy Boulton. Boulton spent the 2021-22 academic year as an O’Brien Fellow in Public Service Journalism at Marquette University examining the social determinants of health. Angela Peterson is a photojournalist with the Journal Sentinel.

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