'Frequent Fliers' Run up Dallas County's Homeless Tab

Aug. 3, 2009
Reprinted with permission from the Dallas Morning News.

By Kim Horner

Dallas County taxpayers spend about $50 million a year sheltering, treating and jailing the homeless.

Perhaps half of that is for the 600 to 1,000 toughest cases – many of whom visit emergency rooms, psychiatric hospitals, jails so often they're called "frequent fliers." These very ill people repeatedly cycle through a massive, uncoordinated system of local, state, federal and private institutions at alarming speed and alarming cost. And despite the millions being spent, many of these chronically homeless people remain in shelters and cardboard boxes.

"What do we get? They're still homeless," said Mike Rawlings, who serves as Dallas' homeless czar. "Somebody would be fired in the business world if they got those results."
The $50 million figure was arrived at by totaling the annual expenses of more than a dozen local taxpayer-funded agencies. It is a conservative figure because some agencies do not track how much they spend on the homeless. And it does not include at least $23 million in private funds spent locally caring for the homeless.

Some of the costs to taxpayers are predictable: the police officers who get the homeless off the street, and the places that house them and treat their mental and physical illnesses. But there are plenty of other expenses: for ambulance runs, removing trash from homeless camps, even staffing for the city's drunk tank.

Dallas officials are working to end this costly cycle by shifting money into housing that would come with services to help people remain stable. But there's a major shortage locally of this type of housing.

"Texas is called a bootstrap state. But we're probably costing ourselves a lot of money by insisting on that bootstrap approach," said Dr. Ron Anderson, president and CEO of the Parkland Health & Hospital System. Parkland Memorial Hospital spent about $15.6 million providing health care to homeless people in 2008.

'Random ricocheting'

There are between 6,000 and 10,000 homeless people in Dallas County, depending on who is counting and the method used.

Of that total, an estimated 10 percent are defined as chronically homeless because they have serious mental illnesses, addictions and disabilities and have been on the streets long-term.

Experts say that even though the chronically homeless represent just 10 percent of the overall homeless population, they use at least half the services. Studies across the nation have found that each chronically homeless person costs taxpayers between $35,000 and $150,000 a year.

"With their random ricocheting through mainstream health and law enforcement systems, they are some of the most expensive people to the public purse," said Philip Mangano, former head of the U.S. Interagency Council on Homelessness in Washington, D.C.

In Dallas, that ricocheting might go like this: A mentally ill homeless man gets arrested for public intoxication. After a couple of nights in jail, at $55.60 a night, he's released and back on the streets. He gets beaten up and spends a week at Parkland hospital. Then he goes to a shelter, where he becomes suicidal. He ends up at a psychiatric hospital at a cost of $373 a night. Then he's back on the downtown streets all over again.

Patients often do not get adequate substance-abuse treatment, or the best medications for their illnesses under the existing system, said Dr. Ed Nace, a psychiatrist and president of the North Texas chapter of the Texas Society of Psychiatric Physicians.

"The bottom line is, it's very easy for people with chronic mental illnesses and addictions to fall through the cracks and to not have insight and emotional stamina to follow through with the care they would need," Nace said.

Just three local homeless people had bills totaling $183,000 for 169 days in Dallas-area psychiatric hospitals and substance-abuse treatment centers between April 2008 and March 2009, according to ValueOptions, the company contracted to provide mental health care for the poor in North Texas.

Police keep a list

Many of the chronically homeless here are familiar to Dallas police officers, who regularly find them panhandling, drinking or sleeping, especially in the central business district. It costs $30.91 for every hour that a police officer is tied up with such issues, and often it takes more than two hours to book someone at the county jail.

Police routinely secure vacant buildings where people have left piles of feces, soiled sleeping bags and broken lighters – only to see them return all over again.

"A lot of these people, they're struggling to survive," Dallas police Sgt. David Conley said. "Not to justify it, but you can almost understand after talking to these guys, the desperation.
"I've met homeless people who can quote Shakespeare. There's some really bright people," Conley said. "But you can take the brightest person and get him hooked on crack, and they're a different person."

This year, Dallas police created a list of people in the central business district with the most offenses. Many are homeless. The idea is to provide treatment if the person is willing, or to keep them in jail longer, if not.

"We're trying to break the cycle of having to deal with the same individuals over and over," Conley said.

'Somebody's child'

Many of Dallas' chronically homeless are repeat visitors at the Office of the Dallas City Marshal and Detention Center in Deep Ellum, where police may bring them if they are cited for public intoxication. A handful come in two or three times a week, costing $59.42 each time they are booked.

"It's like baby-sitting," said Mary Lynn Morris, the center's assistant director. Despite the inmates' sometimes belligerent attitudes, she says she asks employees to be kind. "I always remind the staff, that's somebody's child."

Chronically homeless people also are familiar faces at the county jail, which has housed an average of about 523 homeless people each night – at a cost of $55.60 a day for the 2008-09 fiscal year.

"The only long-term treatment today is in the prisons," Nace said.

The area's mental health care system lacks the kind of long-term care that could prevent people from going back on the streets, said Ron Stretcher, Dallas County's director of criminal justice.

"The clear bottom line is this is a tragically underfunded system. We accomplish nothing by taking a homeless person, holding them in jail 10 days to serve time on a criminal trespass and send them back out," Stretcher said. "All we've done is spent that money for no long-term gain."

Parkland's challenge

A large share of the cost of chronic homelessness locally falls on Parkland Memorial Hospital, which sees homeless people with advanced medical conditions such as AIDS, hepatitis C and tuberculosis.

"The problem could be handled by social programs, but we don't fund those," Anderson said. "They default them to the health care system or the judicial system, and, basically, you have to spend a lot more."

He remembered one homeless patient, now deceased, who had blood-alcohol levels that would put most people in a coma. He was hospitalized dozens of times for problems such as alcohol withdrawal.

"When I ran the ER I used to say if we bought him a place on the French Riviera and gave him a $50,000 a year stipend, it would be cheaper," Anderson said.

Dr. Sue Spalding runs a Parkland program that provides mobile health care to shelters. Providing medication to someone staying at a shelter can be challenging since their belongings can easily be lost or stolen. And, when caring for desperate people struggling with addiction, there's a concern that the patient may sell the medication.

"The challenge with the chronically homeless is, are you giving them something that's worth more money in cash than it's worth to them?" Spalding said.

Looking for a better way

Local officials say they're working to change the existing system of addressing homelessness through a disorganized network of jails, hospitals and shelters.

Rawlings said the money is needed, but it should be shifted to housing and mental health care to take people off the streets for good. He said the city is making inroads at reducing expenses at the jail and hospitals by divertingthem to the city's homeless assistance center, The Bridge.

Still, Dallas County Commissioner John Wiley Price said he's concerned about the high jail and hospital costs.

"You just can't keep doing this and think it's going to go away," Price said. "We need to buy into some different models."

Prevention is the key, Anderson said.

"Somebody will say, 'You're going to take care of people who are just bums,' or they'll have some name for them because they want to make them into a stereotype so they don't have to deal with them," he said. "Once you really see what goes on, once you've been in those shelters, you realize there but for the grace of God, you could be there."

Taxpayers will pay for chronic homelessness one way or another, Anderson said.

"Society will deal with it. It's going to be in a safety net situation, which is going to cost a lot of money," he said. "It's wiser, more compassionate and more humane when you can prevent the escalation. Will some people abuse it? Yes. That's the price you pay. But you can help a lot more people that way."

COST OF HOMELESSNESS IN DALLAS COUNTY

As part of an effort to put an annual price tag on homelessness in Dallas County, more than a dozen public agencies affected by the problem were contacted. Some were able to provide an estimate of their expenses related to the homeless that they considered accurate. Others provided a formula to calculate an estimate. ValueOptions, the managed care company that coordinates mental health care to the poor in Dallas County, said it couldn't offer an estimate. However, those expenses are almost certainly in the millions of dollars.

Copyright 2009. Used with permission from the Dallas Morning News.