| Ensuring Adequate Housing for
New Yorkers with HIV Disease
Housing is a necessity for everyone-and for New Yorkers these days,
housing is especially hard to find and afford. So it's not surprising
that the Columbia School of Public Health CHAIN study confirms:
inadequate housing continues to be a major problem for large numbers
of persons living with AIDS in New York City, many of whom are living
in New York's costly and unsanitary Single Room Occupancy (SRO)
hotels. AIDS often results in swift, unexpected illness, leading
to loss of employment, impoverishment and homelessness. For a person
living with AIDS, homelessness or even the threat of homelessness,
can lead to unnecessary illness and premature death. For many with
HIV/AIDS, permanent housing is the difference in having access to
medication, to stability, and, ultimately, re entry into the labor
market. Pure and simple: Housing equals healthcare and health
for People Living with HIV/AIDS.
People with HIV/AIDS have Specific Housing Needs
The prevalence of HIV among homeless people who are substance users
and people with mental illnesses is estimated to be 62%. Furthermore,
50% of all people with AIDS will experience homelessness or face
the serious risk of becoming homeless at some point during their
illness.
Standard public housing models can play an important role to accommodate
people with HIV that are non-symptomatic, but are largely inappropriate
for most people with AIDS because of long waiting lists, discouraging
application processes and lack of services. Homeless shelters are
expensive and determined by the courts to be medically inappropriate
for severely immune-compromised persons.
On the other hand, housing that is developed specifically to meet
the needs of persons with AIDS has been found to be cost efficient
and extend the longevity of its occupants. Studies have proven that
stable and medically appropriate housing for people with
HIV/AIDS reduces costly inpatient hospitalizations, allows
for successful compliance with complex medical and medication regimens,
and allows residents to address other priority issues such as mental
health needs and substance addictions. Housing with appropriate
services has also proven to benefit clients with psychosocial functioning,
helping them achieve self-determination and self-care. Stable
housing is key to recovery.
A recent study by the Corporation for Supportive Housing confirms
that supportive housing with integrated services reduces residents'
use of emergency room services to well over a half of the previous
year's use. In addition, inpatient hospital stays fell sharply once
a person enters supportive housing. Further, the need for residential
mental health care is virtually eliminated in the first year of
supportive housing. In sum, supportive housing is more than
a humanitarian solution for homeless people with AIDS; it is also
a substantial relief to public hospitals and overburdened crisis
treatment programs.
Current Housing Barriers for People Living with
HIV/AIDS
Housing construction and rehabilitation processes are very
difficult.
New York's rules and regulations for new building are often called
the nation's most cumbersome and complex. "You've got to make it
easier to build stuff," explains Howard A. Husock, a housing expert
at Harvard's Kennedy School of Government. Rehabilitation of existing
housing can save money and is a good alternative to new construction,
but the process can be just as unwieldy. New York City maintains
thousands of vacant lots and dilapidated buildings. Many of these
spaces could be turned into new housing for all New Yorkers, including
people with AIDS. In order to make it easier to create more housing
and better housing, New York housing advocates are calling for simplifying
rules on zoning, building, landmarks and access for the disabled.
Land review procedures are cumbersome and often facilitate NIMBY
(Not In My Backyard) sentiments, encouraging certain community members
to act out of fear and ignorance and try to sabotage the development
of AIDS housing in their neighborhood. Simplifying the land review
procedures will foster the atmosphere needed to create housing opportunities.
While still recognizing that New Yorkers need public spaces, housing
advocates maintain that both housing and public spaces are possible
under a simplified process; and warn that dire needs for housing
and open space should not be pit against each other.
Valuable funding resources are used inappropriately.
Unfortunately, during the past few years, the Guiliani administration
turned its back on the housing needs of people with AIDS. AIDS housing
needs, exacerbated by NYC's housing crisis, have quickly exceeded
existing resources. Yet, instead of investing city resources to
help meet the housing needs of PWAs, the City siphoned off federal
HOPWA funds earmarked for AIDS housing to pay for city caseworkers'
salaries at HASA. The City promised to swap HOPWA funding with City
Tax Levy funding in order to garnish increased revenues through
a state match. This infamous accounting rue is known as the "HOPWA
Swap" and has been very detrimental for the HIV community. The increased
revenues received by the City were never reinvested into the housing
needs of the HIV community. In fact, this year the City has reneged
in its commitment to substitute City Tax Levy for cost that was
previously paid for by HOPWA. Thus, the "HOPWA swap"
has deteriorated into the "HOPWA swipe." Approximately
$25 million of NYC's HOPWA funds goes to fund caseworkers' salaries
at HASA; this leaves only a token amount of $150,000 to be allocated
to HPD, the city agency responsible for building new AIDS Housing.
HASA, a central agency for people with AIDS needs drastic
improvement, particularly in its Housing Unit.
HIV/AIDS Services Administration (HASA) is an unique city division,
specifically created to meet the special needs of persons living
with AIDS. Unfortunately HASA has become largely dysfunctional.
To make matters worse, HASA's housing unit is structured such that
it plays a pivotal role in meeting the housing needs of people with
AIDS. HASA is responsible for contracting and monitoring the majority
of AIDS housing contracts in the city and , for providing some direct
forms of housing services (such as emergency housing services).
HASA is the centralized housing referral source for its 30,000 HIV
symptomatic clients, but bad management and lack of leadership have
resulted in a steep decline in the agency's efficacy in recent years.
For example, according to Local Law 49, HASA clients requesting
emergency housing must receive housing that day. Unfortunately,
there are still many cases where PWAs wait all day at the HASA office
and still get turned away homeless. Some PWAs that are able to get
emergency housing only get placed for the night and must repeatedly
wait the entire next day for the next night's placement. Also problematic
is that some HASA clients lose existing apartments and some potential
landlords refuse to rent to HASA clients because the city is notorious
for making late rental payments. It is inexcusable that PWAs lose
their housing or are not able to find housing because of administrative
mistakes on the part of the city.
Rental assistance vouchers are not in keeping with NY's
high market rates.
Currently, close to 13,000 individuals served by HASA take advantage
of the enhanced rental assistance available to persons living with
HIV/AIDS. This program, funded with city and state dollars, provides
a cash supplement between $480-$650 per month for PWAs to remain
in their homes even following the onset of severe illness. While
the rental assistance program has benefited many to secure and maintain
their market-rate apartments, the supplement rate has not been increased
in over a decade. Rental assistance rates are outdated when compared
to fair market rates, but can easily regain their full programmatic
worth by removing the arbitrary caps that are preventing increases
up to market levels.
Scatter-Site housing is underfunded and has been dangerously
deconstructed.
HASA also operates scattered site housing contracts with community-based
organizations that make apartments available to PWAs in various
New York communities. PWAs living in a Scatter-Site apartment are
able remain close to friends, family and support networks. Case
management services and home health care are available to the person
with AIDS in these scattered site apartments. New York City currently
has approximately 4,300 units of scattered site housing available.
Unfortunately, the level of support for individual scattered site
contracts has not been increased since the program was begun 15
years ago, despite the fact that real estate and overhead costs
have grown dramatically during that time. Although the City was
planning to add more scatter site units in the coming year, HASA
officials proposed major changes to the scatter site program that
have been opposed by advocates and housing providers. One provision
mandates that scatter-site providers sign over apartment leases
to HASA clients regardless of whether the client is currently suffering
from mental illness and/or substance abuse. Such mandated lease
assignments may not be congruent with the individual's self-management
abilities and facilitate risk of future evictions. If these issues
are not resolved, it is unlikely that the City will be able to meet
its goal of increasing scatter-site units in the coming year
Congregate and residential housing programs are vital but
need procedural streamlining.
Transitional and permanent congregate housing programs offer their
clients on site case management, support groups, mental health and
substance abuse counseling services. Clients live collectively with
shared facilities, i.e., bathrooms and kitchen. Residents vary in
the length of stay, ranging form a few weeks to permanent, depending
on the parameters and goals of the particular housing program. Some
people with AIDS prefer not to live alone because they require more
intensive assistance. For this population, the City has developed
several residences operated by not-for-profit organizations that
provide on-site services around the clock. These forms of permanent
supportive housing are a cost-effective, comfortable alternative
to nursing homes or hospitals, at approximately one-tenth the cost.
Several community-based organizations operate licensed residential
health care facilities for persons who require around-the-clock
medical attention. These facilities provide medical treatment, on-site
meals, recreation and nutritional therapy, and a range of other
services and treatments. These housing programs function as comfortable,
non-institutional alternatives to long-term hospitalization. In
total, there are approximately 2000 of such units and as waiting
lists indicate, the need is far greater than available units. The
problem is that these critical residences are slower to open because
they typically involve either new construction or renovation. CBO's
wishing to undertake these housing programs must be able to merge
a mixture of funding resources, including city housing capital funds,
service contracts and rent subsidies. One common complaint among
housing providers is the "catch 22" where one city agency mandates
that the provider attain a service contract before they can commit
to receiving capital development funds, but another city agency
mandates that providers secure capital funds before it can apply
for a service contract. Contradictory and onerous administrative
burdens must be eliminated or at less significantly mitigated.
In their present condition, SRO's are unhealthy, unsafe,
and unacceptable for PWAs.
Because of the shortage of permanent housing for people with AIDS,
the City has been forced to rely heavily on SRO hotels to relieve
the housing crisis for people with AIDS. Although the City ostensibly
uses the SRO hotels only for emergency housing, many people with
AIDS actually reside in these hotels for months or even years due
to the shortage of other forms of housing. It is estimated that
approximately 800 HASA clients are placed in commercial SROs. Unfortunately,
conditions in many of these hotels are deplorable. Not only do such
residences lack basic social services, but they frequently place
residents' health in danger from violence or unsanitary conditions.
Ironically, the City pays top rates for such housing placements
for people with AIDS. As noted before, SRO availability is dwindling
as many landlords have stopped accommodating HASA clients because
of HASA's consistent inability to pay vouchers on time. Adding insult
to injury, the option of using commercial SROs continues to diminish
even more as buildings are converted into tourist hotels or higher
market rate housing.
Conclusions
The City clearly needs to reinvigorate its commitment to providing
medically safe and affordable housing for PWAs. A comprehensive
strategy in this area needs to be undertaken, reviewing the current
portfolio of AIDS housing programs that run in conjunction with
the assistance or administration of a number of city agencies. The
City needs a new housing blueprint and mayoral leadership that will
undertake tough issues such as options for reforming HASA, new construction
and renovation of existing housing stock (general public and HIV
specific), and increasing special HIV/AIDS "rental enhancement assistance"
to keep pace with market rates.
A renewed commitment is necessary with regard to services as well.
New York City has developed an impressive array of social and medical
services that enable people with AIDS to live longer and healthier
lives. Housing providers frequently partner with other community-based
agencies in offering services to their residents, often in the convenience
of their own homes. The services range from housekeeping assistance
and babysitting to substance abuse treatment, support groups, tuberculosis
treatment and acupuncture. In addition, many housing providers offer
counseling in activities of daily living, such as nutrition, recreation,
financial management, bereavement and permanency planning counseling.
These services are essential and must be on/at par with the increase
in housing stock in order to make New York City's continued investment
in AIDS housing meaningful.
Recommendations
Implementing the following items would greatly improve the city's
effectiveness in providing adequate housing assistance to people
living with HIV/AIDS.
- Use federal Housing Opportunities for Persons with AIDS (HOPWA)
dollars only to create permanent housing and provide support services
to homeless individuals and families living with AIDS - Undo the
HOPWA swap that has deteriorated into the HOPWA swipe.
- Increase resources for the development of supportive and residential
housing programs. Reduce or soften the zoning rules and eliminate
administrative burdens that hinder the capital or operational
development of new housing for all New Yorkers.
- Eliminate the practice of assigning one-night emergency housing
placement and develop medically appropriate emergency housing
of longer duration.
- Raise the rental enhancement caps from $650.00 for an individual
to fair market rates and build in increases in keeping with the
decision made by the Rent Guidelines Board.
- Reverse the Scatter Site Housing Program provision that forces
clients with co-morbidities such as mental illness and/or substance
abuse to undertake lease agreements that they may not be able
to handle.
- Improve monitoring of living standards in commercial SROs. Enforce
the mandate that living conditions in SROs need to be in compliance
with the corresponding provisions in local law 49.
- Reevaluate the HASA voucher system. Payment against the vouchers
needs to be expedited significantly. Implement a thorough review
and reorganization of the processing and verification mechanisms.
© 2003 Gay Men's Health Crisis
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