Project 25: Saving Money While Saving Lives
Last week my friend Jeanine passed away. She was found unconscious in her apartment. Jeanine suffered from several health complications including a seizure disorder, bouts of depression, and a long history of drinking. The doctors concluded that her body essentially shut down and that nothing could have been done, although it is hard to believe given her athletic 6’2” frame, outgoing personality, and the fact that she walked five miles every day. She was only 52.
I met Jeanine three years ago in the San Diego County women’s jail after her name was brought up among police officers and paramedics as our city’s most frequent user of the ER and jail. I was there to talk with her about a program called Project 25. Started in 2011, Project 25 was conceived of by the United Way of San Diego County with support from CSH. The United Way provided the majority of the funding with the County of San Diego, the City of San Diego and the San Diego Housing Commission playing important roles in both financial support and programming. The idea was simple: target the most costly and frequent users of public resources who were living on the streets of San Diego and, using a Housing First model, provide them with permanent housing and intensive wraparound services. Father Joe's Villages managed the services, oversaw the housing, and collected the data to demonstrate the program’s effectiveness and savings to the community.
The program started with 25 people, grew to 35, and then added Jeanine as the 36th person in the program after officials in the city asked Project 25 to work with her. Like others in the program, Jeanine was initially resistant to the concept. I would like to say that she agreed to participate on our first meeting in jail and things were perfect from there on out, but that’s not the case. We followed her in and out of jail and the ER numerous times before she finally trusted us enough to let us into her life. Once she did, Jeanine was quickly placed into her own apartment and from there the real stabilization began.
Project 25 provided the standard list of services, such as outreach, case management, and coordination with preventative care, but our approach was a little different. We took to heart a quote from an article in The New Yorker by Dr. Jeffery Brenner who stated, “The only person who can change someone’s life is their mother, the reason is that she cares about them and says the same simple things over and over and over.” This quote was the foundation to everything we did. We were going to care about people and repeat, repeat, repeat until it stuck. We also let the participants teach us about what services they really needed. We used a Harm Reduction approach to alcohol and drug use and supported people with trying to make changes that would lessen the impact on their health and housing, while respecting their decisions to continue using. We worked closely with the Father Joe’s Villages medical clinic to prescribe medications that were delivered to participants in their apartments on a daily basis. It meant we were available 24/7, that we talked with landlords, moved people into their apartments, sometimes cleaned their apartment as we encouraged them to do it on their own, and ultimately we never gave up. It was very labor intensive but it worked. Some might say we were enabling, but in Project 25, success had to be redefined; small steps were giant breakthroughs, and we knew that change would not happen overnight.
What people can’t argue with are the results which have just been released by the Fermanian Business and Economic Institute at Point Loma Nazarene University. The report looked at 28 individuals over a two year period and concluded that the community saved $3.7 million when factoring in the cost of housing and services. The median cost per person went from $110,715 yearly while homeless to only $11,717 in the program in year two. These costs included ambulance rides, emergency room visits, hospitalizations, arrests, jail, court, detox and other public behavioral health costs. The fact that a considerable amount of money was saved is tremendous and consistent with countless reports done across the country on programs for people who are frequent users of public services.
The results have been instrumental locally in moving the program from a pilot initiative to a sustainable model. Project 25 has expanded to 20 more individuals with the services being funded partially from a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) as well as through funding from four Medicaid Managed Care Plans. The goal is to have the Medicaid plans fund the program entirely after the three-year SAMHSA grant is over. The housing is being provided through a continued partnership and with strong support from the San Diego Housing Commission.
Although the costs savings have been amazing and expansion is great, the true measure of success is the lives that have been changed. Jeanine’s was one of them. She had a home, paid her rent, attended church, and had a strong relationship with her family, which was her only real goal. Jeanine and I had made plans to attend a presentation for those on disability benefits who wanted to return to work. It was scheduled for the Thursday after she passed. My hope was that she was thinking about returning to work, but maybe she decided to go because I promised to walk with her the 10 blocks to the presentation. I will never know. What I do know was that Jeanine was on her road to recovery. When I received a text message from Marc Stevenson, Project 25 Director, that she had passed I was sad and let him know that. Although he was sad too, he texted back, “I’m happy to be part of a program that can help folks like her find a place in this world before finding their place in the next.”
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Kris Kuntz is the Program and Research Analyst at Father Joe’s Villages and was responsible for data collection and assisted with the evaluation of Project 25.