Introduction: The Landscape of Homelessness Services
Jane let pigeons into her room. Not just one or two pigeons, but an entire flock, leaving birdseed lodged in every crevice in the room and bird droppings splattered across the regulation furniture. In theory, bird whispering sounds romantic. In reality, dozens of birds let loose in a small apartment do serious property damage.
Most landlords would evict someone whose apartment regularly has to be deep-cleaned due to pigeon droppings and peck marks. Most landlords — but not the Downtown Emergency Service Center, one of Seattle’s leading homelessness service providers. For years, Jane [name changed to protect her privacy] has lived in one of the fourteen Permanent Supportive Housing apartment buildings run by the nonprofit where I was a Harvard College Mindich Service Fellow in summer 2019.
PSH offers affordable, independent, and permanent living, in contrast to temporary (and free) shelters. Rent in DESC’s PSH buildings is one-third of income, but many clients have zero income and thus pay nothing. The buildings are supported by state and federal funding as well as private charity. All Permanent Supportive Housing comes with 24/7 staffing at the front desk, on-site clinical support, case management, medication monitoring, and payee services. DESC’s buildings also offer activities arranged and supervised by staff and free on-site meals.
PSH is only one small part of the vast array of services nonprofits like DESC provide for homeless people. DESC also runs five temporary shelters (with 470 beds), mental health and substance abuse clinics, case management, outreach and crisis response programs, a robust fundraising/donations operation, and a thrift shop.
DESC’s clients — the internal parlance referring to the homeless people who use DESC’s services — must meet the standard set by the federal government for “chronic homelessness.” That is, they have been on the streets for years, often in multiple episodes. DESC serves the most vulnerable people in the homeless population. Clients at DESC’s shelters must have serious physical disabilities, mental illness, or substance use disorders to receive services. Otherwise, the organization refers them to shelters and housing options that are better equipped to serve them.
The Invention of Chronic Homelessness
Unlike most of the “innovative solutions to homelessness” that have sprung from Silicon Valley and think tanks, DESC is old-school. Founded in 1979, its full name, the Downtown Emergency Service Center, is left over from a bygone era in which DESC was a sole converted ballroom.
The modern conception of homelessness dates from the 1980s, when DESC was founded. From the 1870s up to the 1970s, “homelessness” referred first to the romanticized young “hobos” of the Gilded Age, then to the Hoovervilles of the Great Depression, and then again to the older disabled World War II veterans and immigrant farmworkers of the postwar era.
In the 1980s, the homeless population skyrocketed, driven in part by the de-institutionalization of the 1960s, coupled with Reagan-era decreases in spending on federal low-income housing programs and other components of the social welfare safety net. The result was an outflow of people into a world that had no place to house them — or at least, no place they could afford. In 2019, over 500,000 Americans were homeless, while almost 17 million homes stood vacant.
Housing First and Harm Reduction
DESC is one of the pioneering models of the — now widely accepted — policies of Harm Reduction and Housing First. Housing First means providing permanent housing to people experiencing homelessness, housing that is not conditional on getting a job or staying sober. It views housing as the foundation for stability and prioritizes clients’ ability to choose whether or not to engage in services. As DESC employees express to me again and again, it is premised on the belief that housing is a fundamental human right.
The archetypal example of Harm Reduction is giving clean needles to substance users, but for DESC and organizations like it, the idea is much broader. Olivia Jelensky, DESC’s volunteer program manager, explained: “We know a lot of our clients use. They’re self-medicating, or they’re not able to get access to the care they need, or they’re just needing to escape for a while. It doesn’t matter what our case managers or staff members say to them — if they’re going to use, they’re going to use. The idea behind harm reduction is that we’re going to give them tools to help them stay safe while you’re using, and in the meantime continue to have these conversations with clients about: what are the underlying reasons that you’re using? What are some things we can do to mitigate those reasons? What are your goals?”
DESC does not — as some critics of Harm Reduction claim — encourage substance use, but neither does it make sobriety a condition of services.
If you’ve heard of DESC, it’s probably because of the 1811 Eastlake building. The 1811 project serves high-utilizers of emergency services related to alcohol abuse. As part of the program, staff members give clients alcohol at certain points in the day — “based on an agreed contract between the clients and case managers,” said Jelensky. This helps clients prevent alcohol withdrawal and its medical consequences, and tends to result in less alcohol consumption for most clients.
A high-profile lawsuit against DESC to prevent the construction of the project was ultimately dismissed by the Washington Supreme Court. The controversy around the project — derisively nicknamed “bunks for drunks” in the popular press — ended up becoming one of DESC’s biggest victories. A paper in the Journal of the American Medical Association demonstrated that, in the first year of operations, the 1811 project saved the city four million dollars in reduced utilization of emergency services like jails, rehab, and hospitals. Alcohol usage amongst residents also dropped by one-third. In the world of homelessness policy, this is borderline miraculous.
For most clients, PSH is the end of the line, the resting place after years of living in streets and shelters. Housing Assistance Case Manager Katrina Brauer works in DESC’s Main Shelter. When trying to persuade a skeptical public about the importance of Housing First- and Harm Reduction-based interventions, she always starts by explaining the conditions that many chronically homeless people live in: streets and shelters.
The Shelter of Last Resort
The lobby of the Main Shelter is gloomy, lit by one sputtering fluorescent light. People are asleep on the floor, or sitting down waiting to be seen at the front desk. Outside, more people congregate: They chat, argue, smoke, fight. More often than not, when I got to work at 8 am, there would be an ambulance or police car outside — or both.
One morning, I have four calls on hold: a case worker wanting to know if I’ve seen her client today, a doctor asking me to come pick a client up from the hospital, a different case worker asking about rest home resources, and a mother asking if she can send her son to live at the shelter. On one side of the office, a woman in tears is asking me to violate confidentiality laws and tell me if her husband is in the shelter; on the other side, a man in a wheelchair with severe sores on his leg is patiently waiting for the EMTs to pick him up. (It took them three hours to arrive.)
Staffing the front desk of DESC’s Main Shelter is a job unlike any other. Along with the case managers, medical staff, janitorial staff, supervisors, and other Main Shelter staff, they keep the engines chugging in what might just be America’s most chaotic workplace environment.
“It’s wild, it’s loud, there’s a lot of sticky surfaces,” said Brauer. “There’s often urine in the elevator and trash on the stairs, and the janitorial staff is diligent, but there’s a lot of people in a small space[…] Imagine if you worked somewhere where you had to be on the lookout for human feces, ’cause I do! And our clients live in it.”
People are often using drugs or smoking in the bathrooms; on one memorable day, a coworker and I have to extinguish a trashcan fire due to a lit cigarette. In the long hallway that connects the entrance to the dormitories — lovingly nicknamed the Bowling Alley — 50 or so clients are lined up. They are sneezing, coughing, chatting, arguing, and doing what Brauer refers to as “responding to internal stimuli — talking or yelling at something I’m not experiencing in my reality but they very much are.”
This environment has profound health consequences for its residents. Brauer worked with a client who had several serious infections and would “spend a few months in the hospital stabilizing and then come back here, and within two days he’d be back in the hospital for a few months again […] He’d get that sick after re-entering this environment.”
“Dormitories have bunk bed style beds, lots of bugs — bedbugs, lice, scabies, all sorts of things.” Brauer has a client who has a “terrible case of body wide scabies, who has serious memory issues and can’t remember why he has scabies and is so itchy and he constantly asks me and then forgets [he] can’t shower. He scratches himself to the point where he bleeds through his shirts.”
Not every homeless shelter is like DESC’s shelters. Employees describe DESC’s Main Shelter as “very low-barrier.” For some, it’s the shelter of last resort. “We cater to a wide range of needs,” Brauer explained. “Other programs are not as forgiving in letting people back in the doors if there’s been assault, lots of theft, property damage, etc. It’s hard to say where they can go if we’re not the appropriate place.”
Of course, the shelter might be a much more peaceful place if DESC practiced more stringent barring of clients. But that’s not DESC’s mission. “If someone’s in crisis, harming other people, that doesn’t make them beyond help.” Katrina said. “I think a lot of my coworkers have that mindset, which I really appreciate, and I wish there were more people like that out in the world.”
Katrina tells me that DESC’s clients become homeless in many ways. Sometimes, the city tears down a rent-controlled building. Sometimes, a parent in another state gets sick; their child visits, stays for longer than anticipated, and then gets home to discover a job loss and an eviction notice. Some people become disabled; some people have criminal charges and can no longer pay the rent while they’re in jail. One client was a full-time student in an apartment until she discovered her “landlord” had been scamming her by way of an eviction notice on her door.
Whatever their story might be, they’ve landed at DESC, and some of them have even landed in Katrina’s office. As a housing assistance case manager, or HACM, Katrina personally works with 15 to 20 clients to help them achieve their goals. This means navigating the chaos of the shelter and of the housing bureaucracy. Case managers might go with clients to the hospital, help them get on the right bus in the morning, provide a quiet space for them.
For most people, the first priority is getting housing. Possible barriers include having no income — so the HACM might focus on working with the client to get social security benefits — or being disabled — so the HACM might work to get that client into Permanent Supportive Housing. “Maybe you have evictions, bad credit, no state ID, legal issues like being a sex offender, memory issues, being married — it’s hard to house a married couple.”
HACMs look everywhere for housing: from Zillow and Craigslist, to nonprofits and agencies that offer subsidized housing, to waiting for the Coordinated Entry process to assign clients to Permanent Supportive Housing or Rapid Re-Housing (which consists of 3-6 months of financial rent assistance).
The process is draining for HACMs and clients alike. “The saddest thing I ever have to do,” Katrina said, “is explain to someone again why we’re still trying to find them housing, and they hate it here.” All she can say to them is “‘I hope you find something soon.’” She sighed. “All the other successes, connecting people to resources, getting them their documents and benefits, it’s all awesome, but ‘when do I get my housing?’”
The Housing Process: Paperwork and Algorithms
A daunting and sometimes-inefficient bureaucracy stands between clients living in shelters and their end-of-the-line permanent housing. Kelsey Beckmeyer, DESC’s Coordinated Entry and Housing Placement Manager, tackles that bureaucracy daily.
It took several weeks of working with Kelsey for me to understand every step of the housing process. It begins with a vulnerability assessment, which is used to prioritize the allocation of housing to the most vulnerable clients. In the summer of 2019, King County still used the VI-SPDAT, a much-criticized self-reported yes-or-no assessment. Agencies could not include observations of client behavior. The VI-SPDAT led to the disproportionate prioritization of white men for housing.
DESC instead prefers to use the Vulnerability Assessment Test — an interview process done by a trained employee, which takes into account observations that employee makes as well as complexities of the client’s narrative, and scores them on ten domains: “survival skills, basic needs, medical risks, indicated mortality risks, communication, orientation/organization, mental health, substance use, social behaviors, homelessness.”
For example, Jelensky had a client who would lay in the middle of a crowded street without understanding that they would get hit by a car. They would count as vulnerable in the domains of survival skills, basic needs, and orientation/organization, but not necessarily substance use or indicated mortality risks (which refers to issues like chronic physical disease).
The VAT is now used throughout the nation as well as in Australia, New Zealand, and Canada. DESC’s administration has also worked with First Nations people to adapt the assessment to be culturally appropriate. (For more information about homelessness and North American indigenous communities, see these articles and more.)
Beckmeyer walked me through the process: Once clients have been scored, they enter the Coordinated Entry system, a federally mandated system meant to ensure that every homeless person can access every housing resource available in the area. The system spits out a list of 30-50 people. Once a week, representatives of major agencies meet to match the people on that list to newly-opened PSH or RRH housing opportunities.
Beckmeyer estimated that 50 units come online every 2 months, and about 20 to 30 people are housed in that time period. In a city with 15,000 homeless people, this amounts to almost nothing.
Biases and Power Dynamics
Case conferencing means making an impossible decision: who deserves housing most? These conversations allow social workers to take into account the personal preferences and knowledge of the clients. But the process is a repeated stressor for clients and for social workers. The extent to which a homeless individual’s preference and autonomy are respected is ultimately still up to the individual social worker, not built into the system. “Having to determine, who do I offer this to? Being the one to make that choice, that’s a lot of power to have,” Kelsey said.
Social workers and the people constructing homelessness policy are disproportionately white women. They may have little knowledge of or experience with the experiences and obstacles homeless people, particularly immigrants, indigenous people, and Black people, are facing. This structural racism, and the general unevenness of power dynamics in social work, take a serious toll on clients.
In my time at DESC, I did not conduct any long interviews with DESC clients, in part because of concerns about clients’ privacy rights and ability to consent. The absence of their perspectives is a serious shortcoming of this article.
Making a Home
Many of the employees I interviewed expressed that the part of their job that made it all worthwhile was getting to see a client housed. “The most memorable event that’s happened” in Jelensky’s time at DESC was “when I moved one of my clients into her first apartment ever […] She was a little ornery at first, a little irritated, and I think she had been promised so many things before and nothing ever panned out for her.”
She didn’t believe the move-in kits and furniture in the apartment could be hers, and asked staff to take it all out. “We kept telling her, no, this is your stuff, this comes with the apartment, it’s yours. And she kept fighting us until we took her into the bathroom. We were showing her the tub, the toilet, the features […] she looked at the toilet and she started crying. And she pointed at the toilet and said: ‘that’s my toilet. I don’t have to share that with anyone if I don’t want to.’” Jelensky started to tear up. “I take so much for granted,” she whispered.
During my internship, Olivia Jelensky and Don Rupp single-handedly ran the In-Kind Gifts department, which moves one ton of clothing per week from donation boxes, through a processing and sorting center (located in the garage of one of the housing buildings), to the shelters, thrift store, and other nonprofits.
In-Kind Gifts manages every kind of donation that isn’t money: sheets and towels for client move-in, food, pet supplies, 50,000 pairs of socks, and even a wild assortment of tchotchkes that serve as bingo prizes — a small incentive for clients to participate in community activities.
In-kind gifts donation is not the most glamorous part of the nonprofit world, but it is absolutely essential. In the main shelter, I frequently ran back to our storage room to get a pair of pants for clients who had wet themselves, a complete outfit for a client who came in wearing only a hospital gown, or a winter coat warm enough to keep a client alive while living on the streets.
Don told me: “[During] the big snowstorms, when you look out the window and you know it’s 20 degrees out, I think — do we have enough coats? That’s survival. Did we do our job, did we do that minimum?” Don told me that he was acutely conscious that his job performance at DESC, unlike his past jobs in retail, can be the difference between someone’s life and death. “That’s the scariest part. I don’t know that anyone would turn around and say it’s Don’s fault, but I still feel that responsibility.”
Waist-deep in half-empty hotel bottles of shampoo and conditioner, surrounded by garbage bags full of clothes to be sorted and delivered, I discovered that I had had no idea what homelessness agencies actually need donated to them. In general, sturdy pants, warm winter coats, hats and gloves, and (new) underwear and socks are most necessary. Don is always looking for hygiene items, tents, and sleeping bags. He reminds people that things they throw away might be survival items for some, especially used pots and pans, umbrellas, and old camping gear. And, last but not least, “games or little knickknacks, things that make a place a home”.
Not useful? Nineteen-year-olds’ prom dresses, knives, can openers or other sharp things that could be used for self-harm, and yet another expired can of tomatoes. (At the Main Shelter, I was sometimes in charge of scraping together meals from what was in the pantry. You can imagine how pleased clients are about such delicacies as coconut-milk-and-old-tomato stew.)
Don’s main initiative at DESC has been building the move-in kit program. Don often heard stories about clients who lived without basic necessities like pillows or towels for months or years. Now, every apartment gets a move-in kit. “A move-in kit includes a garbage can, bedding, sheets, an alarm clock with a radio[…]The idea is that when they walk in, the bed is made, all the stressors of moving in are done, because they are home.” Volunteers “adopt” a building and help make the rooms ready.
In-Kind Gifts also provides every single client a Christmas gift, which is exactly as difficult as it sounds for an organization that houses 2,000 people. “Last year my mom called and asked if I had my tree up,” Don laughs, “and I said no, I don’t have my tree up, I’m busy! And she goes, ‘ugh, Don, you don’t like the holidays anymore.’ Like, Mom, I’m Santa Claus!”
Putting the “Support” in Permanent Supportive Housing
The “permanent” in PSH indicates that except in the worst-case scenario (that a resident is dangerous to other residents or staff) DESC does not evict. Unlike most landlords, DESC is committed to keeping residents housed — which is harder than it sounds.
Jane’s pigeons are the least of the housing troubles. One case manager told me about a client who was a chronic hoarder, and who had rotting food and feces all over the unit, leading to a literal wall-to-wall cover of cockroaches. Another client was a pyromaniac, using the apartment stove to light fires that,because he often wandered off, threatened not only him but everyone in the building.
Serious mental illness may have prevented these clients from maintaining “normal” market housing — certainly many landlords would evict tenants for lesser offenses. Like those landlords, DESC draws the line at fire and cockroach infestations, which seriously affect staff and other residents, as well as making the housing unfit for human inhabitation. Unlike commercial landlords, however, they don’t evict these residents. This is where the “support” element comes in.
In practice, supportive housing means setting up a bird fountain in the garden so Jane can feed her birds outside, as well as asking her to sign an agreement that she will keep the windows closed and will allow staff to come to her room once a week to ensure it is pigeon-free (an extension of the room checks that staff do with many of the clients, all with clients’ consent). Supportive housing means taking the stove out of the pyromaniac’s room and keeping a fire extinguisher close by it. Supportive housing means — for a few unfortunate staff members — putting on full hazmat gear and cleaning up the feces and roaches, moving the hoarding client to a room with less space to store things, and checking with him after every meal to make sure he does not bring leftover food back up to his room.
This sort of support is labor-intensive. Lareesha, a clinical support specialist at Canaday House, described her job as “a little bit of everything […] We help them with any medical needs, we do med monitoring, we reach out to families, to other case managers, to programs like REACH [which does street outreach]. We take them to appointments, grocery shopping, we take them to the doctors.” In permanent housing and at the shelters, clients can voluntarily sign up to have their medications provided to them by staff on a strict schedule, to have their money stewarded by a case manager, or to have their cigarettes or alcohol monitored. It’s high-effort and creative work, but it keeps people housed.
Social Work and Mental Health
“Sometimes when your client cries you shed a couple tears too,” Katrina said. “When you hear a lot of trauma and intense experiences, secondary trauma can happen to you: being exposed to other people’s trauma over and over again. We have to be careful and take care of ourselves and not get burnt out.” She relies heavily on her team: “We go above and beyond to help each other and share resources and support each other’s clients and the shelter.”
Despite the team environment and widespread belief in the mission, DESC’s job turnover rates are very high, even by the standards of homelessness nonprofits: over 50% in some years. Katrina sighed. “If we burn out, our clients miss out on one of the things most important to them, which is stability — the same staff member saying good morning every morning.”
The image of social workers as Mother Teresa-esque heroes does them a massive disservice. The median pay for social workers hovers just below $50,000 a year. On more than one occasion, a colleague would step into the one-room bed-closet-toilet-kitchen apartments in our permanent housing buildings and sigh to me: “I wish I could afford this kind of housing.”
Social service work has gradually shifted from the government into the realm of the nonprofit. Because unions have thrived among government workers — at least relative to the precipitous decline of most American unions — government wages, especially in progressive cities like Seattle, tend to be higher. On the other hand, nonprofits are infamously low-wage industries. The shifting of responsibilities from government to nonprofits is a complex way to outsource labor.
Seattle’s Tech Companies and The Illusion of Corporate Philanthropy
Canaday House, in South Lake Union, is only a few blocks away from Amazon’s Seattle headquarters, and the contrast between run-down housing and gourmet brunch restaurants is jarring. Here, the failure to pay nonprofit workers is more visible, but no less egregious, than in the rest of the country.
Nonprofits like DESC help keep homeless people out of the sights of the tech companies’ employees, prevent devaluation of their land, and — most abstractly but most crucially — provide a moral reassurance that someone in society is doing something about the homeless, clearing corporations of social responsibility. Microsoft and Amazon both hold volunteer days where employees come to help out at DESC. Amazon also invests in nonprofits such as FareStart and Mary’s Place. The volunteers’ help and the charitable contributions are much appreciated, but on a structural level, they help companies absolve themselves of responsibility for the crisis that they helped create.
Rather than offer one day’s labor every year, these organizations could make serious financial contributions to government efforts to end the homelessness crisis. Famously, a head tax of $125 per employee, passed by Seattle’s City Council in 2017, would have directed $50 million towards the homelessness crisis. As The Atlantic reported, Amazon (as well as Starbucks and Vulcan, a company founded by Microsoft’s Paul Allen) played a significant role in coaxing the City Council to repeal it.
Representatives of technology and business express frustration that the city is pouring money into homelessness without seeing any difference. In the same article from The Atlantic, Seattle Metropolitan Chamber of Commerce chair Heather Redman suggested “trying a “moonshot” type solution to homelessness and affordable housing.” Seattle’s tech and business leaders often talk about technological solutions to the problem, citing models such as Amazon’s capabilities in logistics.
This sort of argument makes nonprofits like DESC nervous. “Technology advancements have been phenomenal. But technology will not solve homelessness,” said Kelsey Beckmeyer. “The housing process cannot go forward without a human touch, without allowing people to express their personal preferences and exercise the right to choose where they live.”
The privacy concerns involved in handing over data on the homeless are enormous. DESC works with a lot of sensitive information. Beckmeyer listed “social security numbers, dates of birth, disabilities” as well as “HIV status, if somebody is a survivor of domestic violence”. Even for less sensitive data — “if somebody doesn’t consent, they have the right to not consent!”
Last, and perhaps most importantly, nonprofits like DESC argue that no matter how slick and innovative tech-based solutions to homelessness are, they cannot make housing appear when there is none. I asked five DESC employees what they thought the solution to the homelessness crisis is. All five gave the same answer: affordable housing.
Katrina Brauer told me that the so-called affordable housing in Seattle is “affordable” based on the metric of 50-60% of Area Median Income. Seattle, with its six-figure tech starting salaries, has an extremely high AMI, over $80k a year. Brauer herself made nothing near that at DESC. For her clients, who make between $0 and $10k a year, truly affordable housing is almost impossible to find.
Financing The End of Homelessness
In 2019, DESC calculated that building enough PSH to end chronic homelessness in Seattle would take $800 million dollars, plus $50 million a year in operating costs in perpetuity.
DESC does not heavily pursue private philanthropy, partly out of a belief that homelessness is a complex problem that falls under the domain of the government, and partly because private funding is unreliable. DESC’s reliance on government funding served them well in the 2008 crisis, when DESC was insulated from the worst effects of the crisis, as other agencies suffered serious financial blows.
Besides, DESC’s clients don’t appeal to most private donors. Employees I spoke to acknowledged private donors’ tendencies to go only for ‘innovative’-sounding cost-cutting projects with marketable beneficiaries, such as children and down-on-their-luck families. Often, private donors are only able to commit to small proportions of an ask, and public funding must make up the shortfall. Corporate donors might experience a change of leadership, a rough financial year, or simply a loss of interest.
Moreover, outsiders may not be familiar with best practices or know which organizations are most trusted or most effective on-the-ground. Much of the work done to help chronically homeless individuals has come from within the community. For example, the world of mutual aid and the leadership and contributions of currently and formerly homeless people to nonprofit work hasn’t been covered in this article.
Local, state, and federal governments, on the other hand, ought to be instruments of those communities. They are capable of addressing other nodes in the web of homelessness, such as poverty, housing policy, healthcare costs, structural racism, and so on.
Since I worked at DESC, the Covid-19 pandemic has swept through America, revealing many of the country’s worst inequities and vulnerabilities. (A New York Times look at the pandemic’s effect on the homeless shows that unsheltered living conditions along with state programs to place homeless people in hotel rooms have mitigated the spread of the virus so far. But the death rates in the homeless population are much higher than average, and the crisis has had more insidious effects, as seen in the spike in overdose deaths.) It shouldn’t take a pandemic to show that everyone deserves access to healthcare, a home in which to lock down, food, and water. Governments should recognize that chronic homelessness is a human rights crisis, and should seize the moment to prioritize PSH and affordable housing alongside other anti-poverty measures.
There exists a time — in living memory, no less — where chronic urban homelessness as we know it didn’t exist. Organizations like DESC are not just mitigating an eternal problem. If chronic homelessness was created in our lifetime, it can be ended in our lifetime. All it requires is a paradigm shift.
The original cover art for this article was created by Isabella Aslarus, a student at Harvard College, for the exclusive use of the HPR’s Red Line series.
