TO: Committee Members and General Public

FROM: Matt Green, Councilman Corey Johnson’s Office; John Mudd and Sharon Jasprizza, Midtown South Community Council

SUBJECT: Homeless and Housing Committee Meeting recap for Tuesday, August 6th, 2019 at 9:30am, plus upcoming meeting reminder and announcements

PURPOSE: To develop partnerships and resources to identify problems and find solutions for our homeless and housing crisis

DATE: August 17, 2019

We covered a range of topics during our recent meeting. We continue our conversations on the voucher program, medical and non-medical respite beds, as well as many other issues. Definitive action plans are needed for a few discoveries (see Addendum A).

CHAIR(S): John Mudd, MSCC

POLICY COMMITTEE’S REPORT FOR AUGUST 6, 2019

The prior 8:30am policy meeting wrap-up was presented by Andrew Bonfrancesco, Housing Works; Daniel Pichinson, Chelsea Ryan Clinic; Merril, NYDIS (See Addendum B)

SPEAKER(S): No speakers were present.

Topics discussed…

VOUCHERS

Much has been learned from our previous meetings, much has been corroborated, and many problems highlighted from folks who are servicing and those who are on the servicing end. The difficulties in securing housing with vouchers are multi-layered and necessitate more discussion to unravel the issues and find solutions.

• Please prepare or send questions regarding vouchers for Leilani (DSS) and for HRA rep
• Andrew Bonfrancesco, Housing Works, updated his voucher issues (see Addendum C)
• We’re videotaping testimonials about voucher difficulties at September 3rd, 2019 policy meeting
• Charisma removed herself from the shelter system to keep her HPD Voucher. She was able to find a pathway to housing with support from the (Commissioner) Human Rights Council
• Community members are experiencing difficulties with placement, poor apartment conditions, repetitive application and background check fees
• Difficulties of securing housing with vouchers are as follows:
  • There is no playbook [guide?] to finding participating landlords
  • The list of participating landlords is not up to date and has errors
  • The staff are not apartment specialists; they are learning as they go
  • Staff turnover is high, pay is low
  • There are huge case loads for limited staff due to underfunding
  • Application processes are arduous and redundant
    • The question remains: With the city agencies’ detailed files, why would it be necessary to repeat the process? How can we consolidate [streamline?] the process between landlord, brokers, and the city?
  • Landlords will raise apartments to minimum (?)
  • Housing stock is limited: This is the predominate theme not only from voucher holders seeking apartments, but from working, elderly, homeless, and service providers
  • Landlords are discriminating against voucher users
    • If you are experiencing housing discrimination, please report it by:
      • Contacting NYC Human Resources Administration’s Source of Income Unit (SOI): 929-221-6576 or soi@hra.nyc.gov
      • Filing a complaint with the NYC Commission on Human Rights through this online form or by calling 311 or 212-306-7450
      • Calling the Fair Housing Justice Center at 212–400-8201 or toll-free at 1-866-350-FHJC
• A workshop is being developed to help others navigate the voucher system
  • Nicole McVinua and Charisma will construct an outline for the workshop
• Voucher Contribution: 
  • Nicole McVinua suggests that the city’s support is inefficient, and they could raise it’s participation rate for the escalating rental market
  • Eric Lee: City FHEPS participation could consider 110 % of FMR (Fair Market Rent?); not a firm cap
    • Street Easy and other similar sources will give examples of rent values
  • If the City covers too large a portion of the voucher, will the holder be able to cover their rent in the foreseeable future?
    • Cityfheps will cover the recipient up to 5 years possibly, longer with good reason… If you stay within illegibility, within the guidelines of renewal

MEDICAL RESPITE BEDS

• Cassie Dessalines, Director of Living Room & Safe Haven, BronxWorks updated us on the webinar about One City Respite Program: 

OneCity Health is issuing this Project Participation Opportunity (PPO) for the Respite Services Program with the goals of preventing avoidable hospitalization and Emergency Department (ED) utilization and to facilitate connections to temporary housing resources.

• Cassie is scheduling a visit to The McInnis House (see Addendum D) in Boston for September 12-13, 2019; we need to firm up the guestlist
• Matt Green: DHS reported: There are a couple of hospitals that pay for respite beds, and I believe they work with Communilife too (Bronx Leb, Montefiore). H+H is setting up two Respite Beds and MetroPlus, one. At this time there is one Medical Respite [programs?] in the Bronx and the provider is Comunilife.â€
  • Daniel Pichinson: will continue to reach out to Communilife representatives (see Communilife brochure Addendum F)

RESPITE BEDS

• Drafting Acceptable Recommendations for Non-Medical Respite Bed Policy
  • Cohesive and consistent policies are needed amongst church respite bed providers
  • Outline soft and hard limits that prevent people from accepting a church bed
  • Nicole McVinue (Urban Pathways) suggested that drafting Recommendations for Respite Bed Policy should include someone from the church bed providers; the committee agreed.

PARACHUTE PROGRAM

• Andrew provided the committee with New York City Department of Health and Mental Hygiene announcement of their launch of Parachute NYC, a mental health service that can be accessed by calling 1-800-LIFENET (see Addendum E) 

PUBLIC BATHROOM

• Development, planning group: Allen Oster, CB4; Julie Chou, Renee Kinsella, CB5; Luke Szabados, CB5; Boyeong Hong; Kevin Gurly; Joseph Greeley, CB5; John Mudd, MSCC

HOUSE OUR FUTURE 

• Housing initiatives (Addendum G)

PUBLIC CONCERNS / POLICE AND COMMUNITY

• There were no public concerns. The NYPD was not represented today

ANNOUNCEMENTS

• A planned visit to meet the principal operators and developer of The McInnis House (a Medical Respite Facility) in Boston. Cassie, “I did hear back from David Munson at Boston and he said that 9/12 would work for him for the trip.†
• The Midtown South Community Council and Community Court’s courtyard Urban Farm: We took a moderate approach because of the lateness of the launch. There are planned additions next year. We’ve planted tomatoes, tomatillos, corn, fennel, cabbage, carrots, radishes, herbs, and two fig trees
• Laundry For Kids – update: raised close to $4,546.00 and served 182 kids
• Please support our GoFundMe campaigns: Laundry for Kids and Street Sheets
• Workshops Events: See link to Life Skills flyer and attachment of the scheduled event
• Look out for our Urban Farm GoFundMe to come!
• Homeless and Housing August Meeting Anniversary was our 2 year Anniversary! Sorry if ya missed the champagne! 

AOB

• Suggestions for speakers: Communilife, MetroPlus, One City regarding medical respite bedsADDENDUM A: DISCOVERIES / ACTIONABLE ITEMS

ADDENDUM A: DISCOVERIES, ACTIONS, SOLUTIONS

Below are discoveries from previous discussions, pertinent points for further discussions

DHS

Turning Tide: TurningtheTideNYC is DHS’s comprehensive vision for addressing homelessness. Download “Turning the Tide on Homelessness, Neighborhood by Neighborhoodâ€

• DHS is emphasizing the closing of commercial hotel shelters (cluster units) and have plans to replace them with 90 new shelters with proper wrap-around social services to reduce long-term homelessness: investing high quality of social service on site, and implementing many unique best practices, are of high priority to address trauma
• The services are preventative: Many children in the shelter system will return as adults

NON-MEDICAL RESPITE BEDS

The non-medical respite beds are provided by ESN, a coalition of churches, to DHS to house people overnight.

Problems

• Sleeping in chairs is bad for health and causes long-term problems
• Not enough cots for women
• Some cots sit low and are hard for people to get in and out: The users are less mobile, larger in size, older, and less able
• ADLs (Activities of Daily Living) are not good with the chronic homeless, people are not being able to access respite beds because of poor ADLs, poor mental health etc. 
• Emergency Shelter Network (ESN) require good mentally, drug free, ADLs; too stringent for some clientele with hygiene problems (such as smelly feet)
• One clientele was turned away because he smelled of alcohol; he was sober. He smelled because of his long-term alcohol abuse
• Rules inconsistent amongst the various respite sites

Solutions

• Uniformed policy will alleviate many challenges with church respite beds
• Training for respite bed volunteers (e.g., de-escalation, Thrive, Narcan training kits on site)
• Add cots with appropriate height
• List training recommendations, oversight

ADDENDUM B: POLICY COMMITTEE’S RECAP 8.6.19

(Sub-committee of Homeless and Housing Committee) 

Recap FROM August 6, 2019 Policy Meeting

Name: Home and Housing Policy Committee

Location: Urban Pathways, 575 8th Avenue, 16 floor (between 38th and 39th Street)

Date: Tuesday, August 6, 2019

Time: 8:30am-9:30am

MEMBERS PRESENT

John Mudd, MSCC; Daniel Pichinson, Ryan Chelsea Ryan Clinic; Andrew Bonefresco, Housing Works; Merril, NYDIS; Glenda Harris, community member

COMMITTEE’S PURPOSE

Review policies and their oversight, determine actions, suggest and lobby for change!

CHAIR

John Mudd, MSCC chaired; Cassie was absent

The following topics were discussed…

MEDICAL RESPITE BEDS

• Discussion of Boston trip: Dates suggested were September 12-13
  • Cassie is arranging the Boston Trip for 10-12 for people who can help push for more respite beds in NYC
  • HJC plans to fund medical respite center across the city and is looking for partnerships (see attached proposals)
  • Boston Health Care’s budget could provide insight into the actual expense reductions
• Dan is checking into Health First in Rochester which has state-funded respite beds (through Medicaid). There is a considerable cost-saving factor to having respite beds.
• Cassie is to report more information to come after Webinar session

OLD BUSINESS

• More discussion and discoveries on Andrew’s concerns regarding psychological evaluations to enter a respite site and more

FURTHER PLANNING

• Adding policies concerning chronicity to our task list
• Andrew: psychosocial and psychiatric evaluation policies in order to enter respite sites *Add-on
• Review Voucher policies and oversight

ADDENDUM C: ANDREW’S LETTER

Andrew has concerns with the information discrepancy between what was verbally explained and what DOH has published on their website; Concerns around respite admissions policies (inconsistencies regarding psychological evaluations to enter a respite site); case manager follow up; housing applications requiring fees; and mandatory medical check (see below for more details).

ANDREW BONFRANCESCO, HOUSING WORKS

I made some adjustments to my statement for letter, I’ll outline below where I changed my section. (Let me know your feedback)

1. Info Inconsistency: One of the concerns is the information discrepancy between what is published on the DOH website and what you (Leilani) reported in the meeting (the 5-year limit to recertification vs. no limit based on what you reported during June’s 2019 Homeless and Housing Meeting). The discrepancy can be located on page 3 the last section of the page where it states in the document that “The CityFHEPS program generally provides for up to four annual renewals, with additional extensions available for ‘good cause’ (five years total).†If this is not the case, it would be helpful that the document reflects this to alleviate confusion for those who wish to access more information around this program. 

1. Respite Centers for clients in crisis: I am finding several respite centers in Brooklyn are mandating clients to fill out or submit psychosocial and psychiatric evaluations in order to enter respite. This has caused a significant delay in the process of placement into these programs and it is concerning they are requiring so much information for such a short-stay program.

1. Additionally, the evaluation form that is required to be filled out states that this is not required for admissions into the program. When approaching these locations with this information discrepancy, I am hearing conflicting stories that “they do not need these documents†or that “this is required for our program in the evaluation process†from people within the same agency. It seems there is a disconnect in communication with these respite centers and I am concerned that these may be intentional barriers for entering respite services to restrict access or create a cumbersome process of admissions. Do you know who I would contact or be able to follow up regarding these concerns?

1. Placement into housing services: Working with some of our clients, some of them are reporting issues accessing their case manager for follow up to be placed into housing outside of the shelter. One of the latest concerns regarding access to these services is the wait time it requires a client to access a bed that people may have lost due to curfew or did not check in for the night. Some of my clients are reporting that they are waiting all night for vacancy control to come place them into another bed. Some are reporting that despite waiting until 2:00AM (4 hour wait), they are reporting no one has come to pick them up to take them to another bed. Additionally, these individuals are restricted to a specific shelter for a year and the process for advocating for these people is time-consuming and places a heavy emotional burden on our already vulnerable population. I am significantly concerned that this acts as a barrier to entering our shelter sectors and was wondering if anything could be done to address this cumbersome process?

1. I am also hearing testimonies regarding client’s applications to housing requiring that they pay sums of $50 for credit check, and in order to enter housing locations are required to pass a credit check. While not all people who experience homelessness may have an issue with this process, a portion of our clients who struggle with money management, substance use, or mental illness may have more significant challenges paying this fee for each apartment they may apply to. Do we have any policies or programs in place to support or assist these individuals with navigating this process?

1. Shelter Care for the sick: I am hearing those placed into these shelters are imposed strict guidelines for being allowed to stay in the shelter that day. The reports I have heard are that my clients are required to stay and see the doctor on site, which often takes hours to facilitate in order to stay at the shelter in the day to recover.†

Let me know what your thoughts are or any feedback you have when you have a moment.

Thank you very much.

Andrew Bonfrancesco, LMSW

ADDENDUM D: BOSTON MASSACHUSETTS MEDICAL RESPITE BED

MASSACHUSETTS / Barbara McInnis House 

Agency: Boston Health Care for the Homeless Program
Address: Jean Yawkey Place, 780 Albany Street, Boston, MA 02118 Contact: Sarah Ciambrone, Executive Director, Barbara McInnis House Phone: (857) 654-1701
E-mail: sciambrone@bhchp.org / Website: www.bhchp.org 

Description / Established 1993

Since 1988, medical respite care has been an essential component of the continuum of healthcare services provided by the Boston Health Care for the Homeless Program (BHCHP). Originating as shelter-based medical beds, medical respite care for men and women is now provided in one freestanding facility, the 104-bed Barbara McInnis House which is housed in the top three floors of Jean Yawkey Place on Albany Street in Boston and located across the street from Boston Medical Center. 

Jean Yawkey Place is home not only to the medical respite program but also the dental program, a busy pharmacy and ambulatory clinic, and administration for Boston Health Care for the Homeless Program. 

The McInnis House provides care to men and to women, and provides comprehensive medical, nursing, behavioral, dental, and case management services in an environment sensitive to the needs of homeless adults. 

The McInnis House offers three meals per day that are served in the dining room. Patients recuperate in private, semi-private or two to six bedrooms. The program admits patients 24 hours per day, seven days a week from hospitals, shelters, emergency departments, outpatient clinics, and directly from the street by referral from the BHCHP Street Team. 

Operating agency: Boston Health Care for the Homeless Program (HCH) 

Facility type: Stand-alone  / Number of respite beds: 104

Hours of operation: Admissions office – Monday thru Friday, 8am-4:30pm Average length of stay: approx. 12 days 

Admission Criteria 

• Primary medical problem 

• Psychiatrically stable 

• Independent in Activities of Daily Living 

• In need of short-term recuperative care 

• If on methadone, must be enrolled in methadone maintenance program 

• Disclosure of known communicable disease, including TB, VRE and MRSA 

ADDENDUM E: PARACHUTE INFORMATION

PARACHUTE NYC

The New York City Department of Health and Mental Hygiene announces the launch of Parachute NYC: an innovative citywide approach to provide a “soft-landing†for individuals experiencing psychiatric crisis.

When someone is in crisis—but not at imminent risk to self or others—s/he can be referred to Parachute NYC by calling 1-800-LIFENET. The person will be seen at home by an enhanced Mobile team within 24 hours of the referral. The enhanced Mobile team will have the ability to work with the person as frequently as needed—even daily—for up to one year. The team will help the person to develop a network starting at the first meeting. This network will include the person and other people s/he chooses, such as family, friends, vocational staff, etc.

If the person receiving services needs a different level of care than can be provided at home—and is not at imminent risk to self or others—s/he can be referred to the Crisis Respite Center. The Respite is a home-like, warm, supportive and safe environment for people to stay during times of heightened distress. People may stay at the Respite for up to fourteen days. During their stay, Respite guests will continue to work with the Mobile team. The Respite is staffed with a mixture of peers and behavioral health professionals who are available 24/7 to offer peer support, wellness education and skills building. At this stage, Mobile and Respite services are available only to people living in stable housing.

People who are not interested in receiving treatment from the Mobile team may also stay at the Respite (e.g., someone who already has a mental health provider but is experiencing or anticipating a crisis). These individuals must provide a current clinical evaluation or consent to an evaluation by the Mobile team.

There is significant peer involvement in every component of Parachute NYC; besides mental health services, peers will work as peer health navigators to integrate medical health into the continuum of care.

All referrals to Parachute NYC are made through 1-800-LIFENET.

Parachute NYC also includes a peer operated Support Line for people to call when they are experiencing emotional distress to connect with a trained operator who has had similar experiences. Anyone can call the support line by dialing 646-741-HOPE. All services are confidential and there is no need for a referral.

Currently, Visiting Nurse Service of New York provides enhanced Mobile services and Community Access provides Respite for residents of Manhattan. The Support Line, also operated by Community Access, is available to anyone in New York City. Enhanced Mobile and Respite services will open for Brooklyn residents in April. Brooklyn services will be exclusively for people aged 16-25 experiencing a first episode of psychosis. Services will open in Bronx and Queens, again for people aged 18-65, in late 2013 and early 2014, respectively.

Please visit our website for additional information: http://www.nyc.gov/html/doh/html/mental/parachute.shtml

ADDENDUM F: COMMUNILIFE BROCHURE

About Comunilife 

Founded in 1989, Comunilife is a not-for-profit health and human services agency providing comprehensive mental health, social services and housing. Our mission is to provide vulnerable communities with housing and culturally sensitive support services. 

Services are provided to homeless persons living with mental illness, addictive disorders and HIV/AIDS to enable them to live independently in their community. In addition, we provide affordable housing for persons with low income. 

Comunilife programs employ our Multicultural Relational Approach for Diverse PopulationsTM which emphasizes respect for people’s cultural differences while mobilizing an individual’s strengths and resources of the community. Comunilife currently serves some 3,500 New York City residents throughout the Bronx, Queens, Brooklyn, and Manhattan. 

To make a tax deductible donation please visit www.comunilife.org/donation/. Donations may also be made by mail. For more information contact the development office at (212) 219-1618 ext. 6166 or ikaplan@comunilife.org 

Board of Directors: Raquel Ayala, Chairperson Veronica Kelleher, Vice Chairperson Jason P. Torres, Treasurer Frances Pandolfi, Secretary Carolina Buzzetti Gary Calnek Ruben Cardona Amarylis Cortijo, MD Steve Dyott Hazelien Featherstone James Geraghty Pamela J. Maraldo, PhD Carlos R. Piñeiro, Esq Miguel Sanchez, MD Ann Sullivan Marlene Zurack 

Rosa M. Gil, DSW Founder, President and CEO 

For more information or to discuss medical respite care services contracts, contact: Rosa Cifre, LCSW Chief Program Officer Comunilife, Inc. 462 Seventh Avenue New York, NY 10018 T: (718) 617-1978 info@comunilife.org www.comunilife.org 

Comun e healthy living in community  SOCIAL/MEDICAL RESPITE CARE 8/2015 [?]

Admission criteria: Social/medical respite care programs will serve persons who: 

• Lack suitable housing 
• Have acute or post-acute medical illness which requires short-term resolution and/or care 
• Need an environment in which to prepare for, or recover from, medical procedures such as surgery, chemotherapy, radiation, endoscopy, etc. 
• Are independent in activities of daily living (ADL) with the ability to dress, bathe, transfer and ambulate independently, or with mechanical assistance such as a wheelchair, crutches or cane 
• Are psychiatrically stable enough to accept and receive care and not interrupt the care of others 
• Are sick enough to need more than an emergency shelter bed for the night 
• Are not sick enough to require hospital level care or other medical care (nursing home, psychiatric in-patient care, rehabilitation hospital) 
• Have a condition with an identifiable end point of care for discharge.
  (Patients requiring IV hydration will be assessed on an individual basis.) 

What is social/medical respite care? 

Social/medical respite care is acute and post-acute medical care for persons who are too ill or frail to recover from a physical illness or injury but who are not ill enough to be hospitalized. These individuals may be homeless, or may simply not have a family member or friend to care for them. 

Unlike “respite†for caregivers, “social/ medical respite†is short-term residential care that allows individuals the opportunity to rest and recover in a safe environment while accessing medical care and other supportive services. For homeless patients, staff help secure permanent housing prior to discharge from the program. Challenges such as obtaining food, clothing and shelter, or achieving or maintaining sobriety can compromise adherence to medications, physician instructions and follow-up appointments, thus increasing the probability of future hospitalizations. 

Social/medical respite care closes the gap between acute medical services provided in hospitals and the need for appropriate housing. It is an essential component of the continuum of health care services for the elderly and the homeless. 

Our medical respite care is offered in existing transitional housing. 

Why is social/medical respite care needed? 

It is not uncommon for persons who live alone and have been hospitalized to be temporarily unable to care for themselves following hospital discharge. In the absence of an available caregiver, social/medical respite care can avoid costly and traumatizing external and unnecessary hospitalization. 

For the particularly at-risk homeless population, living on the streets exacerbates health problems, complicates treatment, and disrupts the continuity of care. These people tend to have high rates of physical and mental illness, increased mortality, and frequent hospitalizations. 

Research shows that patients who participate in social/medical respite programs are 50 percent less likely to be readmitted to a hospital at three months and twelve months post-hospital discharge. 

Avoiding costly discharge delays as well as reduces hospital readmissions, social/medical respite care generates significant savings for hospitals and communities. 

 ADDENDUM G: HOUSING OUR FUTURE CAMPAIGN

Please see below new message from our Partners…

Thanks to everyone who participated in last week’s rally! We had a great turnout and received press coverage in NY1, AMNY, BYKLYNER, Fox 5 , , Politico, Patch , and Curbed . You can read the press release , and check out our new report, “ The Tale of Two Housing Markets.â€

House Our Future NY Tweets, Week of August 26^th

1. If we don’t set aside more affordable housing for homeless New Yorkers, people will continue to be shuffled around shelters without being told why. Housing is the only way to reduce the burden on the shelter system! https://nyti.ms/2KW2qyf @kitastew @nytimes #HouseOurFutureNY

1. If we don’t set aside more affordable housing for homeless New Yorkers, our neighbors will continue living on the streets while waiting for housing. Housing is the best way to help people off the streets! @Gregbsmithnyc @THECITYNY #HouseOurFutureNY

1. If we don’t set aside more affordable housing for homeless New Yorkers, our neighbors will have to live in shelters with poor conditions like those on Wards Island until apartments become available to them @Gregbsmithnyc @THECITYNY #HouseOurFutureNY

1. If we don’t set aside more affordable housing for homeless New Yorkers, we’ll continue to see the number of shelter residents who are 65 & older increase. We need to provide them housing! @CityLimitsNews #HouseOurFutureNY

Giselle Routhier, Policy Director, Coalition for the Homeless

129 Fulton Street, New York, NY 10038

212-776-2004

www.coalitionforthehomeless.org

ADDENDUM H: JOSEPHINE ISHMON’S EMAIL

The below email requests updates regarding laundry machines, day care needs to be added to the agenda, and more…

John, please add daycare to the list.

Yesterday, I met briefly with Acacia (who oversees 7 midtown shelters) and

they need more resources, specifically daycare and laundry to handle the

influx of homeless families from FEMA. Mothers cannot work without daycare

for their children and they are having problems finding daycare centers

that will take DHS vouchers. I asked them to try Hudson Guild and Polly

Dodge Early Learning Center.

If anyone knows of other daycare centers in the midtown area, please advise.

They also asked for more laundry vouchers and I gave them what I could but

need to keep a good portion in reserve for the start of the school year.

Matt, have we gotten a meeting with NYCHA on laundry machines for the

smaller space?

Best,

Josephine