Letter: Homeward Bound’s approach to homelessness shows results (An Op-Ed by Shuchin Shukla)
As a physician who focuses on addiction, HIV and hepatitis C, I have seen firsthand how a lack of stable housing can affect individual health. How it can exacerbate property disputes and negative perceptions of public safety. How it can ultimately strain emergency medical services and local government budgets. But mostly I have seen how difficult it is for a person without this basic human right — a safe, healthy place to live — to address any other stress that we all routinely face, let alone opioid overdose risk, suicide risk, justice system involvement or personal safety.
I have seen this in post-Katrina New Orleans, in the South Bronx, and now increasingly through my four years living and working in Asheville. In all of these settings, I have noticed some consistent trends: wages that do not keep up with living expenses, increasing housing costs, precipitating events such as disasters, medical bankruptcy, job loss or family crises. As both the pandemic and extreme weather events have recently shown, many of us are dangerously close to such dire circumstances, whether we know it or not. For those of us fortunate enough to have a safety net, we as a community are all still impacted by the ongoing housing crisis: physically, morally and economically. So what can be done about such a dismal societal prognosis?
The lasting solution will require many parallel long-term efforts related to crisis services, health care access, employment opportunities and public investment, but change will be near impossible without access to proper housing. Study after study has shown that, even without any other service provisions, so much improves when a person living without stable housing gets this basic resource. That is why Homeward Bound is so excited to contribute to these efforts to improve the lives of all Buncombe County residents with our Home Is Key initiative.
I recently joined the board of directors of the local nonprofit Homeward Bound, whose mission is to end homelessness through permanent housing and support. Homeward Bound has experience engaging with this work: Since 2006, we have moved more than 2,250 people into housing, and 92% have not returned to homelessness in our 12-month survey period. But the reality in Buncombe County is changing, adding challenges to what it takes for people to live, work and raise their families all in the same community. As a family doctor, though I can prescribe complex medication regimens to address chronic disease and acute illness, like most health care providers, I wish I could simply prescribe healthy food, safe housing and decent wages for honest work to get to the root of the problem, instead of just mitigating consequences.
Thanks to generous support from Asheville city, Buncombe County, Dogwood Health Trust and an anonymous donor, Homeward Bound can purchase the Days Inn property on Tunnel Road. Renovations will start soon to repurpose the hotel into permanent supportive housing for 85 of our community’s most vulnerable neighbors. Based on our successful experience at a smaller-scale version of this project at Woodfin Apartments, we will repurpose the motel property to create efficiency apartments. This will include infrastructure to facilitate on-site wraparound services for medical, mental and addiction health services, in partnership with expert community organizations.
Case management, job training, social engagement and even exercise resources will be available on the property. The clients we will serve will be those who have struggled with chronic conditions and lack of housing, those who tend to be the hardest to reach, those who have high public service needs and costs. This will be part of a sea change in how we all approach the tragic reality of homelessness.
While this initiative will decrease chronic homelessness in Buncombe County by 40% and undoubtedly save lives by preventing overdose and other health crises, it will also generate cost savings. While the average annual cost per unhoused person for a community can be up to $50,000, the cost per person served through a project like this will be $13,000. This is no Band-Aid: 90% of our Woodfin Apartments’ clients have remained consistently housed, and emergency room visits at Mission Hospital have decreased by 50%. One of our clients who was the most arrested person in Asheville prior to engaging with us at Woodfin now has an 83% decrease in law enforcement interaction. This project will change individual lives and improve our community.
As a proud Homeward Bound board member, I know that housing is health care, and with incredible support and collaboration with Asheville city, Buncombe County, anonymous donors, Dogwood Health Trust, community partners and amazing volunteers, we are evolving to meet the needs of our most vulnerable citizens so we can all thrive with dignity and health.
— Dr. Shuchin Shukla
Shuchin Shukla, MD, MPH, was born and raised in New Orleans, Louisiana. He completed medical school and public health school at Tulane University and completed a residency in family medicine at Montefiore Medical Center in the Bronx, New York. He worked in the South Bronx for 5 years following residency, providing primary care for adults and children, as well as for adults living with HIV. He also served as medical director for Montefiore Project INSPIRE, a primary care based Hepatitis C treatment program. He then moved with his family to Asheville, North Carolina, where he has focused on addiction, homelessness, and marginalized populations. Shuchin is a member of the Board of Directors for Homeward Bound of WNC.