No Safety Net 

Housing First is the salvation of Utah’s chronically homeless. But for some, it doesn’t work.

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Amber Neves perches on the cigarette- and food-stained sofa, clutching a toothbrush. In the front room of a simple bed-and-kitchenette apartment in South Salt Lake, congested with three shopping carts full of bits and pieces that have value at least to 38-year-old Neves, she struggles to explain where she finds herself.

"I need routine and structure," she says on that muggy late May 2016 afternoon, if she is to negotiate the daily buffeting from being, she says, bipolar and obsessive-compulsive. Next to her are a few stained and wrinkled pieces of paper that explain how she lost that "routine and structure." The tattered eviction notice reveals she was kicked out of her apartment in Palmer Court at 999 Main because she was a "nuisance."

Despite staff working with her for over a year at the 7-year-old, permanent supportive housing complex for 300 chronically homeless individuals and families, the notice states that Neves failed to clean her apartment and maintain it in a sanitary condition, rendering it "severely unsafe." On a recent check, the door could only be partially opened because of her chronic hoarding and she had also been caught on camera sheltering a former resident who had been banned.

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Neves spelled backward is seven, she says. "No luck," she adds. With her eviction, she joined the list of those "86'd" from Palmer Court, as tenants call being banned. Which begs the question, where does a mentally ill person go when her last resort has turned her out?

Staff at Palmer Court, which is run by The Road Home, told her to go the downtown shelter, but as for many single, homeless women and men, that's a very dangerous prospect, given the level of crime and violence both within and outside the downtown shelter.

Ask Neves what her options are and she says, "I don't really have any." That's reinforced by a man waiting outside to change the locks and put her out on the street.

All she has to her name is what's in the shopping carts, the contents of a storage unit in West Valley City, her federal disability check and the kindness and concern of friends and advocates who fear for the worst if she ends up on the street.

One such friend, and former boyfriend, is 59-year-old Ed Rehburg, a longtime Palmer Court resident. He negotiates his way around the mess in the apartment Neves is about to lose, trying to figure out how to help her pack. He doesn't understand why Palmer Court evicted her. "They should be able to work with her," he says. "Instead, they kick her out onto the street, and I'm afraid she will die."

Rehburg doesn't know what to do. He can't take her to his apartment because if he's caught housing her, he could get kicked out, too. "I want to stay there," he says. "I'd be lonely as hell if I had to leave." Yet he can't turn his back on a mentally ill person with nowhere to go, especially one he cares about.

His fears are not without precedent that her eviction might amount to a death sentence. Jennifer Oryall was also evicted from Palmer Court with severe mental health problems. Six months later, despite efforts to house her elsewhere, she died in a hospital of congestive heart failure aggravated by meth use. The stories of Neves and Oryall, while perhaps outliers as Palmer Court staffers say, nevertheless underscore the limitations of Utah's much-publicized approach to housing the homeless when the wrap-around services to support them are under-resourced.

"We are talking about a population of people who have an array of issues," says Salt Lake City Homeless Court Judge John Baxter. "Poly-substance abuse, poor parenting, lack of education, lack of job skills, family associations and friend associations with people who are engaged in behaviors that are illegal or at least anti-social. And housing alone has not solved their problems."

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Off the Streets
Palmer Court is one of the jewels in the crown of Salt Lake City's embrace of the Housing First philosophy developed by national homeless advocate guru Sam Tsemberis. Housing First focuses on getting the chronically homeless off the streets and into housing to first stabilize and then provide them with services to build on that stability.

When it opened in 2009, it was called a "paradise" in the local press, a description perhaps warranted not only for providing permanent homes for the chronically homeless, but also for its range of free services, including utilities, cable and a gym. Palmer Court offers a wide range of on-site services designed to support people dealing with, among other things, trauma, mental illness and substance abuse, although key to Housing First is that tenants should not be forced to use such services.

For many of its 305 residents, says 51-year-old single father Jim Thurman who moved there in March 2016, it's still paradise. "It's a godsend. I feel blessed for the opportunity to start my life again at a place that has all these things to offer," he says, citing everything from a playground in the complex's grass and concrete courtyard for his two children, to offices at the complex for multiple state and federal agencies, including Vocational Rehabilitation and Workforce Services, as well as counselors and food pantry deliveries.

But over the last seven years, this permanent refuge for chronically homeless individuals and families has developed some problems. Largely infested with cockroaches and mice—a new extermination company was hired in September 2016—and plagued by "off the hook" drug use according to advocates and tenants, it generates calls for service in the thousands, particularly to the police, but also the fire department and ambulance services. In total, 52 tenants have died since it opened—an unsurprising number, say advocates, given the health and trauma issues its population inherited from years of homelessness. Nevertheless, cops and advocates complain that there are simply too many people with complex problems living together in one location, which itself is just around the corner from notorious motels on State Street riddled with drugs that only add to the situation.

Palmer Court is run by The Road Home. Ask Jeniece Olsen, the shelter's director of supportive housing services, what Palmer's ultimate lack of success with Oryall and Neves reflects about homelessness at a time when Salt Lake City and Salt Lake County are in the midst of developing four new shelters, and she cites numerous factors that have remained, at best, marginalized in discussions mostly focused on the size of the shelters and where to locate them.

With a 7,000-plus shortfall in the availability of affordable housing units in Salt Lake County, she points to a chronic need for not only a dramatic rise in affordable housing, but also a higher minimum wage. "At $7.25 an hour, a single person needs to work 72 hours a week to afford a modest one-bedroom," she says. Along with the ever-fainter hope of expanding Medicaid to make substance abuse and mental health treatment available to all low-income households, she also cites "more resources for on-site services in permanent supportive housing."

That's because, to some degree, the effectiveness of Housing First, particularly for those with extremely high needs such as Neves and Oryall, depends on the case-managers-to-clients ratio. (Palmer Court's management is divided into a property issues team, for whom its population are tenants, and a case management team, for whom many of those tenants are clients). In red Utah, where money has gone to securing the housing, what's left over has allowed for little more than rationing of services, and Palmer Court appears to be a case in point. It has six case managers with caseloads of 32-45 households each. That's a caseload Olsen acknowledges is high, "but bear in mind not everyone needs services every single day. Service need fluctuates over time."

She cites an ideal ratio of 20-25 households for families and 25-30 for singles. Tsemberis recommends a ratio of 12-15 clients per case manager, advocates say. That's accurate, Olsen says, for scattered site-management, where a case manager has clients with acute needs in different parts of the city.

Having said that, she notes, "We'd love some money to get two more case managers." That would allow them, case-management director Kelli Bowers says, "to focus on some of the things beyond the struggle of the day-to-day and give us more opportunity to explore more and direct more what the future can bring for folks."

Judge Baxter argues for a 1-5 case-manager-to-client ratio, "given how needy folks are. Most of the folks I've interacted with, would be better off with daily contact, not just a 15-minute call or dropping by 'to see how you're doing.'"

One person who did need on-site case management, and lots of it, was Oryall. Her sister Jodie Johnson says, "The whole point of Palmer Court is to keep [the mentally ill homeless] off the street. They altogether need a lot of involvement, almost like running a state hospital but with more freedom. There needs to be more case management."

Judge Baxter expresses frustration with Housing First as it has evolved in the city. The idea was, "Once an individual was placed in housing that would make it easier or more practical to access services necessary to maintain a state of fundamental health. If there's been any breakdown in that model, it has been the access to, and successful implementation of, services, which has not been as effective as we hoped it would be. Those services are there, but there are not enough of them. I suspect social workers tear their hair out at the inability to reach as many people successfully as they would like to."

Rehburg argues the system "should have given Amber more help." He doesn't understand how she could have been evicted with no case manager to follow up with her, to help her. "Kicking them out, that attitude is just wrong," he says. "Especially the mentally ill, the schizophrenic. Where's the safety net?"

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IT TAKES A VILLAGE
When The Road Home's director Matt Minkevitch found out a 297-room former Holiday Inn hotel on Main was up for sale, he tried to get both the city and county housing authorities to purchase it without success. Eventually, he secured private donors, including the LDS Church, with Salt Lake City Regional Development Agency tax credits funding a good chunk of the $21-million development. With an annual operating budget of $1.8 million, property management expenses come out of tenants' rents—those that pay them—and county subsidies.

"It's a great adaptive reuse of an old hotel in terms of the reality of funding for permanent supportive housing for some of the highest users of services, some of the most expensive people on the street," Salt Lake City Councilwoman Erin Mendenhall says.

To be eligible for Palmer Court requires having experienced multiple episodes of homelessness and having a disabling condition as head of a household, such as substance abuse issues, mental or physical health. "Everyone needs housing but not everyone needs on-site case management," Bowers says.

Bowers adds that while her case managers' work can be difficult at times, some residents "settle in, they do better, while others, for some reason, continue to need a high level of case management. Some folks it takes a village and all of us to help."

Several residents selected by Palmer Court staff, shared their experiences. All of them stressed that staying away from the "drama" caused by what one calls the building's "problem children," made their lives easier.

After Thurman's marriage fell apart, he says he took to drinking and ended up homeless, electing to sleep on the streets rather than face the violence he witnessed during a brief time at the shelter. When Palmer staff showed him the apartment on the third floor designated for families, he slid against the wall in disbelief, tears running down his cheeks.

On March 27, 2016, he moved into the two-bedroom studio with his 6-year-old daughter and 10-year-old son. "I don't think I could have ever got anything to start out my life with my children as nice as this."

Residents pay 30 percent of their income to Palmer Court in lieu of rent. Thurman's income comes from selling his blood, Palmer taking 30 percent of his plasma money, which amounts to $280 a month, from twice-weekly blood donations.

He doesn't let his children roam the hallways freely, as other parents do, but prefers to accompany them to the courtyard playground, or play catch with his son.

He's passionate about his new home, but says if he got work and made money, he'd move out so others could enjoy the opportunity he's had. In total, 438 men, women and children have moved out of Palmer Court, of which 42.5 percent, The Road Home has verified, went to other housing.

Jennifer Neiser has no intentions of moving out. She and her daughter both are bipolar and came to Palmer Court in 2011 after homelessness and a spell at The Road Home. She has no income from which to pay rent, and is charged $25 a month. Neiser says she has all her needs met at Palmer, including ease of access to her meds and local supermarkets by bus. "As a mom, as an individual who has mental health issues, this is good," she says.

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SHARE AND SHARE ALIKE
Palmer Court is "overwhelming at times," for law enforcement, says Salt Lake City Police Department spokesman Greg Wilking. It has a panoply of issues for law enforcement, fire department and EMTs to deal with. "Domestics, suspicious people, thefts, people dying, intoxication," he lists. Putting a large, diverse group of people, many of them with mental health and substance abuse issues, in a confined space leads to other problems, he says, such as noise, fights and theft. While The Road Home might view Palmer Court as a success, law enforcement, Wilking says, fears "this model isn't working."

Rather than answering calls from Palmer Court itself, the police are summoned to individual apartments, often with multiple residents not always registered with the complex. Calls for services over several years, he says, run into the thousands.

"There's definitely drug use," Bowers says. But, Olsen adds, it's no different than many other low-income housing facilities. When drug trafficking increases, staff monitors it and then addresses it, until dealers disperse and move on. "After we've figured out how they can come into the building, we push them out," a staffer says. All external doors are locked, bar the front lobby, with several monitors over the weekends.

But it's more complex than simply dealers and addicts. "We have a really vulnerable population," property manager Karen Grenko says. "Unfortunately they feel looking out for each other involves sharing what they have," including drugs. "Then you have the other spectrum of tenants saying, 'How can you tolerate this, how can this go on?'"

In some cases, Palmer staffers say, calls are made for the sake of making calls, or because of mental illness. One mentally ill resident called claiming she had been shot. According to a Salt Lake City Police report accessed through a records request, "Staff stated that [redacted] had a been a problem and that they wanted to get her out of the building for a while due to her erratic behavior."

Sometimes, though, tenants still don't get the help they need. One man requested an ambulance, was checked out by EMTs who then left. He asked a resident to take him to the hospital, where he died. No investigation followed. "It's a hard topic to talk about, without having the feeling behind it," Grenko says, succumbing to tears. Complaints by residents of being treated unfairly or abusively by the very same services they call for help upsets staff, she says, who "call them out," when they learn of such behavior. Grenko says, "I don't want someone in that position to make our tenants feel less respected."

At meetings with law enforcement, fire and EMT services, they in turn express their frustrations with time-wasting calls or duplicitous efforts by residents to get free rides to hospital or secure drugs.

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HANGERS-ON
The family of Jennifer Oryall are well known to homeless advocates, The Road Home and Palmer Court. "We have worked with the Oryall family for many years; their particular struggles have been addressed with great care and concern," writes Olsen in an email.

Jennifer's mother Vonnie Johnson says she and her children have struggled with issues including victimization by pedophiles, mental illness, alcoholism and substance abuse, trauma and homelessness. None more so than her second daughter Jennifer.

Jennifer Oryall would get upset with people staring at her in the street or in stores. "What are you staring at?" she'd shout, followed by a string of expletives. She struggled with paranoia, convinced people were following her, trying to hurt her. "At first I believed her, then I realized it was her mental illness," sister Jodie Johnson says. Johnson is 38 and HIV-positive. "She'd get mad at me when I was not doing something. She'd call me every name in the book, including 'AIDS-infested whore.' I had to learn it was not her talking to me, it was her illness, I guess."

Judge Baxter says he misses Oryall and huddles over a reporter's iPhone to look at photographs provided by her family. He recalls her as "a loud character, who might prove a little scary if you encountered her on the street." Even when she appeared before him in Homeless Court, he recalls, she would come up to hug him.

Her sister says Oryall was schizophrenic and had a mental age of 9-13. She got an apartment in Palmer Court in 2010, when she was pregnant with her third daughter, but ended up going to prison on an assault charge in March 2011. She gave temporary custody of the baby to the man she thought was the father, who was staying at her apartment. (A subsequent DNA test revealed the father was unknown).

After Oryall got out of prison, she eventually returned to Palmer Court, Vonnie Johnson says, but to a different apartment from the man raising her child. When she got her Social-Security check, hangers-on would converge on her room, throw food and other matter on the floor. "People in there take advantage of the weak and Jennifer was weak," Vonnie Johnson says. "They'd go up there and sit in her room till all her money was gone and then have nothing to do with her."

Salt Lake City councilman and longtime social worker Andrew Johnston says it's very difficult to understand the isolation of the homeless. "It's not just drug and alcohol abuse. It's a symptom of needing other things; it's a profound isolation experience. It's hard to convey that to folks who see them on the street or in apartments, just how hard it is to have lost touch with family and friends."

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BROKEN WINGS
Eight months after moving back in, Oryall was evicted. "You have been very disruptive to the enjoyment of other residents' homes (screaming and yelling in the lobby and hallways even after being asked to stop on several occasions), threatening staff members and verbally abusing staff members and residents," the court-filed notice dated July 30, 2015, stated.

She called her sister in tears. "I got evicted. Where am I going to go now?" Oryall, who suffered from heart disease, went back to meth. "She went downhill from there, she let it all go, she didn't care anymore," Jodie Johnson says. Volunteers of America thought they found a place for her before Thanksgiving 2015, but the property owner belittled her because of her appearance and behavior. "She told her she couldn't have it just by the way she looked," Vonnie Johnson says.

When Oryall came to see her mother that Thanksgiving, "her heart was broken. It was just like they broke her wings. 'I don't know why they won't let me live there,' she told me. 'Do I look OK?'"

The last three days of her life, Oryall slept on the floor in her sister's house. She told her sister, Jodie Johnson recalls, "'I'm dying, what do I do?' What do you say to that?"

Doctors gave her morphine, making her comfortable in her last hours at the Salt Lake Regional Medical Center one late night in early January 2016. Oryall was 33 years old.

Oryall "wanted to be clean. She didn't want to die," her sister says. "She was living in fear she wasn't wanted or needed."

A PREFERABLE DEATH
Fifty two Palmer Court residents have died, most on the premises, since it opened in 2009, says Road Home's Olsen.

The annual candlelight vigil for the dead homeless last winter revealed 97 homeless people died in 2015. This year, thus far, according to Fourth Street Clinic, 60 have died, of whom 29 were housed, nine of them in Palmer Court.

Salt Lake City Councilman Johnston frames such deaths as positive compared to the alternative. "They died in housing, you lived in a place, had a permanent address, people knew when you passed away. Instead of finding them by the river in a snow bank with no ID."

In mid-September 2016, the man who raised Oryall's third child died at Palmer Court of a drug overdose. He raised the toddler for several years, but the state eventually took her away from him after he overdosed, and Oryall's mother, Vonnie Johnson got the child to raise.

Four months after Jennifer died, Vonnie Johnson learned she had cancer in 60 percent of her bones. She's currently raising four grandchildren, two by Oryall, two from her son who also has mental health issues. Vonnie Johnson will shortly undergo a stem-cell transplant, which she hopes will allow her to care for her grandchildren into their teenage years.

During an interview with a reporter, Oryall's third child came home from childcare. Vonnie Johnson hadn't told her that her father is dead. As with Oryall, she talks about him in the present tense.

"I think this one knows more than anything," she says about her granddaughter regarding Palmer Court.

When the girl was in her supposed father's care, he would tie her to him. When Vonnie Johnson asks the child where he tied the string, the girl touches her wrist. And where did he tie the string to him? Again she touches her wrist. Her father would pass out from drug usage and the child would crawl in a circle around his bed looking for food. After Vonnie Johnson got custody of her, she found her one day "scarfing" wet cat food out of a tin.

A LIFE OF TINY ROOMS
Palmer Court evicts on three grounds: drug manufacturing and dealing (if they have sufficient evidence), violence, and a third, more general rule, that covers "any type of behavior that threatens the health and safety and well-being of other people that live in the building," Grenko says.

"The Jennifers, the Ambers, they're rare," case management director Bowers says. "More of the folks that get evicted are predatory, violent, taking advantage of folks that live here."

Palmer Court is slow to evict, Olsen says, in part because people they kick out only have the Road Home to turn to, because, with an under 3 percent vacancy rate in Salt Lake County finding any available property is extremely difficult.

When it came to evicting Neves, Palmer Court staff worked with her for a year, trying to addressing her hoarding issues. "Her personal health and safety was, and still is, paramount to our staff," Olsen says. Palmer Court even hired a cleaning company, but still, "at one stage, the unit was so uninhabitable that Amber no longer slept there." She moved to another unit while the first was sprayed and cleaned, but both units ended up "cluttered and uninhabitable."

When Neves was evicted, her case manager told her to go to the shelter, where she could get a long-term-stay bed, if one was available. Otherwise she would end up in the overflow beds.

Once someone is evicted from Palmer Court, case management ceases. Prior to the individual leaving, Olsen says the shelter is notified, and if that individual, like Neves, doesn't go to the shelter, then VOA's Homeless Outreach team "can provide services geared toward housing." She says, "We aim to catch individuals that might otherwise fall through cracks in the system."

Through the summer, things only got worse for Neves. For a while, several people hid her in different apartments, but after she fell asleep in one tenant's shower, she flooded the place out and was removed to the street.

Neves was briefly hospitalized after she vomited blood at a dollar store. After she was released, she went to a storage facility in West Valley City and sat in a chair by the gate for 24 hours, waiting for someone to help her open the gate, only to suffer severe sunburn.

By the end of September, a social worker had visited her at a motel on 3500 South, Rehburg says, and got her food and clothing. But by then, Rehburg was at his wits end. Her constant demands night and day were wearing thin. "This is killing me," he says.

Neves says she trusts no one and worries that her friends are trying to sabotage her. "I kind of get stuck in these tiny rooms," she says.

ALONE ON A DAWN-LIT STREET
At both the national and state level, Olsen says, "mental health systems prioritize community care and inpatient treatment is scarce and hard to access." To get someone "pink-sheeted" for a short-term-stay bed is one thing, to get them "white-sheeted" for a long-term-stay another because of a huge waiting list. "If we had that six-month time frame, where we could meet them at the hospital when they're released, we'd have a chance," Olsen says. "Without that chance, we're stuck; we're so stuck."

Olsen argues that Palmer Court, despite its flaws, is very much a success. "The families, the individuals that moved in here, even those that died, had their dignity restored, treated well, community around them cared about them and maybe that's not something they had before. To us, that is a success."

Quite what success is for Neves, however, is difficult to tell. Her former case manager, Olsen says, recently reminded her she needed to schedule a meeting in October and negotiate returning. Staff at Palmer Court "care deeply for Amber and will continue to support her as long as she requires and through as many housing opportunities as it takes," Olsen says.

Problems for Neves, however, continue to push her back to the street. At 5:37 a.m. on an early October morning, Neves leaves a voicemail on a reporter's phone. "Hi, it's Amber. I've been outside Motel 6 all night long." She says her reservation hasn't been paid and her phone's dying. "If you know of anybody who can help me, please let me know or send them my way. OK. Thank you."


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