Has Boise’s New Path program ‘failed’? Here’s why Ada County wants to defund it
When David Hall heard the residents of New Path Community Housing referred to as “the worst of the worst” by Ada County Commissioner Ryan Davidson, those words hit home. Davidson was talking about his neighbors. He was talking about Hall.
“When I read what the commissioners had to say, I was just infuriated,” Hall, a New Path resident, said in an interview with the Idaho Statesman. “Literally livid. Because it’s the same old scapegoats. You know, ‘The worst of the worst,’ they said. I took that personally.”
Ada County commissioners may soon significantly cut their contributions to New Path. Last week, they moved to cut their previous $312,000 in annual funding to $200,000 next year — a 36% drop.
The commissioners’ concerns with New Path boil down to three points: They think hospitals should contribute more, drug treatment should be a bigger focus, and Housing First doesn’t work. Residents and supporters, however, say the commissioners misunderstand the project’s mission.
New Path and Housing First
New Path is a permanent supportive housing initiative that provides long-term apartments to 48 chronically homeless residents. Located at 2200 W. Fairview Ave, the city of Boise-led $7 million project was built by more than 20 private and community partners.
While Hall may have disagreed with the phrase “worst of the worst,” New Path does target Boise’s most severe cases of chronic homelessness. Residents have spent years without a place to live; most have substance abuse issues, mental health concerns or chronic medical problems.
To determine who would receive a New Path apartment, researchers studied Boise’s homeless population to find who had been homeless the longest, had used the most medical services and had the most arrests. Homeless people often have higher rates of arrests because of obstacles created by not having a home, Vanessa Fry, director of the Idaho Policy Institute and Boise homelessness researcher, said. Those charges can include public intoxication, public urination and loitering.
Many residents are what Jodi Peterson, executive director of Boise’s Interfaith Sanctuary homeless shelter, calls “shelter-resistant,” meaning they usually sleep on the streets rather than in shelters.
“New Path identifies a very specific group that has a higher need and require more for a good part of their life,” Peterson said. “… The Housing First model is specifically for the most vulnerable living hard on the street. It’s about getting them off the street and into rooms.”
Opening in November 2018, New Path became Boise’s pilot Housing First initiative. Housing First is a government policy and approach to homelessness used across the country that does not require people to be successful in substance abuse or behavioral programs before receiving housing. Services are offered to Housing First residents, but it is their choice whether to participate. At New Path, Terry Reilly Health Services provides on-site services for residents, including peer support, medical and health services, outpatient mental health treatment, substance abuse treatment, intensive case management services and life skills education.
“This approach is guided by the belief that people need basic necessities like food and a place to live before attending to anything less critical, such as getting a job, budgeting properly, or attending to substance use issues,” the National Alliance to End Homelessness’ website states.
Retention is one of Housing First’s biggest goals. Mental health and substance abuse issues often lead to chronically homeless people returning to the streets when offered other forms of aid. Numerous studies show the Housing First approach is particularly effective in retaining those who experience chronic homelessness. One found that after five years, 88% of Housing First tenants remained housed, compared to only 47% of the residents not in Housing First, the National Low Income Housing Initiative reports.
“Our ultimate goal is to keep people housed,” said Susie Johnson, clinical supervisor at Terry Reilly Health Services. “And part of keeping people housed is all of the behaviors that go with being a good community member.”
The cost savings explained
While those who are chronically homeless make up about 15% of the total homeless population, they account for more than 80% of all homeless-related costs, according to the United States Interagency Council on Homelessness. Focusing on getting chronically homeless people into housing drastically reduces dollars spent by the community.
The Idaho Policy Institute at Boise State University examined records from the three years before New Path’s opening to calculate how much the average New Path resident costs the city. It found — between jail time, paramedic services, mental health and substance abuse services, emergency room care, in-patient hospital stays and arrest costs — each resident of Boise’s New Path had cost the community an average of $77,108 per year before receiving housing.
During a resident’s first year at New Path, that cost fell to $25,763.
In total, the evaluations revealed New Path saved the community $1,381,386 in 2019 by decreasing residents’ utilization of emergency services by 63%.
The Ada County commissioners, however, did not think those cost savings were worth the amount of money the county puts into it. New Path costs the local community $512,000 annually, which goes solely toward treatment. That cost is paid for by Saint Alphonsus, St. Luke’s and Ada County. Federal programs, state programs and residents’ own money pay for ongoing building costs.
The commissioners want the hospitals, which pay $100,000 each, to contribute more. Hospitals saw the largest savings from the program since so many of the residents’ costs to the community are medical-related. They are requesting the hospitals each increase their contributions to $200,000. The hospitals have not responded publicly to the request.
“Under the program that we have right now, we’re spending $1,000 a month for each of the tenants for treatment,” Commissioner Rod Beck said. “And I’m not sure we’re getting much out of it.”
A home for Boise’s chronically homeless
In 2011, not-yet-homeless Hall ran for mayor against then Boise incumbent David Bieter. Hall enjoys telling the story of how he managed to get more than a quarter of the vote despite spending nothing more than the entry fee. Housing First, something that wouldn’t exist in Idaho for seven more years, was a large part of his platform. Today, Hall is the only resident to serve on the board of Terry Reilly Health Services.
Hall has lived at New Path since it opened. He had been homeless for seven years after an injury left him unable to work, Hall said. Years without a place to live worsened Hall’s mental health. He began struggling with serious thoughts of suicide.
“I’m glad I’m here,” Hall said of New Path. “The alternative for me is pretty dark. I have clinical depression. Thoughts of suicide pop up when you’re on the streets. There’s no way out and no way up. You get desperate. I was at that point just before (getting a place at New Path).”
There, he’s been able to get the treatment he needed. Hall’s goal is to eventually leave and rent a place on his own. But he doesn’t think that should be the goal for everyone.
One fellow New Path resident is a man Hall has seen around Boise, usually drinking or sleeping on the streets, for nearly 30 years.
Hall, now 52, first noticed him in his 20s. Hall got to know him, occasionally stopping to give the man change, a cigarette, a kind word. Hall has watched him drink alcohol for decades. He predicts some of his neighbors at New Path will never recover from addiction.
“They’ve spent so much time with alcohol, their mental faculties are gone,” Hall said. “If it wasn’t for a place like this for them to live at, they would be out on the street getting arrested over and over.”
Hall also believes, whether or not these residents recover, it is important they have a place to live.
“They’re not going to change,” Hall said. “I’m not going to expect them to. My humanity runs a bit deeper than some, because I’m willing to sacrifice to make sure he still has a place. … Just seeing him off the streets is worth it, to me. Because he’s not suffering. He’s not getting hit by cars. He’s not getting arrested every 30 days.”
Commissioners want ‘treatment first’
Hall’s words highlight the crux of the debate between New Path and the Ada County commissioners. The commissioners want resident recovery to be New Path’s priority. During a discussion on funding cuts, Beck referenced the Heritage Foundation’s 2020 report titled “The ‘Housing First’ Approach Has Failed: Time to Reform Federal Policy and Make it Work for Homeless Americans” that touted a “treatment first” approach.
“I would rather put it to treatment first rather than housing first,” Beck said. “… It puts responsibility on the tenant to do some things, to get off drugs and things like that. It’s treatment first, not housing first.”
Beck, however, is mistaken on the report’s conclusion. The report doesn’t advocate for the end of all Housing First initiatives. The report is critical of the approach for most homeless people but acknowledges a Housing First approach is still needed for the most severe cases.
“While there is still a need for permanent supportive housing for the severely disabled and chronically homeless, the vast majority of the homeless would be better served in treatment and recovery programs that promote self-sufficiency,” the Heritage Foundation report states.
Commissioner Kendra Kenyon suggested New Path give apartments to those who would be more successful at treatment and remove those who have not been able to recover from addiction. She asked New Path staff if there was a way to determine which New Path residents were making no progress toward recovery.
“Let’s say we’ve got 40-some people in there and 10 of them have been there for a year and a half and they have made no effort towards recovery or sobriety and they continue to probably use illegal drugs,” Kenyon said in a June 2 meeting with New Path staff. “How could we help people who are on the waiting list and have really good intentions and will take these supportive services seriously? To get people the help that want the help? Do we have any kind of mechanism to determine that?”
“Treatment first” requires homeless people to complete treatment steps before they can get housing. Fry said those requirements can mean some people with severe cases of mental illness and substance abuse never make it to the point of receiving housing. Without permanent supportive housing, the future of many of Boise’s chronically homeless residents would be bleak. The majority of studies on the topic have found the life expectancy of chronically homeless people to fall between 40 and 60 years of age.
“You can see (medical services) utilization increased in that year prior (to moving into New Path),” Fry said in a phone interview of the study she conducted on New Path residents’ medical histories. “What we’d likely see is that utilization continue to increase to the point of, in some cases, death.”
When will commissioners decide?
Ada County’s budget process will continue over the next month. The board makes adjustments and holds hearings over the next few weeks. On July 21, the proposed budget will be presented to the public by Ada County Clerk Phil McGrane. On July 27, the board will put the budget to a final vote.
Sally Krutzig covers Treasure Valley growth and development. Have a story suggestion or a question? Email Krutzig at skrutzig@idahostatesman.com.
This story was originally published July 6, 2021 at 4:00 AM.
