Lissette Encarnacion lives at The Brook, but she used to live under a bridge beside the Gowanus Canal.
Encarnacion has had a tough life. For a while though, most things were great — she was married, had a son, had a career. "I had it going on," she said. "I had a double-duplex townhouse, I had a Honda, I was doing my thing, money in the bank. I miss the working life."
But her husband was an alcoholic and one night when he came home, she says he threw her out the window.
She hasn't been the same since.
She and her two sons moved in with her sister, but Encarnacion kept wandering away. Her sister would find her and bring her home — but then about 10 years ago she wandered away and didn’t come back. She became homeless, and because she has epilepsy, she was often picked up by EMTs and taken to the emergency departments at local hospitals. Today, she lives in “permanent supportive housing” at The Brook.
Supportive housing is more than just a place to live. The Brook has social workers, security, a doctor, and even an event planner. The goal is to provide safe, secure housing for people who were once homeless, while also reducing the overall costs of expensive emergency room visits and other services utilized by people who are chronically homeless.
There’s no doubt that Encarnacion needs housing and that supportive housing will do a better job of keeping her, and others in her situation, off the streets. Which is why there's been an increased demand for it. There are about 47,000 supportive housing units in New York, with many of the new buildings going up in the Bronx, where real estate is still relatively inexpensive. Advocates say that supportive housing is less expensive than the alternative: frequent emergency room visits, homeless shelters and jails.
They estimate the cost of those services at $56,000 a year. The cost of living at The Brook per person? $24,000.
"That we, as a society, are paying for somebody to be on the streets — versus coming in to an apartment in a supportive housing building like The Brook . . . .," said Brenda Rosen, of Common Ground, the organization that manages Encarnacion's building.
The problem, however, is that there is not enough supportive housing for all the people who need it, and Federal funding for housing has been decreasing for years. So the question for New York State is: How will we pay for it?
New York State is investing $260 million of state Medicaid savings over the next two years. But the federal government won't match it.
Dr Bruce Vladeck, who formerly administered Medicaid and Medicare under Clinton, argues that federal Medicaid dollars can’t and shouldn’t pay for housing — it is not cost effective. "Medicaid is supposed to be health insurance," he told WNYC, "and not every problem is a healthcare problem."
Yet this past December, the outgoing New York State Commissioner of Health argued in an article in The New England Journal of Medicine that housing is healthcare. Providing housing to the chronically homeless saves healthcare money, so Medicaid should help pay capital costs. New York State Medicaid Director Jason Helgerson went further — he argued that federal Medicaid money already pays for housing, through nursing homes and long hospital stays.
Advocates say that the federal government is worried that if Medicaid invests in supportive housing then housing will become a large line item in the annual budget. It's possible that many Medicaid patients around the country live in substandard housing. Would the federal government have to pay for housing for all of them?
But Rosen of The Brook believes in a policy called housing first. "Housing first says we're going to move you into housing, we're going to wrap you in these services, which again at the end of the day are way more cost-efficient than being on the streets, and through those services and that stable housing, your health outcomes, your mental health, your quality of life, will all improve."
In other words, for people like Encarnacion, housing really is healthcare.