Disregard of Human Dignity In the Context of Social Service Delivery
By Marilyn Montenegro
In spite of clearly inadequate housing there was no agency to provide services designed to place my former client in safe, appropriate and affordable housing. After months of research and advocacy Norma is paying 60 percent of her income to rent a room, with a shared bathroom devoid of grab bars or other mobility aids, no on-site staff and in a neighborhood with high police activity.
Her room has no closet, no shelves, no dresser and no functioning light. As a result—after a week—all of her clothing, toiletries, medication and personal papers are in still black garbage bags in the center of the room,
My former client (Norma), a 54-year-old woman with a host of chronic mental and physical illnesses including COPD, arthritis, neuropathy and depression had been living in a room she shared with an abusive stranger, up a flight of stairs in a building that was so poorly maintained that part the ceiling had fallen on her bed while she was sleeping.
For months, I had offered useless social work advice (e.g. negotiate using I statements) and finally decided to intervene.
Naively I assumed, that since Norma had a history of homelessness and imprisonment, and since I had read that there were new funds available to house homeless people, that with a little persistence we could find housing that would accommodate her physical needs and reduce her rent to between 30 percent and 40 percent of her income. I was so wrong.
Learning the Housing the Homeless System
Coordinated Entry System (CES)
The CES system appeared to be the first step in the process of qualifying for subsidized housing. It turned out that Norma was in the system with a SPDAT score of 12 which, in theory, would have qualified for supportive housing. But since housing options are limited a score of 16 is required to receive services. Norma would not be able to access housing through CES.
Housing for Health
It was suggested that Norma might qualify for Housing for Health (HFH) since she was a high utilizer of medical services. In April, after completing and submitting forms I learned that the forms would not be accepted because I was not part of a “contracted agency.”
In May, the Homeless Services Authority (LAHSA) converted the Homeless Management Information System (HMIS) to the “Clarity” platform, the forms were changed and the system was on blackout for the month.
In June, new forms were completed and submitted to a contracted agency and rejected. HFH was only for high utilizers of Los Angeles County facilities, high utilizers of non-county facilities, like Norma, are not eligible. Norma is not able to use County Facilities because her MediCal HMO, Health Net, is not accepted by those facilities.
Full Service Partnership (FSP) Mental Health Services
It was suggested that the agency providing FSP mental health services should be able to help.
After contact with administrative staff, Norma was assigned a case manager to provide housing referrals. The agency required Norma to continue to pay the same rent she had been paying (60 percent of income) while the agency would pay any amount above that to meet the actual rental fee.
A Room of Her Own
By mid July she had a small clean room with two windows, blinds, and a bed with functional blinds and windows. Although there was a light fixture, there was no light switch. There was no staff on the premises and the other residents did not know if the light worked or how to turn it on. There was no closet and no furniture other than the bed. When I first saw the room, after she had lived there for over a week, all of her possessions were still in garbage bags, piled in the middle of the room, there still was no place to hang or store her clothes and there was light.
In a Better World
In a better world, faced with an unfurnished, unlighted room, Norma would have been able to afford Access to transport her to a store ($2.40 each way).
In a better world Norma would have been able to afford to buy a lamp, a clothes rack, a dresser and some shelves (at least several hundred dollars).
In a better world Norma would have been able to pay to have the furniture delivered or (if packaged for in home assembly) to pay for assembly (at least $50)
In a better world, the property owner would have stopped by after the move in, ensured that there was a working light in the room and assisted obtaining furniture.
In a better world…
In This Dysfunctional World
The mental health agency was able to full fill its contractual commitment to provide housing for a full-service partnership client.
The absentee property owner was able to collect $700 a month for a room in a house that does not meet ADA standards.
Mental health staff was either 1) unable to conceptualize the concept of the Person in Environment as it might impact a person diagnosed with depression living in a room with no furniture, her belongings in garbage bags piled in the center of the room and no lamp or 2) unable to take appropriate action (e.g. immediately finding a lamp, initiating efforts to obtain furniture and following through in a timely manner).
Instead, the client was asked to consider how her poor decisions contributed to her current situation and what the source of her low self-esteem might be.
The Women’s Council discusses a variety of ethical, practice and advocacy issues at its bi-monthly meetings held in the greater LA area. The next meeting of the Women’s Council is Saturday September 9, 2017 at 10 AM in Long Beach. To learn more about the Women’s Council, contact firstname.lastname@example.org or mujerista@All2Easy.net