Are non-profit hospital mergers making things better or worse?
Grant Miller, Publisher

The American people are a generous lot.  In 2017 they gave $410 billion to nonprofits, faith-based organizations, and other charities.  Sick children are often the focus of GoFundMe.com appeals, which raise over $650 million a year.  A child in need tugs at both the heart strings and the wallet in ways that the homeless do not.


The Pilgrims brought a cold Puritan streak with them when they landed on Plymouth Rock in 1620. The concepts of hard work, discipline and frugality are still part of the American DNA four hundred years after William Bradford and the Mayflower Pilgrims became the first dry foot refugees in the Americas.

But the Pilgrims also brought the ideas of blame and shame towards the poor and homeless to our shore. They equated poverty with idleness and moral failing and, all too often, a just punishment handed down by Heaven.  Our response to the homeless problem is still tainted by that strain of thinking.  For generations, the police were tasked with taking the poor and homeless to the county line, where they would become someone else’s problem.

The Department of Housing and Urban Development 2017 estimated that there were in 32,190 homeless in Florida. Miami-Dade County has The Homeless Trusts. Their annual “Point-In-Time” survey estimated that there are 3,528 homeless in Miami-Dade County. That survey relies on minimally trained volunteers. Such counts also exclude certain kinds of homelessness, like people doubled up or couch surfing or people in hospitals or who are incarcerated.

An analysis released by the National Law Center on Homelessness and Poverty suggests that the true number of people experiencing homelessness could be between two and 10 times higher than these official estimates.  It’s a big problem that is often living under bridges, squatting in empty buildings, or hiding in the shadows.

To its credit, Miami-Dade County is trying to do something to solve the problem.  It was created in 1993 by the Board of County Commissioners to administer part of the proceeds of a one-percent food and beverage tax, to implement the Miami-Dade County Community Homeless Plan, and to serve in an advisory capacity to the Board of County Commissioners on issues involving homelessness.

The Trust isn’t a direct service provider. The 27-member Miami-Dade County Homeless Trust Board oversees contract compliance by non-profits agencies contracted with the County, through the Trust, for the provision of housing and services for homeless persons.  It’s piece meal approach to a problem that requires a more comprehensive and strategic solution.

The Homeless Trust, according to the Fiscal Year 2017-18 adopted budget will be getting over $25 million from the local food and beverage tax, almost a million dollars in State grants, and about $32 million from the federal government.

It also will be carrying over $26 million from the year before.  The failure of the Homeless Trust to spend all of the money that it takes in isn’t something that is new. In each of the last three budget cycles, the Trust didn’t spend between $23 million and $24 million each year.

It’s not as if the homeless problem has been solved in Miami-Dade County and that every homeless person and family now have a permanent place to live.  It would be great if everyone could declare victory and go home — and have a home to go to.  But that’s not the case.

All too often the homeless have to jump through hoops before they can get into permanent housing.  They have to get clean and sober. They have to take training. They have to pass tests. Only then will they be deemed worthy of help in a way that would make the old Pilgrims proud.  But stability and sobriety are hard to achieve when you’re living out on the streets.

Camillus House is one of a number of participants in the Homeless Trust’s funding. But these charities, as well meaning as they may be, are only Band-Aids on hemorrhage.

What we need is something different. Something radical. Something that works.

There is an initiative that is being implemented in other urban areas called Housing First.  Their approach is to provide housing to the chronically homeless without the requirement that they pass tests or attend programs or even fill out any forms. If they need and want to go to rehab or detox, these services were provided. If they need and want medical care, it was also provided.

This approach was first tested in Denver with 242 chronically homeless individuals. Five years into the program, 88 percent were still in their apartments and the cost of caring for them in their own homes was less than what it would have cost to take care of them on the streets. Denver found that emergency-service costs alone went down 73 percent for people in the Housing First program, saving $31,545 per person.

And there were additional benefits in Denver. There were reduced wait times at emergency rooms, the police response times improved once the streets were cleared, and, without a large population living on the streets, the urban core was cleaner and more attractive.

In Salt Lake City, they largely solved their chronic homeless problem by building five new apartment complexes. Ninety percent of the money came from the Federal Low Income Housing Tax Credit program, which gives tax credits to large financial corporations that provide financing for housing authorities or nonprofits to build low-income housing, with the other 10 percent of the cost of building coming from state taxes and charitable organizations.

The tenants pay their rent through federal Section 8 housing vouchers.  On-site services, such as counseling, are paid for by state and county general-fund dollars. The result is that Utah’s Housing First program cost between $10,000 and $12,000 per person, about half of the $20,000 it cost to treat and care for homeless people annually on the streets.

To solve this problem, Miami-Dade is going to have to be ready to challenge the status quo. (We need to solve the affordable housing crisis and the problems in existing public housing, too. But those are problems that will be addressed in future columns.)

As my father was fond of telling me when I was growing up, “You can work hard. Or you can work smart.”

It’s time we started working smart on the homeless problem in Miami-Dade County.


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13 COMMENTS

  1. Great article, Grant!
    We need a new Miami-Dade mayor who will tackle this issue the way Utah did. It should be a State-wide, even national project,though. The County will never be able to get caught up with the need if other counties don’t also do their part. The homeless population should be taken care of all over the State so that they don’t all wind up here. At least some could be rehabilitated and reintegrated into society.
    As for the tax credit program, there has to be some very serious oversight. There has been fraud and corruption committed by developers obtaining tax credits. Having lived here most of my life, I would say that this is the fraud and corruption capital of the U.S.A., and too much of it goes unpunished, right under our very noses
    This culture of corruption has to be eliminated for any social program to succeed, and to get the public to support these programs.

  2. I am 62 years old and homeless for more than a year asking “the green shirts” to take me to a shelter, without any success. Every homeless has a different opinion to get in a shelter. There are no instructions anywhere as to get shelter. The “green shirts” maintain a revolving door recycling the same homeless people in and out of the shelters. I only needed a helping hand to continue working, however, I was forced to retire. You talk about the millions being collected, that basically sit in the banks doing nothing. As an emergency, you should at least update the garbage food that is giving in the shelters.

    • There is def a problem and mismanagement is a cause. Miami Dade has implemented the housing first model but there is no justice for the struggling working class. Families, due to the rising economy are being displaced and the only orogram available is HANDS which is a joke. To qualify, one mist make under a certain treshold but to qualify as a tenant, they must make above those means. Which means, it is almost impossible to be in compliance. I see it everyday. As someone from inside, many shelters play with their numbers to make it look pretty to the funders and the people they serve fall between thr cracks. So sad…

  3. Grant, this is an excellent article and with proof of concept worthy of considering. One thing I recall from my years as an ER nurse was how when winter came our homeless population surged. So as the other person commented we ought to look at it nationally so that no one state has the burden if you will. A business case can also be made given the cost analysis. It seems to me that this is an idea who’s time has come. Next we can tackle hunger! Thanks for your article. JJ

  4. Mt Miller: That is a great article. Thank you for sharing that important information. When we read something like that, it will be good to know how we can help. Please guide us.

  5. I am aware of the program initiated in Denver and its reported results. Malcolm Gladwell wrote a piece about it, about the cost effectiveness of targeting and providing housing to the chronically homeless, which was published in “What the Dog Saw.” I agree with Miami-Dade County pursuing this approach towards addressing the issues of the homeless here in Miami.

  6. Great piece and great comments, reflecting that our community cares about homelessness. What action can those who are concerned take now? I’m willing to be part of a grassroots group to start making positive change now through advocacy/education, rather than simply waiting for the current system to change. I’ve seen meaningful change through dedicated individuals so it would be wonderful if “we” could be that change!

  7. The more millions we throw at this issue, the bigger problem we are going to create. All we need to do is the “homeless problem” created by some of the large cities on the west coast, some of them spending billions on failed programs that overtax citizens, create bureaucracy and do not solve anything. Every year the streets of LA, San Francisco, Oakland, Seattle etc resemble third world countries more and more. Let those who want to throw their money away by donating it to “homeless causes” lead the way, I will not be following voluntarily. I will not vote for anyone advocating for a tax based solution to the issue either.

  8. Why not look at how other countries are successful in this? United States tends to be slow at new things that work very well in other countries. I work near UM and there are so many homeless and because its near the Camilus House. So sad to see this everyday.

  9. I understand that you are attempting to outline a problem, but to lay the blame for negative attitudes towards homeless people at the feet of Plymouth Rock Pilgrims is insanity. In Rhode Island, they passed a bill of rights for the homeless (gee, awfully close to where those evil pilgrims landed!). And what about the nasty treatment of homeless in Greece, Brazil, or Hungary (where it is illegal to be homeless!)? While I see that you are trying to make a point about a disenfranchised group that you believe deserves more compassion, don’t confuse or spread unsound ideas, such that Pilgrims are the source of the problem for homeless people.

  10. Jen… clearly you have not seen uncensored video of the neighborhoods of Paris. Europe is far from being a panacea or an example to follow for the care of the homeless nor for socialized medicine. Homelessness in the US could be reduced significantly if we brought back the concept of mental health institutions. Obviously they need to have higher standards than the ones that led to their closure and the dumping of all those patients to the streets. Regarding socialized medicine, the concept is failing in Sweden, Great Britain and most recently in Finland. So please, Western Europe is not an example for anything.

  11. Bravo, Mr. Miller. The Salt Lake and Denver programs are worthy of emulation, and we all stand to benefit from cleaner and safer streets. Miami-Dade County should also mandate and subsidize much more housing in the low-income and affordable housing categories, and cap annual rent increases.

    Poverty rates and homelessness rates are much lower in Western Europe than in the US. In Spain homelessness is such a recent phenomenon that they use often use our word, “homeless” to describe people in that condition.

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