Last of three parts.
Jason Robinson, a clinician with Choices, had spent four hours in the street with a homeless woman who was mentally and physically ill. For days he had tracked her around town, gaining her trust. Now he had the paperwork ready to get her into housing and give her care.
She understood the need to sign. She wanted a home. Exposed daily to the elements, she kept getting beat up. But she couldn't sign because she felt a twin's voice was manipulating her from the inside.
"It's really a sad situation. It's really bothering me," Robinson said.
He gets intense talking about the people he works with, frustrated by how difficult it is to help them. He has his own special needs child. He won't turn away from the suffering of those whose illnesses make them too afraid or too confused to gain shelter from Alaska's cold.
The emotion is part of the work.
"You can't do it if you don't care that much," he said.
The Choices program follows the "housing first" movement, with the philosophy of getting clients housed without preconditions, and then supporting them to get healthy and get jobs. Among various programs in Anchorage, Choices focuses on the hardest cases — people who will likely always need support.
It's expensive and the 10-member team has only 35 clients so far, with a goal of 84. But it costs less for an apartment and a clinician to work through problems daily than leaving an ill person outdoors to cycle through the emergency room in times of crisis.
We pay to care for the homeless one way or the other through agencies, government and health care. The city's camps and shelters are essentially an expensive and poorly managed clinic where hardly anyone gets better.
Choices is one part of a larger solution. A coordinator in the Anchorage mayor's office, Nancy Burke, is developing a database of Anchorage's homeless, seeking a legal waiver so agencies can track individuals' information and find the right services for each. Rather than starting over with each crisis, they will work toward healing and housing the long-term homeless.
Changes in state and federal law will help. The Affordable Care Act and Alaska's Medicaid expansion and Medicaid reform bill, just passed by the Alaska Legislature, provide coverage for more people so they can get help before they become homeless, said Randall Burns, director of the Division of Behavioral Health.
The reform bill also began a yearlong redesign of how Alaska pays for care. Currently, while helping homeless clients, Robinson spends much of his day filling out paperwork to bill Medicaid. He fills out a form every time he gets in the car.
This staggeringly inefficient system assumes patients are coming into an office for appointments measured in 15-minute increments. But Robinson often goes looking for his clients at the library. Recently, while he was fishing in Eklutna, he got a call that a client was about to be evicted from her apartment.
A new Medicaid billing system that supports wrap-around care could allow an agency to bill for helping a client rather than for each individual service. Without that, I'm afraid the new model may not work.
The Legislature funded the $4 million grant that supports Choices for only three years. Burns said Choices needs to get clients into housing, stabilized and routinely supported, so that Medicaid billings will pay for the program to continue when the grant runs out.
This is a chance to solve problems that have been around for decades. Clinician Zack Hicks said one client had been living outdoors since he was 15 years old — now he's 40 and has his first apartment.
"A lot of these people have been homeless for a very long time and they're leery of being in an apartment," said Dr. Aron Wolf, a psychiatrist in Anchorage for decades, who works with Choices. "We've had to take steps like putting a sleeping bag on the floor or even putting up a tent in the apartment. If you've been living outside for 10 or 15 years, you feel nervous being inside."
Jeff Ensley didn't believe it when Jason Robinson finally found him an apartment.
After police picked him up freezing near the Anchorage Golf Course and took him to Providence Alaska Medical Center, Ensley again wandered the city, staying in a hotel, a hostel, shelters and outdoors. Sometimes he only ate because a passerby took pity and gave him a hamburger.
Robinson worked for months to find a landlord who would rent Ensley an apartment with a public housing voucher. A couple of opportunities fell through, including one that Ensley turned down for reasons Robinson couldn't understand, but had to respect.
Then, in March, on Ensley's 49th birthday, an apartment finally came through. Robinson pulled up to the Loussac Library to meet him, an air mattress, pots and pans and other necessities of indoor life in the back of his pickup.
"I said, 'Happy birthday, I got you all these things,' " Robinson recalls. "He said, 'Jason, I don't think I can fit all this in my backpack.' "
It took time for Ensley to accept he had a place of his own.
When we talked, his only complaints about the apartment were the lack of privacy — he feels he is being watched by magic vision — and the sense that sometimes the floor moves as if on wheels. Sometimes he believes he hears people inviting him into the other apartments, but Robinson has helped him realize he shouldn't go unless he knows the people.
Life isn't going to be easy, but at least he is warm and safe. And maybe he will get work and get stable on medication. Now he has that chance.
Anyone could become mentally ill and feel terror and misery that no one else can understand. For decades we've left these people to suffer alone, wandering the woods and sleeping on the ground.
We have to care for them.
Charles Wohlforth's column appears three times weekly.
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