Not in my neighborhood

Dr. Glennah Trochet, Sacramento County’s public-health officer, thought she’d discovered a clever way to treat homeless people with tuberculosis while offering them a step toward permanent housing. The program looked like a win-win situation, until she tried to find a home for it.

As health-care professionals know, TB poses a consistent problem for the homeless in Sacramento. The TB bug can stay active in the body for years without developing into a full-blown infection, but once the infection settles in the lungs, it can be extremely serious, even deadly. TB is also highly communicable in its short contagious phase and tough to beat with drugs. Patients must medicate every day for months, even years, in spite of the fact that symptoms disappear within weeks of popping the first pill.

Because stopping and starting medication can lead to an even tougher drug-resistant form of TB, the county favors “directly observed treatment.” Health officers visit patients’ homes or businesses and watch them take their meds every day. Though this works for the regular population, it’s complicated for homeless people who have no homes or offices to visit.

“So, we will pay for housing,” said Trochet.

The county puts homeless TB patients into hotels for six months so that health officers can find them and keep them consistently medicated. The state reimburses the county for $45 a night, said Trochet—“not exactly luxury hotels.”

Recently, Trochet began to wonder if this six-month window could be used to offer more than TB treatment.

“We are not using that opportunity to improve their lives,” said Trochet.

The county decided to contract with Sacramento Self Help Housing, a nonprofit that gets people off the streets. The goal, said Trochet, was to house a small number of non-contagious, homeless TB patients in one location while social-service providers looked for permanent housing options, offered them employment counseling and job referrals, and helped them fill out applications for food stamps. A perfect marriage: The county would improve homeless people’s lives while treating TB and saving money. The rent on a single location likely would be less expensive than a number of hotel rooms.

“We thought it was such a good idea,” said Trochet.

To Trochet, the partnership seemed ideal, but when Self Help Housing proposed a site—a space for five patients on the bottom floor of a Victorian on 12th Street—Trochet was disappointed to hear that representatives of the local neighborhood association wouldn’t even meet with her to discuss it.

“We are already over-concentrated with social services,” said Sean Wright, acting president of the Alkali and Mansion Flats Historic Neighborhood Association. Off the top of his head, Wright named a number of homeless-services organizations clustered within a few blocks, including Loaves & Fishes, the Union Gospel Mission, Volunteers of America and the Salvation Army.

In Los Angeles, said Wright, “consolidating social services ghettoized the people they were trying to serve.” Wright recommended, as a policy, that Sacramento spread services throughout the city. “This is the first facility we had to take a stand against,” he said, claiming that the neighborhood’s opposition had nothing to do with TB treatment. “Our point was really pretty simple. Regardless of the disease, this particular neighborhood is over-concentrated.”

Trochet did eventually get association representatives to listen to the details of her proposal, but they were steadfast in their refusal. Trochet reluctantly gave up on the 12th Street site, and she and Self Help Housing are now considering other sites outside the Alkali and Mansion Flats neighborhoods.

“We prefer to put this in a neighborhood where people know about it and support the program,” said Trochet.

If the county meets resistance in the next neighborhood, said John Foley, director of Sacramento Self Help Housing, it will look at another and then another.

“If our community doesn’t want this, we’ll stay with the status quo,” said Trochet.