Background

I first met Carly back in 2008 when, together with my colleague Maureen Norton-Hawk, I launched a long-term project following the life experiences of criminalized women. Younger than most of the women we were meeting at homeless shelters and women’s centers around Boston, Carly recently had been released from prison on a drug dealing charge. This was her first and only arrest and she herself had never used hard drugs. “I just smoke weed,” she told me, “because it helps me deal with my emotions from abuse.”

In the wake of childhood sexual abuse Carly had been removed from her family, spent a few good years in foster care and then three not-so-good years in a juvenile residential treatment center which she left the day she turned eighteen. “I regret it now,” Carly murmured, “but at the time I didn’t know what it is to be homeless.”

Two years at homeless shelters and on the streets, then a year in state prison followed by a return to the shelters left Carly with single-minded determination to get an apartment of her own. Life at Long Island Shelter (which has since been closed; see Outcast Island) helped her keep her eye on the prize and her name on every housing waiting list in the Boston area.

Carly’s First Apartment

In 2014 Carly finally got an apartment subsidized through a Section VIII government voucher provided by the non-profit agency Home Start. From the outside the building looked nice enough, but inside the stairwell was disintegrating. For $1150 / month, Carly moved into an apartment in which daily sweeping was insufficient to keep up with the mice droppings on the floors or the piles of sawdust created by some sort of wood-chomping insect. Each time I visited her, I could see the mold growing on more places in the walls. In some places, the mold actually seemed to be holding the wall up.

Complicating matters, the apartment was officially a one-bedroom but actually had another half bedroom. While for some people this would be a bonus, that was not the case for Carly. She explained, “I am too generous and can’t say no to people. I’ve been there and know what it’s like not to have a home. So I let people stay with me and then I get hurt.” For a while she let a man she knew stay in the half room. He “made trouble – brought drugs into the apartment,” and when she told him to leave, finally locking him out, he kicked the door down. “I’m lucky I wasn’t evicted.” Then she let a young woman she met at her church stay with her. “But she wasn’t a true Christian. She kept saying she’d help pay the bills but never did. Then she stole from me.” It took Carly almost six months to persuade the young woman to move out.

Yet with all of this going on, Carly found that having a home allowed her the stability to finish her GED, complete a training program to be a nurse’s aid, and look into possibilities for further education in nursing.

A Turn for the Worse

In December of 2015, I visited Carly at the maternity triage department of one of the local hospitals. Embarrassed, she told me that she had the misfortune to become pregnant the one time she “slipped” from her Christian vow of pre-marital chastity. When she first learned she was pregnant, Carly recalled, she did not want to go ahead with the pregnancy. Single, unemployed and living in a horrid apartment, she did not feel that she was in a position to raise a child. And, she explained, she was afraid that she would be shunned by her church for the unmarried pregnancy. But after a visit to the Boston Center for Pregnancy Choices where “a woman prayed and talked with me,” she decided to keep the baby.

A quick look at the organization’s website confirmed my suspicion that “Choices” may be a bit misleading. This organization does not perform or give referrals for abortions and strongly encourages women considering abortion to have an ultrasound “to determine viability” before going ahead with the abortion. Co-opting the rhetoric of choice, this organization – like many others of its kind – have been described as “the darlings of the pro-life movement,” dedicated to helping women “choose” to go on with pregnancies.

That day in December, like many other days throughout the late fall and early winter months, Carly was in the hospital while the doctors and nurses tried to get her asthma under control. The problem she explained, is that the asthma is triggered by the living conditions in her apartment. “The landlord is a slumlord,” Carly told me. “He will not fix anything.”

Complicating matters further, Carly’s blood pressure was high and the doctors were concerned that she may have pre-eclampsia, a potentially fatal condition for pregnant women. Carly had struggled with obesity for much of her life. In the year before becoming pregnant, she succeeded at losing a great deal of weight, but pregnant, she had become bigger than ever before.

Now eligible for a $1500 Section VIII voucher for a two bedroom apartment for the baby and herself, she could not find a place for the price allowed by Section VIII. And when she occasionally did spot a listing that fell within the allowed rent, she found that landlords often do not want Section VIII tenants. (SeePoor and Homeless Face Discrimination Under America’s Flawed Housing Voucher System“.)

Carly had made about a hundred calls both in Boston and in the furthest suburbs and hadn’t even made it to the stage of actually looking at an apartment. But she had not lost hope: “God doesn’t turn his back on me.” In the meantime, she continued commuting between the roach-haven and the hospital.

A New Home (For Now)

As it turned out, Carly was right to remain hopeful. In mid February she landed a lovely two bedroom apartment (albeit in the one neighborhood she wished to avoid – Dorchester, where she’d spent her drug dealing younger days).

This is how the apartment came about: Among the dozens of people with whom Carly networked in her apartment search she met a real estate agent who knew another agent, and the two of them made it their mission to find her a place. Since real estate agents often present barriers to apartment-seekers with Section VIII vouchers, this was quite exceptional.

“They really helped. They even are splitting the agent’s fee [one month’s rent].” For many Section VIII apartment-seekers the agent’s fee presents an insurmountable barrier to rental. This time, for reasons that we could not ascertain, Home Start was able to pay the fee for Carly. There was, however, one hitch. The monthly rent for the new apartment is $34 / month above the amount permitted by the voucher. Carly told Home Start that she’d pay the difference, but they told her that is not allowed. (For more on bureaucratic hurdles see  Failure by Design: Isabella’s Experiences with Social “Services”.)

The way it finally worked out is that the Boston Center for Pregnancy Choices offered to pay the difference for the first year (Carly does not know what will happen after that one year). She does not know why, but this plan was acceptable to all parties and she should be moving into her apartment next week.

For Carly, the lesson learned is that everything worked out “because I chose life. God is good.”

For me, the lesson isn’t so straightforward. Carly remains precariously housed in an apartment she may be able to keep for only one year. She still lives in one of the most violent neighborhoods in Boston, a neighborhood with particularly high rates of elevated lead levels and of asthma hospitalization rates for children under five. She will be raising a child by herself with no financial support other than welfare and food stamps. Her career momentum is on permanent hold. And, if past track records with similar “pregnancy choice” organizations hold true, Carly is not going to be able to count on her pregnancy-support network for substantial help with the daily grind of single-parenting.

For more on Carly click here and here

For more on housing see Health is Where the Home Is

Christmas House Decorations wallpapers

Maybe it’s because of the bitterly cold temperatures at night this week, or maybe it’s my own visceral response to overdosing on television shows with happy family Christmas scenes and neighborhood holiday lighting competitions, but I’ve been giving a lot of thought recently to how housing and homes impact health.

About a decade ago I traveled to the Mississippi Delta, Texas’s Rio Grande Valley, south-central Illinois, the mountains of northern Idaho and the cities of eastern Massachusetts to speak with individuals and families scraping by without health insurance. Most of these people worked in construction, retail, agricultural or service jobs. The details varied, but across the country I heard about spiraling poor health, declining employability and growing poverty. In 2015 I made return trips to check in with the people I’d met ten years earlier.[i] While I was able to locate nearly all of the original interviewees who owned their homes (including very modest homes of immigrants in colonias in the Rio Grande Valley), I only located a minority of the renters. Typically, their original phone numbers were disconnected and original addresses belonged to subsequent tenants. When I knocked on neighbors’ doors the most common response was, “I don’t know [so-and-so]. I’ve only lived here for a few months myself.”

In previous posts I’ve written about marginalized Boston-area women who cycle through shelters, jails and the streets. In those contexts the “problem of homelessness” is relatively easy to see and define – all I had to do was visit shelters or walk through the public parks in which people without homes congregate during the day. But for me, it took weeks of trudging through muddy housing developments on the outskirts of Mississippi towns and knocking on doors in public housing complexes in a central Illinois cities to get a glimpse of the lives of those less visible Americans who generally manage to rent housing of some sort for periods of time but teeter on a financial edge that keeps them moving from place to place.

Unfinished housing project at 47-04 198th St. in Auburndale stands abandoned for several years.

On my 2015 reprise tour I looked for a total of 145 people in five states and was able to locate 98 of them. The missing people were not evenly distributed either geographically or by race. In Mississippi, the state that consistently has the poorest health profile in the country, I managed to locate only 11 of the 28 people whom I sought. The utter disappearance of 17 of 28 people did not surprise one local healthcare advocate (he asked to remain anonymous): “People move away to Birmingham or Tupelo to look for work. There is very little home ownership in Mississippi. The common thing is ‘lease to own’ in which a developer arranges for people to ‘lease’ (pay rent) and after 20 years they have an option to buy – to switch the rent to a mortgage. But people almost never make it to the 20 years so the developers keep leasing the same houses over.” Many of these houses would not pass even the most cursory safety inspection in other states.

I was able to locate 70 out of 88 white people I’d originally interviewed and 21 of 28 Latinos / Latinas (mostly in the Rio Grande Valley), but I only found 10 of 29 African Americans. This is consistent with national patterns. According to the US Census, the homeownership rate for the fourth quarter 2014 for non-Hispanic White householders was highest at 72 percent. The rate for All Other Races householders was 55 percent. And for Black householders it was only 42 percent. According to researchers Gregory Sharp and Matthew Hall, “The 1968 passage of the Fair Housing Act outlawed housing market discrimination based on race. …  However, emerging racial disparities over the next three decades resulted in black owners who bought their homes in the 2000s being 50 percent more likely to lose their homeowner status than similar white owners.” Even after adjusting for socio-economic characteristics, debt loads, education, and life-cycle traits like divorce or job loss, blacks were more likely to lose their homes than whites.”

Shanice’s Story

I first met Shanice in 2003 at one of the larger Black churches in Decatur, IL – a church known for its strong fellowship and advocacy on behalf of the community. She was happy to share her story with me:

“When I was 18 I worked a job, it was right after coming out of high school. No insurance and they said I wasn’t eligible for Medicaid. My doctor said that I needed to get my tonsils taken out cause they were so swollen it was almost causing me not to be able to breathe. … And so I had to go on like a payment plan with the doctor. … The whole surgery, the surgeon, the day at the hospital and then I had a setback and had to go back into the hospital cost $15,000. During the following year collection agencies called day and night, often making threats. They’d [especially] call on Sunday nights. Said that I would be going to jail if I didn’t pay them.” At age 20, Shanice filed for bankruptcy.

A few years later Shanice gave birth to her daughter. By this time Shanice was working for a storefront loan company that provided health insurance for her, but not for her daughter (she would have had to pay a premium that she could not afford on her salary.) A few years later their statuses reversed: When Illinois expanded Medicaid for children (Kid Care) her daughter became covered but Shanice, having made the decision to go back to school and learn a skill, became uninsured. Shanice was well aware of the risk she was taking was determined to build a better future for herself and her daughter. “It wasn’t just me living this carefree don’t worry about tomorrow life. Now I have someone that was dependent on me so I had to make decisions for the future. … We moved into a nice apartment, we got power, cable, phone and I got a new car.” During that time Shanice began to eat healthier meals and lost over one hundred pounds. In order to pay tuition, “I got Pell grants and student loans.” I asked Shanice how she was able to get credit to buy a car so soon after declaring bankruptcy. “Oh, they go after bankruptcy people like crazy [to sell them stuff]. I was getting credit cards in the mail every night.”

In 2003, after spending time with Shanice and her daughter at the church where they sang in the choirs, participated in groups and clubs that helped them focus on making good decisions, and volunteered helping out the poor in their community, I described Shanice in my notes as “a young woman on the way up.” She was working part-time at her church with youth and looking for her first professional job. “I just completed 1540 hours of cosmetology school and I just graduated last Friday.”

When Shanice and I walked out of the small room where the church choir stored its robes, I asked her if as a cosmetologist she would get health insurance. She answered, “I can get a job but in this field they don’t give insurance. You have to arrange that yourself.”

….

A year or so later I spoke with Shanice again. With a sense of resignation, she told me that medical and credit card debt had piled up and she was preparing to declare bankruptcy a second time.

….

Fast forward twelve years. I returned to the address at which Shanice was living when I initially met her. She had moved on and none of the current neighbors even knew her name. On USSearch I found six other addresses for her and visited each one of them. Two of the addresses did not exist. One was in a decrepit housing project that had been shut down for several years, though some people continued to squat in the apartments. (I was warned that mostly gang members were there and that it wouldn’t be safe for me to go poking around.) One address was in a middle-class, white neighborhood – none of the neighbors whom I could find knew of anyone named Shanice. Two were inhabited by other Black families who had moved in recently. Stopping by her church, I was told that, “Shanice is no longer a member of this church. She’s moved.” No one at the church knew where.

Health and Housing

It’s not hard to understand the devastating health consequences of homelessness. Living on the streets exposes people to cold, rain and assault. Without a home it’s a challenge to eat proper meals, get enough sleep and keep oneself and one’s clothing clean. The stress of not knowing where one can lay one’s head contributes to misuse of drugs and alcohol. And infections of various sorts tend to spread quickly in crowded homeless shelters. Like the people in the shelters, these health consequences are easily identified and counted.

The health consequences of moving around are less immediately visible to the casual eye. But at a community health center in Decatur Illinois, nurse administrators Karen Schneller and Tanya Andricks elaborated on ways in which churn in housing is related to churn in healthcare. Different states and even different counties and towns have different healthcare resources available to residents. Different providers have different medication preferences and treatment protocols so people stop and start treatments. Even with dedicated staff efforts, it is impossible to provide follow-up care for patients who can’t be reached – whose phones are turned off and whose mail is returned “addressee unknown.”

Jenny Trimmell, public health administrator and Melissa Rome, community liaison at the Vermilion County (Illinois) Health Department explained that children like Shanice’s daughter particularly suffer from frequent moves. “When the Cabrini Green housing project in Chicago was closed to pave the way for gentrification former residents were offered vouchers by the Housing Authority and promised housing and jobs in towns in central Illinois. But there was not enough housing and not enough jobs, so people go back and forth to Chicago. There was a cultural adjustment for many moving from Chicago to more rural downstate.  People were unaware that services outside of the city of Chicago may be limited, such as access to health care providers; bus services that do not run 24/7, etc.  Everyone is frustrated. The kids are in and out of schools and medical records kept by parents are incomplete or non-existent. It is difficult for the Health Department to determine immunization status for these children and frequently immunization series have to be started over due to the unknown immunization status.” Trimmell and Rome went on to explain that without the kinds of community support children develop when they stay put in one school, “there are high drop-out rates, teen pregnancies and drug use.”

Musings

Getting to know and then losing track of Shanice and others in similar situations has made me more attuned to the health privileges of stable and secure housing. My home allows me to accumulate the material objects that anchor and enhance my life, both in immediate ways by giving me space to store medication and in less tangible ways by grounding me in the photos, books and furnishings that tie me to my past and to the people I love. My home provides a hidey-hole for times when the outside world feels overwhelming. It gives me a familiar bed and private bathroom when I am sick, and a kitchen in which I can cook the food that I want to eat when I want to eat it. My home allows me to cultivate neighbors who can lend a hand at times of need and offers me the space to nurture those special bonds with the family that looks out for my well-being. In my own home I have the power to keep out rats, roaches, mold and the dust and down that I am allergic to. I am not dependent on the vagaries of landlords or property management companies. No less important, my home gives me an address at which I receive and retain the paperwork that helps keep my financial, medical and legal life in order as well as reminders of when and where to exercise my right to vote (yes – for candidates who support legislation that makes my community healthier).

I plan to return to Decatur next week and resume my search for Shanice. Maybe she has found another supportive church community somewhere else in the area. Maybe she finally has her healthcare coverage straightened out. Maybe her daughter has escaped being one of the kids who’s been subjected to multiple rounds of vaccinations. Maybe she’s become the star of her high school marching band or debate team. I hope so.

 

 

[i] In each community I began with the contact information people had given me when we first met. Only a minority still lived at the same address or had the same phone number. Then I turned to phone books, social media, Google and other public-access online search engines, including USSearch that listed multiple address histories for many of the people. In each community, if my initial attempts to make contact failed, I then called on common acquaintances, knocked on doors of neighboring houses, and asked at local grocery stores, libraries and churches.

For more on this project:”The State(s) of the Affordable Care Act”

For more on housing struggles, take a look at this article about “Carly”

My friend Isabella has been beside herself with worry over her son and her housing situation. Ever since the first time we met (seven years ago!) in a half-way house for women, she has told me that she wants Americans who are fortunate enough to live in secure and stable housing to know what people who are dependent upon the institutional circuit of shelters, clinics, welfare, jails and DYS must go through just to (barely) hang on. I urged her to writer down her experiences. What follows is a Facebook conversation between us about what she’s been going through these past few months.


Isabella: Like many others, my husband and teen-age son and I have been living in what they call “scatter shelters.” What that means is that there aren’t enough good solutions for homeless families so they put us in apartments scattered around the city. Because we are a family, we were given one bedroom in a four bedroom apartment shared by four families. Some of the families have several kids, so it was very crowded. We all shared the living, kitchen and bathroom. One of our housemates at that apartment was an alcoholic and hit our son in the head with a bottle of Grey Goose. After that the manager moved us into another shared apartment in even worse conditions than the first one.

We are not criminals or children, but at the scatter shelter we all have a 9:00 curfew, 11:00 on weekends (though we can get a weekend pass.)

One weekend our son was staying with his grandmother and he called us up to say she had kicked him out. But it was after curfew (he had permission to be out but we had not arranged to be out) so we had to call the shelter supervisor to get permission to go and get him. By the time we reached her and got permission the last T [public transportation] had run so we had to take a taxi, which cost us $120 – a very big part of our monthly income.

 

Susan: Are you able to set up the apartment to feel like home?

 

Isabella: Because of all the moves and living in one room most of our stuff is in storage, including a television and really nice living room set that my father bought us before we lost our housing. But storage is expensive and we owe $3000 to the storage company. The company will not accept a partial payment and told us that they would auction off our stuff if we can’t come up with all of the money right away. But both of us are disabled and we live on Social Security so we couldn’t come up with the money.

homeless-in-storage-unit

I’ve been anxious and depressed through all of this, but what’s happened in the past two weeks has pushed me over the edge and I’m crying as I write this.

 

Susan: What’s been going on?

 

Isabella: Our son had gotten into some trouble for which he was put on probation. Unfortunately, he violated the terms of his probation and so he was taken into DYS (Department of Youth Services) custody for an indefinite time of anywhere between two weeks until up until his eighteenth birthday. So I’m SUPER STRESSED OUT, losing my mind actually, because we have NO IDEA where we’re gonna go. They’re saying that since our son is in the custody of DYS that he cannot be considered a part of our “case file” so we can’t stay in the family shelter. But he can’t be released by DYS to us if we don’t have a stable environment to live in. But we’re going to lose our place in the shelter because he is not living with us RIGHT AT THIS MOMENT and without him as part of our case file we are $26 over the monthly limit to qualify for a homeless shelter.

I called the housing office and was told that our son DOESN’T qualify as homeless, because and I quote the almighty DIRECTOR of DHCD, “He already has a place to stay [in DYS custody]; so he’s not homeless…” They said, “When he gets out and is homeless have him call us to verify he’s on the streets and we’ll reevaluate your eligibility.”

So basically we’re stuck in a Catch 22: Damned if we do, damned if we don’t!!! He CANNOT be released if we do not have a place for him to stay…BUT, we cannot keep a place to stay if he remains in lockup!!! I can’t win! I’m losing my fucking mind!!!!!! I’m so sorry for the vulgarity but I am flabbergasted.

I’m SO SUPER STRESSED I have no idea where we’re going and the thought of being homeless with our son frightens me like nothing has ever frightened me before.


 

While many of the poor, chronically ill and criminalized women I know turn their anger and blame on particular “bitches” who work in social and correctional services, Isabella has made clear to me from the first time we talked that, “It’s a system that is designed for us to fail.” Emergency assistance programs make frequent changes in eligibility criteria for receiving services, causing feelings of uncertainty and vulnerability in those who are dependent upon welfare as well as obligating recipients to spend great amounts of time and energy re-certifying their eligibility for the support and services that, in most other industrialized countries, are considered a basic right.

Even when you qualify for assistance, it turns out that Social Security Insurance (SSI) and Temporary Assistance to Needy Family (welfare) remittances are not sufficient to live on. As a result, recipients also are drawn into homeless shelters or other housing programs. Homeless shelters, while better than the street in most instances, are structured around rules that seem designed for people to break them. For a mother, residence in a homeless shelter is a surefire way to draw in child welfare services. Child welfare services are more likely than not to send women to drug testing programs which in turn easily leads them into the correctional system. Conditions of probation and parole — such as requiring constant urine tests — make it impossible to hold down a job. And children like Isabella’s son who were drawn into child welfare services are more likely than other children to end up in juvenile detention facilities, jails and prisons – all but guaranteeing that they will remain stuck in the same institutional circuit that failed them from the start.

You can read more about Isabella and the institutional circuit in Can’t Catch a Break.