For decades, governments treated homelessness as an intractable problem, relying on a patchwork of shelters and services to look after people considered too troubled or too far gone to keep permanently off the streets. Now, following a national trend, Governor Deval Patrick is proposing a radical change in the way Massachusetts deals with the indigent - giving the homeless homes.
Patrick is proposing spending $10 million to lay the foundation for placing thousands of homeless people in their own apartments over the next five years. Administration officials say taking homeless people off the street - and out of a cycle through jail and emergency rooms - could lead to better lives and lower costs to care for them.
In pilot programs, officials reported declines in costs for services from hospitalization to detox and imprisonment. They have also learned from homeless people in the program such as Burton Tainter that there may be hurdles in any large-scale effort to get the homeless off the streets.
After years of sleeping on grates behind the Boston Public Library, Tainter was given keys to his own apartment in North Quincy. It seemed a dream come true for the 61-year-old former welder from Lynn, who struggled with alcoholism and a host of physical and mental health issues.
But not long after moving in, Tainter wasn't sure he wanted to stay. The days alone were excruciating. The lure of booze and friends from the street was strong. And for weeks at a time, he would vanish from the apartment cluttered with recycled furniture, coffee cans, and cigarettes, resuming his old life of living on park benches in Boston.
"The hardest part is living alone - especially when struggling to stay sober," he said.
Officials discovered that some who had been relocated to apartments slept on the floor or in chairs, instead of their new beds. Others continued to panhandle, horde canned food, and urinate in bottles. Many had trouble coping with the boredom and isolation of living alone, and some returned to the streets.
"Some move in, and it comes naturally to them," said Juanda Furtado, who oversees a housing program for Home Start Inc. in Boston. "Then there are those who . . . have no idea what to do with themselves."
The idea to give homeless people homes has been gaining popularity nationwide, largely because it has been seen as a cost-effective way to get them off the street and into better lives.
Providing homes for those people, researchers say, will ultimately save money, because agencies spend less on housing and other services than they do now on shelter beds, emergency rooms, and other healthcare costs for the homeless. Massachusetts now pays on average $3,000 a month to house some 5,000 families and about $1,000 a month for 24,000 homeless individuals.
In his blueprint for Massachusetts, Patrick calls for an initial $10 million to pay for an array of services to help low-income renters stay in their apartments, provide services to the newly housed, and to start the process of reducing the number of individual and family shelter beds by 20 percent over the next five years. Over the same period, the goal is to provide 1,000 apartments for individuals and 800 homes for families.
Advocates for the new approach cite a study of some 4,600 homeless people in New York City that found those provided housing experienced a 35 percent drop in the use of medical services and a 38 percent decline in imprisonment.
"We're talking about changing the whole context for how we deal with homelessness," said Joe Finn, executive director of the Massachusetts Housing and Shelter Alliance, which over the past two years has overseen a $1.8 million state-subsidized program to house the chronically homeless.
He and others point to the alliance's Home & Healthy for Good program - which has placed more than 230 people in apartments around the state - as evidence the effort can succeed on a larger scale. As of November, about 86 percent of the people in the program had remained in their apartments for more than a year.
The Home & Healthy program reported that costs for hospitalization plummeted from about $1,400 a month for a homeless person on the street to less than $600 a month in the program. Costs for ambulance services, respite care, and detox also dropped significantly.
Still, there were problems in the program: Twenty-two people left their housing because they couldn't handle living in an apartment or were evicted for threatening neighbors, inviting in drug users, or possessing guns. Six people were jailed after police were able to locate them at their new addresses. And three people died.
The flip side to the successes in such pilot programs are the difficulties of looking after people used to the streets. Caseworkers act as social workers and surrogate parents, encouraging the new residents to take their medications and attend medical appointments and teaching them how to cook and clean. In some cases, caseworkers have had to teach the residents to use a stove or brush their teeth.
"Burnout is something that we have to deal with," said Jessie Gaeta, a physician advocate for the Massachusetts Housing and Shelter Alliance. "There's no question it's more work to keep someone housed."
In some cases, the health outcomes did not improve. Of 28 homeless people in a two-year-old housing program run with help from Boston Health Care for the Homeless Program, five people have died, which is about the same rate as if they remained on the streets, said James O'Connell, president of the Boston Health Care for the Homeless Program and a physician who delivers healthcare to homeless people on the street.
"Whatever issues that led them to become homeless, those issues have become magnified," O'Connell said. "They need way more support than we were giving them on the street. Whether the country is ready to support that kind of care worries me a lot."
Furtado, of Home Start Inc., has clients who urinate and defecate on their floors, some who have amassed piles of insect-covered trash that include raw meat and other waste. She once had to push a client into his bathroom, telling him she wouldn't leave until he showered.
One of her clients, Cassandra Hubbs, a 60-year-old former social worker from Maine who spent more than a decade coping with a heroin addiction and living under bridges along Storrow Drive, was initially placed in a Somerville apartment but was forced out by her landlord because of various problems.
"The biggest problem was not bringing my friends home, because they brought the insanity of the streets with them," she said.
Now, she lives with her cat Fatso in a tidy one-bedroom apartment in Jamaica Plain. She offsets her addiction with methadone, avoids old friends, and staves off loneliness by meditating, watching television, and reading Fyodor Dostoyevsky and Anais Nin.
Like Tainter, she doesn't want to go back to the streets.
"It's nice to no longer have to worry about survival," she said.
David Abel can be reached at dabel@globe.com.
