coordinated care campus

THIS PAGE WAS LAST UPDATED JULY 9, 2021. Prior to Council having any discussions about this matter, I also published this blog post.

I’ve heard crystal clear from our residents: they expect Council and other orders of government to address homelessness in our community. As well as mental health and addictions.

As we tackle the huge challenges of homelessness, there are a number of priorities I have. They include:

• Giving people the best possible chance to get and stay healthy

• Reducing social disorder (property crime, loitering in inappropriate places, etc…) in our community

• Eliminating the need for people to wander the streets, store property outside, and find a place to stay warm or use the washroom

• Giving police more time to address criminal issues in our community by spending less time dealing with non-criminal complaints associated with homelessness. Giving criminals in our community less access to non-criminal vulnerable residents, and less ability to hide within the non-criminal population of folks without homes.

• Saving taxpayers money by reducing City resources spent on responding to complaints and cleaning up public places, and reducing the amount of money other levels of government spend on the medical and justice systems

I know that there are many different views on how exactly to address homelessness. But the vast majority of people share these priorities.

These are also priorities are also shared by Council.

To make significant progress on homelessness, Council has authorized the formation of a Community Care Campus. This would not be a place for anyone experiencing homelessness to go. Instead, it would be a place for those who have demonstrated a desire and commitment for getting healthy. It wouldn’t just be a place to live with minimal expectations. It would also include support, medical care, and wellness programs that residents would be required to participate in, and community standards they would be expected to follow.

ON THIS PAGE

Following is more information about the proposed Coordinated Care Campus and Supportive Housing.

An important note: this is my personal page, not an official Council or City page. On this page, I am only speaking for myself. So any mistakes or personal opinions belong to me and me alone. I strongly encourage you to checkout the official information that has been posted about the Coordinated Care Campus here. You can also watch the previous Council discussion here.

I’ve put a lot of information on this page. If you want to read about something specific, you can do so using the following links:

WHAT IS HAPPENING

BACKGROUND INFORMATION

• What is NOT being developed: Emergency Shelter

• What is NOT being developed: Supervised Consumption Site

• What is being developed: Supportive Housing

• A look at the Parkside Inn

• Current spending on homelessness

COORDINATED CARE CAMPUS SPECIFICS

• Physical Build

• Operating Budget

• Per-person breakdown of Operating Budget

• Capital Budget

• Comparing to built-new costs

MORE ABOUT SUPPORTIVE HOUSING

• Why Supportive Housing is needed

• Concerns I often hear

• Data from other communities

The City has purchased the Stonebridge Hotel to convert it into a Supportive Housing development. This will be a place for people who are chronically homeless but are committed and making progress towards health. Onsite there will be counselling, jobs programs, positive social opportunities, and medical care. There will also be 24/7 staff supervision and security.

The City borrowed money to make this project happen. The debt service on this loan as well as operational costs for the Campus will be primarily paid through rent collected in the building, and by re-allocating money that is already being spent in Emergency Shelter and other homelessness initiatives. $25,000/person/year is being spent by the City on those other initiatives: that does not include direct spending by other level of governments, or indirect spending by the City (increased need for RCMP, parks cleanups, etc…). The Coordinated Care Campus will cost $18,500/person/year.

Enforcement Services and Community Social Development will be moving into this building. This will allow the buildings they are currently occupying to be sold or turned into different community uses.

The Coordinated Care Campus will have 120 Supportive Housing units. However, they will not all be occupied to start. At first, during Phase 1 of this project, only people currently living at the Parkside Inn will be moved to the Coordinated Care Campus. The City will move them in, monitor how it is going, and make any necessary changes before moving more people in during Phase 2. There will be another pause and adjustment period before the building is potentially filled as part of Phase 3.

Two Advisory Committees will be formed: one made up of residents and businesses in the neighbourhood, and one made up of people living in the building. These Committees will be used to identify what changes need to be made as the Coordinated Care Campus comes online.

Council will be receiving quarterly, public reports on the Campus. These reports will include significant items of discussion brought up by the Advisory Committees and RCMP statistics for the surrounding neighbourhood.

It is important to note that there is no proposal for an Emergency Shelter to be placed on the Coordinated Care Campus.

An Emergency Shelter is a place like Rotary House. Emergency Shelter is NOT a long-term place for people to be. It is just a place for them to keep warm overnight. Some important elements of Emergency Shelter:

• There is no cost to use Emergency Shelter

• There is a high turnover over of people using Emergency Shelter.

• Very limited possessions are allowed to be brought in. This leads to many possessions being stored nearby, hidden on public or private land.

• People are kicked out early in the morning. This often leads to them spending much of their day wandering the community.

• There are minimal behaviour expectations and qualifications for someone to use Emergency Shelter. This includes no expectations in regards to what they do off of Shelter property.

• While an Emergency Shelter works to refer people to wellness services, it does not offer many services on site.

• Most people in Emergency Shelter sleep on a thin mat, on a concrete floor, inches away from someone else. It is noisy, uncomfortable, and hard to sleep in. Those who rely on Emergency Shelter are often sleep deprived, limiting their ability to get healthy and have positive interactions with others.

Some have suggested that this will be a Supervised Consumption Site. That is not true.

What is usually meant by a Supervised Consumption Site (SCS):

• Anyone can come and use it.

• There is no cost to use it.

• Use is done in a common area.

• There are very minimal behaviour expectations within the site and none for in the surrounding area

• After clients use and are stabilized they are kicked out (so they need to come back and forth every time they use, generating a lot of foot traffic)

• Clients use whatever substance they want

• Clients don't have to have any plan to get healthy to access services at an SCS

Here is more information on SCSs in Alberta.

Grande Prairie currently has a SCS in the Rotary House parking lot. It is NOT under City jurisdiction and doesn't receive City funding, so I don't have full knowledge about it. But my understanding is that the province is currently working to move it inside Rotary House. I have not heard any talk about moving it elsewhere or opening a second one.

Unlike Rotary House, the City will have full control over the Coordinated Care Campus. There has been no discussion about allowing an SCS to be in it. If there was, I have troubles imagining that getting Council (or my) support.

However, there will likely be some substance use permitted in the Coordinated Care Campus. For example: Suboxone and other Opioid Agonist therapies are crucial to helping people struggling with opioid addiction get healthy. A key part of the proposal is to have these substances available and administered by medical practitioners.

There is still a lot of conversation (with the province, researchers, and medical professionals) about the approach to other substances. However, what happens in the Coordinated Care Campus will not be like what happens in a Supervised Consumption Site. Following are some key differences.

Emergency Shelter is NOT what is being developed on the Coordinated Care Campus. Instead, what is being developed is a type of Supportive Housing. It is more similar to what is seen at Rising Above than at Rotary House.

Supportive Housing isn’t just a place for people to just be overnight. It is a permanent place for them to live. It also has both security and support staff (social workers, counselors, nurses, therapists, etc…) on-site 24/7.

Some important elements of Supportive Housing:

• Tenants pay rent.

• There isn’t a high turnover of residents. This means staff have more opportunity to build rapport and will recognize clients in the community.

• People have a unit to store their possessions in: there is no need to hide possessions off-site and wonder the community to access them.

• Residents have both private and common area spaces to be. Food and other services are provided onsite. This means that they only have to leave Campus for work or things like medical appointments. They are not turned out to wonder the community every morning.

• Residents go through a qualification process to get in. This process requires them to show a commitment to meaningful change, and to set and pursue goals relating to wellness and independence.

• There are a number of expectations of residents, including the need to take part in wellness programs and not be a disruption to the surrounding community. Residents will be removed from Supportive Housing if they do not meet these expectations.

• Employment training, health care, positive social programs, and other supports are provided onsite to help people get and stay healthier.

• Residents have a comfortable and private place to actually get a good nights’ sleep. We are all healthier and nicer people when we can sleep well.

Alongside Supportive Housing, several City departments will be moved onto the Coordinated Care Campus. This will allow for the space to be fully utilized, and for there to be more City involvement into and eyes on what is going on.

As we look at new options for Supportive Housing, it is worth looking at the Parkside Inn.

In 2018, the Parkside Inn was a property creating significant problems. It was housing a lot of very vulnerable people with no supervision or support, and also a lot of very criminal people. It was a dangerous situation for the people living in it and for the surrounding neighbourhood. In response, the City took over operations of the property and converted into a pilot Supportive Housing project.

There were very significant learnings from the Parkside Inn. There were also very significant challenges. The biggest issues:

• Legacy Tenants: When the City transitioned it from a motel, there were already people living in it who do not belong in a Supportive Housing project. However, due to Residential Tenancy Act legal protections these people enjoyed, it took a long time for them to be removed. The project improved greatly once it only had program-placed residents in it.

• Site Layout: There is no indoor staff presence that residents need to pass by to get in/out of their units, no space for wellness and social programs, and easy access to the property from the street.

Despite these challenges, there were some successes at the Parkside. 63 residents have been in it since 2019 and 23 have obtained at least 6 months of housing stability. RCMP calls to the property and neighbourhood also decreased significantly:

Someone living on the street costs taxpayers A LOT of money.

Right now, the City spends and administers a huge amount of money on homelessness. About $5,000,000 on direct programs such as Emergency Shelters and street outreach teams.

With about 200 people living on our streets, this works out to $25,000/person/year.

Rotary House also receives about $1,500,000 in direct funding from the province. This drives the total cost being spent by government on direct homelessness initiatives to $32,500/year.

And the actual cost of homelessness is much higher. Some examples of funding NOT accounted for in the above numbers:

• Any homelessness funding given by senior levels of government directly to other organisations in our community

• The cost of RCMP, fire, and ambulance dispatches to complaints associated with homelessness

• The cost of emergency medical care given to people who end up in the hospital due to living rough

• The cost to the City Parks department to cleanup encampments

Our current approach to homelessness is very, very expensive.

The Coordinated Care Campus will have 120 client rooms. There will be three floors, each with residents who have different types of needs. Each floor will have dedicated social work and support staff, and residents will be unable to access floors they do not live on. There will also be both indoor and outdoor common areas to deliver medical care, run wellness programs, offer social programs, and feed people. There will be no regular need for residents to leave the site unless they had a job they were going to: everything needed for them to live and get healthier will be on the Coordinated Care Campus.

The Coordinated Care Campus has more commercial space than is needed for the Supportive Housing program that will be in it. Enforcement Services and Community Social Development (CSD) will move into this excess space. The current buildings housing these departments will be sold by the City, or re-purposed for other uses. This will allow the City to save money on operations, and make sure that Enforcement Services and CSD are onsite to provide help to the Supportive Housing if needed. It will also mean that City staff are the employees primarily exposed to any problems in the neighbourhood (and having unionized staff onsite will provide a strong accountability mechanism for City management to correct those problems!).

Social agencies may also rent some commercial space. However, this would just be an office space for them. They would not be bringing street engaged clients to the site. Services on the Coordinated Care Campus would just be for residents of the building, not for anyone dealing with homelessness to walk up and access.

An external engineering firm (Stephenson Engineering) was used to do a Building Condition Assessment. This is used to identify physical problems with the building, anticipate future capital projects needed, and develop capital and operating budgets for the building. It found that the building has an estimated 43 years of estimated remaining life.

As part of the proposal, some renovations are needed. Internal renovations include installing sprinklers and converting current commercial space into office space. External renovations include fencing and converting part of the parking lot to green space. You can see the planned external site plan here:

The proposed capital budget for the Coordinated Care Campus is $15,500,000 including renovations. The proposal is to finance this through borrowing, with repayments built into the project’s operating budget.

An external accounting firm was hired to help create the Operating Budget and be sure it is aligned with operating budgets from similar facilities in other communities.

The proposed operating budget, including debt repayment, is $3,200,000. However, the only “new” ask from City of Grande Prairie taxpayers is $170,000. This is because the proposed budget has significant revenue.

Residents of this facility will pay rent of $700 in 2022 (rents would increase annually with inflation). Assuming a 10% vacancy rate, this would generate $910,000/year in revenue.

Money this is currently being spent to operate Enforcement Services and Community Social Development offices will go towards the operations of the Coordinated Care Campus. Additionally, any agencies using office space will pay rent. This will generate $330,000.

Most significantly: the City already spends huge amounts of money on Emergency Shelter and homelessness outreach programs. This is primarily federal and provincial funding which is not allowed to be used on anything other than homelessness initiatives. With 120 people no longer living on our streets, $1,800,000 worth of this funding will be transferred to the Coordinated Care Campus.

This will require just $170,000 more than is being spent now to be paid to operate the Coordinated Care Campus. Here is what the budget looks like:

Two important notes about the operating budget:

• Homelessness consumes a HUGE amount of resources in our RCMP, Enforcement Services, Fire, Parks, and other departments. Getting 120 people off our streets will realize very significant savings within these departments. These savings are not accounted for within this budget. And to give a bit of context: the “new” ask of $171,000 is roughly equivalent to the cost of a single RCMP Member. And at any given time, we have about 100 Members in our detachment. So this budget would pay for itself if it eliminates just 1% of the work our police. From talking to our Detachment Commander: he anticipates it saving a lot more work than just 1%.

• The above budget assumes no participation from the provincial and federal governments. However, both senior levels of government are taxing our residents to pay for this type of project across Canada and Alberta. We’re working to get them to invest in a project in our community. If they do, there could be now “new” ask from City taxpayers beyond what they would already be paying to the provincial or federal governments. If our residents will be paying for Supportive Housing projects no matter what, it would be good to see some of that money spent in our community.

There are a lot of studies on the costs to taxpayers of chronic homelessness. From the one I’ve found, low end costs are typically found to be around $50,000/person/year. Some have found costs of over $120,000/person/year. Here is a good survey of research papers on this topic.

As I wrote above, City funding on homelessness initiatives and provincial funding to Rotary House account for $32,500/year. There is additional direct government funding given to other organisations for direct homelessness serving initiatives. And a lot of costs to RCMP, fire, ambulance, parks, emergency medical care, and other government departments.

With these numbers in mind, it is worth looking at per person costs of the proposed Coordinated Care Campus.

Some per person costs I’ve calculated:

• Total Cost per resident: $28,960/year. However, this includes the cost of having offices for Enforcement Services and Community Social Development on-site. The City incurs expenses for those department spaces regardless of where they are.

• Total cost per resident, excluding costs to host City departments: $26,905/year. However, residents of the building will also be required to pay rent.

• Total “subsidized” cost per resident, excluding rent payments and costs to host City departments: $18,505/year.

I made two assumptions in those calculations: 1) that the proposed budget is accurate (I’ve still got a lot of questions about what it includes), 2) that the facility runs at a 10% vacancy rate so only has 108 residents.

Finally, it is worth noting that the City is already spending a lot of money on the folks who would be in any Supportive Housing development that gets built. Most of the subsidized money for this facility would come from this existing funding.

The total proposed Capital Budget for this facility is $15,500,000.

Most of this is a $12,500,000 purchase price. An independent appraisal conducted by Cushman & Wakefield found the property to be currently worth $14,300,000.

$3,000,000 is also allocated towards renovations. Renovations include operational changes (ie: converting space into offices for Enforcement Services and Community Social Development), safety upgrades (ie: adding a sprinkler system), and external work (ie: landscaping and fencing). An external engineering firm was hired to do a Building Condition Assessment to make sure there are no major deficiencies to address.

This $15,500,000 price tag includes the building and land. It also includes most furnishings and accessories needed to operate the building: beds, sheets, towels, plates, cutlery, desks, chairs, tables, etc…

Not included in this capital budget: if the Coordinated Care Campus goes forward, the City would no longer need the City on 99th and Old Firehall buildings. These could be sold to recoup a large portion of the Coordinated Care Campus’ capital investment.

There are some who suggest that Council should find a place to build a new facility rather than re-purpose an existing building. And there are some good reasons to support this. However, it is also important to recognize the cost that comes with building new.

There are two other projects worth comparing the Coordinated Care Campus capital budget to:

• Potential New Grande Prairie Build: on July 6, a private developer presented a Council Committee with estimated prices to build a brand new Supportive Housing building in Grande Prairie. This budget did not include land, completed common areas to run programs in, or the cost of furnishings and accessories.

• Lethbridge Project: Lethbridge is currently pursuing a new 42 unit Supportive Housing project that has secured provincial funding.

Both of these projects have a higher per-unit cost than the Coordinated Care Campus, while having less included in the costs. Here is how they stack up:

Grande Prairie has the highest per capita rate of homelessness in Alberta. The vast majority of folks without homes are dealing with medical and mental health issues. And a majority are indigenous people dealing with the fallout of Residential Schools in their personal lives and families.

With the proper opportunity, a lot of the people living on our streets are both interested in and capable of getting into a home, integrating well with our community, and getting healthy. But too often, people with mental health and addictions issues end up living in emergency shelters or living rough on the street. This leaves them chronically sleep deprived, constantly stressed about the safety of themselves or their possessions, with little dignity, hard for social workers to find, often hungry, and easily accessible to people who will victimize them or encourage them to make poor choices. It is no wonder that they struggle to get healthy.

If we expect people to get healthy, they need to have a safe place to sleep, store their possessions, use the washroom, and eat. They need to be able to choose to spend their time away from others who may harm them or be bad influences. And they need to have positive social interactions with other humans. Without all of these things, there are very few of us who could remain mentally healthy. So it isn’t reasonable to expect someone dealing with mental health issues to heal without them.

It also isn’t reasonable to expect someone to not be wandering our streets if they have to sleep in one place, store their possessions in another, get social interaction in another, eat in another, and access services in multiple other places.

However, Supportive Housing isn’t just about a living space. It also provides on-site health and social services to help, monitor, encourage residents and to hold them accountable for their behaviours. This on-site care gives them the best possible chance of staying housed and getting healthy.

Supportive Housing is needed to get people stabilized and on a path to wellness. Getting people into Supportive Housing also means that they spend far less time on our streets. And by helping people get to a healthy place, it decreases the use of expensive resources such as emergency police, fire, and ambulance response.

Supportive Housing isn’t just needed for the people within it. It is also needed to decrease social disorder in our community, and to decrease the money taxpayers spend on emergency response.

Whenever we talk about Supportive Housing, there are a number of concerns I hear. Here’s my thinking in regards to the most common concerns I receive:

• “There are already too many people wandering our streets.” People who are living rough will spend less time out in the community if they are transitioned into Supportive Housing. We often have people wandering our neighbourhoods because they have nowhere else to be, and because they have to go different places to sleep, eat, socialize, and access various services such as counselling or medical treatment. Giving them a place to be 24/7 and delivering services they need on-site will lead to them spending a lot less time walking through communities. The monitoring on-site will also help make sure people aren’t acquiring possessions that aren’t theirs. And possible eviction is a new accountability tool available to address any misbehavior that might happen in the neighbourhood.

• “These people need accountability, not hand outs.” People in supportive housing pay rent: unlike shelter space, they don’t get it for free. And there is next to nothing the City can do to hold people accountable to anything when they are living rough. Our police are limited by federal and provincial legislation and courts, and those provide little to no tools to hold someone accountable when they are living on the streets. However, to be in supportive housing, people have to sign and get held to a housing agreement. And the relationships they build with staff on-site is the best way to hold them accountable to working towards sobriety and health.

• “These projects will just draw more street engaged people to our community.” Late last year, the Mobile Outreach Program (MOP) was established. One of its main tasks: helping people from other communities get home rather than becoming part of Grande Prairie’s systems. Supportive Housing is to address needs that are already in our community, not to draw people to Grande Prairie. Supportive housing requires rent to be paid and a housing agreement to be adhered to. It won’t attract people to our community who are just looking for a free place to be with no steps towards getting healthy. Additionally, most people who are street engaged in our city are long-time residents of our community. In 2019, we had “Tent City” pop up, and City staff surveyed everyone living in it: over 90% of the people in it were longtime residents of our area.

• “People living on our streets don’t want to get better.” This is true of some people. And Supportive Housing isn’t for them. They will continue to use Emergency Shelter, not get moved into Supportive Housing. However, there are people living on our streets who want to get better and are capable of change. Getting them away from those who are not interested in change is important- it’s hard to make healthy choices when constantly surrounded by people making unhealthy choices.

• “We shouldn’t be encouraging drug use.” Supportive Housing doesn’t encourage drug use. Quite the opposite. There is no “Safe Consumption Site” elements of these projects, and public intoxication has consequences under the housing agreements. One of the big goals of it is to get people mentally healthy and sober by making them physically safe, giving them proper sleep, and engaging them with on-site health and social workers.

• “We should just incarcerate, institutionalize, or banish these people.” The City does encourage and help people from elsewhere to get back home. However, it has no legal ability to prohibit someone from being in Grande Prairie, nor to incarcerate or institutionalize people, even if it wanted to.

• "There are better priorities for tax dollars.” Saving taxpayers dollars is a priority for me. Which is one reason Supportive Housing is needed. We spend a HUGE amount on homelessness. The City spends money on having RCMP, Bylaw, and Fire responding to emergencies and complaints generated by people living rough, having Parks and Bylaw cleanup encampments, and funding emergency shelters. Our community also loses money as social disorder drives investment (and therefore tax revenue) from our core. Homelessness also costs the province a lot of money in terms of medical and justice resources. Someone living without a home costs taxpayers a lot of money. Getting them into supportive housing is less expensive in the short term, and WAY less expensive in the long-term when it succeeds in getting someone healthy enough to live and work independently.

• "You should use X building or Y property instead.” Often people highlight a specific building or piece of property Supportive Housing should be built on. Usually, the property brought up in this conversation has already been considered by the City and found to be not practical for Supportive Housing.

• “You should build this beside Rotary House.” Rotary House is an Emergency Shelter, which is very different from Supportive Housing. There are people in Emergency Shelter with no current desire to move towards health and out of homelessness, where as Supportive Housing is for people showing commitment to meaningful change. I don’t think we help people looking to move out of homelessness when we have them continue to live next to Emergency Shelter, especially if they know a lot of people still residing in Shelter.

• “You should build this way out in the country or in an industrial area.” These settings can be very good places for things like treatment or recovery programs, where people are staying short term to get intensive help. However, the idea of Supportive Housing is to give people a medium-term or permanent place to live so that they can find recovery and build a life. If we want people to be healthy and as independent as possible in the long-term, they need access to things like jobs, shopping, and transit. An industrial area isn’t a good place for anyone to live long-term, and the country isn’t a good place for someone without transportation to live permanently. I’d also highlight that the majority of folks without homes are indigenous people living with the fallout of Residential Schools. I don’t see how an appropriate response to residential schools is to take those most profoundly impacted and force them to live in an institution well outside the City.

As I have thought about Supportive Housing in Grande Prairie, I’ve spent a lot of time learning about it in other communities. This includes site visits to different projects across Canada. I’ve also spent time looking for all the data I can get about Supportive Housing elsewhere. Of particular note is information about impacts it has on surrounding communities. Here are a few interesting reports worth examining:

• Property Values Case Study Series: the impact of social housing on surrounding property values in BC was examined. 13 case studies were used. In 11 of them, property values went up while in 2 property values decreased. 10/13 saw property values around social housing either mirror or grow faster than property values across the municipality.

• Analysis of Non-Market Housing, Crime, and Social-Disorder: the impact of non-market housing on crime and disorder in Edmonton was examined. 5 different neighbourhoods were studied. Despite making up 12% of housing in these neighbourhoods, Non-Market Units were only responsible or 4.2% of police events and 1.3% of Bylaw calls.

• The Real Costs of Homelessness: there are many studies about the costs of homelessness. Leaving people to live on the streets is the most expensive approach taxpayers can take. It has huge direct costs in terms of emergency shelter, emergency medical care, police response, and cleaning up of parks. It also has huge indirect costs to taxpayers as it drives investment away from certain parts of a community. This paper is a good summary of many of the studies on the cost of homelessness.

• The Efficacy of Supportive Housing: there are a lot of studies on Supportive Housing. Every single one I have seen shows that people with mental health issues and no stable housing show improvement when given a place to live as well as mental health support. This is just one of many studies on Supportive Housing that I could’ve linked to.

I’d also love to hear from you directly. Let me know if you have any questions, thoughts, or ideas.

To see the latest about what is being discussed at Council, you can follow me on Facebook. You can also give me a call at 780-402-4166 or email me at dbressey@cityofgp.com.

Thanks for taking the time to read this page!

-Dylan