A Plan to Eradicate Homelessness
The homeless—those we see each day and others living invisible lives—can succumb to bodily insults both terrible and terribly expensive, and the rest of us foot the bill unwittingly.
The costly embarrassment of urban homelessness can come to a screeching halt by moving the homeless into simple concrete houses in specially built villages on inexpensive rural land, according to Vipin Kalia, MD (www.solvehomelessness.blogspot.com).
He explains that a street person is prone to a “$1 Million Homeless Man” phenomenon, in which something like a frozen toe can lead to a hospitalization and a $10,000 to $25,000 medical bill (that’s the first one society pays for).
After the poor soul is put back on the street, if the tissues don’t heal, maggots can find their way into the wounds. The homeless man is brought back in to have the wounds treated and for further removal of dead tissue (debridement).
This cycle of frozen toes and body parts, poor healing, and eviction from homeless shelters/nursing homes leads to more debridement, and a higher level of amputation is repeated dozens of times. “Creeping amputation” becomes a way of life for the man, with him losing more and more of his limbs.
Society didn’t provide bare-minimum housing, so he ends up in a nursing home with a social cost of $60–100K per year, and over several years, this can easily add up to $1 million.
Inexpensive, consolidated housing is the key to reducing these costs and setting the maximum number of indigent people on the road to self-sufficiency.
Dr. Kalia, a graduate of Indiana University School of Medicine, has been pondering for years how to prevent the worst cases he sees in his medical practice at Indianapolis Wishard Memorial (county) Hospital and Indianapolis VA (federal) Hospital.
“After a while, one realizes that nobody has thought this problem through comprehensively. It is not because of lack of brainpower,” Dr. Kalia says.
He points out that there are more educated people with MDs, PhDs, masters, MBAs, and other advanced college degrees in five square miles of the city than in many entire third-world countries. In the same way, the wealth in five square miles of downtown Indianapolis (as in central business districts of all major cities) exceeds the GDPs of many third-world countries.
He proposes the creation of villages on the outskirts of town in which concrete houses, eight feet by sixteen feet, would house the inner city’s most unfortunate.
“With simple amenities in each house and a building with common dining, all homeless people could be assured of ‘three hots and a cot’ without having to be in jail,” he states.
Existing organizations that help the homeless, such as downtown Indianapolis’s venerable Wheeler Mission, could bring their services to the destitute.
Because the homeless don’t have cars, they lack the ability to get themselves around from one service or medical organization to another. If all the organizations could come to them, rather than the other way around, their care would be ensured.
Work opportunities for residents could be created both on- and off-site, with jobs requiring no special skills or even a required arrival time. Unlike conventional programs, the residents would have no mandatory schedule or attendance at meetings or religious services.
Those wanting to better themselves would have ample opportunities, and all others would at least be kept out of the weather. Everyone would be free to live as he or she pleased, so long as no laws were broken.
Dr. Kalia estimates that total costs of building homes (about $4400 each) and required infrastructure, along with staffing fees, would be about $38 million.
Critics might balk at this sum of money, but he reminds them that concrete houses could last 100 years, and that the $1 Million Homeless Man scenario avoided 38 times out of 1000 inhabitants (about 4% of village inhabitants) over 10 years would pay for the whole program.
Homelessness has always had a basic irreducibility. Despite the efforts of countless service organizations, the numbers of homeless people can be brought only so low.
Accepting this fact of life and the expenses to society that go along with it, a more innovative way of handling the problem makes fiscal sense.
Marion County has a sizeable homeless problem, estimated to be 4400 to 7300 people without a home at least once during a year. Dr. Kalia points out that approximately 25% of the homeless are veterans who have served their country.
About 900 beds in Indianapolis provide a night of relief, scattered across 50–100 charitable groups, broken down by ethnic and denominational subgroupings. Apart from direct medical costs, the inefficient operation of these separate programs also bears a significant cost, again ultimately paid by everyone.
Though the work performed by these charities is extremely demanding and often heroic, many homeless people choose not to participate. Reasons for preferring taking one’s chances on the street, and thus multiplying the likelihood of serious illness or death, include safety, possible theft of personal belongings, and health hazards.
Some might wonder about the safety of persons in such a village. The plan calls for both security teams and for solid metal doors and barred windows for each of the houses.
Houses would be arranged in clusters of sixty-four, with each cluster segregated from the rest on the basis of male/female, single or family, criminal tendencies, behavioral characteristics, and known psychiatric disorders.
Labor to build the villages would initially be outsourced, but eventually those living in the villages with prior building skills could be given the opportunity to build the houses and other buildings themselves.
By the same token, inhabitants willing to work would be charged $50–100/month, to help support the program. Those who make nothing could stay for free, however they would not be provided TV or Internet privileges.
Everyone wanting outside work could get transportation to the nearest bus route. Because detrimental behavior can be a recurrent issue for homeless people who get jobs, voluntary escrow accounts could hold their money for a five-year buffer, released in small increments to cover costs of a basic regular life as they prove their stability.
Dr. Kalia offers up a final request for help, “This is a big and perhaps shocking idea to some, but anyone who wants to collaborate and end homelessness now can call me at (317) 414-4439. If we don’t try, nothing will change.” More information on this project is available at www.solvehomelessness.blogspot.com.
proposal coauthors:
Vipin Kalia, MD, has a BA in chemistry from Purdue University and studied medicine at Indiana University School of Medicine. He did his post-graduate training in internal medicine at Indiana University Medical Center at Indianapolis. He is assistant professor of medicine at Indiana University and general internist at the VA Hospital in Indianapolis.
Paul Wilson, MBA, has a BS in liberal arts from Excelsior College. His graduate degree is from Indiana University Kelley School of Business. He is a writer and editor in Indianapolis, specializing in public policy and health care.
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