Off the Streets

A new initiative aims to get medically vulnerable homeless people into housing

Guadalupe Cora looks around her studio apartment wide-eyed as she explains how she feels to have a bed to sleep on, a soft carpet to walk on and a refrigerator filled with food.

Cora, who has lived in her new home for just more than a week, is the first placement for 51 Homes, a Tucson initiative that's part of a national effort to house the most medically vulnerable homeless people.

Cora has lived on Tucson's streets and camps off and on for 12 years, all while living through a stroke, a debilitating accident she suffered at a temp job, and physical problems she's had since her thyroid was removed. She gets around with the help of a walker.

Cora made a fresh pot of coffee in her kitchen, and she eagerly offers coffee to everyone who walks into her new place.

"It sometimes feels strange not having to go walking everywhere, (and) not having to go to Guadalupe's," Cora says.

One of her stops always included picking up a sack lunch at the Casa Maria soup kitchen, which Cora refers to as Guadalupe's, the name Tucson homeless call the organization because of the Virgin de Guadalupe painted on the side. She'd share the sack lunches she picked up from Casa Maria and other organizations with her friends at a camp on the outskirts of Tucson.

Cora refers to those friends as "those guys," and they call her "nana," a Mexican nickname for grandmother.

"Those guys, we're like a family, more than family. We take care of each other," Cora says. "I have to get out and see them. I have been missing them. It's a lot of shame."

Cora begins crying. "Someone else should have won this. A lot of people are in worse situations than I am."

Sharon Francis, clinical supervisor for La Frontera's RAPP (Readily Accessible People Program) drop-in center, is Cora's navigator—the person who helped identify Cora as eligible for 51 Homes and who is assigned to help her "navigate" various resources.

Francis, one of about 100 volunteers who set out in 20 teams during 51 Homes' survey week, which began on April 11, tells Cora they can make plans to meet up with "those guys."

The 51 Homes volunteers canvassed targeted areas and used a vulnerability index created by New York-based Common Ground to assess which homeless are most at risk of premature death. The survey identified 186 people at risk, with 10 percent more than 60 years old; the oldest person identified is 88. Nineteen of those interviewed said they'd been homeless for more than 10 years, and one person claimed to have been homeless for more than 40 years.

W. Mark Clark, president and CEO of CODAC Behavioral Health Services and co-chair of the 51 Homes initiative, says the idea of housing the most vulnerable homeless people came from Common Ground, which started the national campaign called 100,000 Homes (

Cities asked to participate usually have more than 1,000 people identified as homeless in the annual street count. Clark says Phoenix signed on last year with a goal of housing 50 homeless. Tucson made 51 its goal—to make sure it beat Phoenix.

Other Arizona communities involved include Sierra Vista and Flagstaff.

In Tucson, there are two goals: to find homes for 51 of the most medically vulnerable homeless people, and to collect information to improve homeless services.

Clark says one example of a change to improve services involved altering a city of Tucson policy for its Section 8 housing waiting list. Every six months, the city sent out a letter to those on the waiting list, and "if you didn't respond, they'd take you off the list. If you're experiencing chronic homelessness, you don't get regular mail," Clark says. "Well, now they've changed their policy."

Another change Clark is excited about is the fact that area agencies are adopting the vulnerability index to assess clients. Clark says the Southern Arizona AIDS Foundation is now using the index for its intake process.

The index looks at specific indicators to assess medical risk: Does the client have tri-morbidity—in other words, have at least one health condition, plus a mental-health issue and a substance-abuse disorder? Hospitalized more than three times the past year? Older than 60? Have HIV/AIDS, a liver disease or cirrhosis, kidney disease or end-stage renal disease? Has the person suffered from a cold or wet-weather injury?

Clark says the city committed 27 of its housing Section 8 vouchers to 51 Homes, and the Veterans Administration committed 12 of its HUD vouchers. The Community Partnership of Southern Arizona committed 12 housing vouchers reserved for those in the public behavioral-health system.

"Our goal is to house the 51 within a year," Clark says. "51 Homes is very much a housing-first model."

Past models have been based on a homeless person's performance: Housing is a reward for working or being clean and sober for a period of time. Clark says he and other advocates learned that housing in and of itself is therapeutic.

"We know that people use less emergency services if they are housed rather than living on the streets. There are also fewer interactions with law enforcement. ... We know just by housing people and keeping them housed, their quality of life improves. We know they are going to cost the community less."

Now that Cora is in housing, she says she's interested in taking classes to get her GED, and she's interested in finding a job. Francis says she's looking into resources to help Cora achieve those goals.

Cora points to a picture of Jesus, as well as three rocks—representing the holy trinity—all sitting on top of her TV set, and explains how her faith helped during the worst times. While on the streets, she kept the rocks in a sock, which came in handy once when a man attacked her.

One of "those guys" ended up helping her chase the man off.

When asked what she wants to tell people about Tucson's homeless, Cora replies: "Mostly, don't be afraid of homeless. We are not criminals. That's how they judge us—drug addicts and thieves. ... Don't treat us like dirt."

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