Tom Sullivan / Herald
"I had a much gentler form of homelessness than any of the street people," said Carl Freese. "I was never ... out sleeping on concrete sheets."
Carl Freese lives in a small, white house with a red door. He sits inside on a weathered leather chair with his legs crossed, his wrists hanging over the armrests. He is aware of his body's frailty. Behind him, a map of the world looks over a table covered with little orange prescription bottles.
Freese's phone rings. He listens for a few seconds, chuckles and hangs up. "How exciting! I won a free cruise to the Bahamas!"
Freese has quite a bit of experience with cruise ships. After studying music at the University of Rhode Island, he worked on the Queen Elizabeth II for 11 years, traveling through the Caribbean, South America, Hawaii and Tahiti. He quickly moved up to become the cruise director, one of the ship's five senior officers.
Tom Sullivan / Herald
After 11 years travelling the Caribbean, South America and Hawaii as an entertainer and cruise director, Freese accumulated a variety of items with strong sentimental value. Despite having to sell his home, Freese was able to keep various mementos.
"I thought, at the time, I had enough money stacked away to be able to do whatever I wanted to do."
Freese had a large savings account, a down payment ready for a house and a 12-month emergency fund.
He returned home to Rhode Island and began managing jewelry stores in southeastern New England. In 2002, doctors found that he was going through congestive heart failure and needed a transplant. "I remember them coming at me with the cardiac paddles and thinking, 'Oh, this is probably not good,'" Freese says.
By 2005, Freese was selling furniture to pay for his medical care. "Do I buy groceries, or do I buy the pharmaceuticals I need?" he recalls thinking. Freese soon lost his apartment.
For Rhode Island's homeless population, 2012 was a tumultous year. The state's first housing program, the Neighborhood Opportunities Program, and stimulus money from the Obama administration both expired.
But activists succeeded in passing the Homeless Bill of Rights, which calls for increased attention to equal treatment for the homeless, and the Housing Resources Commission adopted "Opening Doors Rhode Island: A Strategic Plan to Prevent and End Homelessness."
In 2013, Rhode Island saw a 9 percent drop in the number of homeless people, from 4,868 to 4,447 people.
When it comes to managing homelessness, there are essentially two major players: the service providers and the homeless. From the perspective of a service provider, it is most efficient to group people with the same problems together. But homeless people are not thinking about which category they fall into. They're thinking about where they're going to sleep each night.
The current infrastructure categorizes the homeless as following one of three main routes.
Service providers may divert them from shelters completely, prompting them to find refuge on a friend's couch or in a spare room while searching for permanent housing. Some may be offered a short stay in a shelter before developing a long-term solution. And others could need more extensive services before being able to settle into long-term housing.
Freese followed the first path. He started out couch-surfing at the homes of friends, family members and members of his church. "I had a much gentler form of homelessness than any of the street people," Freese says. "I was never ... out sleeping on concrete sheets."
Couch-surfing works for only so long, says Irene Glasser, a research associate who teaches ANTH 1301: "Anthropology of Homelessness." Family members or friends who rent apartments usually cannot accommodate a visitor for more than 30 days.
One night more than a decade ago, John Freitas and Barbara Kalil had no place to stay.
"Up until we put our stuff in a friend's car we thought something was going to happen — her unemployment check was going to come in, someone was going to help us," Freitas says. "There's a million reasons why people become homeless, but there's a general theme: They didn't plan on it. They didn't think it would happen. And it wasn't real until it happened to them."
"If you're lucky, you'll land in a city that has shelters. We did. We ended up in Providence."
Freitas' friend took them to a shelter called Travelers Aid, which was renamed Crossroads 10 years ago. "We brought toasters, coffee pots. We had about eight bags on the sidewalk," Freitas says.
The staff at Travelers Aid told them to catch the "Goose," a bus that would take them to Cranston, where they could stay.
Tom Sullivan / Herald
Crossroads, a homeless shelter and service provider, is located in Providence's former YMCA building, where it moved 10 years ago.
Freitas spent the night at a men's shelter, while Kalil had to check into a women's shelter.
"It was scary, even for me. ... These are the first homeless people I've ever talked to," Freitas says, "and all the things I'd seen in the movies ... are running through my head.
"I'm sleeping with one eye open, ... and I'm worried about Barbara down the street."
Crossroads is Rhode Island's largest provider of services to homeless individuals and families, according to Karen Santilli, chief marketing and strategy officer at Crossroads. The former Young Men's Christian Association building, a tall brick building that towers over Broad Street, was renovated when the organization moved in 10 years ago.
Walking through the front doors, the smell of disinfectant is strong, and the decor is simple and clean.
The Crossroads mission is to "secure stable housing for homeless and at-risk individuals and families" through emergency services, case management, education and employment services and an emergency shelter.
Entering into a shelter like Crossroads prompts a number of assessments. Most attempting to enter a shelter will first call 211, a hotline intended to be a "one-stop service for vital information" started by the Atlanta United Way in 1997, according to 211us.org.
Though 211's original purpose was to provide information about food banks, shelters, physical and mental health resources and employment support, the hotline has also become a burden for many people hoping to enter shelters.
Sometimes, homeless people cannot get into a shelter unless they have already called into 211, Freitas says.
One night, years after he first arrived at a homeless shelter, Freitas was doing the "HUD count," counting homeless people on the streets or in shelters for the Department of Housing and Urban Development. He met a homeless family with a 2-year-old son and a 7-month-old baby. "They went to a shelter and were told, 'You're not on the list. Go out. Call 211. Get on the 211 list. Do the intake, then come in and we'll try and help you.'"
Freitas spent the night trying to get them into a shelter but was unsuccessful, ultimately letting the family into the ATM lobby at Kennedy Plaza, where they spent the night.
"How do you do that? How do you tell a family that's standing right in front of you, 'You have to go out and call 211 and register with them'?" Freitas remembers. "And they're standing at your desk, you've got a space at your shelter, you can't take 'em in."
Santilli says she has heard stories of shelters holding spots for families in the community who were not registered with 211 but whom the shelter believed needed a space. But these shelters then denied beds to Providence families registered with 211 that were previously told the shelter had open beds.
"There were some struggles when this system first started," Santilli says, adding that the Crossroads Family Shelter manager met with 211 and state officials when it was first launched in Rhode Island.
Those who end up in a shelter will likely encounter the Homeless Management Information System — an online electronic database established in 2004 when Congress directed HUD to start gathering homelessness data.
"The reality is that we are working with human beings who are in crisis," Santilli says. Before being able to provide services, case managers have to input required information into the HMIS. "You have to prove that you're homeless. How do you prove that you're homeless? How do you prove a negative?" Santilli says. "They just want to take a shower or do their laundry."
The HMIS collects universal data elements, including name, social security number, date of birth, race, ethnicity, gender, veteran status, disabling condition, residence prior to program entry and housing status. Emergency shelters collect additional data related to income sources and chronic health conditions such as HIV/AIDS, mental illnesses and substance abuse, information that many people are hesitant to share.
Data is also collected for eligibility in other types of housing, such as permanent supportive housing, transitional housing or motels paid for by vouchers.
"We're one of the best states in the country at collecting data about the homeless," says Jim Ryczek, executive director of the Rhode Island Coalition for the Homeless.
But while data collection makes sense in theory, it creates obstacles in practice for both well-intentioned service providers and the homeless themselves.
HUD won't fund people without the HMIS, wrote Eric Hirsch, a professor at Providence College who evaluates housing programs, in an email to The Herald. And the data sets are used to assess the efficacy of different programs, funnelling more funding toward programs identified as effective by its standards, Hirsch wrote.
Shelters and service providers also have their own ways of deciding what the homeless need. Crossroads uses the Service Prioritization Decision Assessment Tool, which gives a score based on the acuity of the homeless individual's or family's needs, Santilli explains: the higher the perceived need, the higher the score.
"We have another series of tools that assess their employability," she adds.
Amos House, another service provider, does an initial intake assessment of mental health to help determine whether the center can accommodate individuals or whether it should refer them elsewhere.
"When an individual or family is homeless, and they come to Crossroads seeking help, we will connect them with a case advocate that will start working with them right away," Santilli says.
Tom Sullivan / Herald
Clockwise from left: The family room at Crossroads includes an area where the children can play house. Anthony Wright is a case manager at Crossroads, where he connects homeless individuals with the resources they need. Eric Oliveras, front desk supervisor at Crossroads, processes paperwork for client intake.
The case management component of shelters is a more recent development, Freitas says. "That happens today because of the advocacy work and because of the bitchin' we did back then."
The case workers aim to connect the homeless individual or family with necessary resources, either within the organization or outside of it. "We can't be everything to everybody," Santilli says.
These resources include housing. But the approaches that different programs take can seem contradictory, because they have evolved in different ways.
Homelessness first became a major issue in the United States during the Great Depression. But between the 1940s and the 1980s, "there weren't too many homeless people in the U.S.," Hirsch wrote in "Understanding Homelessness in Rhode Island."
The homelessness crisis resurfaced in the 1980s when many social programs were cut due to budgetary constraints, including the revocation of the New Construction and Substantial Rehabilitation Programs in 1983. HUD created the project-based Section 8 housing program in 1968, which included previously repealed records. HUD has not approved any projects since 1983, though projects approved before 1983 are still receiving subsidies.
"We started to see some more investments in public housing" in the 1990s, Ryczek says.
The conservative culture shift that occurred in the 1980s sparked a belief that people would not engage with services that would better their lives unless they were incentivized to do so. Some believed that the homeless should not receive housing unless they were 'housing-ready.'
"It used to be that we had this idea of a continuum of care," Glasser says, which involved taking people living on the streets and placing them into temporary housing, then transitional housing and finally permanent housing.
"The dominant view was that many homeless people, particularly those who had been homeless for a long time, were not ready for an immediate move back into the community in their own permanent housing unit," Hirsch wrote. "The idea was to put homeless people into two-year programs to make them 'housing ready,' ... to become 'clean and sober.'"
These two-year programs are considered transitional housing, and are largely being phased out, as the majority have been labeled ineffective.
The '80s culture shift also resulted in a very specific stereotype associated with the homeless that still pervades today. Many people blame homelessness on homeless people themselves, Hirsch wrote. "Some have suggested that homeless people lived on the street by choice, and that many of them were former patients released from state mental institutions who had walked away from shelters," Hirsch wrote. "Others blame substance abuse and suggest that most homeless persons are alcoholics."
But this line of thought is not logical, Hirsch wrote, because most state mental institution closings occurred between 1955 and 1975, and "the trend in abuse of alcohol and illegal drugs has been down since the mid-'70s, not up." There isn't nearly as strong a correlation between these two issues and homelessness as people are led to believe, he added.
But substance abuse is still a pervasive problem in the homeless community.
"A lot of homeless people become substance abusers after they become homeless," Freitas says, "because 'homeless' and 'hopeless' are like one word."
Addiction, particularly to cigarettes, is tricky among the homeless population, Glasser says. Not only are cigarettes physically addicting, but there is also a social component to the addiction because cigarettes are frequently used to barter between homeless people.
Since the 1980s, the rise in homelessness has correlated with increasing levels of income inequality.
The Housing First program at Riverwood Mental Health Center marries housing — funded through various voucher programs, like Section 8 — and services, which are funded at Riverwood by the Substance Abuse Mental Health Services Administration, Glasser says. The Housing First model has also been adopted at House of Hope, Providence Center and Access Agency.
Housing First has been very successful, advocates say, because its tenants are given no requirements other than what a regular tenant would assume. Glasser says she has observed a pattern of behavior in which clients initially just want the apartment. "But after they don't have to worry about where to sleep every night, or where to eat every day, they say, 'Okay, what am I doing with my life?'" They then start taking advantage of the services available to them on a voluntary basis, she says.
Many of Crossroads' housing programs are based on the Housing First model. Research and program results show that once an individual or family is housed, treatment programs for issues like mental health or substance abuse are much more effective, Santilli says. Before its recent overhaul, Crossroads' mission statement was to provide essential services to homeless individuals and families. Though Crossroads still provides services, it is now more focused on "securing stable homes," Santilli says.
Amos House, on the other hand, still has a 90-day transitional program that requires clients to take a "pact of sobriety," before entering into "Phase Two," their permanent supportive housing program.
"We know that that's a big part of turning your life around," says Annie Colella, coordinator of marketing and special events at Amos House.
Tom Sullivan / Herald
Amos House, a service provider that currently maintains Rhode Island's largest soup kitchen, serves over 400 meals per day. Lines of people waiting for lunch begin to form each morning before Amos House starts serving the meal at 11 a.m.
Amos House consists of several small buildings, including an old blue house that now serves as the development offices and the social services offices, and a building that houses the soup kitchen and serves as a meeting space for the many support groups within Amos House. The organization's Phase Two housing is currently full, and Amos House is engaged in a capital campaign to convert the houses currently serving as offices and classrooms back into client housing.
Around half of Amos House's staff are graduates of the program.
"We don't look at people's pasts. If they had looked at my past, they would have never let me in this building," says Sonny Ramsey, an Amos House case manager.
Ramsey was imprisoned over 47 times by the time he was 35 before starting at Amos House. "Men listen to me because they know I've done it all," he says.
Tom Sullivan / Herald
Clockwise from bottom left: Douglas Spikes, assistant chef at the Amos House soup kitchen, prepares lunch. Nicholas Grumbach, a doctor, has volunteered at the Amos House soup kitchen for nine years, and works with some of his patients in the kitchen. Amos House has employment training programs in the culinary arts and carpentry. Eugene Burrell is in the culinary arts program, and works in the kitchen.
"Homelessness is unacceptable. It is solvable and preventable," wrote the Rhode Island Housing Resources Commission in its 2012 report.
The plan includes, among other goals, ways to retool the state's "homeless crisis response system" and increase access to affordable housing.
Tom Sullivan / Herald
Sonny Ramsey shares his name with his grandfather, whose picture he keeps in his office. "That's the name I destroyed in the streets, that's the name I rebuilt," Ramsey said. After graduating from the 90-day transitional housing program, he now works as a case manager at Amos House.
Anticipating a HUD-required overhaul of the current service provider assessment process, the report includes suggestions on how to streamline intake procedures for the homeless. The plan also suggests that case managers, outreach workers and drop-in center staff members in temporary, transitional and permanent housing receive comprehensive and consistent training.
The HRC aims to develop a system where more low-income housing is available for individuals and families across the state, with plans to create 100 permanent supportive housing units each year.
Tom Sullivan / Herald
Carl Freese takes a slew of medications to manage his heart transplant and the diabetes he now battles. He was recently hospitalized for two weeks due to a rejection episode.
Freese's church has been a huge source of strength for him throughout his struggles. Members of his church found sterile sand to create a rock garden, even though he is immunosuppressed. Freese found supportive housing through House of Hope, which allowed him to fully recover from surgery and become eligible for a new heart.
For Freese, the strong pharmaceuticals he was prescribed after an episode of double pneumonia wreaked havoc on his organs. After his cancer surgery, he needed a stable home in which he could recover from his pneumonia in order to become eligible for a new heart. Without supportive housing, Freese would not have been able to heal from the surgery enough to get the transplant, he says.
"Without subsidized housing, I still could not today afford a place of my own."
Tom Sullivan / Herald
Leah Brothers, Freese's health aide, helps with tasks that he finds difficult to perform around the house.
Freese started working with the House of Hope Community Development Corporation and got an apartment through a supportive housing program. Freese received his "new ticker" in 2008.
"People laugh at me when I say that supportive housing saved my life," he says. "But it really did."