The California State bill called the Homeless Bill of Rights and Fairness Act failed to make it through the Assembly's Appropriations Committee because it provided a provision for building and maintaining hygiene centers across the state. The cost was too prohibitive for the more conservative members of the committee. However, if the cost of providing primary care to the homeless through community centers is examined, the cost of the hygiene centers, when paired with primary care providers, would more than pay for the cost of building and maintaining them. This letter argues for reintroducing the bill during the next legislative session with an expanded mission of partnering the hygiene centers with primary care providers.
Homeless Rights
Assembly Member Mike Gatto
Chair, Appropriations Committee
P.O. Box 942849, Rm. 2114
Tel [HIDDEN]
Dear Assembly Member Gatto:
I was distressed to learn that the Homeless Person's Bill of Rights and Fairness bill (AB5) failed to make it through the Appropriations Committee.[footnoteRef:2] Based on my understanding the state would have incurred a substantial financial burden by requiring the construction of local hygiene centers across the state and their continued support from year to year. Provision 53.4 was estimated to cost the state close to $216 million to build the hygiene centers and another $81 to maintain annually. The minimum services that would have been offered were 24-hour access to bathroom and shower facilities. [2: Melody Gutierrez. "California Homeless Rights Bill Fails in Assembly Committee." Sacramento Bee. (24 May 2013): 1, internet, 25 Jun. 2013. Available: http://blogs.sacbee.com/capitolalertlatest/2013/05/ammianos-homeless-rights-bill-fails-in-assembly-committee.html.]
The funds for the hygiene centers would have been distributed by the State Department of Public Health to county health agencies, which means that as a public health nurse I would have been involved in implementing this program and therefore have a vested interest in the benefits this bill would have provided to the health of the community. According to a recent report by the National Alliance to End Homelessness, the homeless population in the State of California has increased from 133,129 in 2009 to 135,928 in 2011.[footnoteRef:3] This translates into about one homeless person for every 278 California residents. Of these, approximately 25% are chronically homeless, 20% are families, 63% have no shelter, and close to 14% are veterans. [3: Peter Witte, Lisa Stand, and Samantha Batko. The State of Homelessness in America 2012 (Washington, D.C.: National Alliance to End Homelessness, 2012), 56, internet, 25 Jun. 2013. Available http://www.endhomelessness.org/page/-/files/4361_file_FINAL_The_State_of_Homelessness_in_America_2012.pdf.]
However, these figures underestimate the extent of the problem, since they are based on the average prevalence at any point in time. If yearly incidence rates are used instead,[footnoteRef:4] the estimated number of Californians who experience homeless each year would be between 492,000 and 750,000, or one in 76 to one in 50 residents. This should no longer come as a surprise given recent U.S. Census Bureau estimates suggesting the actual poverty rate in California is the highest in the nation at 23.5%.[footnoteRef:5] With close to 9 million California residents living from paycheck to paycheck and the economy continuing to struggle, homelessness is inevitable for many, including the 27% under 18 years of age. [4: California Department of Finance. "E-2. California County Population Estimates and Components of Change by Year -- July 1, 2010 -- 2012. CA.gov (2012): 1, internet, 26 Jun. 2013. Available: http://www.dof.ca.gov/research/demographic/reports/estimates/e-2/.] [5: Kathleen Short. "The Research Supplemental Poverty Measure: 2011" Census.gov (2012): 32, internet, 26 Jun. 2013. Available: http://www.census.gov/prod/2012pubs/p60-244.pdf.]
With so many residents facing homelessness, it seems imperative to understand the cost of not implementing the hygiene centers through the local public health departments. When researchers examined the hospitalization rates of homeless persons in Honolulu, Hawaii, they found that hospitalizations in acute-care hospitals occurred at a rate 5.6-fold above the average for state residents.[footnoteRef:6] for psychiatric hospitals, it was 131-fold higher. The estimated cost of the excess hospitalization for the 1,751 homeless persons studied was close to $3.5 million in 1992 dollars. In 2010 dollars,[footnoteRef:7] this would amount to about $4.9 million. Based on a homeless population of 136,000 to 750,000 for the State of California, the excess medical costs associated with homelessness could be somewhere between $381 million and $2.1 billion dollars per year. [6: Jon V. Martell et al., "Hospitalization in an Urban Homeless Population: The Honolulu Urban Homeless Project." Annals of Internal Medicine 116.4 (1992): 299.] [7: U.S. Census Bureau. "Table 142. Consumer Price Indexes of Medical Care Prices: 1980 to 2010." Census.gov (2011): 1, internet, 28 Jun. 2013. Available: www.census.gov/compendia/statab/2012/tables/12s0142.pdf.]
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