Unsure how many years lie ahead of him, Gerald Dupree reflects on the past 36, from his 15 years as a fabric buyer on Fashion Avenue to his last eight weeks in an AIDS residence on Broadway–and insists that these last weeks have been his happiest.
Outside the Narragansett Hotel, an SRO that houses 60 people with AIDS, neighbors jog by in the early morning. It’s a pleasant change from the streets near the transitional home Dupree just left. On those blocks, dealers sell the drugs that have haunted him since he was 11 years old. Inside the Upper West Side building, staff provide him with nutrition, recreation and counseling to keep his year-long sobriety on track and his manic-depression in check.
Here he can concentrate on becoming his mother’s son once again. “My mother didn’t raise me to be a heroin addict, to smoke crack and sniff cocaine,” he says. “This is as happy as I’ve been in 36 years because I’m sober. If I have a problem, I have lots of people to help me.”
Dupree represents the current face of AIDS: increasingly poor and of color with mental illness or a history of substance abuse–and now, in light of medical breakthroughs, living longer despite HIV infection. To prolong his life, Dupree swallows 12 pills a day, mostly the protease inhibitors that within the last 18 months have given the AIDS community real hope for better health and long-term survival.
For most nonprofit groups housing homeless people with AIDS, these longer life expectancies have ushered in a new supportive housing era, redefining their apartment blocks and rooming houses as places where life begins anew–not where it ends. But this redefinition is taking place within an overburdened AIDS housing infrastructure. Currently, the city has about 910 units of supportive “congregate” housing–mostly nonprofit group homes with social services such as case management, counseling, nutrition, recreation and, in some cases, health care. There are another 1,930 “scattered site” apartments rented from private landlords with city funds, where tenants also receive services. For the more than 1,650 people with AIDS who cannot be accommodated in this system, the city budgeted $19.8 million this year–half of it from the state–on rooms in commercial SROs.
“The emphasis was, ‘People are dying,'” explains Maureen Friar, executive director of the Supportive Housing Network of New York. “That has been changing in part due to medicines, in part due to nutrition. There’s a need for continuous housing and supportive services that are appropriate.”
Yet while housing providers foresee serving more people with AIDS for longer periods of time, the city’s efforts to jumpstart AIDS housing development have fallen woefully behind due to poor agency coordination and insufficient funding for supportive housing operations. As a result, the terrain is becoming increasingly complex, even for longtime housing professionals.
For congregate housing, where tenants generally need more attention than at scattered-site programs, funding for operations is a Holy Grail–an elusive prize without which a development is doomed. “As a developer you have to get your development funding and hope the general operating funds will be available,” explains Debbie Widerkehr, former director of real estate development at Housing and Services Inc., which manages the Narragansett. “It’s like cooking a meal and hoping all the food will be warm at the same time.”
Therefore, most congregate AIDS housing providers are desperately dependent on government money–the few funding streams able to handle the typical $20,000 to $30,000 annual tag per resident. Although federal money for housing development is plentiful, the city’s failure during the last three years to provide long-term operational funding has left millions of such dollars unspent.
Until this year, the city Human Resources Administration just didn’t have the money to issue a Request for Proposals for congregate permanent housing operating contracts, city officials say. “Our Office of Management and Budget allows us to offer RFPs only when there’s money to fund the project. That basically has prevented us from offering a permanent congregate housing contract for almost two years,” said John Dereszewski, director of contracts for HRA’s Division of AIDS Services and Income Support (DASIS), at a conference in late November.
Quite simply, explains Scott Turner, the city’s Housing Opportunities for Persons With AIDS (HOPWA) administrator, “The projects haven’t gone forward because HRA hadn’t issued RFPs.”
Meanwhile, the federal Department of Housing and Urban Development, which gives the city millions of dollars annually through the HOPWA program, had mandated, until recently, that nonprofits couldn’t access development cash until they garnered 10 years of operating money.
Thus, until three months ago, $32.6 million in HOPWA development money from 1994 and 1995 had been sitting in Department of Housing Preservation and Development coffers. In September, the city finally whittled its remaining $14.1 million 1994 HOPWA funds down to zero. However, another $18.5 million from the 1995 budget has yet to be spent.
One problem had been that when HPD funds a development project, HRA does not automatically offer operating funds.
At Turner and the advocates’ urging, the two city agencies recently agreed to better coordinate their funding. And by reducing payments to commercial SRO owners by $1.5 million, HRA freed up money to issue a new RFP for operating funds in permanent congregate housing this summer.
Despite this streamlining, the city still faces a tremendous backlog. Officials have repeatedly underestimated the number of people with AIDS needing help from DASIS each year. Last spring, the city projected a caseload of 18,914 for June 1998–but the current caseload already tops 20,300. And as the caseload increases, so does the need for housing. About 25 percent of new DASIS clients are either homeless or inadequately housed, according to city officials.
And AIDS experts agree that a longer life expectancy means more people need more housing for longer periods of time. Even though protease inhibitors may prolong life, the drugs require that users adhere to an exact dosage timetable. Studies have found that people with mental disabilities or drug problems are less likely to take their medication properly. Therefore, providers say, their clients need stable housing and, in many cases, counseling and other ongoing support.
“If you have a chaotic lifestyle and have no home, it’s hard to maintain the regimen,” explains Donald P. Chamberlain, associate director of AIDS Housing of Washington, which builds supportive housing in Seattle and organizes a national AIDS housing conference. “And fewer people of color, low-income, homeless are going to be successful without more help in getting supportive services with housing.”
But with past funding missteps, the AIDS supportive housing plan the city created three years ago has limped out of the starting gate.
In its 1995 Consolidated Plan, a five-year analysis of how the city should spend federal grants, the city planned to add more than 2,000 units of supportive housing by 1996, for a total of 3,650 units. And although officials predicted they would need at least another 3,300 units of AIDS housing by June 1997, today there are only 2,800 congregate and scattered site units.
Similarly, HPD planned to develop 170 units of housing using 1996 HOPWA money, but fell 83 units short. HRA’s plan to support 170 units of transitional housing with operating funds fell 64 units short.
“In a city with such a desperate need for housing, particularly AIDS housing, the underspending in AIDS-dedicated funding streams is a tragedy,” says Gina Quattrochi, executive director of Bailey House–which created the city’s first AIDS congregate residence in 1983. “The government should spend these funds in a timely and appropriate manner.”
The city’s executive budget for fiscal year 1998 projects only 180 more units of new congregate housing by next June. Even so, officials say the city intends to be prepared for the future. “[Longer life expectancies] create a challenge to meet the need of services and AIDS housing,” says Ron Johnson, the city’s AIDS policy coordinator. “We are reviewing the availability of AIDS housing and speeding up the development of units.”
In the meantime, nonprofit organizations are becoming more creative in sustaining their clients’ incomes while diversifying their own funding. Increasingly, they are looking to job training. At Bailey House, a two-year-old program provides residents with technical skills and job experience in addition to GED and college classes. It recently won $700,000 from HUD to go national with sites in Albany, Chicago, Los Angeles and elsewhere.
Housing providers also predict a greater need for so-called mixed residences, like the Narragansett where 60 of the 100 tenants have AIDS and the remaining 40 are low-income, rent-stabilized residents. Here tenants with AIDS feel less isolated from the rest of society–and additional rents help sustain the supportive housing program.
Providers and advocates have even begun to tap more Medicaid funding by linking their housing developments with medical centers and clinics. And they may start sharing duplicative tasks, such as accounting. Along the way, the groups can latch onto relatively sparse private funding, like this year’s NYC AIDS Fund, a pool of 15 funders awarding $300,000 total this month to about four AIDS housing programs.
Even though the city increases the DASIS budget each year, many providers wonder if funding will increase at a rate to cover everyone. “If there was affordable housing and subsidized housing, it would take some of the pressure off,” says David Terrio, owner of Burchman Terrio Urban Consultants, a housing planning firm for community groups.
As for Dupree, he knows that AIDS has stolen years from him–but he is grateful he at least lives where staffers have gone out of their way to make these days his happiest. “The epidemic is not getting better,” Dupree says. “There’s a lot of hope with these drugs. All it does is prolong your life. There’s no cure. There’s not even a vaccination. They need more places like this.”