If you do not know them, make eye contact. Let them know you see them and contribute to organizations that are experts in connecting them to assistance. If you have a sincere interest in this issue, familiarize yourself with organizations in your community so that you can inform individuals experiencing homelessness how to connect with the organizations that can help
As a part of my series about “Heroes Of The Homeless Crisis” I had the pleasure of interviewing Linda Little of Neighborhood Service Organization.
Linda Little BSN, MBA, RN, CCM is President and CEO of Neighborhood Service Organization, a safety-net health and human service agency in Detroit, Mich. Coupling her clinical experience in critical care with an exceptional business acumen, Linda has nearly 30 years of proven healthcare leadership with an emphasis on population health management, revenue cycle optimization, physician alignment, operational efficiency, strategic planning, and quality/performance improvement. Learn more at nso-mi.org.
Thank you so much for joining us! Our readers would love to ‘get to know you’ a bit better. Can you tell us a bit about your personal background, and how you grew up?
I grew up in a traditional working class family in Detroit. We didn’t live in the best neighborhood, but I did not know it at the time. I went to Catholic school all the way up through high school and had a really strong family focus and background. God, family and community. These were the top three pillars of my life and that’s still true today.
I was a teen mom that didn’t fit the stereotype. I didn’t come from a broken home. In fact, my parents have been married for 53 years. I was a bit naïve as a teenager. I never would have thought that a single choice I made when I was 16 would have led to a total change in the trajectory of my life. But this circumstance, this choice that I made, really helped me to understand the significance and impact of every decision I made afterward.
Being a teen mom certainly made life much more challenging, but it also made life very focused for me. I was on the path to go to medical school. Instead, I pursued a career as a nurse, the best career choice I made. I don’t regret where I am today and am proud of the successful person my son is, but my personal journey really underscores the impact that one single choice can have on the trajectory of your whole life.
Is there a particular story or incident that inspired you to get involved in your work helping people who are homeless?
What inspired me to do this work was the opportunity to take my 25 years of experience as a nurse and leader working in the healthcare delivery system and bring it to this community-based agency so that we can deliver a holistic approach to this population to improve their overall health and well-being.
I have such an affinity for people who are experiencing poverty or who are part of a vulnerable population. People who are homeless…that’s just the tip of the iceberg for so many other issues that played into that. Housing instability is just the icing on the cake. There are so any other things within those layers that are not being addressed and I wanted to help raise awareness of those underlying issues, too.
Homelessness has been a problem for a long time in the United States. But it seems that it has gotten a lot worse over the past five years, particularly in the large cities, such as Los Angeles, New York, Seattle, and San Francisco. Can you explain to our readers what brought us to this place? Where did this crisis come from?
There is a poverty gap in our community, in our culture in the U.S., that seemed to widen as the economic recovery occurred after the 2008 crisis. There are many systems and programs designed to enable communities that are on the curve of economic recovery, resurgence or renaissance, like Detroit. However, all those dollars and revitalization programs and development approaches are for people who have the means to actively participate. That same degree of energy and effort has not been spent on those on the lower socio-economic track or those who live in neighborhoods that aren’t able to participate in these revitalization opportunities.
Inequity is inequity. And simply put, that’s what it is. If those experiencing these unique issues are not at the decision-making table to design these programs, oftentimes their voices are not represented to afford them to have access to that opportunity. That’s why diversity of thought is so important. We need different stakeholders and representatives around the table making these decisions, inserting various perspectives into developing the process so that those who are not afforded the seat at the table aren’t left behind. And that’s what we’re seeing. The people who were already on the fray are being displaced. That is why the gap is widening. Nonetheless, I also understand that there are not enough resources to do everything at once. I believe that those committed to the revitalization of communities have the best intentions. Limited resources have to be deployed to achieve what is considered the best return on the investment.
For the benefit of our readers, can you describe the typical progression of how one starts as a healthy young person with a place to live, a job, an education, a family support system, a social support system, a community support system, to an individual who is sleeping on the ground at night? How does that progression occur?
You will be surprised to learn about the myths people have about homelessness. I talk to people who we serve and many people who have experienced homelessness. There is not one path to homelessness. It seems that many of the root causes stem from poverty and choices. It may have been one choice or a series of choices, but there’s usually a series of events that have occurred in an individual’s life that have caused them to suffer some traumatic event. Trauma plays a major role, whether they chose to use an illegal substance or mishandle a license that they’ve had (i.e. physicians) or to steal money that caused them to commit a federal crime, which led to time spent in prison and then the family ostracized them and they had no place to go. Also, studies show that more than 50 percent of American are living paycheck to paycheck, with minimal savings. That makes one out of two of us one paycheck away from housing instability.
These choices that people make and the trauma that results after this path in their life occurs, it leads to so many underlining issues within an individual. What we as a community and society need to recognize is that your own next door neighbor could be a single step away from experiencing homelessness, someone in your family or anyone you know. Homelessness is closer to each of us than it has ever been before as a society.
There are a lot of people during this current COVID-19 crisis who are experiencing this right now. Those folks have no paycheck and, in some instances, unemployment won’t improve the situation or the money is not able to reach them in time. This pandemic has also illuminated the transient homeless population who was once sleeping on the sofa of friends or family who can no longer do this due to real or perceived risks of exposing others in the household. We anticipate seeing a different type of homelessness as a result of the COVID-19 pandemic.
A question that many people who are not familiar with the intricacies of this problem ask is, “Why don’t homeless people just move to a city that has cheaper housing?” How do you answer this question?
How do you logically ask someone who doesn’t have resources to pick up and relocate to another city? This question ignores the possibility of real barriers and assumes that an individual has the resources and even the mental capacity to do so. It is often difficult for someone with stable income and a career to pick up and relocate. This reluctance is compounded for someone in crisis who does not have resources.
If someone passes a homeless person on the street, what is the best way to help them?
The best way to help someone, if you don’t know them, is through organizations that help people on the street. Individuals who are chronically homeless, someone who has been on the street for a year or more, develop coping mechanisms that would be foreign to you or I if we have not had training or exposure to this population. A person who is homeless typically has a huge degree of mistrust and has learned coping skills in order to survive. It is best to, contact an organization that is equipped with trained staff and professionals who deal with the issues that people who are homeless face on a regular basis. I would say support those organizations financially, or by volunteering, and let them help.
What is the best way to respond if a homeless person asks for money for rent or gas?
If you do not know them, make eye contact. Let them know you see them and contribute to organizations that are experts in connecting them to assistance. If you have a sincere interest in this issue, familiarize yourself with organizations in your community so that you can inform individuals experiencing homelessness how to connect with the organizations that can help.
Can you describe to our readers how your work is making an impact battling this crisis?
Neighborhood Service Organization, or NSO, has a continuum of services to address homelessness. Our goal is to eventually take everyone that comes into contact with us, who encounters our agency, and end homelessness for that individual. For those that we have touched and been able to transition into permanent supportive housing, we have a 95 percent retention rate. NSO has an emergency shelter, transitional housing or rapid rehousing, permanent supportive housing as well as street medicine to meet their medical needs. We have a street outreach team that goes out and tries to engage the homeless population in an effort to get them into the pipeline for housing solutions available in our community.
NSO has the largest permanent supportive housing unit in Michigan with 155 one-bedroom apartments and we have relationships with landlords to add capacity for another 150 units–for a total of more than 300 units of permanent housing. Here we provide all necessary services to empower residents to take charge of their lives by connecting them to life skills groups, substance abuse services, basic computer skills, employment services and primary healthcare, behavioral healthcare, and dental services.
We also answer about 90,000 housing crisis calls annually and we transition about 1,000 to permanent supportive housing every year.
This is the work we do as one agency, but we connect with thousands of homeless people on a daily basis to engage them into housing solutions. And this takes multiple touches to do that. We first have to build relationships with them. It helps that we also deliver medical care to them. Our organization has partnerships with medical schools throughout our tri-county area to help deliver our street medicine programs and services. We are their point of contact for food, education, medications they need, substance use treatment, even family reunification. We try to develop a full continuum of homeless recovery services for this population to ultimately engage them and then help end homelessness for them.
How has the COVID-19 pandemic affected the homeless crisis, and the homeless community? Also how has it affected your ability to help people?
We know that the homeless population is one of the most vulnerable populations for this type of virus to infect, simply because of their propensity to congregate. Shelters further encourage that congregation. There have been major efforts made by NSO, the City of Detroit, Detroit Health Department and others to try to safeguard this virus from spreading throughout the homeless population.
As an agency, we took every precaution to make certain we were able to meet the CDC guidelines for distancing, hand washing, screening, isolation and quarantining and testing that we could. We even relocated our clients from our current walk-in center into a larger facility to be able to allow them to physically distance. We implemented COVID symptomatic screening multiple times throughout the day, including temperature checks, and we have a designated isolation room set up, We also started working with the City of Detroit to transition those folks who were symptomatic to the quarantine site right away, to mitigate exposure to others within the shelter.
NSO is fortunate as an agency to have a medical team on staff. We have a medical director of primary care and nurse practitioners who were already delivering services through our street medicine program. We expanded the clinic in our walk-in center from two days a week to five days a week, incorporating tele-behavioral services on site. We also are meeting all of their basic needs, because they can’t come and go as they normally would due to the Governor’s Shelter-in-Place executive order. This includes laundry services, three meals a day, any health needs they have or court dates they may have.
When this crisis began, we decided to take on the responsibility of providing the services that people need as they are sheltering in place and then ask for the funding support to do it, not the other way around. And that’s what we’ve done. We’re not completely there, but a lot of community donors have stepped up and supported our efforts to deliver these expanded services to our clients.
Can you share something about your work that makes you most proud? Is there a particular story or incident that you found most uplifting?
I am here because of the clients that we serve every day, and it is always a privilege and an honor to serve them. But interacting with the staff during this crisis and seeing how they’ve stepped up to protect and serve this vulnerable population has been absolutely awe-inspiring for me.
These are not healthcare workers. They didn’t sign up to work in the medical profession or respond to a public health crisis, but they took their positions as advocates and service providers and protectors of this vulnerable population seriously. They showed up and they have been there risking their own lives to help others. Some of them have tested positive for COVID-19 and some have lost family members, while others are fighting for their lives battling this virus. I am forever grateful to them and I am in awe of their heroism and bravery.
I know intimately what they’re dealing with. Our team is facing the same scenarios and making the same sacrifices as healthcare workers on the front lines in hospitals, but they aren’t receiving all of the accommodations, such as special day care centers, because they aren’t technically healthcare professionals. They are doing all of this work despite the challenges and risks.
We have more than 300 employees, and to be able to transition everyone who is normally out in the community delivering face-to-face services to telehealth in a matter of days, that is commitment. They were eager to continue to deliver those services, because they knew our consumers would need them now more than ever.
Without sharing real names, can you share a story with our readers about a particular individual who was impacted or helped by your work?
We had a homeless person who encountered NSO through our street outreach team. We spent some time working with her, earning her trust and, eventually, she agreed to services.
She had bronchitis and asthma exacerbation at the same time and couldn’t breathe and was not getting enough oxygen. Our street medicine team assessed her and took her immediately to the hospital where she was treated and stayed for about a week. To this day she will tell you NSO’s street medicine team saved her life.
After a few years she was able to obtain permanent housing and began to work with us as a peer support specialist.
She was given a second chance and a job. . . something to hope for. She was reunited with her family and just completed her associate’s degree. She is currently pursuing a bachelor’s degree in social work. She also serves on the board of our street medicine team now, too.
Can you share three things that the community and society can do to help you address the root of this crisis? Can you give some examples?
The root cause is poverty. Our community and society need to work toward solutions to eradicate poverty. I understand we may always have social and socio-economic classes, but poverty is something that should not exist in the United States of America. The formulas used by many states and government entities to distribute resources disproportionately affects vulnerable populations. This has been affirmed by researchers who have demonstrated that your zip code determines your life expectancy and quality of life. We can change this system inequity.
We also need to address other social inequities, like access to healthcare and make certain people have access to resources in the medical and mental healthcare they need, which often plays a role in homelessness, too. The homeless population is the most densely populated with chronic medical conditions, and there’s a reason for that.
We also need more affordable housing solutions, not the formula used today. The current formula excludes a lot of people, such as those who work minimum wage jobs and struggle to pay rent.
If you had the power to influence legislation, which three laws would you like to see introduced that might help you in your work?
I would like legislation that promotes innovative housing solutions. Legislation that encourages private and public partnerships to address gaps in the housing continuum. The government would have to be involved to reduce some of the risk and provide stability to projects. Other states have done this successfully and I think it would work.
I would like to see us increase the minimum wage. Each state is different, but here in Detroit a living wage, which is different than a minimum wage, is about $11 an hour. I believe if we increased the minimum wage to $15 an hour across the U.S. it would enable any individual to have some type of affordable housing and maintain at least a minimum livelihood. Everyone deserves that.
I’d also like to see everyone have access to healthcare. Healthcare is a right, not a privilege. The value of a human life should not be based on the resource a person has. Through my own experience, people may need to be incentivized. There may need to be some sort of incentive to engage and drive people to the right level of care and promotes preventive and wellness services. These steps have been proven to drive down healthcare costs, while improving healthcare outcomes.
Those three things I think can really change the state of our society for the better.
I know that this is not easy work. What keeps you going?
The love for my community and the need for our services keeps me going. God, family and community, as I mentioned earlier, are the three pillars I live by. If a family member of mine was in need, I would hope that someone would do the same for them.
Do you have hope that one day this great social challenge can be solved completely?
Yes, that would make me very happy. It would be a blessing if these needs no longer existed and I was put out of a job!
What are your “5 things I wish someone told me when I first started” and why. Please share a story or example for each.
Pace yourself — I have learned that the need is much greater than anticipated…COVID-19 will surely expand the demand for services. I sometimes find myself working 14–16 hour days. This is not a pace for positive health.
Maintain a routine of self-care that is not negotiable — If you do not carve out time for yourself, it will easily be used up by something else. It took me a while to figure out a schedule to get much needed exercise and take care of myself.
Find a trusted CEO network — There are things that you experience as a nonprofit CEO that can only be understood by those who have been there. Trusted sources to bounce off ideas and exchange best practices can be priceless.
It is ok to say “no” — Going back to the need being so great, it is easy to engage in projects or programs that may or may not be aligned with your particular mission or strategic plan. Using a mission matrix can help to illuminate the pros and cons of engaging in new programs or projects that are in the best interest of your agency or populations served.
Fill your cup — In this role, you pour a lot of yourself into others. It is important to fill your own cup so that you have more to give. I use daily motivationals, enriching books or journals, and podcasts to help fill me up on a daily basis.
You are a person of enormous influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)
I would change the algorithms that distributes funds into communities for essential services (public schools, healthcare access, housing assistance, etc.) to significantly reduce inequities. I can talk about this subject all day and how it impacts so many things in our community. Allow me to give one example: there are public schools in vulnerable communities that can barely purchase toilet paper, not to mention textbooks and appropriate salaries for teachers to prepare students for success. How can this be? The most at risk schools should receive more resources to address the contributing factors that serve as barriers to education. Instead, they receive fewer resources because their students perform at a lower level or their tax base may not be as high. This sets up for a downward spiral of inequities that spans a lifetime for the children affected. Knowing what we do today about the impact of social determinants on health, education, etc., I would adjust formulas used to distribute resources for essential services based on acuity/risk factors for the populations served. This would allow the communities with the greatest need to have the resources it needs to address them. I can always dream…right?
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“I did then what I knew how to do. Now that I know better, I do better.” This quote by Dr. Maya Angelou means so much. To me, it means you know what you know at the time you know it, but once you have enlightenment you have a responsibility to act responsibly and not beat yourself up about it.
I believe that life is a journey, not a destination. I believe if we keep an open mind and heart there are always opportunities to grow and learn, grow and develop, and as you grow and develop and incorporate those lessons learned into your life, you get better outcomes and become a better person. You also make better choices and decisions. I’ve definitely experienced this in my life. I’m always growing and always looking for ways that I can continue to learn and develop.
Is there a person in the world, or in the US whom you would love to have a private breakfast or lunch with, and why? He or she might just see this, especially if we tag them. :-)
Warren Buffet. I know that this is an interesting choice. He seems to be a very insightful man, and he is in the top 1 percent wealth category for our nation. He experiences a different reality than many of us on a daily basis. I would want to understand how he sees many of the issues facing our communities and hear some of his thoughts on solutions.
How can our readers follow you online?
This was very meaningful, thank you so much.