SEATTLE — The 5-year-old building at 1811 Eastlake on the edge of Seattle’s downtown area is fairly nondescript: four stories, blue and gray in color — not unlike apartment complexes found in many cities.
It’s what’s inside that has made this development one of the nation’s most interesting and unusual public health programs for chronic homeless drunks — and one that some San Francisco officials are considering replicating.
The government-subsidized housing project in Seattle caters exclusively to 75 hardcore alcoholics who came from the streets and are allowed to keep drinking, snub treatment and still keep a roof over their heads.
View attachment 17089 Kelly Lauderdale, who has a severe drinking problem, buys beer to bring back to his apartment at 1811 Eastlake in Seattle.
Driving the policy is the idea that getting these people into housing saves money and lives, and improves the quality of life in neighborhoods hardhit by anti-social behavior.
The San Francisco Department of Public Health already provides housing for about 1,000 of the formerly homeless in buildings with mixed populations of the mentally ill, substance abusers and people
with AIDS. Those who choose to are allowed to use drugs and alcohol in the privacy of their own rooms.
Seattle’s 1811 Eastlake program, however, goes further.
Not only is the building limited to extreme inebriates, but the building’s staff also will go on booze runs for some residents and then methodically dole out the beer, wine, vodka and other preferred intoxicants like medicine.
Critics of the Seattle program have derisively dubbed it “bunks for drunks.’’ News accounts have described it as a “wet house.’’
Yet in the five years since it opened, 1811 Eastlake has saved taxpayers millions of dollars. A University of Washington study showed the residents tend to drink less, take fewer trips to the emergency room and are more likely to accept treatment once they’re in a stable environment.
View attachment 17090 Lauderdale (left) talks to David Anderson, a residential counselor. “Wet house’’ staff go on booze runs for some residents.
The publicly funded program, with an annual operating budget of just over $1 million, has no mandate that the residents stop drinking or receive treatment. But there are case workers and a nurse on staff to help willing residents tackle their life-threatening addiction. Street alcoholics “will accept housing at a price they’re willing to pay — and that’s not having too many restrictions on their autonomy,” said Daniel Malone, housing director at Downtown Emergency Service Center, the nonprofit homeless services agency that operates 1811 Eastlake.
The success has local officials considering whether it might work in San Francisco, although they admit that it could be difficult to find the ideal location in the dense city.
Last week, Supervisor Bevan Dufty and representatives of the city’s Department of Public Health toured 1811 Eastlake.
“This seems like an appropriate response for this hardto- serve population,” Dufty said. Although San Francisco already does much of the same work, he believes the concentrated focus on chronic inebriates — “a unique and difficult population’’ — will have a greater benefit.
“I think there is merit,’’ Dufty said.
San Francisco spends about $13.5 million a year dealing with inveterate street drunks who pass out in doorways, vomit and urinate in public, get rushed to the emergency room and cycle through the city’s various treatment programs, including a “sobering center.” They are a challenging group to help, with severe behavioral problems and lifethreatening medical conditions.
Seattle faced similar costs, but University of Washington researchers calculated more than $4 million in savings over a year’s period after the program began. The study, which was published last year in the Journal of the American Medical Association, also found that the residents’ average daily alcohol consumption dropped from 15.7 drinks a day to 10.6.
“It may not seem like a lot, but when you think about the health effects, that’s a considerable and potentially beneficial reduction,’’ said Amnon Shoenfeld, who heads the Department of Community and Human Services for King County, which includes Seattle.
The executive director of Downtown Emergency Service Center, Bill Hobson, calls the program “pre-recovery housing,” a clinical term that he says carries less stigma. It also has a ring of optimism. Hobson, an opinionated and passionate administrator who is fiercely protective of his residents, said he has no expectation that the people who live at 1811 Eastlake will be sober.
“But there’s always that hope,” he said.
As of late last week, seven residents had stopped drinking, according to 1811 Eastlake’s manager. The likelihood that they’ll stay sober is slim, given their history, age and severity of alcoholism. Yet sobriety for some residents, current and former, has endured.
View attachment 17091 Kelly Lauderdale, who moved into 1811 Eastlake in Seattle three years ago, has cut back to a six-pack or so a day.
For most, the best hope is that they’ll drink less.
The original residents, predominantly men, were selected from a ranked list of 200 of the most frequent users of the public hospital, jail and sobering center in Seattle. They also had to fail conventional treatment at least a half-dozen times. By the time the building opened in late 2005, the first person on the list was dead.
So were two others in the top 10. Annual turnover is around 25 percent due to deaths, evictions and people who are moved into hospice care, nursing homes or other housing.
The vacancies don’t last long.
Inside the doors
The apartment house sits on the northeast edge of downtown in the Denny Triangle neighborhood. The area, once dominated by warehouses and light industry, is a budding enclave of new condo complexes and offices, with more businesses moving in to support the new residents and workers.
There is little indication from the outside of 1811 Eastlake that a troubled population lives inside, save the occasional resident staggering in or out of the building.
Inside, it is much different.
On the day Dufty visited, two residents passing by him in the lobby got into an escalating verbal spat with each other and snapped at a program manager who attempted to intervene. Not long after, another intoxicated resident shouted profanities at the visiting group from San Francisco. Flare-ups are not unusual.
The housing component is split into two categories. On the ground floor, there are 26 sparsely furnished, office-like cubicle rooms with no doors, and walls that don’t reach the ceiling. The design enables staff members to closely watch the most medically fragile residents.
Upstairs are 49 traditional studios with small kitchenettes and private bathrooms.
The stoves have automatic shut-off timers in case a resident passes out. The bathroom floor and the kitchen sink have overflow drains to prevent floods if the faucet is left on or the toilet overflows.
Every apartment has a twoway intercom, allowing front desk staffers to make announcements to the group or individuals. The system also allows staff to listen in on the residents, although administrators say there’s neither the time nor inclination to do that. Residents put 30 percent of their income — for most that means welfare or disability payments — toward rent. They are offered three meals a day.
But they buy their own alcohol.
Under house rules, drinking is not allowed in the common areas, and all residents must sign a code of conduct upon moving in. Violent behavior is grounds for eviction. So is behaving badly in the neighborhood.
Since the beginning of the year, seven residents — or almost 1 in 10 — have died.
That’s about on pace with years past.
The apartment complex is well-known to the city’s emergency responders. As of last week, the Fire Department and private ambulance crews had been dispatched to the property 119 times this year to handle such ailments as seizures, injuries from falls and fights, blackouts and acute conditions related to liver, gastrointestinal and heart disease. The annual tally of emergency responses has ranged from 196 to 248, according to Seattle Fire Department logs. Officials say these people would have required many more emergency room visits and paramedic calls if they were living on the streets.
Lauderdale, who likes to cook at 1811 Eastlake, says alcoholism cost him his catering job.
Effie Wardenburg, an emergency medical technician, said she has been called to 1811 Eastlake numerous times during her two years working for an ambulance company under government contract.
“It’s easy to see how some people could be critical of the program, believing that by providing housing and allowing chronic alcoholics to drink there and not requiring them to get help is enabling them,’’ she said.
“But the reality is, these chronic alcoholics would be on the streets otherwise and we, taxpayers, are going to be paying for them one way or another. We’re already taking care of them. We’re just doing it differently and for less money.’’
The University of Washington study backs that up. Researchers tracked 95 residents and found that the average one racked up $42,964 in health care and incarceration bills in the year prior to moving into 1811 Eastlake, compared with $13,440 during their first year of residency.
The project faced a rocky beginning. A developer with nearby real estate holdings sued to block construction of the proposed apartment building and the owner of a familyrun trophy shop next door joined the lawsuit, which delayed the project for more than two years. The plaintiffs eventually lost when the state Supreme Court refused to consider an appeal of a lower court’s decision that allowed the project to proceed.
Local newspaper columnists, talk show hosts and some experts in the addiction field who push abstinence over all else mocked the idea.
Hobson, meanwhile, worked to build political support. He got the backing of the influential Downtown Seattle Association, Police Department brass, the mayor and other elected officials who were eager to get the most problematic inebriates off the streets.
The $11.2 million development was built with local, state and federal funds, and private tax-credit financing.
The first wave of residents moved in mid-December 2005.
Most criticism has quieted with the passage of time. Robb Anderson, who owns the trophy shop that has been in his family for three generations, is still angry, saying that he has almost daily run-ins with people drinking, littering or dropping their pants to relieve themselves on his property.
He acknowledges that not all the troublemakers live at 1811 Eastlake, “but we didn’t have a problem here before it opened,’’ he said.
The Chronicle spoke to a half-dozen other property owners and managers in the area and found they had no major complaints.
The site was selected, in part, because there were few businesses and residences in the immediate vicinity and it was buffered on two sides by Interstate 5 and an overpass.
The location also was a short walk to Seattle’s fare-free downtown bus zone and convenience stores.
Dufty said he was impressed with what he observed in Seattle and plans to meet with Mayor Gavin Newsom, business leaders, health officials and others to see if there’s a willingness to create something similar in San Francisco. The Department of Public Health already plans to add 500 units to its housing stock over the next three years, a potential opportunity to tailor a project specifically for homeless alcoholics, said Marc Trotz, the department’s director of housing and urban health who accompanied Dufty on the trip north Thursday.
In San Francisco, health officials pegged the annual cost of providing alcohol abuse-related care for the 225 most frequent users of the system at $13.5 million, or $60,000 per person. Combined, according to health department findings released in 2008, they accounted for 1,980 ambulance pickups, 1,986 emergency room visits, 2,170 days of inpatient hospitalization and 1,214 visits to the sobering center.
It’s a life that Kelly Lauderdale knows well. The 53year-old Seattle resident is soft-spoken, thoughtful, and has a bad drinking problem.
He moved into 1811 Eastlake three years ago after being homeless on and off for eight years.
He now downs a six-pack or so of beer a day. That’s less alcohol than the three liters of wine he used to drink daily — so much, he said, that he was almost always assured a mat on the floor at the dreary sobering center during the bonechilling Seattle rains. He ended up there hundreds of times. He said his alcoholism cost him a catering job, landed him in jail for drunken driving, shattered his humerus bone in a fall he can’t remember, and ravaged his liver and esophagus. His best friend at 1811 Eastlake was found dead not long ago at a bus stop, a loss that has shaken Lauderdale.
Still, he said, he’s doing better than when he was on the streets. He doesn’t have to worry about keeping warm, and he’s surrounded by people who know his name and want to see him get better.
“This is my home,’’ Lauderdale said, “and I plan to stay here until I go live with Jesus.’’
By Rachel Gordon
CHRONICLE STAFF WRITER
October 03, 2010