Pronounced Echo 

• Niki Chan
• Advocates point out to a chronic need for more services for the formerly homeless.

From 2014 through the end of 2016, 19 tenants and two unauthorized individuals died at Palmer Court, the Salt Lake City supportive housing complex home to 300 or so chronically homeless single adults and families. Eleven of those deaths were unattended, meaning they were not from natural causes—if you can call the multitude of medical issues that can follow and strike a formerly chronically homeless person finally housed "natural." Four were alcohol-related, five were drug overdoses and one remains an open investigation. Most died alone in their apartment. Four of them were in a state of decomposition, a story tragically familiar to any apartment complex.

The Salt Lake City Police Department reports documenting the deaths, which City Weekly accessed through a record request, make sad, bleak reading. There's the Christmas card addressed to "Dad" in a box shipped to Utah from Kentucky. The father was "obviously echo," an officer wrote, meaning dead. He lay on the bed in "a process of decomposition [that] was still visibly active." His apartment was clean and tidy and there were pay stubs that attested to someone who had successfully built a new life for himself, finding temporary work at a Marriott hotel.

Then there's the poignant story of a mentally ill man whose wife had been dead for several days in bed, but he did not know what to do. Or the man who collapsed unable to breathe in the hallway, and a witness too traumatized to leave his room and seek help.

Palmer Court is owned and run by downtown shelter The Road Home. "There are certainly some tragic stories in there," Road Home's Executive Director Matt Minkevitch says about the reports. "They reflect so much of the human suffering with which agencies like ours deal on a daily basis."

Stories of lonely deaths also transpire at Grace Mary Manor, a much smaller supportive housing complex for the chronically homeless run by Salt Lake County. It has 86 single-occupant apartments. In the past seven years, an average of eight people per year died at Palmer, while three or four died at Grace Mary. Excepting that is in 2015, when 15 residents died.

The county's Housing Authority director Zach Bale says he and his team "really dug into data" from that year, but "it was very difficult to find out why" so many had died in such a short period.

Two social workers agreed to review the 21 reports on the basis of anonymity because they did not have permission from their agencies to discuss the work of others. "It does scream that we just need more [case managers]. We just need more. It's got to be more individualized care, and a focus on substance abuse and mental health," one said.

Minkevitch says his "very experienced" case managers are working diligently, "knocking on doors every day, checking on their clients daily." At the same time, he notes, if an individual refuses to meet with their case manager, it is not grounds for eviction. "That's not what our housing model is directed to do. There aren't sticks involved, it's far more carrots and encouragement."

The death reports, in themselves, do little to reflect either the complex, trauma-heavy journeys of residents through years or decades of homelessness to permanent shelter, or the challenges of trying to provide services, support and care for individuals who, in some cases, would rather isolate themselves in their new apartment after years on the streets, sleeping on the floor or curled up against the wall because that is what is familiar. Palmer's case managers and staff often have to rely on social events, Minkevitch says, like bingo, coffee hours or a movie, to coax people out of their apartments.

For some advocates, there remains a disconnect between what they see as lip service by the state to housing the homeless and the paucity of funding available to deliver all that they need to rebuild and regain their lives once they are in housing. As Salt Lake City struggles with the public reaction to its announcement of four small sites within the metropolitan area, the long-term ramifications of what that will mean with regard to a deficit of beds available for shelter remain unclear. The Road Home, after all, can sleep up to 1,100 people a night at a push, while the new shelters promise beds for 600. Licensed clinical social worker and executive director of Utah Domestic Violence Coalition Jenn Oxborrow says 65 percent of homeless women are DV survivors, yet there is a lack of shelter for single women. "It really all comes down to funding and policy at the end of the day," she says. "With the four new sites, you have to have comprehensive teams to support the needs of people or you're just going to have a series of small Road Homes all over again."

Oxborrow criticizes the lack of funding available for case management and the wide array of services that are needed to tackle the mental, medical, substance abuse and trauma-related complexities of the street's most vulnerable people who are funneled through what's called the "triage" system to permanent supportive housing in places like Palmer and Grace Mary. "I don't see administrators of funding looking for partnerships with direct service providers like Matt," Oxborrow says. "I see funding administrators not driven by a sense of public stewardship to solve the problem. Folks like Matt are willing to do the hardest, messiest part of the work. Instead of funders giving them the ability to find solutions, we limit them, then criticize the work they're doing on the ground, and it's just not fair."

Case managers are the frontline troops in the daily battle to monitor, support, encourage and guide residents, even if some decline such efforts. "I think of them as a bridge," Bale says. "We need low enough [case manager to client] ratios to make sure we can support and be present enough so we generally know what's going on." The ideal case manager-to-client ratio is 1 to 10 or 12. Bale says the county's sites have roughly a 20 to 25 caseload, while Palmer has 1 to 30 or 32. Palmer Court's case managers, staff and residents would inevitably benefit from a doubling of the ranks of case managers. "I would think that permanent supportive housing providers including The Road Home would benefit greatly from having additional case managers on the ground providing additional services," Minkevitch says.

Case managers' jobs are "frigging hard," Bale says. Follow veteran street outreach worker Ed Snoddy at Volunteers of America around, and you'll find he is a master of patience. "It's an amazing combo of having the ability to nudge and push and cajole and at times steer and nudge [a client] into your car," Bale says, to take them to a medical appointment or detox.

A number of the death reports noted that the deceased tenants had missed recent medical appointments, such as for kidney dialysis. Minkevitch says the next step in the evolution of supportive housing has to be onsite medical services. While Bale sees a potential "shining light" in possibly hiring a nurse care manager to provide medical support for non-medical trained case managers, Palmer Court pursued a different route. With the help of the Association of Utah Community Health Centers' Alan Pruys, The Road Home and Fourth Street applied for a federal grant from Health Resources & Services Administration (HRSA) to turn the former hotel's banquet kitchen and restaurant into a satellite clinic operated by Fourth Street. While the clinic was not to be limited to Palmer residents, Minkevitch sees many advantages to such a clinic, including encouraging isolating tenants to attend health fairs, and potentially reducing the number of emergency calls to fire and police by both residents and staff. HRSA denied the application, however, and so it's back to the drawing board.

The clinic "simply should happen," Minkevitch says. "It's too important for it not to happen."