The City of Palliative Care • Hacker News Board

Re: The City of Palliative Care

#21

Post by AstralStorm » Sat, Dec 04, 2021, 8:50 AM UTC

novok wrote: post #20

disabled wrote: post #7

Earlier quoted context omitted.

It’s quite offensive, as somebody who nearly died from sepsis (a couple of months ago), like the drug user in the article, but for different reasons. In my case it was from an infected portacath, that was carelessly flushed during routine maintenance and care. Also, I cost more, on a per year basis, than the individual in the article, as I require an orphan drug and will for the rest of my life. I am American but for…

Do you think the chronic drug addicted homeless could sustainably live in a house without utterly destroying it even if the 'rent' was $50/month?

Do you think it is easy to actually destroy a house if you actively don't want to?

We're talking chiefly people addicted to opiates, not someone affected by stimulant psychosis. They can handle homework just fine.

And even if that was the case, the cost would be lower than keeping these people in hotels and less damaging than sleeping rough.

Re: The City of Palliative Care

#22

Post by jessriedel » Sat, Dec 04, 2021, 2:14 PM UTC

randometc wrote: post #10

riverlong wrote: post #5

Earlier quoted context omitted.

Sorry, that was a typo on my end. I'll push a fix momentarily. (Do note that the math for $630k over 9y was right.)

A point in time count isn’t a good denominator to understand cost per person given an annual budget. This article sheds some light: https://missionlocal.org/2019/07/in-san-francisco-we-obsess-... > the Department of Homelessness itself applies a multiplier of 2.89 to the PIT count to estimate how many individuals are homeless not just on one day but throughout the entire year.

The PIT number seems like the best single number to use. Unlike the one you quote, PIT is not influenced by the somewhate arbitrary choice of a year as a unit of measure. And even if you include people who are homeless for a single day over the entire year (who are, as the article mentions, also spending time in jail or the hospital, which get their own budget), the difference is less than 3x.

Re: The City of Palliative Care

#23

Post by jessriedel » Sat, Dec 04, 2021, 2:17 PM UTC

glenda wrote: post #9

jessriedel wrote: post #4

> To get to this number, I averaged the number of annual homeless in San Francisco since 2013, which is 6,864, and averaged the city’s homeless budgets from 2016 through 2023 (I could not find prior budgets), which is $486 million per year. That’s $632,000 per homeless person per year No, that's $486M/6864 = $70,800 per homeless person per year. It's only after multiplying by the 9 years she lived in SF do you get $6…

70k per year is less than we spend keeping someone in prison, which is where many people believe we should put drug addicts. The truth is it’s not about the money, people just don’t want to see other people suffering where they live. As a society, even spending all this money, we are failing to help some of our most vulnerable citizens. It’s quite telling that conversations about social safety nets always become abou…

No where in the article does the author bring up taxes or the cost per tax payer. The entire focus of the article is on the effect on the homeless person.

Re: The City of Palliative Care

#24

Post by mindslight » Sat, Dec 04, 2021, 2:27 PM UTC

I wish this post had continued with the analogy rather than pulling the ripcord with "the government has inadvertently created a thing of immense cruelty: this is a system that takes in people and slowly, but surely, kills them.".

Hard drug addiction can be seen as a terminal disease. The main cost to the city is truck rolls for EMT response. $100k/yr is much more than it costs to feed and house an individual in basic accommodations. The main cause of overdoses is purity/potency. Taken together, it seems like treating the situation as a public health problem with a palliative approach would save the city a lot of money as well as making life better for those trapped in it. Especially if SF could then turn around to the state and claim healthcare reimbursement for doing so.

Re: The City of Palliative Care

#25

Post by mindslight » Sat, Dec 04, 2021, 2:37 PM UTC

breckenedge wrote: post #12

nick__m wrote: post #11

Earlier quoted context omitted.

Could you define palliative care, please ? I to tought that it was a branch of medicine dedicated to the relief of the suffering of those who are afflicted with a disease that will eventually kill them. But clearly you indicate that it's more than that so I would like to know.

Her elevator speech definition: Palliative care is a whole person approach to medicine for patients with a terminal diagnosis who are still undergoing active treatment.

FWIW definitions like that didn't help me understand what palliative care means in practice or what it would have done for me as a caregiver, apart from its well-defined subset of hospice. People kept asking me if I had considered "palliative care", but could never define what it was. I don't think that was just a polite way of saying hospice - it was a distinct group at the same VNA. It didn't help that this palliative team I tried talking to was small and there was some administrative weirdness. In the end it didn't matter for me - full on hospice was definitively appropriate, and they did their job very well. But in the interests of helping others in a similar situation, more concrete explanations of the mechanics would help!

Re: The City of Palliative Care

#26

Post by novok » Sat, Dec 04, 2021, 9:19 PM UTC

AstralStorm wrote: post #21

novok wrote: post #20

Earlier quoted context omitted.

Do you think the chronic drug addicted homeless could sustainably live in a house without utterly destroying it even if the 'rent' was $50/month?

Do you think it is easy to actually destroy a house if you actively don't want to? We're talking chiefly people addicted to opiates, not someone affected by stimulant psychosis. They can handle homework just fine. And even if that was the case, the cost would be lower than keeping these people in hotels and less damaging than sleeping rough.

The other half of the drug crisis is stimulants actually: https://www.theatlantic.com/magazine/archive/2021/11/the-new...

And yes, it's actually very, very easy to do incredible amounts of damage to a place without much action. Don't clean it and leave trash rotting everywhere and cause an insect and vermin infestation. Throw literal shit on the walls, leave a clogged faucet on and forget about it and cause a lot of water damage everywhere along with a very bad mold problem, punch the walls in anger and leave huge holes in the drywall and broken windows. Rip off cabinet doors and use it as firewood because it's 'free firewood'. Fixing damage from bad behavior like that crosses into 6 figures very quickly.

And if your actively angry, you can do shit like pour concrete down the toliet and faucets and more.

These people need active management in a long term mental health facility, not just housing. The +%90 of invisible homeless that don't have a serious mental illness, brain damage and crippling drug addictions yes can be helped by housing. Most 'invisible' homeless people in that category get out within a year or two. I think what everyone is referencing when they are talking about homeless is the chronic visible ones yelling at a random tree.

Re: The City of Palliative Care

#27

Post by olliej » Sun, Dec 05, 2021, 2:49 AM UTC

novok wrote: post #19

olliej wrote: post #18

Earlier quoted context omitted.

And all of CAs public long term care facilities were closed in the 80s in order to save money, even though in reality it has ended up costing vastly vastly more.

At this rate the city could build a new long term mental care center and put all the severe chronic homeless in it and probably save money.

Yup, but you run into the same problem as housing other healthy folk, which is the lack of space for and general resistance to new housing or buildings :-/

It’s one of those things where once you remove it, resets listing it is really difficult and expensive.

Re: The City of Palliative Care

#28

Post by watersb » Sun, Dec 05, 2021, 4:54 AM UTC

olliej wrote: post #18

bsder wrote: post #13

Earlier quoted context omitted.

Agreed. For example, a recent report on the SF homeless population flags 15% of them as having a traumatic brain injury. You can spend as much as you want on other things, but those people need permanent, long-term medical care and nothing less is going to help.

And all of CAs public long term care facilities were closed in the 80s in order to save money, even though in reality it has ended up costing vastly vastly more.

I lived in Berkeley at the time, as yes the number of people on the streets that had been suddenly kicked out of long-term care facilities overwhelmed other public services, who were ill-equipped to provide anything more than crisis containment.

Teachers. Churches. Fire departments. Emergency rooms of hospitals. Police officers... God bless them all. God, what the Berkeley Police officers had to deal with in the 1980s...

(Then everyone got AIDS and died during the earthquake and the fire.)

My wife was a teacher at a day program for adults with severe developmental disabilities. A shoestring budget, subsistence wages, hard work. The program had been started out of necessity by an indomitable mother with a son who needed 24-hour care. Her son had his 21st birthday, and there was no longer a place for him in the public schools.

It's a horrifically expensive situation all around.