Guardianship is not a homelessness policy | OPINION

By Amelia McKeon

The federal government’s proposal to expand guardianship for homeless veterans is being framed as compassionate. It is anything but. It is a dangerous shift toward using one of the most restrictive legal tools we have as a substitute for real solutions — and it risks turning guardianship into a mechanism for forced institutionalization.

In Colorado, we already have a system designed for exactly that purpose. It is called civil commitment. And that distinction matters.

But that is not what this proposal risks creating.

Consider a different scenario — one that is already playing out in systems across the country. A man experiencing homelessness cycles in and out of emergency rooms. He has untreated mental illness and often leaves against medical advice. He is difficult to engage. Under an expanded guardianship approach, he could be deemed incapacitated and placed under guardianship — not because all alternatives were exhausted, but because the system does not have the resources to support him in the community.

Once under guardianship, the path of least resistance becomes clear: placement in an institutional setting whe

This is where Colorado offers a critical lesson.

If someone truly cannot make decisions due to mental illness and poses a risk to themselves or others, Colorado law already provides a structured, rights-protective process: a mental health hold, followed by short-term certification, and, if necessary, longer-term commitment.

Guardianship is one of the most serious interventions a court can impose. It transfers decision-making authority from an individual to another person because the court has determined that the individual cannot safely make certain decisions on their own. But even under guardianship, the person does not disappear. A guardian does not override a person’s life — they support it. They honor the individual’s preferences and values, use the least restrictive options available, and make decisions with the person, not for them.

I have worked with individuals under guardianship who refused certain medications but were open to therapy and stable housing. Instead of forcing compliance, we built a plan around what they would accept. Over time, their stability improved — not because we overrode them, but because we respected them. That is what good guardianship looks like.

Let’s be clear: guardianship itself is not the problem. The misuse of it is.

That process includes medical evaluation, legal standards, court oversight, and defined timelines. It is designed specifically for involuntary treatment and placement.

Guardianship is not.

When guardianship is used to force people into institutional care — especially in systems that have historically been costly, restrictive, and misaligned with individual preference — it stops being protective and starts being coercive. We have seen this before. Institutional systems have long prioritized placement over people, efficiency over autonomy, and liability reduction over dignity. Guardianship should never be the legal justification that makes that easier.

I have seen individuals placed in higher levels of care simply because there was nowhere else for them to go — despite clearly expressing that they wanted something different. In those moments, guardianship was not empowering. It was a legal pathway to override preference in the name of system convenience.

There is a fundamental principle in guardianship practice that every good guardian understands: you do not substitute your judgment for the person’s life — you carry it forward. That means respecting expressed wishes, even when they are complicated. It means balancing safety with autonomy, not replacing one with the other. It means avoiding unnecessary institutionalization at all costs. This is first and most important in the National Guardianship Association’s Standards of Practice.

The proposal also risks conflating homelessness with incapacity. A person can be unhoused, struggling, and still capable of making decisions about their life. I have seen individuals stabilize once given access to housing and consistent support without ever needing guardianship. What they lacked was not capacity. It was access.

If guardianship becomes the entry point to services, rather than the last resort after all else fails, we have inverted the system.

And that is what this is really about. We need improved access to supportive housing. We need support and access for behavioral health resources. We do not have enough community-based services. So instead of building those systems, we are reaching for control. Guardianship becomes the workaround.

But in a state like Colorado, where a legal pathway for involuntary care already exists, using guardianship this way is not just inappropriate — it is redundant and dangerous. It blurs legal standards, attempts to bypass safeguards, and expands a tool that was never meant to carry that weight.

If guardianship is expanded in any context, the standard must be unwavering: it must remain a true last resort, it must be individualized, it must prioritize the person’s will and preferences, and it must never be used to justify unnecessary institutionalization. Anything less is not guardianship — it is control disguised as care.

We owe veterans more than safety at any cost. We owe them dignity, autonomy, and real options — not forced ones.

Guardianship has a role to play. But it cannot — and must not — become a shortcut to manage people when we have failed to support them. Because the moment we use it that way, we are no longer protecting rights.

We are taking them.

Full Article & Source:
Guardianship is not a homelessness policy | OPINION 

See Also:
VA-DOJ Memorandum of Understanding on Guardianship Threatens to Strip Rights from Homeless Veterans

A New Push to Put Homeless Veterans Under Legal Guardianship

Paralyzed Veterans of America Issues Statement Following VA-DOJ Agreement Allowing Guardianship Proceedings for Veterans with Catastrophic Disabilities

V.A. Begins Drive to Put Homeless Veterans Into Guardianship

County begins ‘unprecedented’ forced care

• Conservatorship law changes in California for all counties 

By MARIJKE ROWLAND

For the second time in a year, Stanislaus County is a testing ground for sweeping changes to California mental health policy.

In January, Stanislaus became one of a handful of counties to begin implementing SB 43 a year earlier than required. The new law is aimed at curbing the state’s homelessness crisis, but could also increase the number of people forced into care against their will.

Passed in late 2023, the law adds to the state’s criteria for conservatorship, a kind of legal guardianship for people living with severe mental health disorders. The law expands the definition of “gravely disabled,” which was first set in the 1967 Lanterman-Petris-Short Act (LPS) signed by then Gov. Ronald Reagan. That landmark legislation ended California’s practice of warehousing people with mental illnesses in state psychiatric facilities and instead set up criteria for who could be involuntarily committed for both short and long-term holds.

The “gravely disabled” threshold for conservatorship had previously required a corresponding mental health diagnosis, but SB 43 has now added “severe substance use disorder” and inability to provide for “personal safety or necessary medical care” as standalone criteria. Before, only those who could not provide for their own food, clothing and shelter could be placed in involuntary care.

The new broader definition was championed by Gov. Gavin Newsom along with a slate of other statewide mental health policy and funding shifts made to address homelessness, including Proposition 1 and CARE Court.

Stanislaus County implemented the latter, a new civil court division that can order those with untreated schizophrenia or other psychotic disorders into housing and treatment, a year before most other counties as part of its pilot program.

SB 43 is the first significant change to California conservatorship law in more than four decades. Getting county agencies on the same page took more than a year of monthly meetings with affected stakeholders, including law enforcement, medical staff and mental health professionals.

“This kind of LPS reform, which is unprecedented actually, affects almost all sectors,” said Bernardo Mora, medical director of Stanislaus County Behavioral Health and Recovery Services. “Hospitals, health clinics, doctors’ offices, emergency services, law enforcement, the court system, DA, PD – I’m probably leaving somebody out.”

Stanislaus County supervisors were eager to implement the new law and agreed to move the deadline up a full year. The county is among four– including Sacramento, San Bernardino and San Diego – that deployed SB 43 this year. San Francisco and San Luis Obispo counties implemented it at the start of 2024. The remaining 52 counties have until January 2026.

Critics of SB 43 said broadening the “gravely disabled” definition has the potential to place many more people into forced conservatorship, which severely limits their civil liberties. Groups like Human Rights Watch and Disability Rights California also worry that involuntary holds would skyrocket across the state. 

But Mora said that has not played out in practice, so far. He said data from San Francisco and San Luis Obispo show an initial increase in 5150 holds, but that numbers leveled off by year’s end. 

State law allows 5150 holds, which can be initiated by law enforcement or medical and mental health professionals, if people meet one of three criteria: danger to themselves, danger to others or gravely disabled. The 72-hour holds are the first step to possibly longer term holds, including 14-day 5250 holds all the way to permanent conservatorship.

Local law enforcement officials also said they were not expecting a sharp increase in their 5150 holds because of the new criteria. Representatives from the Modesto Police Department, among other Valley agencies, were part of the county stakeholder meetings on SB 43 over the past year.

Modesto Police Lt. Michael Hammond said officers already regularly make in-the-field evaluations on 5150 holds and adding the substance abuse is another part of the criteria. 

“It’s one more tool in our tool belt, but then again it’s just an application for a hold, and we still have to take them to the hospital,” said Hammond. “They still have to be seen by medical staff and mental health staff, and so I don’t expect to see a rise in holds based on that.”

He said all patrol officers participated in two days of training on the new definitions, and received new forms for 5150 hold applications. 

Local health providers, including those who manage regional hospitals were also part of the county stakeholder meetings. A spokesperson for Sutter, which has a large footprint in Stanislaus County and operates Memorial Medical Center, said along with updated training and resources the organization has hired additional substance-use-treatment navigators for its emergency departments.

But Sutter officials said, based on early data, they also are not expecting an influx of new 5150 holds at the hospital. 

Mora said this is because, while the definition may have expanded, the most affected populations often already have a combination of both mental health disorders and substance abuse. 

“It’s actually very common to have both a behavioral health disorder and a (substance use) disorder,” said More. “The estimates are something around half of folks, if you have one, you have the other – and vice versa. So we’re already serving these folks.”

Full Article & Source:
County begins ‘unprecedented’ forced care

Abdicated Authority: How We Fail Conservatees

Author(s): Nicolas Badre, MD,Alex V. Barnard, PhD 

Key Takeaways

• California's homelessness crisis and misuse of conservatorship highlight the complexities of involuntary psychiatric care, with recent legislative efforts expanding treatment criteria.
• The debate on involuntary treatment focuses on balancing life-saving care and civil liberties, with both sides agreeing on the importance of law application over wording.

SHOW MORE

How can we ensure an accountable, effective, and limited conservatorship system? Here are some actionable concepts.

BillionPhotos.com/AdobeStock

States began reforming their laws on involuntary mental health treatment to put an end to indefinite commitments 70 years ago, yet there is still no consensus on when involuntary treatment works, for whom, and to what it is needed. The binary debate on the necessity or harm of involuntary treatment has often overshadowed pragmatic solutions. Here we focus on actionable concepts that involve a greater role for government in ensuring an accountable, effective, and limited conservatorship system.

California encapsulates many aspects of the broad debate concerning involuntary psychiatric care. The state faces a significant homelessness crisis, characterized by political desires to utilize mental health services to address the perceived nuisance of homeless individuals, particularly those using substances in public. It is also notorious for controversies surrounding the misuse of conservatorship to restrict liberties, as highlighted by the high-profile case of Britney Spears,¹ and farther back by the case of Brian Wilson.²

In recent years, the state has moved aggressively to expand the use of involuntary treatment. As Governor Gavin Newsom declared, “We know what it takes to help people with mental illness out of the shadows and out of encampments—housing and treatment. It’s time to go big and reform the system.”³ This vision is exemplified by Senate Bill 43 in 2023, which made substance use disorders eligible for conservatorship and expanded the definition of “grave disability”—the key criterion for conservatorship—to include an inability to provide for personal safety and medical care (alongside food, clothing, and shelter).

Diagnosing the Problem

Proponents of expanding involuntary treatment argue that it provides life-saving care for individuals who are unable or unwilling to consent to treatment, and who might otherwise wind up incarcerated, homeless, or dead. Opponents argue that forced treatment is traumatic and that the needs of individuals with serious mental illnesses are best met through voluntary services, independent housing, and peer supports. Both sides of this debate, however, seem to agree that the specific wording and structure of commitment laws is impactful and worth fighting over.

We argue that problems in the current conservatorship system are more related to implementation than the wording of the law. The landmark Supreme Court decision in O'Connor v Donaldson (1975) established that the state “cannot confine a non-dangerous individual who is capable of surviving safely by himself or with the help family or friends.”⁴ Yet law enforcement, inpatient psychiatrists, judges, and public guardians define “grave disability” differently.

Emphasis should be placed on the consistent and fair application of current laws. Multiple attempts at changing conservatorship laws in California have had little impact. The vehement debates about precise wording of involuntary laws are less important than how they are applied by stakeholders, “you would be hard-pressed to find anything resembling a strategy for how judges, clinicians, or bureaucrats should be using the law as written.”⁵

Each of the actors involved in the continuum of conservatorship can effectively block someone from advancing on the pathway to the conservatorship, none of them can ensure that a person who needs it gets it or ensure that other actors deliver quality care. Furthermore, the fragmentation hinders adequate evidence to be disseminated rendering each participant with inadequate information to evaluate the need for conservatorship.

While conservatees are legally required to be in the least restrictive setting, many linger inappropriately in locked facilities because step-down programs are mostly private and screen out those with criminal justice history, substance use, or comorbid medical issues.

Because of a lack of state guidance or evaluation, there are no clear outcome measures for conservatorship, meaning that conservatees in some counties of the state rapidly cycle on and off conservatorship while others are left on conservatorship, with the important civil liberties restrictions it entails, for life. These problems stem not from commitment laws but the way the state has effectively “abdicated authority” over them: declining to use its regulatory and financial levers to provide direction to the conservatorship system.

Proposals for Improvement

Data Collection

While both sides agree the current system is dysfunctional, we lack the basic data needed to assess the nature and scale of that dysfunction. Lee and Cohen highlighted significant limitations in the reporting of civil commitment across the United States, finding that only 25 states offered a publicly-available count. As they point out “without accurate incidence estimates, links to potentially contributing and consequent factors of civil commitment cannot be reliably assessed.”⁶ It is antithetical to science to discuss the necessity of more or less civil commitment without knowing how much civil commitment is currently being performed and for what reasons. An absence of baseline data also makes it impossible to assess whether changes to commitment laws actually change the number of commitments, much less improve outcomes.

Oversight Enhancement

Clinicians often resist oversight, fearing their expertise and morality are under scrutiny. Clinicians in California are familiar with vigorous public defenders representing clients in conservatorship hearings who challenge their diagnosis, the veracity of hearsay from family members, and the treatment team's ability to predict the future. However, oversight could encompass various aspects that benefit both providers and the people they serve, such as:

• Providing training and guidelines to ensure that the multiple actors in the conservatorship system (physicians, law enforcement, judges, public guardians) define criteria in a way consistent with evidence about who is most likely to benefit from conservatorship.
• Ensuring that local mental health departments provide adequate reimbursement to ensure that mandated services are available for individuals under conservatorship. Without such measures, private hospitals are deincentivized to adequately treat individuals.
• Counterbalancing reimbursement, for-profit programs must be overseen to curb excess on the inappropriate use of involuntary programs. Recent reporting shows how major hospital chains twist criteria to extend inpatient stays.⁷
• Safeguarding against for-profit programs selecting only the most cost-efficient admission by creating requirements of admission or providing a safety net of public institutions.

When California closed its Department of Mental Health in 2012, it left a significant oversight void that remains unaddressed. The state needs to have dedicated leadership specifically focused on regulating the conservatorship system.

Funding for Appropriate Placements

Contrary to popular folklore, California has a high rate of involuntary treatment—nearly 500 involuntary holds per 100,000 annually compared to less than 200 in Texas,⁶ or European countries like France and England.⁸ Despite this, the state only had about 5000 conservatorships in 2018,⁹ compared with over 100,000 individuals on emergency holds that year. The real bottleneck is not the availability of acute psychiatric beds, then, but placements afterwards. Locked, sub-acute mental health rehabilitation centers are in such high demand that they can afford to be selective, leaving many patients without placement options. Patients are thus subjected to either inappropriate, long-term hospital stays or discharged rapidly, contributing to the revolving door phenomenon. Focusing investments to ensure patients can step down to less restrictive levels of care can avoid both the expense and civil liberties concerns of expanding inpatient placements.

Concluding Thoughts

Seventy years ago, societal measures led to the closure of state hospitals and a shift in the care of individuals with severe mental illness. Today’s system relies heavily on short-term involuntary holds without effectively transferring patients to lower levels of care, resulting in high readmission rates. The current fragmented, complicated, and unregulated system fails to achieve the goals of both proponents and opponents of involuntary treatment. In other domains, like corrections, such poor data and oversight would be deemed unacceptable. Ultimately, the states have failed to fulfill their roles by “abdicating their authority” and leaving implementation up to individual courts, hospitals, and clinicians. Effective measures to increase accountability would benefit both sides of the debate on involuntary care.

Dr Badre is a clinical and forensic psychiatrist in San Diego. He teaches medical education, psychopharmacology, ethics in psychiatry, and correctional care. Dr Badre can be reached at his website, BadreMD.com. Dr Barnard is an assistant professor of sociology at New York University. His research examines decision-making in public mental health care in France and the United States.

Full Article & Source:
Abdicated Authority: How We Fail Conservatees

Letter: Public guardian failures

Letters to the Editor 

 

By Dr. Madeleine Grant

Updated: December 14, 2023

The tragedy of the Office of Public Advocacy to provide adequate public guardians may seem abstract to many, but affects us all - as it contributes to homelessness.

Bear in mind that some of the most visible and troubled unhoused people would benefit from a guardian, because of severe mental illness and/or cognitive impairment. As a doctor who works with some of them, I suspect that we need more, not fewer, guardians.

The recently reported failure of a private guardian led to some of his clients losing housing or benefits. This is how people end up on the street.

There are many reasons for the increase in unhoused citizens, but the failures of Alaska’s safety net - the prolonged loss of food stamps, lengthy delays getting on Medicaid, and the multiple Medicaid disenrollments - certainly contribute.

The Anchorage Assembly and Mayor Dave Bronson are correct in calling for the state government to help the city with its homeless crisis. Fixing the shameful holes in our safety net would help.

— Dr. Madeleine Grant

Anchorage

Source:
Letter: Public guardian failures

Conservatorship bill signed into law with goals to fix homelessness issue in California

Senate Bill 43 will assign a conservator to someone unable to care for themselves, including those with severe substance abuse issues or mental health issues.

Author: Jeannie Nguyen

SACRAMENTO, Calif. — Governor Gavin Newsom signed a new bill into law that would make mental health treatment mandatory, which is an effort to address the ongoing homelessness issue. However, some advocates said the bill is not the right move to solving the problem.

Senate Bill 43 was authored by Senator Susan Eggman. She said this is the state moving in the right direction when it comes to fixing homelessness.

"Now we're gonna have a lot more tools to be able to actually help folks," said Senator Eggman (D) of San Joaquin County.

The bill works off of a previous law that would appoint a conservator to anyone unable to provide for their basic needs because of a mental health disorder. SB 43 would also include people with severe substance abuse or serious mental health issues. Senator Eggman said this is slightly different than CARE Court, which makes treatment optional.

"Being able to hold somebody against their will and then the 5250, holding them for maybe up to two weeks, then the potential month and then potentially being conserved for a longer period of time," she said.

Among the bill's supporters is Sacramento Mayor Darrell Steinberg.

"If the choice is using the law to make sure somebody gets help or leaving them out on the streets to be to be subjected to the worst kinds of conditions, and to be a danger to themselves or to other people, the choice is real clear to me get the person help," said Mayor Steinberg.

However, advocates like the Sacramento Regional Coalition to End Homelessness (SRCEH) said this is a violation of people's civil rights, impacting those minority communities most.

"It would disproportionately impact, particularly, African American and indigenous people experiencing homelessness," said Bob Erlenbusch, executive director of SRCEH.

Senator Eggman said civil rights won't be violated and that nothing changed in the due process. The only difference is the criteria when someone is being evaluated for treatment.

"It is my responsibility to try to make things better for Californians," Eggman said.

Full Article & Source:
Conservatorship bill signed into law with goals to fix homelessness issue in California

Disabled Veteran Gets Ultimatum – Get Rid Of His PTSD Support Dog or Get Evicted

By Monica P

Many war veterans experience difficulties getting used to the life they had in their home country. Sadly, some of them suffer from Post Traumatic Stress Disorder (PTSD) and need the help of service dogs to cope with the state of desperation they find themselves trapped in.

Willie Williams is a 73-year-old veteran who served in the Vietnam war. Currently, he resides at the Freedom’s Path on the Chillicothe VA Medical Center campus in Ohio. But as it turns out this place isn’t really pet friendly.

Just recently, Willie got an anonymous letter that turned his world upside down. Using some harsh words, he was threatened to leave the place.

“Willie, it’s time for you and your dog to go. You will no longer be tolerated. Move out.”

But it didn’t stop there. Shortly after, the campus authorities sent him an official letter asking from him to choose between his service dog Diamond, or his apartment.

Apparently, someone saw Diamond walking inside the campus without her leash, which Willie says was just a one-time occurrence.

Struggling with depression, loneliness, and isolation, Diamond is his only friend and companion and he can’t imagine his life without her.

Without seeing a way out from the unenviable situation, Willie turned to the media for help. But the campus’ lawyer was straightforward regarding this veteran’s case. Unless he gets rid of Diamond, he can no longer stay in the campus.

As he isn’t planning on abandoning his loving dog, Willie faces homelessness in the weeks to come.

“This is not a spot and place I want to be in right now in my life. Like I said, at my age, I don’t know how much time I got. All I want to do is live and let live”, he said in a heartbreaking statement.

Please take a minute of your time to share Willie’s plea for help. Let’s spread the word and demand fair treatment for both him and Diamond.

Full Article & Source:
Disabled Veteran Gets Ultimatum – Get Rid Of His PTSD Support Dog or Get Evicted

California governor seeks to expand involuntary treatment

California's governor wants to make it easier for the government to force psychiatric treatment for people with mental illness.

By DON THOMPSON

SACRAMENTO, Calif. (AP) - Gov. Gavin Newsom wants to make it easier for the government to force psychiatric treatment for people with mental illness and expand statewide a still-developing test program that allows officials to more easily take control over those deemed unable to care for themselves.

In a State of the State address Wednesday devoted almost entirely to the issue of homelessness, the Democratic governor said the state should broaden those laws “within the bounds of deep respect for civil liberties and personal freedoms - but with an equal emphasis on helping people into the life-saving treatment that they need at the precise moment they need it.”

Newsom drew support from members of both political parties. But civil libertarians have concerns, while advocates for the mentally ill warned that proper services must be in place and voluntary options exhausted first.

”We often look too quickly to getting individuals off the street involuntarily without assuring that the resources are available, the treatment is available first. And I think the governor candidly acknowledged that in his address," said Curtis Child, legislative director at Disability Rights California.

San Francisco, with one of the nation's most visible homeless populations, is on the verge of trying a new conservatorship program to allow court-ordered mental health treatment for people deemed incapable of caring for their own health and well-being because of serious mental illness or drug addiction.

Temporary conservatorships could be triggered with an individual's eighth 72-hour involuntary mental health hold in a 12-month period. Such commitments are commonly called “5150s," after the legal code section for detaining someone considered to be a danger to themselves or others due to mental illness.

Under the program, a 28-day temporary conservatorships could be followed by six-month programs in which judges could order patients to receive treatment. If they can't be treated at home, they could be ordered into community-based residential care facilities.

San Francisco is “very close” to having the five-year test program running after creating new processes and safeguards in coordination with providers and the courts, said Jeff Cretan, a spokesman for Mayor London Breed.

"That's an important, thoughtful process we have to go through because these are people’s civil rights we’re talking about,” Cretan said.

Newsom said California should allow every county to establish similar so-called housing conservatorships. They are different than longstanding probate conservatorships, in which a judge appoints a guardian for an adult who is unable to care for himself or herself.

“I am thrilled that the governor understands that it is not compassionate, it’s not humane, it’s not progressive to let people unravel and die on our streets," said state Sen. Scott Wiener, a Democrat from San Francisco who wrote two related laws creating the test program. “There are people on our streets who are so severely debilitated with mental health and eviction challenges that they cannot accept voluntary services and we have to help them.”

Opponents to his legislation included the ACLU of California, Western Center on Law and Poverty, and Disability Rights California, which were concerned it didn't do enough to respect individual rights, and the California Public Defenders Association, which feared it could “sweep many more people into the civil commitment system.”

The governor also called for removing some of the conditions for counties to implement what's know as Laura's Law, which lets service providers and loved ones ask judges to force recalcitrant people into outpatient mental health treatment programs.

It is named after 19-year-old Laura Wilcox, who was fatally shot with two others at a Nevada County mental health clinic in 2001 by a man who had refused psychiatric treatment.

Newsom said the law currently is too hard to use, but his office could not provide more details on what he wants to see changed.

Republican Sen. John Moorlach of Costa Mesa, who also proposed an involuntary commitment bill that died last month, applauded Newsom's proposals.

“We as a state shut down our mental health institutions and the patients migrated to the streets and to the jails,” Moorlach said, calling current conditions inhumane.

Then-Gov. Ronald Reagan in 1967 outlawed lifetime commitments for those deemed mentally ill, while the U.S. Supreme Court in 1975 ruled that mental illness alone is not enough to justify involuntary commitments.

The governor said all his other proposals hinge “on an individual being capable of accepting help, to get off the streets and into treatment in the first place.”

“Some, tragically, are not,” he said while advocating “better legal tools" to “help people access the treatment they need.”

Senate President Pro Tem Toni Atkins, D-San Diego, said the Legislature would need to take a “cautious approach" to some proposals, including making it easier for local governments to force the mentally ill into treatment.

Full Article & Source:
California governor seeks to expand involuntary treatment

The New Face of Homelessness: Elderly and Disabled

The story of three brothers evicted from their family home show the difficulties this population faces in the East Bay.

by Jade Yamazaki Stewart

William & Darryl Patrick are living on the street in front of their former home.

The Patrick brothers lived in their family home on Berkeley's Evelyn Avenue for most of their lives. Their parents bought the house in 1953, before the brothers were even born. They played Little League at a local elementary school, and attended Berkeley High. But Darryl and William struggled with mental disabilities and could not live on their own. Meanwhile, Frederick began suffering from congestive heart failure in his forties, which made it hard for him to live independently. In 2015, all three brothers were living with their mother. But then she died — and the family began fighting over her estate.

Now the brothers, all of whom are around 60 years old, live in a recreational vehicle on the street in front of their old home. In August, Berkeley police evicted William and Darryl from the house and nearly arrested them for trespassing. They were living there illegally after an earlier May eviction ordered by their brother-in-law, who ended up managing the property.

"We'd been living in the house our whole lives," William said recently. "We're really irate about getting kicked out of our home."

Plywood boards now cover the windows of their vacant house, which the brothers still partly own. The locks have been changed so that they cannot enter. A green plastic wreath decorated with red ornaments still hangs above the home's doorway from last Christmas.

Neighbors managed to convince the police to let the Patricks stay in the RV. But the motor home is badly insulated and doesn't have a functioning bathroom or kitchen, and the brothers are regularly awakened at night by cars speeding by.

Many elderly people become homeless under similar situations. "Disabled adults often become homeless when their caretakers pass away," said Elaine de Coligny, executive director of the homeless advocacy group EveryOne Home.

Disabled homeless people are extremely common in the Bay Area and less likely to find new housing than other homeless people. And elderly or disabled people suffer more serious health consequences from living in the street than their younger, healthier counterparts.

EveryOne Home estimates that 42 percent of the 8,000 people who are homeless at any given time in Alameda County have a disability. The numbers are even higher in Berkeley, which is a mecca for the disabled due to its role in the birth of the disability-rights movement. Some 68 percent of the 2,000 people who annually experience homelessness in Berkeley are disabled, according to a city report. Analysis conducted for the report concluded that having a disability of any kind increased the likelihood that someone would remain homeless by 733 percent.

People over the age of 50 already make up around half of homeless in the United States, according to Dr. Margot Kushel, a professor of medicine and director of UCSF's Center for Vulnerable Populations. And the percentage of homeless people over 50 is projected to keep rising until 2030, with the homeless population older than 65 expected to triple.

Kushel has conducted research following 350 people over the age of 50 who were homeless in Oakland in 2015. Nearly half had never been homeless before they reached that age. Unlike younger people, whose homelessness is normally tied to a long history of issues, Kushel found that people who started living in the streets later in life could often trace their homelessness to a single event. Common causes of homelessness included losing a job, having a family member or roommate lose a job, or having a family member die. Many became homeless after an elderly parent's death led to them being forced out of their family homes. Family disputes over estates were often involved.

Because seniors like the Patricks often receive fixed retirement incomes that do not increase along with rising housing prices, many people who become homeless after age 50 cannot afford new places to live, noted Leslie Gleason, director of programs for Shelter Inc., a group that fights to end homelessness in the Bay Area.

When the Patrick's mother died, she was survived by Darryl, William, Frederick, and their sister, Annette Olsen. Carmel Patrick died without a will, so Annette successfully petitioned to become her administrator in June 2017. Then Annette died in April 2018, and her husband, Michael Olsen, succeeded her as administrator. Frederick unsuccessfully objected in court to both administrations.
In April 2019, Michael hired lawyer Richard Palenchar and sought to evict the brothers from the house. A lawyer representing the brothers without pay objected on their behalf. "Defendants Patrick are senior citizens and not in good health," Elaine Videa wrote. "Evicting them out of their home would cause severe hardship, further injuring their health, and cause severe emotional distress." But the court ordered the brothers to vacate the property by May 14.

Frederick was in the hospital at the time, but William, Darryl, and their terrier Honey Bear started living in a Ford SUV in front of the house. Then they drove the car to Ukiah and lived in it for a couple of weeks in June. But William drove off the side of the freeway one night, totaling the car and landing himself and Darryl in a hospital. Honey Bear wound up in a dog pound. Darryl returned to Evelyn Avenue and started living there illegally, but William spent a month in an assisted-living facility in Sacramento. When Frederick was released from the hospital, he and Darryl immediately drove to Ukiah to retrieve Honey Bear from the pound.

By the time of the second eviction, Frederick was back in the hospital being treated for symptoms of his congestive heart failure. Following his Sep. 6 release, he joined his brothers in the RV, where they have now been living with Honey Bear for around a month.

"I just don't know how long we're going to be out here in this thing," William said.

The brothers' disabilities, like those of thousands of other homeless people in Alameda County, make their lives especially difficult. William was born premature and oxygen-deprived. Their father, who had head injuries from World War II, punched William in the left eye when he was nine or 10, according to a letter from the Social Security Administration. The following year, a neighborhood bully hit William in the side of the head with a rock, causing injury and trauma. Their father also shook Darryl when he was an infant, causing brain damage, according to Frederick. Darryl is also diabetic.

Frederick has been suffering from congestive heart failure for 20 years. This causes edema, accumulations of liquid in his legs. His calves are swollen, purple, and have holes in them where his skin has burst from the pressure. Liquid oozes out of the holes, and he has to change his bandages every day. This is difficult in the cramped space of the RV.

None of the brothers have money right now, and their mother's estate consists solely of the house, which hasn't been sold. So concerned neighbors like their former next-door neighbor Douglas Walters have been helping the Patricks by bringing them meals and other necessities. Walters keeps a cooler in the RV stocked full of ice for storing food. He gave the brothers a water tank so that they could take sponge baths and do dishes.

"These were guys that I was going to see laid out on the street in fairly short order," said Walters, who has lived next to the Patricks for 23 years, and used to chat with their mother over the fence. "I didn't think it was anything they deserved by any means."

He worries that Darryl and William's stint in Ukiah shows what might happen to them without help.

Meanwhile, neighbor Andrea Henson brought the brothers' case to Osha Neumann, a lawyer with the East Bay Community Law Center who specializes in homelessness. Neumann and Henson have been working to find an assisted living situation for the Patricks, but haven't had any luck.

Elderly and disabled homeless people often can't live independently and need assisted living situations, which are becoming scarce and expensive in the Bay Area. Between January 2016 to August 2019, dozens of residential care facilities for the elderly closed in Alameda County, according to Dr. Robert Ratner, the housing services director at the Alameda County Health Care Services Agency. The remaining facilities normally cost more than $4,000 per person per month to stay in, Ratner said.

Such facilities have all but disappeared in the Bay Area, Kushel said, because rising housing prices have made them economically unfeasable. The brothers said that when they looked into finding board and care houses to stay in, they were told that the only one available was in Sacramento, and that the wait period for entry was three to five years.

That long being on the street could kill an elderly person in poor health. "The very experience of being homeless makes chronic health conditions worse because it makes it hard to get prescriptions, go to the doctor and get to appointments," Shelter Inc.'s Gleason said.

Neighbors have called various social service organizations, so far to no avail. Despite the brothers' obvious health issues, Adult Protective Services evidently doesn't consider them dependent adults because they don't have enough documented physical and mental disabilities to qualify.
As a mother of a 24-year-old with mental disabilities, Gleason is worried about what will happen when she dies and her son is left on his own.

"We see what's happening to 60 and 70 year olds now, and we're afraid," Gleason said. "We're scared to death about what's going to happen to our kids."

In spite of it all, the brothers are luckier than most homelwess people in the East Bay because they have support from friends, Neumann said.

"Imagine how hard it would be for a homeless person without a phone, a computer or a permanent address to get the help they need," he said. "Know that the difficulties we are facing in trying to help the brothers are the same difficulties that homeless people face across the Bay Area and across the country."

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The New Face of Homelessness: Elderly and Disabled

More older adults spending ‘golden years’ in homelessness

After a lifetime of working hard, Linda Boamah thought she was setting herself up for a comfortable retirement.

But the former optical-lab worker became ill with multiple chronic conditions in 2014 and in less than two years lost everything, including her house, life savings and pride.

"I couldn't work anymore because I got congestive heart failure, COPD (chronic obstructive pulmonary disease) and am diabetic," said the 62-year-old East Side resident. "The money I had saved up was quickly depleted, and I was terrified."

Thankfully, a friend stepped in and offered Boamah a room to sleep in, sparing her from becoming part of the growing population of seniors living on the streets and in shelters.

About half of the homeless in the United States are people 50 or older, studies show. The number of older homeless adults is projected to increase by 33 percent in the next decade and double by 2050.

"We're at the beginning of the wave and have an opportunity to not only improve the quality of life of these homeless and formerly homeless elders, but also extend their lives," said Katrina Van Valkenburgh, central region managing director for CSH, also known as the Corporation for Supportive Housing.

The average life expectancy for a homeless older adult is 63 years, compared with 80 for someone who always has had stable housing, she said.

Leaders from across the Midwest are meeting in Columbus this week to talk about helping this aging homeless population get into and keep affordable housing. The two-day event is hosted by CSH and National Church Residences, which specializes in low-income and affordable senior housing.

It kicked off on Tuesday with a tour of two supportive housing properties owned by National Church Residences. Today, housing experts from across the country are meeting.

Aging adults who have been homeless experience chronic illnesses and geriatric conditions 15 to 20 years earlier than the general population, said Dr. Margot Kushel, a professor of medicine at the University of California-San Francisco who followed 350 homeless people in Oakland, California.

Although the median age of the participants was 58, they had more trouble bathing, dressing and eating than many in their 70s, 80s and 90s, Kushel said. They also had a harder time using transportation, taking medication, managing money, applying for benefits and arranging job interviews.

One answer is creating more affordable and supportive housing — the theme of today's gathering. Supportive housing complexes provide tenants with tailored services such as life-skills training, alcohol and drug abuse programs and case management so they can have more stable, productive lives.

After six months of living with her friend, Boamah was able to secure an apartment in June at National Church Residences' Commons at Third near Grandview Heights.

"I was so worried before about what was going to happen to me that I was making myself even more sick," she said. "I love my new home. It's peaceful and quiet."

Though supportive housing has been available for people who have been homeless or have struggled with addiction or mental illness for decades, they need to be adapted to the unique needs of older residents, Kushel said. Rooms, for instance, need good lighting and grab bars in the bathroom. Many residents also could use personal-care attendants to help them bathe and get dressed.

Leon Williams, 63, of the North Side, said if it weren't for the supportive services at Commons at Third, he'd probably still be living in a nursing home, where he landed in 2009 after falling and dislocating his shoulder. He remained there for six years because of prostate cancer, a knee replacement and a spinal condition that forced him into a wheelchair.

"Unlike the nursing home, I can come and go when I please," he said, adding that he enjoys eating at the many restaurants near his new home.

After two bouts of homelessness, mostly recently in 2005 after a difficult divorce that led to substance-abuse problems, Jerome Johnson, 47, of the West Side, said he's glad to have found permanent supportive housing at another National Church Residences property, Commons at Buckingham, while he is still relatively young and healthy.

"It took me a lot of work and paperwork to get here, and I'm never leaving if I can help it," he said.

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More older adults spending ‘golden years’ in homelessness