Perspectives

Yes, in My Backyard

Learning from Other Cities, Los Angeles Tries a New Line in Response to Homelessness

“I’d like to share a story,” said Paul Koegel, associate director of RAND Health. He aimed to set the proper tone for a RAND policy forum on homelessness in Los Angeles and on the lessons the city could learn from other cities dealing with homelessness around the country.

“A woman lives in a small village by a river,” he continued, as if depicting the historical core of Los Angeles. “Every day, she goes down to the river to get water. One day, as she is drawing water from the river, she sees baskets of babies floating by. She begins trying to rescue the babies and calls to the other villagers for help. Soon, she and the other villagers are so busy taking the babies out of the river and trying to care for them that no one thinks to hike upstream to find out how the babies are getting into the river in the first place.”

With this allegory, Koegel illustrated the problem of homelessness in Los Angeles. Until recently, he explained, those who have taken it upon themselves to try to assist the city’s enormous homeless population have “simply had their hands too full to stop and consider where the homeless are coming from” and what is causing their ranks to swell. Los Angeles finds itself years behind many other U.S. cities in addressing the homelessness problem. However, the sheer magnitude of the city’s problem has captured the rest of the nation’s attention.

“Los Angeles is the nation’s homelessness capital.” — Tori Osborne, special adviser to Los Angeles Mayor Antonio Villaraigosa

The purpose of the policy forum was “to hike upstream” to discover what has kept Los Angeles behind and what it must start doing to catch up. In general, the panelists agreed that the problems in Los Angeles stem not only from a housing shortage and the inability of some people to compete for a limited number of housing units, but also from the difficulties of coordinating efforts across multiple government jurisdictions and of providing the homeless with services that can help them remain in long-term housing.

Other forum participants were Suzanne Wenzel, a RAND senior behavioral scientist who specializes in research on homeless women and adolescents; Tori Osborne, a special adviser to Los Angeles Mayor Antonio Villaraigosa; and Ed Edelman, former Los Angeles city council member, retired Los Angeles County supervisor, creator of the Los Angeles Homeless Services Authority (LAHSA), and now homelessness “czar” for the City of Santa Monica.

A Frayed Social Fabric

On any given day, some 90,000 men, women, and children are homeless in Los Angeles, according to Osborne. “Los Angeles is a city with 262,000 millionaires, not counting the value of their homes. And in any given year, some 240,000 individuals cycle in and out of homelessness, living at least some time in their cars, on the street, or in a shelter, by far the largest number of any city in the nation,” she said. “Los Angeles is the nation’s homelessness capital.”

AP IMAGES/RIC FRANCIS   Monique Romero, 30, who resides with her cousin on Skid Row in Los Angeles, says many mental patients are illegally dumped there. Ten Los Angeles hospitals have been accused of discharging homeless patients to the streets of Skid Row rather than to a relative or a shelter.

Los Angeles is also the only major city in the nation that has had no coordinated, long-term plan to address homelessness, Osborne admitted.

In the 1960s, homelessness was not a visible problem in Los Angeles. But by the mid-1970s, the number of homeless on the city’s streets had risen noticeably because of several changes in the fabric of society.

One change in urban areas such as Los Angeles was the closure or relocation of factories, resulting in the loss of thousands of manufacturing jobs for both skilled and unskilled laborers. Coupled with the loss of jobs — and especially influential in the Los Angeles area, according to Wenzel — has been the city’s notorious shortage of affordable housing, worsened by the gentrification of formerly affordable neighborhoods. “Homelessness is the extreme result of poverty,” Osborne concurred.

Another important change by the mid-1970s, not just in Los Angeles or California but across the country, according to Edelman, was the closure of state mental hospitals (partly based on the belief that the state did not have the right to institutionalize the mentally ill, with or without their consent, and probably used also as a cost-saving measure). However, no steps were taken in California to ensure that those released from its hospitals would receive regular medication, follow-up care, or assistance in finding housing or jobs.

Thus, many ended up on the street. Osborne estimated that 35 percent of the homeless people in Los Angeles today are mentally ill. “Homeless people need all the services other poor people need and usually more,” she said.

Wenzel reminded the audience that the public’s perception of the typical homeless person remains that of an alcoholic male. However, the face of homelessness in Los Angeles and around the nation has been changing over the past 20 years. By the late 1990s, some one-third of homeless adults were women, she said, and many of the women had young children.

Only in L.A., Sadly for L.A.

Los Angeles is not the only U.S. city to have experienced an affordable housing shortage, the loss of manufacturing jobs, and deinstitutionalization. The draw of the mild year-round climate might account for part of the unusually large homeless population in the city. But what truly distinguishes Los Angeles from other cities is its failure to have addressed the problem in any concerted way, and many attribute this failure to the complex division of social services between the City and County of Los Angeles.

What truly distinguishes Los Angeles from other cities is its failure to have addressed the problem in any concerted way, and many attribute this failure to the complex division of social services between the City and County of Los Angeles.

The division of responsibilities and funding for the homeless between the city and county is “the single greatest contributor to the failure of the region to address the problem effectively,” said Osborne. Historically, funds for affordable housing have flowed through the city, whereas supportive services, such as health care and job training, have been funded entirely by the county. The division spurred suits and countersuits between the city and the county in the 1980s.

In 1993, former Los Angeles Mayor Tom Bradley helped then-supervisor Edelman create LAHSA, a joint endeavor between the city and county. However, the agency has lacked the authority to address the multiplicity of thorny issues underlying homelessness, said Edelman.

Compounding the lack of coordination, he explained, is that Los Angeles County comprises not just the City of Los Angeles but also 87 other, smaller cities, including Santa Monica and Beverly Hills, two of the nation’s wealthiest, and Compton and Wilmington, among the poorest. The county is the nation’s most populous, with more than 10 million people spread across more than 4,000 square miles.

“LAHSA could be much more than it is today, more preeminent,” said Edelman. “We need a structure to coordinate all homeless activities, and hopefully LAHSA will be given additional powers and will bring in the other cities with homeless populations to collaborate, to develop a regional approach. We’re trying to help move the collaboration we need in this region, because one government can’t do it alone.”

The Costs of Doing Nothing

Edelman quickly dispelled the notion that the failure of the county and cities to spend more money on fighting homelessness in Los Angeles is saving taxpayers money. He cited the example of one chronically homeless man, “Million-Dollar Murray,” whose unmet needs for mental health care and shelter, as itemized in a seminal New Yorker magazine article, ended up costing the city of Reno, Nevada, over $1 million.

“In addition to mental health and drug treatment services,” Edelman explained, “the homeless often incur the services of paramedics, fire and police departments, and hospital emergency rooms, not to mention city services and jail staff, all at significant cost. When the problem is viewed this way, it is easy to see that providing appropriate care would be less costly” than the current practice.

“It’s not just a compassion issue. It’s a dollars-and-cents issue. The public doesn’t see homelessness very often, but we’re all paying the price.” — Ed Edelman, retired Los Angeles County supervisor

“It’s not just a compassion issue,” Edelman asserted. “It’s a dollars-and-cents issue. The public doesn’t see homelessness very often, but we’re all paying the price.”

Wenzel agreed that the need for housing is only the beginning. It is accompanied by an equally critical need for services to help people with problems such as poor education, hunger, substance abuse, sexually transmitted diseases, and mental disabilities.

Koegel and Osborne emphasized the need for “permanent supportive housing” for the homeless. Permanent supportive housing consists of long-term housing complete with staff who can guide the formerly homeless to food, physical and mental health treatment, substance abuse treatment, job training, day care, and support to help find and keep a job.

Shelters sometimes try to provide some of these services, but “where they fall short is in their very mission,” said Osborne. By definition, shelters are intended to provide not a home but a temporary place to stay. Because the stays are limited and often for emergencies, the shelters cannot address the complex long-term needs of the residents or ensure that they take their medication, stay off drugs, follow through with job training, and care for their children. “What is needed,” said Osborne, “is a fundamental paradigm shift from an emergency response and shelter mentality to permanent housing.”

Much to Learn from One Another

The panelists discussed various efforts over the past decade to address homelessness in Los Angeles. For example, some of the largest efforts have been faith based. Religious organizations run many of the area shelters and have been at the forefront of an effort to decentralize the shelters that are currently concentrated in the Skid Row area of downtown by creating shelters in each of the five supervisorial districts that make up the county.

What is needed is a long-term consolidated effort by a coalition of governmental, religious, business, and residential organizations, all of which have much to gain from solving the homelessness problem. In this regard, Los Angeles could learn a lot from other U.S. cities.

But given the magnitude and complexity of the problem, all four panelists agreed that what is needed is a long-term consolidated effort by a coalition of governmental, religious, business, and residential organizations, all of which have much to gain from solving the homelessness problem — and from one another’s support. In this regard, the panelists said Los Angeles could learn a lot from other U.S. cities, such as Atlanta, Cleveland, Dallas, Denver, Miami, New York City, Philadelphia, Pittsburgh, San Diego, and Seattle.

Osborne, who had visited New York City “to learn from their mistakes” as well as their successes, outlined a three-step strategy based on the New York model and since approved by the Los Angeles mayor. The strategy is to provide adequate funding and authority for LAHSA; to formulate a ten-year plan to develop permanent supportive housing, complete with a permanent funding source for the city’s affordable housing trust fund and with support from business, faith-based, and other organizations; and to build the public will needed to overcome the pervasive “not in my backyard” attitude that has helped to keep the homeless concentrated on Skid Row rather than integrated into outlying communities. Doing so will take the combined efforts of business, religious, and other groups, said Osborne. Wenzel added that this effort will also require using education and evidence-based research to fight ignorance and fear.

DIANE BALDWIN   Regional collaboration is one key to reducing homelessness, according to Ed Edelman, left, creator of the Los Angeles Homeless Services Authority and homelessness “czar” for the City of Santa Monica. He joins Suzanne Wenzel, who conducts research on homeless women and adolescents; Paul Koegel, associate director of RAND Health; and Tori Osborne, special adviser to the mayor of Los Angeles.

Edelman described another initiative borrowed from New York and launched in Santa Monica, which has a disproportionately large homeless population of its own. The initiative replaces the use of some of the local courts in areas with dense homeless populations with community courts, in which specially trained judges refer homeless offenders to treatment or hand down sentences of community service instead of jail time. “We need these courts in areas with high homeless populations,” said Edelman, “so that judges can examine the underlying issues of homeless people accused of crimes and so they can get the kind of help they need.”

Audience members offered suggestions of their own. Susan Rabinowitz, a physician who works with homeless youth, said county administrators should rethink their current policy of emancipating youth from foster care at the age of 18, since “even the most privileged 18-year-olds generally lack the inner resources to succeed on their own.”

Paul Tepper, director of the Weingart Center Association, a nonprofit consulting firm that is helping LAHSA develop its ten-year strategic plan, offered three recommendations that he said could be implemented “immediately”: create more affordable housing by rehabilitating existing structures rather than relying entirely on new construction, identify the homeless most likely to be eligible for Social Security Disability Insurance and assist them with the application process, and increase the monthly allotment of general relief funds provided by the county to homeless individuals to help them afford housing.

The strategies contained in Mayor Villaraigosa’s plan and the recommendations proposed by the various experts offer Los Angeles an opportunity to catch up with other cities and, it is hoped, to avoid some of their mistakes. As Edelman put it, “We are all paying the costs, even though we don’t always see the homeless. We need to develop the public will to solve this problem. There are many pressing issues in Los Angeles, but homelessness has to be on the radar screen every day, because it’s too easy to put it out of sight and therefore out of mind.”