A newly diagnosed lung cancer patient asks her doctor what the recommended treatment is.
“I’m sorry,” the doctor says, “but we only treat late-stage cancer. Come back in a year when the cancer has spread and your prognosis is worse. We’ll do our best to help you then.”
That’s a crazy scenario. It would be irresponsible and life-threatening. And ultimately, it would make saving the patient’s life significantly harder and more expensive.
Unfortunately, that’s often how we deal with homelessness in Los Angeles. And it’s a big reason why the crisis keeps getting worse.
In our current homeless services system, people experiencing homelessness are interviewed, evaluated and ranked according to how vulnerable and sick they are, with those scoring the highest “acuity” getting highest priority for services and housing. The perfectly sensible goal is to house the people most at risk of dying. That is smart, humane and necessary. This approach requires comprehensive, long-term solutions. Most often, that means permanent supportive housing, which is a proven solution for the most vulnerable or chronically homeless, but very expensive and slow to build.
An unintended side effect of this approach is that the homeless services system provides relatively few resources to assist people who score lower on the vulnerability index, such as people who have been homeless for a shorter time, may still be employed, are younger, or do not suffer from disease or addiction. Such people are significantly easier and much less expensive to help. Some may simply require a short-term rental subsidy to get off the streets and stably housed.
Tens of thousands of unhoused people in Los Angeles do not have a high acuity score, do not require costly and permanent programs, and do not qualify for most services. Among people experiencing homelessness here, that includes nearly half of single adults, nearly 60% of families with children, and 65% of young people. Despite those huge numbers, quick and nimble approaches to help these people are largely underfunded.
I have met many people who say they want services and housing, but do not qualify because they are, essentially, “not homeless enough.” A community college student. A waitress. A retired nurse. A former engineer. When we turn them away, they live in their cars, or in tents, on sidewalks and under bridges.
Left homeless, they inevitably encounter trauma. They go without restful sleep. Their physical and mental health begins to deteriorate. Their belongings are stolen or seized. They may suffer physical or sexual assault. They may start relying on drugs to mask the pain. They suffer the shame and indignity of wearing soiled clothing, and of having to urinate and defecate in public. They may lose their job because of these circumstances. They grow accustomed to life on the streets. They keep growing sicker and more vulnerable until they are finally “homeless enough” to qualify for services or housing. And by then, we are racing to find them support before they end up like one of the more than 1,000 people who died on our streets last year.
This is illogical, counter-productive and maddening. While we spend more than a billion dollars to provide housing for the most vulnerable, we essentially operate a conveyor belt that leads people who are newly homeless into vulnerability, trauma and disease — and in dire need of the most expensive intervention. As long as we do that, the crisis will continue to get worse. The cancer will spread.
There are plenty of ways to prevent this. We can invest more heavily in short-term rental subsidies. We can promote and fund shared housing, where people share a home and a sense of community with others stabilizing their lives. We can sponsor family reunification efforts and programs like Host Homes, where families literally open their homes for a few months to someone getting back on their feet. New state funds proposed by Governor Newsom could potentially present an opportunity to do this.
We certainly can’t retreat from our commitment to house the most vulnerable, but if we want to make significant progress in reducing homelessness, we need to stop making people become more vulnerable before we help them. No one should be “not homeless enough” to help.