Confronted with the worst regional homeless problem in the nation, Los Angeles city housing officials hope to build thousands of heavily subsidized apartments for the most intransigent street people, placing them in buildings that will also offer medical care, counseling and job training.
That model, known as "permanent supportive housing," is not a novel one: Los Angeles County already has about 5,000 supportive housing units. But the approach has become increasingly popular among big-city politicians trying to find solutions for chronically homeless, people who have been on the streets for more than a year and suffer from a disability.
The county has one of the highest ratios of chronically homeless people in the nation -- about 34,500 of the total 88,000 homeless. In October, Mayor Antonio Villaraigosa announced a $50-million investment that will create about 300 new permanent supportive housing units for the chronically homeless.
City housing officials have since said they would like to add about 3,000 units, although their plans will be contingent on the success of Villaraigosa's proposed $1-billion housing bond and the multibillion-dollar infrastructure bond proposal being hashed out in Sacramento.
"L.A. has the biggest visible homeless problem in America, and to get some traction to make a difference, I think 3,000 units would really go a long way ... to doing that, in changing public perceptions that homelessness is such an intractable problem," said Lyn Hikida, spokeswoman for the nonprofit Corporation for Supportive Housing.
If successful, Los Angeles will join other cities that have embraced the idea that the best way to help many hard-core homeless people is to first put a permanent roof over their heads.
New York City will add 9,000 supportive units to its stock of 20,000 under a $1-billion program announced in November.
And in San Francisco, Mayor Gavin Newsom is overseeing the conversion of hundreds of hotel rooms into supportive housing.
The new interest in supportive housing has been largely sparked by the Bush administration's point man on homeless issues, Philip Mangano. The founder of a housing and shelter program in Massachusetts who is now executive director of the Interagency Council on the Homeless, Mangano has pushed cities to look beyond the long-established social-work approach.
In that process, which the federal government calls the "continuum of care," homeless people are typically assigned to emergency shelters, then get treatment for their addictions and illnesses, then receive "transitional" housing for a few months. If they appear to be doing all right, caseworkers then help them find more permanent homes.
This works for some homeless people, Mangano argues, but not for many chronically homeless people with disruptive medical and lifestyle problems.
What those people often need, he says, are permanent homes.
"What mayors across the country are discovering is that the old status quo response was not getting the job done," Mangano said in a telephone interview. "That's driven more and more mayors to understand that the solution of permanent supportive housing is the future."
In recent years, an increasing amount of money spent on homeless programs has gone to those that specifically address chronic homelessness, an approach that has generated some controversy.
"We're in favor of helping everybody, not for the federal government to be telling cities you have to end chronic homelessness first," said Michael Stoops, acting executive director of the National Coalition for the Homeless in Washington, D.C. "I think what's happening is that the businesspeople want to get the chronic homeless people off of their downtown streets."
Villaraigosa said he plans to address housing problems for all kinds of Angelenos with his proposed $1-billion bond.
But he chose to begin with the supportive housing pledge to help those who needed it most, said Sophia Heller, the mayor's director of policy for economic development and housing.
The first 300 apartments -- paid for with money the mayor squeezed from the city budget -- will be mainly around skid row, Heller said, and many of them will be rehabilitated hotels.
An example of the idea at work can be found at the recently renovated St. George Hotel, a few blocks from skid row.
With its bay windows, fresh paint and Frank Lloyd Wright-designed window tiles, the century-old St. George could pass for a trendy rehabbed loft building from the outside.
Inside, 80 formerly homeless people live in tiny efficiency apartments. In the clean, carpeted basement, social workers and medical workers see residents, conduct Narcotics Anonymous meetings and help peregrine souls reconnect to society. That can be as easy as helping residents understand bus schedules and as complicated as helping them apply for government aid.
Although those services are available to homeless people in scattered sites downtown, St. George resident Philip Smith said it makes a difference when they are only an elevator ride away.
"It's convenient," said Smith, 55. "And, of course, life is better."
Until social workers persuaded Smith to live at the St. George, he was a five-year veteran of the streets, a man diagnosed with schizophrenia who spent his nights at emergency shelters and in hospital waiting rooms.
He dug through trash bins and stood in soup-kitchen lines, smoked crack and went through a period of heavy drinking, he said.
From time to time, his legs would swell like strained water balloons, landing him in emergency rooms he couldn't afford.
Now the big-eyed, gentle man keeps tidy house in his tiny third-floor room, whiling away his days in front of a color TV.
The yearly cost of housing and caring for Smith at the St. George is about $16,300, nearly all of it paid with federal tax money, according to Michael Alvidrez, executive director of the Skid Row Housing Trust.
But Alvidrez and others say this is probably a bargain compared with the moral and monetary price of leaving people like Smith on the street. They point to an influential study from 2001, in which researchers at the University of Pennsylvania tracked 4,679 mentally ill homeless people in New York City who were put into special housing units. The study found that the reduced burden on city services was equal to 95% of the cost of the supportive housing.
Mangano frequently cites another study, from 1998, in which a UC San Diego researcher tracked 15 chronically homeless people and found that they racked up nearly $1.5 million in medical services over 18 months. At the end of the study period, all 15 remained homeless.
"If you leave somebody out on the street, it's very expensive," said Mitchell Netburn, executive director of the Los Angeles Homeless Services Authority. "They're bouncing around to shelters, emergency rooms or jail."
Still, experts on homelessness concede that the biggest challenge to expanding supportive housing in Los Angeles will be finding the money to keep the facilities well-staffed.
In some existing L.A. buildings, "supportive housing" simply means a lobby office where a counselor makes weekly visits.
"The philosophy is there, if not the resources," Alvidrez said.
And even the best-equipped buildings cannot guarantee a solution to the complicated problems its residents often bring with them.
At a beautifully renovated Skid Row Housing Trust building called the Lincoln Hotel -- where an on-site case manager tends to formerly homeless tenants -- a meeting room is adorned with a letter and a picture from Joseph Burgess.
Burgess called the Lincoln Hotel "a place to retreat, to think, to enjoy my life in comfort. I tend to be more reflective at home.... I feel I should have, at least, one more fight left in me."
Burgess left in November 2003, Alvidrez said.
No one is sure where he went.