Los Angeles County supervisors are poised to approve a program that will identify the 50 most vulnerable homeless people on downtown's skid row and move them within 100 days into apartments with readily accessible support services.
The program, patterned after projects underway in New York City and elsewhere, is not only aimed at saving the lives of those most likely to die on the streets, but also is expected to save taxpayers the millions of dollars typically spent on people who cycle in and out of shelters, jails and emergency rooms.
"A lot of these folks fall through the cracks when they go through the shelters," said Supervisor Zev Yaroslavsky, a major proponent of the project. "If we can't make this work, then we've got a problem."
On Tuesday, the board will probably approve two contracts with homeless advocacy groups to provide training and housing for the program. Four of the five supervisors have indicated they support the program.
The county has struggled to address the vast homelessness problem. A year ago, supervisors approved an unprecedented $100-million homeless initiative, anchored by five regional assistance centers. But the program faltered after communities balked at the prospect of homeless people coming to their neighborhoods. The county quietly switched gears, deciding instead to fund private organizations and smaller efforts, such as a housing program for families on skid row.
The county's slow progress has fueled skepticism from some.
Many of the details of Project 50 -- including cost, staffing and location -- have yet to be worked out. The board is expected to ask Tuesday for a more detailed plan within 30 days.
About one-third of the county's roughly 70,000 homeless people are classified as chronically homeless -- meaning they have lived on the streets for a year or more and have disabilities such as AIDS or mental illness.
Many experts say placing the chronically homeless in permanent housing with social services nearby is more effective than providing them with temporary shelter and more effective than requiring them to get sober before finding them housing. The numbers back up that position: 85% of homeless people living in supportive housing stay off the streets, said Gary Blasi, a UCLA law professor who has studied homelessness.
Chronically homeless people are "fragile in terms of both fiscal and psychological health," said Philip Mangano, executive director of the U.S. Interagency Council on Homelessness, which has endorsed such "housing first" programs. "Delivering the treatment and other services that they need is more effectively done when a person is in a stable location," Mangano said.
New York City-based Common Ground, which is slated to get one of the two county contracts, housed many of the homeless people living in Times Square and helped launch similar efforts elsewhere.
The agency's staff will train local teams to survey skid row residents.
Outreach workers will take a visual inventory of the area over a two-week period to observe who sleeps there regularly. Officials will follow up in person, talking to as many people as possible to learn about their health, time spent on the streets and other factors to determine how vulnerable they are.
The so-called vulnerability index will determine those most at risk of dying on skid row, and outreach workers will talk with them about moving voluntarily into supportive housing provided by the Skid Row Housing Trust, which is expected to be awarded the second contract Tuesday. The organization helps refurbish and provide housing to the homeless and other needy people.
The 50 people identified will have caseworkers to help them and nearby support services, such as mental health and substance abuse counselors.
The Department of Veterans Affairs of Greater Los Angeles will work with the street teams to identify veterans, who represent 12% of the county's homeless population.
Common Ground has long worked to develop traditional shelter-type housing for homeless people in New York and elsewhere. The agency claims its Times Square project, similar to the program proposed in Los Angeles, helped house about 90% of the people living on the streets in that part of Manhattan. It also is bringing its "street to home" approach to areas of Brooklyn and Queens.
The costs of shelter, emergency room care and incarceration can range from $40,000 to $150,000 per homeless person per year, said Blasi, the UCLA professor. Supportive housing for one individual costs between $14,000 and $25,000, he added.
County officials acknowledge criticism that the program targets a small group in a large population of needy people, but they hope to eventually expand it across skid row and elsewhere.
Some advocates agree with the county and say starting slow is the way to go.
Rebecca Isaacs, executive director of the Los Angeles Homeless Services Authority, said "the idea is to pick something . . . that is manageable" and can become a model for a larger effort.
But some question the county's ability to pull off this new project and wonder whether it eventually will include enough people to make a difference in what is widely acknowledged to be the nation's largest homeless population.
"It's a step in the right direction, but, in my opinion, it's too small of a step," said Orlando Ward, public affairs director for skid row's Midnight Mission. "Let's get this elephant moving."
Ward said local officials tend to "just build permanent supportive housing and hope somebody lands in it.
"L.A. has never been that sophisticated in their approach," he said.
Former software developer Brian Tierney should know. When Tierney, 48, lost his job, he said he drifted from the sidewalks of Long Beach to L.A.'s skid row, living outside "like an animal" for several years before chance and some kind strangers helped guide him to a small, clean, subsidized apartment at the St. George Hotel downtown.
But he thinks Project 50 could be a hard sell to the people who need it most. After a recent police crackdown cleared some of skid row's streets, "the people that are left out there are really hard-core street people," Tierney said. "Those people have been out there so long, they would be really uncomfortable inside."
Reaching that population requires a gentle, skillful approach, said Tierney, who lives in an 86-unit building with support services similar to those envisioned in Project 50. The St. George offers a medical examination room in the basement, as well as caseworkers, a psychiatrist, a doctor and a nurse. The program is funded largely by federal and other grants.
L.A. City Councilwoman Jan Perry, whose district includes parts of skid row, said she hopes Project 50 can build on existing programs run by local agencies. And she'd prefer to see people already in emergency shelter beds given the first chance at more permanent supportive housing.
"They've already made a proactive choice to come in off the street into a bed," said Perry. "Their chances of recovery are already enhanced."
Los Angeles has long lagged behind other cities in offering modern homeless services, traditionally emphasizing shelter beds clustered on skid row rather than stable housing with support services, according to advocates elsewhere.
County officials are hoping Project 50 can help change that.