Housing crisis or health crisis? On the streets of California it’s both.

Propelled by the novel coronavirus, California is rushing to shelter thousands of its most vulnerable residents – homeless people who live outdoors and can’t “stay at home” to protect themselves and others from COVID-19.

Day One of that unprecedented effort in Los Angeles revealed the daunting struggle that lies ahead across the state. By dinnertime on a recent Friday, a shuttle bus had dropped off only four homeless people at a community center that was being turned into a shelter in the Echo Park neighborhood. 

The four clients sat on the curb, waiting to be checked in. But the nurse had yet to arrive. Cots had not been delivered. One of the four, a distraught older woman in gray sweatpants, kept repeating “food, food.” When a helper tried to escort her to a restroom across the street to wash up before eating, she would not follow. Eventually, she wandered off and could not be coaxed back.

“It’s tough,” admits Los Angeles Mayor Eric Garcetti. “We’ve never moved this many people, ever.” 

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In a matter of weeks, the city is trying to voluntarily move 6,000 unsheltered people into 42 community and recreation centers that are being converted into shelters. Those who are especially vulnerable, though not showing symptoms of COVID-19, as well as those who need to be quarantined will be sent to hotels, motels, or care centers.

But the mayor and others deeply involved in this issue are also looking ahead to after the crisis, whenever that comes. And how California responds to the needs of homeless people during a pandemic – particularly the unsheltered – may well shape thinking about what is still needed to address a vexing, complex problem that was a crisis long before the coronavirus hit. 

“It’s certainly something we’re thinking about now,” Mayor Garcetti told a press briefing. “What can we do … to get the homeless, not just out of this crisis, but off the streets?” 

A first-order priority

California is ground zero for America’s homelessness crisis. About 150,000 people are homeless here, living in shelters, on sidewalks, in tent encampments, canyon washes, and under bridges in the Golden State, often in highly unsanitary conditions. Many are older and in poor health, which heightens the risk of an explosion in severe virus cases that could further strain medical and city services. 

Before the coronavirus hit, Democratic Gov. Gavin Newsom had made homelessness his first priority, devoting his entire State of the State speech to the subject. It polled as the top issue among voters as well. Now COVID-19 has added even more urgency to the issue, underscoring what people who work with the homeless population have known all along – that the challenge is not only in tackling a housing crisis but also a health one.

To slow the growth of the virus, the governor, in a March 18 executive order, directed $150 million to localities to help with shelters and hotel and motel rooms. The state also purchased more than 1,300 camper trailers for people who might need to be quarantined. 

So far, the effort has been intense but spotty, accompanied by a debate about whether to move people into shared shelters or individual motel rooms.

As of April 1, Los Angeles had converted 13 community centers to shelters with 565 beds. The shelters are 95% full. More shelters as well as hotels, motels, and 1,000 quarantine beds are expected to come online in the next few days; 900 are already available. So far, five cases of COVID-19 have been identified in the homeless community.

Some homeless people are skeptical about the safety of shelters in a pandemic. “We’re safer out here than in a shelter,” says Ayman Ahmed, who sleeps in a tent at Echo Park Lake, voicing a common sentiment.

Still, the crisis is clearing away barriers that would normally hinder progress. Resources are being freed up, regulations eased, and eviction moratoriums declared in an all-hands-on-deck response that people who work with the homeless population hope can be extended after the pandemic ends. As those who are unsheltered enter temporary accommodation, even gathering data about them could be helpful in the long term, because so little is known about this population.

“We don’t know how many people are disconnected from homeless and health services. We don’t know the length of time the unsheltered have been on the streets. Both are predictive factors that show how hard or easy it may be to stably house someone,” says Gary Painter, an expert on homelessness at the University of Southern California in Los Angeles.

Meanwhile, community support for emergency sheltering – instead of resistance – has been “pretty fantastic,” says Heidi Marston, interim executive director of the Los Angeles Homeless Services Authority. “As bad and unfortunate and uncertain as this pandemic is, it’s renewing a sense of crisis response and urgency that we have been looking for across the whole system.” 

Cutting red tape

Bay Area Community Services, based in Oakland, runs programs that provide short-term and permanent housing for homeless residents, with an emphasis on seniors and those with physical or mental health conditions. Outreach workers have fanned out across the San Francisco Bay Area to educate those living on the streets and in vehicles about the coronavirus.

“What we’ve seen is that a lot of people don’t know the severity of the crisis,” says Jamie Almanza, the group’s executive director. As workers attempt to shepherd people into shelters and other temporary housing, she adds, “The question is how to capture this moment and this sense of urgency we’re seeing.”

Governor Newsom’s emergency order has sliced through red tape that can slow down efforts to house those who lack permanent shelter. A pair of hotels in Oakland will provide housing for almost 400 people living in encampments, and in San Francisco, officials have identified some 8,500 vacant rooms in 30 hotels where they will seek to place homeless individuals and families in the days and weeks ahead. 

As cities and counties work with state and federal agencies, Ms. Almanza says public officials are releasing emergency funds and relaxing rules on existing spending on homelessness. To locate available housing, officials are relying on local nonprofits. Ms. Almanza hopes the increased cooperation and trust will last beyond the pandemic given that, with or without the threat of COVID-19, those living on the streets and in shelters face a daily life-or-death struggle.

“It’s becoming crystal clear during this crisis that the nonprofit organizations are the front-line first responders,” she says. “And what this could mean for the long term is a better understanding by government funders of what can happen when we all really come together.”

Lessons learned in Fresno

The 2007-08 housing market crash contributed to a rise in California’s homeless population as banks foreclosed on homeowners and large encampments sprouted in cities across the state.

In 2008, officials in Fresno embarked on a 10-year plan to reduce homelessness, funneling more funding and resources into rapid re-housing, permanent housing, and supportive services. By 2017, the city’s homeless population had fallen almost 60%, according to the U.S. Interagency Council on Homelessness, a much steeper decline than seen elsewhere in California. 

The numbers have climbed again over the past few years as Fresno – like the state as a whole – contends with an acute shortage of affordable housing. But city officials assert that, in the same way they learned lessons from the housing crash, the pandemic response can inform policies for aiding the homeless population now and in the future.

“This is a crisis within a crisis,” says H. Spees, director of strategic initiatives for Fresno Mayor Lee Brand. “You have the homelessness crisis being enveloped by the COVID-19 crisis, and with that, you have the opportunity to leverage short-term responses into long-term solutions.”

Last week, in the span of 72 hours, the city opened up 300 new shelter beds in a vacant hotel and two other buildings and began housing homeless residents. The swift action could serve as a template for the city long after the pandemic passes.

“We don’t have all the answers,” Mr. Spees says. “But we are seeing waves of public and private resources come together to speed up the street-to-home transition, and it’s demonstrating that moving people off the streets can happen quickly when we have collective effort.”

Removing barriers 

In East Palo Alto, south of San Francisco, the Rev. Paul Bains laments that it has taken a pandemic to bring greater urgency to the cause of ending homelessness. At the same time, as the president of WeHOPE, a homeless shelter and supportive services provider, he recognizes that the coronavirus response presents an opportunity.

“There is so much attention right now on getting people off the streets and out of the elements and giving them a chance to get healthy,” he says. “Barriers are being removed because people are realizing what the risks are for someone who doesn’t have a place to live.”

In the past week, Mr. Bains has secured $230,000 in funding to expand WeHOPE’s fleet of mobile shower trailers and purchase 15,000 face masks to distribute to homeless individuals, outreach workers, and emergency responders. He credits local officials and Governor Newsom for creating momentum to prioritize initiatives on homelessness.

“What we’re seeing is that, with community collaboration and strong leadership, we have the wherewithal to address these systemic issues,” Mr. Bains says. 

But it’s not just a spirit of collaboration that will be needed, says Margot Kushel, director of the Center for Vulnerable Populations at the University of California, San Francisco. It also takes a serious, sustained, financial commitment.

“Homelessness is a catastrophe,” she says. “It requires a level of response that is not going to be free and is going to cost money, but is absolutely essential to preserve health.”

That money could be harder to find as the U.S. goes into a recession that will sap state budgets. California has a substantial rainy day fund, but it is likely to be drawn down rapidly in a deep economic downturn. 

Dr. Kushel believes that hotels could perhaps play a larger role in a long-term solution to homelessness in California. When the crisis is over, some of the high-end hotels will go back to being hotels, she says. “There might be others who believe that having full occupancy brings more value to their properties.”