The phenomenon of hostile landscaping in Los Angeles has further marginalized a swelling unhoused population.

Last May, in Los Angeles’ coastal Venice neighborhood, Adam Smith noticed a series of planter boxes in the middle of a familiar sidewalk. Affixed near the intersection of Third and Sunset avenues, mere blocks from a Google campus and a suite of oceanside cafes, the standalone planters ran roughly the length of a wall delineating a parking lot behind a luxury condo complex.

Previously, Smith told Capital & Main, a group of six to 10 homeless people had regularly slept in tents on that block, favoring it for its relatively plentiful street light. A volunteer for the Culver-Palms Burrito Project, which prepares and serves the titular food to the unhoused of West Los Angeles, he’d become acquainted with individuals living there over the course of several years.

Once the planters were installed, however, the sidewalk was clear. “That next day, after I saw [the planter boxes] for the first time, I went there to look around because I figured they were sleeping somewhere else,” Smith said. “I found people up around the corner, just, like, a block away.”

Companies are privatizing public space to create more “landscape” for their businesses.

Throughout Los Angeles, landscaping is put to aggressive use, functioning as a weapon of anti-homelessness under the guise of beautification. Just as both public and private architectural design throttle space available to the unhoused internationally — via, among other examples, spikes on ledges and bars on benches to discourage sitting and lying down — and cities such as San Francisco arrange boulders to deter homeless encampments, the phenomenon of hostile landscaping in Los Angeles has further marginalized a swelling unhoused population.

Where the sidewalk ends: Unidentified man, downtown Los Angeles. (Photo: Marco Amador)

Nearly 20 miles from Venice, a Los Feliz traffic median at the intersection of Vermont and Prospect avenues, and Hollywood Blvd., has regularly seen encampments arranged on its concrete ground, abutting a raised patch of desert landscaping and sycamore trees.

Christened “Vermont Triangle,” the median’s first redesign occurred in 2008, when the now-defunct Community Redevelopment Agency spearheaded a project to “improv[e] the pedestrian amenities” and “enhanc[e] the physical appearance of the existing median park.” According to the Los Angeles Times, this yielded seating areas, lampposts to echo those at nearby Barnsdall Art Park, and the sycamores. Eventually, unhoused people began to pitch tents, availing themselves of the median’s modest stretches of open public space.

Now, due to pressure from local business owners, Vermont Triangle is in flux. City Councilmember David Ryu’s office, the Times noted, plans to invest $18,000 in another redesign, following a 2013 re-landscape. The 2013 update was financed in part by the Hollywood Hotel and Kaiser Permanente, according to Jeff Zarrinnam, who serves on the board of governors of the East Hollywood Business Improvement District. (Ryu’s office couldn’t be reached for comment.) Current proposals range from adding art installations and neighborhood signs, which Zarrinnam said the Los Feliz Neighborhood Council and East Hollywood Neighborhood Council have floated, to putting in planters.

Zarrinnam said he supports “bridge housing,” a term the municipal government, neighborhood councils and local businesses use to favorably denote temporary homeless shelters and transitional housing. Yet reports indicate that the current state of temporary housing for many homeless people in Los Angeles County — who, as of May, numbered approximately 53,000 — is nothing short of abysmal. A recent investigation by radio station KPCC found infestations, harassment and medical negligence, among other scourges at various facilities throughout Los Angeles County, including those funded by the Los Angeles Homeless Services Authority (LAHSA), which conducts the county’s annual homeless census.

Sidewalk in Los Angeles’ North Sea district. (Photo: Marco Amador)

Steve Diaz, an organizer for Los Angeles Community Action Network (LA CAN) who works with unhoused populations in downtown and South L.A., calls hostile landscaping of public space “the next level of criminalization” of homelessness. He alluded to an industrial neighborhood overlapping Skid Row, whose business owners call “The North Sea”: a cluster of converted seafood warehouses and factories painted the same hues of oceanic blue — complete with landscaped sidewalks.

“They started breaking the concrete and taking away from the sidewalk to place different types of flowers, whatever garden they were putting in,” Diaz said. “You have a major street [on] Skid Row that, at one point, was home to a lot of homeless folks now being gated off, and then the concrete being broken to start using these gardening pockets within the space to eliminate sidewalk access.” (Miguel Nelson, a North Sea business owner involved in the area’s marketing efforts, declined to respond publicly.)

As private property owners adopt guerrilla tactics to thwart homeless encampments, legal issues arise. Skid Row activist General Jeff Page has observed that, while property owners are permitted to control up to three feet of sidewalk extending from their buildings, “The North Sea is taking upwards of five to 10 feet of sidewalk, allowing only for ADA (Americans with Disabilities Act) compliance and zero space for homeless tents and/or encampments.” (The Los Angeles Department of Public Works stated that the North Sea sidewalk landscaping is currently under investigation and thus couldn’t comment further on the matter.)

What’s more, business owners in South L.A. have illegally installed fences around their property, which, according to Diaz, will eventually give way to sidewalk landscaping. Relatedly, Adam Smith has been corresponding with city officials to ascertain the permit status of the Venice planters. The West L.A. office of the Bureau of Engineering, which issues revocable permits, told Capital & Main that it did not have a permit on file for the planters. Without one, according to the bureau, “no portion of the public right-of-way, including sidewalk, is allowed for private use.”

Nevertheless, the planters remain and, according to Smith, have multiplied. Additional boxes, he said, are now ensconced in the sidewalk around the corner, to where the previously ousted people had first moved.

“For some people, [landscaping] sounds like a great idea,” Diaz said. “But you’re literally privatizing public space to create more ‘landscape’ for your business.”

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California has been more expensive than most of the country for a long time, but the gap became a chasm beginning in the 1970s.

John Holguin should be in a celebratory mood. He is just about to close escrow on his first house. But like too many Californians, he’s feeling a sense of diminished possibilities.

Holguin, 48, works for the Santa Cruz County Department of Public Works, striping roads and maintaining the county’s bridges and storm drains. His wife is a school receptionist, and their combined annual income of $82,000 places them squarely in Santa Cruz County’s middle class.

Yet Holguin had to withdraw from his retirement fund to afford his piece of the California Dream: a house in Watsonville, an agricultural community that has seen home prices shoot up as Bay Area tech workers and investors snatch up homes in the region.

His $3,200 monthly mortgage payment will eat up 75 percent of his take-home pay, he says. When he does retire, eight years later than planned, he and his wife will probably head for Arizona, where some of his high school classmates have already settled.

Activists and civic leaders are recognizing the extent of California’s housing crisis. They are organizing around changes to housing codes, rent control, and local and state bond measures.

Holguin’s two kids, junior college students, will help with the mortgage on the new home, but he does not expect them to remain in the state. “They know if they want to buy something, if they want to succeed, it’s not going to be here in California,” he says.

California’s housing shortage has made it difficult to be middle class and harder to be poor. But there are signs in Holguin’s home county, and elsewhere in the state, that activists and civic leaders are recognizing the extent of the crisis. They are organizing around changes to housing codes, rent control, and local and state bond measures.

At a June 12 Santa Cruz County Board of Supervisors meeting, Supervisor Zach Friend suggested that residents may have “reached a real tipping point” in their willingness to support new affordable housing. He was responding to almost a dozen community, business and nonprofit leaders who spoke in support of the board’s unanimous vote that day to direct staff to prepare revisions to the county housing code to ease the way for more affordable housing development.

“It’s one thing to say that you are in favor of affordable housing,” but when a project is proposed in your neighborhood, “you can find a lot of reasons as to why you don’t support it.”

But it may take time to fix a problem that has been decades in the making, and it will certainly take political will to build and maintain affordable housing in sought-after coastal regions. Santa Cruz activists hope that Friend and other supervisors will vote this summer to place a bond measure of up to $250 million on the November ballot that could fund affordable rental housing, support first-time homebuyers, and provide housing for the homelessness.

Funding and policy changes are only the beginning. City and county officials must greenlight projects, sometimes over neighborhood opposition.

“It’s one thing to say that you are in favor of affordable housing,” Friend noted at the June 12 meeting, but when “a project actually comes forward, especially one in your neighborhood, you can find a lot of reasons as to why you don’t support it.”

California has been more expensive than most of the country for a long time. But the gap widened beginning in the 1970s when home prices grew from 30 percent above national levels to more than 80 percent higher by the end of the decade. Now the median-priced California home costs more than twice the median-priced U.S. home, according to Zillow.

Research suggests that the public “feels the pain” but is “not really enamored by some of the most obvious solutions,” says Jim Mayer of California Forward, a nonprofit organization that focuses on fiscal and government reform. “They’re really not supportive of a whole lot more homes if they think it is going to lead to more traffic and congestion, and more crime, and impact the schools.”

California would need as many as 100,000 more housing units a year than it is currently building to meet the demands of its growing population, according to the state’s Legislative Analyst’s Office.

Meanwhile, some of John Holguin’s co-workers rise in the dark to commute from Los Banos, a small bedroom community some 80 miles east. Others stay with family in Santa Cruz during the week, only to travel 150 miles home to Sacramento on the weekend. (Holguin’s 17-mile commute from Watsonville along Highway 1 will take as long as 45 minutes because of traffic.) “Only in California do we have watersheds and commute sheds,” says Mayer.

“My parents bought their first place at 25, and I’m 48,” Holguin notes. “To me it seemed like they had it easier back then.” He’s right about his parents’ generation of homebuyers. Back in 1975, the median home price in the state was $193,774 (in 2017 dollars). Last year, according to the California Realtors Association, it was $537,860 — nearly three times that much.

Of course, Santa Cruz is a particularly pricey slice of the California real estate market. Its sun, surf and scenery draw tourists, as well as tech industry workers from “over the hill” in Silicon Valley, who have money to spend. The median price for a single family home in Santa Cruz County shot up to $935,100 in March, a record high, the Santa Cruz Sentinel reported.

Santa Cruz County is home to lower-wage agricultural and service industries, making affordability a particular challenge for those who work there. Also, local redevelopment agencies, one of the few funding sources for affordable housing available to local governments, were eliminated in 2012, contributing to the housing shortage across the state.

Small-town Santa Cruz also faces pressure from its University of California campus, whose chancellor announced plans last fall to increase its student body by as many as 10,000 students by 2040. In a sign of voter frustration, the city of Santa Cruz approved a non-binding measure opposing the university’s growth plans by a margin of 76-23 percent.

And then there is the resistance on the part of some residents to accommodate growth. Some simply want to “preserve the open space and restrain the growth” as much as possible, says Don Lane, one of the leaders of Affordable Housing Santa Cruz County, a local coalition that is advocating for a housing bond measure to be placed on the November ballot. “But you’ve just got all this high-priced housing, and it’s still crowded, and traffic is still getting worse.”

Lane, a former mayor of the city of Santa Cruz, says denser “infill” housing in commercial corridors will lead to a more efficient and effective use of space without compromising the region’s preservationist traditions.

The plight of Santa Cruz’s middle-income residents is not as dire as that of its poor, of which there are many. The county has among the highest poverty rates in the state. Farmworkers live in overcrowded and sometimes dangerous conditions. At the June 12 board meeting, Ann López, the director of the Center for Farmworker Families, relayed an instance of 16 people living together in a home of less than 1,000 square feet.

Matthew Nathanson, a public health nurse with the county, was motivated to advocate for an affordable housing ballot measure after witnessing the clients he serves “falling into homelessness” because of their inability to afford rent. The median rent for a two-bedroom home in Santa Cruz was $2,450 a month in May, a 4.7 percent increase from a year ago, the Santa Cruz Sentinel reported.

Nathanson, who is also a regional vice president with Service Employees International Union Local 521, says that housing has become a central issue for city and county workers like Holguin, who are becoming increasingly difficult to recruit. Road workers who are on call during the rainy season need to live “within a reasonable distance” of their jobs, he adds. And pay increases won at the bargaining table risk being “all wiped out” by the cost of housing.

The measure, which would require a two-thirds vote of the public, would be paid for by commercial and residential property owners, according to Lane. The original proposal was for $250 million, but he says the bond measure is now “looking more like $150 million” and could benefit between 1,500 and 2,000 households.

The campaign was inspired by the success of housing measures in Alameda and Santa Clara counties, he says. Another $4 billion housing measure will be on the state ballot this November.

Still, once the funding is in place, the projects will need to get approved by local governments and built. The bond measure proposed for November is only one piece of the puzzle, according to Nathanson.

“It took us a long time to get into this situation,” he says. “I think there is a shift going on, but it’s going to be a struggle.”

Research assistance provided by Jake Conran.

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The University of Southern California is under federal investigation for its handling of sexual misconduct complaints against long-time campus gynecologist George Tyndall. The Los Angeles Police Department is investigating some 52 complaints about Tyndall and multiple lawsuits have been filed against Tyndall and USC.

In the shadow of Tyndall’s case and other high-profile scandals at the university, a coalition of graduate students at the USC Dworak-Peck School of Social Work worry that another ongoing harassment case against associate professor Erick Guerrero is drawing too little attention.

“With the Tyndall case coming forward, it’s disappointing that there hasn’t been any connection between our issue and this larger thing,” said Robin Petering, who completed her Ph.D at USC last year and is the leader of the coalition Social Workers for Accountability and Transparency (SW4AT). “So few people know about the case.”

At issue is a finding by the campus Office of Equity and Diversity that Guerrero had sexually harassed two students. Guerrero was disciplined but remains on staff.

The OED findings were kept confidential. In October, more than 70 social work school faculty signed a statement complaining that they became aware of the case through media reports of a lawsuit filed against Guerrero and USC by one of the students allegedly harassed.

In a lawsuit filed in L.A. County Superior Court, graduate student Karissa Fenwick says Guerrero – then her dissertation advisor – made unwanted advances while they attended a conference in New Orleans. Fenwick’s complaint details sexual comments and inappropriate touching at a bar where they met for a meeting. Guerrero then suggested the student wait for an Uber in his hotel room, where he tried to kiss her. Fenwick says she fled the room, and was warned the next day to not speak of the interaction.

An unnamed student, not a plaintiff but noted extensively in the lawsuit as “Student X,” was also allegedly the target of unwanted and “inappropriate conduct of a sexual nature,” including remarks about her hair and physique.

The SW4AT coalition has launched a campaign called “I Am Student X” to raise awareness of the issue of sexual harassment in academia. The group is highly critical of the university’s handling of the Guerrero case and contends that “the University does not prioritize student safety or health over other agendas.”

“Every department has a story and experiences,” Petering said. “Our experience in our school is not unique.”

Guerrero denies the charges in the Fenwick lawsuit and filed a grievance last September challenging the OED findings, which were upheld. On June 5, Guerrero’s attorney Mark Hathaway filed a writ in L.A. Superior Court challenging what it calls “a quasi-judicial proceeding” by the OED.

Hathaway declined to discuss next steps in the court case against Guerrero, as did Fenwick’s attorney. The School of Social Work did not respond to calls for comment.

The SW4AT coalition is strategizing on how to use the momentum of yet another USC scandal to raise the profile of the cases at the school of social work. “If you don’t connect them you run the risk of not being able to prevent these things in the future,” Petering said.

“What is the university going to do to prevent another Tyndall?”

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An estimated five to 10 percent of homeless people in the United States have pets, according to the Nevada nonprofit organization, Pets of the Homeless. Take a trip through the tent cities that line the sidewalks of downtown Los Angeles and you’ll see dogs, cats, even birds. As any pet owner can tell you, animals provide affection, comfort and stability, something that can be particularly meaningful when your life’s possessions could be swept away at any time by a police raid.

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The animals benefit too. Most pets would prefer constant companionship outdoors to solitary shelter.

But many homeless shelters and housing programs don’t allow pets. The expenses, logistics and liabilities involved in housing animals can be prohibitive for programs that are already underfunded. The number of shelters that allow animals are on the rise, however.

I recently visited with a handful of homeless and formerly homeless pet owners in Los Angeles to learn about their lives.

Maria, 64

Maria sells off-brand cigarettes in front of a row of tents on a busy street in downtown Los Angeles. She keeps her tobacco merchandise arranged neatly on a small plastic tray, and beside her a tiny Chihuahua puppy, Cici, runs and plays amid the sidewalk foot traffic, or naps in the small carrier at Maria’s feet.

Maria has been living here since getting out of jail in November, she says, “for something I didn’t do. It took them 35 days to realize I didn’t do it.” She emerged to find her husband of 37 years was gone. “He disappeared with all my money and all my stuff,” she adds. “The day I came out I slept on the sidewalk. My pillow was the cement and my blanket was the jacket I was wearing.”

“I was angry the first few months,” she continues. But in February she bought Cici from a street vendor for $40. “She has taken me out of my depression over what my husband did. She’s become everything to me. She’s my life.”

Maria knows everyone in her tent community. People stop by every few minutes to say hi. A couple even buy cigarettes, including a young man named Toby. “I call him my adopted son from the street, I take care of him. He’s been on the street since he was 16.” Toby recently turned 20, Maria says. “I got him a big-ass cake and some money, some clothes. I’m the first person who celebrated his birthday on the street.”

In a little over a month, Maria is scheduled to move to federally subsidized Section 8 housing in Long Beach. It’s far from her friends here, but she’s happy to go. “All I want is a roof over my head. As long as me and my dog got that, I’ll be alright.”

Craig, aka Taco, 58

“He’s my best friend,” Taco says of his 10-month-old puppy, Hambone. “I didn’t realize that a person could have such an attachment to an animal. But I do.”

Taco tells me he’s lived in California all his life, “except for I lived in Chicago for nine years. I loved Chicago, the weather, everything about Chicago. My ex-wife, she didn’t like the weather. We relocated back to L.A.”

Taco is single now. “My guards are still up, but I want to have those old feelings back again. Because I’m somewhat of a romantic type guy.” But Taco doesn’t get lonely, because he has Hambone. “He cheers me up when I’m sad. He’ll nudge me. He’ll come with concern, and then he’ll start playing, trying to make me laugh.”

Taco and Hambone live in a small single-room occupancy apartment, or SRO, in a building run by a nonprofit social services agency. “I came down here to Skid Row for the resources. A friend was telling me about the housing.”

He says his apartment is nice, and much better than shelters he’s stayed in, “but you’re on Skid Row. Skid Row’s like the courtyard, if you’ve ever been to the penitentiary. You have be ready, you have to have your shoes strapped up.”

Taco says he’s on the list for Section 8 housing, and looking forward to moving. He thinks he might like to live near Staples Center. A woman walks by with a small dog, and Hambone strains on his leash, whimpering and sniffing the other dog. “Stop it, stop it,” Taco scolds. “That’s a girl dog. She snapped at you, right? You’ll learn, you’ll learn women too.”

Thomasina, 30

“I’ve had Flower since she was a puppy,” Thomasina says of her yellow Chihuahua mix. “This lady had a box of them in front of a store. The people I was staying with at the time bought her for their daughter, but they didn’t take care of her. She was so small, covered in fleas, so scared. So I started taking care of her. And ever since she’s been by my side. My little partner in crime.”

That was five years ago, when Thomasina’s life was in chaos. She had no stable place to live, and few opportunities. “I wanted to be in the working world, but had to live my life in the street. I got into prostitution by default.” She came to Skid Row in search of housing and social services, a move that was inspired in part by Oprah Winfrey. “I saw this clip of Oprah, and her words spoke to my heart,” she says, laughing. “She was saying, you have to help yourself, you have to do what you have to do.”

Thomasina was placed in dog-friendly SRO housing. “That room was my peace of mind,” she said. But living on Skid Row was often frightening. “Females down there usually have brothers or a boyfriend, people that can help them. It was just me and my dog. I didn’t have anyone watching my back. I was an easy target.” She was frequently harassed, sometimes by other residents in the building, and spent a lot of time hiding in her room. It was claustrophobic, she says, but having her dog kept her sane.

When Flower had a litter of puppies a couple of years ago, Thomasina gave them all away, but one was returned because he was too timid. Now both dogs are registered emotional support animals. Last year Thomasina moved from Skid Row to a small apartment she describes as “perfect.” But she was facing homelessness again when the landlord recently decided pets were no longer allowed. The nonprofit HEART helped her contest the eviction and stay in her home with her little Chihuahua family.

Crushow, 40

Crushow describes himself as a community activist and “art Jedi.” He’s on the way to his studio and can only talk for a few minutes. “I have show this weekend at Hotel Rendon. It’s called Art at the Rendon. Each artist gets their own room to install their art.”

Crushow introduces me to his three pit bulls and a tortoiseshell cat named Justice. The cat perches calmly of the edge of Crushow’s makeshift shelter, surveying the neighborhood. Crushow says when he’s away, neighbors take care of his pets, and he does the same for them. “We all try to look out for each other.”

Crushow is philosophical about life on the street. “Your box is bigger than mine, so what? I got another box I go to. And an office I go to. And an art studio I go to. It doesn’t matter what box it is. People are constricted and taught how to think. And I’m not.”

He shrugs. “Get caught up in that rat race all you want to, but when you die, what do you have? What did you do while you were here? Just thought about yourself and your big-ass box?”

Carol, age unknown

“I like walking around here,” Carol says, walking through Little Tokyo with a giant grey pit bull named Boss. She gestures toward Skid Row where she lives. “It’s like a war zone down there.” When I ask how long she’s been there, she replies, “Too long. Too long!”

Carol says she’s been depressed since Mother’s Day. Her own mother died a couple years ago, and it’s especially painful at certain times of the year. “Anniversaries are hard. Her birthday is hard.” Walking Boss helps cheer her up a little.

Carol tells me that she looks after Boss and a few other dogs for friends. He was one of a litter of nine puppies. “I took care of his mama, Lady, when she was in labor. It took 14 hours for all those puppies to be born!” That was a year ago. “We didn’t let their paws touch the sidewalk till they’d all had their shots. They can get Parvo that way.”

Carol is happy to talk but decides against being photographed.

Two weeks later, I meet a man on Skid Row who introduces me to four pit bulls he keeps in a pen next to his tent. One slips out the side of the pen and comes running over. It’s Boss! Then a couple of the other dogs follow his lead, and I realize the pen is nothing more that propped-up fencing. The dogs could easily knock it down – but they know better. After I play with the dogs for a while, their owner orders them back into the pen and they all trot home obediently. He tells them to sit for my camera, and they do, wagging their tails. I want to learn more about how he got so good at training dogs, but he shakes his head. “I don’t do interviews.”

Doctor: “Some medical conditions won’t get better until a person is housed. How do you store diabetes meds without a fridge?”

The 2018 Los Angeles Homeless Services Authority estimates that about 53,000 homeless people live in Los Angeles County, a slight drop that reverses a significant six-year surge. Their backgrounds are as varied as Los Angeles itself. Some are in shelters. Many more live in cars or in tents, or in any variety of unpermitted spaces. You wouldn’t necessarily know who’s homeless just by looking at them, as I discovered on a ride-along with a multidisciplinary outreach team in March.

The team is part of the Judy and Bernard Briskin Malibu/Pacific Palisades Homeless Project, which was launched in January 2017 to fund health care, temporary housing and case management in Malibu and Pacific Palisades, as part of a continuum of care for the most vulnerable homeless, usually those with medical concerns.

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I rode in a van with two professionals from the Venice Family Clinic, Dr. Coley King, DO, the clinic’s director of homeless services, and a psychiatrist, Dr. Wes Ryan. A social worker from partner homeless service agency the People Concern, Alex Gittinger, rounded out the team.

“Some medical conditions won’t get better until a person is housed,” King said. “How do you store diabetes meds without a fridge?”

The group’s mandate is to get people into a sustainable living situation, whether it’s nearby – super expensive – or in the San Fernando Valley or Inland Empire. Even after a client is placed in permanent housing, the team will follow up and, ideally, get the person to regularly visit the clinic.

Some of their clients obtain temporary housing through vouchers that pay for residential motels. The funding is limited and, as King puts it, “super complicated,” but is often a combination of money from the Department of Housing and Urban Development (HUD) and Housing Authority of the City of Los Angeles (HACLA). The team has to be judicious with who gets a voucher for temporary or permanent housing, especially on Los Angeles’ Westside.

A tan and wiry 56-year-old, Michael was hit by a car while riding his bike on PCH. He insisted on using painkillers indefinitely.

“We don’t just drop people off at an apartment,” Gittinger said. “People who have been out on the streets for decades need continuous care to transition into living indoors [and] a new community, to build a network of friends, to become responsible with paying rent and utilities.”

The afternoon’s first stop was a small but clean Santa Monica motel where Michael was living while he recovered from injuries. A tan and wiry 56-year-old, Michael was hit by a car while riding his bike on Pacific Coast Highway in Malibu. It wasn’t his first time. He had a titanium rod in one leg from another hit-and-run on PCH. As Dr. King took his blood pressure, he reminded Michael that he has to be weaned off pain meds to avoid getting addicted.

Michael walked with a bamboo cane topped by a plastic golf ball and insisted on using painkillers at night — indefinitely. Dr. King warned against getting hooked, telling Michael that the voucher money for the medication in question would run out soon. Michael acquiesced and took a blister pack of new, less addictive meds.

After taking his vitals, King brought Michael to the Ocean Park Community Center in Santa Monica, where a nurse gave him a B12 injection. There, King and one of the center’s coordinators tried to convince him to consider one of the 70 beds in the OPCC shelter, noting that funding for his motel room will also soon run out.

Social Worker: “The first time I say, ‘I’m Alex and I do outreach,’ they shout at us to go away. And beer cans fly. But we keep showing up.”

“I’m too old to be around people who annoy me,” Michael replied. When King dropped Michael back at his motel, the injured man signed a form for $200 cash and a $200 EBT card, which will have to last him a month.

“You can buy a raw chicken with an EBT card but not prepared food,” King said, on his way to the next client. “How does that make sense? None of these places has a kitchen.”

At another small residential motel in Santa Monica, I met Dennis, a Vietnam vet in his 60s who’s bedridden with a serious leg wound in his shabby but livable room. He let me photograph him, but didn’t want to talk. While Dr. King took his vitals and asked him about his recent flu, Gittinger told me the Malibu team has been visiting Dennis for months, since they found him in an encampment in the bushes of Zuma Beach.

“Dennis didn’t want anything to do with us in the beginning, but we kept coming and bringing food,” Gittinger said.

Dennis is linked to the Veterans Affairs hospital in West Los Angeles, but didn’t like the organization’s red tape. He needed some consistency, someone to come to him, Gittinger said.

“We get to know the residents and the homeless population in an area, and it’s a small area so we’re not spread too thin,” Gittinger said. “We work with the sheriff, the city and over time we have found the hot spots. It’s all about building relationships. It may take 50 engagements with someone. The first time I say, ‘I’m Alex and I do outreach,’ they shout at us to go away. And beer cans fly. But we keep showing up.”

A secluded Zuma Beach encampment is called “Margaritaville” because it seems like a good spot for a college party. But nobody is partying.

Dennis is on a short list for senior housing in the Inland Empire. If it works out, he will be living with a friend he met in an encampment in Malibu, and will be permanently housed for the first time in more than two decades.

Our next stop was a Zuma Beach encampment of a half-dozen men in the high scrubby bushes near the parking lot. The location was secluded and if you’re homeless and living outside, you would probably want to crash there. The team called it “Margaritaville,” because it seemed like a good location for a college party. But nobody was partying.

At Margaritaville I met another Dennis — a beefy and well-groomed man in his 30s who told me he’s been at the encampment since last July 5 and that he wants to go back to school for photography. He was engaging and willing to talk, but vague about what led him to the beach. He had worked as a driver for Safeway and as a photographer, was an apprentice in the carpenters union for a while and had lived in San Francisco’s Tenderloin until he “couldn’t take the noise.” The beach may be a salubrious setting, and it even has outdoor showers – meant for swimmers, but the homeless population stealthily uses them too – but Dennis said it’s hard to fully relax. He worries that if he lets down his guard someone could take his things, and rats would come for his food.

“More and more are getting priced out. Either the rent has risen too much or they lost their job, and someone falls ill . . . The next step is a tent.”

Further down the coast highway, in Malibu, the team split up to check on several clients outside an upscale mini-mall. One was a man in his mid-60s. Tom – not his real name – was well-groomed and wearing khakis and a black polo shirt. He might have been a friend of the members of the team, hanging out with them in front of Starbucks — except that King was taking his blood pressure. Tom didn’t feel comfortable with my presence but I learned from the team that he was married and had owned a house, but has been living in his SUV for months and is suffering from chest pains, high blood pressure and general stress.

“He’s in denial about being homeless,” King said. The team has working on getting Tom a voucher for senior housing. They’re concerned that Tom’s age, health concerns and newness to being homeless make him more vulnerable to a life without shelter. A lot of the people living outdoors have been doing this for years and are very resourceful, knowing which establishments won’t hassle them for using the restroom. And sometimes, like the younger men at Zuma, they consider their experience as simply living off the land. That is, until their health fails or the weather goes bad.

There are about 30 people in the Venice outreach orbit, and about three dozen or so similar teams around Los Angeles County, all with different funding, each serving up to several hundred clients. “Nowhere near meeting the need of the entire homeless population,” Dr. King said.

Not everyone who experiences homelessness needs a team. But even those who pull themselves up by their bootstraps have relied on the kindness of strangers.

Gittinger said he looks at homelessness in the U.S. as a systemic problem, not an individual problem.

“More and more are getting priced out,” he said. “For whatever reason they can’t afford the rent anymore. Either the rent has risen too much or they lost their job, and someone falls ill. And with their last savings they may buy an RV or a van, and they try to keep it up. Then the van gets ticketed or towed and impounded, and they can’t pay to get it back. The next step is a tent.”

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While social service organizations wait – often many months – for housing to open up for their homeless clients, they have an opportunity to prepare to successfully move them into housing. That means providing physical and mental health care, addiction services and social service case management. In this interview, Dr. Coley King, director of homeless services at Los Angeles’ Venice Family Clinic, explains how multidisciplinary teams work in preparing homeless people for a better life. We began by asking him about the kinds of health issues he sees on the streets.

DR. COLEY KING: We see, on one level, similar things as the general population but at a much accelerated rate, with people dying 20, 30 years sooner. We see a hepatitis C epidemic. Combine that with ongoing alcohol dependence, very early cirrhosis, decompensated liver failure, emergency room visits, extended ICU [intensive care unit] hospitalizations.

We see all forms of addiction. We see the meth epidemic, with poor dentition and serious cardiomyopathy and cardio toxicity from the meth. We see the obvious opiate epidemic. Another common uptick in illness and injury is physical injury and assault, which is at a much higher rate. And murder.

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CAPITAL & MAIN: How about those who are at the end of life?

When someone is in end-stage liver disease, we may refer them to hospice care. That might be a very creative, modern use of traditional hospice care. They need to know how to handle homeless patients that might still be in the street or a shelter or supported housing apartment, which would not be a traditional setting for a hospice patient.

Can you give us an example of someone you served at the end of life?

We had a situation, a fellow in his 50s, and he didn’t want to quit drinking. We got him into a shelter and linked him to hospice care. He got meaningful pain management treatment, he became happier. He had a chaplain who gave end-of-life counseling. We got him into an apartment with the supportive housing team. He seemed to be happy and he lived there for two or three months until he passed away.

Tell about your outreach.

We have extensive outreach services through the Venice Family Clinic that started small 10 years ago and has continued to grow. Either a physician or PA [physician’s assistant] or NP [nurse practitioner] is part of the team, and a social service agency provides the framework for that team with case managers, social workers and addiction counselors. That’s a team unit, a medical provider and medical home involved with social services. There is a multidisciplinary team. That is part of Proposition H [a voter-approved quarter-cent sales tax for homeless services], to man these teams countywide through the L.A. County DHS [Department of Health Services].

Within that, I see two types of housing teams. There would be more outreach-based teams that might fit with Prop. H, to discover who’s homeless, what kind of problems they’re having, addiction and health problems, [and to] link them to health care, to mental health care and link them to addiction services, and link to a housing team or a plan.

The other side of that would be high-end supportive housing teams that are registry based, that may have 50 patients or clients assigned to that team, to house them and support them in housing for three or four years before they are stable [enough] to hand off to lower level teams. These are the highly vulnerable tri-morbid patients, with mental illness, physical illness, addiction, a lot of years on the street. We are involved with several of these teams that are outreach- and registry based.

How are these teams funded?

These are all under the umbrella of the Venice Family Clinic. We serve a private grant, several DMH [Department of Mental Health] and DHS grants, in collaboration with St. Joseph Center and the People Concern. Those are our partner social service agencies.

Prop. H is what we’re working under for the outreach teams. We’re working with outreach teams across the county to collaborate with social service agencies and medical. That’s the big show right now.

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For Los Angeles County’s homeless, a shower and clean clothes are more than a hygiene issue. They’re a matter of humanity.

Eric Finister feels fresh. As fresh as a chronically homeless man can feel. The 53-year-old has just emerged from the showers at a Lava Mae portable trailer parked alongside Mount Tabor Missionary Baptist Church in South Los Angeles, and he looks sharp: his soft face glowing, salt-and-pepper beard trimmed and wearing new clothes.

For a moment, he can forget about the crowded, trash-strewn reality of Western Avenue and the hustle that exist only a few yards away.

“This is what helps,” Finister says. “I count this as a blessing to be able to come get a shower, have some fresh clothes and a meal to eat. This helps me along the way until I get back to where I know to be, and when I do, I will never forget this place.”

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For the roughly 53,000 men and women in Los Angeles County who don’t have permanent housing (and for some who do), a shower and clean clothes are more than a matter of hygiene. They’re a matter of humanity. Cleaning up can dissolve the separateness between a homeless person and the rest of society. It’s a door through which some will come to mental health services, substance abuse counseling, church and other community contacts and, finally, housing.

Lava Mae calls it “radical hospitality,” and it’s in very short supply in Los Angeles. The privately funded group runs two trailers with three showers each on a daily schedule around town. The city operates one similar trailer at the Skid Row Community ReFresh Spot on Crocker Street downtown; the other option is shelters, which are avoided by a significant number of the homeless.

If L.A. County were a refugee camp, by United Nations standards its number of public showers would be considered woefully insufficient.

The United Nations High Commission for Refugees’ standard for displaced-persons camps is one shower for every 50 people; if we think of Los Angeles County as one giant refugee camp, that would mean about 1,140 showers. A 2017 study looking at the lack of toilets on L.A.’s Skid Row (nine public toilets for roughly 2,000 people at night) also found a “scarcity of showers.”

“[The shower] transmits that we care about you and that you have dignity as a human being,” says Paul Asplund, Lava Mae’s director of partnerships and development. He’s a big, voluble guy with a graying beard who was once homeless himself 30 years ago, and has since had several successful careers.

“We notice a change when people emerge from the shower,” Asplund adds. “They’ve pressed the pause button on a chaotic life. They’ve had 15 to 20 minutes of privacy, peace and hot water, clean towels and some products. We know that has got to improve their health, if only from a psychological aspect. We haven’t quantified this in a larger way, but we’re not a health mission. We’re on a dignity mission.”

Asplund finds Lava Mae’s “guests” are more likely to seek out the other resources available at Mount Tabor. His job is to bring together partners like those at this church, where folks seeking showers also find food, clothes, and representatives from the L.A. Homeless Services Authority, the Department of Mental Health, Mount Tabor’s ministry and others who can put them on a path to housing.

Finister’s story is not unusual: He grew up in Compton, the youngest of 10 children. He has worked in warehouses, but his last job was doing homecare for his elderly parents after they moved to a rented trailer in a mobile home park in neighboring Paramount. Several years ago a funeral for one of his sisters put his parents behind on rent, and when they got evicted and went to assisted living, Finister ended up on the street. He crashed with various friends and lived for a while in Long Beach’s Bixby Park. He has adult children but, he says, “I can’t go to them like this.” He’s currently on the county’s general relief program and is staying at a shelter on Western Avenue called the Testimonial Community Love Center. He wants to work and to have a permanent home, and to get them he needs a positive outlook. The shower helps.

Lava Mae staff greeted a man who looked like an apparition, his clothes blackened and stained. “Hook me up!” he said, motioning to a shower.

“When I came last Wednesday, they got jazz! Man, I’m like, ‘Oooh! I can get with this!’” he enthused. The custom-built Lava Mae trailers have three complete bathrooms, each with a toilet, sink and shower, cleaned after every use and stocked with donated products. “I can take my time, lather up, and do what I gotta do and come out: Ta-da!”

Bernice Noflin, Mount Tabor’s outreach coordinator, notes that committing to help the homeless has created new energy in the church.

“What I didn’t expect was the benefit to our ministry, to the people working in this church,” she says. “Purpose is huge. Sometimes it’s what keeps you alive. It’s healing for all.”

As Finister and I talk on the sun-baked sidewalk, a slow parade of men turn up. One of them comes like an apparition, his very identity lost in clothes blackened and stained, a man to whom polite society would give a wide berth. The Lava Mae folks step forward and greet him. “Hook me up!” he says, motioning to the trailer.

On another day, Ismael Godinez, a caseworker with Homeless Outreach Program Integrated Care System, or HOPICS, is operating out of its South L.A. office. As he drives out in a van to do some intake paperwork with a single mother with five kids, and who is living out of her old SUV at Ted Watkins Memorial Park, Godinez tells me that he already has an appointment later in the week to drive another client to the Lava Mae showers.

“He wasn’t using all our services, but when I mentioned that I could get him a shower, his eyes lit up,” says Godinez. “He was, like, ‘Oh, I’d like that.’”

People find showers anywhere they can or take “birdbaths” — washing up at a sink in a restaurant or gas station.

Having a shower to offer, like a meal or a fresh set of clothes, is a chance to connect. On the drive over, Godinez says he hoped to win a little more of the man’s trust. He related another case where one of their clients had an opportunity to go for a job interview, and one of the mental health workers let him borrow a suit, and he got the job.

John Helyar, manager of the outreach teams at HOPICS, says that his group doesn’t get that much demand for showers or laundry. People find showers elsewhere or take “birdbaths” — washing up at a sink in a restaurant or gas station — and when they need clothes they get them from clothing giveaways. His teams get people to showers when they want them, but that need is dwarfed by the most obvious one: housing. That remains the big roadblock, two years after voters approved a massive housing ballot initiative. “HHH was passed in November 2016, so barely anything has come online yet, and it’s going to be a while before it [does],” Helyar explains.

Still, in places where homeless encampments are dense or services simply scarce, the showers are a draw.

L.A. Metro plans to put bathrooms and showers in some of its 93 rail stations.

“Bringing these mobile showers or the ReFresh Spot on Skid Row really gives us a tool for engagement teams,” says Celeste Rodriguez, homelessness policy coordinator in the Mayor’s Office of Economic Opportunity. “At the end of [the shower], there’s another moment of engagement to connect them to outreach teams, which get them to services and ultimately to long-term housing, which is everyone’s goal.”

The city’s ReFresh Spot project, launched in December 2017, is already very popular with the homeless. It is currently transitioning to its second phase, which will see three trailers offering more than a dozen showers, toilets and a set of clothes washers and dryers.

“It’s not just a porta-potty,” says Zita Davis, executive officer at the Mayor’s Office of Economic Opportunity. “It includes what we call ambassadors; they serve as kind of outreach folks. They welcome anyone who wants to use the facilities. They also direct them to professionals who are on site, if they need additional services. There’s always a clinical person who’s on site and can help with referrals. And they can make connections, to try to develop a plan for them so that they can ultimately end up in housing.”

Other public agencies are also seeing the need. The L.A. Metro board of directors voted recently to create a plan for putting bathrooms and showers in some of the 93 existing Metro stations, the first two appearing at the North Hollywood and the Westlake/MacArthur Park Red Line stations.

“It’s not a business that the city has been in, providing temporary showers and toilets,” says Davis. “These are some of the innovative ideas and projects that the city has put forward to try and bring dignity to folks who don’t yet have housing. Building infrastructure takes longer, so this is an approach to addressing needs today.”

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“The beauty of having people inside [shelters] is that they can detox
from the survival mode of the streets.”

It took 20 deaths from a Hepatitis A outbreak among San Diego’s homeless population for city officials to realize their efforts to address a mushrooming crisis were failing. Besides being an eyesore for housed residents, the squalor on the streets had become an infectious disease crisis with hundreds of hospitalizations, mostly on the public’s dime.

As the crisis unfolded late in 2017, San Diego’s city council took an unprecedented action among West Coast cities to allocate $6.5 million for three large, semi-permanent rigid tent shelters. Though the shelters serve now as nodes for addiction rehabilitation and employment connection services, the most fundamental service the shelters provide for San Diego’s homeless is a chance to wash their bodies, and a safe, clean place to sleep.

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“Since then, we’ve had 14 cities come down here begging us to do in their communities what we do in San Diego,” boasts Bob McElroy, CEO of the Alpha Project, which operates the largest of the shelters that are home to 325 men and women. “You have to have a starting point. Allowing people to lie on their ass in the street is not a starting point. The simple reality is that it’s better to have people inside as opposed to outside.”

But McElroy’s no-nonsense tone betrays how he views homeless policy “dictated,” as he says, “by paperhangers who don’t understand or have a relationship to the homeless population.” Without bringing people inside—where they can keep their bodies clean and need not worry about getting robbed or assaulted—McElroy expects little about the present homeless crisis to change.

Although cities and counties across California and up the West Coast are spending more money on homelessness than ever before, the problem continues to worsen. Pending the results of this year’s annual homeless census, Los Angeles Mayor Eric Garcetti warned Angelenos in early May to expect an increase in 2018 over the previous year.

At the center of the homeless crisis are the filthy encampments where people eat, sleep and relieve themselves, all within the same few square yards. In most jurisdictions, the dominant strategy has been simply to “clean-up” the encampments by shoveling their contents into garbage trucks and dispersing the residents—as San Francisco and Orange County have demonstrated on a massive scale over the past few months. Invariably, however, the camps return after a few weeks.

Public backlash forced Orange County supervisors to backpedal a plan to erect a serviced shelter on county property in Irvine.

Although San Diego has recently emerged as a leader in fostering “sanctioned” homeless camps, where residents are both allowed to stay put and provided with basic services, the idea behind them is not new. Oakland piloted a program that supplied one of the city’s largest encampments with portable toilets and regular trash pick-up. More than a year later, Oakland has moved on to providing some of its homeless with rigid “tuff-shed” shelters on publicly owned sites, with access to city services.

“The beauty of having people inside is that they can detox from the survival mode of the streets,” says McElroy. “It gives us time to develop the relationships and the trust necessary to get people to seek mental health services, get them back on their prescribed medications.”

But sanctioned camps are extremely controversial among housed residents who live near their proposed locations. Public backlash forced Orange County supervisors to backpedal a plan that would have erected a serviced shelter on county property in Irvine.

After Los Angeles Mayor Garcetti announced that the first of 15 proposed large-scale shelters for the city would be built in Koreatown, local residents held a rally to protest it, citing concerns over public safety. (The mayor’s office did not respond to requests for details about the shelters.)

The challenge of scaling shower pilot programs across a four-county region with more than 60,000 homeless looms large.

In the meantime, city and county leaders are working to expand a series of programs intended to provide homeless residents with, at the very least, a chance to clean up. Prompted by San Diego’s hepatitis outbreak, L.A. County Supervisor Hilda Solis pushed to establish a mobile shower pilot program at a pair of locations around Los Angeles County. Aside from offering L.A.’s unhoused a chance to get clean, the shower stations also serve as a connecting point to services to help those experiencing homelessness.

“For those of us who are housed, it might be hard to imagine, but it is fundamentally transformative for someone who has been living on the streets to be able to take a shower, or to have a place other than an alleyway or behind a bush to go to the bathroom,” said Metro transportation director and L.A. City Councilmember Mike Bonin, when other Metro directors recently voted to study adding bathrooms and showers to the county rail system.

The two existing sites that are a part of the L.A. County pilot program can serve up to about 90 people each week per site, according to Supervisor Solis’ office. Still, the challenge of scaling the shower pilot programs across a four-county region with more than 60,000 homeless looms large.

McElroy doesn’t want to criticize mobile shower programs that Los Angeles has rolled out so far, but questions whether giving people a place to shower will have any meaningful effect if they return to an unhealthy outdoor camp.

“I hate using cliches, but it’s a Band-Aid,” he says. “I would not want to say that’s not a cool thing to do, because it is. But, when you’re dealing with human beings and you take things in pieces, it doesn’t work. Come on, put up a structure and get a couple hundred people in there, and start transitioning them through. Give people time to detox from the street. That’s the only way change is going to happen.”

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