Informing Innovative Policy Solutions to Address L.A.'s Dual Crises

Transcript

Christine Lanoie-Newman

Good afternoon, everyone, and thanks so much for joining us today. I'm Christine Lanoie-Newman, and I'm delighted to welcome you to today's webinar: Informing Innovative Policy Solutions to Address L.A.'s Dual Crises. This is a live broadcast brought to you from the RAND Corporation, a nonprofit, nonpartisan research and analysis organization that brings evidence, systems thinking, and solutions to address society's most pressing issues. One of those issues is housing and homelessness, a priority topic for RAND. One I know is shared by all of you joining today.

Last year, thanks to support from the Peter Lowy Family Foundation and as part of our Tomorrow Demands Today campaign, we launched the RAND Center on Housing and Homelessness in Los Angeles. The center is addressing both the demand and supply sides of the housing and homelessness crisis. Our work brings together interdisciplinary expertise, rigorous data collection, and analytic methods to address the challenges of providing affordable housing solutions in one of the most expensive housing markets in the country. It also seeks to better understand and serve the needs of people experiencing homelessness in L.A. Today's webinar topic is one result of the center's efforts. And you can find all of our publications shown here and more at rand.org.

So, here's what you can expect over the next hour. In just a moment, I'm going to turn the screen over to our researchers, Sarah Hunter and Jason Ward, who are codirectors of the Center, and Rick Garvey, our survey expert. They'll take us through about a 20-minute presentation of their recent project and the potential implications of their findings. Please use the Q&A feature at the bottom of your screen to write questions at any point during the presentation or after, and I will use your questions to moderate a conversation with the researchers immediately following their convers—their presentation. So, now it is my pleasure to hand the screen over to Sarah Hunter to begin the presentation.

Sarah B. Hunter

Thanks, Christine. I just want to thank everyone who's taking the time out of their day today to participate in this presentation. So, as many of you know, homelessness is one of the most pressing policy issues facing Los Angeles today. In this study, we sought to provide a better understanding of the extent of street homelessness in three L.A. neighborhoods—Hollywood, Skid Row, and Venice—and also provide information about the demographics, housing experiences, needs, and preferences among the unsheltered in these places. This work is critically important as the number of unhoused individuals who are dying on our streets has increased over the past several years, especially during the pandemic. In a recent report by L.A. County Department of Public Health, they documented that 1,988 unhoused people died after the onset of the pandemic between April 2020 and March 2021. That is more than five people a day, over 165 people in a month.

Next, I'm going to turn it over to my colleague Jason to tell you more of what motivated the study.

Jason M. Ward

Thanks, Sarah. Yeah, so there were two key motivations for us in embarking on this study. The first was considering the wide-ranging effects of the COVID-19 pandemic on the effort to combat unsheltered homelessness. Important tools for rapidly housing people emerged from the early days of the pandemic, including Project Roomkey, which aimed to house around 15,000 people in L.A. County, but ultimately housed around 4,300, with many of these coming from congregate shelters that experienced reduced capacity aimed at decreasing the transmission of the virus. But regardless of how Project Roomkey fell— may have fallen short of its goals, it showed that it was possible to develop new, creative sources of housing rapidly—and, to some extent, effectively—in L.A.

Another, perhaps more important, factor was the emergence over 2021 and into the present of multiple ad hoc policies around homeless encampments, including the proposed solution for a high-profile lawsuit filed by residents and property owners in downtown L.A. over the conditions on Skid Row. That's been presided over by Federal Judge David Carter. Carter's preliminary order, issued in April of 2021, would have required the city and county to house everyone on Skid Row within a six-month period, marking a dramatic shift from acuity- or needs-based prioritization of scarce housing resources.

Another pair of key events echoing this shift to a geography-based approach to providing housing were the high-profile and very different approaches to clearing encampments from Echo Park and the oceanfront walk in Venice. Where the former event was widely criticized for being conducted hastily and ineffectively, resulting in a large number of people displaced from the park, either never leaving the streets or returning to the streets after relatively short spells in Project Roomkey housing. While the slower and more systematic effort in Venice resulted in successfully housing nearly all affected individuals, with recent data suggesting that most of these people remain housed several months later.

Finally, the city's recently updated 41.18 anti-camping ordinance was quickly debated and enacted in late 2021, but today the use of this policy to designate locations off-limit for camping and associated enforcement activities in these designated areas have varied dramatically across different council districts.

All these events have served to highlight the lack of data on the unsheltered population outside of the annual point-in-time count and demographic survey of people experiencing homelessness conducted each January by the county. And even this limited data source was absent for 2021 due to its cancelation over COVID-related public safety concerns. For example, at the time of the Carter order, estimates of the number of affected people on Skid Row in media and other reports often differed by thousands. Additionally, plans involving specific types of housing solutions—such as congregate shelters, temporary hotel rooms, and so forth—that were often projected to have costs into the hundreds of millions of dollars were being formulated with no clear evidence on the housing needs and preferences of unsheltered people, information that's critical to understanding the feasibility of these policies.

I'll now hand it off to Rick Garvey, our coauthor and field director for this study, to tell us— tell you a bit about how the study was formulated and conducted.

Rick Garvey

Thanks, Jason. I appreciate it. So, we decided we wanted to focus on three main neighborhoods in Los Angeles that had the most density of encampments in, you know, across the city. It's a very large area, so we couldn't survey the entire city. So, we focused on Hollywood, Venice, and Skid Row for our study here.

One of the things that we wanted to understand was how many people were really on the street. One of the limitations of the annual point-in-time count that LAHSA does is that it is just that: It is a single point in time. It occurs on the last weekend in January. And we wanted to see if those numbers hold throughout the course of the year. So, one of the things we decided to do was to introduce some variability in the counts. The way we decided to do that was to do multiple counts in the same areas. We decided to count Skid Row every two weeks—we started in September, and we've continued to count through today—Hollywood once a month, and Venice once a month. In addition, we alternated the time of our counts. Some of the counts we did from 9 p.m. to 1 a.m. as people were just getting settled for the night. Some of the counts we did from 5 a.m. to 9 a.m. as people were coming out of their tents in the morning. We also alternated according to the time of month. We know that a lot of people get their general relief checks during the first ten days of each month. We wanted to see if there were any variation between early in the month and late in the month. And we also alternated the days of the week.

When we went out to do our counts, we counted three different types of folks. We counted people. We counted vehicles that were being used for people living in them—either cars, vans, or RVs. And we also counted tents and makeshift shelters. We then differentiated those into small, which were six feet or lower; medium, which were 6 to 12 feet; or large, which were 12 feet or greater. In addition, we stopped by the Veterans Row in Westwood, where there was a large encampment of vets outside the VA campus. We did complete a couple of counts there and one round of surveys there before that area was completely cleared early in January.

We also conducted some surveys similar to the way LAHSA did it. And we wanted to make sure that it was a random selection. So, the way that we did it was we walked down the streets with our hand counters, and we approached every third person we encountered on Skid Row. So, there was no choice of who the interviewers could approach. It was just whoever came up on the counter. Since Hollywood and Venice are a little lighter in terms of total numbers, we decided to use every other person for both Hollywood and Venice. We then screened them for eligibility and conducted a 10- to 15- minute paper survey. I have a team of field workers that we went out into the streets with our branded T-shirts and our clipboards, and we tried to understand the demographics of folks that we ran into, their history of homelessness, physical and mental health issues that they may be experiencing, substance use, and then a lot of information on both their housing needs and their housing preferences. The findings that we're going to talk about today are interim with about 216 people, but we have since interviewed more than 400, and we are hoping to interview more in the future.

Jason M. Ward

Thanks, Rick. So, now I'll discuss the interim results from the enumeration component that Rick just described. This covers about the first four months of the study from very late in September through January. In our interim report, we reported results simply as a single number for each count, representing the sum of individuals, vehicles, and tents and makeshift structures. We didn't impute larger numbers of individuals for vehicles and tents we counted, as is done in the annual county effort, though in a future report we will explore the effects of doing this.

The graph here shows the time series of data for these counts with the total number on the y-axis and time on the x-axis. As can be seen, our numbers fluctuate from count to count, particularly in Skid Row. One outline measure— sorry, one outlier measure here we counted represented an approximately 20% increase relative to the counts before and after it. This may have been related to a large COVID testing and vaccination event happening in the area, but this example more broadly shows the importance of assessing numbers of unhoused people over a longer time period to develop a more robust understanding of the size of these populations.

We didn't find a strong pattern of variation related to counting in the morning or at night, though in Hollywood, there's some evidence that numbers are higher in the evening. If you look at the curve on this chart here for Hollywood, all these counts were begun with an a.m. shift and then alternated p.m. and a.m. shift, and you see there a little bit of evidence of some differences in Hollywood that look more systematic.

We counted around 1,300 people in Skid Row on average, around 650 in Hollywood, and around 500 in Venice. On average, these numbers increased by around 17% over the four months, which you can sort of see from the broad upward trends in these— in each area. Our counts have been ongoing since January, however, and we've seen more month-to-month fluctuation in Skid Row and Hollywood around the sort of average number seen here. However, we're starting to see evidence of a more consistent upward trend in Venice. We're going to assess the direction of these longer-term trends in a future report, as we are still conducting counts at the present time, and we'll do so at least into mid-summer.

Now I'll turn to what we found from our survey effort. The results we're going to present here are tabulations from 216 surveys representing around 100 people in Skid Row and around 50 each in Hollywood and Venice. We also surveyed around a dozen people camped along San Vicente in front of the Brentwood VA campus.

In demographic terms, our results are similar to 2020 LAHSA data on broad dimensions like age and gender. As in this past research, most of our respondents were between the ages 25 and 54, and around 70% were men. However, relative to the 2020 LAHSA data, a larger share of our respondents were Black or African-American. This— our number was around 38% higher than what was last reported by LAHSA. And a smaller share reported Hispanic ethnicity.

We asked a number of questions about the duration of homelessness experienced by our respondents. Over three quarters of them reported being continuously homeless for more than a year, with over half reporting a span of three years or more. Over three quarters of our respondents also reported being in the area we surveyed them for more than six months. In terms of where respondents were before we encountered them, around two thirds of our respondents reported previously being elsewhere in L.A. County and nearly 80% reported being elsewhere in California, suggesting that unsheltered homelessness in our research is primarily a homegrown phenomenon. This is similar to findings from past demographic survey data conducted by LAHSA.

Now I'll show you some results on characteristics of our respondents around mental and physical health and substance use. Nearly half of respondents reported ever having been told they had a chronic health condition, and more than half reported ever being told they had a chronic mental health condition. These results suggest that a substantial portion of our respondents had meaningful physical and mental health needs. This evidence is important for a number of policy issues, including the pending settlement of the Carter lawsuit being negotiated by the city, which hinges on providing housing for those without physical— significant physical and mental health care needs, as the city is currently contending that the needs of these people are the responsibility of the county.

In terms of substance use disorders and patterns of substance use, only 20% of our respondents reported ever being told they had a substance use disorder. [sirens in background] Sorry—urban living. But we saw higher levels of respondents reporting regularly using hard drugs like heroin, methamphetamine, fentanyl, or prescription opioids, suggesting that our question about a substance use disorder may be conservative in measuring the needs of respondents with respect to this dimension.

Now I'm going to hand it off to my coauthor, Sarah, to talk about what we learned about housing needs and preferences of our respondents.

Sarah B. Hunter

Great, thanks. We found across all three sites that about 90% of respondents reported that they were interested in obtaining housing. We also asked each of our participants about what sort of housing options they would accept. And this is new information, because again, in the LAHSA demographic survey, they don't ask these questions. So how we asked this question was we listed each of these different options—nine options—and they said whether they would or would not accept it with a simple yes/no answer. And these included safe camping, group shelter, bridge housing, transitional or interim housing, recovery/sober living housing, a permanent stay in a motel or hotel-like setting, shared housing, and supportive housing. And for a few of these, we also helped to define what this meant, with supportive housing being defined as having one's own apartment with case management and bridge housing being temporary shelter with onsite services. And as you can see here, the majority of participants indicated interest in staying in a setting where they had their own private room or space. About half of participants indicated they would be interested in transitional or interim housing, also safe camping or shared housing. And about a third were interested in group shelter or recovery/sober living housing.

We also asked participants what factors had prevented them from moving into housing in Los Angeles since becoming homeless in L.A. So, we listed 12 options, and they could also have the opportunity to say something else, express another issue not mentioned here. What you see is the most common response was never being contacted for move-in, with about 43% of our sample indicating this. Other frequently endorsed factors were lack of privacy, sense of safety in the housing options available, issues regarding paperwork, hours and curfew, the housing location, and cleanliness. Now, we've heard quite a bit before about what's called "the three P's"—partners, pets, and possessions—as being barriers for people potentially moving into shelter housing. Our data suggests that generally, L.A. is doing a good job on that, because that was not frequently mentioned as a barrier to moving into housing. We found that almost half of the people we surveyed had been offered some sort of housing while they've been homeless in Los Angeles, and about a third reported that they were currently on a waitlist for housing.

I'm going to turn it back over to Jason to talk a little bit about what we think are the policy implications of this work.

Jason M. Ward

Thanks, Sarah. So, yeah, there are a few things that jumped out to us as we went over what we found in this interim work. Our latest count data suggests that there's a large amount of fluctuation over time in the size of visible unhoused individuals, though, as I mentioned earlier, we're starting to see some evidence, more secular increase in Venice. Broadly speaking, having a better understanding of these kinds of trends may bear on the deployment of resources across areas of the city and on the future of attempting to enforce policies like the city's 41.18 anti-camping ordinance, as well as the city's settlement with the Carter case, which requires the city to assess the size of populations in each council district.

Another issue that we think is important to highlight is that the incidence of respondents saying a key barrier to obtaining housing was never being contacted for move-in points to what we think may be an addressable problem in the current system. Finding ways to shorten the time required to match eligible individuals with open housing as well as increasing the size and stability of the caseworker workforce may be two ways in which this barrier can be lowered and may have a meaningful effect on the overall size of the visible problem of unsheltered Angelinos.

Finally, our results suggested a low level of interest in moving off the streets into group shelter settings. This suggests to us that plans, of which there seem to be many, that appear to hinge at least in some large part on rapidly scaling up group shelters as a part of enforcing anti-camping ordinances and other such policies may not make a large impact on reducing unsheltered populations. We noted that a much higher number of people indicated interest in safe camping as a temporary housing option. This may actually be a cheaper and faster way to address immediate needs, though recent outcomes from outgoing Councilmember Mike Bonin's attempt to propose safe camping sites around West L.A. suggest that rapidly increasing either shelter or safe camping capacity may be a controversial process.

As we mentioned, this study is ongoing. We believe the LA LEADS study represents an important resource for policy and transparency around this critical issue. And we're currently exploring more permanent sources of funding to support the continuation and potentially a meaningful expansion of this effort. We would also welcome the chance to brief policymakers and stakeholders in more depth about this study and our findings. The contact information for Sarah and I is here and can also be found at the Center's website. And with that, I'll turn it back over to Christine.

Thanks so much Sarah, Jason, and Rick for that presentation. And I see some people have started to put questions into the Q&A feature. Please keep them coming. We want to talk about things that are of direct interest to all of you, so please keep your questions coming.

So, let me just jump right in, then. First question is: Could we just—very pragmatic focus, which I love—could we just buy a lot of land, put tiny houses there, and then house the unsheltered in their tiny homes—which I think speaks to one of your issues about privacy for the group home solution—and then add a social services bungalow and provide services?

So, can you— for that idea of a solution, can you speak to how that fits into your findings, and your thoughts on that?

Jason M. Ward

Yeah, I can say a few things about that. I think first off, you know, there's been a pretty rapid scaling up of the effort to create more tiny homes in the last year. That's perhaps been one of the areas of significant progress in finding at least interim or temporary solutions. You know, tiny homes obviously have limitations in that they don't have bathrooms on— you know, within the unit. And an additional wrinkle is that to some extent, it's not clear how people should think of tiny homes. Tiny homes were originally pitched as a, you know, what's essentially the size of sort of a tool shed or something. And the initial idea was that two people would share each of these structures. I think due to the COVID pandemic, primarily, that was kind of quickly abandoned. And to the best of my knowledge, tiny homes are all sort of allocated to one person per home. So it's not clear whether, you know, that's sort of the new reality of tiny homes or whether in the future there may be some interest in trying to group people up in these quite small shelters.

You know, more broadly, I think tiny homes— scaling them up rapidly shares many of the same problems with any solution, which is that, in general, there seems to be significant community opposition to putting anything anywhere, you know, to some extent, particularly a more affluent and sort of— affluent areas such as West L.A., you know, where there's been pushback on, you know, group shelters, bridge housing, safe camping, tiny homes, et cetera. So, you know, I think the actual process of simply putting anything anywhere is really a barrier that's shared by any solution. And tiny homes may be the cost-effective way to do something that's relatively private, but it won't sort of escape some of these broader barriers.

Thank you.

Sarah B. Hunter

Yeah, just to add comment on that is, I don't think tiny homes are really going to provide us with a permanent housing solution. They're designed to be a temporary or transitional housing setting, so it isn't necessarily a result in fixing our unsheltered homeless population's crises.

Rick Garvey

I will also add that people I have spoken to anecdotally, they do like the fact that the tiny homes offer privacy, and they're air conditioned, which can be a big deal, especially out in the valley or downtown where it gets extremely hot.

Thank you. Okay, moving on. How would you respond to people who interpret your findings as confirming that people experiencing homelessness are "shelter resistant"? And that's in quotes.

Sarah B. Hunter

I'll start trying to answer that. And I think just building on some of the other research that we've done, for example, where we enroll 26 veterans on the streets of Los Angeles and followed them for up to a year. And what we found—very consistent with these findings, that most of them told us they were very interested in becoming housed. But we saw them over the course of the year actually attempting to become housed and failing along the way. So, I've heard other service providers use this term that maybe clients aren't, quote unquote, "service resistant," but that the services are actually "client resistant." Right? That we have to do a better job of meeting the needs of people on the streets. And having— asking them to go to a certain place at a certain time—especially during the pandemic, when many of these offices were closed, and the only way to access and get contact was through the internet—is not really meeting the needs of the people you're trying to serve, as an example.

Jason M. Ward

Right. And I would also add that, you know, just referring specifically to the findings in our report, we don't see evidence that people are sort of housing resistant. We see evidence that perhaps they're sort of group shelter resistant, which seems like a very specific thing. But we see, you know, remarkably broad interest in housing and a remarkably broad array of options that people say would be acceptable to them.

Great. Thank you. Did your work include reviewing and accounting for how many times people have been housed and then returned to the streets for whatever reason? And kind of that cycle of temporary housing and losing it. And did you have a solution to that or any thoughts on that problem?

Jason M. Ward

Yeah, so we didn't actually ask about that. And, you know, touching on this kind of a question about did we ask about, you know, A, B, and C brings up a broad point, which is: One of the goals of the study was to try to balance informativeness in a survey with minimizing the burden on respondents and sort of, you know, making it a survey that people could actually get through. So to that extent, we sort of traded off breadth for depth in some cases. However, you know, in terms of our interest in continuing this work, the— just— questions like this from interested parties, stakeholders, et cetera, have sort of already been helping us build a list of things we might actually want to rearrange or tuck into a little bit more. And this is one of the issues, is sort of thinking about people's past experiences a little more deeply in terms of whether they had gone in and out of housing and different aspects of their interactions with caseworkers and others, and try to understand more policy-specific issues that might be brought to bear.

Rick Garvey

We did talk to quite a few people who had at least tried the Project Roomkey when it first started and were either asked to leave or left on their own because of various rules, curfews, things like that. But we did not do it in a systematic manner.

Thank you. One point you had touched on in your presentation, but it was very quick and there's a question coming up about it, is this idea that your data actually proves a counterintuitive point about California being very hospitable to unsheltered people. And it sounds like, from what you said—again, briefly—that your data did not bear that out, that that is not, in fact, the case that unhoused come to California specifically because of the resources here. So can you talk a little bit more and maybe unpack that data point and the fact that it did kind of come across as counterintuitive?

Jason M. Ward

Yeah. I guess in terms of it being counterintuitive to this notion that people sort of arrive in California to be homeless, you know, we didn't find strong evidence of that. And that's consistent with past research conducted by LAHSA that's found the same thing. You know, I think that— you look at a, you know, just a simple correlation between California and Southern California, in particular, and the L.A. area being one of the most expensive housing markets in the country. It's not, you know, it's not hard to see how people can fall into homelessness here. A remarkable amount of the renter population in the L.A. area are extremely rent-burdened. You know, it doesn't take much to fall out of housing here. There was actually just an article in the L.A. Times about the increasingly competitive nature of simply securing an apartment to rent, even among people with solid employment, et cetera. So, you know, that perhaps shouldn't be too surprising, you know, and also the idea that— I think that sort of relies on the idea to some extent that homelessness is kind of a lifestyle choice. Which, you know, there may be limited evidence that that's the case in some small numbers. But most people, you know, prefer to have a successful, normal, housed sort of a life. And so, yeah, we didn't necessarily find that too surprising. But I think there is a persistent narrative that says otherwise.

Yeah. That's helpful. Thank you. How representative is your data? And I'm thinking specifically about the preferences and that piece. Is that, you know, how sure are you and how representative is it of the the homeless population writ large?

Rick Garvey

Well, the fact that we used random selection I think speaks to a lot of that. You know, we didn't just choose people who looked like they wanted to talk to us. So I do feel that our methods are strong in terms of getting a random sample. It's not a large enough sample, I don't think, to really understand everything, so we're hoping to do some more in the future. But I think it is fairly representative.

Jason M. Ward

Yeah, and one additional point is that since we tabulated and put together these interim findings, we roughly doubled the size of survey respondents over the subsequent months to around a total of 400. And just taking your cursory— we haven't dug in depth to those, but just taking a cursory look at the nature of responses, when we doubled the size of the sample, they did not change in a particularly qualitatively meaningful way. So we feel that we captured a pretty good, sort of, what seems like a pretty stable set of responses and opinions among people based on the fact that it wasn't very sensitive to increasing our sample size.

Great. Thank you. Can you talk about if and how your work may have applications in other urban areas, cities elsewhere in the nation besides Los Angeles? Or was this meant to be very place-specific?

Sarah B. Hunter

I think it was designed to be place-specific to help inform the challenges we face here in Los Angeles. But I think, you know, certainly other cities or regions could design their tests and use similar methods. And we hope our study will help inform what other regions and cities and counties might do in terms of better understanding what the needs and preferences are among the unsheltered.

Rick Garvey

I think it's also important to remember that Los Angeles has by far the most unsheltered people who are unhoused, whereas in many other parts of the country there are systems in place where they're not actually sleeping on the sidewalk the way they are here in Los Angeles.

Yeah. This is a question, would like a follow up about the geographic locations of where folks who are unsheltered come from. And a large slice of the respondents apparently reported that they've been homeless for 2 to 3 years. And so what was the time frame that you asked about for where they were prior to experiencing homelessness? Did you— was that part of your questioning of where they were and what their housing situation was prior to them being homeless?

Jason M. Ward

Right. So that goes back to the sort of breadth versus depth of our survey. What we actually asked people was, "before you were in the location where we encountered you, where were you?" Right? So, we didn't actually say, "where were you last housed?" That's something that might be interesting to explore in the future. However, you know, in terms of sort of imputing things from the data we did collect, as you mentioned, you know, the fact that people had been continuously homeless for so long. And in many cases— we asked a question that we didn't present results from in the slides about your total lifetime period of homelessness. And for most people, there was a pretty high correlation between their current spell of homelessness and their lifetime spell of homelessness, suggesting that, like— this question we asked about where were you before probably at least captured a lot of where people last had a place to live. But that's something that we can't say with certainty, based on the sort of parsimonious nature of how we ask those questions.

There are a couple questions coming up about veteran populations, homeless veterans. And I know that wasn't specifically a subpopulation target of this particular work, but I know it's part of your broader mandate in the center to look at the population of veterans who are experiencing homelessness. So, anything you can share about insights, findings, or ongoing work for veterans?

Sarah B. Hunter

Well, yeah. So, I mean, we did do— you know, after we got started, we did kind of go to Veterans Row to see what was happening there, but they cleaned it up fairly quickly right after we started our efforts there. So that's why we have such a small survey sample from that area. But yeah, I would say, you know, we're going to continue to study housing instability among veterans nationally; that's some of the work we're following up on. We've partnered with researchers at the Greater L.A. VA Medical Center, and they have got additional funding to continue to look at the cohort of veterans that we enrolled in our longitudinal effort. And they should have some work out later this year on what they found. And because they work at the VA, they're able to look at outcomes like health service utilization, which we were unable to do because the only thing we had access to were the veterans themselves and not their health service record. So that's some work that should be coming out later around that population. But generally what we found was, as I mentioned earlier, we enrolled 26 veterans in and around West L.A. with a specific focus of having folks that could get to the greater L.A. VA campus either by foot or by public transport, because we were specifically interested in why—you know, you have access to these services here—are you continuing to live on the streets? Over the course of the year, three of those 26 veterans were permanently housed. About two-thirds found some sort of transitional housing during that period. But there were a good third of individuals that remained unhoused for the entire year.

Rick Garvey

Another thing I'll add about the veterans is the fact that the VA has so many resources and so much land here in Los Angeles. They were able to put on the VA campus all sorts of different types of shelter and housing services. So there are tiny homes. There is a sanctioned campground. There is a safe parking lot. There is a domiciliary which has medical services available for temporary housing. There are VASH vouchers which allow people to have permanent housing. And there is a bridge housing program at the welcome center. So, there are all sorts of different types of housing available for veterans on the campus, which makes it a lot easier.

Jason M. Ward

Yeah, in terms of our report as well, while we presented here results that included the small sample of individuals we encountered on Veterans Row with the rest of our respondents, in the appendix of the report, we tabulate all these things by survey site, including the small sample of individuals we surveyed on Veterans Row. And there are some differences in that population, though with the sample size being what it is, you know, there may be some caveats. But interested readers can go and see if there— what they find about those kinds of differences, according to the study.

Great. You had a slide and some data about chronic health, mental health, and substance use disorder rates. How do you— how do those compare to the general population? So, should we think of those as high, or are those in line, or— can you talk a little bit more about that?

Sarah B. Hunter

Yeah. I mean, they're a little high. I think, among the general population, in one's lifetime, you'd see about one in five people developing a mental health— or having a mental health condition, whereas among our sample it was close to half of people. You know, this isn't surprising. Living on the street is very challenging. So if you don't end up on the street because of your mental health disorders, certainly you could develop a mental health disorder due to living on the street. You have lack of safety, high rates of trauma, violence, et cetera, that could cause PTSD and/or a number of other mental health disorders. So it is higher. I think national data show that about half of Americans today do have one or more chronic health condition. But you know, I'm not sure. Does— Jason, Rick, maybe you know. I don't know how that breaks down by age, and so, that— to make it directly comparable to our sample.

Jason M. Ward

Yeah. I was going to say, I don't think we have a great beat on that. I mean, there's some CDC data showing that around half of individuals 45 to 64 have at least one chronic disease. But, you know, that's sort of half of our population that we— you know, the majority of people, as we saw, were 25 to 54. So I think in some sense, these people are generally relatively physically less healthy than the average population, which is perhaps to be expected given the rigors of living on the streets.

Yeah. Were there any notable differences? You said you picked three spots in Los Angeles to conduct the surveys. Any noticeable differences, particularly with substance use, across those three areas that you want to share?

Sarah B. Hunter

The population in Venice was a little younger, and the population in Skid Row was a little higher. Rates of—you know, this was self-reported—you know, "did someone ever tell you you had a substance use disorder?" So among that, for that question, the rates were— again, these, you know, once you break it down by site, we're not talking about a lot of people. It was slightly higher reporting in Venice at 22% versus 15% in Hollywood and 18% in Skid Row and 50% among the 12 people on Veterans Row.

Okay. Have you all looked at how other countries who have, you know, low homeless populations, what best practices or policies or lessons learned we can take from there and apply here? Has that been part of your work, or is there anything fruitful you can see there as a potential to apply to this issue here in L.A. and beyond?

Sarah B. Hunter

Oh, I think, you know, in some senses it's hard to compare internationally given how other countries have much more robust social service systems compared to the U.S. So, you know, they— those countries don't have the extent of homelessness that our country has. And so it's hard to compare because, you know, the systems are so different from birth moving forward for people to rely on compared to the U.S.

Mm hmm.

Sarah B. Hunter

And then looking within the U.S., there have been some areas like, for example, that have focused on ending veterans homelessness or ending chronic homelessness in ways that in many cases are very different in Los Angeles in that they're much smaller regions. So it's easier for the service systems and nonprofit providers that serve these populations to collaborate. And that's one method that's shown to be really useful, is that they collaborate very closely. Every system knows every single person out on the street, and they work intently week by week. Where is this person? What are they doing? Who needs to intervene and support this person to transition them to a more stable setting? We don't have nearly that level of coordination in our county and in our city, primarily just due to the size of the region. It's very difficult. And we've separated into service planning areas. We have eight service planning areas. We designated different nonprofit providers to lead efforts in those areas. We have the city. We have the county. We have 88 different cities in our county and unincorporated regions. So it just makes it very, very difficult to coordinate. We have a Los Angeles CoC—Continuum of Care—that gets HUD funding. Long Beach, Pasadena, and other areas don't participate. They do their own efforts and get their own funding. So that's just, you know, just as an example, many, many ways in which it makes it challenging to end homelessness because of how many systems are involved and how disconnected we are. And there's no one central authority or entity that's responsible.

Jason M. Ward

And I would also point to some aspects that are unique to the regional housing market. As I had sort of alluded to earlier, you know, L.A. is an incredibly expensive housing market with a dramatic shortage of housing. And I think even if you compare it to other really large metropolitan areas like Houston, which has had some significant success in addressing their homelessness problem, you know, despite Houston and L.A. being—I mean, L.A. is much larger, but it's a very large metropolitan area in the U.S. The amount of unsheltered homeless they have in Houston, I believe, is you know, at most around 10% of the population in L.A. However, to the extent that Houston has been successful, people have pointed to factors like just a much higher level of coordination in terms of, as Sarah mentioned, having a sense of who are all the people that need help? They have a much quicker process to build housing, much, much lower costs, just a lot of factors that are not encountered in L.A. And so, I think L.A. in some sense is a problem unto itself relative to many other areas.

Yeah, that makes sense. Jason, you talked— you mentioned very briefly the idea and barrier of community opposition, particularly in West L.A. Can you talk a little bit more about that, specifically if any of your findings give us new insights or ideas or ways to address this as a barrier?

Jason M. Ward

I mean, I guess I would say our findings perhaps serve more to highlight the fact that west. L.A. sort of has a problem. And, you know, I don't know that we encountered anything that points to really great solutions. It more points to the fact that we need to find solutions. And, you know, in some sense, just to zoom out a little bit, I'm sort of struck by— you know, it's obvious why people have concerns about having people camped out right in front of their homes and things like this. You know, it's not great for the homeowner. It's not great for the people camping there. It's just a really bad issue. But I'm sort of struck by the fact that many proposed solutions seem to encounter so much pushback when the status quo seems so bad. So, I don't really— you know, I don't know that we've found anything that points to a way forward, other than perhaps trying to really increase the efficiency of the system and maybe to— you know, one silver lining is: If you do look at what was accomplished in Venice on the ocean front walk, I think that was the result of a very deliberate marshaling of resources that might offer a way forward, you know. But I think that it would be tough to do that over and over again, though not impossible. And maybe that's just the sort of level things need to rise to.

Sarah B. Hunter

You know, just bring some more optimism on that note is: One thing we found that we think is really potentially policy-relevant and an easy fix is this idea that over— you know, most people want to be housed, so they are not resistant to that idea. But over half of them, you know, never were contacted for follow up, which suggests that if we can speed up that system, that would be ideal. And we know, too, that the homeless service sector, that's a very challenging job. If people are being sent out there—outreach workers—without, you know, they can't say, "okay, I can walk you over to shelter today." That's rarely the case. It's like, "let me get your name; let's follow up; I will need to do an assessment." And then you're on a waiting list for nine months, 12 months, who knows? And during that time, you may be—with street cleaning, street sweeps, encampment sweeps—being displaced from where you are and therefore become disconnected from that caseworker that you're working with. And so, if you have to move someplace else that may be serviced by a different nonprofit outreach service provider, and you have to start kind of like all over again the process of establishing that relationship, figuring out where you are on the waiting list, et cetera. So, I think our findings do lend some idea of potential solutions of making that system more robust and working more closely and collaboratively so that we connect people to make the match sooner and faster.

Great, thank you. What's next? I mean, you mentioned at one point this is an interim— interim findings. You've talked about all of the work that needs to be done to get to solutions and policy change. So if you were, in an ideal world, perfectly resourced and had all you needed, what would you tackle next in terms of either this particular project or kind of what's next on horizon to move this work forward?

Jason M. Ward

So, in terms of what we actually will be doing with the— what we've sort of been involved in since this report's data, sort of data collection stops. As I mentioned, we've roughly doubled the sample size of survey respondents. So in a future report, we're going to both highlight the ongoing count effort. We're going to release a report that looks at the count data over a much longer time frame that I think will end up being at least nine or ten months, which, you know, is sort of an unprecedented amount of continuity. We're interested in seeing what we learn from that. We hope to be able to acquire data from LAHSA that's disaggregated geographically.

And tell us what LAHSA is. You've mentioned that acronym a lot; I just want to make sure that everyone has—

Jason M. Ward

Alright. Yeah. Los Angeles Homeless Services Authority. That's the county-affiliated authority that—

Sarah B. Hunter

City and county. City.

Jason M. Ward

—manages a lot, all the funding around homelessness services and also manages the annual count and demographic survey that we referenced.

Thank you.

Jason M. Ward

So, we hope to be able to sort of make more of an apples-to-apples comparison to the LAHSA data to look at sort of the timespan we've explored with respect to times further in the past in these small areas that we're actually considering. In terms of going forward, you know, we would love to just try to find a way to continue this project as a permanent resource. We think that it could sort of really be a kind of ongoing temperature check and policy-relevant set of data to bring to bear on addressing this problem. We would also love to expand the scope of the project to other sites. Obviously, we've chosen these three sites that are pretty salient to a lot of recent policy. But, for instance, we don't have a sense of what's going on in San Fernando Valley. We don't have a sense of what's going on in many important parts of South L.A., East L.A., and so forth. So, all those things would be of great interest to us, and we think that would be of great interest to policy.

Sarah B. Hunter

And just to add to that, as we mentioned earlier, we had a very brief survey. It opened up doors of other questions that we would want to ask. So, if we could have another survey effort where things we would ask more about, when were you first— you know, where did you live when you first became homeless? Things of that nature. So we can inform that. We didn't ask specifically about tiny homes. That wasn't really on our radar screen when we started this work. So there's a lot of additional questions we might want to revamp or revisit. We would also love to do a more longitudinal effort— qualitative effort where we can have more, like, a conversation or discussion with people on the street—rather than this very brief survey, where we get more, like, yes/no answers—to really kind of understand, like, why did you become homeless? Why are you here? What are other places you can go? Are you connected to your family? How so? Things of that nature, so we can kind of build the story of people's lives and why they are where they are. You could see some of that in the 26 Veterans study we did, that we were able to kind of pull together stories of these veterans by doing a more in-depth effort.

Rick Garvey

Another thing that—

Sarah B. Hunter

And what about if you take that one layer further? Like, if you have that sort of more complete, nuanced representative data collection, then does it give you more entree into policy solutions? Like, what is the next step after that if you take the aperture out even further?

Jason M. Ward

You know, one thing I was going to say is that, you know, Sarah sort of reminded me about things we would like to know going forward. And, for instance, some things that have occurred to us more recently—in addition to some things we mentioned during the presentation—are, for instance, learning more about people's sources of income and ability to work. Because this bears on, for instance, the types of services and support they may need and sort of different approaches to reintegrating people into housing and potentially a better life. So those types of things we would love to dig down deeper into with future survey work as well.

Rick Garvey

I'd also be interested in seeing what the impacts of the 41.18 law are, because it is impacting different neighborhoods in different ways. Some council members are using it. Some council members are not using it. And so, I think that would be a very interesting thing to look into in the future.

Great. Thank you. We are closing in on the end of the hour, so I'll ask one final question. This is for all three of you. And after doing this work, what surprised you most, if anything, when you saw your findings and your results?

Sarah B. Hunter

For me, it was the number of people who said they've been offered housing. You know, that was close to half our sample. And that, you know, about a third were on a waiting list.

Jason M. Ward

Yeah, I was surprised initially by the extraordinarily large number of people who said they had been, for instance, continuously homeless for three or more years. Because that's just staggering to think about. Though, given the effects of the COVID pandemic on many aspects of the system we use to house people, perhaps that shouldn't have been entirely shocking. But I think it really makes a point about the— for anyone who thinks about that, it's just a very sobering thought. I think we were all struck by the fact that the primary barrier to obtaining housing that people highlighted was this failure to be contacted for move-in. You know, we had— in terms of when we sort of made a list of things to say, to ask people about, this was actually, like, you know, kind of low in the list, meaning it wasn't, like, the very first thought that we had. And I think we were all taken aback a little bit by how, you know, how much of a barrier this apparently is.

Rick Garvey

For me, as someone who's been on the streets now for almost a year doing this, I think it's how hopeful people remain and how resilient people are. The fact that they can sleep in tents through the rain; you know, rats running around; getting their hopes offered for housing and then dashed; just how hopeful they remain and the fact that they're able to stay in good— you know, in general, they're mostly okay. When we ask them how they're doing, they say they're okay. And, you know, some people say they're blessed. And then when I come home to my apartment in Venice, it just makes me appreciate what I have. So I think just the resiliency of people on the street was what really surprised me.

Thank you so much. And thank all of you for joining us today and a great conversation. Appreciate your questions and your attendance. Like I said, this will be made available at the rand.org website—this full recording—and happy to share it out with anyone who reaches out. If you have a question that didn't get answered and you still want to engage, please reach out to us as well to the addresses that Sara and Jason provided during their presentation. Thank you.

Jason M. Ward

Thanks, everyone.

Rick Garvey

Thanks, Christine. Thank you.