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LOS ANGELES — The job sounds impossible: solve the health care crisis in the massive and desperately sick homeless population of Skid Row, which sprawls across dozens of blocks just south of downtown.

Marc Trotz readily admits he’s daunted.


“I don’t feel successful any day I come to work,” he said.

But as director of Los Angeles County’s new Housing for Health initiative, Trotz is trying to make a dent, starting with the estimated 2,000 people on Skid Row who have no shelter aside from tents, boxes, or cars. His office is located in this sprawling neighborhood of extreme poverty, so Trotz works amid the shanties and tents, the stench a daily reminder of how much work he has yet to do.

His partner in this mission: Dr. Mitch Katz, who directs the county’s Department of Health Services. Trotz and Katz had success addressing a homeless crisis in San Francisco earlier this decade by moving people into permanent housing and connecting them with support services.


Now, they’re trying a similar tactic in LA.

It’s a bold approach: They’re using health care dollars not just for blood tests and antiviral medications, but also to pay for housing for the sickest residents of Skid Row. The idea is to first give the homeless a stable place to live, then gradually treat their medical and mental health needs — instead of waiting for them to quit drugs and clean up before settling them into an apartment.

Each week, Dr. Susan Partovi helps the homeless on Skid Row, just a few blocks from wealthy downtown Los Angeles. Dom Smith/STAT

National experts applaud the strategy: “We think it’s absolutely essential,” said Matthew Doherty, executive director of the United States Interagency Council on Homelessness. “People cannot address their [health and addiction] challenges when they are struggling with homelessness every day and every night.”

So far, the county has allocated nearly $60 million in health funding for new housing. Officials look for available units across the county, typically in affordable housing developments. Residents generally pay 30 percent of their income, however low that may be.

The county is also stepping up its health outreach. It moved a clinic to Skid Row, and Trotz has organized battalions of health workers from public agencies and nonprofits to canvas the region, in an initiative called C3 for County+City+Community.

Four teams — each made up of nurses, mental health and substance abuse experts, and homeless advocates — return day after day to their assigned sectors of Skid Row so they get to know the residents and gain their trust. Previous outreach efforts have been too scattershot, Trotz said.

“We can’t just be wandering around with two people and a couple of backpacks,” he said. “You can’t just say, ‘Hey, how are you doing?’ and hand out some socks.”

“People cannot address their [health and addiction] challenges when they are struggling with homelessness.”

Matthew Doherty, United States Interagency Council on Homelessness

Outreach workers often find that offering medical help is the best way to engage people living on the streets, who are often suspicious of strangers.

“They have a gaping wound. We have a nurse who can help,” said Sara Shortt, who runs the program from a vibrant, renovated storefront on Skid Row. “A random window opens and they’re ready for detox — maybe it’s that their tent got stolen for the seventh time. Because we’re there, we can be around when that window opens.”

In its first four months, the team has assigned 184 people to permanent housing, including many who suffer from chronic kidney and pulmonary disease, HIV, heart failure, and cirrhosis. Officials say they are likely to reach and perhaps even top their goal of housing 250 people in the first year.

They hope to get nearly 2,000 people — nearly all of Skid Row’s unsheltered — into permanent housing within four years.

City and county leaders are now scrambling to find more money to expand this program and others; they recently proposed a new tax on LA’s wealthiest residents. It’s estimated it will cost nearly $2 billion to provide housing for the city’s 26,000 homeless residents. Add Los Angeles county residents to that total and the homeless population for the region stands at nearly 50,000.

“If I could wave a magic wand, everyone over the age of 60 who was homeless would be housed,” said Dr. Susan Partovi, who walks a sector with the outreach teams and staffs two clinics on Skid Row. “Housing is the cure for homelessness. It’s also the cure for a homeless person with diabetes, with drug addiction or hypertension. It’s the first cure.”

The “housing first” approach worked for T.D. Osborne. When he moved to LA from Seattle in the ’80s, he had a stable job with Amtrak, working in the dining cars. But a cocaine addiction led him to lose everything: his job, his wife, his home. Osborne alternated between shelters and the homes of friends for years. He found an apartment through the Skid Row Housing Trust in 2004 and finally became clean in 2010.

“I had to give up 100 percent of everything — cocaine, drinking,” he said. “That would have been hard on the streets.”

He’s since been successfully treated for a goiter and and other health issues. “Having housing made it easier to get to the appointments I needed, to get blood work,” he said.

Osborne, 57, is now working with one of Shortt’s teams, reaching out to others who have similar stories. “I understand the addiction part,” he said. “I understand the hopelessness. Even when you start receiving help, it takes a while. It’s not easy.”