California Dreaming

Updated: Jun 28

It only takes one "Yes"



Los Angeles has a homelessness problem that will only continue to grow. In 2020, the documented count of people experiencing homelessness in Los Angeles County was nearly 65,000! If all homeless people in LA showed up to Dodger Stadium, 10,000 would have to stand outside the gates. It is anticipated that by 2025 (just 3 years from now) the documented homeless count will reach 80,000 people. Let’s put that in perspective: there are only 107 cities in the state with a population higher than 80,000 people. And talk about what’s being done so far…according to the Los Angeles County Jail, the Jail is the biggest provider of behavioral health services is Los Angeles County Jail (yes, those twin towers that loom over DTLA)! 1/3 of the LA County Jail population has a mental health diagnosis – that is 5,666 people – every day – who are being cared for in the prison. Prison is not the right place for homeless people or those diagnosed with a mental condition.


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About a year ago, someone asked me if I had any ideas about how to help solve the homelessness problem in Los Angeles. Being a healthcare planner in the state of California aware of the impact SB1957 has had on health systems and hospitals, in my head, I developed a scenario where the hospitals slated for closure would be re-purposed for a new model of care for homelessness and people experiencing mental health challenges. I call it California Dreaming.


For those of you who don’t know, SB1957 is the result of hospital infrastructure failure after the 1991 Northridge earthquake that rocked a hospital to the ground. After that quake, California decided that its hospitals needed to be seismically sound enough to sustain earthquakes and remain standing. That meant for many health systems (after seismic assessment) up and down the state, their hospitals would need to be retrofitted, replaced and/or re-purposed. Therein lies the challenge – what to do with the old buildings?



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As I look around this City of Angels, I see failing infrastructure for both humans and buildings alike. I’d love to see that change and for these two things to come together and help support each other. These old hospital buildings with all their heavy infrastructure don’t need to be re-built to HCAi Acute Care standards; instead, they can be repurposed into a “whole health” environment! This promotes the health and well-being of a population in need inside buildings designed for healing (and bonus, already built!).


Example uses of existing hospitals include the conversion of an Emergency Department (ED) to a “crisis stabilization unit”, with observation beds and outpatient services. Re-developing these massive structures into rehabilitation and single-unit living quarters provides shelter, safety, and a space to heal. The structures can include spaces for counseling and group therapies to help people cope. As people can do more for themselves, they can earn agency by learning skills through building work programs while earning a wage. These buildings can offer a safe place for people to take the time they need to change.


Let’s face it, building anything new takes a long time in the state of California. But, by re-purposing existing hospitals, there is no need to build new. Since these spaces would be turning into residential/outpatient services at the most, the requirements to convert are minimal and adaptable building re-use has a low carbon footprint. Additionally, there is no “not-in-my-backyard”: since this is a renovation and not a new build, there is no public recourse to protest.


Ideally, area hospitals whose EDs are overfilled with, and financially impacted by, behavioral health and homeless patient populations will divert clients to these crisis stabilization units designed to provide the right services in the right location. The cost in California for a patient who leaves the ED without being seen is $685, and the hourly cost of diversion is $5,400/hr! Building off of the idea of Alameda County’s John George Model of Care, in Portland, OR, we helped to develop an organized approach to health systems coming together to help share the burden of over-impacted EDs. It can be done.


Los Angeles, what are we waiting for? California – what are you doing with your Structural Performance Category 1 & 2 buildings that need repair/replacing by 2030? I see this as an opportunity to do good with what we have. Don’t you? Additional Resources:


Homelessness & Housing Map (ArcGIS Storymap): https://storymaps.arcgis.com/stories/400d7b75f18747c4ae1ad22d662781a3


https://hcai.ca.gov/visualizations/inpatient-hospitalizations-and-emergency-department-visits-for-patients-with-a-behavioral-health-diagnosis-in-california-patient-demographics/



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