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Delivering on a promise of new hope

Skid row's severe cases get off the streets and manage to keep their rooms, in most instances. But it takes political will and enormous effort by staff. And there are no smooth outcomes.

August 07, 2010|By Christopher Goffard | Los Angeles Times Staff Writer

Everywhere Carrie Bach looked, there was cause for hope or its opposite. People were getting better and people were dying. They were inching toward trust and hiding in hypodermics. They were filling the air with prayer and fouling it with crack vapor. They were reclaiming a place in the human race and fleeing deeper into narcotic netherworlds. There were blackout drunks now lucid and blackout drunks still landing themselves in the emergency room.

In early 2009, the county's push to house skid row's 50 most hard-core homeless was entering its second year. Even as their fates remained precarious, clients were trying to learn the names of an ever-shifting staff. Almost all the original outreach workers, drug counselors and social workers were gone. They'd crumpled under the pressure or cycled back to their departments or found better-paying work.

Bach herself was quitting as director. From the start she'd known Project 50's stakes: not just human lives and millions of dollars but also, perhaps, the fate of homelessness policy in Greater Los Angeles. But she'd come to feel isolated, a small and expendable player. Her judgment was questioned by colleagues and bosses: once when she led a reporter to a client's room and the resulting article mentioned roaches, and again when she helped a client who had been arrested tap her welfare money while in jail.

The program, which gave apartments to homeless addicts with few conditions, had always been controversial, and if something should go wrong -- if someone in power found grounds to raise a clamor -- she feared she would be the scapegoat.

She'd fostered risky personal relationships with clients, going way beyond the job description. County bosses admired Bach's zeal and knew that an unconventional program required a pliable playbook. But now they wondered whether her background as a public-health nurse had trained her to draw boundaries with mentally ill addicts.

"I've never been under such stress," Bach said. "I don't regret one moment of it. It was awesome. It's just that it really did test me, and it showed my cracks."

Among clients who had grown to love Bach, who got little explanation for her departure, the news hit hard. Maurice Lewis, the first one housed, summed up the feeling: "We were like her children."

The new director, John Snibbe, a clinical psychologist with the county Mental Health Department, was everything Bach was not: guarded in speech, by-the-book, skilled in politics and bureaucracy. He would tighten procedures where Bach had left them loose. He would methodically screen people for federal benefits eligibility. He knew all about boundaries. There seemed small likelihood the clients would ever view themselves as his children.

Rotating back to a desk job in the Public Health Department, Bach found it hard to divorce herself entirely from the people to whom she'd devoted a year. Soon after leaving, she made plans to attend Project 50's monthly birthday party for the clients. Then her phone rang. The new director's secretary was on the line, sounding a little embarrassed, relaying word not to come. The clients needed to make a clean break.


From the outset, a selling point of the two-year, $3.6-million program was the promise that it would largely pay for itself. Cathy McFee, a longtime addict with a festering abscess on her leg, provided a striking, if extreme, illustration.

During her last year on the streets, McFee had spent about 40 days in the hospital, costing taxpayers nearly $90,000. The year after Project 50 placed her in the Sanborn Hotel, with easy access to nurses, she visited the hospital just once, for a $940 tab.

"This has not cost us practically anything," Zev Yaroslavsky told fellow L.A. County supervisors at a May 2009 board meeting, seeking their votes for a tenfold expansion of Project 50. "We know enough to know that this is working."

But other supervisors balked at the expansion to 500. At a time of slashed programs and a bottomed-out economy, Supervisor Don Knabe asked, was it wise to spend heavily on the chronically homeless to "essentially provide them permanent housing for the rest of their lives?"

Since it began, the program has managed to shepherd 68 of the chronically homeless into apartments. Of the surviving 62, the county reports that 52 remain housed in one form or another. Some have transferred to nursing homes or been taken in by families.

All of the 39 who still live in Project 50 apartments are receiving medical help at the clinic next to the program's headquarters. Thirty-seven are voluntarily getting treatment for mental disorders, 17 for substance abuse. Eight have been sober for more than six months. Of 50 identified on the county's original list of skid row's most vulnerable, 20 were never found, mostly because of a one-month delay early in the search for a transient and elusive population.

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