Last September, the White House sent a delegation to Los Angeles, California, to study Skid Row. Afterward, President Donald Trump denounced the state’s failure to deal with homelessness, and blamed the problem on “the liberal policies of overregulation, excessive taxation, and poor public service delivery.”

The administration, he said, might “do something to get that whole thing cleaned up.”

Local homeless advocates dismissed the administration’s Skid Row tour as partisan grandstanding. The affordable-housing crisis in California is severe, but it’s just one slice of a nationwide shame: More than 550,000 people across the country experienced homelessness in 2018.

Though the overall homeless population appears to be declining, practically every major city has tried, unsuccessfully, to “clean up” the problem. But the answer isn’t as simple as providing housing to people without homes. Politicians and community groups have been trying to “end homelessness” for decades, with tactics ranging from banishing the homeless from public spaces to furnishing them with instant housing.

Veteran advocates know that the lofty goal of “ending homelessness” obscures the messier, slower work of helping individual people change their day-to-day lives from day to day, and pushing social service providers and government agencies to start treating homeless people with patience and dignity—things that they often need more than housing itself.

The unmet need for housing is a function of endemic poverty, disinvestment in public housing, and chronic underfunding of Section 8, the federal rental subsidy program for low-income households. According to the National Low Income Housing Coalition (NLCHP), it takes three full-time workers earning the federal minimum wage ($7.15) about 127 hours a week of work to afford a two-bedroom apartment at the national average rent. Moreover, cities with large homeless populations also tend to suffer from soaring rents, exploding inequality, and rapid gentrification.

Homelessness is a predictable result of deliberate policy choices and the structural scarcity of affordable housing affects everyone. Yet homelessness is often treated as a personal failing by the social welfare system and a public nuisance by law enforcement. “People often confuse what causes homelessness with which people end up homeless,” said Steve Berg, vice president of programs and policy of the National Alliance to End Homelessness.

In Los Angeles County, where the homeless population climbed by 12 percent in 2018 to 59,000 individuals, a huge street population is constantly exposed to police; arrests of homeless people have risen steadily in recent years to roughly 14,000 in 2016. Rapidly gentrifying San Francisco has also made homeless people a target of “quality of life” crackdowns; authorities field roughly 2,500 calls a week complaining about homelessness, drug use, and public safety.

More than half of cities nationwide ban people from sitting or lying down in certain public spaces, and about a third prohibit “loitering” in public, according to a study on anti-homeless laws by the National Law Center on Homelessness & Poverty. (On the federal level, the Trump administration has signaled it may expand policies that criminalize homelessness. At the same time, local anti-encampment strictures could be sharply restrained by a recent Supreme Court decision.)

Although the daily cost of incarcerating homeless people vastly exceeds the cost of shelter, jails and prisons have become de facto shelters for many homeless people. The National Council on State Governments estimates that more than one in 10 people cycling through jails and prisons also cycle through homelessness. Likewise, people who have been repeatedly incarcerated are 13 times more likely to experience homelessness than the general population, and as with the incarcerated population in general, black men experience homelessness at much higher rates than white men.

“Any kind of system response that’s moving people from block to block, or into a shelter and back to the streets, or into a hospital bed and back out to the streets,” said Jennifer Friedenbach, the executive director of the Coalition on Homelessness in San Francisco, “simply increases the trauma that homeless people are already experiencing from such severe instability and not having a place to live.”

New York City police often target homeless people for public-order violations, particularly in the subway, where the growing presence of unsheltered homeless people has prompted both Mayor Bill de Blasio and Governor Andrew Cuomo to deploy additional police to pressure them to go to shelters or to otherwise move out of sight.

“The kind of aggressive policing and public policies that are criminalizing homeless people—it’s hard to look at it that outside the broader context of how racism functions in our society,” said Carl Siciliano, founder and executive director of the Ali Forney Center, a shelter and community center for LGBTQ homeless youth.

Less-aggressive methods of pushing homeless people off the streets also have sparked controversy. De Blasio recently launched a program to help outreach workers target and encourage them to enter the city’s shelter system, which has expanded in order to provide for the city’s law guaranteeing the right to shelter.

No matter how much outreach the city deploys in the subway corridors, says Giselle Routhier, the policy director of Coalition for the Homeless, “It’s just going to create a culture of…increased criminalization, increased surveillance of people who are homeless, further shuffling people around, forcing them further underground and away from engaging with anybody, because the engagements they’re dealing with are becoming more and more frequent and more and more traumatizing. And the mayor actually needs to invest in housing. It’s very simple.”

Homes for the Homeless

One straightforward way to reduce the homeless populations is to simply give homes to the homeless. To that end, many cities are adopting a “Housing First” model—often implemented as an emergency intervention, with essentially a one-time boost to help people find an apartment. Cities will usually cover the first few months of rent and provide some short-term social services, in the hope that people’s situations will stabilize—allowing them to take care of other issues, such as joblessness—and start to live independently.

Under the Obama administration, the Department of Housing and Urban Development invested heavily in Housing First through grants to localities. Many municipalities have embraced Housing First as an austerity-minded approach: a time-limited government intervention that maintains an underlying ethos of “self sufficiency.” Prioritizing housing, without preconditions like sobriety or income requirements, diverges from previous approaches that focus on “housing readiness,” which generally forced people to undergo services and treatment before they could qualify for independent housing.

Samantha Blatko, a research associate with the Urban Institute, described the most basic short-term form of Housing First, known as “rapid rehousing,” as “essentially an intervention that’s formed out of the [fact] that there are not enough resources, and so it’s provided on an as-needed basis.” While early research on Housing First shows that many do stay housed, people often need much more than a home to escape homelessness for good.

New York City’s experiment with Housing First under then-Mayor Michael Bloomberg churned the massive shelter population by pushing people in and out of shelter, without significantly reducing it. From 2005 to 2011, several thousand families exited the shelter to enter rapid-rehousing apartments with short-term subsidies under two different programs, lasting two or five years. The program initially coincided with a sharp decline in the length of stay in shelters.

One study by New York–based Institute for Children, Poverty, and Homelessness (ICPH) tracked families from the tumult of the shelter system into rapid rehousing. Without adequate social supports, the think tank estimated, more than 60 percent of families eventually returned to homelessness. By the time the subsidies ended around 2011, the shelter system had swelled to about 40,000. Today, about 60,000 individuals stay in the city’s shelters every night.

One former Housing First client, Maria Teresa Walles, testified last year to the City Council about cycling between dilapidated shelter housing and an unsustainable apartment: “I know the system is like a revolving door. I was in the system twice. The first time, I was in the system with my family, but unfortunately, things changed, and I went in again with my husband, as an adult couple…. I had to go back into the shelter system after the government discontinued the program. My husband and I stayed in the system for four years until we finally got our place…. Instead of investing the funding into shelters that provide temporary housing, we should be putting this into permanent housing. For the amount we are spending on shelters, we could house people in an apartment.”

Ralph de Costa Nunez, president of the ICPH, told The Nation that Housing First could be a solution for an estimated 20 percent of homeless families. Many others need transitional services to stabilize over the course of several months, such as education, job training, or therapy. “They’re victims of domestic violence, [they have] mental health histories, some have substance abuse histories, many have foster care histories,” Nunez said. “So they have this institutional background. We just can’t take that group and put them in an apartment and say, Good, we’ve solved it.’”

In Los Angeles, Housing First has been implemented in the form of “rapid rehousing” for veterans and single adults, as well as permanent supportive housing schemes for chronically homeless people who have been homeless for more than a year and have major physical or psychological needs. In both programs, some advocates fear that the rush toward permanent housing is leaving behind the people who need a longer on-ramp toward stability.

Herb Smith, president of the Los Angeles Mission, said that while getting a roof over someone’s head is a critical step, in some cases, “services are actually more important than housing. People can live very well in a tent, but if they’re not getting the mental health and education and other support services that they might need, it doesn’t matter where they live. That’s the ultimate challenge for us.”

Beyond Housing

Some homeless advocates see housing as one of many priorities, and maybe not even the first. For some people, a living-wage job might prove just as valuable as an apartment. An analysis of the Los Angeles homeless population by the Economic Roundtable, an LA think tank, found that certain subgroups, such as young people and those who have been homeless three months or less, might exit homelessness faster if placed immediately in an employment program.

The study recommended that Los Angeles adopt a triage system to route people who are ready to work into training or employment assistance, both to avoid chronic homelessness and ensure that they can make rent once they are rehoused. The same system could be applied to homelessness prevention, by identifying financially distressed households who need rental assistance and other supports to prevent displacement or eviction.

A more open-ended approach to meeting homeless people’s needs might center public health, rather than permanent housing. Focusing on basic health needs might be a way to connect to those who are reluctant to enter the shelter system or engage with service providers, often because of well-founded distrust, fear, or trauma.

“As an expression of rights, Housing First makes perfect sense,” said Randall Kuhn, a researcher at the University of California–Los Angeles. “But if you approach it strictly from a health standpoint, what you would find is that some people don’t need housing, some people don’t want housing, and some people don’t get housing.”

But service providers can still reduce harm by reaching homeless people where they are—for example, by expanding street medicine programs to help them cope with injury and chronic disease.

“If you can build relationships…maintain a person’s sense of connection with systems, and provide services that will be beneficial, and help people heal,” Kuhn said, “then there will come a time when they will probably really want housing.”

And when that time comes, it’s the City’s duty to make sure there’s a home waiting for them.