ARUN RATH, HOST:
It's ALL THINGS CONSIDERED from NPR West. I'm Arun Rath.
STEPHEN ROBBINS: Can I get the Austin Blues with onions and sweet peppers?
RATH: On Third Street in downtown L.A., Stephen Robbins (ph) is ordering one of the exotic grilled sausages on the menu at Wurstkueche.
ROBBINS: A small fry with the walnut dip and truffle oil.
RATH: Walk just a few blocks away and there's a more modest business on the street.
LEAH: Me - I sit out here and, you know, I sell my cigarettes. I may sell other things. I'm not going to say.
RATH: That's Leah. I met her while she was sitting on a milk crate on Fifth Street.
LEAH: Cigarettes are $2.50 a pack out here. So you can get a carton for $25 and sell it for $50 and double your money.
RATH: Leah doesn't want to give her last name because she says it's not safe to do that here on L.A.'s Skid Row. A lot of people want to fix Skid Row, but how it's done is extremely controversial. And as downtown L.A. develops, it's a problem that's become more and more urgent. That's our cover story today.
RATH: Skid Row is like a different planet from the affluent downtown areas that practically surround it. Fifty blocks of sidewalk here are jammed with people who live on the street and their worldly possessions crammed into shopping carts, crates, cardboard boxes.
In the hot midday Southern California sun, the place stinks of urine, human excrement and garbage. Last year, there was a major outbreak of tuberculosis here. Lizette Nelson (ph) is crossing the street with her rolling suitcase. She says she's headed to a shelter called Pathways.
LIZETTE NELSON: If not for them, I guess I'd be sleeping on Skid Row with the rest of these people.
RATH: More than 1,000 people sleep on the street in Skid Row in cardboard boxes and tents, just a mile from City Hall. Leah, she's the woman I met selling cigarettes, says she's seen some changes on the street lately.
LEAH: Definitely has gotten worse on violence. The cops are starting to crack down more, I guess 'cause they want to clean it up down here to make it a little bit better for people to live. But this is Skid Row. It's always going to be Skid Row.
RATH: But a lot of people, including some with very deep pockets, disagree.
TOM GILMORE: Everybody needs to ultimately deal with the fact that downtown is going to continue to develop. There will be development in Skid Row. There will be.
RATH: That's developer Tom Gilmore. He was speaking at a panel discussion last month about the future of Skid Row.
GILMORE: Skid Row is not where people are born. It is where they come because of what I think everybody can now agree is at best an outdated notion of segregating, isolating and concentrating the homeless population and the services associated with them in one area. And I think that because there's a new residential population in downtown, everybody is beginning to understand that it's not the rug you can sweep everything under.
RATH: And Gilmore says development doesn't mean reducing services for the homeless. But Gilmore's perspective was offensive to several in the audience who believe development will favor the well-off at the expense of the poor.
(SOUNDBITE OF PROTEST CHANT)
UNIDENTIFIED MAN: Racists and bigots.
RATH: Longtime activists say that there is a real danger the development will simply ignore the needs of the thousands living on Skid Row. But new residents and businesses say they want to play a role in improving Skid Row. Blair Besten helped organize the panel discussed discussion.
BLAIR BESTEN: I'm the executive director of the Historic Core Business Improvement District and I'm also a resident.
RATH: The Business Improvement District collects taxes from local property owners. That money pays for street clean-ups and private security patrols. Besten says the homeless on Skid Row used to be easier for the city to ignore. But with more people moving downtown, that's changing.
BESTEN: A sense of shame is really motivating people now to finally address this issue because it's so apparent in the streets everywhere you look.
(SOUNDBITE OF SPEECH BABBLE)
RATH: The lobby of the Union Rescue Mission is packed on a recent morning. They've been working on Skid Row for decades. It feels like a cross between an apartment building and a secure court facility. They have private rooms alongside temporary shelter and dorms for about 800 people. The mission also provides substance-abuse counseling and other services. It's a Christian charity, although non-Christians and non-believers are welcome here. Andy Bales runs the Mission and has worked on Skid Row for almost 10 years.
ANDY BALES: What I describe Skid Row as is the biggest man-made disaster in the United States.
RATH: Bales says things had been improving on Skid Row, but they've taken a bad turn since the recession. Hospitals from the region, and even other states, have been dumping homeless patients on Skid Row illegally. He says jails are releasing inmates without enough preparation and resources have been reduced for shelters in favor of other approaches.
BALES: What you see that's different than it was just a few years ago - fear had left Skid Row. That's back. Violence every day - across the street, there's crack cocaine sales. And by the self-cleaning restroom on the corner down here, they're selling heroin. You know, take that times 49 blocks - that's what Skid Row is. And the answer for this really is decentralizing services.
RATH: Andy Bales says ideally people should receive treatment and help in their own communities. But he says it can be difficult to convince neighborhoods to accept new homeless shelters, affordable housing or treat facilities. Do you have any fear that there could be a situation where this neighborhood is transformed - it's gentrified or whatever word you want to use - but the people that were here are still wherever they end up not getting the services they need?
BALES: I do have a fear of that because we often - we are often market-driven instead of compassion-driven. Of course, we need investors. We need all of that. But we need compassionate people who care about the people who are potentially displaced. And we need to make sure there's a place for them to go and that place is not just on the sidewalk or a bush in another neighborhood.
RATH: Shelters like the Union Rescue Mission continue to fill up with people in need. But recently, another place opened up for some of L.A.'s chronically homeless - the Star Apartments on Skid Row. The building is beautiful, modern and bright. There are more than 100 apartments where the homeless can stay permanently, turn their lives around and get easy access to a health clinic and other services on-site. NPR's Tom Dreisbach went to the grand opening and has the story.
MIKE ALVIDREZ: It's my great pleasure to honor you to the grand opening of the Star Apartments today. And today is a great day.
TOM DREISBACH, BYLINE: That's Mike Alvidrez. He runs the nonprofit Skid Row Housing Trust. And on this sunny morning in L.A., he officially unveiled its latest project. But away from the speeches, sitting on a second-floor patio, I met Jude Burns eating breakfast. Burns is 44 years old but there was a cane at his side. He says it helps him walk through his pain.
JUDE BURNS: 'Cause sometimes it's so bad, man, I can't even get out of bed. But then I have good days and bad days. You know, so today's one of the good days.
DREISBACH: Burns now lives at the Star Apartments - moved in about a year ago. He and the other residents were allowed to settle in before the big grand opening. But he didn't always need this type of help.
Burns moved to L.A. a few years back to be closer to his 14-year-old son. He had been diagnosed with diabetes, but he says he had it under control. Then on New Year's Eve 2011, his son was shot and killed in in South L.A. - an apparently random murder. Jude Burns went into a deep depression.
BURNS: After my son's death, my health just started going completely downhill.
DREISBACH: The diabetes got worse. He got pancreatitis. Then came the complications. He needed two surgeries. For a while, he bounced around between friends' couches and hospitals.
BURNS: I would say I was at the emergency room at least once every two months.
DREISBACH: After all, he wasn't making regular doctor's appointments to deal with his health problems. Instead, he went to the closest ER and waited eight, nine, 10 hours at a time.
BURNS: Actually, I've probably been in every hospital in California if you ask me. I've been in a lot of emergency rooms.
DREISBACH: After one of his surgeries, his luck changed. A hospital social worker linked Burns up with temporary housing through Lamp Community on Skid Row. They told him about the Star Apartments.
BURNS: Now, I've got my own place. I have my own keys. I'm happy about that - thankful.
DREISBACH: Burns says it was the first time in three years he had his own stove, his own refrigerator, his own bathroom. And most importantly, now Burns doesn't have to drag himself to the ER to see a doctor or social worker.
BURNS: They're also going to have clinics and doctors and stuff downstairs, you know? Everything is right here.
DREISBACH: There are caseworkers on site downstairs alongside a health clinic that's opening with staffed doctors and nurses. This model of ending homelessness is called permanent supportive housing. The idea's that the best way to improve the homeless situation and to handle all the chronic health and mental health problems is to get people housed first, then work on the other issues that can seem extremely challenging.
MARC TROTZ: In fact, many people would consider the folks that we're housing un-housable. They're too sick. They're too disruptive. They're too drug-addicted. And our philosophy is to just flip that around.
DREISBACH: That's Marc Trotz. He runs L.A. County's two-year-old Housing For Health program. They're helping to run the Star Apartments and have actually moved staff inside the building.
TROTZ: We know that a home doesn't miraculously cure mental illness or long-term substance-abuse issues. But we know you can't - it's almost impossible to get to those issues when someone is homeless.
DREISBACH: Trotz calls Skid Row a health disaster zone.
TROTZ: We're stuck in this cycle that we see where this population basically revolves from the street to the hospital to the jails back to the street, maybe to shelter, maybe to treatment and can do that for five, 10, 15 years and just steadily decline in health and die essentially.
DREISBACH: Trotz and the county want to break that cycle by creating buildings like the Star Apartments throughout L.A. County. According to Trotz, they have created 700 units in the county with a goal of 10,000 by 2018.
Dennis Culhane is a professor of social policy at the University of Pennsylvania. He says experience has shown that permanent supportive housing works.
DENNIS CULHANE: The research is very robust. It shows that about 85 percent of the people who are placed in this housing remain there one year later. Even among the people who exit, many of them are exiting to other planned arrangements only as a few percentage is actually returning to homelessness.
DREISBACH: Culhane says these program's frequently save government money, too, by reducing ER visits and time in jail. Some worry that the focus on permanent support of housing for the sickest and most desperate will shortchange emergency services for the majority of the homeless. And at its current rate, the county is well behind schedule on meeting its goal of creating 10,000 units of permanent supportive housing. But Jude Burns has a word for his one unit at the Star Apartments - a blessing. Tom Dreisbach, NPR News.
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