Our special guest today is John Maceri, the chief executive officer of The People Concern, a leading Los Angeles based organization that serves the homeless community and those experiencing poverty, mental and physical illness, abuse, and addiction. Today’s discussion will focus on permanent supportive housing and some of the creative methods that The People Concern and their partners have used to achieve significant solutions.
There are hundreds of millions of dollars being spent each year in moving people in and out of the system. While there is a pressing need to build new housing, it costs far less than “managing” the existing people and services that care for homeless communities. It’s simply an illusion that costs are going to be more to provide permanent supportive housing. The pandemic has laid bare lots of structural inequities and problems in our systems, which need to be addressed—but there are also creative solutions. Part of the American Dream should include the ability to live in a community where financial pressure does not overly stress the population from year to year.
Mentioned in this episode
The People Concern
Airport Marina Counseling
Robert Strock Website
Robert’s Book, Awareness that Heals
Free Downloadable Introspective Guides
Note: Below, you’ll find timecodes for specific sections of the podcast. To get the most value out of the podcast, I encourage you to listen to the complete episode. However, there are times when you want to skip ahead or repeat a particular section. By clicking on the timecode, you’ll be able to jump to that specific section of the podcast
The Missing Conversation, episode seven
On this podcast, we will propose critical new strategies to address world issues, including homelessness, immigration, amongst several others, and making a connection to how our individual psychology contributes and can help transform the dangers that we face. We will break from traditional thinking. As we look at our challenges from a freer and more independent point of view, your host Robert Strock has had 45 years of experience as a psychotherapist author and humanitarian, and has developed a unique approach to communication, contemplation and inquiry, born from working on his own challenges.
Robert Strock (00:00:43):
Thank you very much for listening to The Missing Conversation on today’s show. I have a really special guest who shares my passion to help the homeless in a very tangible, concrete way through the programs that he’s been doing for a lot longer than I have. There aren’t many people that I can say share that same degree of passion that I’ve met, it’s a gift to share that experience with you, John. So I’d like to introduce John Maceri, who is the Chief Executive Officer of The People Concern, but The People Concern is a leading provider, an advocate for evidence-based solutions to the multi-faceted challenges inherited in homelessness and domestic violence. The organization provides a comprehensive and fully integrated system of care, including housing, mental health, primary medical care, and domestic violence services. The agency has an annual operating budget of $67 million dollars, employees, a staff of over 650 people. And it has an active volunteer core of 700 who serve more than 6,000 individuals and families a year in the Los Angeles area.
Robert Strock (00:02:23):
Prior to this position that John had, he served for 12 years as the executive director of homestead, hospice, and shelter, providing residential care and supportive housing for people living with HIV and AIDS. In addition to his work with the Santa Monica Bay area, human relations council, where he currently serves as board chair, he also serves on the board of no home home Alliance, a nonprofit serving homeless individuals and immigrants in the North Hollywood area of the San Fernando Valley. His resume could easily go on and on and it’s filled with more devotion than we have time to fully acknowledge. Welcome, John, and I understand your agency is one of the largest of its kind in Los Angeles County. And it’s a real honor to have you with us.
John Maceri (00:03:26):
Thank you, Robert. It’s nice to be with you. Thank you for inviting me this morning. I enjoyed our conversations previously, and I’m looking forward to a great conversation today.
Robert Strock (00:03:38):
Great. I’d like to also introduce you to my longest, dearest friend of 50 years, Co-president of Global Bridge Foundation will serve as our host, even though with you and I, I doubt that it will be needed. We won’t need that much help. I doubt, and he’ll hopefully support the essence of what might be missing or help amplify us up or down. Uh, I’ve shared so many experiences with Dave through the years that it would be impossible to also dignify that in our psychological background and programs that we’ve run for close to 50 years. Hi Dave,
Dave Knapp (00:04:22):
Hi there and John, it’s a pleasure. Actually until this introduction I had not realized, how long and how much you work with HIV and AIDS. I had a younger brother who had the disease when they had no name for it, in 1980. And, we shepherd it, maybe is not the right word, but he was with it 20 years through times when there was no treatment, through times when treatments were identified, improved. So, on top of what you’re already doing now continue to do, uh, just a lot of respect, a lot of respect.
John Maceri (00:05:14):
Well, thank you. Thank you, Dave. It’s really been my privilege to do all of this work that I really had the honor to be involved in for so many years. So thank you. And it’s nice to be with you. I’m a great admirer of your work as well. Your collective work, you and Robert, I’m familiar with the work that you’ve done for decades and decades in the behavioral health field. And it’s a nice segue, I think, into the conversations that we’re going to have today about people experiencing homelessness.
Robert Strock (00:05:44):
Yeah, that’s great. One little tidbit, you know, Dave brought in the hyperbaric machine with his brother and was innovating, as you would know how long people survive more than two years at that time. So, we’ve got some creative people here. So John, I would really love it. If you would give us a sense of The People Concern and especially focus on the innovative elements that you think you’ve been able to bring to it and share whatever details that you believe are most inspiring, but also the ones that are realistic and necessary.
John Maceri (00:06:22):
Yes. Well thank you, Robert. So The People Concern was formed four years ago in the merger between the ocean park community center, OPCC based in Santa Monica, on the West side and lamp community, based in skid row. And so in bringing together those two organizations, we provide housing and comprehensive wraparound services to individuals experiencing homelessness and victims of domestic violence. And that includes everything from street outreach. So when you talk about sort of the key components of services, it begins really with outreach and engagement with multidisciplinary teams that are out on the street every day. We have a healthcare professional, a mental health professional, substance abuse specialist, and then people with lived experience. So we really do have the full compliment of disciplines represented on the teams that are going out every day and engaging people, meeting them where they are, literally parks, beaches, under freeway overpasses, and beginning to build trusting relationships with them, which is really the foundation of all the work that we do is really building trust and understanding what the needs of the individuals are.
John Maceri (00:07:39):
I think one of the things we’ve always tried to do at our agency is not sort of coerce people into doing what we want them to do or what we think is good for them, but to really try to get to know them and understand what is it they want and need, and then work from there, we operate an access center on the West side, which has a medical clinic that is staffed with our partners at Venice Family Clinic for primary medical care. And the physicians that work in the clinic also go out with street medicine teams, and the outreach teams and provide street medicine. So we’re very proud of that. And we were one of the first agencies, doing that in Los Angeles County. A lot of the things that are now best practice and standard of care were really implemented in our organization.
John Maceri (00:08:30):
Quite a long time ago, we operate several interim housing programs. And then we, as I said, provide comprehensive wraparound services. So behavioral health, domestic violence services, primary healthcare substance use with the goal of really helping people be their best selves, whatever that looks like for them, because our goal is not just getting people housed. It’s keeping people housed. So 92% of the people that we house are never homeless again. And the reason for that is because of the wraparound services. So not every person experiencing homelessness is a victim of domestic violence. Not every homeless person is experiencing or struggling with mental illness, but every person that we work with has cumulative trauma in their life. And so we’re really trying to drill down and understand, you know, how can we bridge sort of where people are and where they want to be.
John Maceri (00:09:26):
And we really see that as the essence of our work, I would say finally, the other thing that kind of makes us unique, and we’re not the only homeless service provider that has domestic violence as part of our core mission, but there are very few organizations that actually have homelessness and domestic violence as part of their core mission. People know that The People Concern, or know OPCC or Lamp Community, as homeless service providers, which we are. But what people don’t realize is we operate the second oldest domestic violence shelter in the state of California, “Sojourn,” which has been in continual operation since 1977. So our understanding of the intersectionality between domestic violence, intimate partner, violence and homelessness, especially among women and children, again, we’ve been doing that work for decades. So today our focus really continues to be on eliminating people’s human suffering, meeting their basic human needs for access to food and clothing and taking care of their hygiene supplies and connecting them to medical and mental health services.
John Maceri (00:10:37):
But we’re never going to get ahead of the issue of homelessness unless we scale significantly the production of permanent housing. And so that has been an area that our agency has really leaned into in the last couple of years. And I know we’re going to talk more about that in a few minutes, but essentially, it has really been our mission to disrupt the current system of housing production by really looking at how can we lower the cost per unit as well as the time, not sacrificing quality, but we simply cannot get to scale at over $550,000 a unit and taking three to five years to build one unit that will house an individual or a couple. And in some cases, perhaps a family, but with a number of people we have living on our streets currently, as well as the potential tsunami of people that will fall into homelessness. If these eviction and rep moratoriums are not cured when they’re over, we are facing a crisis. We’ve had a housing crisis in Los Angeles for a very long time. It is more acute, I think the pandemic has frankly laid bare all of the issues that we at The People Concern and our colleagues have been struggling with for decades, which is a lack of affordable housing. And now we see that on our streets, manifesting itself on our streets, in ways that we have never seen before.
Robert Strock (00:12:13):
One of the things that I’ve never understood in our conversation so far … and if you could briefly give us an understanding of how are, from what I understand over 2000 people that you are giving permanent housing, how many buildings is it set up over, where they spread out? Just give us a feel for that, just to give the magnitude of it. And also maybe just start to give us a little bit of how you’re shifting and orientation with FlyawayHomes and just give us a feel for that to give all the people that are listening what you’re really doing and how the cooperative players are really aiding you.
John Maceri (00:12:59):
Yes, we support over 2000 individuals and families in permanent supportive housing throughout the Los Angeles County area. So all the way from Antelope Valley down to Long Beach, our permanent supportive housing is split between what we describe as scattered site housing, which are units in market rate, buildings owned by private landlords. So there may be one tenant in that building, there could be 10 tenants in the building. It depends on the individual property owner. And then project based buildings which are built from the ground up and are specifically built for permanent supportive housing to house our population. So we have a mix that the portfolio is kind of tipping more now towards project based, because in the last couple of years, along with our development partners, we’ve had more units coming online. So it’s when you ask how many buildings it’s several dozen on the project based side.
John Maceri (00:13:58):
And those buildings range from, on the small side, some of the older projects, maybe 30, 35 units, and some of the larger buildings are maybe 100, 120 units. Although average size is usually somewhere between 45 and 60 units per building on the scattered site. There are several hundred buildings again that we’re working with private property owners. Our experience has been that, often when we work with the property owner and they house one of our clients because of our wraparound services they often will call us when they have vacancies and then there will be other, as units become available in those buildings, and we’ll house more individuals. So it’s not unusual for us to start with one unit in a building and get 5 to 10 units, as those units turnover and are made available. So we have a mix, as I said, between scattered site and project based.
John Maceri (00:14:58):
And we’ve been doing that. I’ve been at the agency 21 years and we’ve been doing permanent supportive housing. For all of that time, actually, we’ve been doing permanent supportive housing since 1994. We were one of the first shelter plus care grantees in Los Angeles County under the HUD continuum of care. And so we’ve been at it for a very long time. And in those days it was mostly scattered site where we would go out and work with landlords to secure units. We’ve had long-standing development partners for decades that have built projects that we provide the supportive services. And again, we were doing that long before now, affordable housing developers, most affordable housing developers and most permanent supportive housing developers are now providing their own services to their tenants. But we were doing that for them long before they had fully integrated departments to do that.
John Maceri (00:15:55):
FlyawayHomes was incubated out of The People Concern, a little over three years ago where our permanent supportive housing committee and our agency had been working with developers primarily. I mean, they had really kind of functioned to help us identify new landlords. We had staff who were doing that, but we also had volunteers who would help us and kind of managing the buildings that were in the pipeline. And, you know, we realized that we were never going to get to scale. We the system and we The People Concern, we’re never going to get to scale. If we continue down the current path that we simply had to find a different mechanism. And so we gave the committee a charge. We said, you know, if we were going to build a new mouse trap, a better mouse trap, here’s what we know about the current development process and system.
John Maceri (00:16:49):
How would we change it? And so we, the committee, spent a year and we brought in finance experts, construction experts, who had not worked traditionally in the affordable or permanent supportive housing space, and the reason we did that is we wanted them to really think outside the box. We had some ideas, I have always been passionate about harnessing private capital. You know, I’ve been a big believer for a long time that, and this is based on the work that we do for donors who support our work at The People Concern who would often say to me, you know, gee, I wished there was a way that I could help on the housing side, but it’s so expensive. And there’s no way that I can see myself being involved in that. And so that was always kind of, you know, in the back of my head and could never quite figure out how to connect the current system of financing, housing production with these private individuals, people of Goodwill who really wanted to help. So that was kind of an under girding of our process, at any rate they spent a year, the committee spent a year talking to folks, and out of that process was born, FlyawayHomes. Can Dave … did you have a question you want to interject? Yeah.
Dave Knapp (00:18:16):
I do have a question. I want to take a step back to the, the individual relationships with, with owners of buildings. I’m interested to know two things, and this is a more general question about how, and who pays the rent, who signs a lease. If you, uh, have somebody move out, does that lease, allow you to move another one of your clients or persons that you are helping in? Or how does that work? Yeah, as I’d like to join that question, John, and also ask the range of generosity or lack of, or just simply getting rent with the various owners, whether they’re giving you some kind of a break, or whether you’re paying fair market rent at most of these facilities.
John Maceri (00:19:07):
So I’ll answer both of those questions. Let me just rewind a little bit to the scattered side and project based. So to answer the question who pays the rent, who holds the lease in most cases, the clients that people we’re serving hold the lease, they have a direct lease with the landlord, whether it’s the landlord, the private landlord in their homes, or whether it’s in a project-based unit owned by a developer. However, we, The People Concern, and this is an area where again, we were ahead of the curve, we’ve had master lease units where the agency holds the lease for over a decade. And why did we do that? We did that because we work with a lot of people who have poor credit histories. They have poor rental histories, they have poor work histories. And so, you know, not surprisingly, especially in very competitive and expensive housing markets, it’s very difficult for them to obtain housing.
John Maceri (00:20:06):
So we’ve used those master leased units to be able to rent, to sublease. And we have obviously the right to sublet those units. So the win-win for the landlord is they get their rent in full, on time every month from us. And we’re responsible then for working with the tenants. So right now we have a few dozen units, not all, it’s not a lot in our master lease portfolio in terms of the rent charge. In most cases, it’s market rent. In a few cases, we have some owners who have been generous and they’d given us slightly below market. And I can tell you no one’s discounting the rent, because frankly, you know, Los Angeles, all of Los Angeles is a very expensive and tight rental market, but we’ve had landlords that we worked with for a very long time. There are limited rent hikes, you know, it’s usually 1 to 2% a year, so it’s not, you know, they’re not hiking up the rent 10 or 15% every year.
John Maceri (00:21:10):
And these are not rent controlled units. So I find that personally generous from the owners side. So that’s how the leases work. As I said, they’re generally held by the individuals. And the reason for that is because permanent housing is permanent housing for our clients, just like permanent housing for all of us. If you were renting an apartment, the expectation is as long as you pay your rent on time, abide by the conditions in terms of the lease, then it’s yours for as long as you want to live there. And we want individuals to be as independent as possible. That being said, we work with some individuals who are just going to have a very difficult time, even if they have a rental subsidy, competing in the rental market, especially now people with poor work or credit histories have a really, really tough time. So we have found that the master lease units have been a real stepping stone and a bridge for some individuals who otherwise wouldn’t have been able to rent an apartment.
Robert Strock (00:22:16):
So I want to get in a couple of really key questions, cause I rarely have an opportunity to talk with someone who can answer my question in a way that’s grounded in, based on the facts and not based on my opinion. And some of them might not be easy, but I’d be really curious if what you have trusted in the study, many studies that have gone on, as to what the average homeless person on the street costs the County or the state in just being homeless with emergency medical services, police and other costs. And if you looked at what the costs appear to be in your relatively new program at Kensington, what you see as being the cost to run the program per person, as you project them out, what they’re likely to be, in how that compares.
Robert Strock (00:23:16):
And the reason why I want to ask that is because I know part of the most inspirational conversations that we’ve had is if we’re fortunate enough to find a larger landmass that is on the outskirts of Los Angeles, the amount of tiny homes or the equivalents could bring the cost down even significantly further beyond what you’ve been able to do, because you’ve had to work within the parameters of more traditional, less land. And therefore you couldn’t have the luxury of less cost housing more than you’ve already done a Flyaway. So if you could kind of give people the idea of how close we are to even, and then realizing that there’s the other option of, if we can find the right land, that we actually might be able to set up a program with tremendously comprehensive care, a tremendous sense of belonging. And I’m curious where you see the costs might end up being, if we really could get the, let’s say the eyes, ears and the best parts of the minds of the people in power to see what is really possible.
John Maceri (00:24:30):
Yeah. So you’ve identified, I think a few important things to consider Robert, the first is, I think for anybody listening, if you take nothing away from our conversation today, I’d like to disabuse you of the notion that people living on the streets don’t cost us anything. Then people who have an aversion to rental subsidy or providing services or housing with services, you know, as being too expensive, that the counterweight to that is that, well if people are living on the streets, it’s not costing us anything that simply isn’t true. There have been studies done around the country and they vary because the researchers look at different costs. So we have, you know, setting aside for a minute, just the moral and human costs. So just setting that aside, and I don’t want to say forgetting that because to me, in my opinion, that is front and center, but just from a numbers standpoint, setting the human piece of it aside, the fact is that there’s an enormous cost in terms of first responder because often police and paramedics are the last resort.
John Maceri (00:25:38):
For people experiencing homelessness. They’re the last resort for the community. People don’t know what to do. The LA County jail is the largest mental health institution in the country because we arrest people. We put them in jail and then a few days, few weeks they’re out. And they recycle through these very expensive systems. The same is true for our healthcare systems, which are completely overwhelmed now with the pandemic, but even prior to the pandemic, we see, and we’ve done a lot. This is another area we’ve done. A lot of work is the high utilizers, people experiencing homelessness who are high utilizers of the healthcare system. And so you have people going in and out of emergency rooms, in and out of inpatient hospitalizations that cost an enormous amount of money. And I do not blame, I want to be clear, I don’t blame the healthcare system and I don’t blame the first responders because defacto, they become the default position. So there’s hundreds of millions, billions of dollars, literally being spent every year in recycling people in and out of the system. So that’s, you know, when we say we don’t have enough money, we have plenty of money. We just, the money isn’t being spent in smart and strategic ways to the second part, this idea …
Dave Knapp (00:26:49):
Before you go to the second part, I want to just amplify that point. My son’s a firefighter in the city of Ventura, probably one third of their many, many calls are to the homeless living in what is the LA river concrete basin, where there are medical emergencies, transports, many fires set as they try to keep warm in the winter. So it’s just absolutely pervasive.
John Maceri (00:27:17):
Yeah, it’s true. Everywhere. Yeah. Continue. Yeah. Thank you for saying that, Dave, and that’s true. And I dare say if you talk to firefighters anywhere, certainly, you know, in California, but this is true across the country, if you talk to first responders, police, they will tell you that is an extraordinary amount and it’s not uncommon, a third or more of their calls are calls related to people experiencing homelessness. So there’s an enormous amount of money being spent in these systems that the second piece of it is, you know, what does it cost to provide housing and services? So even in Los Angeles where you have a very expensive rental market and where fair market rents are higher than they are in other parts of the country matching a rental subsidy for a year, along with supportive services, you know, depending on the individual and the needs of the individual, we’re talking about probably somewhere between 15 to $18,000 per year, per person.
John Maceri (00:28:19):
So that’s paying for the housing and for the services. So, you know, just think about that for a minute. Compared to, you know, a few days in the hospital, in an inpatient unit that’s running, probably 3 to $4,000 a day, again, depending on the needs of the individual, the average emergency room visit is pushing North of a thousand dollars. So, it doesn’t take very long. You can do the quick math to see that if we were investing in housing and services we would be spending far less money, we would have far better outcomes, both for the people experiencing homelessness, as well as taking enormous pressure off of the first responders and the healthcare system. And people’s quality of life would be much better to your third point, Robert, in terms of what could we do, relative to solving the current homelessness crisis.
John Maceri (00:29:23):
And I think we need to really be clear and understand that there is no one way, I am a huge proponent of disrupting the current system, I am not a proponent of saying that we shouldn’t continue to build new housing. We absolutely need to continue to build new housing. What I’m saying is that we need to find also, it’s not either/or, it’s a both, we need to find alternatives to our current models. So we could look at … I mean, there are alternatives that are viable even in Los Angeles where you have high land costs. You know, we could look at things like using modular construction, doing infill projects by Ride, doing adaptive reuse. And I know that sometimes people, some critics will say, well, there hasn’t been enough adaptive reuse done to know that it’s really effective in what’s been done.
John Maceri (00:30:15):
It costs about the equivalent. Well, you know, I think it’s a little hard to make the argument that it’s not cost effective when we haven’t done enough to get it to scale. It is true. You know, it’s like manufacturing something. And when you do your prototype and you run whatever you’re manufacturing and you produce the first dozen or two dozen or a couple of hundred items, of course, they cost more than when you’re producing a million of them. And the same is true with housing production, is in the current system everything, every project is a one-off, you know, we start, there’s a financing mechanism, but essentially we’re starting from ground zero all over again, every time. And we have to get beyond that. So we can use, you know, modular. We could look at tiny homes, tiny homes are effected.
John Maceri (00:31:04):
They’re challenging in the urban core of Los Angeles because they require land and large parcels of land. So where tiny homes have been used have generally been in communities where there are larger parcels of open land and where land is less expensive, but it doesn’t mean that we can’t do it. There are parts of Los Angeles County that do have, open land that is available. We could create therapeutic communities, we could public, private partnerships. There all kinds of things that we could do, we could bring in, you know, things like grid alternatives to do solar, both in terms of installing them in the housing units, but also as a potential employment opportunity, you know, for the residents, we can use organizations like Every Table that have done a great job in being able to produce high quality nutritious food, to be able to supply these communities.
John Maceri (00:32:08):
You could do therapeutic work with organizations like Airport Marina Counseling, for instance, where you could have interns who would provide behavioral health services. So there’s all kinds of ways that we could leverage our resources. Not all of those resources would be appropriate to every single housing development, not every community is going to be able to accommodate tiny homes, but every community in Los Angeles could certainly accommodate modular or manufactured construction. We can do, in field projects, on much smaller parcels of land. We could build, by right, on parcels 7,500 to 10,000 square feet where generally you need 20,000 or more. So there are all kinds of things that we could be doing that would bring the cost per unit down and the manufacturing time down as well.
Robert Strock (00:33:04):
So the one question that I really want to zero in on, and I’m probably going to have to stop myself from being OCD, cause I’m going to want to repeat it over and over again is if you compare the costs as they appear to be. And I understand it’s not absolutely set, but the range of what Kensington would be per person to give the MultiCare, the therapeutic community, the permit housing, versus the average cost of the street and take your best range of estimates of what one costs and what the other costs. And as the listener is really hearing this, if we could really let it in, we’re letting our brothers and sisters be in the street and they’re not being cared for. It’s costing X, if they were in a program is costing Y and hopefully having a number of people join us in our outrage at the benefit and the creativity being judged.
John Maceri (00:34:09):
Yeah. So, very directly and I’ll use Kensington, which is our 14 acre campus that we just developed up in Lancaster that opened in September, the permanent, there’s several components of that therapeutic community. Those are the permanent supportive housing, the interim housing, and then the wraparound services. So the permanent supportive housing, the first phase of last November. So it’s been just a little over a year and the second phase of the permanent housing will be completed in the spring. And then the interim housing just opened in September. But to answer your question directly, if we look at the cost of keeping someone permanently housed at Kensington per year we’re looking at around $15,000 per person, that’s housing and services all in, and the studies that I’ve seen, which have ranged, you know, from as low as $50,000 up to, well, over $150,000 per person, per year, to leave people on the streets, especially people who are high utilizers.
John Maceri (00:35:15):
And I’ll just give you another, you know, this is not anecdote. This is fact. So I said earlier that we’ve done a lot of work with high utilizers. And several years ago we did a pilot project with, now Providence St. John’s Health Center, in Santa Monica. And we started with the hypothesis that we believed they did that. Most of the people experiencing homelessness who were coming into the emergency department were not coming in because they had acute medical conditions that needed to be treated. They were coming in because they needed housing and they needed ongoing primary care. I mean, many of them had very serious chronic health conditions. Many of them were mentally ill. Many of them were substance addicted, but there the driver into the emergency room wasn’t because they had a medical emergency. So we said, let’s work together for 3 months, 90 days.
John Maceri (00:36:09):
And let’s embed, we actually embedded two of our nurses. We have two RNs on staff to put our nurses in the emergency department. And we want to see, you know, what sort of, what we discover over this 90 day period. So the results of that pilot were that we saw 174 unduplicated individuals, several of the174 in the cohort had multiple visits, but there were 174 on duplicated individuals of those 174, only one person came in because they actually needed to be in the emergency department. They had fallen and broken their wrist and they had fallen because they were intoxicated. So whether or not they had broken their wrist, I don’t know, but they had a broken wrist. Every other person, the other 173 came in for all the reasons that I described. So then we said to the hospital, we’d like you to do a random data poll, pick any 10 of these patients that you want.
John Maceri (00:37:07):
We want to do a comparison. We want to look at their emergency room, visit costs. And we want to look at the inpatient visit costs. What we discovered is the average inpatient visit cost $35,000 for those individuals that to be hospitalized. The average cost of the emergency department visit was about $5,000. That was just 10 of the 174. So you extrapolate that over a period of time. Then what we did is we looked at those 10 patients over the next year and not surprisingly when they were given to us to provide ongoing support case management and housing is a goal. Was that the only time they would go to the hospital or the emergency department is when they really needed to go to the emergency department. And not surprisingly, it found that of those 10, we only had two individuals who return one to the emergency department.
John Maceri (00:38:06):
One to the hospital, the hospital stay dropped from $35,000 to under $5,000. And the $5,000 emergency visit was under $800. So again, you know we’ll lift up this idea that there is enormous amount of money. And again, I want to emphasize that was only 10 individuals out of a sample of 174. So, you know, obviously not all 174 were, but all 174 were in the emergency department. So just on the low end of the scale, even if one of every one of those visits costs a thousand dollars, the amount of money that is spent. And many of those people by the way were also transported by ambulance or paramedics responded. So you, you began to see this sort of exponential costs involved in this work. If we could just capture some of those savings to get back to the point that the question that you asked Robert is how much does it cost?
John Maceri (00:39:11):
It costs far, far less, and the quality of life for individuals and not just people experiencing homelessness. I mean, for the community as well, you know, the community complaints that they don’t want people sleeping or camping on the streets or in their vehicles are intense. And then they get outraged when we want to build housing, you know, for them. But the fact of the matter is that if they don’t have housing, they’re going to continue to sleep on the streets and that’s going to grow, sleep in their vehicles. So I think as a community and as a society, frankly, we have to decide, what are we going to be angry about? Because you can’t have it both ways. You can’t be mad that people are on the streets and you can’t be mad when we want to put them in housing.
Robert Strock (00:39:55):
So what I really want to highlight is the illusion that the costs are going to even be more is an illusion. And for the people that are hearing this to really let this in, as they’re driving up on a, uh, stop, stop sign or stoplight, and they have a homeless person knocking on the door, I would like them to be thinking every time that happens, visualize this could be solved. Yes, this is on us as a society to be creative enough, to put our best minds together. As you said, in a multiple planning to be able to not only cost more, but to cost less and have everybody be taken care of. And it’s just going to visualize a pool of people that include the philanthropic world. That includes the government. That includes hopefully part of the corporate world. And we need to have the shared outrage and this information go out because it’s so tragic. And as we’ve talked about, we’re just barely beginning to get creative on how housing costs could be minimized, how eating costs could be minimized, how mental health could be minimized, how medical health could be minimized, and so it’s even more than that. So I guess the, I would ask you
Robert Strock (00:41:34):
Is what do you see as the key obstacles and challenges that we need to address? And we being not only obviously us, but the people that have some potential to have influence, to give a better chance of long-term planning that really can take this into consideration rather than the great work of short-term planning to take people off the streets temporarily, but to have that be permanent housing, what do you see as being the best way to make progress? And …
Dave Knapp (00:42:07):
I did want to jump in here. I want
Dave Knapp (00:42:09):
To ask you as you answer that question, and of course people are going to be listening to this and they can’t see that you have the most magnificent, full head of hair. They can’t, they can’t see that. And I just knowing what you’ve known and even Robert having shared with me over this time period, you know, in the last years where he has had this passion grow in him. But you it’s been so long. How do you manage to not pull it all out all the time? So as you describe these obstacles, I just, I have to say to myself, I’m just amazed that you got any hair left. Well, let me first say, I’m glad nobody can see this because they would say I have no hair.
John Maceri (00:42:57):
So, thank you, Dave, for the compliment, I’ve a full head of hair, that’s genetics, fortunately male pattern baldness doesn’t run in my family. So I thank my maternal grandfather for that. There are plenty of times though that I want to pull my hair out. I mean I’ve been doing this for a very long time and all kidding aside, to answer your question, Robert there were a few things I think, and I mean this sincerely, this is really not meant to be around … I have long felt that we have not treated homelessness and, and the housing crisis, because if the root of this is, you know, decades of bad public policy and disinvestment in affordable housing and permanent supportive housing as a subset of affordable housing.
John Maceri (00:43:45):
But as I said earlier the pandemic is laid bare. I think a lot of structural inequities and problems in our systems and homelessness is a manifestation in many ways of extreme poverty and all of the social determinants of health that sort of lead people into homelessness. That being said, I have long been frustrated that I don’t feel a collective sense of moral outrage around this. Um, you know, I did a Ted talk a few years ago, and I talked about my own experience with a group of academics that were hosted here in the United States. And I was asked to be part of the delegation, and we spent time together in Los Angeles, and we spent a lot of time in skid row. And I sat next to a man from Belgium and I watched him all day.
John Maceri (00:44:40):
He was very intently, kind of looking at the horror, you know, that is skid row. And so when we were done, I asked him what he thought, and I will never sort of forget the look on his face. And I mean, his words are seared in my brain to this day. And he said, I’m horrified. I am absolutely horrified that the richest country on the planet lets your citizens live like abandoned animals on the streets. He said, in my country, this would never be tolerated. We would overthrow the government. And you know that’s when I say collective, you know outrage, there’s a lot of hand ringing. There’s a lot of … you talk to elected officials and their staff who are, by and large good people, but we get stuck in these bureaucratic systems where you talk to individuals, you know, privately and they’ll tell you, yes.
John Maceri (00:45:40):
You know, I’m really concerned that, yes, this is really bad. Yes. I want to do something. And then you start to suggest alternatives and you get the … oh, well we couldn’t possibly do that. No, no, no, no. That’s against the rules. That’s again, you know? And so I’ve spent my life pushing up against those very broken systems. And I know I’m wildly unpopular with some of my colleagues, in both the affordable housing development world, as well as in the homeless service world that I will never stop saying that the current system is fundamentally broken. It’s not that there are bad people doing bad things. There are really good, great, wonderful people trying to do good, great, wonderful things that they are working within systems that are fundamentally broken. And I believe that we need no other proof than the fact that it costs North of a half a million dollars and three to five years to build one unit to house one person or one couple … that is it’s not sustainable.
John Maceri (00:46:39):
It’s not scalable. And in the crisis, we’re in it’s unconscionable and it’s inhumane in my opinion, to continue pretending that the status quo is good enough. You know, in our agency, we say status quo is Latin for the mess we’re in. And that’s how I see it. So I think the first step is there needs to be a collective moral outrage. And I want to clarify, that’s not the community being mad at people experiencing homelessness or being mad because, you know, they don’t want to step on almost people on their way to Starbucks. It’s about as a community that we allow this, this has become … we’ve raised a generation of young people who see visible street homelessness as a fact of life, they have grown up in Los Angeles, not knowing anything. I have a 22 year old nephew. This has been his whole life, in spite of the work that I do.
John Maceri (00:47:30):
You know, this is normal for him and for his generation, that’s the place we’d come to. So, I think that we need a collective, moral outreach. That’s the first thing, the second thing is we need elected officials, who are not afraid to stand up and say some of the things that I have said specifically around what are you going to be mad at? Because the way affordable housing development goes now is the developer goes hand in hand to the elected office. And more times than not, the elected official tells them, well, you go out to the neighborhood council or whatever the local neighborhood group is, and you know, tell them about your project and maybe the project gets built and maybe it doesn’t. And what we’ve taught neighborhoods is if you organize and you scream loud enough usually the developer either abandons the project or is delayed for years and years, which also drive up the cost.
John Maceri (00:48:27):
That’s the other thing, that it’s not just the financing system. We need to be clear that delays in construction also drive up costs rather than what I think should happen is because by and large most of these projects can be done by right. The developer doesn’t really have to ask the permission of the community. They do that because they want to be good neighbors. And because these projects are going to be in communities for decades. And so they’re trying to do the right thing. And the elected officials again, are trying to represent their constituents, but we need to flip that script. And I think what needs to happen is the elected official needs to go out with the developer to the meeting, not say, go out, get yelled at, get spanked, and then come back to me and maybe I’ll support it. And maybe I won’t, but they go together and say to the community, we are here to listen to your genuine concerns about good design, about safety, security, loitering, good property management, maintaining the property.
John Maceri (00:49:26):
Those are legitimate things that all of us are concerned about. If you own property, of course, you want to make sure that your neighbors, whether it’s a single family home or it’s an affordable, permanent supportive housing development are well-designed, well-maintained, well managed. Those are fair and legitimate concerns. Let’s talk about those things, but also let’s be clear. This project is going to get built. So all the screaming, yelling in the world is not going to stop the project from going forward. And I think frankly, if we did more of that, we would have fewer projects that would get stalled and delayed. So I think that’s the second thing. The third thing is we need to find a different way to finance the construction of new housing. You know, I didn’t finish my thought about Flyaway, but essentially what happened was the result of our years study and our firm’s supportive housing committee was the development of Flyaway, which is kind of used as a few basic principles.
John Maceri (00:50:25):
The first is that we use modular housing, whether it’s shipping containers or some kind of prefab that over a time can be systematized and it can become a production commodity. So you get some basic designs again that are high quality that are durable, and then depending on the lot size, can be the population that you’re housing, whether it’s individuals or it’s families, that you can adapt the designs, but you get some basic designs. You’ve got a production model. That is predictable. That the second thing is that on the initial designs we’re using our shared housing and so shared housing is not the ultimate solution. Not everyone does well in shared housing. Not everyone belongs in shared housing, but we can house more people, it’s shared housing that’s been used very effectively in seniors, it has been used very effectively in people with disabilities, in the recovery community, it’s not been used wide scale where people experiencing homelessness.
John Maceri (00:51:26):
And there is a segment we’ve been doing shared housing, and many of our master lease units are shared, and it’s been very effective for a long period of time, so it can be done. And again, we have to open up our eyes and our minds to other alternatives of housing that not everyone does well in their own units. In fact, our own experience has been that that is often that transition from the streets into housing is often the loneliest time for people and is quite a difficult adjustment. So we have to look at alternative models. The third thing with Flyaway is that it harnesses private capital on the front end. So essentially each development is formed a limited liability corporation, private investors buy a share, they get a small return about 4% on their investment. So they’re not making a philanthropic donation. They are actually investing in a real estate transaction.
John Maceri (00:52:17):
That’s specifically targeted for people experiencing homelessness and on the back end they get a return on their money. And finally the Flyaway is no different than any other affordable housing developer is that they rely on long-term rental subsidies. So that’s the other thing we need to do is we need to secure, not just for Flyaway, but for all developers and for anyone who’s going to require a rental subsidy for a long period of time. We need to make sure that those federal rental subsidies are both available in Los Angeles and are as flexible as possible to be applied to as many different housing types as possible. I think if we could do all of those things, Robert, that what we would see is we would see a revolution in terms of housing production, because what’s happening now is you have many developers that are kind of following suit with Flyaway.
John Maceri (00:53:09):
Right? I can tell you when we started talking about shared housing and modular construction a few years ago, you know, again, it was like being the skunk at the garden party. Everyone was saying, this is bad. It’s not dignified. You know, I not sure what’s dignified about somebody living in a tent or in a sleeping bag under a freeway overpass. There’s nothing dignified about that. So I think I’m hard pressed to sort of defend that compared to someone’s sharing a two bedroom, two bath, you know, apartment where people have their own private living space that share a common kitchen, dining room, living room area. And it because it’s permanent housing and the leases are month to month. If someone wants to move, they’re welcome to do that. So, I think again there are too many folks protecting the status quo because there are all kinds of reasons why people would want to do that.
John Maceri (00:54:09):
So I think we have to be a lot more innovative and creative. Again, none of what I’m proposing should be substandard, poor quality, you know, cramming people into uninhabitable spaces. I’m not talking about any of that. I’m talking about safe, clean places to live that could be built from the ground up, could be rehabilitated, and that we should use every tool in the arsenal. If we find large parcels of land, where we can do tiny home communities and create therapeutic communities, that’s what we did at Kensington, not with tiny homes, but Kensington is not a housing project. It’s not an interim housing projects, not a homeless shelter. It’s a therapeutic community by design, from the ground up, where people have a sense of purpose and belonging and you know, where we want them to live and thrive.
Robert Strock (00:55:01):
So, John, thank you very much for giving all the practical and humane details, along with the outrage. And I want to pick up on the outrage as being commensurate, really with a longing, to take care of our really unfortunate brothers and sisters of which we could be them. And I think all of us, whether we’re speaking right now or whether we’re listening right now, we have no idea how we became the ones that might be okay, or we became the ones that aren’t okay. And I think it’s so important that we, we realize that there is a solution. It is practical, it is affordable, and it’s gonna require people that have wealth to reevaluate their wealth because they can be part of the solution. It’s going to require philanthropies to see how viable this is and how fulfilling it could be by being given more information about the real practical, I won’t use the word guaranteed, but likelihood of success at such an important area of not only taking care of the homeless, but it really sets it up for people that are suffering from a natural disaster of fires or people that are underemployed or unemployed from COVID and all the people that are really needing at least a transitional, if not a long-term home, where they might be happier than the rat race of trying to make more money and trying to get ahead and this and that they may be able to actually enjoy the community far more than our so-called most desirable world.
Robert Strock (00:56:59):
And I think it needs to be included as part of the American dream to live in a community where the financial pressure isn’t driving you crazy, you know, year in and year out. And that you have neighbors that have similar kinds of issues. So I thank you for referencing a number of the features of other ways of having low costs that are part of our proposals. And, and so appreciate the shared both inspiration, but also outrage and longing to have a much larger group of people that are on the same wavelength that want to give their time, because they don’t have anything better to do. It’s not a sacrifice, it’s a joy, it’s an inspiration. And the only part that’s really hard is we need more of us to be able to really be on that wavelength.
John Maceri (00:57:45):
Yeah. Well, thank you, Robert. And thank you for saying that. And Robert and Dave, thank you for having me today. It’s really been a privilege to talk with you and kind of share thoughts that you know, you and I have talked about. I hope you know, whoever’s listening, the other takeaway is that you said something I want to underscore that the issue of homelessness is solvable. This is not, I do not know any person working in the affordable housing or permanent supportive housing space or in homeless services, or most of our elected officials who get up in the morning, scratching their heads, saying, gee, we don’t know what to do. We know exactly what needs to be done, exactly what needs to be done. The problem is we need the resources and we need people to get out of the way and let us get to it.
John Maceri (00:58:27):
And so part of what, you know, our advocacy has been is that we need a disruptor in the system. We need to see the housing crisis and the homelessness crisis where the crisis that it is, we need a war mentality. And we need absolutely focused, dedicated resources on this. We have the best and brightest, you know, here in Los Angeles who that given the tools can scale up. And I would just say to anyone listening, if you want to join the revolution, and this is a revolution, and I think that the best sense of the word, to find a new gear, because we absolutely need to do that in Los Angeles. What we cannot continue is hand ringing and worrying when the solution is in front of us, we need to get about it, get it.
John Maceri (00:59:20):
And we need to get to the business of getting housing, built, getting people moved in with an appropriate level of support and community helping others, as a community helping itself. Ultimately. So I’ve said this to you, Robert, I don’t really care what people’s motivation is. You know, if you’re an empathetic, compassionate person that just no matter how much it costs, even if it costs more than leaving people on the streets, which we know it doesn’t, but even if it did, it’s the right thing to do, or you’re somebody who’s just angry about people experiencing homelessness in your neighborhood and degrading your quality of life or you’re somewhere in between. That’s okay. Because the solution is exactly the same. Yeah.
Robert Strock (01:00:02):
Yeah. I love your word revolution. And I would add the word evolution, because it really is an evolution to consider everybody as part of ourselves in some way. And that if they can’t be happy, if they’re overlapped in that world, we can’t really be happy. We can suppress it, but for us to be able to be a fulfilled society, we need to bring the bottom up. And, in the fact that you’ve helped us clarify, in tangible ways, through your believable experience to see that it’s actually in a certain way, it’s actually something that can cost less, and that’s mind blowing for anyone that’s willing to contemplate that. So I really thank you for that. Dave, did you have one thing you wanted to say.
Dave Knapp (01:00:54):
I did, and this may be, this is something I’ve been wanting to ask. It may end up being deleted, but I get the sense of some people believe if you build it, people won’t come. And I’m wondering what your experience is with that. If, this is created, will people from the street buy in, is there a core homeless population that just isn’t transient, is a skid row person?
John Maceri (01:01:28):
Yeah. That’s a great question. As you can imagine, I get asked that a lot, a lot, and I think, and I know this is not your motivation for asking that question today, because I know you know, your heart that often people will ask that question because it’s easier to assume that people don’t want help and they don’t want housing. And that just simply isn’t true. You know that is not to say that every single person we encounter who’s on the streets is going to jump into our arms and move into housing. The first time we offer it, because that’s not how it works. What has happened to most people on the streets is, as I said earlier, they have a lot of accumulated trauma. They often have been in and out of system, especially people I’m talking about who’ve been on the streets for a very long time and who have struggled with fractured relationships.
John Maceri (01:02:18):
And so trust is a big deal. They’ve been promised things a lot that never materialized. What we have experienced is when you offer people something that they want, and by and large, most everybody wants to live indoors, there are always going to be a handful of people who are just not ready, for whatever reason, but the vast majority, that is a very, very small number of folks. And I worked with … I said I’ve been doing this work, I’ve been at our agency 21 years. So I’ve worked with thousands of homeless people over the years. We just worked on an encampment where we moved. There were 35 people in the accompaniment. We’ve moved 30 people indoors in the last five weeks, why did we do that? They left their encampment because we had housing for them.
John Maceri (01:03:08):
That’s what they wanted. They wanted to live indoors, but until we could offer them housing, they weren’t interested in sort of temporary solutions. So when we offer people what they want, and I think, you know … look at it from the perspective of imaging in our lives, when you’re in engaged in interacting with people, or when you go into a store to buy something, if that store doesn’t have what you want, you’re generally not going to spend your money purchasing something else. So people experiencing homelessness. So you know, we walk up and say, gee, what is it you need and want. And they say, what I need and want is housing, or what I need and want is a job. If we aren’t able to deliver on those things, then we’re just kind of seen as we don’t have anything of value to them. So that’s really the essence of the work. Dave, it’s really about not just building trust, but it’s being able to deliver on those promises. And because we have such a lack of housing, it’s really hard for those, those really hardworking, dedicated outreach teams to be out there every day and hearing what it is that people want. And I can tell you 99% of the time people say they want it because they want housing. So …
Dave Knapp (01:04:29):
The one nuance, I don’t want to let go and let just fly by, is what you’re saying is permanent housing.
John Maceri (01:04:36):
Dave Knapp (01:04:37):
Not a shelter for the night.
John Maceri (01:04:40):
Dave Knapp (01:04:40):
Now here’s a place for a few weeks, but here’s an option where you can make your home.
John Maceri (01:04:45):
Robert Strock (01:04:47):
The other thing that I think is pretty intuitively obvious, what you’re saying is even more amazing because the people on the streets have not really had offers like this very often.
John Maceri (01:05:02):
Robert Strock (01:05:02):
And the offers they’ve had, a lot of them have been fantasies. And so thinking about two great years down the line, which I’m not sure it’ll be the next two years, but let’s say thinking to great years down the line and the word is on the street, hey these programs are actually pretty cool. I actually like my neighbors, the amount of receptivity in the amount of skepticism is going to go down and the amount of receptivity is going to go up.
Robert Strock (01:05:29):
So I think there’s something so optimistic if a role can start to happen. And if the powers that be really start to have, as you shared, we shared together, and we do share together the moral outrage and the deep longing to have people that are at the bottom, have opportunities to care for themselves. I think one of the things we haven’t said is that, and I know that you work this way and all the good programs work this way is that when people are at a program, they’re being asked to bring their best self to the program. And that’s an important piece. It’s not just a free giveaway. It’s a giveaway of saying, well, what’s your potential?
John Maceri (01:06:11):
Robert Strock (01:06:13):
But we’re looking at them as human beings that have the potential to be whatever they can be. And we’re going to attempt to maximize that out, no matter who we are, because that’s why it’s being done.
John Maceri (01:06:24):
I know I couldn’t agree more. I mean, look, people experiencing homelessness want the same things that we all want. Everyone wants a sense of connection, a sense of purpose and belonging, whatever that looks different for all of us, right? We choose different vocations. We have different hobbies. We have different friends. I mean, whatever our social networks are, but at the end of the day, we all want a sense of being cared for, loved, respected, treated with dignity and a sense of purpose in life. And so, I mean that is definitely part of what we’re trying to create, you know in all of the work that we do is that connection that helps people feel part of something bigger than themselves. And the second thing that we are, you know, the people concerned are very focused on, is that people are active participants in their own recovery and their own lives.
John Maceri (01:07:18):
We very clearly say, we’re not here to change, fix, or rescue people, people change, fix, and rescue themselves. We’re here to provide the tools and resources and support to help people make informed decisions about their lives. But we … they do the work. You know, we are the helpers, we’re walking alongside them in their journey to whatever their best selves, whatever that looks like for them, that’s our role here. We’re not the concierge service or the, you know, the goodie bag that we’re giving away all the freebies. We’re really here to try and support people in their journey and make sure that they have access to whatever tools and resources they have to make informed choices.
Robert Strock (01:08:06):
Well, it’s my hope that the audience can hear this is indeed an overwhelming missing conversation in our world today and starting in Los Angeles. And I know John, you and I both share the same inspiration to start with Los Angeles, which is not to be understated, how big that is, but hopefully being a model for other major cities as well, because this is a problem that can be solved everywhere. And it doesn’t matter whether you go to Austin where there’s another program that’s successfully operating right now, or anywhere else in the United States. It’s costly to be on the streets and the programs have capacity to be less cost, and humane and transformational. And so again I would use your word revolutionary and evolutionary together and outrage and longing. I’m hoping that there will be thousands and thousands and thousands of people that will want to come forward to support this completely worthy cause. And John, I can only say thank you so much for joining our show. You’ve added credibility that I could not hope to establish anywhere near on my own and Dave, again, as always, thanks for filling in as you do. So thanks so much John, a pleasure.
John Maceri (01:09:38):
No, thank you both. I really was a pleasure being with you today. Thank you for all the good work that you’re doing to continue to keep the conversation going. So thank you.
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