As we drove into the MacArthur Park area of Los Angeles our driver briefed me on how he would let me know it was time to go. “If I ask you for a yellow highlighter, I don’t need a highlighter. It’s time to go. If I ask for a red pen, we are in imminent danger so be observant and move quickly but don’t run.” This wasn’t going to be a “looky-loo” drive-by tour.
As if on cue, we drove past a shirtless homeless man as he hurled a metal object into the side of a parked car with startling rage. It was a reminder that the doctor, nurses, and social worker in the van were working on the bleeding edge of the homelessness crisis in America.
Ten minutes later, we parked the van in the parking lot of a convenience store and located the man, whom I’ll call Robert. He was half sliding off his wheelchair, unable to support himself. After years of crystal meth use and living on the streets, he was emaciated and covered in sores. He was in his early 30s but looked closer to 70. It was hard to imagine how he would still be alive in a month’s time. Our driver and team coordinator, Joseph Becerra, said such an outcome was possible, but Robert might also live beyond anyone’s expectations. “You never know. People’s ability to survive will always surprise you.”
Joseph Becerra, a certified clinical supervisor with USC Street Medicine. Photo by Erica Tricarico/AHCJ
A security guard approached us and told us, “You can’t park there. You have to move the van.” Our driver and team coordinator, Joseph Becerra, apologized and said we would move it right away. He gave the keys to one of the nurses who parked it nearby.
Dr. Katia Cnop got on her knees and asked Robert how he was doing with more bedside manner than most doctors would find difficult to manage when seeing dozens of patients a day in the best hospitals in the country. She held his hand and asked about his sores and medications. The smell made me dizzy. She wore rubber gloves but no mask, making eye contact with him the entire time. She gave him cream for an infection in his eye that she cleaned out, unwrapped the bandages on his legs and feet, washed them, applying fresh dressings.
Later when we left, she thanked me for coming. I said, “thank you, for everything you do every day,” and she replied saying, “OK,” with the embarrassed look that heroes often give when they are thanked for something they can’t imagine themselves not doing.
Joseph Becerra is a Street Medicine Community Health Worker and Certified Addiction Treatment Counselor. He has a family with young children and lives in Los Angeles. But he has also survived 14 years of homelessness and drug addiction, some as a child with his parents. He finally got clean when confronted with hard prison time. Eventually he went to school, became certified as an addiction counselor, and came back to the streets to pay it forward.
Joseph and Dr. Cnop are part of the Street Medicine program at the Keck School of Medicine. Five medical teams treated over 1000 patients in 2024 on the Eastside of Los Angeles, South LA, Hollywood, Mid?City, and Council District 1, which includes MacArthur Park. The program has resulted in a 75% reduction in hospital admissions and reduced the length of stay from 12 to 7.9 days. 42% of the people they treat are housed within a year.
Last year, California voters approved Proposition 1, which allows the state to borrow $6.38 billion to build 4,350 housing units, half of which will be reserved for veterans, and add 6,800 mental health and addiction treatment beds. In a state where Democrats outnumber Republicans 2:1, the measure passed by a margin of 50.2% to 49.8%, with opposition from both the Left and Right. Some thought the state shouldn’t waste any more money in a losing battle against homelessness while others objected to focusing on mental health and addiction treatment.
Throughout Los Angeles, police are clearing out homeless encampments. Many of the front line people caring for the unsheltered homeless often have mixed opinions on forced clearing. They are dangerous, can be dominated by violent gangs selling drugs (I was told that four separate gangs operate in MacArthur Park), and increase victimization compared to shelters.
As we rode back to the Keck School, Joseph noted that many of the encampments had been cleared out, and some were being bulldozed as we drove by. In Washington, National Guard troops were being deployed throughout the city to help the Metropolitan Police address crime and homelessness. Encampments were being cleared from several prominent locations. The unprecedented move by President Donald Trump has been extremely controversial, yet many DC residents have expressed mixed feelings given the impact of crime and unsheltered homelessness on their quality of life. While crime rates in the District have fallen, they still remain significantly higher than many other cities of similar size.
While general homelessness rates have soared, the veteran population has seen marked, credible, and sustained progress. Between 2023 and 2024 alone, veteran homelessness fell by 7.5%, with a 10.7% decrease in unsheltered veterans. Since 2010, the reduction is even more dramatic: a 55% decline in the number of veterans experiencing homelessness. “The secret to this decrease is not a mystery,” said Ann Oliva, CEO of the National Alliance to End Homelessness. “Ending homelessness comes down to three things: using person-centered and evidence-based policy and program design, providing key resources at a scale necessary to get the job done, and showing the leadership and public will to keep a long-term commitment to our goals.”
One of the biggest advantages homeless veterans have is a widespread belief that they are more deserving of our help and compassion. “Those who have served this nation,” then Secretary of Veterans Affairs Eric Shinseki said in 2009, “should never find themselves on the streets, living without care and without hope.” He was right. But no one should. We all pay for our failure to do anything less.
So why does this population, so often highlighted for its complex needs, fare so much better? The answer lies in the interplay of stable housing and wraparound services—exemplified by the HUD-VASH (Veterans Affairs Supportive Housing) program. Unlike the fragmented, underfunded responses available to many people experiencing homelessness, the “Housing First” approach for veterans is coupled with robust, sustained funding and intensive case management.
HUD-VASH vouchers provide rental subsidies similar to Section 8 Housing Choice Vouchers, but what sets them apart is the built-in requirement for VA-supported case management services. This means that veterans are not simply given a voucher and sent on their way—they receive clinical care, assistance in navigating the housing system, help with substance use or mental health needs, and access to food and income supports.
This integration of housing with wraparound care drives results. Veterans quickly get off the street, stabilize in housing, and regain control of their lives. The system is collaborative—partnering federal agencies, state and local governments, and nonprofits. Case managers stay involved, checking in on progress, troubleshooting problems, and fostering community integration. This is not just a brief hand off, but ongoing support with the flexibility to deal with setbacks. The result: lease-up rates are high and the time to housing is short, even for highly vulnerable, chronically homeless veterans.
Perhaps most importantly, HUD-VASH and its wraparound services demonstrate that targeted, well-resourced interventions tailored to individual populations can work—and work at scale. If these best practices were more widely adopted and adjusted for the broader homeless population, we would have stronger tools to stem America’s growing crisis. Until then, the treatment of veterans’ homelessness stands as a national model, showing that success is possible with the right resources, structure, and commitment.
In San Francisco, I visited Swords to Plowshares, a nonprofit dedicated to supporting veterans as they navigate the challenges of post-military life so that they can achieve health, housing, wellness, and stability. Founded in 1974, they have grown into a major housing and health care provider with a $30 million budget. They run six permanent, supportive housing sites and two drop-in centers. I visited Edwin M. Lee Apartments with Executive Director Tramecia Garner and Executive Director Emeritus, Michael Blecker, a Vietnam Veteran who led the organization for 42 years. Garner took over the organization last year, after four years as a counselor and then Chief Operating Officer. This unique building in Mission Bay was developed in partnership with Chinatown Community Development Center and provides permanent housing for 62 veterans and 57 low-income families. All veterans are formerly homeless and have one or more disabilities.
Edwin M. Lee Apartments is the personification of wraparound support. Services include mental healthcare, peer support, and VA case management. Residents get one free meal a day six times a week and have access to a computer lab, and internal garden courtyard which they share with the families who live there. The building has won numerous architectural awards, which is no surprise. It wasn’t cheap to build, costing over $78 million. Funding came from multiple public and private sources at the federal, state, and city levels, including the Veterans Housing and Homelessness Prevention Program and HUD-VASH rental subsidies. However, at $655,000 per unit, the cost of development is actually less than market-rate developments in San Francisco that can exceed $700,000.
Veterans also get important services that are often missing from non-veterans experiencing homelessness, or veterans with less than honorable discharges. The McKinney-Vento Homeless Assistance Act, first enacted in 1987, created the first dedicated federal funding stream for homelessness and, critically, allowed funds to pay directly for supportive services. That framework recognized that housing stability for people experiencing homelessness depends not only on rent subsidies but also on intensive support like case management, substance use treatment, and employment services. Over time, however, services once funded by McKinney-Vento have increasingly been shifted to operating budgets within housing programs. This change stretches already thin operating funds that must also cover core expenses such as maintenance, utilities, and staffing. As a result, housing providers face a trade-off: every dollar spent on supportive services is a dollar not available for the basic costs of keeping buildings safe and habitable. The shift has weakened service capacity at the very moment that tenant populations present with higher needs, creating gaps in care that undermine both housing stability and long-term outcomes.
The debate over “Housing First” policies is too often framed as a zero sum approach, where one must be for it or against it. In fact, it is a much more nuanced. For those who are economically homeless, Housing First is irrelevant. They need only housing. For those who are working and homeless, incarcerating them would actually result in more damage, likely resulting in the loss of the job they have. And for those who need mental health or addiction treatment, it is a reasonable question whether housing them in apartments without support rather than requiring treatment, where they would also be housed, is fair to anyone. Once placed in an apartment in states with strong tenant protections, those who are disruptive or a danger to themselves or others can take months to evict. I heard this several times while in California in August. In two cases, someone had set fire to their unit or a neighbor’s. In another, someone shot another tenant. None of them had yet been evicted after months of expensive litigation.
At a hearing in 2023, then Sen. JD Vance (R-Ohio) expressed his skepticism over the Housing First strategy for reducing homelessness, questioning its effectiveness rather than its objective. “I worry that what Housing First has done is taken a lot of people who are very much struggling and very much deserving of our compassion, though I think how we provide that compassion is up for debate,” he said, “but it also introduces people with serious drug problems, with serious mental illness problems, into communities with kids who are already in a very unstable situation. And now they’re having things like drug use normalized around them.”
In a Truth Social post on August 10, President Trump wrote, “The Homeless have to move out [of Washington, DC], IMMEDIATELY. We will give you places to stay, but FAR from the Capital. The Criminals, you don’t have to move out. We’re going to put you in jail where you belong.” Two days later, White House Press Secretary Karoline Levitt said, “homeless individuals will be given the option to leave their encampment to be taken to a shelter, to be offered addiction or mental health services, and if they refuse they will be susceptible to fines or jail time.”
President Trump’s July 24, 2025 Executive Order on Ending Crime and Disorder on America’s Streets, requires the Secretary of Health and Human Services and the Secretary of Housing and Urban Development to take “appropriate actions to increase accountability in their provision of, and grants awarded for, homelessness assistance and transitional living programs. These actions shall include, to the extent permitted by law, ending support for ‘housing first’ policies that deprioritize accountability and fail to promote treatment, recovery, and self-sufficiency; increasing competition among grantees through broadening the applicant pool; and holding grantees to higher standards of effectiveness in reducing homelessness and increasing public safety.”
As with everything else, you get what you pay for. If we want to keep people from returning to homelessness, we have to pay to help them make a complete transition. If not, we will pay more – much more. Permanent Supportive Housing with Continuum of Care support costs $22,000 and $36,000 per year. The average incarceration in the United States cost $30,000–$60,000 per year per inmate, and in states like California and New York, exceeded $80,000, according to a 2012 study by the Vera Institute.
One promising new treatment was approved by the Food and Drug Administration in 2023. ABILIFY ASIMTUFII® (aripiprazole), is an extended-release injectable suspension for the treatment of schizophrenia in adults and for the maintenance monotherapy treatment of bipolar I disorder in adults. Administered by a healthcare professional, to appropriate patients, it is intended for dosing once every two months, rather than oral medications that generally have to be taken daily. The Keck Street Medicine program offers the drug to some of the unsheltered homeless it treats. Not everyone tolerates aripiprazole well, and patients have to be monitored closely for serious side effects. But it is a game changer for many.
Ultimately, we are going to have to choose. We can treat homelessness with the humanity, compassion and care of people like Katia Cnop, Joseph Becerra, Tramecia Garner, and Michael Blecker. We can do nothing, losing millions in lost business revenue, human productivity and emergency medicine costs paid for by hospitals and Medicaid. Or we can chose incarceration, and pay more than twice as much in taxpayer dollars. In the case of homelessness, care, compassion and humanity actually costs less. There’s really no good reason not to choose it.
Click here to listen to NHC’s new podcast episode with Joseph Becerra to learn more.