More than 2,500 homeless individuals sleep on the streets of the 53-square-block Skid Row area in downtown Los Angeles.
"Skid row is the worst manmade disaster in the United States. There's human waste on the sidewalks. There's all kinds of disease," says Rev. Andy Bales, CEO of Skid Row's Union Rescue Mission, the nation's largest private homeless shelter. He lost his leg to staph infection he contracted while serving the homeless on Skid Row.
But California's homelessness crisis extends far beyond Skid Row and Los Angeles. The state's homeless population has jumped more than 12 percent in the last five years, and it's part of a national crisis.
The city's particular predicament is notable for its sheer scale. Bales says that Los Angeles, which has the largest unsheltered homeless population in America, has failed to deal with what's become a public health and humanitarian crisis. More than 1,000 homeless people died on the streets of Los Angeles County last year, according to government figures.
In 2016, Los Angeles voters approved a referendum to spend more than $1.2 billion dollars building new housing for the homeless. It's part of a plan championed by Los Angeles Mayor Eric Garcetti, who declined our interview request.
The city set a target in 2016 of building 10,000 new housing units within a decade, but just one percent of those apartments will be ready for occupancy by the end of 2019.
"It's going to be too late when they get through spending the money," says Jimmy Anderson, who's lived on Skid Row for 40 years and currently sleeps at Union Rescue Mission. "There's going to be triple the homeless who're out here now."
Building in California isn't easy.
The state legislative analyst's office found that "increasing competition for limited housing is the primary driver of housing cost growth in coastal California," which has some of the nation's highest housing prices and rents thanks partly to local interest groups, which often use tools like zoning and the state's environmental review law to delay or kill new housing projects. Those obstacles prevent new housing units from being built, which drives up prices. As a result, people living on the margins are priced out and turn to the streets.
Even after voters approved more than $1.2 billion dollars specifically to build housing for the increasing homeless population, a recent report by the L.A.'s Controller's Office attributed the delays and cost overruns largely to regulatory barriers, permitting challenges, and bureaucratic confusion.
Meanwhile, the existing shelters are running out of space.
"Women and kids are going to take over the [Union Rescue Mission] and all the men are going to have to move back out here onto the street," Anderson says.
The city's approach to homelessness, known as "Housing First," was adopted by municipalities nationwide after Utah reportedly reduced chronic homelessness by 91 percent by giving away permanent apartments with no strings attached.
But state auditors later attributed those findings to a data collection error. Utahns don't actually know how their homeless population has changed over the years, or what effect various homelessness programs have had on Utah's homeless population, which is estimated to be two-thirds the size of just Skid Row's homeless population. What's more, building housing for the homeless is considerably more costly and complex in Los Angeles than in Salt Lake City.
The city initially ballparked the permanent units at a median cost of $350,000 a piece. Three years later, the estimated cost rose to more than half a million per unit. Some units are approaching $700,000 each.
Andy Bales says he saw it coming.
"I was a critic 10 years ago of this plan even before it came about," he says. "A very expensive way of spending all the resources on a few and leaving the many out in the cold."
In Los Angeles, three out of four homeless people live unsheltered on the street. Bales had wanted the city to allocate a portion of the money to nonprofits and churches like his to provide temporary relief but says critics dismissed and even laughed at him.
"There's this group that is so dogmatic about permanent supportive housing as the solution," he says. "And they think the only solution is the perfect rather than good."
Bales says that, given the current emergency, the city should reconsider its heavy focus on finding a long term solution.
Union Rescue Mission just opened what's called a Sprung structure, a relatively inexpensive but sturdy and weather-resistant tent with 120 beds. He encourages the city to invest more in Sprung structures and other cheap, easily constructed solutions like mobile homes, container homes, or even 3-D printed concrete houses.
"We cannot spend $600,000 per person per unit and ever get it done," says Bales. "We've got to think innovatively or we're going to have a bigger disaster on our hands."
In terms of where to put these structures, the L.A. Controller's Office reports that the city owns more than 7,500 lots, though neighborhood councils regularly fight to keep shelters out.
Property owners in Skid Row and elsewhere in the city would like to see the police clear homeless encampments out of their neighborhoods, which could also help to avert the emerging public health crisis.
But past court settlements prevent that, and a September ruling on a case out of Idaho from the U.S. Court of Appeals for the 9th Circuit found that doing so constitutes cruel and unusual punishment when cities don't have "adequate shelter" to accommodate everyone living on the streets. Los Angeles and Los Angeles County have signed onto a lawsuit challenging that ruling.
"We just firmly believe that the police are not an answer to homelessness," says Becky Dennison of the Venice Community Housing Corporation, which opposes the criminalization of sidewalk camping in Los Angeles.
Dennison says that the focus should remain on building more housing, not arresting people for being unable to find shelter. But proponents of the lawsuit say the city needs guidance from the courts on what constitutes "adequate shelter" before investing in solutions that might free them to enforce anti-camping laws.
"We don't actually ever need to criminalize low income people for non-criminal behaviors," Dennison says.
Given the lack of progress on permanent or temporary housing, Bales is also hesitant to sign onto the lawsuit for the time being.
"I'm not signing on to remove people from the streets until we have enough places to go," Bales says. "When we get that, then we can worry about asking somebody to leave the streets."
Under the increasing pressure in recent months, the city has erected a few of its own Sprung structures to address the crisis. Bales says it's still not nearly enough.
"It's ridiculous. I mean, who would want to leave 44,000 people on the streets to die while you stick with your very expensive plan to help a few?"
Produced by Zach Weissmueller. Camera by Benjamin Gaskell and John Osterhoudt. Music by Kai Engel.