Health First, Housing Forward Encampment Sweeps Do Not End Homelessness. Stabilization Does.
California is clearing encampments again.
Sidewalks are power washed. Tents are removed. Public space is restored. Local officials announce that the city is making progress. Residents feel momentary relief because their neighborhood looks normal again.
Then the tents reappear three blocks away.
We are not solving a problem. We are moving it.
Encampment sweeps create the illusion of progress. They do not produce change. The core issue is not where people sleep. The core issue is why they cannot stabilize long enough to stay housed once they get there.
Homelessness is not caused by the absence of shelter.
It is caused by the absence of stability.
And stability requires something our system keeps ignoring: health.
WHAT IS BEING DISMANTLED
The most effective model California has ever deployed to interrupt the homelessness cycle is Recuperative Care under the CalAIM Community Supports benefit.
Hospitals discharge patients into recuperative care so they can recover, manage medications, receive wound care, begin detox, enter behavioral health services and work with case management.
It is not a shelter.
It is medical stabilization.
This model addresses health first.
Only then does it move toward housing.
Yet the state is in the process of pulling this benefit back. Other states are adopting or expanding similar models using their own local funds because they see the outcomes. California is removing the program while increasing encampment enforcement.
We are eliminating the intervention that prevents tents from returning.
WHAT ENCAMPMENTS ACTUALLY REFLECT
People do not end up in encampments because they missed a rent payment. They end up there because three things collided:
Unstabilized medical conditions.
Unaddressed substance dependency.
Behavioral health impairment.
Hospitals discharge individuals with open wounds that need twice daily dressing. Shelters cannot manage psych stabilization or medication schedules. Someone relapses while waiting for detox, gets exited from the program and returns to the street.
Everyone sees tents.
Few see the deterioration that forces a person into one.
Housing without stabilization fails.
Shelter without treatment churns.
Encampment sweeps shift bodies without producing outcomes.
HEALTH FIRST, HOUSING FORWARD
Health First, Housing Forward is not a slogan. It is a sequence.
Health First:
Stabilize the body. Manage medications. Address wounds. Begin detox or behavioral health care. Rebuild capacity for decision making.
Housing Forward:
Once stabilized, move toward housing with a plan, clinical support and continuity.
A person cannot engage in housing stability while their body is failing or their mind is in survival mode.
Recuperative care captures people at the inflection point between hospital and street. It interrupts the trajectory while change is possible.
Other states have recognized the value of this model and have created local funding mechanisms. California, with the largest homeless population in the nation, is moving in the opposite direction.
POLICY SHOULD FOLLOW DATA
Recuperative care reduces hospital readmissions.
It reduces use of emergency services.
It increases enrollment in treatment.
It increases the rate of successful housing placement.
It reduces returns to homelessness.
Encampment sweeps produce exactly one measurable outcome.
A temporarily cleaner sidewalk.
If state leadership continues removing medical stabilization programs while increasing enforcement, California will accelerate the homelessness cycle. We are removing tents while eliminating the program that keeps people from needing them.
We should be expanding the model statewide. Instead, we are dismantling it.
If health plans no longer fund it under CalAIM, cities and counties must. If it cannot be justified as a Medicaid cost reduction, justify it as an encampment reduction strategy.
Encampment sweeps do not reduce homelessness.
Stabilization does.
Health First.
Housing Forward.
Stop shifting the problem.
Start solving it.