Operational Truths: Lessons from Running 1,500 Beds in Los Angeles and Fresno

Medical first

I serve as CEO of Soul Housing Recuperative Care. Before that I ran day-to-day operations. That work put me in the room for the decisions that matter and on the floor when those decisions show up as results. It also made one thing very clear. Housing without medical stabilization does not hold.

Housing First is a simple promise. Get people indoors and then work on everything else. The promise is appealing. The problem is practical. If someone leaves a hospital with uncontrolled diabetes, an untreated wound, or unmanaged behavioral health needs, a key and a lease will not change the outcome. Medications lapse. Symptoms return. ER visits resume. Jobs are lost. The new address becomes another short stop in a long crisis.

Recuperative care fills the gap between discharge and permanent housing. It is not a shelter. It is not a long-term placement. It is a medically informed setting where people stabilize, get on consistent medication schedules, eat reliably, and have their care coordinated. When that happens first, the housing that follows is more likely to last. When it does not happen, the system pays for the same crisis again under a different heading.

Running facilities at this scale teaches you to ignore slogans and follow the work. Medical stability is not optional. You cannot expect someone to keep employment or meet the terms of a lease while managing untreated conditions. Consistency beats good intentions. Regular meals, medication administration, and predictable routines keep people from sliding back. Alignment matters. Hospitals, managed care plans, and community providers have to work from the same plan of care or the participant gets three versions of support and one set of results. Facilities are systems, not just beds. Staffing, pharmacy, supply chains, and data flows all have to line up or the model fails no matter how committed the team is.

I do not dismiss Housing First. I disagree with the idea that housing alone is sufficient. Housing plus medical stabilization is the standard that works. Recuperative care provides that standard. It reduces readmissions, protects housing placements, and gives people a fair chance to return to work and hold on to their progress.

In the past year I have watched the pattern repeat. When we address medical needs first, people keep housing. When we do not, they cycle back to crisis and everyone pays for it, including the patient. This is not a theory debate. It is an operational fact that shows up in staffing rosters, pharmacy logs, meal counts, and discharge plans.

If the goal is outcomes, funding and policy should follow what works. Pay for stabilization so that placements succeed. Pay for continuity so that small setbacks do not become new crises. Pay for aligned systems so that each handoff carries the plan forward rather than resetting it. Do that and the public will see fewer revolving doors and more people quietly keeping their keys.