The Los Angeles County General Hospital was hailed a state-of-the-art institution when it opened in the midst of the Great Depression. The 19-story Art Deco structure started as a trauma teaching hospital before becoming one of the busiest public hospitals in the western United States. The inscription over the front door still reads: “The doctors of the attending staff give their services without charge in order that no citizens of the county shall be deprived of health or life for lack of such care and services.”
That mission was not always upheld. During the 1970s Chicano movement, activists rallied around concerns of Latina women being sterilized there without their consent. Protests erupted outside the hospital through the 1980s to push the LA health care system to better address the HIV and AIDS epidemic.
The building sits largely unused after the passage of the California Hospital Seismic Safety Law, now only housing office space, as the city faces another public health crisis: homelessness. For the nearly 59,000 people experiencing homelessness in Los Angeles County, a primary way to receive public health services has been through the emergency room.
That’s about to change at the Los Angeles County General Hospital campus, which is making room for a county initiative known as Restorative Care Villages. These “villages” are designed to provide residents with a full continuum of services — recuperative care, supportive housing, a rest and recovery center plus psychiatric services — alongside education, training, employment and recreational and social amenities.
Villages across four medical sites are set to open across the county by the end of 2021. At the Los Angeles County General Hospital campus — now known as the LAC+USC campus — the Restorative Care Village is the first phase of a larger “Healthy Village” envisioned by County Supervisor Hilda Solis.
The concept for a “village inside a hospital facility” emerged after unsuccessful attempts by the county to build “enhanced neighborhood model treatment centers” in residential neighborhoods, according to Jo Ann Yanagimoto-Pinedo, deputy director of strategic initiatives with LA County’s Department of Mental Health.
In 2014, the Department of Mental Health received a grant from the California Health Facilities Financing Authority to build 560 beds in residential treatment facilities across the county. “Unfortunately, that never came to fruition because of all the NIMBYism,” says Yanagimoto-Pinedo. “We have a really large homeless population in the county, and siting treatment facilities within neighborhoods is really difficult to do.”
The alternative plan? 240 beds on healthcare campuses throughout the county, in facilities designed to hold both “residential treatment beds” and “recuperative care beds” alongside supportive health services. Residential treatment beds serve as an alternative to hospitalization for individuals with mental health needs. Recuperative care beds serve as immediate housing and supportive services for patients experiencing homelessness who are transitioning out of an acute-care hospital.
By putting the beds on existing healthcare campuses, neighbors were less likely to protest, and the plan also addresses a problem of hospitals discharging housing-insecure patients who didn’t have a safe place to fully recover, according to Libby Boyce, who oversees interim housing beds and outreach teams through the county’s Housing for Health program. At any given time, according to the county, there are between 50 and 100 patients at LAC+USC who fall into that category.
Supervisor Solis embraced the vision and the Board of Supervisors voted unanimously to support it in 2017. In late 2019, the board approved $68.4 million for construction of the first phase of the Restorative Care Village at LAC+USC. The village will be constructed on underused land surrounding the hospital.
Community meetings helped determine the best model for the LAC+USC village and the international firm CannonDesign unveiled renderings for the two main components this December. First, there is a four-story Recuperative Care Center with 96 beds to provide immediate placement for people being discharged from an inpatient hospital setting who lack a supportive place to live. Secondly, a 64-bed Residential Treatment Program will encompass four buildings providing a short-term alternative to hospitalization to address mental health needs.
All buildings include modular, prefabricated components and will be oriented around a landscaped courtyard and promenade. The building cladding was inspired by the historic architecture of the landmark General Hospital, and multi-colored paneling takes cues from colorful murals in the surrounding neighborhoods. Artwork both inside and outside the structures is another important element, according to Dave Hunt, CannonDesign’s Southern California health practice leader.
‘It’s a very rich courtyard environment,” says Hunt. “There was an interest from the surrounding communities that this would be a community asset. So courtyard areas will welcome the community in, and it helps the residents feel a sense of connectedness. It’s not a stigmatized place, it’s a place to get back into their normal life and integrate with the community.”
Grant funding from the California Health Facilities Financing Authority dictates that all the campuses be ready to serve residents by the end of 2021. Modular construction will help the team overseeing the LAC+USC campus meet this “very aggressive timeline,” says Hunt.
The other sites featuring Restorative Village Programs, which are being designed and built by other firms, are the MLK Behavioral Health Center, with 16 residential treatment beds, along with a variety of residential and outpatient treatment programs for mental health and substance use disorders, the Rancho Los Amigos National Rehabilitation Center, with 80 residential treatment beds and 50 recuperative care beds. The Olive View-UCLA Medical Center will hold 80 residential treatment beds and 48 recuperative care beds alongside mental health outpatient and urgent care centers.
The larger “Healthy Village” envisioned in and around the LAC+USC campus includes restoring the Art Deco hospital and transforming some of its unused space into housing for high-need populations.
“This is more than whole-person care — it’s about providing a very warm, welcoming environment to people who probably aren’t used to receiving care,” Yanagimoto-Pinedo says. “If you look at traditional government healthcare facilities, they’re not welcoming, they’re very cold and very institutional. We’re trying to change that because — well, why? Why should it have to be like that?”