Statistics about homeless kids in Orange County and their often precarious health situations are grim, which is why advocates for the unhoused are encouraged about a recently renovated, six-bed, three-bath home in Santa Ana.

Unlike most fixer-uppers, the house that’s drawing so much attention this month has a name, the Children and Families Recuperative Care Center, and a couple sponsors, the Illumination Foundation and CalOptima.

Explaining a bit about those sponsors and the house’s name also explains what the house is, and what it might mean for homeless kids.

First, CalOptima is the public health insurance agency that, among other things, oversees Medi-Cal and Medicare in Orange County. And the Illumination Foundation is a nonprofit that helps homeless people in Orange, Los Angeles, Riverside and San Bernardino counties get access to housing and social services, including health care.

Second, the phrase “Recuperative Care Center” is, in this context, bureaucracy-speak for a place where unhoused people can stay when they’re sick enough to need some kind of long-term health treatment but not so sick that their treatment has to take place inside a hospital. That concept might not mean much for people who routinely sleep in a home, often with access to family or friends who can help them while they’re convalescing, but for people who sleep in homeless shelters, or parks, or cars – often on their own – recuperative care can be life-saving.

That’s probably why, in recent years, it’s become relatively common.

Pooja Bhalla, chief executive at Illumination Foundation and a driving force behind the new center in Santa Ana, says there are at least 500 recuperative care beds in the four-county region served by her agency. Others estimate that roughly 1% of the nation’s 358,435 shelter beds are set aside for people struggling to recover from long-term illness.

But all of those recuperative care beds are for homeless adults. Bhalla and others said the beds in the Santa Ana house are the first in the country to be set aside specifically for kids and their families.

And that, according to Bhalla and others, is a critical new twist.

“I’ve been working in this space for 30 years, and I’ve been dreaming about a recuperative care facility like this, something for children. But it hasn’t happened until now,” Bhalla said.

“We hope it’ll be a model,” she added. “We know a lot of people are paying attention.”

Technically, the Santa Ana property is divided into two structures. One has a kitchen and bedrooms for patients and their families. The other holds offices for medical staff who administer treatments prescribed by physicians, and a case worker who helps patients’ families find permanent housing and employment.

A maximum stay at the new Santa Ana house is 90 days, though Bhalla said the goal is to help families stabilize faster than that.

The house unofficially started accepting patients in mid-November. By Dec. 5, when Illumination Foundation and representatives from CalOptima and others turned out for a formal ribbon-cutting, it was at its six-family capacity.

The most recent patient list runs from the grave to the chronic. It includes a 4-year-old with cancer, a teenager suffering mental health problems and suicidal thoughts and a 9-year-old having seizures in his sleep.

Bhalla said if patients are too sick they’re pushed back to the hospitals from which they’re typically referred, usually Children’s Hospital of Orange County (CHOC) or UCI Medical Center.

But if the kids can be helped in a setting that allows them to see other children, stay with at least one parent, and maybe play a bit in the big backyard, the outcomes usually will be better and the expense to taxpayers will be lower.

Keeping the house full, sadly, isn’t likely to be a challenge.

“The fastest growing groups of homeless people are seniors and single women,” Bhalla said, explaining that many of those newly homeless women also are mothers with young children.

She added this: “What we know, for sure, is that this home, and other places like it, are badly needed.”

Sick kids in cars

The math that supports Bhalla’s contention is tough to contemplate but not hard to compute.

A few days after the Santa Ana house officially opened, the Orange County Board of Supervisors released the county’s 30th annual Report on the Conditions of Children. The report, written by researchers from Cal State Fullerton and a dozen private and public agencies, tracks everything from math scores and breastfeeding to gang activity.

It also offers detailed data about children in Orange County who face, in the county’s language, “housing insecurity.”

Overall, the county found that 26,943 school-age children fall into that particular abyss, basing that number on 2023 reports from local school districts. That doesn’t include kids who are too young for school and others who aren’t enrolled.

But the county data goes a bit further, offering different versions of what “housing insecurity” actually means.

For example, most (24,183) of the local children listed as housing insecure by the county live in homes or apartments shared by two or more families. A smaller group (1,241) sleeps in motels or hotels, while another similarly sized group (1,083) sleeps in homeless shelters.

A smaller subset of school-age children, (436), live in none of those places. Instead, they sleep alone or with family members in vehicles, parks, unoccupied buildings or the streets, among other places.

Because there is exactly one recuperative care house for children, and it has room for exactly six kids, children in that last group – those sleeping in the most dire circumstances – are the most likely candidates to wind up in the Santa Ana house if they become chronically ill.

But how many will that be? How many homeless kids are actually sick enough to need recuperative care?

The county doesn’t track that, but federal studies on the harm that homelessness does on kids’ health suggest the local numbers could be big.

In June, the Department of Health and Human Services issued a report that said unhoused children are more than twice as likely to suffer from long-term medical conditions than are children who have access to traditional housing. Other health and health-adjacent problems – malnutrition, suicide, becoming victims of violence, long-term risk for heart disease, post-traumatic stress – also occur at much higher rates among children in families struggling to find a place to sleep.

Bhalla, who holds a doctorate in nursing and health care policy, noted that the actual health status of unhoused children is difficult to track. Because unhoused children often are brought in for treatment only when their health problems become acute, there isn’t public health data to chronicle that episode. Such data, if it existed, could be used by medical experts to fight disease and by policymakers to allocate money for programs that could prevent children from becoming sick in the first place.

“We know that (homeless kids) are at much higher risk of developing all kinds of medical issues – respiratory issues, that kind of thing. But we can’t know for sure how much because they don’t have regular pediatrician appointments,” Bhalla said.

“How to bring medical care to children who need it? That’s part of what the center will be doing,” she added.

Insurance puzzle

There are plenty of reasons why the Santa Ana home is the nation’s first to provide recuperative care for children. Homeless people, in general, have little political clout, and homeless kids, in particular, have the least political clout of all, in part because they can’t vote.

Also, as big as the numbers are for homeless children, they’re just a sliver of the total homeless population. Last year, the Department of Housing and Urban Development estimated the nation’s homeless count at 653,104 people, which would make it a bit smaller than Alaska but bigger than Vermont and Wyoming.

But the biggest hurdle to getting long-term care for sick, unhoused kids might be insurance.

Though 98% of children are insured, through private or public programs, none of those insurance programs covers real estate costs.

Bhalla and Michael Hunn, chief executive of CalOptima, described a unique workaround that let state and local insurance money pay for the house that will serve as the out-of-hospital medical center for a few unhoused kids in Orange County.

Though the details are byzantine, the basics work like this:

Earlier this year, CalOptima offered a $3.5 million grant to the Illumination Foundation. The money came from a pool of dollars ostensibly set aside by the state to help Medi-Cal patients find housing, a pool known as the Housing and Homelessness Incentive Program.  Given that homeless children staying at the Santa Ana center are, in fact, getting housing during their stay, a house-turned-recuperative-care-center could qualify for the funding.

And that’s what happened.

Bhalla’s organization used the promise of the CalOptima grant to buy and renovate the Santa Ana home. And CalOptima, in addition to providing the seed money, tweaked its reimbursement rates and made other changes to make the new home a sustainable operation once it got up and running.

Hunn, during the home’s grand opening in early December, told the audience that the house would be “self-sustaining,” and could operate like a tiny hospital-away-from-the-hospital.

“It’s a unique model,” he said.

Bhalla wants it to be less unique. She said last week that she’s already hoping to find a home that will become a second center.

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