The Effects of the Housing Crisis on the ILH Industry

With most low-income households paying more than half of their income for housing, this price-out forces many vulnerable individuals with chronic and persistent mental health disabilities into the ILH as a last ditch option before homelessness. The threat of becoming unhoused is compounded by the observation that the same pressures that are removing alternative housing options for tenants may also drive many ILHs to change their business operations from supporting people with mental health disabilities to operating as single-family rental homes, student housing, or short-term rentals.

It is important to emphasize that although many ILH operators manage healthy homes that promote long-term landlord-tenant relationships with their tenants, a significant number of homes provide housing that is uninhabitable, deplorable, and rife with exploitation. While many of these homes may be operated for the purpose of warehousing tenants in abusive conditions, the larger number of homes that are poorly run often do so out of poor operator judgment and lack of knowledge and access to resources that support best ILH practices and mental health competency. As a result, the complaints about day-to-day issues in the ILH industry are often similar, including habitability problems, infestations, physical safety, unlawful medication management, poor quality of meals, mismanagement of fixed income, lack of leases, unlawful evictions, arbitrary house rules, and lack of conflict resolution processes. In addition to health and safety concerns, over time, these conditions take a significant toll on mental health and recovery, preventing tenants from achieving housing stability.6 Living in such an environment would arguably be considered abusive.

However, these problematic homes, despite having reputations as poorly run ILHs, still receive a steady flow of tenants due to prospective tenant desperation and the unavailability of affordable alternative housing options for the most vulnerable within the mental health community.

Tenant Sourcing for an Underground Housing Industry

Critical to the success of the ILH industry is the ease with which it can secure a steady flow of tenants to the homes.

1. ILH Operator Searching:

   The first pool of tenants comes from the ILH operators’ own sourcing of tenants by utilizing mental health service provider locations or psychiatric facilities.
   • The intensity of the operator’s tenant search ranges from advertisements posted at these locations to patrolling the front entrances of facilities for recently discharged mental health patients who often face homelessness or housing challenges after commitment to a psychiatric facility.
   • Prospective tenants in this case are frequently viewed as commodities to be obtained and shuffled around into available beds within the operator’s ILH network, never to be allowed the opportunity to form lasting relationships in any residence or to make the ILH a home where they can thrive.

2. Case Management Referrals:

   The second source comes from the ILH operator’s relationships with various mental health service providers in the local community.
   • These relationships are often informal, lacking any contract, and therefore without accountability. Operators often make their homes known to the provider network in their respective county. Home information typically ends up in informal housing lists kept and managed by each service provider. Whenever a social worker or case manager needs to place a client, they will refer to this list.
   • One particular concern with this practice arises from the fact that providers are often under tremendous pressure to find housing for clients, yet do not have the resources to do so. This has the potential for placement of vulnerable mental health clients into homes that never receive any formal screening by provider networks.7 Often times, provider lists of ILHs, even between providers serving the same geographic area, are as varied as the number of providers serving those clients, representing a mere snapshot of a larger ILH industry.
   • This opaque understanding of the size of the industry is also what makes it so difficult to hold ILH operators accountable for uninhabitable homes and abusive conditions. If there is no sense of the scope of the ILH’s operation, it becomes virtually impossible to target lasting and sustainable advocacy and mitigate the harm to tenants living in these homes. It is therefore more often the case that a particular ILH is selected because it happens to have an available bed, and not because the home has been vetted for how well it would fit with the tenants’ expressed needs or disability.

3. Referral Arrangements:

   Third, it has been observed that some tenants are also placed in ILH homes through the supporting underground network of referral service providers.
   • These are unlicensed and unbonded operations that utilize their familiarity with the local county mental health environment to locate tenants in need of housing.
   • Providers in this case can refer these clients to selected ILHs with whom they may have off-the-books financial kickback arrangements for per-tenant referrals into the home.
   • These referral providers may have little obligation or interest in tenant safety, being only concerned about the collection of fees in exchange for filling ILH beds.

Peer-run Room and Board Coalitions:

Several counties in California including San Diego, San Bernardino, Fresno, Santa Clara, and Alameda, have engaged in initiatives to address the gap in availability of ILH housing stock. One founding model is the Independent Living Association in San Diego County.8

These collaborative initiatives, based on the concept of peer-led coalitions, are critical in addressing the ILH industry since they bring county programs, service providers, tenants, advocates, and ILH operators together to map out the industry within participating counties and formulate strategies to provide advocacy and services.9These coalitions create centralized resources for prospective tenants, advocates, and service providers to find ILHs that best match the need of any particular tenant through the use of directory listings of member homes. These efforts to map the ILH industry are based on the recognized mutual benefit that tenants and operators receive by making the ILH known to the community in exchange for adhering to quality standards that prioritize tenants’ safety and well-being. The goal is for ILHs to receive long-term tenancies that fit their operation and access to resources while tenants are allowed the opportunity to find a home that maximizes their chance for wellness and recovery.

However, despite the benefits of peer-led coalitions, third parties will remain in control of housing selection as long as prospective tenants are deprived of the opportunity to be involved in selecting housing based on their own expectations of safety, habitability, and fit. The next section will explore how this decision deprivation arises.

What Makes Issues with the Industry so Difficult to Address?

Tenant Decision Deprivation

Critical factors that lead so many tenants to poorly run or abusive ILHs include the disparity in knowledge and the lop-sided power dynamic during several stages of the housing and tenancy experience. These factors deprive the tenant of any meaningful chance to decide where they want to live.

This knowledge disparity appears early on in the housing search. As discussed previously, many prospective tenants rely on their case management service provider or other third parties to locate a home.

The provider is ultimately in the driver’s seat knowing what other homes may be available while the prospective tenants’ role ultimately boils down to passive agreement or acquiescence to a choice without ever having a meaningful opportunity to participate in the decision-making process.

Exacerbating the knowledge disparity problem is the tremendous pressure providers are under to place increasing numbers of clients into an ILH industry that is reticent about disclosing what is available in a manner that can be effectively assessed by case management providers, advocates, and prospective tenants.

Another point of tenant knowledge disparity, and in turn decision deprivation, arises out of the power imbalance in the tenant relationship with the ILH operator. Once a tenant is housed in an ILH, several factors can make it difficult for them to leave a poorly run, uninhabitable, or abusive home.

First, the operator and the tenant may both be acutely aware that the ILH placement is likely the last resort before the tenant faces homelessness. The very real fear of being evicted and becoming unhoused is a constant presence for tenants that often discourages them from expressing concerns about poor living conditions or taking steps to leave an uninhabitable situation.

Second, there often is an established financial dynamic that makes leaving difficult. The operator controls any deposits and, in some cases, makes tenancy contingent on the tenant signing over control of their income to the operator, either unofficially or officially as, for example, the operator becoming representative payee of fixed government income. While operators have stated that their tenant’s relinquishment of financial control is the only way to secure rent payments on time or at all, the nature of this one-sided relationship leaves the tenant without the power or ability to leave a bad housing situation. Among particularly unscrupulous ILH operators, this financial leverage is also used as a potent tool for the commoditization and warehousing of tenants whereby they are moved from one home to another while the operator collects entire amounts of government benefits in the guise of ‘rent’ payments. This reshuffling of tenants to various locations also ensures that those who complain are hidden away to silence their voices and avoid detection by advocates or investigative agencies.

The Operator Cult of Personality

The at-first-glance symbiotic relationship that develops between a tenant and their landlord operator does not always reflect the mental influence operators may have on the tenant. In many ILHs, tenants do not refer to the operator by his or her name, but rather use terms of endearment reserved for family members or loved ones.

Tenants learn to view their operator as a savior who takes care of them while keeping homelessness at bay by the “generous” offering of a room and board. At best, this relationship stigmatizes and infantilizes the adult tenant. At its worst it robs the tenant of their sense of individuality, choice, and independence by teaching the tenant that the operator is the only one looking out for their interest as a family member would.

This learned helplessness manifests in particularly concerning ways when advocates or protective agencies are called in to investigate an abuse allegation only to be turned away at the door by the complaining tenant who reports that nothing is wrong because “Mama takes good care of me.” This form of power imbalance manifesting even without the physical presence of the operator, is the most concerning as it is so deeply rooted in a tenant’s psyche that it shapes the tenant’s belief that they cannot do any better and deserve to live in exploitive and uninhabitable conditions.

Poor ILH Conditions Often Start with the Failure to Adhere to Landlord-Tenant Laws

All too often law enforcement is called to an ILH to investigate allegations made against a tenant. In cases where the complainant is the tenant, law enforcement often only takes further action if there are clear signs of abuse or criminal activity. However, in the majority of tenant complaint cases the issue is not necessarily criminal in nature, rather it is problems arising out of management of the ILH, for example lack of food access, money management problems, and verbal conflicts; or habitability concerns such as exposed wiring, leaky roofs, mold, and infestations. Many of these problems are violations of landlord-tenant law and do not meet the threshold for law enforcement intervention. Unfortunately, outside of the penal code, there are scant legal protections for tenants and it falls upon existing landlord-tenant law to provide slower and less effective remedies to protect tenant rights.

Most ILH homes fail to provide written leases or any other documentation establishing legal tenancy. Landlord-tenant relations are often informal and verbal, creating situations where conflicts are difficult to resolve because they become he-said-she-said scenarios.

The short-term effect is that it removes tenant recourse since the tenant cannot rely on contractual language to support their rights through provider assistance or judicial relief. The long-term impact is the negative effect on the tenant’s wellness and recovery as uncertainty of verbal terms removes the ability of the tenant to feel secure in his or her own home.10

Compounding the conflicts arising out of informal tenancy relationships is the resulting lack of opportunities for tenants to self-advocate and obtain knowledge about rights under landlord-tenant law. For example, most tenants do not know that typical habitability violations, such as exposed wiring, leaky roofs, mold, faulty plumbing, and infestations, that form many of the ILH tenant complaints can be addressed through the ‘repair and deduct rent’ or ‘rent withholding’ principles of landlord-tenant law.11

More problematic is that service providers and advocates report the increased use of unlawful evictions using the 5150 involuntary psychiatric commitment statute.12 The ILH operator will attempt to use the 5150 criteria to involve law enforcement and paint the tenant as a person who is a risk to self or a danger to other tenants in order to justify immediate removal of the tenant from the ILH and an end-run around legal eviction protections.

By the time the tenant is discharged out of the 5150 hold, they may arrive at the ILH to find their belongings dumped on the curb outside the home. Unscrupulous operators will rely on the tenant’s despair from their 5150 experience or their fear of calling in authorities to stop the unlawful eviction.

In many scenarios, the ILH operator does not even attempt a 5150 eviction, instead opting for an illegal eviction when the tenant leaves the ILH for a brief period.13 Because most tenants possess very few belongings, and in most cases no furniture, these self-help evictions by the operator are easy to execute and often go uncontested by the tenant.

Contrastingly, where written lease documentation is lacking, a written “house rules” document setting limitations on activities and conduct is often the first thing a tenant is required to agree to prior to their tenancy in the ILH. These rules may place restrictions on facility usage, phone and mail access, visitation rights, and access to amenities such as use of cooking appliances and food storage. They may also require relinquishing control of privacy, limiting space for tenants to keep their belongings secure from unauthorized access; medications, the withholding of which serves as a means to control the tenant; and operator management of tenants’ income which prevents exploited tenants from leaving the home or complaining.

While these restrictions may not appear as egregious as many abuse and habitability problems encountered in many ILHs, they are often seen alongside abusive and exploitive conditions. Furthermore, heavy-handed proscriptions diminish a tenant’s sense of “home” and promote a locked-institutional culture which is counter to the purpose of a community ILH. With the importance of “home” for a tenant’s wellness and recovery, this housing insecurity and instability has a significant negative impact on the tenant.14

Lack of Oversight and Agency Protection

In California there is little to no oversight of the ILH industry. Aside from the landlord-tenant protections discussed in previous sections, there are few affirmative protections in place. Advocates occasionally rely on local city ordinances and codes in their efforts to improve ILH conditions, yet the effectiveness of these options vary from city to city. The inability of many city and county agencies to address problems in ILH homes is further exacerbated by the “whack-a-mole” nature of poorly run or abusive homes. In rare instances of successful intervention to shut down an ILH, it is often a matter of days before the business changes its name or relocates to a new facility to continue business as usual.

Code enforcement agencies and fire departments are often called to ILHs by tenants and advocates, but the jurisdictional limitations of these agencies are relatively narrow and often are not sufficient to address the many underlying issues of day-to-day habitability problems, exploitation, and abuse.

Code enforcement may limit action to the rarest of cases, those that involve obvious code violations such as illegal structural additions or waste hazards. Likewise, fire departments are limited to acting in cases where physical conditions pose a fire danger to a structure. However, these are not issues that typify more chronic problems affecting the day-to-day quality of life in an ILH.

In a few cities, local ordinances may require a license to operate a rental housing business, tying those requirements of compliance to registration and existing building safety ordinances.15 However, like building and fire code complaints, these license requirements can rarely be enforced due to the underground and transient nature of the ILH industry. City agencies simply do not have the infrastructure to account for the ILHs within their borders nor to enforce a license against homes in violation of the ordinance.

An agency often mentioned in the context of ILH oversight is the Community Care Licensing (CCL) division of the California Department of Social Services. However, contrary to belief, CCL does not have jurisdiction within ILHs because these homes do not provide 24-hour non-medical services like for example the Adult Residential Facilities (ARF).16

Tenants living in ILHs are typically independent and able to live in their own community arrangement without additional assistance. The only time CCL may step in to investigate an ILH occurs if there is an allegation about the ILH operator engaging in the provision of ARF-covered services without a CCL license. CCL does not have jurisdiction to investigate allegations of abuse or uninhabitable conditions if there is no element of care practices that require a license. Typical complaints to CCL from ILH tenants include medication management and provision of other forms of assistance to tenants relating to activities of daily living, such as showering, dressing, ambulation, and feeding.17 However, even in those examples, ILH operators have found ways to get around CCL regulations. Many ILH operators may require tenants in need of assistance with daily activities or medication management to become In-Home Supportive Services (IHSS)18 recipients and appoint the operator as their IHSS provider. This legally allows the operator to engage in services normally requiring a CCL license. ILH operators who are IHSS providers end up getting paid by the tenant for their IHSS services while avoiding the administrative and operational expenses of running an ARF. Therefore, whether an ILH is engaged in the unlicensed care practice or IHSS service remains an exceedingly difficult distinction to make and must be determined on a case-by-case basis. To this date, CCL has not publicly provided clarifying standards to determine whether the practice constitutes an unlicensed service or a legitimate provision of IHSS.

Even if CCL becomes involved, the enforcement action is limited to demanding the ILH operator cease the unlicensed care practice or apply for an ARF license. While monetary fines may be levied, the ILH operator is usually given time to make the requested corrective action.19

Of course, mere corrective action on one violation does little to discourage the commission of the same or different violation(s) in the future. While CCL may cross-report allegations falling outside of the agency’s jurisdiction to law enforcement or Adult Protective Services (APS), involvement of these agencies have their own jurisdictional hurdles.

When APS becomes involved, there are often two hurdles to effective APS assistance. First, the abused or affected tenant must be an elder or dependent adult.20 Most of the tenants living in ILHs are independent adults who are under age 65. This categorically dismisses most tenants from APS assistance. Even those adults who are IHSS recipients may not be considered dependent adults because tenants often receive relatively low levels of IHSS assistance, such as housekeeping, shopping, meal preparation, medication management, and accompaniment to medical appointments, that do not meet the “physical or mental limitation” prong of the dependent adult definition.

Second, APS is a client-centered service, which means that no action can be taken to advocate for the tenant without his or her expressed consent. As discussed in preceding sections, the power-disparity between the tenant and the operator, fed by the paternalistic persona of the operator often causes the tenant “victim” to recant an allegation or refuse to allow action by APS. The tenant’s very real fear of retaliation or eviction often halts action by APS before assistance or referrals can be rendered. Once a tenant has refused APS assistance, a referral to other agencies, including law enforcement, is in most circumstances ruled out.

Involvement of law enforcement at the ILH, often at the behest of the ILH operator, presents its own complications. While there are many examples of abuses that warrant immediate police involvement, most cases of violations against tenants do not rise to criminal conduct or violations of the law to allow for law enforcement action. Allegations made by tenants rarely involve reports of criminal activity or physical plant habitability so egregious that police will move to shut down an ILH operation. More common are the complaints about lower-level issues including verbal abuse, disrespect, tenant conflicts, and habitability problems. As a result, these complaints often end up being referred by law enforcement to APS, CCL, or code enforcement.21

While the chance that a potential problem is resolved directly through officer involvement is small, the risk to the tenant can at times be significant. Situations may escalate from a small tenant-operator verbal conflict to a mental health crisis point when officers arrive on scene. Advocates and providers are not only concerned that this has the potential to result in a use-of-force confrontation with the tenant, but also that police involvement jeopardizes the tenuous long-term relationship between tenant and operator. Advocates and service providers on many occasions are left scrambling to find new home placement for a tenant after a police encounter at the ILH results in efforts to evict the tenant.

Advocacy Strategies towards Safe Housing:

Due to lack of oversight, and to an extent, collaboration between responsible agencies, it may fall on county programs, providers, and advocates to come up with novel initiatives to entice the ILH industry to improve practices and living conditions. These solutions center around peer advocacy, community organizing, resources to case management providers, and measured state and local legislation.

Peer-Advocacy and the Importance of Lived Experience

As discussed in preceding sections, tenants are rarely afforded the ability, opportunity, or education needed for them to self-advocate for their own housing. Whether by decision deprivation, undue operator influence, or the complexities of landlord-tenant rights, the risk of the tenants’ interest being lost in the process of securing and maintaining housing remain high.

It therefore becomes important to mobilize community peer networks of people who have lived experience with mental health disabilities and ILH tenancy. Whether through the county, non-profit peer programs, or grass roots peer efforts, the network of peers could coordinate and provide the industry-wide trainings to tenants on a variety of topics and issues ranging from landlord-tenant rights to meal preparation and community resources.

For example, service providers, county patients’ rights, and peer advocates could coordinate outreach and training efforts on housing rights to tenants and educate them on how to preserve their tenancy when faced with housing and tenants’ rights violations, including unlawful evictions and severe habitability violations. Peer support and training on life skills, such as money management, nutrition, self-care, and access to vocational programs, further promote tenant independence.22

Peer-led initiatives also de-stigmatize disability from being considered a dependent condition and recognize that tenants with disabilities have the right and ability to actively participate in their own search for a stable and safe home while self-advocating for housing rights and sustainable independent living. This could involve peer advocates working alongside tenants and case management providers to guide the tenant through the process of making an informed decision about where and how they want to live.

Finally, involving peers with lived experience is also a critical way to build trust in both tenant and ILH communities. Outreach led by peer advocates may be seen as less intrusive by both communities compared to engagement from professional advocates or local government programs.

Community Coalitions

As mentioned previously, in at least five counties in California – San Bernardino, San Diego, Alameda, and Santa Clara – initiatives are in place or under development to form member-based peer-led coalitions to address widespread problems concerning ILH safety and habitability in those counties.

Through these coalitions, ILH operators are enticed to become members by offering operators incentives such as access to exclusive member referrals of tenants, problem resolution processes, business operational trainings, access to network resources, and inclusion in a network database where the operators can advertise their businesses. In return for membership, ILH member operators must adhere to tenants-rights standards, provide written lease agreements, submit to unannounced site reviews, create plans of correction, and to other conditions set forth by the network.

The reach and effectiveness of these networks to mitigate the proliferation of unsafe ILHs and improve living conditions for ILH tenants has already been proven in participating counties. For example, a coalition in San Diego County referred to as the Independent Living Association (ILA), increased membership from 16 to 76 ILHs covering 631 beds from its inception in 2013 to present.23 What this means is that 76 ILHs signed on to adhere to quality standards and voluntarily agreed to be subject to review of physical plant and conflict resolution processes in order to create stable home environments for tenants.

Increased Resources to Providers

Case managers, social workers, and other provider staff are under incredible pressure to house extremely vulnerable clients. Providing additional resources can help relieve the pressure including increased funding to case management infrastructure and peer support. These resources would empower staff to make better connections with operators, provide a much-needed opportunity to vet the homes for safety, and allow for full-service case management.

Funding is also available through grants from the federal agency SAMHSA (Substance Abuse and Mental Health Services Administration).25 These include Grants for the Benefit of Homeless Individuals (GBHI) to fund coordination of housing services and supportive services as well as training and resources available through SSI/SSDI Outreach, Access, and Recovery (SOAR).

Providers, including case management staff, social workers, and discharge planners could also benefit from support by peer providers who can offer mental health-centered trainings and other services mentioned above, including partnering with those providers on outreach to tenants and ILH operators.

These are just a few examples of the types of funding and resources that can help relieve the pressure on providers to house clients. Additionally, most providers have fundraising or resource development staff, however they would also benefit from partnerships with community volunteers, including peers with lived experience.

Legislative Options in the Future?

As mentioned in preceding sections, the ILH industry is governed only by landlord-tenant law and, in rare instances, local business license ordinances. While many advocates have supported ideas of targeting the industry with further legislation creating accountability by operators, there have yet to be any concrete proposals on how to do so.

One potential avenue for state legislation is to create a public registry requirement whereby any ILHs must register their operation. Such legislation would shine public light on a currently underground industry by identifying and mapping the homes statewide. This would create a critical tool to assist state and local government as well as advocates in targeting their efforts to protect the home safety and security of tenants in ILHs. It also creates an instrument for law enforcement to identify operators who have a history of running homes that jeopardize the health and safety of tenants while also ensuring accountability of referral businesses and providers that send tenants to those homes.

However, any legislative effort to bring the ILH industry into the public sphere would face potential hurdles.

First, registries may involve funding for an entity to host the registry, or even expand on the jurisdictional duties of an existing entity. In this fiscal environment, these appropriations-tied proposals may face a financial challenge. One way to overcome this challenge is to delegate registry hosting to an existing non-governmental organization.

Secondly, without careful messaging about the need for a registry, ILH operators may oppose the legislation due to erroneous fears that they would be burdened by rules and administrative fees as quasi–Adult Residential Facilities (ARF) under state oversight. The cautionary tale here is that such efforts would likely drive many of the ILHs, including many well-run homes, out of business thereby leaving another critical void in affordable housing.

Therefore, much-needed legislation must be measured and directed in a manner that doesn’t shake up an industry already looking to shutter its mental health housing business to make room for more profitable business opportunities.

Advocates, including Disability Rights California, have supported more indirect legislation governing the ILH industry by creating accountability for service providers, placement agencies26 and referral services that place tenants in uninhabitable or abusive ILH conditions. Though comprehensive legislative measures covering entities referring tenants to ILHs have yet to materialize, the existing model of referral accountability in the ARF and RCFE industry may point the way for similar efforts in the ILH industry.

For example, AB2744, a 2018 state bill proposal that did not pass, sought to increase transparency by requiring businesses engaged in the referral of residents to RCFEs to be registered and subject to resident disclosure requirements detailing the referrer’s business dealings with the RCFE so conflicts of interests could be identified.27 Currently Health and Safety Code Section 1536.1 creates liability for placement agencies who fail to notify CCL of licensed homes that jeopardize the health and safety of a resident.

These proposed and existing laws governing licensed community living facilities could form the basis for similar language governing any business or organization referring tenants to ILHs. Targeting the source of tenant referrals to ILHs with known problematic history by imposing liability and creating accountability could be an effective way to mitigate the harm that these exploitive ILHs pose to tenants.

Conclusion

Addressing meaningful change within the ILH industry may appear to be a daunting task. The perfect storm of housing unaffordability, homelessness, and the mental health crisis has increased community reliance on these homes as the last resort before tenants become unhoused.

While the most effective efforts to protect tenants against unscrupulous ILH operators remain elusive, years of investigating the industry and working with community and local government stakeholders have revealed some fundamental guiding principles from which to base advocacy and action towards the ILH industry.

These principles, centered around operator accountability, tenant empowerment, public awareness, and deeper engagement with referral entities to the ILH industry, will require sustained grassroots and local government support in order to result in tangible outcomes that promote, enforce, and sustain safe housing for tenants in the ILH system.

Until that is achieved, the word ‘Home’ in the Independent Living Home moniker will never mean the place we all associate with a safe environment for healing, wellness, and recovery.

Information about available homes is often only available to service providers and case managers. Tenants often lack similar access to information about which homes are available and the conditions and contract terms existing in each home.

Service providers must be expected to engage tenants in finding and selecting an appropriate and desirable home. This tenant-provider engagement is a critical first step to ensure that housing is stable and a good fit for a tenant.

Furthermore, peer-led training must also focus on issues and topics that are diverse and will allow tenants to not only protect their housing arrangement but also have the life tools to be independent. Such trainings can range from landlord-tenant rights to accessing community resources and beyond.

Providers face significant challenges as they seek affordable and sustainable housing for their clients. We must ensure that there is support by leadership at local and state levels, including legislators and executive management, as well as the local community to access funds and resources directed towards enhancing their connection with ILHs during the tenant-housing process. Increased effort should also be directed towards seeking these resources through partnerships with peers with lived experience and community organizers who can provide help with outreach, resource development, training, and other support for both providers and clients.

The underground ILH industry must be mapped in order for any meaningful changes to take hold. A registry requirement for a business to operate as an ILH is a critical tool to achieving this purpose. The registry coupled with increased local government support for member-based peer-led coalitions creates a framework that would encourage the ILH industry to participate through incentives including community and provider support, resource access, tenant matching, business development, and mental health education.

Creating these networks can uplift and recognize homes that provide quality housing while diverting tenant prospects away from poor performing ILHs.

This network is an avenue to centralize ILH information within a county allowing for providers and advocates to understand the unique size and availability of ILHs in their local communities.

Tenants in need of ILH placements often place their faith and trust in programs and services to help them find a safe and clean home in which they are safe and supported. Tenants rely on the represented knowledge and connections of providers in securing appropriate housing This includes a wide range of service providers who assist tenants to find housing in the community, including case managers, hospital social workers, and discharge planners from higher levels of care.

Most providers and referral businesses work with their own lists of ILH operators with whom they are familiar or have established relationships with over time. However, some will send tenants to live in ILHs with known histories of uninhabitable living conditions, abuse by the home operators, and tenants’ rights violations.

The California legislature must pass and operationalize legislation that creates accountability for agencies, service providers, discharge planners, and businesses that refer tenants to homes that they know have a poor history of severe habitability problems and tenants’ rights violations without disclosing such history to the tenant. Such legislation must be brought into alignment with existing penalties under California’s Penal Code Section 368 covering dependent adult abuse. Sanctioning these services who refer clients to abusive or uninhabitable ILHs recognizes the important roles these entities have in the safety of the tenants they serve.