Bill Fisher, 61, is the unofficial mayor of Star Apartments and the founder of the community’s gardening club, which tends a bountiful garden on the spacious and serene terrace of an unusual new structure that is home to 102 formerly homeless individuals. “The way I ended up homeless – I’m an iron worker – I wound up getting in a little trouble and went to jail,” Bill says. “Before that, I hadn’t been in trouble since I was 19 years old. So I got out of jail, the economy tanked, and I wound up homeless, living on the streets down there.”

“Down there” is Skid Row, a 50-block area in Downtown Los Angeles with the highest concentration of homelessness in the country: men and women, many suffering from mental and physical illnesses, living in tents, sleeping on squares of cardboard, transporting their belongings in shopping carts. “It’s tough out there,” says Bill, whose heart started giving out 10 years earlier. “I was on San Julian Street, the heart of the mess. I did the shelter shuffle. I was two weeks away from getting back to work, then my heart just went so far south that I ended up in the hospital having surgery.”

Like the other residents of Star Apartments, Bill was a frequent visitor to the emergency room and user of other county health services. “I’d go out at night, play my guitar, and my heart would go out,” he explains. “I’d fall down, and boom, off to the emergency room.” While the building was under construction, the County of Los Angeles began targeting housing subsidies using a Coordinated Entry System that prioritizes housing for the sickest people currently living on the streets.

Dana Trujillo, Skid Row Housing Trust’s Housing Development Director, explains that the project was not originally intended to serve frequent ER users, who are a subset of the people they typically serve. “We’ve been adapting our programs to deal with the health issues of our residents,” she says. “We weren’t surprised by it, but we didn’t really have a precedent for working with this concentrated level of health issues.” The mission of Skid Row Housing Trust is to provide permanent supportive housing so that people who have experienced homelessness, prolonged extreme poverty, poor health, disabilities, mental illness or addiction can lead safe, stable lives in wellness. Following a Housing First model of affordable housing for the homeless, the Trust provides a variety of vital services to residents at each of its 24 buildings. For instance, a counselor who specializes in hoarding issues makes the rounds of all the Trust’s properties. “When people come back into housing, there is a lot of re-educating regarding paying rent and keeping the units clean that needs to happen,” says Joey Aguilar, the Trust’s Manager of Resident Services. “That’s why we have the hoarding specialist, and case managers who troubleshoot.”

But after the Coordinated Entry System was implemented in 2013, the focus for Star Apartments shifted. “A lot of the people here have some severe conditions,” Joey continues. “So it’s been a learning curve for us, catching up on the medical components.” Central to the focus on providing homes for the sickest and most vulnerable is locating a county-run medical clinic on-site. It will be the Trust’s seventh clinic. “There is a huge nexus between housing and health and having access to health services,” Dana adds. “Having the clinics in our buildings has a significant impact.” One study demonstrated that visits to the ER dropped from 11, 12, or 13 times a year to at most one among residents with a clinic in their building. In sprawling Los Angeles, the benefit is very clear. “Imagine," says Joey, “being on public transportation in LA traffic trying to get to your doctor appointment.”

Bill’s heart surgery was a success, but he didn’t heal properly after his breast plate was put in. After eight weeks in the hospital, he was released to recuperate at the Weingart Center for the Homeless. From there he was referred to the brand new Star Apartments. “I watched them building this building,” says Bill. “And I wound up living in it. I think I got lucky coming in here. Everyone on the staff is so cool, we have a good time here.” While he'll still be traveling to see his cardiologist, the on-site health clinic will help Bill with primary care issues and monitoring his chronic atrial fibrillation. Otherwise, Bill says, “To go out to the clinics, it takes a whole day. Your whole day is shot.”

Star Apartments is a striking and innovative structure designed by renowned architect Michael Maltzan, made up of modular units that seem to float over the existing one-story concrete building, the interior of which was completely gutted and renovated to provide space for the health clinic, offices, and an attractive lobby. Each of the 102 rectangular units was prefabricated in Idaho – bathrooms, appliances, cabinets, and insulation already installed – shipped to Los Angeles, and then lifted by crane and stacked on top of the original structure. “All we had to do was connect the units to the utilities,” Dana says, “like Legos.”

Joey believes that good design makes a big difference in people’s lives. “Having a beautiful view and a great space to live in helps the residents feel great," he says, "and it's great for the people who work here. I think design is very underappreciated at times, especially with marginalized communities. It shows people care.” Dana agrees: “You shouldn’t just have iconic buildings for multi-millionaires. You should produce iconic buildings for people of all walks of life.”

It’s the openness of the building that Bill most appreciates. “Normally public housing is all indoors,” he notes. “Here it’s all outdoors. We have beautiful walkways, and the terraces. It’s amazing.” These features are not an accident. As part of its development process, the Trust reviews design ideas with residents to get feedback on plans for new buildings. “We incorporate the lessons we’ve learned over time," says Dana. "And having single-loaded corridors, so units open to the outside, not into hallways, is something we try to incorporate into all our new buildings.”

Someone once told Dana that if she was looking for a challenge, she should work in affordable housing  – because if you can build affordable housing, you can do anything. One of the unique aspects of financing the Star Apartments project was the amount of philanthropic dollars that came in to specifically support the build-out of the outdoor spaces and the health clinic. “There was a lot of interest in the health and wellness aspect of the project, as well as the unique construction type,” she says. A $1 million Affordable Housing Program grant, awarded through Bank member Community Bank, was also vital to the project. “Every dollar that we had in the deal was absolutely necessary to accomplish this vision,” Dana continues. “And AHP always comes in at the end to help us get over that bridge. The Federal Home Loan Bank of San Francisco has been an important partner for us for a long time.”

Bill greets each day by opening his front door and admiring the cityscape. Inside his compact apartment he’s able to express his own unique sense of style using found art, like twigs and branches brought in from the Los Angeles River and prints of great paintings – Van Gogh is a favorite – separated from old calendars, to liven up the walls and kitchen cabinets. He has a place for the old guitars he likes to refurbish, and to store treasures like a collection of antique sheet music he recently discovered at a thrift store, which he loves as much for the artwork as for the music. “This is home,” he says. “It’s great. I’ve got people that come over, we talk politics, we play music, and we laugh.”