In early 2019, Santa Clara County, California , had more people sleeping in shelters, tents, cars, on the streets or in other makeshift accommodations than it had seen in more than a decade.

For years, San Jose native Lola Logan was one of them, and her descent into homelessness began like many others.

"We were doing good, and then we just weren't," says Logan, a 61-year-old grandmother who previously worked as an accountant and a home health aide. Unable to keep up with soaring rent in San Jose, she says she was evicted from her apartment and slept huddled on the sidewalk, "freezing cold, nothing to block the wind, really – just praying to God you make it through the night sometimes."

It was about four years before Logan was under a roof of her own again, after a cancer diagnosis and other vulnerabilities launched her to the top of the county's waitlist for a new affordable housing building that opened in August. Now, through an initiative that provides medical and social services for formerly homeless people – including for 85% of residents in the new building – Logan speaks with a dietician regularly, and a nurse visits her apartment weekly to set up her medication for the next few days.

"They literally changed my life," Logan says. "I believe they understood my situation a lot clearer, so they knew what was happening and what I needed."

The initiative – Hope Clinic , which operates out of Santa Clara Valley Medical Center – was born from the realization that for many chronically homeless people, obtaining housing is a crucial first step that ultimately falls short of meeting their often complex health and social needs. By weaving together health care, case management, and social services and support through a permanent supportive housing model, clinic staff seek to ensure the recently housed don't wind up back on the streets.

"The key to sustaining that housing status, once we get homeless folks off the street, is really to provide a suite of services – especially for those that are most vulnerable to potentially having medical, mental health or substance abuse breakdowns," says Dr. Cheryl Ho, Hope Clinic's medical director.

Services for the homeless population are badly needed in this county of 1.9 million people and hub of uber-wealthy Silicon Valley. This year, Santa Clara County had 9,706 homeless residents, up from 7,394 in 2017, according to the local point-in-time count conducted in January . Roughly 4 in 5 were unsheltered , and two-thirds had been homeless for a year or longer. Many also had chronic health conditions or physical disabilities, used drugs or alcohol, or were grappling with psychiatric or emotional issues.

"We're seeing a huge uptick in our homeless population here, and it's largely because of the affordable housing crisis and the cost of living," says Libby Echeverria, a clinical social worker who manages Hope Clinic. "People are becoming homeless at about twice the rate that we can help them – the faucet is just on."

These are the people that Hope Clinic serves. Its 13-person team includes physicians, mental health providers, a dietitian and nurses, and the clinic has seen about 400 people in more than 1,000 clinic visits since opening in late May, Echeverria says.

The clinic caters to those who have recently qualified for permanent supportive housing – people who receive government rental subsidies are eligible for its services – which is expanding in the area as a core tenet of the county's plan to battle homelessness. In 2016, county voters approved issuing up to $950 million in general obligation bonds to help fund 4,800 new affordable housing units over the next decade, with 1,800 dedicated to permanent supportive housing. So far, 821 such units have been built, including more than 130 units in Logan's building.

The housing funding is "part of our effort to expand the supportive housing system, reduce homelessness and really try to spur housing development, which is needed at all levels in Santa Clara County and in California in general," says Ky Le, who directs the Santa Clara County Office of Supportive Housing.

Homeless people must have a disabling condition to qualify for the new permanent supportive housing, and they're prioritized based on a vulnerability index that essentially quantifies "their risk of dying on the streets," Echeverria says. Most patients are on MediCal, the state's Medicaid program; Hope Clinic will help them enroll if they're uninsured.

"These are the most complex and the lowest-functioning out of all of our homeless population," Echeverria says.

As Hope Clinic scales up in coming years, it plans to serve about 4,000 of the county's newly housed residents. Le says that as patients become more medically and socially stable, they'll likely be transferred to other providers so Hope Clinic can keep up with demand.

Evidence is anecdotal so far, but the clinic's outcomes appear promising, Echeverria says.

"We work very closely with the case managers, we have weekly conferences with them (and) daily, there's texts going back and forth between the doctor and the case managers," Echeverria says. "We've been able to decrease emergency room use, decrease admissions, decrease the use of psychiatric emergency room – all because we're able to intervene so early."

Getting people off the streets and coordinating their care also could significantly cut the public cost of caring for these residents. From 2007 to 2012, the county and its partners spent $520 million annually on health care, social services, law enforcement and other services for the area's homeless. People with the highest 5% of costs accounted for roughly half of all these costs in 2012, according to a study prepared for county stakeholders.

Even so, a 2018 county report notes that "resources are limited and the demand for affordable housing and supportive services far exceeds the system's current capacity."

Other initiatives are underway to help the homeless still on the streets. The Valley Homeless Healthcare Program – the umbrella group that runs Hope Clinic and is jointly funded by the county's supportive housing office and Santa Clara Valley Medical Center – also oversees a mobile clinic for teenagers, clinics offering services for transgender people and those with opioid withdrawal, and a "backpack medicine" team that gives medical supplies and physical assessments in homeless encampments.

In addition to expanding the area's supportive housing system and increasing services for people who are homeless, Le says his office's upcoming 2025 plan will address ways to keep people from becoming homeless in the first place.

The plan's focus, he says, is on strengthening social safety net programs, changing land use policy to allow for more housing and building "an economy that works for everyone."