Guests who moved into SIP hotels on or before Nov. 15, 2020, are eligible to participate in SF COVID-19 Command Center’s rehousing program, which will offer three housing options. Most of my clients prefer to remain in the City, close to their providers (yours truly), but some say they will refuse Tenderloin and Bayview-Hunters Point to avoid drugs and violence. While waiting for an elevator at a SIP hotel, one SIP hotel guest excitedly told me that she was moving out to Tracy (over 60 miles south of SF) to start a new life.
This rehousing process has picked up pace as federal government reimbursement for SIP hotels will run out Sept. 30, 2021, and the City plans to gradually close SIP hotels between fall 2021 and mid-2022. SF Department of Homelessness and Supportive Housing plans to spend $1 billion to house 6,000 homeless people by July 2022.
According to
a report by Coalition on Homelessness, SF has a “generational opportunity” to cut homelessness in half by using federal, state and local Prop C funds to purchase
struggling hotels and convert them into permanent supportive housing, which is
quicker and half the cost of newly constructed affordable housing.
Inside SIP hotel floor with separate hallways leading to case managers, medical staff, and Homebridge caregivers, meeting the needs of SIP hotel guests, who receive three meals per day in subsidized rooms with private bath, laundry service, and three daily check-ins by staff who carry walkie-talkies. SIP hotel guests also sign in/out of a book in the lobby, and cameras record goings-on in common areas. This surveillance system reminds me of assisted living.
This investment in SIP hotels has transformed lives of unhoused people by providing onsite access to basic needs.
“…beyond the healthcare services, it’s also the simple dignity of housing that has allowed patients to heal. Having a chance to rest, to use the bathroom without having to run from place to place, to have three nutritious meals per day — these basic dignities are prerequisites for managing any health condition.”—Naomi Schoenfeld, NP, quoted by Diane Qi and Rani Mukherjee, “Providing more supportive housing is the best way to heal the homeless: San Francisco must act quickly to acquire more hotels and other sites,” SF Examiner (Apr. 13, 2021)
No wonder SIP
hotel care coordinators offer incentives like food and gift cards to engage comfy
guests to get assessed for rehousing, provide documentation (state ID, Social
Security card, proof of current income), and sign participation agreements that include fill-in-the-blank for reasonable accommodation/life safety
concerns (with verification from health provider). Participants have up to two business days to respond to a housing option. Rehousing is a limited opportunity: Participants who refuse three times end their eligibility for rehousing. One client seeks to stall the rehousing process, as he wishes to remain at his SIP hotel until closing in order to maintain access to onsite medical care (also supported by his primary care physician).
Another program to transition SIP hotel guests is Flexible Housing Subsidy (FHS) Pool, which places them in private market rate rentals and provides support services. Under this FHS arrangement, tenants contribute rent based on 30% of their income and the remainder subsidized by nonprofits through 2022, then the City takes over funding.
Attention Adult Protective Services: Muni commuter holds up sign reading “Stop violence against the elderly in the SIP hotels.” (June 15 was World Elder Abuse Awareness Day.)
During this pandemic, other unhoused people were moved into group shelters and outdoor tent camps, like this “safe sleeping village” fenced outside SF Main Library. SF Supervisor Rafael Mandelman proposed controversial expansion of temporary safe sleeping sites, with an average cost of $190 per tent, per night! This “shelter for all” policy has been criticized for taking resources from long-term solutions, like permanent supportive housing. Puzzling why SF Department of Homelessness and Supportive Housing recently sought $20 million over next two years to fund 260 tents in six Safe Sleeping Villages, at a cost of over $60K per tent, per year?
Poster reminder to Share the Sidewalk: Keep it clear, clean, and cool ("look out for one another - especially kids and seniors").
California Gov. Newsom said “what’s happening (tent camps) on our sidewalks is unacceptable.” Henceforth, he proposed more home-ful plans: spend $12 billion to house homeless people over five years ($7 billion to expand Project Homekey, convert hotels to housing + $1.75 billion to build affordable housing + $3.5 billion on new housing and rental support); and state’s payment of all back rent owed by lower-income people who haven’t been able to pay rent during pandemic.
Yet the state’s spending on homelessness has been criticized for a lack of centralized system to track spending, and inability to determine duplicative efforts, according to state auditor’s report: Nine state agencies spent $13 billion through 41 programs to address homelessness in the past three years…like too many chefs in the kitchen?!
“With more than 151,000 Californians who experienced homelessness in 2019, the State has the largest homeless population in the nation, but its approach to addressing homelessness is disjointed. At least nine state agencies administer and oversee 41 different programs that provide funding to mitigate homelessness, yet no single entity oversees the State’s efforts or is responsible for developing a statewide strategic plan.”—Elaine M. Howle, California State Auditor, Homelessness in California: State’s Uncoordinated Approach to Addressing Homelessness Has Hampered the Effectiveness of Its Efforts (Feb. 2021).
In response
to this state audit, California unveiled Homeless
Data Integration System
(HDIS), the first statewide repository of homelessness data from 44 regional
continuums of care; some stats from 2020:
·
161,548
people experienced homelessness on a single night in January 2020
·
In
2020, local providers reported serving 248,130 people experiencing homelessness
(36,810 from age 55-64; 14,802 from age 65+)
·
Of
the people who were served, 91,626 people (37%) moved into permanent housing
throughout 2020
Unhoused clients pay relatively sizeable amounts from their government income for storage space, which is limited when they stay in shelters (typically one backpack, one luggage). Example: 73-year-old Buffalo Sojourn of Oakland has been “unhoused on and off” for the past 20 years, and spends $480 (out of his $700 government aid check) to pay for monthly storage of his Black Panther Party memorabilia.
Coalition on Homelessness (COH) issued a report, Stop the Revolving Door: A Street Level Framework for a New System (Sep. 2020), based on pre-pandemic surveys of homeless experts (584 unhoused people in SF) and called for:
·
Prevention:
pass policies to keep housing affordable; expand access to variety of permanent
supportive housing options (rental assistance/subsidies).
·
Shelter:
majority prefer legal camp with amenities (over existing shelters associated
with institutionalization, dependency, stigma, strict curfews that interfere
with getting hired/maintaining jobs); demand for both clean and sober shelter;
high quality case management (many complained of low-quality).
·
Substance
use: need for diverse system that includes methods of harm reduction and
abstinence.
·
Mental
health: bring mental health services including peer support where homeless
people already congregate at drop-ins, shelters and navigation centers; stable
housing after treatment is critical to stabilizing mental health.
·
Trans
homelessness: need gender-affirming care.
COH report's "revolving door" refers to homeless people churning through SF’s homeless response system without landing permanent housing. But the report doesn’t address the revolving door of staff who work with the unhoused population (other than briefly mentioning "it is difficult to attract and maintain quality staff" in Shelter section, p. 42), allowing clients to fall through the cracks. Yet dedicated staff is essential to build stable therapeutic relationships with clients to provide case management, substance use and mental health treatment services. Sadly, as in long-term care facilities, there appears to be high turnover among staff who work with the unhoused population that can negatively affect operations and client outcomes. And staff turnover existed prior to this year's Great Resignation. In last year's Performance Audit of SF Department of Homelessness and Supportive Housing (DHSH), SF Budget and Legislative Analyst noted high staff turnover/understaffing, insufficient contract oversight and unspent funds made DHSH unprepared to handle the growing homelessness crisis amid the pandemic.
Home Match, a
nonprofit that pairs older adults who have extra home space with people seeking
affordable housing, is “good at homeless prevention,” said its Program Director
Karen Coppock.
Tents inside fenced parking lot and outside parklet space keep sidewalk clear.
Encampments opposite outdoor murals.
Books adorn this Bigbelly trash compactor on streets of Tenderloin, sharing space with tents; Helayne B. reminds us of our humanity: we are like books, full of stories.
Warning sign on traffic light post marks drug-free zone in Tenderloin, yet enforcement is lax.
Tenderloin’s Sierra Madre Apartments fire displaced 60 residents, mostly seniors, a reminder how precarious our housing status is.
UC Hastings Law is constructing 14-story, mixed use complex that includes 600+ units of below-market-rate graduate student housing with occupancy set for June 2023. Murals painted on building exteriors make art freely accessible to people on the street.
Mural of androgynous face on Mosser Tower Apartments, with balconies that provide perfect pandemic escape!
Alicia McCarthy’s “Untitled” mural on luxury hotel that was former SRO.
Mural on boarded up Aviary storefront invites viewers into meditating frame of mind.
Mural of “Misunderstanding” by 13-year-old Marisol, painted in groovy style.
Van Mess (ongoing construction for five years, three years overdue and counting) could use some colorful murals as distraction during slow traffic.
While moving forward with SF’s reopening, it’s also an opportune time to reflect on how this pandemic has exposed many broken systems and prompted emergency measures to invest in our safety net: food security with Great Plates home-delivered meals (ending next month); Medicare coverage of telehealth; CARES Act coverage of uninsured patients with COVID-19; free COVID-19 testing and vaccination; universal basic income pilot; etc.
Home-ful measures included eviction moratorium and rental assistance, suspension of homeless sweeps and “poverty tows” (people who live in their cars). Now there’s consideration of more city-sanctioned spaces for unhoused people to park and live in their vehicles.
California spending billions to house homeless in hotels
ReplyDeleteCHRISTOPHER WEBER
August 4, 2021
LOS ANGELES (AP) — When homeless outreach workers first visited her encampment under a Los Angeles highway overpass last fall, Veronica Perez was skeptical of their offer of not just a bed, but a furnished apartment complete with meals, counseling and the promise of some stability in her life.
“They said they had housing for me, but it just didn’t seem real," Perez said. “When you're homeless, you become leery and you don't trust people."
Perez, 57, had been sleeping in cars or tents all over Southern California since she lost her job at a storage facility three years ago and couldn't pay her rent.
The second time the outreach team came to the camp beneath Interstate 405, Perez decided she was ready to take a chance and make a change.
She accepted the offer and took residence in one of 6,000 new units built statewide over the past year as part of Project Homekey. The program started in June 2020 is repurposing vacant hotels, motels and other unused properties as permanent supportive housing.
Homekey is the lynchpin of Gov. Gavin Newsom’s $12 billion plan to combat homelessness in the nation's most populous state. California has an estimated 161,000 unhoused people, more than a quarter of the nationwide total of 580,000, according to the the U.S. Department of Housing and Urban Development. Newsom signed the funding bill July 19, calling it the "largest single investment in providing support for the most vulnerable in American history."
Newsom's office said $800 million — most of it federal Coronavirus Aid, Relief and Economic Security Act money — was spent on Homekey in 2020 to provide shelter for 8,200 people. Now the administration plans to go even bigger: California will spend $5.8 billion of state and federal funds over two years to expand the program and create an estimated 42,000 housing units.
“If you think of last year as a proof of concept, you can think of this year as taking this strategy to scale and making it a centerpiece of California’s approach to housing the homeless,” said Jason Elliott, senior counselor to Newsom…
In California, Homekey is an outgrowth of Project Roomkey, a temporary effort during the coronavirus outbreak to find shelter at hotels, which Elliot said provided beds for 42,000 homeless people 65 and older or others susceptible to COVID-19. It has been extended through June 2022.
Under Homekey, the state buys the properties, covers all construction and conversion costs, then hands them over to cities or counties that contract with local service providers.
…At her new home in central Los Angeles, Perez relishes her privacy, enjoys the three meals provided daily and appreciates that she was allowed to bring her cat…
Perez was diagnosed with PTSD from her years on the streets and receives on-site counseling. Others with more severe mental health problems or addictions also get the treatment they require.
The goal is to make sure even the “hardest-to-house” people will come inside, said Dr. Margot Kushel, director of the Center for Vulnerable Populations at the University of California, San Francisco…“Some people need services that go along with that housing, and some people don’t. But the really essential thing is that without the housing, the services don’t work,” she said.
Eventually Perez will be presented with housing vouchers that will allow her to rent a subsidized apartment.
It's unclear how long those vouchers might last, however, raising concerns from advocates about the long-term success in a state with exorbitant housing costs.
A new database shows nearly 250,000 people sought housing services in 2020. About 117,000 of them are still waiting for help…
https://www.aol.com/california-spending-billions-house-homeless-193842495-215740425.html
Closing hotels could disconnect hundreds from critical health care services
ReplyDeleteSep. 22, 2021
By Sydney Johnson
Even those who disagree on housing solutions can often find common ground around one given fact: People with safe and supportive housing are less likely to suffer from physical health conditions, mental illness or substance use.
So when the pandemic reached the Bay Area in March 2020, San Francisco launched a bold shelter-in-place program that would make good use of hotel rooms going empty during the pandemic….e program has helped keep residents healthy while lowering the number of emergency room visits at a time when hospital resources are already strained.
“Our data is not complete, but everything we have preliminarily shows this is a really effective program,” said Naomi Schoenfeld, a medical anthropologist and principal investigator on the study. “We know for sure that there have been reductions in mortality in overdoses for people inside versus on the street.”
But much of that progress is at stake now as San Francsico moves ahead with plans to wind down the emergency shelter program…
As of Sept. 22 there are 1,600 shelter-in-place hotel residents currently, and 2,089 have exited, according to San Francisco data.
Numerous studies have shown that a steady roof over one’s head has a range of health benefits, from calming the nervous system, to better environmental health conditions, to giving people the time and planning needed to attend doctor’s appointments and maintain regimens.
And the shelter-in-place hotels have gone beyond basic shelter to help unhoused people stay healthy during a global pandemic. Residents were able to access care at their hotels including COVID and HIV testing, wound treatment, physical or occupational therapy, psychiatry and assistance with insurance.
The UCSF research found that providing unhoused residents with stable housing in the hotels led to a reduction in emergency room use, an increase in outpatient primary care and a reduction in substance use.
“People have their own room and bathroom, and they’re delivered three meals per day. That as a baseline of humanity and dignity goes a long way,” Schoenfeld said. “But the added role of nursing staff helps people begin to develop trust, and some did a really good job helping people feel safe and respected.”
Experiences and types of health care services vary among the sites,…Residents receive intake evaluations to assess medical, mental health and substance needs and are then connected with in-home health support…
Those connections alone are precious, health advocates say, especially among individuals who have learned to distrust government and health care systems that may have neglected them in the past.
…San Francisco is now in the process of moving residents out of the shelter-in-place hotels and into permanent housing,…expected to continue through September 2022, according to Deborah Bouck of the San Francisco Department of Homelessness and Supportive Housing.
“Our focus is on rehousing guests and transitioning them to their new care providers who will coordinate medical care and other supportive services,” said Bouck.
…Twenty of the original 25 hotels remain operational currently. And while President Joe Biden has promised to continue to reimburse emergency COVID-19 costs such as the shelter-in-place hotel program through the end of 2021,
…fear that people will fall off in the process, putting some back in the position they were before the pandemic.
…The City estimates there were 8,035 homeless residents in 2019, the latest available count, which marks a 30% increase from two years prior. Many shelter-in-place hotel residents are above 50 years old and live with pre-existing health conditions, putting them at greater risk of COVID-19 and other illnesses if transfers to permanent housing aren’t successful…
https://www.sfexaminer.com/news/closing-hotels-could-disconnect-hundreds-from-critical-health-care-services/
Decline of assisted living facilities impacts S.F.’s aging homeless population
ReplyDeleteSYDNEY JOHNSON
Sep. 28, 2021
…Over the past decade, the number of residential care facilities has plummeted across San Francisco. Between 2012-2018, The City lost 186 beds in residential care facilities for the elderly that serve under 15 people, according to city reports. More than two dozen of these small facilities shut down during that time, while just 74 beds were added at larger facilities.
…Between 2018 and 2021, nearly 460 beds at assisted living facilities for the elderly were added. But these beds were almost entirely within large facilities that serve more than 100 people, including the San Francisco Campus for Jewish Living and Portola Gardens.
Smaller assisted living facilities that offer a more home-like setting, meanwhile, are falling out of the fabric of The City’s health care and housing networks, creating a gap in the care continuum as the population ages.
Those seeking assisted living often face long waitlists, are moved out of county or end up on the streets. As of January 2019, 103 individuals were waiting to be placed into an assisted living facility…
“We have lost a lot of board and care facilities, and this has contributed to the homelessness crises,” said Jennifer Friedenbach, director of the Coalition on Homelessness…
City leaders are now exploring potential policy changes to help curb the trend. This month, the Board of Supervisors passed an ordinance that would require approval for the change of use of any existing residential care facility to discourage additional losses.
The rule also makes it easier to open new residential care facilities by removing permit requirements for facilities of seven or more beds in all residential zoning districts.
The ordinance will become effective on Oct. 31, but it’s already been put to the test through a pilot version…helped slow down the conversion of one 33-bed facility on Broderick Street run by the nonprofit Richmond Area Multi-Services…
“These residents we serve are very stable right now, but historically they had been homeless, hospitalized, and that’s why they stay with us so they can continue to live in the community,” said Christina Shea, director of clinical services at Richmond Area Multi-Services.
…advocates say that increased funding for subsidies to cover bed costs is necessary to make these facilities financially sustainable for both residents and caregivers.
The monthly break-even rate for assisted living beds is over $2,000 for small facilities,…more than two times the Supplemental Security Income for assisted living residents in California. That has made it near impossible for some centers to stay financially feasible while catering to low-income residents without outside funding.
“There have been moves in recent budgets but not nearly at the scale we need,” said Mandelman, referring to the Department of Public Health’s goal of adding 400 overnight treatment beds. Just 73 of those beds are slotted for residential care, and there’s not yet a date on when those might become available.
…“Back to the 1970s, we had a flourishing mental health system in San Francisco and a big part of that was all of these Victorian homes that families could buy for cheap and convert into board and care,” said Friedenbach.
But over time, San Francisco’s exorbitant housing prices have pushed out these small businesses, and it has become more economical to invest in beds at facilities that are already financially stable. At the same time, the minimum wage has increased by 46% while the Supplemental Security Income rate for assisted living residents has only increased by 8%, making it harder and harder to keep staff and businesses afloat.
…Keeping these kinds of facilities open is also an obligation under Gov. Gavin Newsom’s Master Plan on Aging, which directs health systems to avoid unnecessary institutionalization and isolation…
https://www.sfexaminer.com/news/can-san-francisco-stop-the-extinction-of-small-assisted-living-facilities/