B6 | SFPUBLICPRESS.ORG | SPECIAL REPORT ON HOMELESSNESS | SAN FRANCISCO PUBLIC PRESS, FALL 2014
Audit says city agencies need better tracking of formerly homeless SUPPORTIVE continued from B5
people we encounter who are chronically homeless have something deeper going on,” he said. “We’re specifically built to help people who have a hard time getting from place to place on their own, understanding what they need to do, physically having mobility issues, and may have all kinds of substance abuse, mental disorders, cognitive or personality issues that prevent them from connecting the dots themselves.” NEED FOR BETTER RECORDS Staff at the Department of Public Health and the Human Services Agency rarely communicate with each other to coordinate their procedures. One consequence is that clients cannot easily move from one of these tracks to the other based on need. It is hard, for example, to move from Human Services Agency housing to a Department of Public Health building if a physical or psychiatric condition emerges that requires intense supervision. A transfer like that almost never happens. “There’s so many different departments and different buildings, and that often causes confusion and lack of support,” said Gaeta of the Tenderloin Housing Clinic. “So often we have a tenant with such severe mental health issues who is not doing well in our buildings because we don’t have the level of support to survive. And we don’t want to evict them, but sometimes we don’t know what else to do.” The messy process of assigning people to housing makes it difficult to assess the value of the city’s multibillion-dollar investment in homeless services in the last decade. Ben Rosenfield, the city controller, concluded in a 2011 audit of supportive housing that neither the Department of Public Health nor the Human Services Agency had any way to measure the success of their programs. Both departments, he wrote, “need to collect a variety of tenant outcome data, including data on residents’ length of stay in housing, exits from supportive housing, benefits received, support services used and changes in health and employment status.” City officials had trouble explaining what happened to all the people who moved into permanent supportive housing but have since moved out. Some were reunited with family or friends. A few moved to programs with fewer services. Other clients were evicted, and returned to the street or shelters. Some died, others ended up in jail and a few simply disappeared. “We don’t have good information about why they haven’t succeeded,”
Terrence Smith prays regularly at St. Boniface Catholic Church in the Tenderloin (above). Photos by Angela Hart // Public Press said Amanda Fried, deputy director of policy for Dufty’s program at the mayor’s office, called Housing, Opportunity, Partnerships and Engagement. Dufty is most often the first person to whom city departments refer queries regarding the city’s homelessness programs. But even he has trouble getting good data about the success or shortcomings of housing first-programs — a sign of the complexity of the bureaucracy that San Francisco has constructed to battle the problem. Both Public Health and Human Services officials said privacy rules restricted public access to their client databases. They cited exemptions within the California Public Records Act that restricted records of welfare recipients from being disclosed. They declined to release versions with private details redacted, saying it was impossible to cleanse identifying information. LIMITED RESOURCES A core assumption of the 10-year homelessness plan was that it would achieve financial savings. Not only would the housing-first policy ap-
proach improve lives by rescuing people from the streets, but it would also save millions of dollars by reducing emergency medical care. At the time, the city estimated it was spending a total of $183 million —about $61,000 per person for each of the 3,000 chronically homeless — on emergency room care, treatment in the county jail and other services. Prioritizing housing was expected to reduce these costs to $16,000 per person per year. It was not until Gavin Newsom took over as mayor in 2004 that the city fully embraced “housing first.” Care Not Cash drastically reduced general assistance and similar monetary payments to the homeless. As of this fall checks of up to $444 were reduced to $62 when clients got a promise of housing. The difference helped fund permanent supportive housing. The target population was people without a home for at least a year, or who returned to the streets four or more times within three years. Newsom cited research that stabilizing those with the highest need would save millions of dollars by reducing astronomical hospital bills.
Newsom said he had to make a radical change because the streets were so visibly out of control. “I got really fed up because there’d been an acute increase in people who were dying on the streets,” he said. The city got financial backing for its supportive housing expansion from the federal Department of Housing and Urban Development and the state Mental Health Services Act, under which the state collects a 1 percent income tax from people earning $1 million a year or more. Now, the Department of Public Health’s Direct Access to Housing runs 1,539 units at 34 sites, mostly in the Tenderloin. Yet somehow, after a decade of work, the backlog of people eligible for these programs is as long as it has ever been. “Between Care Not Cash units, Direct Access to Housing units and people waiting in shelters, there’s got to be at the very least 1,000 people on various waiting lists,” said Dufty of the Mayor’s Office of Housing. While no one is claiming to have “abolished” homelessness, chronic or otherwise, city officials do talk of progress toward expanding supportive housing. Mayor Lee has said the city succeeded in meeting most of its goals
in the 10-year plan, which called for an addition of 3,000 supportive housing units. Since 2004, the city built or leased 2,699 units. Including housing that existed before, the city now has 6,355 units, according to figures in city audits. While it was a huge feat to get that much built, many of the goals were never realized, said Angela Alioto, who wrote the plan. Alioto, a former president of San Francisco’s Board of Supervisors, ran a vigorous mayoral campaign against Newsom in the 2003 Democratic primary. When she withdrew from the race, Newsom asked her to orchestrate his battle plan against homelessness. After Lee became mayor in 2011, he disbanded Alioto’s homelessness planning committee, which met about once a month. Then homelessness appeared to worsen. “The 10-year plan kind of fell off a cliff,” Alioto said. “The interest wasn’t there.” Without the 10-year plan, she said, the situation on the streets would have deteriorated faster. Her biggest frustration was that bureaucracy made it hard for clients to get needed services. “It’s so ridiculous to me how many rules and regulations we make homeless people jump through,” she said.
Meanwhile, Lee announced in June that he was recalling the Homeless Outreach Team from its daily rounds and reconstituting the service this fall as a roving street-side medical clinic to head off problems that might otherwise clog emergency rooms. It was not clear whether the team would continue in its primary role of identifying and interviewing candidates for supportive housing. Newsom had sharp words for his successor, saying that under Lee, homelessness grew while the city failed to provide adequate resources for supportive housing. “There’s been no accountability,” Newsom said. “The need is more acute than ever. The street population has changed to a degree that so many people are dually diagnosed. So many are suffering from paranoid schizophrenia and self-medicating. And the chronic element is becoming more and more visible, and more difficult for the city to address.”
The Fund for Investigative Journalism provided support for this reporting project. Visit www.fij.org.
Even in supportive housing, some residents struggle to avoid eviction EVICTION continued from B1
Julia Smith, 64, waits for a chance at a shelter bed at Glide in the Tenderloin. Photo by Paayal Zaveri // Public Press
her. She decided to move out voluntarily, she said, from sheer battle fatigue. In the aftermath, securing a shelter slot is a tedious endeavor for Smith. With a bad back (she has three fractured vertebrae) and her depression diagnosis, she worried about the consequences if she could no longer make time to see her doctor. Her goal now is to save money to find a new place to live. The bulk of her income comes from $867 per month in Social Security benefits. To get off the street, she said, “I need more money.” Overworked staff at supportive housing programs say they face conflicts regularly, often because of inappropriate behaviors that homeless people bring indoors and need to be dealt with. Some tenants struggle with hoarding and cluttering. Amelia Rudberg, a case manager at the Seneca Hotel on Sixth Street, said managers must evict hoarders to maintain a “standard of habitability” demanded by the Department of Public Health. Tensions can even turn violent. Samara Miller, a case manager at the Raman Hotel on Howard Street, said she and her colleagues first try to keep problems from becoming physical by informally conversing with tenants who threaten others. If the problem continues, staff makes the tenants agree in writing to desist. Eviction is a last resort. “We want to keep people housed, we don’t want them to go back onto the street,” Miller said, “The other balance is keeping the community safe as well.” But supportive housing caseworkers have few effective tools to shift tenant behavior short of threatening eviction, Macmillan said. “That seems ridiculous.”
In April, the Eviction Defense Collaborative proposed altering that dynamic by creating a new, $200,000 city program to mediate disputes between landlords and tenants. By setting standards for conflict resolution, a mediation service would “dramatically reduce the number of formal evictions,” Macmillan said. That, in turn, could offset the costs of court proceedings for about 400 people. The Board of Supervisors rejected the proposal as written last spring. But Macmillan is working with District 2 Supervisor Mark Farrell to revise the proposal for another attempt at funding. To the mentally ill, eviction lawsuits can be especially challenging. Richard Merriel, 48, spent a month in jail this summer on the charge that he violated his parole. Meanwhile, he racked up $1,400 in unpaid rent at the Mission Hotel on South Van Ness Avenue, one of the Tenderloin Housing Clinic’s city-sponsored supportive housing sites. When the organization sent him an eviction notice, Merriel did not realize he could seek legal advice, he said. He signed the papers without question. His oversight might be explained by his medical diagnoses. Merriel said he suffers from paranoid schizophrenia, bipolar disorder and antisocial personality disorder. He also has difficulty reading and writing. It was his overlapping set of disabling conditions that qualified him for a supportive housing program in the first place. Merriel, who collects a monthly Social Security check of $961, said he was renting rooms in hotels immediately following his eviction. But by September, his money was running out. His fear was that soon he might have to resume sleeping on the streets. But with a case manager’s help, he said he was hope-
ful that he could get into a new room through a supportive housing program at Hotel Isabel on Mission Street in SoMa. The goal for the city and outside advocates should be to provide enough help for people in supportive housing to remain housed, said Deepa Varma, a staff attorney at the Eviction Defense Collaborative. “Both sides lose if this person becomes homeless.”
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