Slide 1:

Housing and Urban Health

Marc Trotz, Director, Housing & Urban Health
San Francisco Department of Public Health
Email: marc.trotz@sfdph.org

Slide 2:

Characteristics of the Homeless*(n=2508)

• 75% male, 45% African American
• 30% of males are veterans
• 63% were current or past cocaine smokers with 35% reporting current use
• 39% had a history of using injection drugs
• 23% hospitalized for mental illness
• 63% had behavioral health disorder

  *Robertson et al, UCSF, 2003

Slide 3:

Utilization of Resources

• 3 times more likely to use ED than general population1
• 40% use the ED at least once each year¹
• 10% used 40% of hospital days²

¹Kushel et al, UCSF, 2003
²Fernandez et al, UCSF 2000

Slide 4:

Why Does the Department Invest in Housing?

• Reduce over-utilization of high-end healthcare resources
• Increase the effectiveness of DPH services by providing a safe and healthy environment for clients
• Provide housing tailored to the needs of clients and provide community-based exits from DPH institutions

Slide 5:

Who Do We House?

• Chronically homeless
• People with complex medical & BH disorders
• People with a history of institutional care
• People who have never or not successfully been housed

Slide 6:

Direct Access to Housing Program (DAH)

• Permanent housing
• Master-leasing
• Low threshold - directly from streets and institutions
• On-site support services

Slide 7:

DAH Services

• Support services (case mgmt)
• Medical care (nurses, NP, MD supervision)
• Behavioral health team
• Property management
• Third party rent payment

Slide 8:

Referral System:Access Points

• Street outreach teams
• Emergency shelters
• Community-based organizations
• High-utilizer case mgmt teams
• Primary care clinics
• Institutional settings

Slide 9:

Practicing Low-Threshold Supportive Housing

• “Screening-in”
• Voluntary services
• Active engagement
• Tenants’ rights

Slide 10:

DAH Units

	Pacific Bay Inn (1999)	75
	Windsor (1999)	92
	Le Nain (2000)	86
	Broderick Street RCF (2001)	33
New	Star (2003)	54
New	Camelot (2003)	53
	Total	393

Slide 11:

Financial Information

$400 Support Services
$400 Lease
$400 Property Management
$1,200 per unit per month

Residents pay fifty percent of their income towards rent
(avg. rent paid is $300)

Slide 12:

DAH Housing Outcomes

Two-thirds of residents remain housed for > 2 years

Slide 13:

DAH Housing Outcomes

This slide contains a pie chart that shows the outcomes of the DAH housing program. The data is as follows:

• Remained Housed — 67
• Market Rate Housing — 11
• Higher Level Care — 5
• Died — 4
• Evicted — 4
• Other — 9

Slide 14:

DAH Healthcare Outcomes*

• 58% reduction in emergency room use
• 57% reduction in hospital inpatient bed use
• Reduction in length of psychiatric hospitalization

*Kessel and Kushel, UCSF, 2003

Slide 15:

Windsor Hotel

Date Started	1999
Location	238 Eddy Street
Number of Units	76 permanent, 16 short-term
Access Points	Primary care clinics, institutional settings, street outreach teams
Supportive Services Provider	Housing and Urban Health
Supportive Sercvices Staffing	Nurse manager, nurse practitioner, nurse, social worker

This slide also contains a picture of the Windsor Hotel.

Slide 16:

Broderick Street Adult RCF

Date Started	2001
Location	1421 Broderick St.
Number of Units	33
Access Points	Institutional settings
Supportive Services Provider	Page St. Guest House and Richmond Area Multiservices Agency
Supportive Sercvices Staffing	24hr nursing, 2 counselors, counselor supervisors, nurse manager
Funding	General Fund, MediCal

This slide also contains a picture of the Broderick Street Adult RCF.

Slide 17:

Pacific Bay Inn

Date Started	1999
Location	520 Jones Street
Number of Units	75
Access Points	Street outreach teams, emergency shelters, high utilizer case management, primary care clinics
Supportive Services Provider	Episcopal Community Services
Supportive Sercvices Staffing	Site supervisor and 3 case managers, employment specialists
Funding	GF; in the first three years also Hilton Grant

This slide also contains a picture of the Parrot Bay Inn.

Slide 18:

Housing and Urban Health

Marc Trotz, Director, Housing & Urban Health
San Francisco Department of Public Health
Email: marc.trotz@sfdph.org