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Friday, May 2, 2008

So the Audit says the Care Not Cash Program Works, Right?…Right?

Posted By on Fri, May 2, 2008 at 12:24 PM

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By Benjamin Wachs

The audit of his signature homelessness program, Care Not Cash, is a chance for Gavin Newsom to preen extra hard. “Mayor’s Care Not Cash Achieving Its Goals” trumpets the city’s website. The Examiner offers a glowing testimony to the power of the program, only noting right at the end of the graphic that the source is the City Controller’s office, rather than an independent study.

To be fair, the results of the audit are legitimately good news, as far as they go. It’s just that they don’t go very far at all. Let’s peer behind the looking glass:

The Bad News is Bad

First off – and this is important – the only thing the audit tells us … the only thing … is that Care Not Cash placed 2,217 people in single room housing. That’s it.

Are they better off? Well, that it doesn’t say.

“The audit did not attempt to determine the overall effectiveness of the support services offered as part of Care Not Cash. For example, we neither investigated the number or percentage of clients participating in support services by individual service, nor attempted to assess the outcomes of clients participating in services.” (Page 7)

In fact … and this is also important … the audit COULDN’T POSSIBLY determine that, because that Care Not Cash uses “can only provide snapshots of the active (County Adult Assistance Program) caseload. The system does not allow for reporting on services provided to clients in past time periods.” (also page 7).

The audit is able to say that 90% of the people placed in Care Not Cash housing stay there for at least a year … but that misses the point. What’s happening in their lives? Are they better off? Turns out, that’s the one thing we can’t possibly know.

Well, gosh.

If there isn’t a systemic way to track the outcomes of people in the program, the best way to find out what’s happening is to talk to them. Listen to their stories. The audit does that … with five people.

Five Out of 2,217.

This is not what we’d call a “representative sample.” Ever.

And at least one of those people told the interviewers he thought the program sucked. Hmmmm …

The program is also not what we’d call tremendously efficient. It takes 58% of Care Not Cash clients up to 90 days to get housing … a long time on the street. It takes an additional 22% of clients up to 150 days to get housing … and the remaining 20% take over 150 days.

Not exactly fast service. And the waits are also only going to get longer:

“Human Services expects that, going forward, the time to house clients will increase because there is no longer a surplus of new Care Not Cash rooms and because clients must now wait approximately 30 days for their first monthly CAAP meeting to become eligible for housing opportunities.” (page 16)

Nor is there compelling evidence that, once housed, the additional social services provided to Care Not Cash recipients will make all that much of a difference. Don’t misunderstand: they COULD make a huge difference, there’s just no evidence of it … and you kind of have to wonder how much of a difference it could possibly make when you read this:

“(E)ach homeless CAAP client who becomes housed through the Care Not Cash program receives an estimated average of one additional hour of health treatment and services per month.” (page 11).

One more hour a month of services? Again, maybe this does really make a difference – but I don’t find it compelling on its face.

Finally, there’s no actual evidence that Care Not Cash is decreasing the number of homeless people in San Francisco. In fact, the “Homeless Count” keeps going up.

So to say that “Care Not Cash (is) Achieving Its Goals” is a huge stretch: if the goal is to move people into housing, yes, it’s doing that. If the goal is to improve their lives … the system isn’t set up to track that. And if the goal is to reduce the homelessness problem, definitely not.

What the program IS doing is saving San Francisco money (see below). But even that could be done better.

The audit notes that the rent the city pays for the single rooms it puts Care Not Cash recipients in has increased by 20% since 2003 – 2004. That’s significantly more than at two comparison programs, in Portland and Chicago.

“San Francisco paid a much higher average amount to lease and operate SRO buildings used to house homeless clients,” the audit notes. BUT “Although San Francisco’s average amount paid per room per month was by far the highest, we cannot conclude that it is unreasonable.” (pages 25 – 26)

Really? Because I can. According to the Census, the median rent in San Francisco increased by 8% from 2003 – 2006. Now, granted, that doesn’t exactly overlap with the Care Not Cash period (census data taking a while to compile and all), but if the city as a whole is seeing rents go up around 8%, and Care Not Cash is seeing them go up 20%, I’d say that’s “unreasonable.”

But … there is good news!

The program unquestionably shifts money away from cash handouts to social services – Newsom deserves credit for that. And it also saves the city money while doing it, thus paying for itself. Also unquestionably good news.

In fact, Care Not Cash’s biggest success is saving money. Check this out (this is amazing):

“In 2003, Human Services provided cash grants to an average of 2,553 homeless clients per month. After Care Not Cash, the average number of homeless clients receiving CAAP benefits decreased to 545 clients per month” (page 14)


Now, some will say (and have already said) that this is a bad thing, because the city’s turning its back on literally thousands of homeless people who won’t accept smaller payments in exchange for a place to say.

Oh, suck it, will ‘ya? It seems pretty clear that people who were trying to milk the system decided to bail once the milk got fortified. If nothing else, Care Not Cash may have helped us figure out who wants to stop being homeless and who doesn’t. That’s impressive. And if we save money doing it, that’s even more impressive.

The audit clearly isn’t a triumph for Newsom … despite what the Mayor’s flacks are saying and the press is repeating. But the audit doesn’t doom Care Not Cash either. Care Not Cash might actually be a worthwhile program … what it needs to do is get its ass in gear, track its human results, and then get a real audit, an independent one. The kind that talks to more than 5 people.

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Benjamin Wachs


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