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Urban Triage: Faced with a Housing Scarcity, San Francisco Focuses on Keeping Its Homeless Alive, if Not Sheltered 

Tuesday, Sep 30 2014
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For Tarazano "Terry" Chambliss, being homeless in San Francisco meant always thinking in the now, or in the immediate future: where his next meal was coming from, and which big-hearted woman in Hunters Point might be cajoled into cooking it; where he could park his truck for the night, and whether his 8-year-old daughter would sleep there with him; where to get food stamps without having to deal with a cranky office clerk.

Chambliss was, by many measures, one of the lucky ones. He eventually got a job at Providence Baptist Church Shelter in the Bayview, and went on to work as an "engagement specialist" for the San Francisco Homeless Outreach Team (SFHOT). For the past six years, he's been driving around the city, bouncing from encampments at Golden Gate Park to cardboard townships beneath the freeway at 16th and Portrero streets, sometimes appeasing city supervisors who'd complain about homeless people inundating their districts. He's gotten to know the city's most down-and-out: the people who sleep outside, live out of shopping carts, and suffer untreated complications from alcohol or drug injections. His colleague Jason Albertson, who works as an SFHOT psychiatric social worker, compares this work to "moving through a natural disaster."

In San Francisco, that disaster has only gotten worse.

Rising property values, Ellis Act evictions, and Airbnb tourism have pinched the city's housing supply, making it harder for even middle-class people to afford homes. Local nonprofits that serve the poor are gradually being displaced to Oakland, and families are winding up on the street.

"We've lost 400 beds since 2007," Jackie Jenks, executive director of the Tenderloin nonprofit Hospitality House, explains. "And in the Tenderloin we've been noticing more encampments, more people sleeping [outside], and more families. It's gotten so that our staff can't afford to live here."

In response, the city is revamping its homeless outreach program, albeit with a change in focus: "street medicine" for the sickest of the sick, rather than permanent lodging for those who can handle it. With affordable real estate in short supply, getting the homeless into homes has become less of a priority. The new goal is to keep people out of emergency rooms and manage their chronic conditions — skin infections, liver disease, diabetes — all of which get exacerbated by the urban environment.

That's certainly noble, and apparently the same gambit has worked in other cities. Still, it suggests that San Francisco is so resigned to its housing scarcity that it's resorted to a kind of wartime triage. If the city can't solve the fundamental problem of homelessness, it'll just try to keep people alive and breathing.

"No one is losing sight of the fact that housing is the final answer to this issue," says Supervisor Mark Farrell, who persuaded the Board of Supervisors to allocate nearly $1.4 million in supplemental funds to the homeless outreach team earlier this year, which induced Mayor Ed Lee to add $3 million to the program's annual budget. (It's now about $10.6 million). But, Farrell cautions, until the city can afford to house everybody, "we need to address those who are dying on the streets."

Tackling the homeless problem has been both an ongoing social experiment and a political wedge issue in San Francisco for decades. In 2002, voters passed Gavin Newsom's controversial Care Not Cash ballot initiative, which reduced General Assistance checks but ramped up other services. Care Not Cash begat the original homeless outreach team, which was overseen by a Mission-based nonprofit called Community Awareness & Treatment Services (CATS).

In its later years, CATS was often criticized for poor management and a lack of resources, and according to the organization's union representative, Jane Bosio, it often had to operate at the whims of supervisors. (If a politico complained about encampments in his district, the staff had to drop everything else and go sort it out, she says.)

This year, the city's Department of Public Health tried to rectify those problems by hiring a new, Long Beach-based contractor and a team of medical personnel. CATS will be out by November, as will about half of the outreach team's original employees, including Chambliss. In the meantime, the outreach team has had to scale back services and not take on any new homeless clients. The Department of Public Health assures that when the program comes back, it will be more robust and more efficient. Until then, the city's indigent will flood neighborhood drop-in centers and take up more space on Market Street.

Granted, they might still be sitting on the corner even after the new program is implemented.

The last homeless count, in 2013, found 6,436 people in need of shelter. And according to the outreach team's interim Executive Director Maria X. Martinez, the city only has about 311 "stabilization rooms" (temporary dwellings) to serve them. Many of those rooms are already occupied by folks who the team is case-managing, Martinez adds. The Department of Public Health has $2.6 million in its budget for temporary beds next year, but that's only enough to hold people in the shelter system while they wait for housing that doesn't exist, Bosio says.

So instead of shepherding clients into homes, Martinez's staff is often stuck depositing them in detox centers or in San Francisco General Hospital. Much of the outreach team's energy goes toward managing the "Million Dollar Murrays" — people with mental illness, substance abuse problems, and a slew of chronic conditions — who can individually cost up to $100,000 a year.

Yet even the more able-bodied homeless are in dire need of care.

"These are folks who are exposed to the elements for long periods of time," Albertson explains. "They don't have access to clean water or bathing facilities." Their symptoms, he adds, are most consistent with survivors of a hurricane, earthquake, or forest fire.

Absent long-term shelters, Albertson's best recourse is to provide socks, water, and medicine, and help homeless people manage their diabetes or hepatitis C.

Veteran physician Barry Zevin, who will head up the street-medicine program, says he's hopeful it will get people into ongoing health care and ultimately save their lives. He does, however, find San Francisco's homeless problem deeply dispiriting.

"The situation for many homeless people that I see isn't that different than it was in 1991," he says, adding that in 1991, policymakers thought that widespread homelessness — both in San Francisco and nationally — was an "emergency" they could somehow contain.

"I'm saddened that we're here in 2014," Zevin says, "and I'm still doing the same thing I was doing 23 years ago."

Even if the city is funneling more money into outreach, the new order isn't without problems.

Bosio, who has emerged as an outspoken critic of the revamped rogram, says she has no objection to street medicine per se — she praises Zevin, and predicts that SFHOT can do the same work in its new iteration, given that housing won't magically materialize, anyway.

What does rankle her, though, is the city's replacing a community nonprofit with a long-distance, nonunion contractor that won't actually run day-to-day operations: The Department of Public Health will oversee the program, though outreach workers won't receive Department of Public Health wages or benefits. She's also piqued that most of the people who got laid off during the transition were lower-rung workers who'd once been homeless themselves; Bosio fears they'll be replaced by well-intentioned outsiders with four-year degrees ­— people who, she believes, won't have the same understanding of what it means to be homeless. That might suit the program's new mission, but it veers away from the original goal of employing people might not have other job opportunities.

And layoffs, justified or not, leave the city with another out-of-work population whose members can't afford to live here. "I don't think the 'shift' is the problem," Bosio says. "To my mind, it's the city's ... complete disrespect for people who've been there a long time and done all this work."

Chambliss was a casualty of the outreach team's transition. And, like many of his former clients, he's a victim of the city's housing crunch, currently living with his daughter in the East Bay city of Antioch.

But Chambliss doesn't see himself teetering on the edge of homelessness anymore. He's optimistic that CATS will rehire him at a decreased wage, perhaps $5 or $6 less an hour, and barring that, he's sent résumés to every public health agency with job openings.

Anything to stay off the street.


About The Author

Rachel Swan

Rachel Swan

Rachel Swan was a staff writer at SF Weekly from 2013 to 2015. In previous lives she was a music editor, IP hack, and tutor of Cal athletes.

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