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tv   [untitled]    May 5, 2014 10:30pm-11:01pm PDT

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you a table that is like that. and >> but, mission creek, the cost to build could be... >> well, that is the cost, yeah, yeah, so i am not talking about the cost. >> but i am, and we are not doing our job if we are not talking about capitol costs that is why. we need to. >> and i am specifically asking you to overlay the capitol costs in every one of these projects in order to look at this. >> and order, the mayor's office on housing sxim sure that they have it at their fingertips. >> we can work on it. >> okay. >> but i want to make the point that i think that we are going to be strategic about this, it has to be step one of the equation. >> absolutely. you are right. >> so, we looked at the before and after, of the level of care, and you know, you wanted to talk more about money and now i am bringing in the slides that is actually about the human picture. >> and. >> which is great, and this is
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such an important part of it as well. and it is my ending slide and so i was ending on that note. and being ahead of a cohort of 683 people living with hiv, who were homeless, and we don't know what happened to them, other than that 73 of them entered the direct access to housing and 610 did not and my guess, and then it might have found our housing and might still be homeless, and if you look at the line up on top, and that is the mortality rate for those that moved into the direct access to housing, and if you look at the other line, and the staircase going down, that is the mortality rate for those that did not go into the direct access to housing. >> stark difference. >> yeah. >> okay. >> so, we will make sure that you get more information in terms of the actual cost and
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are there any other questions that i can answer? >> colleagues any questions? >> no. >> thank you so much for all of your hard work on this. >> and so, last, we have well, steven, i believe is coming from supportive housing and your colleague as well, i believe. >> okay. >> and char on. thank you for being here and we have not had a chance to meet, but thanks for being here. >> thanks for asking us to be here, i am with the corporation for supportive housing and i work on the state and local policy. and so, i think that steven is going to bring up the next slide. okay, there they are. csh is a national non-profit, it has been around for 22 years, and we promote housing as a platform to improve the lives of vulnerable individuals. to maximize these of public
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resources, and to build strong healthy communities. we do this through our 4 lines of business. and so i am just going to launch into our presentation again, thank you very much for inviting us here today. and i am going to be talking about research regarding cost effective strategies, around homelessness, and first of all, just to mention that housing is the most basic determinant of anybody's well-being and without it, the people cannot access hygiene sources, of food and nutrition food and they can't store medication and they can't find places to sleep. and they are frequently incarcerated much more often than others who are housed. for that reason, homelessness is very expensive as you have been hearing this morning and some of the great studies that confirm this. and the first major study
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proving that homelessness is expensive to our public systems, match the data of the supporting residents in new york to county, records on the cost of those individuals, both before and after they became residents of supportive housing. and this study revealed homelessness costs 40,000 dollars per year and shelter hospital and incarceration costs and later studies, due to reveal the cost of homelessness, and as he mentioned the economic roundtable report and that looked at 10,000 recipients who are homeless and looked at county data and compared that to 1,000 people who are living formally resipants who are homeless and living in
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supportive housing. and the roundtable, researchers found that homeless gr recipients encouraged an average of $2897 per month, and county costs whereas formally homeless individuals, living in support of housing, encourages $605, in costs. and other studies since then, documented all for the supportive housing, and go to the next slide, thanks. >> homeless people were serious with the illness remain stablely housed and get healthy when connected to housing, people with hiv who remain homeless have strikingly shorter life spans than people living in supportive housing and the people living in supportive housing significantly decrease their hospital intake patient days and their jail days. and residents of supportive housing decrease state medicaid expenditures including nursing home expenditures and savings
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of almost $9,000 per year, after taking into consideration the cost of this housing program. and you were asking, supervisor farrell about the cost of capitol. it does include it. >> was that ground up or readapted use of existing buildings. >> i am not sure, and sorry i can't answer that question, i am not sure what the combination of costs were. the one thing to keep in mind that when you do fund capitol expenditures you are loeg the cost of operating the building, so there is over time, those costs are usually, and it is actually usually less expensive to build a new building than it is, to master lease, and provide operating subsidies for that building, over time. i understand, and i understand that it is a balancing act and over time, it is what amount of time, >> right. >> and the opinion, if you say
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fabulous and ten years and 75 years. >> right. >> you will have to do more research. >> i am not aware of any research out there right now. >> probably, the most, celebrated study was one that was published in the journal of american medical association, and using a randomized control group that compared the cost of housing and the use of public services among the supportive housing residents. and this study, found cost among the supportive residents was $2449 per month less than the cost of healthcare detox and incarceration and emergency medical services among the control group who remained chronically homeless. and research has also allowed us to piece together what it takes to end homelessness as well as house public systems can achieve the greatest cost of effectiveness. so thank you. >> and so we know from the research, that the most people
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experiencing homelessness are homelessness for a short periods and fall into it simply because they cannot afford the housing on their income. and it is important to remember that these individuals and families, do not need support of housing, but they need short and medium term assistance to break down the barriers to allow them to access housing such as the security departments, and back utility payments. and, in many communities, like san francisco, they also need a permanently affordable place to live. but they do not need the intensive prolonged services that usually come with the supportive housing. >> do you find that across, and i find that interesting. >> do you find that across all jurisdictions as well? >> yes. >> to the truth, almost? >> yes, it was actually a recent study of rapid rehousing programs which is this model that i just described and that joyce mentioned, and in 14 communities across the country,
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they were very diverse communities and they found out that rapid rehousing program, that generally, they cost about 4,000 in just, these short term solutions if they can connect that person to an affordable place to live and the individual will remain, safely housed for at least a year, and there are more studies being done to see if those individuals and families remained housed beyond that. >> okay. thanks. >> you are welcome. >> others who are homeless, and those who have the severe barriers to housing stability need more than an affordable place to live. thank you. >> and it is this population about 20 to 26 percent, of homeless people in california, that encouraged the highest cost for the public systems. and the economic roundtable study and i mentioned it earlier revealed a minority of homeless people, acquired disproportionate county costs and that study, ten percent of
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the homeless gr recipients, studied incur the costs of over 6,000 to 8,000 dollars per month. and 2 thirds of those costs ran the healthcare system. and we will know from the trends in the healthcare spending that some homeless people are going to be more expensive after the implementation of the affordable care act, than others. and even though many of these people are now eligible for medical, and medical will not reimburse for an inpatient stay that is longer than medically necessary and so we know people who are frequent user of emergency rooms, are often homeless, and more than half are homeless. and they are often, they are also associated with high end patient frequency. and the people who are chronically homeless, samely
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stay housed longer than those who are housed and with the same conditions and the same severity. so, because an inpatient stay under medical cannot be reimbursed if it is longer than medically necessary, this means potentially losing a patient who is in-patient stay can be paid by medical or other insurance, to a person who is homeless. hospital staff keep on those patients longer we know that for research. staff generally know that a homeless patient once they are released cannot recover because they are on the streets, and for all of the reasons that i mentioned at the beginning of my presentation, we cannot get well. and in addition, to that, there has been tremendous negative around the hospital dumping and that has led to a lot of hospital staff keeping the patients longer who are homeless as well. because county hospitals care for a disproportion ate number
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of patients who are homeless and we think that this research and reality will have the significant bearing on the county budgets. >> finally, chronically homeless people are more likely to be readmitted to the hospital than the patients who are housed again for the simple fact that homeless people cannot get well on the streets. for readmissions under the affordable care act will simply impact the county budgets, again because county hospitals see a disproportionate number of homeless people. research has always revealing how to identify reach and house individuals, experiencing these severe barriers to housing stability. and we know that research shows that public systems recoup on average, a return on investment of over 2 dollars, for every dollar invested as you have heard already. and research is showing that
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identifying county residents according to high health cost by risk of hospital readmission and jail recidivism and a combination of these issues and out reaching and engaging these individuals where they are and assessing housing and services needs and targeted those in need of support of housing, for supportive housing, and have all about now evidence based practices, my colleagues, steven stum will talk more about how they are telling those models further and i look forward to any questions that you may have. >> colleagues any questions? >> okay. >> thank you for your presentation, much appreciated. >> >> good morning, supervisors and members of the public i'm steve shum and i am a senior
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program manager with csh and work out of the san francisco office and in addition of sharing our account of the recent research on the cost effectiveness for the supportive housing for the most vulnerable populations we wanted to spot light the social fund here in san francisco. and talk about how supportive housing, may be a viable alternative to the resolving door of crisis services for homeless men and women who are high cost frequent users of these same publicly funded services and so the social initiative is our national effort to replicate a model of housing that is linked to case management and care coordination services with access to integrated primary care, and deliver health services all targeted to high cost frequent users of crisis and health services for homeless. csh received the five year award for the national community service and the same
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federal agency that funds the americor program and granting a good chunk of the socialization funds to support the housing initiatives across the country, and this includes, san francisco, los angeles, washington, county, michigan and the state of connecticut. our strategy is to work with the local partners tho develop and refine this model of supportive housing, and two, build a solid base for residents and that supportive housing is the effective intervention for the high cost users and three, develop the blueprint for replication and bau we are confident that the csh evaluation will show that providing supportive housing will result in reduced healthcare costs and improve health out comes. >> and in san francisco, we are fortunate to partner with the tender loin development organization and direct access
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to housing program and two organizations with a vast amount of experience providing supportive housing. and here, in the community, they are providing affordable housing and an array of service and access to primary care and behavior health service to 172 formally homeless individuals, at the community, and the beautifully renovated ymca building at the corner of golden gate and levenworth. 50 of the tenants who moved into the building, were identified by the san francisco health plan as their highest cost utilizers for the homeless, and 122 were identified by dph, as medically fragile users. the on site housing and services team at the community, is a robust one, and it includes, property manager staff and social workers and case managers and on site, dph
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staff including a nurse, and lutheran social services money management staff. >> the on sight team is working closely to coordinate care for a population where 92 percent of the tenants have a chronic health condition and 87 have a mental health issue and 76 percent of attendant have a history of substance abuse and so they are working with the tenants to improve their health and well-being and quality of life and as she mentioned we have seen several studies over the years that have documented how access to supportive housing is improved out comes for vulnerable populations, resulting in reduced substance use, fewer visits to the emergency department shorter hospital stays, reductions in detox and psychiatric services
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and reduced costs. the social fund evaluation, aims to be the first study on supportive housing impact on healthcare utilization and healthcare cost and outcomes and some preliminary results from the csh fund initiative in los angeles, are pretty promising. for the 89 high cost frequent users of the public services are housed in supportive housing this cohort experienced an estimated public cost avoidance or reduction in public services of nearly 48,000 per person per year. according to the evaluation, the estimated annual cost of accessing public services when homeless was approximately 67,per individual per year, and compared with approximately 19,000 per individual, per year which housed in supporting housing. these early results from the los angeles are a hopeful find that improve the quality of
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care by stabilizing high cost frequent users in support of housing can reduce the costs and improve the health out comes. thank you for this opportunity, to speak with you folks today. thank you, very much. and for being here, steven. and colleagues any questions? >> supervisor avalos? >> just some comments. i really appreciate the work and the analysis and something that we you know, hear about you know, over and over again, and it is very politicalized and the people who are user or frequent users of the various systems who are homeless and it is clear that as a good body of evidence, that shows that providing the level of support helps, and now i am not sure if every homeless person is going to ned this level of support but i think that it actually gives us, you know, an indication, that either of those levels that we need to be providing, and we have to debate every year, and you know, dph, and hsa and what
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level of support do we want to include with our supportive housing and you know, we actually make the decisions at the very end of the budget process and we try to move a little bit of money, towards you know the great every support, for the people who are homeless, and i would like to be able to use some of this evidence, to say that you know, in all cases, you know, we are going to need to do that at that level of support and it actually has a great deal of effectiveness, and we see better out comes. so, i just want to thank you for showing this and i think that it is something that we need to be able to look at across and not just dph, but hsa as well. hsa is actually kind of where we see kind of the greatest difficulty in trying to make sure that we are not just from a funding, or, you know, beds, but actually we are funding supportive services, and to help people, and find the greater opportunities, and so the case management, and the employment, and you know, counseling, and things of that sort as well. so i appreciate it, the
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presentation, thank you. >> and i think that the important take away is that the supportive housing intervention when targeted to the most vulnerable folks and that is where you are seeing the most cost safe ands making sure that this intervention is targeted to the most vulnerable folks and i think that is definitely part of the equation as san francisco is looking at coordinated entry systems or some sort of coordinated accessment process as they are trying to match up the vunerbility of the homeless individuals and families with some kind of meaningful intervention that is going to have an impact on their lives. >> thank you very much. >> i also want to take this moment very quickly to introduce, a colleague of mine, and that is beth stoke.s and she is our new western region direct and her she has a long time roots here in san francisco and having worked and run, hampton family center and i just wanted to acknowledge her and thank you for this opportunity.
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>> thank you very much appreciated. >> okay, we are through our speaker list right now. so i am going to open this up to public comment. i have a number of speaker cars, if you want to get up in line, if you are not first up, line up. robert weber, robert chambers, ma lisa thompson, and joe wilson, and dan bowers, and adelman, and moniko. >> so those individuals come forward and come on up to the podium and everyone has two minutes to speak. sir if you want to come up. >> i'm robert khamers and a participant in hospitality house and also the client of other services in the
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neighborhood nearby. and i was aformally homeless and in the end of 2011 and i was successful in having the table housing now, and through, the help of and in san francisco who provide the help to the community and so my point of view is that san francisco is effective with i
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had to address the other parts of my life to improve those so that i could, or that i could like, basically socially and network, and get, to what ended up happening is that i got a roommate situation, and so, school, clothing pantries and everything, was important, and healthcare, and so i would say that the top quality of life, like, big businesses that are new, to the area, needed to address, and the lowest quality of life which is homelessness, and so the other, and as they get subsidized and get the incentives they need to be directed in all of those areas that san francisco has been using. >> thank you.
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>> next speaker. >> yes, my name is moses thompson and just correct about the evictions, and rather than wait until the individuals and families on the streets we need to provide preventive measure to homelessness, and providing the evictions of the resources like the legal representation >> hi, i'm julia, and i work with the hospitality house and born and raised in san francisco and i just want to thank you for calling this hearing and really showing that homelessness is a priority for san francisco. and but we can't really ignore and i am also glad to hear that there is so much support, that mental health services and drug rehabilitation are working and that they are saving us more than they are costing us both
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in tax payer money and human life and i do want to continue that forward thinking mentality as we continue to deal with homelessness, and because it is a multifaceted problem, and i think that you have mentioned that several times that we need to look at the short and the long run, providing legal representation for the people facing eviction and fixing some of the vacant problems under the housing authority, you know there are people on the streets and they are vacant in the housing authority and fixing those is a great to do it and we need to look at the long term problems. you can't address homelessness without also addressing affordable housing, the crisis that is going on right now. whether that is shelters or apartments and not enough housing for people with lower incomes. and so we can't stop there we need to file the financial independence for all san franciscan and so that comes down to providing jobs and job
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training and placement and say safety net when the people are without an income to keep them in the housing just to reiterate that we can't sweep them into the over crowded jails and hospitals and san francisco is booming right now and i think that we should take this time of prosperity and help out the citizens that need it the most. >> thank you. >> good afternoon budget and finance subcommittee, i am walter jones and i support the people who have problems, in housing, and currently, right, i am doing the whole program and an internship with organizing development and so i am coming to this meeting, right? and just listening to all of the things going on in san francisco with the big companies and things like that,
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and i guess, focus right now, is the cost effective strategies, like, for homeless, right? and so my points here is on the real important to me is i was having the money and just being in the ten dir loin housing clinic and the housing for ten years, and then participating as an community engagement organizer for the last six years under a spipend and those things have helped me i started april 4, 2004, that is when they started to carry that cash and luckily i got pushed into it and a shelter, which was a good thing in the beginning i was lucky enough to get in housing, so the thing that helped me mostly was getting involved with the community and i speak to you guys and the other part was just recently happen is by a lucky turn not going through a drug program or not being arrested or anything like that, i have got exposed
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to a trauma recovery, and point being, it made me aware of the culture that we live in, and the people that do live in the sro it is like a trauma culture and i want to push out listening to the different options that were here and $11,000 for a shelter and $4,000 for the housing, and so my thing is awareness and i guess, work as a resource for people that are homeless and educational awareness. >> thank you. >> good morning, members of the committee i am joe wilson with the hospitality house and apology for holding this hearing and in the spot light to some important issue i want to just suggest a couple of strategies, that could be effective, one, is expanding the long term operating subsidy program so that more families
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and individuals, can actually stay in permanent housing and i think that is good common sense proposal and we are having the vacant units and essential and i think that we are having the people on the street and the vacant units unoccupied makes no sense, and we are also grappling with the national picture and we have seen over the past 25 years of the dismentaling of the social net and we have seen a rapid build up in the complex and we have also seen a significant transition from the manufacturing base economy to a serve based economy and all of those have implications that the communities like ours are dealing with and so we can't thing that there is a magic bull. i want to highlight a piece of the report that looked at the expenditures that are allocated and one figure that did jump out is the fact that we