points -- it was not clear how they provide transportation to the shelters that are throughout the city, so that is also follow-up that we are continuing to do. supervisor kim: every place provides information about where the shelters are and usually includes public transportation. there were no instances of a single reservation by phone systems. another system used to the counter for alliance, including album be the county. what they're doing is providing where the shelters are located. this does go so far as to check in with to has openings but they are referring to the site to see if they get in.

this is related to the fact that people go to the shelter and get on a waiting list for a specific program. new york city uses the intake points. seattle uses -- >> the question was specifically is there a program and others that we would want to have a broad overview. are there programs that we have not implemented that we may want to? >> seattle uses a vulnerability index. they assess every client and then they determine housing placement based on how these are assessed. this is targeted that way just a way that new york does. this matches clients to the individual shelter programs.

>> thank you. >> i'm curious as to what percentage are released. >> on average of three-12th are released at 4:30. then, on an average of 15-25 are released after 8:00 p.m. if they don't need curfew. >> thank you. i want to follow up with the shelter monitoring committee. if o>> how many are turned awaya

nightly basis? >> this committee is actually in the midst of conducting their first turn away count, that was the information that i was going to present. i can't give you some rough numbers based on the last three counts. the count conducted in 2008 and in 2009, we went to three different changes and reservation locations and 290 individuals were seeking shelter and 93 were provided shelter which means that on an average 32% of clients were provided the shelter

reservation. what this does not include it is whether there was reservations available and the client turned them down. fowe changed the methodology. if we started tracking turn away preference.

the majority of the times these units were at providence. based on that issue, clients did not want to go to that because they had transportation. last year, we were wondering whether this was a shelter bed or a token. last year, of the 303 clients seeking shelter, 103 were provided a reservation. >> what is that the percentage? >> less than 50%.

>> the question that was sent to answer what are the health needs of shelter clients, what are the city's plans in providing services to shelter clients. this is in the wave of the implementation of the patient protection. the ph is in a number of the shelters and providing the health services, primary care services, and public health- related services. i will turn it to -- who actually oversees some of the shelter care as well as -- who is the public health nurse.

>> to answer the questions, i will briefly review -- >> do you have any paper as well? we usually get something that we can follow as a committee. please proceed as we work out office.

if you don't have this available -- i can move to other presentations if we need more time. >> no, i have this as a power point. >> why don't we give you more time. i will ask a representative from the mayor's office of disability to come up. >> good afternoon. >> i'm not sure if that is on.

we have had discussions in the ticket about what individuals -- we had discussions about what individuals with disabilities face. >> we're working with many clients in the office. we have begun to view the access to the homeless shelters within the context of the disability rate and the access issues. in the last few years, we have

seen that increasing number of people with disabilities. those are both physical disabilities as well as the chronic health conditions, condition and parents that result from advanced age. veterans returning home with increased health and mental health needs. so, the issues that we see fall within two categories. first of all, structural access. while the three largest shelters in the city's portfolio are generally the most physically accessible, they tend to present the greatest challenge for people with cognitive and psychiatric disabilities. when we talk about the homeless shelter population, we are talking about 80% of people who qualify as having some disability or a combination of that.

the shelters tend to be crowded. there is a long list of rules. historically, some of the biggest challenges are to our clients with mental-health this would allow people to have a choice. within the infrastructure, this is aging. elevators, accessibility features for must be maintained and so right now we are facing a crunch in the system, even for those existing shelters.

in addition to have to be helped going up and down stairs by help with staff and residents. we have made vast improvements with a basic understanding as it relates to staff and other residents. some of the continuing challenges are, first of all the ever changing staff because they

actually do challenging work. and the transition out of the field. this rotates through various shelters. that in combination with the higher need of residence makes a difficult environment and oftentimes it difficult interaction or conflict between the staff and the residence. one of the other issues we are experiencing is the difficulty with understanding and implementing communication access requirements. we need to have this requirement and the cost to have these interpreters for our clients to

are death or hard of hearing, real-time captioning, trained staff that would be able to communicate with folks with cognitive or mental health disabilities in a way that would make a case management. also, the reservation process. we have been hearing complaints with people who have serious mental health conditions, physical impairments. we hear that the reservation progress is long and process. this would prevent a serious disadvantage to securing a long term stay in a shelter.

furthermore, some of them must travel a large distance. the other issues we're finding is the lack of the history of the established accommodation. that does not seem to be following people from shelter to shelter because of the factors that basically limit the person with a disability to obtain affordable, accessible safe housing. some we have people have been in the guard wasystem for a while.

this does not follow the individual. in the next day, they have to go over again and start with the reasonable accommodation request. finally, one of the issues that we faced all the time in our office of actually trying to help with some type this the shortage of the accurate and appropriate case management services that specifically address the needs that we are talking about. we're not talking about basic case management services that really case management services tailored to address higher levels of needs, whether that is mental health issues some of the case managers, whenever they are available, they are not aware of the community resources that would be most beneficial to address to the clients.

in conclusion, we actually feel that that this is supposed to be a temporary situation while everyone gets access to affordable housing. this is not exactly what happens. in the case of the people with disabilities, whether they are visible, indivisible, this is not a very safe process. this is not enough to allow the opportunity to allow easy rentals. as long as there is a need for emergency shelters, it should be a vast investment on behalf of the city both in terms of the building stock, of improving our actual infrastructure and in terms of improving the overall

process for getting the shelter. >> i want to address one of the last point you brought out. you had mentioned -- not being enough for many of our lowest income individuals or disabled or seniors. we don't give a preference because that is a lot of money that they get that should be enough for them to find regular housing. can you responded to that statement? >> the average is about $800. compared to the general assistance fund is a lot of money but $800 to try to find housing in the city of san francisco is also a very difficult amount of money.

even if people are able to access housing where they will pay 50% of their income, they are not eligible for food stamps. they have to manage prescriptions, copays, food, rent. >> do you feel that we have been adequately addressing these issues in our shelter system? >> we could be making great progress. we have been working on this but there is more to be done. the population is changing. the amount of time that it takes a better is to get access to their benefits is really long.

asked a lot of these people end up in the streets. also we have had a lot in our social support systems and their is -- many people were coming out of the hospitals with really high medical needs and they are not able to be appropriately in a place to recover. so, we have been putting a lot more pressure on an already factored system. >> what percentage of our homeless people have disabilities. >> we tried to do a steady between the shelter residents

and the change of systems, we found a correlation of 40%-50%. this is a vague estimate. we're looking at the number of the people on the streets, we seem to see more people with obvious disabilities and a lot has to do with the downturn of the economy. we would like to throw around the number of about 8%. >> you said roughly 80% is from what you have seen. >> i would like to thank you for the work that you are being done and i think a lot of progress has been made out on this board.

one question that i have. i am wondering if you can talk about the homeless shelter and how this system works. how does this system work. you are trying to go to a shelter, how does this system deal with that individual? >> for our adults, we have already mentioned the changing in the reservation system. we switched to a system where if a client went to any of these sites, this system allows that sight to see any vacancy available in the system at the time that the client is asking. so, this is a way of creating a one-stop process rather than having clients having to go to each shelter site to

participate. the clients to do that. the way the system works in practicality is that at 7:00 a.m. when the system begins each day, any reservations become available if the resource center bed it is identified. those are available for 90 day reservations. beds that already have a reservation that will not be used that they are available for a one day reservation. these are available first thing in the morning and they are taken up by the first people at the reservation sites often during the daytime hours. it is in the afternoon, there might be none available. only at 4:30 when they began to drop and each curfew hour which varies at 7:00 come 8:00, and 10:00 p.m.. or as time passes and clients

don't show up, they are made available through this system for a one night or a long-term reservation. >> in terms of how the system treats the adult population, is there a difference in terms of the treatment that is given, say if someone is participating in be at assistance program. is there a difference in terms of how they deal with that and how they are participating? >> the reservation is twofold. they go to the resource center for -- clients, the others go to the county welfare office. our shelter system is consistent across the board depending on the shelter you are in in terms of the dial of the services within that shelter and each individual must abide by this, whether you are -- the only difference is that the

shelters release the beds for the -- clients at the shelter, the county welfare offices releases the beds for -- >> for those that are watching, can you explain what this is? >> this is the county adult assistance program and this is part of our program for those individuals who get a shelter bed instead of a county grant. >> are the individuals who are involved and those who are not, are they vying for the same beds, the same number? is there a different way in which that is allocated? >> it is a different number of beds. earlier when i spoke, there are several hundred resource center beds that are controlled by the

resource center. 490 are controlled by the cap program. they are released for one night stays. the differences that the client only has their bed between 30 and 40 days until they go back to the county for recertification whereas a -- client can keep that dead for 90 days with an additional 30 days. >> i know there is a community presentation coming up and so maybe we can go to that and i will follow up on this question but one of the questions that have from us so that there are no surprises, is trying to understand how we got to this point and what the rationale for that is. my understanding is that if you look at the homeless population, about 7% of that population are basically people who are

enrolled in -- >> that's correct. >> about 33% are set aside for that population. maybe those numbers are wrong. that is something i would like to explore once we hear from the community. >> sure. >> thank you. >> i will be holding off my questions until after public comment.

>> we met when i was still the medical director. nice to see you. i'm currently overseeing the shelter house and community- based programs for the department. i'm going to go over that there are about five areas and public health services and one is through the community services through contract in, through the shelter monitoring committee, where we do our urgent care and podiatry services.

we also have the shelter wellness program that will go into more detail and there is an emergency response system and a team that has the shelters and disaster report. the health services has a woman's drop-in shelter. the monitoring committee is host it through the public health. they can go into more details. these of the standard care violations. we have the house