of these to urgent visits, we do primary care referral. we to screen for clients and we do testing for staff. we are at the largest shelters. you can see on slide where we're located. can you hear me? we have a homeless family team. we conduct three urgent care clinics at hamilton family emergency shelter. we serve both the emergency shelter and a six-month rooms. we also do health education for children groups. i also provide daily consultations for shelter staff, case management on client at health and safety issues. we do a weekly clinic and covers connecting point, which is also

basically an urgent care clinic. as public health nurse, i am and medical adviser for the homeless family consortium to prioritize the families on the priority list for shelter rooms. hours shelter health and wellness program consists of dr. bourne, myself, and a registered dietitian with a couple of nursing students here and there. i also provide consultation on a daily basis to all the shelters on client and environmental health and safety issues. we do policy recommendations, staff training, provide materials. we are working on the emergency response is, hygiene and in the station, and primary care referral is a big part of our job. supervisor kim: it would be helpful if you share the microphone because we have to

transfer back and forth. >> thank you. we are done, actually. we do consultations with the department of public health service's that actually are helping consoles themselves. we translate this between other shelters and design programs. we do what is called a critical incident that review. it has been an extremely successful program. we designed about five years ago. we do, support and medical review for deaths in shelters. we make policy reviews and changes, and it has led to less debt spend better outcomes. we have quarterly screenings. we do flu, tb, and tetanus vaccines, and we collaborate, as i said. the dietitian program has been a very successful program. it was the number one complaint area through the shelter committee, and through the city

posed a public health nutrition as, a dietitian. she has made a huge difference both in assessing the status of the food, how it is handled, how it is translated into real life so that human beings are able to eat more nutritious meals. a little background, this is one of the questions you have posed to us, and i wanted to go over some statistics we do know about the health and wellness of folks in seven cisco that experiencing homelessness. we know that 75% have a chronic illness, either medical or behavioral health issue. from the 2009 count, we have some idea, and there are some statistics there. right now, -- this is also from the 2011 account. scott had mentioned the vulnerability index. we have been doing some research looking act that -- looking at that. we have been working with common grounds to see if our medical system can pull up the data

automatically so we can look at a best practice so we do not actually have to ask the client. it brings to us some information on illnesses. the average u.s. homeless statistics and the general u.s. population. you can see the illnesses. the ones that are highlighted are specifically asked because they are correlated with a higher risk of death. dry morbidity includes things like lung disease, heart disease, hypertension, but they are coordinated. you have a medical illness, substance-abuse illness, or mental health together, so you can see that in san francisco, a little less than 7% of the clients that are experiencing homelessness have had hiv, which is much higher than the general

homeless population in the nation. we are looking at ways to look at this data. there's also the high usage of multiple systems. i do not have the data now, but we are looking at close to 90% of our homeless or have been. really briefly, and this is -- site for the complicated side, but the geriatric model care looks at the person's functioning and what their needs are and trying to get an individual down to the lowest level of care that they would need. in the green is what any human being needs to survive and function, which is necessities of daily living, which is access to shelter, food, nutrition, hygiene. in our system, the people experiencing less this assistance, we are going to have primary care homes. this is looking at different levels of need and where people access services. in general, we know, from what

we were just saying, that our clients are very ill, and the services are not geared to their levels of need. our clients are chronically ill. they are elderly. they have functional impairment that joanna was just speaking about and disabilities. there are critical needs. our clients have a lot of cognitive impairment and trauma. i personally feel probably not one of the number one issues affecting our clients' past or present at that their ability to function in the system, and there is a gap between the level of services that we are able to supply at the shelter, given the best care and the level in the that our clients have. daily activity living, the ability to shower, they've come up and to take care of themselves. there's one issue with families,

looking at the purity of services, of what we have an offer for families, and looking at access to beds, developing of a respite care system, and there are some best practices there that i wanted to highlight that we are looking at. in dph, we are looking at initiatives expanding any project, homeless connect, prioritizing domestic violence in shelters, reviewing other practices which we are talking about now, and strengthening the relationship. we have already been proven to ourselves that affects our outcomes. briefly, what is working with other cities, and i think we are really lucky in san francisco to be at the forefront of a lot. we work with the national health care for the homeless, and we are one of the only cities to have a standard of care legislation. but what we do not have the other cities have is a more public health planning model. in new york, it is altogether, looking at integrating homeless services in places like seattle

with the public health department has authority to set standards and monitor in the shelter not based on legislation, but on current best practice. other centers using the ditch and resources and correlating that what needs the clients have for activities of daily living. other things that other cities have, new york city has a large overdose prevention program in the shelter system decreasing death. home-based support. when someone has an in-home support need, if you had a home, the in-home support person could come to you and take care of you. we are really looking at being able to increase those services in the shelters. we talked about shelter staff and supporting them to be at the highest level that they can be in order to support a growing population of sicker folks.

a closer link between primary care systems and the shelters -- some locations have a really close link so that there is almost no gap in getting people into primary care from the hon. we still could do better. having regular transportation -- it is not cost effective for the health plans to have missed appointments. some centers are leveraging dollars to actually do that. coordinating discharge plans. our programs where they have a system as clients along, and there are some practices out there. as always, collaboration and monitoring. the yen. supervisor kim: -- the end. supervisor kim: thank you. i did have some follow questions, but for the sake of time, i wanted to give the chance for community books to

speak as well. i really do appreciate the services that the client provides to our city. i think they are vitally important and much appreciated. thank you. i wanted to bring up jenny from coalition on homelessness or our first community presentation. i'm not sure if you want to combine your presentation together. we have all or questions, we will ask them. that my great. thank you for having this hearing. i wanted to thank all the people who have been working so hard to try to address the housing crisis that thousands of san franciscans are facing. i did not know if we can do this in a way where both the audience can see or not -- maybe go sideways that way or something.

i wanted to walk people through the distances that folks travel in order to get access to shelters in san francisco. i am talking about the resourced center process. for individuals on public assistance, they have a different system. shelters are available on demand. they have to show what the first night, but then, their reservation is basically there until their monthly apartment. at which time the worker, if they are not using it, has the discretion to stop the bed but is it generally until they get housing. could be nine months. could be less or longer. could be -- but that is a different system. we're going to start off with glide memorial. they are at the top there on ellis street and taylor. someone probably order to get a bed, trying to get a 90-day event, would get there the night

before or sometimes as early as 3:00 a.m. and they would wait there until the reservation opens at 7:00. they will probably get move because of street cleaning that happens, the sidewalk leading. glide is working hard to try to address that so there's not so much jostling. most of the resource centers have tried different things to address the situation but are really limited by the existing system. the person with travel, and let's say at 7:00 a.m., they do not get a reservation. they will travel to msc south, which is almost a mile walk. they'll get there and wait until about 11:00. remember, they will have their belongings with the most likely. there's a more than likely chance they have some kind of disability. they made the elderly. when they get to south, they will be waiting until 11:00 to get a wristband, which was a system it developed. before, people were not eating

all they because they were waiting in line all day, so they developed the wristband system. once they get a wristband, they will leave. they are not allowed to stay. they will leave and go a mile back up for a meal, and that will probably be the only meal of their day. at that point, -- because of the system and so much time they are spending in line. at that point, after eating, they will head back another mile, walking again with their belongings. when they get there, they will be waiting until 5:00 when they start looking back -- looking at the possibility of a one-night that. they may be there as late as the clock, which is really quite common. trying to see if they can get a one-night bed. if they are lucky and they get a one-night bed, then they are spending the night there. the next morning, they will have to wake up again really early, maybe get a few hours of sleep, get to a resource center.

this individual says there will give another one a try. they will travel about half a mile to 16th and cap. when they get there, again, 3:00 a.m., waited till about 7:00 a.m., but they are one of the first in line. let's say they are not the first, which is more than likely the case, they will then leave. again, they have their belongings with them, go through that thing at 11:00, try to get a one-night bed that night. but say they do and it is in the bayview. they will be traveling at that point a few miles. 3.5 miles because they do not have transportation to providence to spend the night. again, perhaps waking up early in the morning to try to get a shelter bed the next night. the point is that you are spending a whole lot of time trying to get shelter. it means that is all they are

doing, and they are trapped in a cycle of homelessness as a result. i will turn it over to lj, who will walk us through a slide show. she is on the board of the coalition for homelessness. [applause] >> ok. i want to thank you, supervisors, for hearing us today and allowing us to make this presentation to you. i am also grateful that the department heads are here as well giving their input. this slide show is based on out reach that we have done to the

different sites. we will get it going right now. not getting it. can we get back to the first slide. ok. all right. ok.

life on the streets -- human beings are not meant to live on the streets. they are is up for help because of exposure to infection, the elements, and to violence. supervisor kim: if you do not mind standing closer to the microphone. >> sure. this is out reach we did at the light theglide. we got there at 3:00 in the morning and found many people sleeping there along the side. according to the city's last homeless count, 53% of homeless people were experiencing homelessness for the first time. in the last homeless count, more than half, 55%, reported a disability. this is just to show you an example of just how many people are sleeping on the sidewalks

because they are either choosing not to do the runaround that jenny just described -- a lot of them are seniors, disabled in wheelchairs, and the preference would be to sleep outside a reservation site, so the they will hopefully be one of the first few people to get a reservation. this is actually what is happening. this is 3:08 in the morning. this is what we saw. again, the line goes up and down. living outside complicates efforts to treat injuries and illnesses. these outcomes are disastrous. homeless people suffer preventable illnesses at three to six times the rates

experienced by others. this is just one example of the health impact of what you just saw with people sleeping outside. again, they are choosing that because, typically, there are just one-night beds available. instead of going through the tedious process, it is easier to sleep out front and the first in line. here is an elderly gentleman asleep. he is in his wheelchair. when he woke up, when i spoke jim, his exact words were, "how can i wheelchair myself from site to site? i might as well stay here." and to results in a dramatically lower life expectancy by an average of 30 years. glide at 4:22 a.m. -- there's more people there. four-o'clock 17, i spoke with this woman. she got there at 4:10 hoping to be the first person in line.

she actually was willing to have an interview with us. what i have to do now is just switch to that video. [applause] i might need some help. supervisor kim: could summon help? but it might be helpful if someone could just stand with her. so she could just focus on the presentation. >> are we rolling? i am from the coalition on homelessness. [inaudible] four-o'clock 30 in the morning. i got here at 3:00. there were approximately 20 people asleep all along the side. the first woman or the first person who was a woman to get

here to be in line for a that reservation got here at 4:10 in the morning, and she is willing to talk to us and let everybody know that people really have to get out here this early in the morning to get a bed. this is all -- it is not on. these are the streets with it on march 29. supervisor kim: if he could speak in the microphone. we are also broadcasting this on tv. >> you got it. this is the coalition on

homelessness street outreach we did on march 29, 2012, where we interviewed this woman. >> [inaudible] >> i have been coming up here probably about five months now, but i have been here before. but all the people here are good people. the staff is good, the food is good. the service is good. it is just about how you are getting into the system to get a bed. you have to get extra early in the morning to stand in this line, and sometimes, you are not guaranteed a dead. sometimes if you go to other shelters, they do not want to accept you, or you are not qualified. your age or your sexuality -- there's a lot of discrimination about getting into these

shelters. i go over the to the women's shelters -- you have to sit in the chair 24 hours a day unless you have a family. if you have a family, you get room. if you do not, use it in the chair. i have chronic back pain. i have ptsd. i'm hungry, homeless. i need all this damn hell, and i cannot get it. motels and hotels strategy you up for all this money for weekly. if they do, they want to take your whole ssi fucking check. >> i want to get back to the reservation system. tell us what time it is? >> for cluster seven, something like that. sometimes, and try to get here at 6:00.

i will go to the church. they take everybody out at 6:15 because they give the kids practice, and then you leave, and you are not welcome back until 6:00 p.m., but the latest you can go is 9:00. that church is discriminating against the shelters because they do not want the shelter people living at the church, so that is why they have to move. what are people going to do on the first? they might have money. they cannot afford a room. it is the best place to go. it is quiet. they feed you good food. they have good people there. the churches are discriminating against shelters. somebody has got to do something because of they do not, it will be have it out here. robbery, stealing, more drugs, more people living in front of properties and businesses, and

the police come and pick you up. if you do not open the door, what are we going to do? we're not going to stay in the street and get ran the fuck over. i ain't. that is the best i can do for you. >> thank you very much. >> as you can see, raw, unedited footage that we took. >> ok. she goes on to talk about the token issue.

>> i know they give us beds at the we have to wait two or three hours later, but the problem is they send us to these places, but we are homeless. how are we going to get there? they do not give as tokens, so when we get on the bus, we get a ticket. i just got a ticket going to a shelter yesterday. i had to take it to the place on van ness, and i still have the ticket in my pocket. they talk about it is 100- something dollars. how in the hell am i going to pay that? they need to come up with a plan. help us out. i know we cannot drive to go over there. if you get on there and jump on them enough to get to a shelter, you get a ticket. if you get on the bus and you get off and the police are awaiting their, you get a dam ticket. come up with some type of

solution. [applause] get us there. get bids for us. get all these cards they have sitting in these lots that ain't doing shit. put some gas in these motherfuckers. supervisor kim: thank you. do you have more? i just want to get to public comment because we are getting close to 3:00. >> i have one more. i want to go back to this. >> i know richard is part of this presentation as well. >> these are pictures of msc

drop-in, the reservation site. we got there at 6:00 p.m.. there were 25 people waiting with their wristbands to see if they had gotten a bed, standing outside, not allowed in. 6:30, there were 40 people standing outside. again, wristbands, not allowed to get in, waiting to see if they got a bed. this is the shelter line at 6:30 p.m.. there's 37 people told. this is the line you have to stand in, even when you have a reservation, just to be let in. they are just waiting to be let in. as you can see, for seniors, disabled, standing in these lines is a hardship. getting away from a line-based system would dramatically improve the shelter system. over 1/3 of shelter beds are set

aside for homeless cap recipients. you have heard this information on multiple occasions, but it is important to repeat. however, they make up only 7% of the homeless population. and they get to keep the beds even if they do not use them. the unused beds are released one night at a time. this creates an undue burden on people with disabilities. this is just the last video that i have for you. >> good morning, sir. what is your name? >> gary allen. >> where are we right now? >> in front of the mission neighborhood resource center. >> what time did you get here? >> 6:00. >> 6:00 in the morning. why did you get here at 6:00 when they do not open