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 center. 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 care for the homeless, and we are one of the only cities to