and 13 percent is what we call lost, or the local operating subsidies and those are new programs to hsa and new in terms of the sro master lease. and ten percent of our units are family units and 90 percent are adults. >> this is not... >> this is a portion of what we have in the city. >> exactly. >> just to be clear. >> thank you. >> all right. >> so moving on to the cost for the shelter which is i think why we are here today, to look at the cost benefits and the effectiveness of homeless programs in san francisco as a city. and so the cost per shelter bed, for all of our shelters, the average cost per bed, night is $29, or an average of

$10,585 per year. so, then the next door shelter, which is the larger shelter, and it is 24 a night or $8760. the sanctuary *, $32 a night, $11680 and msc south, $29, $10,585 a year. but, if you take the family shelters, all of them which includes the emergency, and all is three. and the average cost per bed is $31 or $11,315 a year. >> could i ask you, has that stayed relatively constant? >> it has. we are just we are just releasing it for the single

adult in the families and they have two left and it has been constant over the last four or five years. >> thank you. >> not that, and inflation has not gone up or the cost of food and electricity and in the shelter, but that will have to deal with as we negotiate the contract. >> understood. >> understood. >> let's look at the cost of if you compare the two of housing. >> we are talking about supportive housing? >> the supportive housing and there are different types of housing n >> yes, exactly. >> and so, with this slide.

>> yes. >> it for supportive housing is $4,250. and these are general fund dollars. and massive lease, $8,600 or per year, $2,200. >> shelter plus care is our hud funded program, that we have to competitively, procure every year. in order to be eligible for the shelter plus care funded program you have to have a chronic homeless definition, which means three or four, episodes of homelessness in one year.

the operating costs includes, the master lease that includes, the operating the building and the utility and property management and the supportive costs are segregated and that is the case management and the support on site for the individual tenants of the family tenants. >> and scott, walton is the program manager. >> how do these two costs together will give us the over all yearly cost per unit. >> and you sum up. and this is the biggest example and and per unit is for the permanent supporting housing. >> and if you sum it up, yes. >> on the master lease, and that is basically equivalent to

the cost per shelter bed. >> yeah. >> and then, in some cases a little cheaper. >> and so that is surprising, at least from my perspective. and because, i think, well, again, we will get more into that, i think, and but, again, given what was talked about ten years ago, and again, not advocating for anything, and i think that it is an interesting statistic and what they say is that the permanent supportive housing is the thing that matters the most, i don't think that anybody disagreewise that. >> that number is fascinating >> yeah. >> so part of the hud priorities in which we try to align ourselves in san francisco, is. is permanent supportive housing and rapid rehousing. and need supporting next year

when we renew, we are able to ask for what is called the bonus, points and those generally are new housing units in the portfolio and so let's go on to the services that are provided in the permanent supportive housing. >> and i think that the bottom line, in the number one line, is the subsidized rent. >> with the providers is that he they actively engage the services with the clients and i think that the service providers are welcoming them to them and to provide a lots of referrals, and conflict resolution, and we put that in there because often, when, you

live and in supportive housing, there are conflicts, and especially if you are in a large building. and so, that, i think that our providers work very intensely with our clients to make sure that everyone feels safe and that their needs are being met and some of our sites we have the sites we have food pantries. >> what it does is what it does is reduces the emergency room and inpatient and medical and healthcare costs because you are housed. and there is a decline in the criminal justice system cost, so instead of housing individuals, in jails, and they are able to be on their own

with the supportive services in the building and feel a part of the community. and it improves, the client's health, and i am sure and it increases the treatment and decreased substance abuse use, because there are programs, quite often, on site, with the individual, housing the referrals for the individuals and last, it improves the employment, and the ssi disability, benefits, out comes. and because, now you are housed, and you are stable, and you are looking at, whether or not you qualify for ssi, or if there is some type of employment, that is available for you, so that you are stable in the job and you don't have

to worry about carrying around your belongings. >> the cost expended for the supportive houses and versing the shelter housing. not just the money that is expended but the money throughout the city which is an important point. >> we have been working through to supplement the out reach and i think that they have been involved in and part of the dialogue was originally was, and you know, let's increase the number of stabilization beds, in addition, you know, to

allow our homeless out reach team to have something to offer individual on the street if we are going to have more people. >> that is right. >> and that i think is the one topic, that the stabilization beds where the people that i think that have had the different opinions, and whether it should be for the supportive housing and i just find it fascinating that the shelter and the stabilization and the housing is probably on the money expended out of the door is almost, and it is equivalent if you will but, then, also, underneath that there is also cost savings and you mentioned many points here on the things that actually that are better for us as a city and better for those individuals and take that as the most important point, and if we do it and take that approach and i just want to... >> okay, the colleagues, questions? thoughts? okay. thank you. >> thank you. >> much appreciated. >> okay, up next. margo, thank you for being

here, and for all of your hard work on this topic was well and for your preparation. >> good morning, supervisors. i was taking very fast notes as you were asking, them the questions, i hope that i will be able to answer some of the details that you are actually interested in. and so, i am the interim director of housing and you are ben health and they developed us in 1998 because the housing department really saw that housing and there was something that our clients needed and they are usually not able to access on their own, and we are able able to access on our available housing and the philosophy about it for us is that housing is healthcare to us. and that homelessness is a healthcare issue and we can talk about that and i will give you the evaluations that i have and what you want to do is you want to invite, homeless people inside, and we want to support

them as tenants and you also want them to recover from their trauma and improve their over all health and well-being. and so, i will talk a little bit about our portfolio and directly as it is related to supportive housing and describe it as well. and then, i will talk about our evaluations. >> and this is a policy slide show, just very quickly i am not going to bore you with that, but already in 1998, the health commission, has a resolution, that talked about expanding services for the housing, in order to prevent illness, and help people that are sick on their feet and then of course, if you came along in 2004, but you know a lot about that, and so, we have approached the homelessness as a health issue and supportive housing as a health intervention, and long before some of the agencies across the country did that.

and in terms of the portfolio that they have in the housing and urban health and we have 1707 units at 36 sites and some of you yesterday at the grand opening of the latest site that chp and bridge opened together. where they have access to all 120 units and we also have 150 units for the people that come directly out of laguna honda and want to live in the community. >> and we have a subsidy program that will provide us that is more or less, and the 90 units and the number change as the rent in the city changes. and we also, of course, found, many, many hospital beds, at laguna honda and also, found it that is out of the county, for the dph, clients, and then we have many of the treatment beds and the long term beds in county as well as out of county.

>> i was approached for this slide and it was overwhelming but it shows, that some of the sites and what i want to emphasize, is that it was especially between 2006 and 2013 *, that the redevelopment and the non-profit providers came in to give the access to the homeless people in the newly developed building and we were talking earlier about the housing pipeline and so that worked very much in 2006 and 2013, and it is starting to be some what dried up for the dph. in the next two fiscal years you will have two buildings and 60 units in the buildings that are for seniors and a majority of them have to meet the definitions of being documented. so, that is and can be a problem for us. and i also want to tell you a

little bit about the age of our clients, and 26, we set aside, where we set aside and actually the buildings, and are developed and financed so that 26 percent of the units are set aside for seniors and since those are seniors buildings and that means 55 years and older or 63 1k3 older depending on the mechanism, and about 58 percent of the residents, are over 55, years old. and so, over half of the residents are 55 years or older and so in the adult buildings there are of course, a lot of seniors and when we consider that in general people's health, is not necessarily compatible to that kind of health that we have had fairly a sheltered, and life that did not involve homelessness and the people are probably more like 65 years old. and in terms of their health

and it is chronically they are not. >> and in the rental subsidy program and between 41 and 72 of the residents are for a 50-year, low and the numbers are shorter or smaller because the subsidy programs and the people are younger, and then in our site and the subsidy program, 52 percent of the residents, are 50 years or older. and you were asking for a couple of questions about the north valley, and 450 of our units are owned and that is 6 buildings that we owned, and about 150 the rent, it is not a master lease, but it is a block lease, and from the non-profit agencies and those are the model sros and have been around for a while and about 1200 of the units newly developed units are totally remodeled buildings that have been remodeled in the last couple of years.

>> supervisor, mar. yeah. >> just have a question of aging and homelessness. >> you said that there is about 26 percent of these sites have a population of the seniors and the people over 55 percent, 58 percent. >> let me clarify that. and so let me find that, and this smaller number, of 26 percent, is used for the ear marked for the seniors it has to be 62 and over, depending on what the mechanism what and what kind of grants we get, however, we house 58 percent of all of the people at 55 years and older. >> and then, you also made a reference to the homeless population, because of the lack of healthcare over many years

and probably ages a lot and more quickly and as a senior population grows, with the baby boom generation, and it is not only the growth of the number of babies, but, also, that they age faster so there might even more more of a need for the homeless, senior, support, and it sounds like. >> that is right. and so, three of the buildings that we are involved with, and that we will be opening over the next two fiscal years and there are 15 years and over 65 housing for seniors over 62 and then, we have set aside in each building, around 20 units for the homeless seniors over 62. >> and i could see how cost effective that might be, with an aging senior isolated and without access to services verses, some kind of supportive housing, or some kind of have more access to the people and social support but potential wrap around services. >> and some of my evaluation

slides are about the senior supportive housing and i think that will be of interest to you, i think. okay. moving on. so the key elements, in dph's supportive housing is that we have a really low entrance, and i, commented earlier on that. and in it, and in the 90s and the early, 2000, or the 2004, and and the non-profit developers and that, and in the way and to work in the population, and so, we do have a master lease of the building that our population who are older, who have special needs, and substance abuse and mental health and a lot of physical issues. that they actually can maintain the housing with the right

support services. >> and it is not at all of our sites. and we would like that. and so dph and the important was the control of access.

the number from the community and to the hospital to dph and so, you have... and the long term care, which includes laguna honda and a lot in the community and the case management programs and it includes, dph and the community, ones, and the serving center and of course, a lot of out reach teams, including the hot team, before, clients. and are you interested in hearing those access works? since there was a little bit talked about in english. >> and so, okay, we have what we have is called the access to housing poor and we really

emphasized the people keep the practice in the building and make sure that we prioritize, or coming in from the high end services right away. >> would you say that the majority of the clients, come from the homeless out reach team and they come from, you know, sfgeneral or come from, you know, what are the main sources? as you said. >> specific kind of geographically. >> yeah, so we have some data for them. and the richardson, and 120 units in the haze valley, and the chp and in the mercy building and 20 percent of the people coming from the out reach, and the out reach, and

20 percent, in terms of case management programs that does not mean that they not be in stabilization units. 20 percent from the clinics, and 15 percent are coming from the medical respite and 5 percent are coming. or something like that. >> thanks. >> the placement that was approved for the applications to be sure that the people don't need a higher level of care and especially, and then, access team, and they really match, the available spots that we have, and available to the needs.

we open it on january second. and then in the last three and a half months, we have 500 referrals that came to our pool, and so he just want to point out really how, the people are for supportive housing and i am sure that many of the people, and many of the other people, are trying to get into hsa supportive housing and we cannot be under estimated how much people want it and need it and then, the least application process happens on site and it is a lot of support around it and the case manager said and the support the clients and hand hold the people through the process and our access team, and helps if there is any kind of failures that come in and to the on sight services people, and it

is also charged with helping the agencies and the clients that enter the housing. >> and a couple of comparative cost slides, and so for one month is the supportive housing and which includes either the master lease, and the operator subsidy of the support service and it includes the operating subsidy program and the support service and so that makes up the cost in the buildings, and it is about $1500. and there is some variation around it. and then, we compare that to other costs that we see, that one ambulance transport costs about the same, and two visits to the san francisco general hospital, and commerce center and the emergency department, costs about the same and one day, and in the inpatient, units, is about the same, as this one day in icu and actually less than one in icu and then, at the medical

respite, it is just under a week, and that you can stay there for $1500. and it pays for 4 visits at the service center which tends to be very fast turnover between 8 to 12 hours. and for days and then it has the residential program, and four days, in medical detoxification program. and so, what we provide in terms of the support services on site, and joyce mentioned some off of the services that are really the normal for all of the supportive housing sites, and case management, and groups and substance abuse and mental health services including the reduction groups *. and then makes the party payment mandatory and, then provide it at the large sites on site. and provide everybody who needs a slot with a slot and includes

the activity and it includes prevention, and it inincludes, crisis intervention and it includes, doing things like making sure that every building has a food bank. to go to supportive housing and that there is, and it is a lot of activities and include the food and summer program and many of the people here know that the holiday celebrations often involve the staff cooking for the residents. >> and it was one of the first newly developed buildings that we were able to access, and it was some what of a shock and it was, of course, great for a while that we were able to refer the people from dph that we have not been able to refer

to the sro units because of the level of accessibility that they needed. and so that is all, and 106 departments and we did some studies around those. it cost the year after and it was less one million 900,000 and so for that you can do the math, better than i, that is approximately, 2.2 million in healthcare reductions in the first year. and the total program at that time, cost about a million dollars. so, the over one million dollars, that was safe, was saved to the public funds and now this does not include whether or not there was a change in incarceration, or any of those kind of services and so it was really just the health department expenditures. >> so, i guess that the logical question is why aren't we doing

more of this? >> well, we did do more of it off wards and we did another 1100 units in collaboration with the non-profit providers and the mayor's office of housing and since then, a lot of those buildings were in the pipeline, and a lot of them came on and it was wonderful for our client population and our patient population and including at our facility and the people that just have no place to move to and therefore that is where they are. and so not only did it cost a lot of monday where, but they were also not very happy with the setting. and as a pipeline, it is some what drying up in terms of units for homeless, and for dph and there is more affordable housing in the pipeline and for the supportive housing might be able to speak some to that and the mayor's office on housing will speak to that but some of it is really availability of

space, and of funding. and of grants, and in order to really put that off and it takes about 5 years, sometimes, up to ten years, to develop a new site. >> okay. >> thank you. >> so, if we saw 58 percent reduction in the emergency room used and i will talk about that more when it gets to mission creek, 57 percent reduction in hospital inpatient bed use and reduction in the length of the hospitalizations and those are in the first year of, and so the people are stabilizing and the whole community, and they are in a building like that and it is stabilizing. so out comes and just the ones and the reduction in the emergency, medical cost and of course, stable housing and we had a turn around rate of 8.8 in 2013. and the over all eviction ra