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 rate which includes those where we were actually able to avoid an eviction and the people surrendered their units and it was 2.6 percent and it was improved freedom and improved quality of life and we cannot put a dollar value to of course. and so the average length of stay for those who left, was around 3 years and so the longest was 6.3 years. and of those, who left, they set a one, and actually died in supportive housing. and then you heard the age of our population, and then you heard about the medical condition of our population that is probably not surprising, so we have a turnover of about 12 units. a month, if we don't bring new

housing stock on. and i will talk to you about the richardson, and where the people are coming in from terms of out reach and in terms of case management and community clinics and all trying to send, and 50 percent from the other and 5 percent from the hiv providers and that brings us to the mission creek. mission creek is a beautiful affordable housing, and building, and it is on the street at 4th, and when it was first opened, we were very concerned about our residents actually was there was no infrastructure and not a lot of buildings around and so it was right by the park. and of the 139 units, 51 of them are set aside for homeless seniors and also i just want to mention that ten percent of that ten of them are set aside for the people living with hiv for half of the funding and apply earlier to speak for the mayor's office on the housing and community development and so altogether, you have at

least, 61 people, there. and that, have severe health issues and are mental health and issues and mission creek alone at that time, did get 12 people from laguna honda and so just to look at the health check off and the year before and the year after, so the year before and this was 51 and we don't know about the ten clients, and so the 51 tenants, and there was a 82 percent reduction in the total cost. and because the year after house, i think, is pretty off and it is 2.7 million the year before, and $500,000 and the year after, $451,. >> what was the cost to build them? >> the cost of building that building? >> well, i would have to guess, because it is the health center and the library in there and i would say it years ago, something like $50 million.

>> is that. >> yeah? >> okay, because we can all place bets, but that you know, at times it was a shocking amount of money for us at the health department because we are not in affordable housing world. >> i understand that. but what i think is that we are looking at these are stark numbers that you have a reduction of costs one year from the individual services and from a city's administrative perspective, it is a big difference and if costs $100 million to save, 2 million a year, that will take 75 years for break even on that. you know it could cost a lot less. >> right. >> so i think that one without the other does not really paint the picture. >> yeah, so let's say that it was $40,000 because the public library cost a certain amount of money and then at the health center in there and which is not exclusive to mission creek, represents. >> but not to guess, i think that hopefully, we have that information and also as we analyze. >> i wanted to point it out.

>> as we analyze these things, i think that it is, and again, it does not and you can't, and this in and off itself is great. is awesome and everyone will agree with that and better out comes just for being in the housing. >> but i think as we talk about this, from a city perspective, and part this is analyzing and we have the cost from the city and we talk about the pipeline and i know that is a big, larger topic and not just homeless and affordable and otherwise. >> absolutely, and i would, you know, i would mention to guess that part of the drying out of the pipeline and has to do the economic down turn and these projects take 5, 6, 7, 8, years to come on. and so there was some slowing down of the affordable housing. >> and i will add to that, in this environment, if we are talking get and we need to plan for the long term and do the things short term and thes a balancing act for my perspective and i know that people have stark opinions on both sides of that. but, if we are talking about

heightened real estate market and the static health savings cost will not increase that much. >> yeah, going up. >> medical cost and inflation, but the real estate prices are going up and i think that is the difference here about whether this is a great way for our city to are spending the dollars verses another program to achieve the same goal at the end of the day. >> yes. >> so, i also wanted to show you what it is in terms of the individual, so this is the average, and the average cost in healthcare was 35,000 and the year after was about 6,000. and so, again, 82 percent reduction and those are the averages. and the cost of healthcare utlyization broken down by emergency department visits and by inpatient days and by inpatient days and you can see it as a really large decrease in terms of the inpatient days, and a little bit of a smaller,

decrease in terms of the emergency department visit and then, also, a large decrease in site custody, and if you and you know, and if you move it back, scott? >> and it shows it and i can't see it on the slides and maybe you can see it. it actually shows you, what the skills are missing and the care utlyization was and knows that we have the laguna honda and we have the many slots there and there is always a wait list, to for the people to get into laguna honda and you only get to the wait list if you have been found eligible and so everyone who is on the wait list needs to go there and also