so i would like to caution us all in creating a more wider system of community support that looks like that people and keeping them in their community rather than for laguna honda or extending other shuttles serviced this for people not able to access them i suggest if i come up with a solution off the top of my head a system with appropriate case management that will be stabilizing the individual and supporting them and a place for a permanent housing our office is here to support and we we were not knifed to the communications around 9-1-1 meeting or other issues but here to work with everyone and

courage you to look at the adult serviced i'm happy to answer any questions you may have. >> supervisor christensen. >> supervisor kim thank you again for being here and we'll make sure that the mayor's office on disability is included in future meetings i apologize you were not invite and you described some of the barriers that the disabled person today. >> what the ideal system looked like our department has the sense of the numbers beyond i guess the folks that come into the office and describe the situation you realty is it has a long waiting list and challenging for the city to get more unit online because of cost we're also competing on that crazy rental and housing market can you describe a vision of a

healthy shelter realistically because the numbers of the community will ended up in the shelters at a certain up to this point in time. >> i believe that people that talk about the different types of shelter systems i'll focus on the smaller scale shelter system with a lot more case management i am thinking of the unit i'm sorry the in take unit at the department the aging and adult services we have a lot of case managers that are specifically trained to take care of the aging issues and think of a congratulated shelter or environment that is smaller and assessable and provides more serviced and connecting people with disables and perhaps some

modifications to the in home support services and working with the departments to be able to access the support along with the transit services that people need to survive in the community. >> thank you supervisor campos. >> thank you very much and i also want to thank the department of public health for its work just a question i don't know if it's a dumb question but something i'm trying to fourth how this works if you have someone who has chronic serious illness who happens to be homelessness and staying in a shelter but certain treatment that is needed where you know their presents in that shelter and lack of access to the facilities or whatever it is is a problem and what point do you

decide to hospital lists the person what point do you decide to do more than having them in the shelter system not only in terms of the what's the right thing to do for that patient but also i would minimal the cost of care if the person gets worse is also an issue i don't know how that worked but in our local we have something to say about that. >> so that's a really good question supervisor it is a situation is an individual situation; right? we have plenty of clients right now with hiv living in the shelter system i'm not an expert but i'll say either inconsistent and medication schedule or being in an environment that is not

easy to clean or keep safe or consistent can have negative impacts on their health so some point again it really needs some medical individualized assessment for a proper environment >> maybe we'll hear from the department of public health are there guidelines i follow? >> yeah. i'd love to answer that. >> thank you. >> so the problem is there's various levels of care i need to be very sick to be anytime milled to the hospital there are a group of management to make sure that people are not milled unnecessarily when i started nursing thirty years ago there was an admission people could be admitted easy in those

days and place like laguna honda those are skilled facilities you need an organization c or someone a pass to get improving for the therapy and getting back on your feet and respite it's really designed for acute illness you have a problem there's a reason for that everybody who's placed in the beds had chronic needs and they'll fill up that's the model of care so the gap we have is for chronic care issues for people that need some custodial assistance we didn't leverage it more and more in shelters but there's a limit to how much time of your housed ouchlt how much time no one has a twenty-four

hour facility care if you need the care for that much time there's no place for you so if you're quadriplegic and sound like laguna honda will take me not necessarily the therapy didn't change that so - >> can you ask you how many people do you have an estimate of how many people. >> in custodial. >> yeah. >> to be held in a place so something can fourth things about a week two weeks to 2 a month of significant cases and it it is quite a task to figure out this i've had i won't name the hospital not san francisco general hospital but the hospital that discharged a person 5 hundred ups and downs

and he was living in a center until they could fourth something sew do you have a sense of the total population in this category. >> on an even day in shelters. >> yeah. >> as i mentioned i mean, i on tell you the person people that are referred to me not everybody but i don't know that my data is scientific as say, i mentioned - >> i actually i know there are many people who are here for public comment maybe we can follow-up at some point it will be good to know and track that because those folks some point you're dealing with them in the system; right? they get so sick they get taken though the e.r. or if there's a way of tracking

that i mean we're certainly spending money and maybe it's not the most cost effective way or humane way more importantly this is something i'll be interested in. >> the critical analysis whereby the best way as i mentioned i don't get every person in this situation referred to me this will be better. >> i wanted to add if the committee would allow me to the concept that the disability is very different for instance if we have a blind person who's been blind and knows how to navigate properly urging the ability navigation training this is a different story than someone who was homeless by

uncontrolled diabetes and has no idea how to manage fwhg a shelter for the first individual i described that would be simple to show them give them a quick tour of the facility and for the reasonable accommodations for the second individuals he didn't need necessarily nursing care or custodial care, he needs connections to a proper training facility to learn how to be trained essential those are the expenses expenses are different and needs different the same worries about a person with a mental health so folks on the street who are going into a shelter because of the living environment and because of the lack of training around how to handle people with significant mental health they get to

compensate it so again not about people that are not able to self-care by going to the restroom or using the shire but all the facts of self-care. >> supervisor kim. >> thank you actually, my question is for the department of public health again and then i would like to move on to public comment. >> so i just want to appreciate a lot of the questions about the need today i feel like we have a sense of that already and need to analyze some of that data like the critical incident i'm curious what we did with the medical assessment of back in 2012, 2013 and what we do with the data i'm looking at that right now number one is the

depression 44 percent have expressed that and 29.2 percent hypertension for this percent chronic disease and liver disease s&p 500 and so on we've been collecting some of the data to get a snapshot of who stays in our shelters and i'd like to get that data from there on. >> well, i think that data was part of the decision to decide to being the nursing model some of the things like chronic illness didn't require a doctor when we moved into s c a everyone was getting a medical home so unfortunately, we were trying to focus on the acu and didn't spend a lot of time figuring out how many people have medical homes i think now

we have a breatherer around this we'll probably start looking at the data to inform what we're going to be doing and also i need to say that also helped to the discussion arson moving the hot team from bug transportation project to being a program that engages people that are some of the things we'll go back and relook at the data that will help us in new discussions about the best model in working with the agency from the advocates so we're looking at the data. >> i want to appreciate that i feel like the department has a lot of great data and if it's not the right data we need what's the right data to 4th i know that every case is a unique situation but this is you know a

large issue for our shelter providers and i feel like we need concrete ways of addressing larger categories and making sure they're getting the needs met and if the data is not helping us to figure out this it would be good to know what data to inform the work with the dph but i want to mention in our conversations with director barbara garcia she's talked about a lot of great ideas we're interested in the providers partnering up and doing a pilot with one of our health clinics that provides additional help and something we've decided last friday as well. >> we are looking that and hopefully work with the dph based on all the questions that are coming up maybe that can be

considered so we can easy out how many people we'll help like kate is saying one or two but we need to figure out one or two that needs that level of care so that intense of data thaim they'll be collecting. >> thank you. >> so we're going to open up for public comment right now i know there's a number of speakers supervisor kim will facilitate that we have to ask people to stay within 2 minutes and 30 seconds to go there's a soft bureauser and louder buzzer when our time is up. >> so supervisor kim has a number of supervisor kim has a number of speakers she'll. >> we'll be calling up all the speakers. >> be patient. >> we'll allow the members of

the public. >> loans it is based on fear and enforcement that's what the police do that is why it self-work respect me respect me. >> that is so bull shit crossing process of a content never, ever makes sense. >> i'll be speaking to the members of the public if you want to ask a speaker to speak before you some members of the public have to leave before others and if you're a senior or disabled please feel free to line up i'll call the first names on the list again, you don't have to go in the order you've been called (calling names) and then i'll call up the next list. >> i want to get going arrest i

will many jackson i live at the next door i'm hiv positive with hypertension and a lot of things one of the problems i started the shelter system they sent me to over there on delores on valencia and gave me a bed and someone stole my pills i went to see my worker and after my 90 days is up they'll send me to another shelter and someone could steel my meds i'm getting sicker by being in the shuttles i can't manage my care when i first came in i did everything the way they asked me i did did the one day and signed up for a

case manager and sleep in the same beds those people you are asking the wrong people questions so you should talk to the people in the shelters not for me spending the night risking getting bedbugs and having sick people in the shelter system that's not good, i go to the bathroom and there's bloody bandage on the floor and feces where people expanded changeism there are 3 nurses that live in the shelter they have resources i know if you go to a shelter you see the nursing they live in the shelter the fire department i could tell you how many times a night they come they. come 6 times a night

before i go to bed (clapping) and to the members of the public i'll say we have a rule in the board of supervisors we ask people to try not to give voraciously will comments it's okay to show support with a non-vocal way we ask you to do that in favor of the efficiency of this program thank you for following that. >> if you don't mind speaking into the mike and happy black history month. >> the reason we have you on the mike there are people watching on that television or online. >> i have to read this right quick i'm very nervous i'm almost 70 years old i'm homeless

and disabled and living in a shelter i work every day i work another a index ssi take care of disabled seniors i can't get my help anywhere i've put in so many applications and tried for lottery and i'm tired i don't care about 50 or thirty percent i work everyday i can pay my own way i am an older woman because i'm sdarld my legs hurting hurt i can't get up to go to work i continue to do this for over thirty years this is not only for me but other disabled help us we want someone to stay with a kitchen and bathroom so we can live like human beings the way

wisp raised so to so thank you and god bless you (clapping.) >> hi yesterday at the shelter a person a wheel from the coalition from homeless shelters came and said there maybe a problem about the e.c. s shelters being twenty-four hour they're not maybe twenty-four hours anymore we need the shelter to stay twourts because it is very exhausting to be homeless and difficulty finding a restroom when the shelters close also it is common to get sick when you stay in the shelter there's a lot of germs

and when you have brooklyn bronchitis you need a twenty-four hour shelter to lie down and a lot of older he seniors shelter folks that need a place to rest during the day thank you (clapping.) >> good afternoon supervisors i'm kathy an e.c. s director and i manage 5 hundred and 34 single beds essential a next door shelter and additional more during the winter season we appreciate the focus on the shelter residents and welcome the dialog and especially the problem solving i hope that will come out of this process we know that our fellow san franciscans find themselves coming with acute health conditions as kate when is wonderful and very, very supportive has trained us with acute and chronic the solutions

need to be both of those issues our city shelters were not designed to take care of of people so sick they can't self-care we're seeing an increase in people that come to shelters even though we don't have the captain or resources we appreciate the department of public health and response to this crisis that's a crisis and becoming mora crisis by bedding two nurses in the shelter this will give us the ability to access the medical needs that nurses and shelters are the beginning and again assessment are very important we hear a lot of issues and i'll end by saying the shelters don't have the staff capacity for the folks that are coming in so sick we

have 10 behavorial health expert in the city and two follow resources wound next door and again, i resonate the folks that are coming to us have complex needs and solution and a lot of the work goes into liaisoning and collaborating with other agencies on behalf of them thank you you. >> good afternoon, supervisors ken with the service i'm joined by my colleague we appreciate very much the folks on health and welcome the resources that will be broadcast kathy talked about the needs we can't do the

shelter without the alternated resources we want to talk about the help of the agencies themselves that are providing the assistance tonight the organizations will serve more than one thousand those 3 organizations more one thousand homeless men and women and children and the south sanitary next door we'll provide the safety net for food and shelter and pope hope people on the road to get the shelter without the resources it's difficult we hope that people get through the difficult facts and circumstances as a respite we'll provide those services with the resources that are insufficient to pay the bills together our 3 organizations are requesting the city grant a 4 hundred 14 thousand emergency supplemental

allocations in order to cover the unfunded expenses of the san francisco's four largest shelters wow. (laughter) >> i'll talk very quickly this one 44 we're asking to excuse me. the 4 hundred and 14 to combine with the one hundred for you with the allocation from human services agency i want to say we believe in housing but as long as we need the shelter if has to be funded we can't do it by ourselves we put over the years millions of in support of shelter related activity and b will do this this year we have some 4 hundred and 14 thousand after the fundraising more half a million dollars we've been

short we can't do that year after year and turn it to my colleague. >> hello supervisors executive director thank you for the conversation and the society has been here since 1960 serving vulnerable people with the needs of domestic violence and a and homeless difficulties since the early 80s thank you for the perspire years this additional funding allowed for much need additional services, however ken mentioned the funding didn't address the raising costs the 3 shelters speaking here are experiencing more needs and great service utensiltion while be flat funded new our contract where did he go we go to outside

funding we do our job and but the philanthropic outcomes those are easily addressed by the employment services but a difficult case to make for the shelters for homeless people as ken mentions there's a thousand people a night being served by our organizations and s f a we provide the sleeping and meals and also by mission and contractors support and community and team building for the staff we do this as a substantially inadequate funding leaving us with unfunded balances we hope you'll consider our requests thank you for what you do. >> thank you and good afternoon, supervisors i'm deborah the deputy director let

me reiterate our reason for today's hearing the experience at hampton collaborates the shelter needs and we're grateful yourself consideration of solutions at the same time we're deeply contenders store the financial health of our organization we do negotiating everyday because it's that in our dna but we have to pay for it our organizations will bloody more $400000 in red inc. this year alone that's net of our fundraising it's a loss following other years of deficit we can't sustain so with e p.s. the society i urge you to fund this supplemental request at the same time it's important to note this is an interim request a

band add that as to the the bleeding but not a cure funding the disbursement of fund prudent person pursuant will allow us the continued operation of our shelters without running deficit without outing further shelter funding. >> as you consider funding this emergency request we ask i work with our organizations and the broader community to fund shelter for homeless families and individuals adequately and in the future i want to xrets may strong support for other areas a supplemental request on the coalition for homelessness and in particular to improve the services and shelters for families and the reservation for shelters for family there are