the data is a little bit old and helpful in informing our office on the demographics in the shelters and i know that we need to do another assessment to get the details on the actual services we need to provide at our shelter i think the data was informative even in looking at what the current demographics are and i have the presentation here or the data you had presented to our office last year to address the needs even the 059.5 percent of clients in you'll our shelters at some point needs our medical emergency assistance that's a high percentage we're not talking about one or two clients a broad swath of our population that's homeless when they think about what we look at

aerial shelter system and understanding our sheltered system is not set up to address the clinic tell hoping the changes i think we have to face realty and adjust the types of services and staff in place i know our office worked hard with barbara garcia to find the full-time nurses under our directorship in the shelter system and having spent a night no one of the shelters there's no one on site so help the clients i saw and myself in i had medical needs and how important it is to have a nurse someone should remain in a hospital but unfortunately you you know there are people that are going to be in our shelter system and addressing that as a realistic some of the data

points will be helpful to my colleagues or who had access to the data we've seen i also remember over 50 percent of our clients are between 40 and 59 that's a stunning number for a lot of people and i know that dph said we're angling in place on the streets so when our 40 your body maybe a lot older than most 40 years old not living on the street so moving towards the solutions we might have to improve our shelters it's important to acknowledge this is historically the offer seer that manages our shelter system and how important that partnership of the department of public health i'm existing we're working on keep that in mind the

respite shelter on st. anthony's moving from this site we're looking to expand the respite shelters to double almost double we're looking to expand another 20 beds i think this is important but i think what became clear in the discussions we've been having we need more services in our shelters as well and the 20 beds will be filled fast it will be helpful to hear if dph and then perhaps go to the gentleman from the mayor's office on disability after sxrifrz have questions. >> supervisor christensen. >> i'll be quick at some point

the medical respite shelters a great idea you've mentioned there are shuttles that offer up to 60 days. >> a medical respite opens mission street and is that about 50 beds to people are disregard from san francisco general hospital and need care their disregard into the respite and we have 60 beds. >> i wanted to applaud i think the movement offering skilled nursing aid at locations is such a welcomed development and i mentioned that you will be collecting data for this pilot program i think there are to things not only the resources and the money that are saved when emergency services are diverted to non-emergency but i

think about the care people must receive and it is better like auditors looking avenue people and not having the people k5r9d off to other locations so it's good for the people it so you would this intermediate needs isle i'll be interested 2, 3, 4 following what can be established for that need thank you >> thank you supervisor kim are there other. >> yes. our last city presenter is the gentleman under the mayor's office on disability it is in its been such a resource with our shelter system

particularly for the growing population of our individuals about homelands that are disabled. >> thank you, supervisor kim and thank you members of the committee about having this hearing and evaluating and inviting our office to speak on the issue our office from the beginning has been involved in the shelter group assess meetings we've been supportive of the h f a to create the rules part of it with the people p with significant disabilities we hear from and the antidotes should they arises month many of our folks due to age are trauma through the streets people with disabilities have a higher incidents of

injuries especially what they're not able to defend themselves from other folks also consistency that's pelosi why our officer is involved the in trying to create a uniformed rule so people have come to the issues and have memory oishgdz understanding the importance i reilly's release we've shifted the conversation and provided information as a initiate restoration of the uniform rules to provide clarity that helped foepgz to 70 self-care we've heard a lot of incidents with people with disabilities themselves and that's the residents that come to our office and say that the shelter is not the proper environment and patient have been dropped by

shelter staff and for folks who have been xhaep there's no proper support they're interested in the discussion about the nursing system and nursing care and the medical for the outreach team i'd like to caution you that san francisco and the nation in general based on the homestead decision from the supreme court chosen to people with disabled shouldn't be thrown into a hospital or into a nursing home but having management that creates a community support system we would like to propose this body brings the involvement of

the department of aging and adult services they're the primary experts on the support that people with the seniors with cognitive impairment and chronic disabilities are able to provide to the city as supervisor kim said a homeless shelter is no the place to stabilize and improve the quality of living current the respite she recalls are slated for individuals who have a medical crisis so a person that has a surgery or wound that is expected to heal they'll go to the shelter two months and be able to return and move on with their struggles of homelessness

however, there are a huge number have been stainless in our shelters now that didn't have that option people that have aged disabilities and disabilities important 0 a long time were stabilized in their home and have the housing crisis they end up on the streets and not able to access their support services the in home support services have rules about hours you can be attended to so being able to access the services in a shelter system is almost impossible on diagnoses you have medical costs or spend time because the diagnoses care is difficult in the shelter they may have transportation issues in getting into their diagnose

center 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