So many faces, so hard to count

San Francisco Chronicle - - FRONT PAGE - By Joaquin Palomino

How many peo­ple are home­less in San Fran­cisco?

That ques­tion is the ba­sis for the most fre­quent Google search in the city re­gard­ing home­less­ness. The an­swer, though, is elu­sive.

Mul­ti­ple govern­ment agen­cies have at­tempted to cal­cu­late the scope of home­less­ness, but ac­cu­rately mea­sur­ing it or its so­cial and eco­nomic im­pacts is dif­fi­cult, if not im­pos­si­ble. Home­less­ness can take many forms and is of­ten a tem­po­rary sta­tus, mak­ing it hard to re­li­ably track.

The city hopes to build a more com­pre­hen­sive in­for­ma­tion sys­tem, mak­ing it eas­ier to count and pro­vide as­sis­tance to home­less peo­ple. Cur­rently, how­ever, es­ti­mates on the num­ber of peo­ple liv­ing on San Fran­cisco’s streets — and the costs as­so­ci­ated with them — vary dra­mat­i­cally.

The fig­ure 6,686 is the most widely cir­cu­lated ap­prox­i­ma­tion of home­less adults in the city. That num­ber comes from a count made on a sin­gle night in Jan­uary 2015, when vol­un­teers fanned out across San Fran­cisco and iden­ti­fied peo­ple who ap­peared to be sleep­ing on the streets, in parks, in cars, or any­where else not

meant for hu­man habi­ta­tion.

Those stay­ing in a tem­po­rary shel­ter that evening were also counted to come up with the fi­nal es­ti­mate.

The bi­en­nial sur­vey — con­ducted in cities across the coun­try at the be­hest of the fed­eral De­part­ment of Hous­ing and Ur­ban De­vel­op­ment — pro­vides the only con­sis­tent and uni­form data enu­mer­at­ing street peo­ple. The in­for­ma­tion from those counts in­flu­ences ev­ery­thing from fed­eral fund­ing for home­less ser­vices to news­pa­per head­lines to dis­cus­sions at City Hall. But they stem from an im­pre­cise sci­ence.

In some cities, in­clud­ing San Fran­cisco, vol­un­teers are told not to speak with the peo­ple they’re count­ing for safety rea­sons, forc­ing them to rely on vis­ual cues. Some, like a per­son curled up in a sleep­ing bag on the street, are pretty clear. Oth­ers, like some­one push­ing a cart full of re­cy­clables, are less de­fin­i­tive.

“It’s a big un­der­count, be­cause they just look at some­one and as­sume a hous­ing sta­tus,” said Jen­nifer Frieden­bach, ex­ec­u­tive di­rec­tor of the San Fran­cisco ad­vo­cacy group Coali­tion on Home­less­ness.

The HUD sur­vey also ex­cludes peo­ple sleep­ing on a friend’s couch or wait­ing for a shel­ter bed, as well as in­di­vid­u­als who evaded the can­vassers. The thou­sands of for­merly home­less re­sid­ing in per­ma­nent sup­port­ive hous­ing — which of­fers a suite of ser­vices along with an apart­ment room for life — are also ex­cluded from the fig­ure.

“It’s not per­fect, but it’s a good snap­shot in time of the home­less,” said Ed­uardo Cabr­era, a spokesman for HUD who par­tic­i­pated in San Fran­cisco’s most re­cent sur­vey. “At this point, it’s the best tool we have to mea­sure the ex­tent of home­less­ness.”

9,975 home­less in the city?

San Fran­cisco’s De­part­ment of Public Health main­tains a ro­bust data­base that ac­counts for every home­less per­son that uses med­i­cal, men­tal health or sub­stance abuse ser­vices in the city.

Un­like the HUD count, which takes place over just a few hours, Public Health’s data­base, called the Co­or­di­nated Care Man­age­ment Sys­tem, tracks peo­ple who have ex­pe­ri­enced home­less­ness at any point dur­ing an en­tire fis­cal year.

“It’s bet­ter for get­ting a sense of how many peo­ple in a com­mu­nity are touched by home­less­ness over a longer time span,” said Barry Lee, a Penn State so­ci­ol­ogy pro­fes­sor fa­mil­iar with sim­i­lar track­ing sys­tems. “By its na­ture, home­less­ness is episodic, it’s fluid.”

In fis­cal 2014-15, Public Health’s CCMS re­ported 9,975 home­less in­di­vid­u­als in the city, a fig­ure nearly 50 per­cent higher than the bi­en­nial home­less count’s es­ti­mate (32 per­cent higher when in­clud­ing the sup­ple­men­tal youth count). The data­base, which pro­vides a de­tailed break­down of the health con­di­tions and de­mo­graph­ics of the peo­ple it tracks, paints a stark pic­ture.

In the 2014-15 fis­cal year:

More than half of the home­less peo­ple in CCMS had his­to­ries of de­pres­sion or psy­choses.

Roughly 60 per­cent had, at some point, abused drugs or al­co­hol.

A third had been in­ter­mit­tently home­less for longer than a decade, up from 9 per­cent in 2007. Nearly half of those in­di­vid­u­als were African Amer­i­can. Just 6 per­cent of the city’s gen­eral pop­u­la­tion is black.

The num­ber of home­less peo­ple age 60 or older jumped 30 per­cent, from 856 in­di­vid­u­als in 2007 to 1,103 last year.

79 home­less peo­ple died in 2014-15. As of April, 87 home­less in­di­vid­u­als had died in 2015-16, with three months left in the fis­cal year.

Home­less peo­ple cost the city nearly $150 mil­lion in emer­gency health care last year, in­clud­ing am­bu­lance rides, emer­gency room vis­its, place­ments in sober­ing cen­ters and other ser­vices. A rel­a­tively small num­ber ac­crued sig­nif­i­cantly high care costs.

The 1,320 home­less peo­ple need­ing the most aid re­quired $106 mil­lion in emer­gency med­i­cal and men­tal health ser­vices last year — or roughly $80,000 on av­er­age — ac­count­ing for more than a fifth of all such costs in San Fran­cisco.

“They’re a very vul­ner­a­ble, very sick, and very high-cost group,” said Maria X. Martinez, a Public Health di­rec­tor who helps over­see CCMS. “They’re the peo­ple you’re step­ping over on the streets.”

Public Health’s in­for­ma­tion sys­tem has helped San Fran­cisco tar­get and track its most needy res­i­dents, but it has a prac­ti­cal lim­i­ta­tion: It cap­tures only those us­ing med­i­cal, men­tal health or sub­stance abuse ser­vices.

Chil­dren on streets

Younger street peo­ple, who are typ­i­cally health­ier, are un­der-rep­re­sented, ac­cord­ing to Frieden­bach. The more than 2,000 school­child­ren liv­ing with­out a sta­ble home, ac­cord­ing to the San Fran­cisco Uni­fied School Dis­trict, are also prob­a­bly miss­ing from the data­base.

Frieden­bach es­ti­mates there are closer to 13,000 home­less peo­ple in the city over the course of an en­tire year.

While Public Health’s data­base shows the home­less pop­u­la­tion is get­ting older and

sicker, and spend­ing more time on the streets, it also sug­gests there are now fewer of them in San Fran­cisco. In 2007, the city health de­part­ment recorded nearly 12,000 home­less in­di­vid­u­als.

The data run counter to the point-in-time es­ti­mates. Both HUD and the bi­en­nial count show the num­ber of home­less, par­tic­u­larly those with­out shel­ter, has grown over the past decade — a trend that matches public per­cep­tion in the city.

“I’ve been here 26 years, and the home­less prob­lem is worse than it has ever been,” said Can­dace Combs, a mas­sage stu­dio owner and pres­i­dent of the Mis­sion Creek Mer­chants As­so­ci­a­tion. “When I walk by these en­camp­ments, as a woman, it doesn’t feel safe.”

Public grows more im­pa­tient

Combs isn’t the only per­son con­cerned about the grow­ing num­ber of tarps and tents on the side­walks; there has been a surge in 311 com­plaints re­gard­ing en­camp­ments in re­cent years.

In 2013, the city’s 311 line recorded 898 en­camp­ment-re­lated griev­ances, or be­tween two and three per day, ac­cord­ing to a Chron­i­cle anal­y­sis. As of mid-May this year, there had been 6,982 com­plaints about home­less camps, or more than 50 per day. (Andy Mai­moni, deputy di­rec­tor of 311, at­trib­uted some of the growth to a new cat­e­gory for home­less camps added to the mo­bile app in Oc­to­ber.)

311 com­plaints, of course, don’t mea­sure the num­ber of home­less peo­ple, but public sen­ti­ment. The spike in such griev­ances may not re­flect a grow­ing home­less pop­u­la­tion, just a more vis­i­ble one.

“There used to a be a lot of mar­ginal space, but that has be­come valu­able real es­tate in a lot of places,” Lee, of Penn State, said, re­fer­ring not just to the sit­u­a­tion in San Fran­cisco, but many parts of the na­tion. “You might be see­ing more peo­ple out and about, but it could be be­cause they have nowhere else to go.”

The dif­fi­culty of ac­cu­rately track­ing how many peo­ple are home­less isn’t unique to San Fran­cisco. Due to its of­ten tran­sient and tem­po­rary na­ture, it’s vir­tu­ally im­pos­si­ble to make a pre­cise count of home­less in­di­vid­u­als.

“I don’t think any city will ever say, ‘We feel con­fi­dent that we have counted every sin­gle home­less per­son,’ ” said Nan Ro­man, pres­i­dent of Na­tional Al­liance to End Home­less­ness in Wash­ing­ton, D.C. “But you can get close, you can get the di­men­sions, and if you’re con­sis­tent in the count method­ol­ogy, you can mea­sure progress from year to year.”

Cur­rently, San Fran­cisco doesn’t have a sin­gle in­for­ma­tion net­work to track home­less peo­ple, but rather a num­ber of sep­a­rate data­bases man­aged by dif­fer­ent ser­vice providers. Jeff Kosit­sky, di­rec­tor of San Fran­cisco’s new De­part­ment of Home­less­ness and Sup­port­ive Hous­ing, hopes to solve that prob­lem.

Bet­ter track­ing crit­i­cal

Kosit­sky plans to unite the dis­parate home­less in­for­ma­tion sys­tems, in­clud­ing the De­part­ment of Public Health’s CCMS, al­low­ing the city to bet­ter track its need­i­est res­i­dents and con­nect them to ap­pro­pri­ate ser­vices — whether that’s hous­ing, a shel­ter bed or med­i­cal care.

Putting all ser­vices un­der one roof should not only make it eas­ier for the city to track the num­ber of peo­ple liv­ing on the streets, it should also make it sim­pler for home­less peo­ple to ac­cess care.

“If you’re home­less, you may need to be as­sessed three, four dif­fer­ent times, an­swer­ing the same ques­tions each time; it’s un­fair, in­ef­fi­cient and not re­spect­ful of peo­ple we’re try­ing to serve,” he said. “Clients have to get into many dif­fer­ent lines to ac­cess ser­vices, and we’re go­ing to ask them to get into one line.”

Kosit­sky an­tic­i­pates the new home­less sys­tem will be par­tially run­ning by Oc­to­ber and fully func­tional by au­tumn 2018.

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