Homeless Outreach Team shifts to street medicine
“Having part of the homeless team be focused on actual medical delivery would be a significant improvement.”
Mark Farrell, S.F. supervisor
San Francisco’s in-yourface homeless problem may seem even more pronounced this fall as the city temporarily scales back its Homeless Outreach Team in order to remake it.
The team — which was criticized by City Hall officials earlier this year for being understaffed and ineffective — won’t work on weekends, will be slower to respond to calls for assistance during the week and won’t accept any new homeless clients for case management and social work services.
In revealing the cutbacks, city public health chief Barbara Garcia pledged it’s just a temporary “time of transition,” and that the team would emerge stronger when a largely new staff with a new vision is in place by Nov. 30.The team will move away from its decadelong mission of luring homeless people off the streets with temporary housing units because there’s hardly any short-term housing to offer in today’s crazed real estate market.
Instead, the team is shifting to a street medicine model, aiming to connect to homeless people by offering them medical care — even right there on the sidewalk. Dr. Barry Zevin, a physician who has treated homeless people for 23 years, will serve as the team’s medical director.
“In the process of changing the model, we are having to shut things down and start
things up,” said Maria X. Martinez, interim director of the Homeless Outreach Team. “We think it’s going to take us a couple of months to be fully staffed in the new service model, and that’s where all our attention is going.”
But not everyone is pleased with the delay, considering the big effort at City Hall this spring to approve emergency funds for the program.
“Obviously, the intent of increasing funding for the Homeless Outreach Team was to see immediate results on the street,” said Supervisor Mark Farrell, who successfully pushed the legislative effort. He said the shift to street medicine was known when the vote was taken, but not that it would mean months of downtime for the team.
Shift away from housing
City Hall has grappled for years with San Francisco’s seemingly intractable homeless problem. The most recent survey, conducted in January 2013, found 6,436 homeless people in the city. The figure hasn’t budged since 2005, despite initiatives to get people off the streets.
The Homeless Outreach Team was founded 10 years ago by then-Mayor Gavin Newsom with the idea of having outreach workers — often formerly homeless people themselves — fan out around the city 24/7 to try to persuade homeless people to move inside to temporary beds. The plan was for a case manager to then work with the homeless person to find permanent housing, drug and alcohol counseling, and mental health services.
But, as available housing in San Francisco for anyone — let alone homeless people — has dwindled, the team became more of a taxi service, shuttling homeless people to San Francisco General Hospital, shelters and sobering centers, Martinez said.
Most of the stabilization rooms — the technical word for the immediate, temporary beds the team has to offer — are in privately operated single room occupancy hotels, but with the booming real estate market, landlords are increasingly renting the previously undesirable rooms for more cash to families, middle-class workers and even some young techies.
The housing shortage has been made even more acute because of City Attorney Dennis Herrera’s lawsuit against the Thakor family, which owns 15 SRO hotels containing 880 rooms around the city. Many of them have been used as temporary units for homeless people, and Herrera alleges the Thakors have maintained slumlord conditions with sewage leaks, bedbugs, roaches and lead paint.
1st real job for many
At the urging of the Board of Supervisors, the Department of Public Health is working to move their homeless clients out of those hotels, effectively putting an even tighter squeeze on the supply of temporary housing.
The transition away from housing to street medicine has angered many of the previous members of the outreach team who have lost their jobs because they lack medical training. They have slammed the Health Department for what they view as a quick and callous dismissal of longtime workers.
Jane Bosio, their representative in the Office and Professional Employees International Union Local 3, said that for many of the workers this was their first real job after having been homeless or incarcerated or struggling with substance abuse. She said some longtime workers are either being demoted or left jobless and without severance.
“These are by and large some great folks who work really hard and care very, very much about the people they serve on the street,” Bosio said. “They’ve been treated with a level of disrespect for their skills and their work.”
Martinez said everyone was invited to reapply for jobs on the new team. Those who didn’t make the cut could get jobs in related venues, including homeless shelters.
Additional spending
The team took center stage at City Hall in February when Farrell argued the organization was too small to be effective. His colleagues and the mayor approved spending an extra $3 million annually on the team — on top of the $7.4 million it already gets each year from the city — in the budget year that began July 1.
In May and June, the board also approved an additional emergency $1.3 million to beef up the team before the start of the new budget year. Farrell said he’s fine with giving the Health Department “operational leeway” to make changes to the team and is confident it will emerge stronger than before.
“Having part of the homeless team be focused on actual medical delivery would be a significant improvement,” he said.
But he said his office has requested more details from the Health Department to determine where the extra money, particularly the $1.3 million in emergency funds, is going.
“We have to keep an eye on the ball and make sure that the intent of our legislation and our financial resources are fully implemented,” he said.
Martinez said the department will provide a full accounting and that all of the money is being spent as city officials intended.