Addressing Homelessness

Recent surveys on homelessness have found that there are approximately 600,000 homeless people in America; that New York City has 60,000 and San Francisco has 6,400 individuals/families living without a permanent residence. Another study found that different cities had different percentages of homeless living on the streets. San Francisco has about half of this population in shelters at a cost of $165 million per year, most of it county money with some of it going to related services. This figure does not include city costs for medical care and does not include charitable efforts to provide food and shelter to San Francisco’s homeless. When these costs are added, they total more than $200 million that is spent annually on our 6,000+ homeless. We are spending $30,000 per homeless person per year and still half of them are still sleeping on sidewalks and under bridges.

It makes one wonder if there is a better way to help this desperate population. I think there is. First a little history.

Until the 1990s, San Francisco had few homeless people. Single individuals who were poor and in need of food and shelter went first to 150 Otis Street and applied for General Assistance. Families that were poor went to 170 Otis and applied for AFDC.

Applicants for aid would be identified and interviewed and if found eligible, were given a list of hotels and residence centers to call for a room. The clients would be given a cash grant, Medi-Cal, food stamps (now called SNAP) and a Muni fast pass.  There were more than 3,500 individuals on G.A and about 15,000 families on AFDC. Not all the G.A. clients were really eligible to the aid and not all the AFDC recipients were close to being homeless, but about 3,000 single people, mainly men, and thousands of families would have been homeless without these programs.

In 1978, an analyst for the Department of Social Services (now called the Department of Human Services), which administered these programs, produced a report to change the General Assistance program. The report recommended dividing the G.A. caseload into three groups: the permanently disabled, the temporarily disabled and the employable.

Workers assigned the permanently disabled would work to get their clients on Social Security disability (known as OASDI) if they had worked long enough to qualify, or on VA benefits if eligible, or on SSI which was federal/state welfare for the disabled poor. If G.A. clients got on these government programs, the county would be reimbursed for its costs back to the application date from the client’s retro check, and the client would receive welfare benefits that exceeded G.A. payments. G.A. clients who were employable were referred to ETRS for jobs.

But because of the generous G.A. payments and difficulty proving residence, there was an unacceptable level of fraud. People who didn’t live in the county would get aid. People with excess assets would receive benefits to which they were not entitled.

To address this issue, the analyst recommended turning G.A. into an in-kind benefit program. The client would receive little or no cash but get a place to live, food stamps, Medi-Cal and a Muni fast pass. The analyst recommended the City buy the many rundown and filthy residential hotels that clients were living in, fix them up to be clean and safe, and offer them to the clients rent free. The hotels would have been bought either through normal real estate transactions or, if necessary, by eminent domain or police power. Real estate values in the late 70s were a small fraction of what they are today. These hotels are worth many times as much as they would have cost the city in 1980.

While the recommendation to divide the caseload was eventually accepted, the idea about making G.A. an in kind program and buying hotels was rejected by those on the Left and the Right. The Left objected because they wanted clients to have cash to spend as they freely chose. The Right objected to the government replacing the private sector in real estate. It looked like socialism to the Right.

Years later, a young member of the Board of Supervisors with greater political ambitions, unveiled a program called “Care not Cash” which was a move to an in-kind G.A. program but without G.A.

Around the same time, a young American President, eager to reduce the budget deficit, changed the AFDC program into a workfare program. The idea was to end generational welfare and get people back into the work force. There was no more AFDC for the long term poor families to turn to. 

Now, in 2014, the homeless problem in San Francisco has grown from a few hundred in 1980 to as many as 7,000, including children. Every neighborhood now has homeless people sleeping on park benches or city sidewalks; raiding garbage cans for bits of food or recyclable bottles and cans; relieving themselves in public; using public bathrooms for bathing; dressed in rags and suffering in ways the rest of us could not bear and no one should have to. Many of the homeless here have health problems that only get worse with neglect. Many wind up at San Francisco General Hospital needing in patient or out patient treatment.  Many have serious conditions like AIDS, Cancer, diabetes, kidney failure, liver damage, pancreatitis or heart disease.

There are many good people working hard to help the homeless. The city has a program to coordinate with non profits to find more residential opportunities for the needy. Good work is being done in the Tenderloin and the Mission to convert some sleazy hotels into attractive and safe homes for those so in need of them. Charitable organizations are providing clothing and free food to thousands of people each day. Citizens are generously donating their clothing to non profits and charities to clothe this population. The staff at San Francisco General provide excellent medical care to their homeless patients.

But none of this is enough. What should be done?

I think that the analyst who wrote the G.A. report 37 years ago would recommend the following:

The homeless should first go to San Francisco General Hospital to apply for assistance. There they will be identified with basic information like name, birth date, place of birth, social security number and any known medical information. Some might be missing from friend and family who would like to help them. Some might need immediate medical attention. Each person should get a complete physical and a warm shower or bath. While at SFGH, they can get clean clothing selected from the very large inventory already at SFGH.

If the individuals are deemed to be permanently disabled or aged, eligibility workers there should evaluate whether they are eligible to government aid such as VA, OASDI, or SSI, Medi-cal and food stamps. They could then be placed at Laguna Honda’s old, now vacant hospital. It has capacity of more than 300 beds. It was closed when the new facility was built. The new one is more earthquake safe. The old one has never lost a patient to earthquake and probably never will. Patients here die on their own since they have advanced conditions that are usually terminal.

If the individuals applying for homeless assistance are temporarily disabled, they could soon be housed at what will be the old SFGH when the new hospital is completed next year. Old SFGH could house hundreds of  temporarily disabled people providing them with a safe comfortable room and bathroom as well as medical attention to bring them back to health.

If the individuals are deemed employable, with no serious medical or psychological conditions, they need to be housed in safe, clean SROs many of which are in the Tenderloin, SOMA, downtown and Mission districts or in well managed housing project units. Those not already run by non profits dedicated to helping the homeless should be brought up to code and decency for the homeless.

Since these people are healthy enough to work, they should be given work to do in the City to partially pay back for all that they will receive from it. They can help clean and fix their own buildings, pick up litter in the neighborhood, and can help park workers keep the weeds from overwhelming them. Some can help feed the homeless. Others can help other programs intended to help them. Some can collect recyclables that are not already in garbage cans.

Those who can work should does so, not only to contribute to their community, but also as a way to come back into the mainstream, slowly but surely. It also gives them something to do and a feeling of worth raising their self esteem.  

It would seem that most people who are homeless in San Francisco would jump at this idea. It is hard to imagine many preferring to live out on the streets instead of getting a chance to enjoy are more normal life. But those who do prefer the outdoor life should be discouraged from this lifestyle. Those who are too mentally challenged to make this obvious choice can be brought to SFGH on a 5150. This allows them to be kept under observation for three days or as long as 14 days. During that time, these people can go through the same process. After three days of having nice warm meals, new clothes, a few warm baths or showers, and a clean comfy bed to sleep in, many of these people might want to join the program. Those who are healthy and still don’t want in would be released but advised that they can not sleep or eliminate waste products wherever they want. They must get housing on their own and not in city parks or city sidewalks.

These ideas come with a price tag. Running the old SFGH and Laguna Honda will require additional staff and 24 hour coverage. Since all the patients at both should eligible to Medi-Cal, some of these costs should be reimbursed. The aged and permanently disabled would be eligible to Social Security benefits if they worked long enough or SSI if they didn’t. SSI pays $877 or $961 (if living in an SRO) a month per person. This money could go toward paying for their living costs. Food Stamps, now called SNAP, provides $189 a month for an individual and $632 for a family of four. These benefits can go toward feeding the homeless.

And homeless activists must agree that this idea is much better than anything their people have now. They should advocate for this by urging every homeless person to come in out of the cold.