City struggles to meet housing needs of growing number of homeless with disabilities

City struggles to meet housing needs of growing number of homeless with disabilities

James Johnson currently has a roof over his head, but prefers to spend much of his day outdoors because he does not feel safe inside the Medical Respite and Sobering Center where he has lived for a year-and-a-half.

Sobriety is not a requirement for most housing and shelter options for the homeless in San Francisco, but Johnson said that he has been sober for 16 months and has completed the necessary programs to qualify him for the next step in The City’s system of care — permanent supportive housing.

But Johnson has remained stuck at the facility despite having received two offers of housing. It’s not because he doesn’t want a permanent home, but because The City has twice failed to provide him with a unit that is accessible for the wheelchair he must use, Johnson said.

The City is required to follow local, state and federal disability and fair housing laws when housing the formerly homeless, with some exceptions, experts have told the San Francisco Examiner. However, Johnson’s story illustrates how difficult it can be for The City’s disabled residents to get into supportive housing.

It also highlights continued challenges in The City’s rollout of a data-driven Coordinated Entry system, which is supposed to prioritize and quickly house the most needy residents amidst scarce resources.

Despite the new system, The City has struggled to find an accessible unit for Johnson. City officials interviewed by The Examiner about his case were unable to even say how many permanent supportive housing units are currently accessible for tenants with disabilities.

The medical respite center where Johnson is staying provides “post-acute, recuperative medical care” for people who have nowhere to go after a discharge from the hospital, according to its medical director, Dr. Kelly Eagan.

It is not meant to be a permanent housing solution, and Eagan said client stays average about eight weeks.

“I would like to know why I am still sitting at this respite? I’m taking up a bed that someone else could use,” said Johnson on a recent Wednesday.

Disability rights advocates say that a lack of adequate affordable housing has caused homeless clients to languish in inappropriate care settings before.

Bill Hirsh, executive director of the AIDS Legal Referral Panel, said that his organization is aware of “many instances where there are people that are stuck in levels of care they no longer need because there isn’t an affordable housing opportunity for them.”

“This happens at multiple points in the system. Sick folks who are at Laguna Honda — well they get better and don’t need care there. But there is no place for them to go. They are stuck in a bed at Laguna Honda that costs The City a ton of money. Someone else might need that bed but can’t get in,” said Hirsh.

Johnson said that the respite facility has allowed him to recover from a number of serious health issues related to his drug abuse, and without it, he would likely be on the street. But he has long since recovered from a major surgery in February and no longer feels safe there.

“Living there is horrible,” said Johnson. “We have to deal with feces and urine on the ground of the bathroom for 24 hours at a time.”

Inside the center, clients’ beds are divided by partitions and separated by just a few inches of space. A few months ago Johnson’s neighbor’s colostomy bag burst in the middle of the night, with no janitor on site to clean it up, he alleged.

Johnson filed a complaint about substandard conditions and bullying in the facility. Since then, he alleges he has faced retaliation from staff there.

He added that his insurance suspended support for a physical therapy program he was ordered to complete following a surgery earlier this year that left him permanently disabled, because the center lacks space to perform the exercises.

“Everyday I’m here I’m living with stress and anxiety and right now, depression,” said Johnson.

New priorities

Johnson’s first housing offer came in December 2018 as part of The City’s now defunct Direct Access to Housing program, for a unit at the Pacific Bay Inn, which Johnson said was not able to accommodate his wheelchair.

“I couldn’t get into the building. I could barely fit in the elevator — I had to force myself to stand up in the wheelchair, holding on for dear life to avoid the door closing on my foot,” said Johnson.

“In the unit, I couldn’t even get in the bathroom. There [were] no handicap bars,” he added.

Johnson said that he was forced to reject the unit and thought that a new offer would follow shortly — but he didn’t get as much as a follow up call.

The City began prioritizing families for Coordinated Entry in 2017, and single adults in mid -2018, according to Jeff Kositsky, director of the Department of Homelessness and Supportive Housing (HSH). He described the new system as a “major sea change” that is between two to five years away from “really being done.”

The system prioritizes clients based on how long they have been homeless, chronic illness and acuity, or risk of homelessness, among other things.

It was set up to help avoid issues like Johnson is facing. Most of the estimated 8,011 people who are homeless in The City on any given night have some type of disability, whether mental or physical, like Johnson does, said Kositsky.

“It’s been a slow rollout and it’s been very choppy. But we are getting there,” he said about Coordinated Entry, adding that other cities that have already implemented the system, like Houston, have had significant successes in reducing homelessness.

“People used to have to get on 40 different waiting lists. Now you don’t have to get on any waiting list. So I think [the system] is a lot more respectful [to clients],” he said.

Homeless clients who are ready to be discharged from the medical respite center can either be placed in permanent supportive housing, if they are prioritized under Coordinated Entry, or in a Navigation Center or a 90-day shelter bed if they do not meet the new system’s eligibility requirements.

About 15 to 20 percent of the medical respite center’s clients meet the prioritization requirements, according to Eagan. Johnson is among them.

Once an apartment matching a client’s needs becomes available, an appointment to view the unit is scheduled, said HSH Spokesperson Abigail Stewart-Kahn, who added that clients have “an opportunity to view up to three apartments.”

If a client turns down an apartment, they must wait for the next apartment that meets their needs to become available, she said.

Johnson was prioritized earlier this year and over the summer received a second referral for a unit at the Canon Kip Senior Center, with an appointment scheduled on Sept. 5.

Scarred by his previous experience at the Pacific Bay Inn, Johnson decided to be proactive. He informed the case manager facilitating the referral at the time that he is paraplegic, and says he even sent pictures he took in the Pacific Bay Inn unit to demonstrate what type of unit doesn’t work for him.

But once again Johnson, was shown a unit with a bathroom that could not accommodate his wheelchair. He was told by a representative of Canon Kip’s property management company, Caritas Property Management, that they would look into it and that he could request accommodations while a background check was being processed.

A few weeks later, however, Johnson said he got a call informing him that his application to Canon Kip was denied, reportedly not because of “the ADA accommodation requested, but for my background.”

“I said what? This is bizarre. They told me the unit was mine. Why would I be denied? I thought this was emergency housing,” said Johnson.

Background check

Johnson is up front about his criminal history.

A San Francisco native, Johnson grew up with a single mother and four siblings on the 17th floor of Visitacion Valley’s notorious Geneva Towers, a public housing project that has since been demolished.

His life took a traumatic turn at age 7, when his mother was violently assaulted, he said. The attack placed her in the hospital while her children were left to fend for themselves for weeks before anybody noticed.

After that, Johnson and all but one of his siblings were placed in foster care, where they suffered varying forms of abuse. After aging out of the system, Johnson found himself teetering on the edge of homelessness and without a high school diploma.

He soon became addicted to crack cocaine, and “struggled with it for all of my life,” he said.

At the height of his addiction, Johnson said he “robbed some people” for drug money, leading him to serve nearly 16 years of a 19-year sentence.

After his release in 2014, his life spiraled downward after he nursed a dying girlfriend and his own health deteriorated from years of drug abuse. Johnson was eventually treated for Hepatitis C and a hip infection.

Sixteen months ago, he realized that he needed to straighten out his life and sobered up so that he could get access to surgery and critically needed health care. He hasn’t looked back.

“I cleaned up,” said Johnson. “They attached me to services. I was going to my doctor appointments because I feared going to a shelter. Now that I’m sober, I’m like, ‘Oh no, I don’t want to go there.’ They are horrible.”

While it is illegal to deny housing due to a person’s race or disability status, housing providers have some discretion in declining potential tenants for criminal backgrounds. Kositsky identified the issue as something the department is working to address.

“With Coordinated Entry, the way it’s supposed to work is that we send clients to a unit and they get to move in. But the reality of it is, given how housing law works, that the property manager has a right to do a screening and to decline a client,” he said during an interview last Friday.

He said there are “certain things” that make it “hard to get housing anywhere.”

“We hardly screen anyone out,” Kositsky said, but added that “we haven’t quite made uniform policies.”

But Johnson said he was not notified about the Fair Chance Ordinance, which among other things dictates that potential affordable housing tenants have a right not to be asked about prior convictions on a rental application form, until after he participated in an appeal hearing regarding his background check on Sept. 26.

Johnson said he entered that hearing with a Caritas representatives, but did not have his case manager present or representation from The City. A request for comment to Caritas’ director of property management was not returned by press time.

Only this past Friday, following inquiries by the Examiner, was Johnson notified that his appeal had been granted, and that he now qualifies for housing at Canon Kip.

HSH officials could not comment on the specifics of Johnsons’ case, citing privacy protections in regard to medical information. Stewart-Kahn said that the department must “balance the needs of each individual with our ethical responsibility to the whole community they are moving into.”

She said if a client has had previous issues with a housing or shelter provider, those issues must be worked through and could prevent a client from being placed in a particular building.

But Johnson said that he has never lived in a shelter or come into contact with The City’s homelessness system before.

“I have been in jail for most of my adult life,” said Johnson. “The only thing that is going on here is that they keep offering me units for people who can walk.”

A lack of data

The City’s current permanent supportive housing portfolio for homeless individuals with mental, physical, and substance use disorders is comprised of 7,939 units across some 70 buildings, of which roughly 800 to 1,000 turn over annually, according to Kositsky.

But even the department has been unable to respond to a request for information on how many of those units are currently accessible to people living with disabilities, including those in wheelchairs.

“What proportion of HSH’s permanent supportive housing profile is ADA compliant is not a question we can fully answer at this time and we are working towards that,” said Stewart-Kahn.

“We are always trying to increase our portfolio with new developments and with what is available in the housing market,” Stewart-Kahn added. “Understanding that there are challenges with existing buildings that make ADA compliance difficult, in order to increase our compliance in permanent supportive housing, anything that is developed and owned by The City follows some very strict guidelines around proportions that have to be compliant.”

Some of the supportive housing buildings are newly constructed and designed to accommodate a variety of needs — like the 120-unit Richardson Apartments, a building that came online in 2011 and features accessible or adaptable bathrooms.

“The level of thought and detail that we put into designing those buildings is down to the way the bathroom doors open. So if somebody overdoses or passes out in the bathroom, the door swings in the right direction so you can get in,” said Kositsky, formerly with Community Housing Partnership, which designed and spearheaded construction of a number of new supportive housing buildings.

In 2014, the requirements for ADA mobility units increased from 5 percent to 10 percent in new developments, including permanent supportive housing, and the requirements for visually and hearing impaired households increased from 2 percent to 4 percent.

According to the Mayor’s Office of Housing and Community Development, all units in new developments are either fully accessible or adaptable to meet individual needs, including physical disability, and some 1,188 permanently supportive housing units are currently in the pipeline.

But a majority of The City’s Supportive Housing units are located in existing Single Room Occupancy hotels and other buildings master-leased by The City to meet a growing need for rehousing its homeless population. Many of these buildings are privately or nonprofit owned and managed.

“Trying to take a master-leased site and make it work is really hard,” Kositsky said.

Those buildings rarely come accessible for people living with disabilities, said Hirsh, of the AIDS Legal Referral Panel.

While all supportive housing buildings are covered by the federal Fair Housing Act, and the disability portions of it by the Fair Housing Amendments Act (FHAA), there are “different requirements for new construction and [rehabbed] existing buildings” in regard to ADA compliance, he said.

“What The City often does is make some limited improvements to the [older] buildings to make sure that they comply with basic codes that The City has,” said Hirsh.

Hirsh said that his organization and other disability rights advocates worked to establish a Housing Modification Fund to sponsor such improvements.

“The City has some money to [install] grab bars in bathrooms, for example. Someone at risk of losing housing because they can no longer use their restroom can access a fund from The City to fix the bathroom so they may be able to stay,” said Hirsh.

Kositsky said that he was “shocked” when he stepped into his role in 2016 and “looked at the pipeline for housing” and saw that “there was zero new units for single adults, chronically homeless people.”

Kositsky added that then-mayor Ed Lee “quickly changed direction, and we added like 900 units into the pipeline which is great. But the problem is…this takes time.”

According to Kositsky, the first of those units — which would serve high priority clients like Johnson — are not scheduled to come online until 2021.

In the meantime, Kositsky said the department will “facilitate transfers” if clients are placed in buildings that no longer meet their needs.

“There’s a guy who I know who ended up getting housed a couple months ago and then he got really sick with cancer and he just needs to be in a different kind of facility,” said Kositsky. “We will eventually accommodate his request. We can do that. It just takes time.”

But for those battling life-threatening illnesses out on the streets or in substandard shelter settings, time is of the essence.

“If people have to wait, people are going to die. That’s what’s happening — since I have been here [at the respite] six guys have died. People most likely will relapse,” said Johnson, adding that drug sales occur on a daily basis immediately outside of the South of Market facility. “I’m on the verge of relapsing every day.”

Jessica Lehman, executive director of Senior and Disability Action, said that while it is not uncommon for people like Johnson to languish at the wrong level of care, she identified it as an “equity issue.”

“The City’s Coordinated Entry system and Behavioral Health system need to make sure that they are providing equal services to people with disabilities,” Lehman said. “If the expectation is that when someone has completed a recovery program that they get moved into housing so they can stay sober, then that needs to be possible for people with disabilities as well.”

“It’s not enough to say, ‘oh you can have this unit — sorry it’s not accessible.’ The City obviously has a clear legal responsibility to make sure accessible units are available,” she said.

Susan Mizner, a disability lawyer for the ACLU who for nine years served as director of the San Francisco Mayor’s Office on Disability under former Mayor Gavin Newsom, said that while most housing is subject to the FHAA, The City “has an independent obligation under Title II of the ADA act to ensure that its programs are equally accessible to people with disabilities.”

“That includes equally accessible to people in wheelchairs. It does appear on its face that there is a problem here,” she said.

Mizner said that there are some exceptions under FFAA in regard to renovated permanent supportive housing buildings — for example, if a two story building doesn’t have an elevator, there is “no obligation that the units on the second story be ADA accessible.”

While working for The City, Mizner said she “repeatedly asked for assessments of the number of applicants who needed accessibility because that assessment would then dictate construction,” she said. “I don’t believe that I ever got that number.”

In regard to Johnson’s housing offers, Mizner said that the accessibility needs of “this population should be front and center criteria for how [The City places] people.”

“Poverty disables and disability impoverishes,” said Mizner.

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