Even those who disagree on housing solutions can often find common ground around one given fact: People with safe and supportive housing are less likely to suffer from physical health conditions, mental illness or substance use.
So when the pandemic reached the Bay Area in March 2020, San Francisco launched a bold shelter-in-place program that would make good use of hotel rooms going empty during the pandemic. The emergency program provides private hotel rooms, meals and connections to health care for otherwise unhoused residents in San Francisco. Over the course of the pandemic, it grew to include 25 hotels and housing more than 3,800 individuals.
Now, experts at UCSF studying the impact of the shelter-in-place hotels say the program has helped keep residents healthy while lowering the number of emergency room visits at a time when hospital resources are already strained.
“Our data is not complete, but everything we have preliminarily shows this is a really effective program,” said Naomi Schoenfeld, a medical anthropologist and principal investigator on the study. “We know for sure that there have been reductions in mortality in overdoses for people inside versus on the street.”
But much of that progress is at stake now as San Francsico moves ahead with plans to wind down the emergency shelter program.
“By consolidating the hotels, they are losing hundreds of beds that could be used for these health outcomes that instead are going to the private market,” said Carlos Wadkins, the human rights organizer for the Coalition on Homelessness.
The plan is to relocate residents to permanent supportive housing. But The City is still working out the details on exactly where and what those longer-term solutions might entail. That has some medical practitioners and housing advocates fearful for those who might get lost in the uncertainty and difficult process of uprooting yet again.
As of Sept. 22 there are 1,600 shelter-in-place hotel residents currently, and 2,089 have exited, according to San Francisco data.
Numerous studies have shown that a steady roof over one’s head has a range of health benefits, from calming the nervous system, to better environmental health conditions, to giving people the time and planning needed to attend doctor’s appointments and maintain regimens.
And the shelter-in-place hotels have gone beyond basic shelter to help unhoused people stay healthy during a global pandemic. Residents were able to access care at their hotels including COVID and HIV testing, wound treatment, physical or occupational therapy, psychiatry and assistance with insurance.
The UCSF research found that providing unhoused residents with stable housing in the hotels led to a reduction in emergency room use, an increase in outpatient primary care and a reduction in substance use.
“People have their own room and bathroom, and they’re delivered three meals per day. That as a baseline of humanity and dignity goes a long way,” Schoenfeld said. “But the added role of nursing staff helps people begin to develop trust, and some did a really good job helping people feel safe and respected.”
Experiences and types of health care services vary among the sites, ranging from full-time nursing available five days a week to one half-day of nursing care per week. Residents receive intake evaluations to assess medical, mental health and substance needs and are then connected with in-home health support including physical or occupational therapy, psychiatry and other primary care, according to Schoenfeld.
Those connections alone are precious, health advocates say, especially among individuals who have learned to distrust government and health care systems that may have neglected them in the past.
“Some folks already have a health care provider or clinic they like to go to. But a lot of people aren’t able to meet those appointments or don’t have electricity to keep informed,” said Wadkins. “Just the stability of a hotel room allows people to access their health care.”
San Francisco is now in the process of moving residents out of the shelter-in-place hotels and into permanent housing, a stated goal of the program from the start. The process is expected to continue through September 2022, according to Deborah Bouck of the San Francisco Department of Homelessness and Supportive Housing.
“Our focus is on rehousing guests and transitioning them to their new care providers who will coordinate medical care and other supportive services,” said Bouck.
But already efforts to purchase hotels for long-term housing in San Francisco have been met with fierce pushback. Take the situation that’s unfolding in Japantown at the Kimpton Buchanan Hotel. On Sept. 7, city officials decided to slow plans to convert the 131-room tourist hotel at 1800 Sutter St. into permanent supportive housing after neighbors said it would hurt the economy and tourism in Japantown, which itself has a history of marginalization.
Supervisor Dean Preston, whose district includes Kimpton Buchanan, has since proposed that The City purchase two other hotels in his district for permanent housing, the Majestic Hotel at 1500 Sutter St. and the Gotham Hotel at 835 Turk St.
Facing those hurdles, plus the challenges of uprooting individuals who are medically fragile, health experts say The City should pump the brakes on plans on winding the program down yet.
“I’m worried, I’m really worried,” said Schoenfeld, who is also a nurse practitioner. “We can’t close the hotels now. It’s not safe and it’s not humane. The pandemic is not over. There are a lot of questions around new variants and waning vaccine efficacy, and there’s funding for this.”
Twenty of the original 25 hotels remain operational currently. And while President Joe Biden has promised to continue to reimburse emergency COVID-19 costs such as the shelter-in-place hotel program through the end of 2021, city officials are slowly but surely moving forward with plans to relocate residents over the course of the next year.
To be sure, Schoenfeld and Wadkins support the pathways to permanent supportive housing. But they fear that people will fall off in the process, putting some back in the position they were before the pandemic.
While the program has been a lifeline for some residents and The City’s hospital system during the pandemic, its reach is still a far cry from the 8,250 rooms sought by some members of the Board of Supervisors back in 2020.
The City estimates there were 8,035 homeless residents in 2019, the latest available count, which marks a 30% increase from two years prior. Many shelter-in-place hotel residents are above 50 years old and live with pre-existing health conditions, putting them at greater risk of COVID-19 and other illnesses if transfers to permanent housing aren’t successful.
“The City has underutilized these resources,” Wadkins said. “There are people on the street and in hotels who could use this. Each hotel they close is that many people they could be intaking.”