Providing more supportive housing is the best way to heal the homeless

San Francisco must act quickly to acquire more hotels and other sites

By Diane Qi and Rani Mukherjee

As COVID-19 spread, cities nationwide were forced to confront the homelessness crisis in a new light: large groups of unhoused people sleeping in encampments or shelters became high-risk for COVID-19 transmission. In response, in the span of only six months, San Francisco opened up 25 Shelter-In-Place hotels to shelter more than 2,500 people.

For many residents, the hotels have become a refuge for healing from the physical and mental strains of living unhoused. One resident’s experience managing their diabetes illustrates this pivotal connection between housing and healing:

“[Before the hotel] I was looking really, really bad. My kidneys were shutting down, my health was going down rapidly…Due to a…lack of time and privacy, I wasn’t really paying as much attention to it as I should have…When you are around people all the time, it’s difficult to have thoughts to yourself, to ponder pros and cons or make decisions that are so important regarding my health…With moving, I was allowed time, medicine, and support from the medical staff…[Now], I’m on top of my diabetes. My [blood sugar] has come down incredibly…Things are looking up.”

In the hotels, all residents are screened for their health and social needs and are able to connect to primary care, mental health care, substance use treatment, physical therapy, and social services. Often, these services are delivered directly in hotel rooms.

Naomi Schoenfeld is a nurse practitioner and a medical anthropologist who provides medical care in the hotels and is currently researching how the hotels have impacted the health of the residents. She shared her experience with us: “

I have seen remarkable improvements in some patients’ health. The hotels have been very successful at connecting patients to the services they need. People with severe leg ulcers, ulcers that were simply not getting better because of the instability of homelessness, are finally getting the wound care they need. But beyond the healthcare services, it’s also the simple dignity of housing that has allowed patients to heal. Having a chance to rest, to use the bathroom without having to run from place to place, to have three nutritious meals per day — these basic dignities are prerequisites for managing any health condition.”

The Shelter-In-Place hotels have shown us that a radical restructuring of our housing system is not only feasible, but healing. Now, we should build on this moment to meaningfully address housing inequity in the city, even beyond the pandemic.

In the medical community, we know that homelessness leads to negative health outcomes, and that the most effective solution to homelessness is permanent supportive housing: housing that, like the Shelter-In-Place hotels, offers medical and social services, but unlike the Shelter-In-Place hotels, are permanent.

Right now in San Francisco, we have a rare opportunity to reduce homelessness by investing in permanent supportive housing. Between newly released Proposition C funds, state and federal emergency relief funds, bond money, and a declining housing market with hotels and student housing complexes for sale, we are in a unique position in which funding and buildings are, for once, not a barrier. It is well within capacity for the City to urgently purchase at least 600 new permanent supportive housing units for unhoused people, including those who were not offered a hotel room.

As clinicians we are often on the receiving end of the failures of a revolving door care system, and limited to band-aid solutions. But, in this moment, we have the perfect confluence of opportunities to address the source of sickness. Housing is the cure. We implore the city to act now and acquire hotels and student housing as permanent supportive housing.

Diane Qi and Rani Mukherjee are medical students at UCSF who provide care to unhoused patients. They are both involved in research and advocacy at the intersection of health, housing and homelessness.

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