Marc Trotz, Director, Housing

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• Marc Trotz, Director, Housing Urban Health
• San Francisco Department of Public Health
• Email marc.trotz_at_sfdph.org

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Why does the Department Invest in Housing?

• Reduce over-utilization of high-end healthcare
  resources.
• Increase the effectiveness of DPH services by
  providing a safe and healthy environment for
  clients.
• Provide housing tailored to the needs of clients
  and provide community based exits from DPH
  institutions.

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Who Do We House?

• Chronically homeless
• People with complex medical BH disorders
• People with a history of institutional care
• People who have never or not successfully been
  housed

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Utilization of Resources

• 3 times more likely to use ED than general
  population1
• 40 use the ED at least once each year1
• 10 used 40 of hospital days2
• 1Kushel et al, UCSF, 2003
• 2Fernandez et al, UCSF 2000

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Characteristics of the Homeless(n2508)

• 75 male, 45 African American
• 30 of males are veterans
• 63 were current or past cocaine smokers with 35
  reporting current use
• 39 had a history of using injection drugs
• 23 hospitalized for mental illness
• 63 had behavioral health disorder
• Robertson et al, UCSF, 2003

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DAH Units
New
New
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Direct Access to Housing Program (DAH)

• Permanent housing
• Master-Leasing
• Low threshold- directly from streets and
  institutions
• On-site support services

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Practicing Low-Threshold Supportive Housing

• Screening-in
• Voluntary services
• Active engagement
• Tenants rights

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DAH Services

• Support services (case mgmt)
• Medical care (nurses, NP, MD supervision)
• Behavioral health team
• Property management
• Third party rent payment

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Referral SystemAccess Points

• Street outreach teams
• Emergency shelters
• Community based organizations
• High-utilizer case mgt teams
• Primary care clinics
• Institutional settings

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Financial Information

• 400 Support Services
• 400 Lease
• 400 Property Management
• 1,200 per unit per month
• Residents pay fifty percent of their income
  towards rent.
• (avg. rent paid is 300)

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Federally Qualified Health Centers

• Healthcare for the Homeless Clinics
• Higher rate of reimbursement to
• Cover uninsured
• Cover wrap around care for complex people
• Has been used to support short-term housing- e.g.
  McInnis House in Boston

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Federally Qualified Health Centers

• Reimburses for face to face interactions
• Flat rate reimbursement- 209 in SF
• Reimburses for
• Medical Doctors (including psychiatrists)
• Physician Assistants and Nurse Practitioners
• LCSW (not MFT)
• Not nursing

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Federally Qualified Health Centers

• Example of potential revenue
• Example A
• 100 unit building with some on-site services
• 10 Medicaid patients seen weekly
• 10X209 2090/week 108,000/year
• Example B
• 100 unit building with extensive services
• 20 Medicaid patients seen daily (5 days/wk)
• 20x2094180 1,086,000/year

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DAH Housing Outcomes

• Two thirds of residents remain housed for gt 2
  years

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DAH Housing Outcomes
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DAH Healthcare Outcomes

• 58 reduction in emergency room use.
• 57 reduction in hospital inpatient bed use.
• Reduction in length of psychiatric
  hospitalization
• Kessel and Kushel, UCSF, 2003

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Windsor Hotel
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Broderick Street Adult RCF
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Pacific Bay Inn
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• Marc Trotz, Director, Housing Urban Health
• San Francisco Department of Public Health
• Email marc.trotz_at_sfdph.org