Marc Trotz, Director, Housing

1

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

2
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

3
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

4
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

5
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

6
Direct Access to Housing Program (DAH)

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

7
DAH Services

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

8
Referral SystemAccess Points

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

9
Practicing Low-Threshold Supportive Housing

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

10
DAH Units
New
New
11
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)

12
DAH Housing Outcomes

• Two-thirds of residents remain housed for gt 2
  years

13
DAH Housing Outcomes
14
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

15
Windsor Hotel
16
Broderick Street Adult RCF
17
Pacific Bay Inn
18

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