We're getting out of the shelter business." At no point did he mention implementing shelter health and safety standards.
James Leonard, a member of the Shelter Monitoring Committee who has spent the past 18 months homeless in San Francisco and San Diego, won't stay in the shelters anymore. All of his possessions were stolen three times. He missed several job interviews because he couldn't charge his cell phone. Frustrated, he hit the streets again. The Homeless Outreach Team found him, officially dubbed him "shelter challenged," and gave him a stabilization bed, which he hopes will eventually transition into a lease in a single-room-occupancy hotel.
He told us the lack of standards contributes to the problem of chronic homelessness because more people would stay in the shelters, off the street, if they were safe and treatment were consistent from facility to facility.
"People keep looking at what's wrong with those homeless people and keep skipping over what's wrong with those shelters and some of those staff members," he said. "It's a system set up to fail unless it has standards."
The issues extend beyond each shelter's four walls. It's a matter of public health for all San Franciscans. "Even if the shelters exist for a minute, they have to be healthy and humane," said Dr. Deborah Borne, medical director of homeless programs at the HSA's Tom Waddell Health Center. "Because if they aren't, they're a danger to themselves and to others."
She cited the example of sitting on a Muni bus beside someone whose bag may be carrying bedbugs. "Everyone in San Francisco is affected by the fact that we have health issues in the shelters."
Borne moved from New York to San Francisco about a year and a half ago. On her fourth day on the job at Tom Waddell, a resident died at Next Door, which houses about 250 people per night and is one of the city's largest shelters. She said the death was not the fault of any specific department, agency, or person, but it could have been avoided if some basic health and hygiene practices were standard for shelter staff and residents.
She brought together several key people, secured $300,000 in funding through HSA director Trent Rhorer, and launched the Shelter Health Initiative, a pilot project that included some of the standards that are part of Ammiano's legislation specifically targeting health and hygiene.
Next Door and Hamilton Family Center participated, were surveyed on needs, and received adequate supplies of things like soap, hand towels, sanitizer, and gloves. "Up to the date of the training, they still didn't have available the basic equipment required to protect themselves," said Jill Jarvie, a public health nurse from Tom Waddell who ran the pilot program.
It's not enough to have cases of rubber gloves and hand sanitizer. They have to be used, and used properly. "Something like a cold virus can stay alive for a couple of days," Jarvie said. Close conditions in shelters compound the risk. "When you're working in a place that sees 300 people a day, how you wash your hands can really make a difference," she added.
Thorough hand-washing techniques and procedures for cleaning up bodily fluids taught to staff trickle down to residents, and so far, it's working. According to Jarvie, Next Door has reported a decrease in illnesses. "It's been exciting to see we can actually do this," she said. The price of the pilot was about $15,000, a cost that would fall over time through bulk purchasing of supplies and as training becomes more standardized. Soon public health officials will be launching another phase, focused on bedbugs and scabies.
An initial budget analyst's report, based on information provided by the HSA, predicted a $6.2 million price tag to fully implement standards throughout the city's shelter system.
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