San Francisco Chronicle - Corporation for Supportive Housing by opzroyikiwizik


Signs of hope in helping S.F. homeless turn lives around
On-site medical, psychiatric aid makes housing program work at
reasonable cost
By Kevin Fagan
May 9, 2004
                                                       complex, all cleaned and restored to pristine shape,
If chronic homelessness truly ends one day in San      and a bevy of nurses, doctors and counselors
Francisco, historians may well look back on Jan.       staffing those buildings around the clock. Within
16, 2004, as the day the ending began.                 these buildings live 400 residents drawn from
                                                       among the most troubled, dysfunctional homeless
                                                       people in San Francisco -- heroin and crack
That‟s when more than two dozen experts from
                                                       addicts, severe alcoholics, the mentally ill and the
around the country gathered with national
                                                       severely disabled.
homelessness czar Philip Mangano and new Mayor
Gavin Newsom at City Hall to bat around ideas
for helping the down and out get off the streets.      The remarkable thing is that they stay. Trotz‟s
The leaders heard about innovative programs in         charts showed that of the 650 chronically homeless
Atlanta, Philadelphia and New York -- but then         people housed by Direct Access since it began five
came the stunner.                                      years ago, 85 percent have remained housed --
                                                       compared to a turnover rate of about 75 percent in
                                                       most other supportive housing programs in the
Marc Trotz, director of housing and urban health
                                                       country, which typically serve a less troubled cut of
for the San Francisco Department of Public
                                                       homeless people.
Health, took the podium and described a pilot city
program that was not only proving effective, but
also was costing a pittance compared to the $200       This means Direct Access residents stop sleeping
million that San Francisco spends every year           in the streets. And stop panhandling. And live
directly and indirectly on homelessness.               healthier lives.

“We think it works,” Trotz, a thin, bespectacled       The price tag for this entire enterprise is only $5.5
man, said in his characteristically quiet voice. “It   million a year. There is an added benefit: Half of
really works.”                                         its budget is paid by federal, state and private
Trotz was describing Direct Access to Housing, a
program that national homeless experts believe         Mangano, who as executive director of the U.S.
might be the most effective solution in the United     Interagency Council on Homelessness is urging
States today for eradicating chronic homelessness.     cities to draft 10-year plans to end chronic
                                                       homelessness, told the roomful of experts: “This
                                                       (Direct Access) is one of the most amazing
Deceptively simple in concept, the program in San
                                                       programs I have ever seen. We all need to beg,
Francisco consists of five formerly ratty, bottom-
                                                       borrow and steal from each other any program
rent residential hotels and one small housing
that works -- and let me tell you, this is one you     She takes a daily cocktail of medications that
need to steal.                                         control her bipolar disorder, dresses in snappy
                                                       suede or silk outfits -- and, in short, looks nothing
“Steal it! It is phenomenal!‟‟                         like the walking disaster she used to be.

The reason for success: More than any other            “For years, I looked after everyone else in the
program of its type in the city, and even in most of   world, didn‟t care what happened to me,” Spillane
the nation, Direct Access goes heavy on medical        said one day, at dawn, as she strolled from Eddy to
and psychiatric support in the buildings where the     Market Street to catch a bus. “Now, I still care.
formerly homeless live.                                But I look after me. I keep straight. I am an
                                                       example. I don‟t backslide.”
“This is where we are headed. This is what I
want,” said Newsom after the January meeting.          The bus she was catching was No. 9. As she got
And since then, as he began the creation of his        on, she was joined by four of her street pals -- all
own 10-year plan, Newsom‟s main thrust toward          of them ex-junkies, like Spillane. They were headed
clearing the 3,000 hard-core homeless off the          to San Francisco General Hospital‟s methadone
streets has been toward programs like Direct           clinic for their daily dose.
                                                       “You could call this the „Meth Express,‟ “ Spillane
“Things like this take time and patience, and that‟s   said with a chuckle as she watched more ex-addicts
what San Francisco‟s program has,” said Maria          get on with every stop -- about a dozen in all, by
Foscarinis, executive director of the National Law     the end of the ride. “And this is what it‟s all about.
Center on Homelessness and Poverty, a nonprofit        Staying clean.”
agency in Washington, D.C. “We have learned that
the only way to go, really, is housing and             While they waited for their doses at the clinic, they
supportive services combined -- and it doesn‟t get     swapped street stories -- and Spillane was clearly
any better than (Direct Access).                       the most level-headed of the bunch. But her roots
                                                       were not far buried.
“There‟s not enough of this kind of program,” she
added, mentioning the similar Pathways to              “OK, you think that‟s bad, check this out,”
Housing in New York as one of the only                 Spillane said after one man showed her a gnarled
approximations to Direct Access. “There needs to       gash on his arm, gouged by dirty needles. She
be more.”                                              hauled up both sleeves to reveal dozens of bullet,
                                                       knife and hypodermic wounds, long healed over.
The real proof is in the people inside Direct
Access.                                                In the crook of her right elbow was the prize scar:
                                                       “It‟s my original track mark, and it was good for
Barbara Spillane, 55, is bipolar and for much of       eight years,” she said, with a wry smile. “Now look
her life was addicted to crack and heroin as she       at it. No longer open for business.”
turned tricks in the city‟s grimiest alleyways. She
spent much of the past decade living out of a          It‟s a miracle, doctors say, when someone this
shopping cart.                                         damaged and this poor can keep coming, day after
                                                       day, on their own to a methadone clinic and stay
Not anymore.                                           housed and clean and stable.

Spillane now calls home Room 508 of the Windsor        For Spillane, the miracle is Direct Access.
Hotel, a beige tower of brick and stucco with an
old-time green awning out front. Located on Eddy       Back at the Windsor, two of the reasons that
Street in the heart of the Tenderloin, the Windsor     Spillane gets on the “Meth Express” bus every day
is the flagship of Direct Access‟ buildings, and       arrived about the time Spillane reached her clinic.
Spillane has been in it, clean of drugs and on
methadone recovery doses, for four years.              They were nurse Carol Baillie, in charge of the
                                                       Windsor‟s supportive services, and her boss Dr.
Josh Bamberger, medical director for the Direct          nonprofit agency manage their money -- Lutheran
Access program.                                          Social Services handles Spillane‟s -- so they won‟t
                                                         run out of cash at the end of every month, which
One or the other checks with Spillane every day to       most of the residents would if left on their own.
make sure she‟s on track with her methadone and
counseling. And if they are too busy, they get           “We don‟t want the homeless who are easy to
another of the hotel‟s case managers or social           place,” said Dr. Bamberger. “We want the ones
workers to do so.                                        who are the sickest, who need the most help, the
                                                         ones who nobody else would take. And the beauty
It‟s all part of a constellation of support staff that   of it is that it is so cheap.”
helps Spillane stay healthy, and by design that
support doesn‟t just include the workers at the          Each resident costs about $1,000 a month to
Windsor. It‟s everyone in her orbit.                     house in Direct Access, he pointed out --
                                                         compared to a cost of about $1,000 a day in a
At the hotel, there are a dozen staff people -- from     hospital. One quarter of Direct Access‟ funding
doctors and social workers to clerks -- to serve its     comes from rent -- mainly SSI checks -- and 25
92 residents. Roughly the same staff-to- resident        percent comes from federal, state and private
ratio holds throughout the entire Direct Access          grants. San Francisco pays the rest.
system: 70 staff spread among the six buildings
and their 400 residents.                                 “It‟s so cost-effective,” Bamberger cracked, “(that)
                                                         Bill Gates could pay for our program with his car
Off site, residents are hooked up with drug and          budget.”
mental health counselors at S.F. General Hospital,
St. Anthony‟s Foundation for clothing, and any of        Spillane spends most of her time in her room in
a host of other nonprofit service agencies for job       the Windsor, watching the Sci-Fi cable channel or
assistance or therapy. Most of the residents can eat     PBS programs, or reading any of the hundreds of
free, if they want, from local food pantries or soup     books filling her shelves. She‟s halfway through
kitchens, such as St. Anthony‟s, but Direct Access       “The Devil‟s Alternative,” by Frederick Forsyth.
has a luxury many residential hotels don‟t -- a
kitchen. So residents can also buy groceries and         The room consists of a desk, a bed, a bathroom
cook them, which is much cheaper than restaurant         and several racks of shoes and dresses. “It‟s
meals.                                                   humble, but it is important,” she said. “It‟s clean,
                                                         and I can actually keep my things. When I was
These agencies all stay in close coordination with       homeless, I always lost everything I owned
each other and with Direct Access to make sure           whenever someone took my shopping cart away. I
the support web is tight.                                don‟t even have any pictures from my past left.‟‟

“We try very hard to make life livable for them, to      Downstairs, whenever the urge hits her to seek
leave them with some money in their pockets so           guidance, there are people waiting -- counselors, or
they can have a real life,” said nurse Baillie. “And     fellow residents in the big TV lounge of
the way the system is set up here, they really don‟t     overstuffed chairs and couches.
have to have much in the way of expenses.”
                                                         “We have movie nights, we play cards, we hang
More than 80 percent of Direct Access‟ residents         out, we help each other,” said Randall Kalal, 42,
get federal disability Supplemental Security Income      who is tenant representative for the hotel. “We
(SSI) checks, typically $800 to $900 a month. The        have a lot of people who need, shall we say, a little
hotel takes half of that (or of whatever other           help filling their time because they can‟t do much
income the resident has, be it welfare or a rare         in the way of physical activity.”
paycheck) for rent.
                                                         Kalal has a severe back injury and was homeless
The leftover $400 or so for each resident, after         for 10 years before scoring a room at the Windsor
rent, can be withdrawn for whatever - clothes, fun,      last year. “Saved my life,” he said. “Not being able
snacks. The program requires that residents let a
to walk too well makes it really hard sleeping in the   roof over the sidewalk. It can be an excruciating
street.”                                                process.

There are many ways chronically homeless people         Abby Lehrman knows. She is a street outreach
make their way to Direct Access: Nurses or              worker for the nonprofit Brinton Homeless
doctors refer them from the emergency or psych          Project, which specifically targets mentally ill street
wards of hospitals, drug rehab clinics send them,       people, and her latest struggle is getting John
city outreach workers send them.                        Gruppe to move out of a cardboard box and into
                                                        Direct Access.
And sometimes it‟s the cops. That‟s how Spillane
got to the Windsor. The cop was Sgt. Joe Garrity,       Gruppe, 57, had been at the Royan Hotel for eight
who today is still a key link in her constellation of   years -- another city- run supportive housing
support workers.                                        complex, but less intensively staffed than Direct
                                                        Access -- until February, when he lit his room on
Garrity found Spillane squatting in a Tenderloin        fire. He was evicted and refused every referral
alley, jamming a heroin needle into her arm, about      service offered him, angry at being told to leave.
five years ago. It was the second time he‟d caught
her with drugs. But instead of hauling her to jail,     Now, Lehrman said, she has a room approved for
he drove her straight to the methadone clinic at        him in Direct Access -- but the tall, rangy man in
S.F. General. “This is your chance,” Spillane           baggy jeans and a gray beard refuses to go.
remembers him telling her -- and for once, she          Lehrman said there is no legal basis for making
listened.                                               him move in.

“He rescued me,” she said, sitting on a bench near      So he sleeps in a dirty cardboard box near the
the Windsor and looking across the street at            Presidio, behind a house with the chilly bay wind
Garrity‟s police station. “I had had enough of the      whipping around him every night. The money
street, and he was smart enough to see it in my         from his $870 monthly SSI check, automatically
face.”                                                  deposited in a bank account, dribbles out for food,
                                                        bus fare, and clothes and the occasional bag of
Garrity still sees her every few days on the street,    marijuana, he said. But mostly it just accumulates
where she likes to hang out with friends. Only          because he can‟t decide how to spend it.
now, he smiles and waves.
                                                        “All I want is to go back to the Royan. In the
“I‟ve been in the Tenderloin for 19 of my 22 years      meantime, I am my own man. I like the fresh air,
as an officer, and you can arrest people like           so what the hell,” said Gruppe, who has been in
Barbara so many times for dope it starts to make        and out of mental institutions. “I talk to Hitler
no difference,” Garrity said. “You realize what         every day on Mission Street, and he‟s not doing so
they really need is programs, not jail. All I did was   bad, either.”
point her in the right direction.”
                                                        Lehrman says it will be a matter of slowly wearing
The greatest tragedy is in the people who should        him down. If ever.
go to Direct Access, but won‟t.
                                                        “You can‟t make a guy like John do what he won‟t
No one can be forced to accept housing and              agree to do, but let me tell you, if I had access to
counseling. And anti-camping and panhandling            10 more Direct Access to Housings I could fill
laws are difficult to enforce in San Francisco, so if   them tomorrow,” she said. “It‟s awful how there is
people really want to sleep outside, they can           not enough homeless housing in this city. It‟s a
indefinitely, as long as they keep moving and don‟t     disgrace.”
aggressively bother anyone.
                                                        The city currently has 2,500 total supportive
That‟s where social workers come in. They are the       housing units -- 1,197 of which are run by San
ones who must persuade the hard core to choose a        Francisco, including Direct Access‟ 400 -- and
                                                        Mayor Newsom hopes to add nearly 1,000 more
units by the end of the year. About 100 of those        “What most people don‟t know is that a lot of us
new rooms will be in the Direct Access program.         just need someone to hold our hands, to give us a
But waiting lists are still months long in many         chance,” she said. “If nobody had taken the time
cases.                                                  to dig through all my crap -- to figure out that
                                                        deep down, despite whatever I might have said, I
“When you‟re homeless, a waiting list might as          really did want to get clean and live right -- I‟d still
well be a rejection for a room,” Lehrman said.          be there on the sidewalk with those crack
“How many of these guys do you think can make           smokers.”
it to appointments? Or control their drug habits or
their mental illness enough to focus on something       As she said that, a man in front of her on Eddy
like a waiting list? It‟s one step forward and 10       Street lit up his glass pipe. Crack fumes spilled
steps back in this work.”                               forth.

“Dorothy” is another Direct Access success story.       “Hell,” she said with a sharp laugh. “I‟d be dead.”

The 42-year-old “graduated” last year after living      The biggest trouble for Spillane, now that she‟s
two years at the Windsor -- becoming one of only        stabilized, is getting over the death of her husband,
two dozen who are able to leave and live on their       Francis, from a heart attack 10 years ago, and the
own each year. Dorothy didn‟t want her full name        loss of her son, who was placed in foster care
used because she is no longer in Direct Access.         when her husband died.
But she credits the program with saving her life.
                                                        She wants Damien Quentin Spillane, now 18, to
“The wonderful thing about that place was they          see how well his mother is doing -- but she has no
hung in there with me,” she said one day as she         legal way to find her son.
headed to work. “What I really needed, and what
that place gave me, was someone to tell me I was        She goes several times a week to the S.F. General
worth something and then to be around when I            Emergency Department Case Management office
felt myself falling. That made all the difference.      for additional therapy in handling this grief. It‟s
Made me want to try.”                                   another pillar holding her up.

Dorothy said she was a crack addict and alcoholic       “It‟s the hardest thing for me,” she said, during
who was stabbed and raped 10 years ago. Her             one recent visit as social worker Kathy O‟Brien
husband left her and she hit the street, losing her     patted her shoulder. Spillane‟s eyes filled with tears
three children to welfare officials.                    and her mouth moved, but no sound came out.
                                                        She stared at the ground, then wiped her eyes and
Today, she lives in a two-room apartment and            looked up, face determined.
works as a clerk at two hotels.
                                                        “Some days when I just don‟t feel like getting out
Generally, when someone comes into Direct               of bed, I tell myself to anyway because I figure I
Access, they stay. A small number are evicted each      have to be an example for my son,” she said.
year; 3 percent of the residents die from acute         “Even if I can‟t see him, I want to live a life he‟d
medical problems.                                       be proud of. So I do now.”

By the time city outreach workers told Dorothy          As Spillane walked away, her social worker took a
about the Windsor four years ago, she was tired of      moment to marvel.
the gutter. Getting clean was the last thing she did,
she said -- moving inside was the first.                “The most important thing is that Barbara has
                                                        worked hard, and faced up to her hard issues,”
At home, her oldest and youngest sons, 15 and 3         said O‟Brien. “We don‟t expect everyone to be
years old (she had the last while living at the         clean or even housed when we work with them,
Windsor), live with her, and she is working on          and when Barbara first came to us five years ago,
getting her other two children back.                    she wasn‟t either. But you go one step at a time,
                                                        and that‟s what she did.”

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