An independent study funded by the National Institutes of Health found that the emergency hotels provided to homeless people during the height of the pandemic led to increased doctor visits and reduced high-cost emergency-room visits.
The experiment, authors said, demonstrated the clear benefits of providing immediate housing for homeless people.
“It’s not perfect … There’s the messiness of housing people very quickly who have a long history of trauma and substance use,” concluded Dr. Elizabeth Abbs, one of the authors of the study, who also works in primary care at Tom Waddell Urban Health Center in the Tenderloin. “But there seems to be more value in providing this temporary housing, because it allows people to prevent diseases, connect to care much easier than the current system, and have a pathway to permanent housing.”
The study, which tracked 346 homeless people who used San Francisco’s Shelter-in-Place Hotel Program from April, 2020, to October, 2022, found that the average emergency-room visits decreased by more than half, while the proportion of residents seeking outpatient care almost doubled.
“What was unique was that attention to upstream determinants of health, like providing resources for housing, outreach to care, and risk reduction for substance use allowed people to stay out of the hospital,” said Abbs.
The study data shows the hotel program can also offer an effective transition for homeless residents before obtaining permanent supportive or independent housing.
Though the emergency hotel program reduced hospital use, it was costly: Most of the cost was underwritten by the federal government, but San Francisco will spend $26 million for potential settlement payments to address the property damage, repairs, and lost revenues claims brought by hotels, according to a recent budget report.
The city’s hotel program started in April, 2020, at the outbreak of the pandemic. It aimed to provide uncrowded shelter for homeless people, who were deemed particularly vulnerable to Covid-19. At its highest capacity, the program provided 2,288 rooms across 25 sites, according to the Department of Homelessness and Supportive Housing. The program included places like Hotel Tilden, Hotel Union Square and Hotel Vertigo.
Before it closed last December, the program had sheltered a total of 3,700 people experiencing homelessness. Over half — 1,831, or 55 percent — were transitioned to permanent housing, while 15 percent (507 people) went to temporary shelters, and 2 percent (83 people) found other institutional shelter, like a nursing home, hospital or jail. Another 14 percent (467 people) left the program voluntarily, and 5 percent (162 people) died while in the program. The rest were discharged due to bad behavior, found a “safe sleep” or “safe parking” site, or left for parts unknown.
Over half of the SIP hotel guests got permanent housing after the program.
Others were directed to temporary shelters and other institutions, while 18 percent declined the offer or left without a notice.
Housing exit 55%
Temporary Shelter 15%
Others 30%
Permanent Housing
Shelter
(including
Navigation
Centers)
1240
353
Exit by Client
Choice or
Bed
Abandonment
467
Permanent Housing:
Flexible Housing Subsidy
Rapid
Rehousing
377
Deceased
162
Over half of the SIP hotel guests got permanent housing after the program.
Others were directed to temporary shelters and other institutions, while 18 percent declined the offer or left without a notice.
Housing exit 55%
Others 30%
Temporary Shelter 15%
1240
Permanent Housing
Permanent Housing:
Flexible Housing Subsidy
377
353
Shelter (including
Navigation Centers)
467
Exit by Client Choice or
Bed Abandonment
162
Deceased
154
Destination Unknown
The research team randomly picked 346 people in the program who had records in the public health department’s medical database and had lived in a hotel for at least three months. The team then examined their medical records six months prior to, and after, their hotel stays. They also interviewed staff working in those hotels about their experience.
The study showed that the hotel program helped drastically reduce the number of emergency-room visits: The mean number of visits per person per year decreased from 3.72 to 1.64 after they were housed in hotels. The outpatient visits once enrolled to the program increased significantly, with clinician visits increasing from 42 to 79 percent and other medical staff visits increasing from 55 to 91 percent.
The temporary hotels led to decreased average emergency room visits and inpatient admission.
The proportion of residents seeking outpatient care almost doubled.
Proportion with Outpatients
Encounters
Average Emergency Department Visits
(per person-year)
Proportion with Outpatients Provider Visits
91%
3.72
76%
55%
Average Inpatient
Admission
(per person-year)
42%
1.66
0.66
0.38
Before
After
Before
After
Before
After
Before
After
The temporary hotels led to decreased average emergency room visits and inpatient admission.
The proportion of residents seeking outpatient care almost doubled.
Average Emergency Department Visits
(per person-year)
Average Inpatient
Admission
(per person-year)
3.72
1.66
0.66
0.38
After
Before
After
Before
Proportion with
Outpatients
Encounters
Proportion with Outpatients Provider Visits
91%
76%
55%
42%
Before
Before
After
After
“A lot of my patients here have benefited from the shelter-in-place hotels or from permanent supportive housing that arose in the past, and they’re able to build community and relationships within their housing units and then also within the clinics in which they get care versus the hospital,” said Abbs, the study’s coauthor.
The picture was not entirely rosy, however: The study also showed that overdose deaths in the first weeks of the program were “devastating for the nursing staff.”
“Clients … within the first two weeks they get to feel that joy, that comfort [of being housed], and then they pass away because of an overdose. We were just getting our feet wet … it was a lot of trial and error. A lot of the deaths did not stop for a good while until we got some kind of semblance of harm reduction on site.”
Through April, 2022, there were 64 reported overdose deaths in the program’s hotels. A study published last year, however, found that the overdose deaths and overall mortality was still lower for homeless people housed in hotels than for other people experiencing homelessness.
Abbs noted that the outbreak of covid coincided with an increase in the fentanyl supply across San Francisco, and that some likely started using the new drug for the first time alone — a dangerous proposition. One study found that the number of fatal overdoses among people experiencing homelessness during covid doubled.
Still, being under a roof, rather than on the streets, helped reduce these deaths.
“There are actually several times more overdoses for people who were unsheltered on the street than in the shelters,” said Abbs.
Nationwide hospital utilization decreased 42% for everyone. So these statistics are overly attributing the changes to the provision of free housing. It’s possibly more like a 10% decrease in ER and hospital admission that can be attributed to the provision of housing. The article mentioned the $26 million in damages but did not include the actual costs for the hotels and the staffing costs to run the program and administration costs. One article stated $386 million in reimbursements was already submitted to FEMA. So that doesn’t include local taxpayer funding. So if $425M was spent on 3600 people that’s $118k per person.
Wish you could compare the damage to the hotels to the hot team stabilization rooms.
55 percent were transitioned to permanent housing… but what’s percentage were able to maintain this housing at 1 year?
Many of these folks will not get any better regardless of the resources provided. Better to use the money for education and aiding our hard working lower classes from being homeless. Large scale simple shelters or preferably repurposing Treasure Island as h. Brown has suggested would help turn around the deplorable street conditions quicker. Additionally, TI would give all the nonprofit providers a nice confined area to attempt engaging these people with services.
With resources.
People will get better with stability. It’s not a straight line tho. People get better. People get worse. Depending on circumstances of the day, week, month, year.
I notice the words … Nice Confined Area. Whether area is nice or not, confinement is not. Remember all those people chafing against stay at home orders …
Thank you for this information article