San Francisco’s Shelter-in-Place hotel program has helped reduce emergency room visits among the homeless, according to a recent study by researchers from the University of California, San Francisco and Berkeley.
Shelter-in-Place hotels provide residents with a room and on-site access to health services, including nursing support, routine wellness checks and health screenings, and harm reduction services aimed at reducing drug overdoses.
After issuing one of the nation’s first shelter-in-place orders to slow the spread of COVID-19, San Francisco began opening temporary shelters in April 2020 in private hotel rooms for people experiencing homelessness and highly vulnerable to COVID-19.
The program has grown to include 25 hotels and 2,288 rooms at its maximum capacity, and has provided shelter for nearly 3,700 people, according to data from the Department of Homelessness and Supportive Housing.
Those who received a hotel placement and previously had high acute medical care utilization saw a 55% decrease in visits. This contrasts with a control cohort of individuals, who did not receive placement and had a smaller decrease (24.8%) in acute service.
Visits among the high-use group who received placement decreased from an average of 1.84 visits in the 90 days before the SIP hotel program to 0.82 visits in the 90 days after their hotel placement.
The types of acute care examined in the study included emergency room visits, psychiatric emergency room stays and hospital stays.
“It makes a difference when there are medical services on site and people who are informed about what is going on in the building,” said Dr Maria Raven, author of the study.
The findings come as San Francisco and California both examine the impacts of using hotels during the pandemic to provide emergency housing for homeless people, and what to do next as homelessness continues to grow in the whole state.
In April 2020, Governor Gavin Newsom announced Project Roomkey, a statewide initiative to acquire hotels to house homeless people across the state during the pandemic. San Francisco received federal funding for its hotel program under the Roomkey initiative. Using city dollars, San Francisco went beyond providing hotel shelter to include on-site medical services.
“We worked with the Department of Public Health to include many comprehensive services to ensure people could actually shelter in place,” said Emily Cohen, deputy director of communications and legislative affairs at the Department for Sans. -shelter and housing with support services. “We had doctors and nurses on site who traveled to SIP hotels. If someone caught COVID, they could be isolated and quarantined and given medical attention.
After implementing its SIP hotel program, San Francisco has seen a 3.5% decrease in overall homelessness since the start of the pandemic and a 15% drop in homelessness, which refers to people who sleep outdoors rather than in a shelter or other temporary accommodation.
“It’s hard for people to be healthy if they don’t have a stable place to live,” Raven said. “The quality of the building and the fact that people have their own bathroom is also extremely important.”
The emergency response study supports the idea that providing non-collective shelter, i.e. individual rooms, with on-site health services can relieve overwhelmed medical systems while meeting needs of housing and resident health, Raven said.
Now San Francisco is ending its hotel program and moving residents to other forms of housing.
As of Aug. 2, about 669 people remained in shelter-in-place hotels, according to the city’s online data dashboard for the program. Of those who left hotels, about 57% moved into permanent accommodation and about 43% left for various alternatives, including 9% who went to temporary shelter and 5% who were fired for inappropriate behavior.
Three existing SIP Hotels will be converted into long-term shelters, according to Cohen, and the city has also acquired two SIP Hotels to keep as permanent housing.
The UCSF study looked at 686 people who frequently use county health services, including emergency department visits, hospital admissions, psychiatric emergency room visits and hospital days between April 2020 and April 2021. Study participants were among the top 10% of users of these services and had three or more emergency room visits in the nine months prior to the implementation of the hotel programs.
Although ER visits declined by nearly 42% nationwide in the first few months of the pandemic, visits among the homeless population remained relatively stable, the study found. But in San Francisco, the hotel program was also found to reduce emergency room visits among participants who were previously homeless.
“The fact that we’ve seen this among the homeless population is significant,” Raven said. “San Francisco decided to do this and it’s not a cheap intervention. Despite the cost, we can see that there was a benefit for people beyond just housing.
San Francisco is currently exploring ways to continue providing onsite medical services — in addition to existing social and case services — in other city-run housing programs. This includes a mobile behavioral health unit to visit housing sites, for example, and decreasing social worker ratios.
“We learned a lot more from SIP hotels and started to implement it more widely,” Cohen said. “We have mobile health care in the shelter program and we would really like to see an increase in those services as well.”