San Francisco’s Shelter-in-Place hotel program helped cut down emergency room visits among people who are homeless, according to a recent study by researchers at the University of California, San Francisco and Berkeley.
Shelter-in-Place hotels provide residents with a room plus on-site access to health services, including nursing support, routine wellness checks and health screenings, as well as harm-reduction services aimed at reducing drug overdoses.
After issuing one of the earliest shelter-in-place orders in the country to slow the spread of COVID-19, San Francisco began opening temporary shelters in April 2020 in private hotel rooms for people who were homeless and highly vulnerable to COVID-19.
The program grew to include 25 hotels and 2,288 rooms at its highest capacity, and provided shelter to 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 use in acute medical care saw a 55% decrease in visits. This was in contrast to a control cohort of individuals, who did not receive a placement and who had a smaller decrease (24.8%) in acute service use.
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.
Types of acute care examined in the study included emergency room visits, psychiatric emergency stays and inpatient stays.
“It does make a difference when there are on-site medical services and people who are cued in to what’s happening in the building,” said Dr. Maria Raven, an author of the study.
The findings come as San Francisco and California are both examining the impacts of using hotels during the pandemic to provide emergency housing for people who are homeless, and what to do next as homelessness continues to grow across the state.
In April 2020, Gov. Gavin Newsom announced Project Roomkey, a statewide initiative to acquire hotels in order to house the homeless across the state during the pandemic. San Francisco received federal funding for its hotel program through the Roomkey initiative. Using city dollars, San Francisco went beyond providing hotel shelter to including medical services on-site.
“We worked with the Department of Public Health to include a lot of wrap-around services to make sure people could actually shelter in place,” said Emily Cohen, Deputy Director for Communications and Legislative Affairs at the Department of Homelessness and Supportive Housing. “We had on-site doctors and nurses going into the SIP hotels. If someone did get COVID, they could get isolation and quarantine and medical care was brought to them.”
After implementing its SIP hotel program, San Francisco saw a 3.5% decrease in overall homelessness since the start of the pandemic, and a 15% drop in unsheltered homelessness, which refers to people who sleep outside rather than in a shelter or other temporary housing.
“It’s hard for people to be healthy if they don’t have a stable place to live,” said Raven. “The quality of the building and the fact that people had their own bathrooms is also hugely important.”
The study on the emergency intervention supports the idea that providing non-congregate shelter, meaning individual rooms, with on-site health services can alleviate overwhelmed medical systems while meeting the housing and health needs of residents, Raven said.
Now, San Francisco is in the process of winding down its hotel program and moving residents into other forms of housing.
As of Aug 2, about 669 people remained in the shelter-in-place hotels, according to The City’s online data dashboard for the program. Of those who have exited the hotels, about 57% have moved into a permanent housing situation and about 43% left for a variety of alternatives, including 9% who went to a temporary shelter and 5% who were discharged for inappropriate behavior.
Three existing SIP hotels will be converted to long-term shelters, according to Cohen, and The City 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 visits and inpatient days between April 2020 and April 2021. Participants in the study were among the top 10% of users of these services and had three or more ER visits in the nine months prior to the implementation of the hotel programs.
Although emergency room visits decreased nationally by nearly 42% during the early months of the pandemic, visits among the homeless population remained relatively steady, the study points out. But in San Francisco, the hotel program proved to decrease ER visits among participants who were previously homeless as well.
“The fact that we saw this among the homeless population is significant,” said Raven. “San Francisco decided to do this and it is not a cheap intervention. Despite the cost, we can see there was a benefit to people beyond just housing.”
San Francisco is now exploring ways to continue providing on-site medical services — in addition to existing social services and case work — in other city-run housing programs. That includes a roaming behavioral health unit to visit housing sites, for example, and decreasing case worker ratios.
“We learned a lot more from the SIP hotels and we have begun implementing this more widely,” Cohen said. “We have roving health care in the shelter program and we’d really love to see an increase in those services as well.”