Housing and Urban Health
Direct Access to Housing (DAH)
All DAH sites are service-enriched, offering tenants access to voluntary on-site support tailored to their needs. On-site support services staff actively engage residents using a harm reduction model to improve their overall health and wellbeing. Engagement is continuous and implemented through community groups, events, and individual outreach. Support services staff help tenants:
- Access and maintain benefits
- Access medical, mental health, and substance abuse treatment
- Secure food and clothing
- Interface with property management to aid in eviction prevention
- Staff also provide other social services and case management
Access to medical care is key to the success of the DAH program. All DAH tenants may chose to access primary and/or psychiatric care through the Housing and Urban Health Clinic. Additionally, some buildings have a registered nurse on site to assist tenants with issues such as medication management or wound care.
The DAH approach is to prioritize the most high-need individuals and to utilize experienced behavioral health and medical service providers in order to keep these clients in stable housing.
Health Care Utilization
Given that DAH is funded by the Department of Public Health, an important outcome measure is health care utilization before and after program placement. Overall, DAH residents use a high level of health care services prior to entering the DAH facility. DAH residents average 12 visits to outpatient medical services before DAH placement. After placement, there tends to be little change in outpatient visits in part because on-site case managers encourage residents to maintain primary care appointments; however, emergency room visits as well as inpatient (both psychiatric and medical) and skilled nursing days decrease significantly after housing placement. In one study of the Plaza Apartments, health care costs dropped from approximately $3 million the year prior to being housed to $1 million the year after housing placement. The overall public expenditure to house Plaza residents was considerably less than for the residents to remain homeless where they are likely to address their health needs through emergency systems of care.
Funding for the DAH program comes predominantly from the City & County of San Francisco General Fund, with additional funding from state and federal grants, such as the Mental Health Services Act and the U.S. Department of Housing and Urban Development’s McKinney-Vento Homeless Assistance Grant. The total cost of providing permanent housing and support services in DAH buildings is approximately $1,500 per month per resident. Residents pay 30% or 50% of their monthly income in rent; the average rent portion is $350. DAH subsidizes the remaining $1,150 through the local, state, and federal sources noted above.
Click here to learn more about the DAH Access and Referral process.