We are working to expand those thousand beds. Our reason for setting part of our strategic framework was not was not a standalone. We are also trying to expand our housing and our problemsolving to help address this. In at fiveyear Strategic Plan we hope to end family homelessness, transitional aged Youth Homelessness and reduce chronic homelessness with adults by 50 . I was asked specifically to address rules and issues with pets and Service Animals in our Emergency Services. Service companion and support animals along with pets, in the facilities are welcome in some facilities, we do not have where we can accommodate we always do. We consider transfers were possible and what we rely on is that the owner of the animal is in control of the animal at all times because these are congregate settings. We rely on the person for their care and control and what i am pleased to say is that our Navigation Center model which tries to be as low threshold as possible is open to pets as well as companion and support animals. I was asked to address the question, what is the protocol if a homeless persons animal is aggressive, or . As i said or a threat to others . We require the owner to be in control or provide control over the animal. If the pet is aggressive, jumps up, bites or knocks people down, we address that with the owner. At times we have had to tell that person their reservation does not have to fozthree, but that animal cannot be present in our facility. We work with control to try to address these concerns. We do have to look at the safety for all participants in our facilities. That is a lot of information. I have more, but i was asked to leave time for your questions. Obviously what we dont get to today, we will look for other ways to provide further information. I do thank you for this opportunity, because our relationship with the Mayors Office on disability has been really critical for us to effectively make our systems as successful as possible. Thank you for that presentation. Stay right there for a few minutes. That was a lot of information, you are correct. We want to stay in touch with you after the meeting. People can approach you if necessary. That would be great. I want to go to my councilmember colleagues. Do any of you have questions for our presenter . Yes. I will keep this a. Thank you for your presentation. That was a little bit overwhelming. That was a lot of information. 4311 that is not accessible for deaf people. You need the full phone number with the air code just so you know. 311 does not work for deaf folks. Another question i had or comment is the lack of communication. Do you know of any person who is killed with sign language. Im not talking about someone who has a minimal or beginner sign language skills, but someone who is fluent in sign language so if there is a deaf person who is there, like how they can get the care. For example a social worker how did they get housing. I know the process can be very overwhelming for a lot of people. There is a lot of different systems that you have to go through in order to get the housing sometimes. To have one person that they connect with who can understand, i do understand and know there is a lot of homelessness and people who need services right now. However, i do understand the challenges that come with it. I do understand it is a first come, first serve system. Since the number of people with disabilities is smaller than other homeless folks, how do we make sure they can be a priority and get the services they need . Also, how do they get interpreters as well . That is the other portion of that as well. Thank you for the comment about 311. I will make sure to add the phone number for tty and access to other presentations in the future. In terms of access and interpretation. We have limited access across our entire system. What i would encourage any adults or family to come forward as go to one of our access and make their needs known and we will work to try to provide the interpretation they need. You mentioned housing, which i did not speak a lot about, and that is very involved for filling out an application. There may be times when we seek something more than just using interpreting services such as tty. To assist a somebody an application, we do try to provide materials in a variety of different parameters, and we use language lines and tty. But we do not have, sign Language Interpreters at every site. We would encourage people to let the need be known and we will do our best to respond as quickly as possible. And assist them through that process. Thank you for the question. We have those same concerns and regardless of the percentage of disabled or challenged individuals in our population. We want to serve everybody equally. It is a matter of looking for the best place to do that. Thank you. I have one more. Most people do not use tty anymore. The technology has changed. Most people use phones. Anyway, just wanted to let you know that tty is an older technology. We have found with cell phones and so forth, if people have the ability to read, it is a really quick way to communicate. We are trying to move our processes forward, and provide as much accessibility, we have funding that is always a challenge, especially when we are trying to add as many new beds as we are trying to add. I think you for bringing this forward. Do we have any other Council Members who would like to councilmember madrid and then mcdonald afterward. Thank you for coming. I just want to clarify one thing , if someone came to you guys without any support, did you say you would send them to public beds at hospitals . I just want to clarify that. One of our basic transit was again is that people in shelter must be able to selfcare, must be able to handle the functions of daily living without the assistance of the shelter staff. What happens is people come sometimes and are sent to shelter and they expect their shelters to handle wound care or administer administer medications where people will lay down in bed and not be able to get back up. These are not skills that we have trained our shelter staff to do, because that is a higher level of care. Therefore, when those things happen we sometimes have to rely on 911, and make an emergency call. Sometimes we have to find out who referred them to the shelter and contact them and see if we can resolve the issue. At times we use dph to help do an assessment. Because there may be some medical care that will help the client, though the individual become more self functioning, and we work with that. When you have our larger shelters which have 340 people in a building, we cannot have the staff responsible for assisting everybody in and out of bed. They are not trained with the proper skills to do that, nor do they have the time to do that when they are trying to monitor the structure for everybody. We dont just put them out on the streets, but we do have to call in Emergency Services many times, because these people are not able to function. If the staff can assist in simple ways, sometimes somebody who has vision impairment, walking the path away from their bed, to the bathroom, or so it is closer to the bathroom may be sufficient assistance. But if those attempts do not work that we have to contact our partners in the city to say we are unable to care for this person in the setting. There is no one single answer. We try to treat these on a casebycase basis. This is one of the great challenges we have across our shelter system. Less so in the family system, because generally if someone needs that kind of assistance, the other family members can provide. In the adult system, people are on their own and do not have somebody identify to help them. We cannot assume that. And we have to help with another kind of resolution. The last question i have is [inaudible] when people go to make reservations we generally assume that they can selfcare. If they have questions, and they need someone to manage the medication, they will tell them this is not a provider that can do that. But, what happens is, you know, we take an approach where we try to provide people the service, and only when it shows that they cant provide it, they soil their beds several times in a row, or they are not able to selfcare, they cannot get up and down when they are in the shower, in the bathroom or on their bed, these are things we have to address because we do not want them to be injured, nor do we want the problem to exacerbate our ability to manage the overall shelter. It is not an automatic denial. That is why we rely on the assistance of public help to assess what might be solutions for these individuals. We try to educate the Hospital System when they are releasing a homeless person to help us determine can the person handle functions of daily living required to manage in the shelter. These are not simple answers, because we deal with each person individually. We do have a system where we treat everybody fairly. If its the only bed that is left when youre out a reservation station is an upper bunk, and you cannot access that , we contact the shelter and we try to swap someone out. We cannot hold beds, any bed that is not claimed it will be released for one night use, even if the person can return tomorrow night for the reservation. Thank you. I appreciate the limitations of what you can provide, and, there is a long way to go. I am concerned about those with disabilities who cannot meet the criteria. I mean, this would have a Chilling Effect on them, even seeking shelter. If they know they are not going to be accepted. If they know they cant do the care they have to, what happens . There has to be a whole population of people. I mean, there is a level of sophistication among people who are homeless. They know what they can access on what they cant access. It is a great question. It is something we also struggle with. Ive artie mentioned that we try to work with our other city departments because our department is not funded with any sort of board care, partial new nursing care and so on and so forth. We try to communicate smoothly with them. Another factor is, as you know, disabilities are very wide ranging and our shelters are basically congregate settings. There are people who cannot handle a congregate setting. There we have some solutions because our Homeless Outreach team, some of our Navigation Centers may offer lesser spaces, fewer people. Or, individual rooms that are not housing, they are a temporary program room. So, we have some of those options. Again in even in those settings, the person needs to be able to handle their daily toileting needs, and so forth. Because we do not have the kind of bedside care that comes with it. We dont say that these people dont deserve it service. We are saying that our department has limits of what its focuses. We need to partner with hsa around inhome support services and aging and Adult Services and dph with their medical services and their various levels of treatment and the options they have. Then we create a better city response. To that end, our board and aided entry effort is helping to identify that. We recently reviewed our coordinated entry with dph and they were saying yes, the people we are prioritizing are the people they would prioritize. That validates our assessment tool. The people who may need more care in an emergency setting may also need more care when they go to housing. These are people we may need to work with beyond our department. I am not surprised that when somebody has issues tied to their life, but if homeless is one of them, to assume our department will take on their issues, that is not the reality. As you state, we need to make sure as a city and county we are i think you for the question. It is important that we continue to struggle with those cases. I do want to say when those cases come up on a casebycase basis, that is how we often develop ongoing a better going forward. They have to have the ability to identify location. They cant go to the shelter if the person has inhome support services we can communicate and then they can access that care in a shelter, or a Navigation Center i dont believe they can provide inhome support services to someone who is on shelter. There needs to be an address or location. This seems to be a selffulfilling problem there. Part of our solution is the Homeless Outreach team. They are out on the streets throughout the city to try to deal with, and identify, who is not accessing services. That could be a choice, or as you say it could be somebody who has decided the services cant help me. What we try to do is figure out what can help them. And maybe reacquaint them with the services that can work for them. It is a joint effort, and then it has expanded with cooperation across city departments that is known as the healthy streets operations center. That involves Public Health, our department, public works which is out on the street all the time, San FranciscoPolice Officers and they have a great number of homeless and focused or trained officers. Departments of emergency management. We are trying to coordinate problemsolving that crosses departments with particularly unsheltered individuals. You may have said this and i missed it, but what is the priority system for . I remember you talking about the priority system creating it into housing, and that type of thing. What are the priorities for getting into the shelters . For the adult shelter system, anybody who asks we try to give them a shelter bed. If you know there is more need, then there are beds, is it just firstcome, first serve . For the adult shelter system, it is. Whether disabled, or not, you get on that list when you rise up, you can get a 90 day reservation, which also you can extend for an additional 30 days by simply asking. While you are waiting to rise on the list, we have Resource Centers that can provide those one night beds for people who do not claim their bed tonight. In our family system, since we have enough congregate beds for everybody, we use the assessment to determine who is going to get the individual rooms, because they are the most acute area. I understand. Thank you. Just hanging onto your question. Thank you, and again i imagine what you are describing, it is a tough job, to say the least. Trying to balance all of the needs. My question is, and i heard you say this twice. Your department is trying to treat everyone equally. I would suggest that folks that are homeless, with physical disabilities, are rightly a little more vulnerable. And as deserving of a Navigation Center, or a congregate area that may be set up for them. That can provide that extra help getting in and out of the beds. Is not a consideration . Is not a bigger nut to crack it another day . It is a wonderful question and there are two parts to my answer. When i said we want to treat everyone fairly, it means everyone has equal access, coordinated entry assesses everyone the same way. You are more likely to rate high enough for permit in support housing placement when you have challenges that include vulnerability and barriers to housing. What you are asking about, is are there special shelters or Navigation Centers that help . When i talked about five Navigation Centers that is from our department. The department of Public Health has opened up hummingbird, which is considered part of the citys six Navigation Centers. It does offer some Mental Health assistance and some medical. When we provide clinics where people can be assessed, and gets, you know, medical assistance but it is not a care facility. Hummingbird has a little more builtin care. That is a challenge that the city is trying to address. It is not our departments expertise to offer medical care. When we offer clinics, we will build the clinic but we have to partner with dph to provide the staffing through street medicine and Shelter Health staff. We are aware of that. Also dph operates the medical respites, which is a shelter step down from hospital. They have expanded that in recent years. Those are outside of the department of homelessness and Supportive Housing. We coordinate with them, but we do not run them. We do not do placements in them. We can talk to the department about individuals that we are concerned about who end up being placed by department of Public Health. No one is ignoring this population, but we are very focused on our charge to reduce homelessness in general. In part of that when we identify people that we cant serve with our programs, we raise it to the city who have some of the expertise to do that. Any comments to the chair, can i im going to get to staff. I just want to compliment you for the work you are doing. I do some work with and for ihss. I am delighted to hear that Public Authority or people you are working with. I know they do have quite a large number of providers. Some of them are oncall providers which i think would be the ones to come to your centers and facilities. It is great that you are doing that. Nicole, what do you have for us . Thank you very much. Thank you for your presentation. I wanted to offer briefly the Mayors Office on disability would be happy to work with you, especially around technologies that the city is using for communication. That is one of the takeaways from some of the council comments. I think we have some things i can work a little better, than what we are using right now. Another thought that i have, is maybe we can work on a way to think about how to talk about our coordinated entry approach, specifically for folks who have disabilities, or are a little more vulnerable in a way that is more visible to folks. I know we are addressing things casebycase. I also think that we can work towards some centralized messaging about our process that might help folks understand questions like the ones that have come up today. Thank you very much. We welcome that. As i say we have had a Great Partnership between our two departments. Prior to this department coming three yea