SAN FRANCISCO — Andrew Douglass shoved his garments and belongings into plastic trash luggage as 5 law enforcement officials surrounded his encampment — a colorless grey tent overflowing alongside a bustling sidewalk within the gritty Tenderloin neighborhood, the place homeless folks lie sprawled on public sidewalks, generally in drug overdoses.
Officers gave him a alternative: Go to a shelter or get arrested and cited for sleeping outdoors.
Douglass was making an attempt to determine what to do as he dismantled his tent. If he accepted momentary shelter, he’d threat lacking an essential appointment along with his avenue drugs case supervisor, who was as a result of meet him at his tent within the morning to assist him safe a low-income housing unit with wraparound companies — and he anxious about shedding his medicines, ID, and different very important paperwork once more in one other homeless sweep.
Douglass, who didn’t have a working cellphone, knew if he moved from the place he’d slept for months, his case supervisor won’t be capable of discover him. “I’m so close to getting housing. I need to be here tomorrow morning so I can try and get inside,” he mentioned, making an attempt to motive with officers as he was handcuffed and arrested for unlawful lodging.
California, the epicenter of the U.S. homelessness disaster, is cracking down on folks dwelling outdoors like by no means earlier than, taking an aggressive new stance to dismantling and clearing homeless encampments within the wake of a watershed U.S. Supreme Courtroom ruling in late June that makes it simpler for presidency companies to effective and arrest folks for dwelling on streets and sidewalks, in broken-down automobiles, or inside public parks — even when there is no such thing as a shelter or housing accessible. From San Francisco to Los Angeles, communities are launching cleanup operations, ratcheting up enforcement of present anticamping legal guidelines, and, in some locations, passing new legal guidelines to attempt to forestall folks from dwelling open air.
On the bottom, well being care consultants and homeless service suppliers say the legislation enforcement crackdown is undercutting taxpayer investments in evidence-based remedy and housing companies which might be being deployed by cities and states across the nation as politicians look to the well being care system to aggressively transfer folks off the streets.
The sweeps — which have taken off below Democratic Gov. Gavin Newsom, who issued an govt order in late July requiring state companies to take away encampments and inspiring native governments to do the identical — have unleashed chaos for homeless folks and are breaking essential connections with well being care suppliers, social service companies, and housing navigators making an attempt to assist them get wholesome and off the streets.
Newsom’s hard-line stance is undermining his signature Medicaid initiative, referred to as CalAIM, which dedicates $12 billion over 5 years partially to serving to homeless folks obtain well being care, housing, and social companies. The experimental program, meant to stabilize probably the most susceptible and maintain low-income sufferers out of expensive institutional care in hospitals, jails, and nursing properties, for example, launched in early 2022 with backing from the Biden administration, and supplies state and nationwide well being care funding to avenue drugs groups, hospitals, medical health insurance corporations, group clinics, and different organizations to serve homeless folks.
It comes as Newsom introduced this month that his well being secretary, Mark Ghaly, who has spearheaded the state’s infusion of social companies for homeless folks into the well being care system, could be stepping down.
Encampment clearings are additionally upheaving long-standing federal well being insurance policies that present billions of {dollars} every year to avenue drugs suppliers, case administration groups, and front-line group clinic staff, together with by means of the nationwide “Health Care for the Homeless” program, which can also be aimed toward serving to homeless folks get wholesome and navigate a path to everlasting housing.
Newsom has been emphatic that streets should not a house and that it’s unsafe to let folks stay outdoors amid public well being hazards like rats, drug needles, and piles of trash. The second-term governor, who has threatened to withhold homelessness funding from communities that fail to point out sufficient progress, argues that his insurance policies are serving to get folks long-term housing and companies.
“There are simply no more excuses,” Newsom mentioned in July.
Well being care suppliers and homelessness consultants say the result’s a slow-moving well being care disaster instigated by the very Democratic politicians touting the necessity for care and companies round California, dwelling to extra homeless folks than some other state within the nation.
No place goes as exhausting as San Francisco, a fiercely liberal metropolis that has lengthy embraced its status as a spot the place homeless folks might discover refuge and sturdy companies.
Now, case managers, housing navigators, and avenue drugs groups say susceptible persons are rising sicker amid the crackdown and that a lot of their sufferers have merely disappeared. Others have misplaced medicines and significant paperwork like beginning certificates and Social Safety playing cards, setting again efforts to stabilize folks with housing, psychological well being companies, and dependancy remedy. Entrance-line suppliers right here say the town has develop into a evident instance of homelessness coverage gone improper.
“All the sweeps and arrests are doing is moving people to the next sidewalk and disrupting their continuity of care. It’s a huge waste of resources,” mentioned Shannon Heuklom, a main care supplier and an professional in avenue drugs for the San Francisco Neighborhood Well being Heart, with a clinic nestled within the coronary heart of the Tenderloin.
“Some portion of folks may end up in a shelter, but for the most part the city is just moving them all around and making them more unwell, making their mental health worse, making their physical health worse,” she mentioned.
Disrupted Care
Within the Tenderloin, Douglass was frantic. Police instructed him and his spouse, Jasmine Byron, and one other accomplice, Christina Richardson, that they may keep away from arrest in the event that they went into a large congregate shelter. However they’d should sacrifice most of their stuff, taking simply two luggage every. They’d already misplaced lifesaving medicines, together with for epilepsy, in a earlier camp clearing. And Douglass had lastly changed his ID and bronchial asthma treatment; he didn’t need extra stuff thrown away amid the chaos.
On this early August morning, Douglass opted to stick with his belongings. The trio are a part of about 70 homeless arrests in San Francisco because the metropolis’s mayor, London Breed, ratcheted up cleanup operations at first of August following the Supreme Courtroom’s resolution in late June, in keeping with San Francisco Police Division spokesperson Evan Sernoffsky.
“We’re here to enforce the law,” mentioned Lt. Wayman Younger, one of many 5 officers. “We get a lot of complaints: People can’t use the sidewalk; there’s a lot of garbage.”
Because the three have been separated and cuffed, a lady driving by caught her arms out her window and clapped, cheering the sidewalk arrest and yelled “Thank you!” A passerby in a wheelchair averted the tense standoff by rolling right into a visitors lane, dodging automobiles as he regarded for a vacant part of sidewalk to make use of.
Douglass missed his housing appointment the morning after his arrest, confirmed his avenue drugs case supervisor, Justin Jackson from the San Francisco Neighborhood Well being Heart. Amid his tossed belongings have been his ID card, which is required to get into housing, so he was again in line on the clinic the subsequent day filling out a Division of Motor Autos voucher kind to exchange it totally free.
As a result of Douglass is homeless and on Medi-Cal, California’s model of Medicaid, he’s eligible for CalAIM companies that help homeless sufferers with discovering a everlasting place to stay, in addition to serving to to cowl safety deposits and utility payments. CalAIM additionally presents eviction prevention assist, and subsequent 12 months California is anticipated so as to add a brand new Medi-Cal profit offering as much as six months of free lease or momentary housing.
However along with his paperwork thrown away, his eligibility for housing was delayed.
Entrance-line staff at the moment are spending immense time and assets serving to folks exchange valuables like medicines, Social Safety playing cards, and beginning certificates misplaced as a result of sweeps. They discover sufferers are skipping routine well being care and spot an uptick in drug use, nervousness, and melancholy.
“This is just making homelessness worse,” mentioned Evelyn Peña, a CalAIM care supervisor on the Mission Neighborhood Well being Heart in San Francisco.
Taylor Cuffaro, a nurse practitioner and avenue drugs supplier with the San Francisco Neighborhood Well being Heart, trudged the streets of the Tenderloin with Eli Benway, a licensed scientific social employee who supplies discuss remedy and different behavioral well being remedy on the road, trying to find sufferers on a brilliant August afternoon.
Some wanted assist managing continual illnesses and psychological well being situations. Others have been due for antipsychotic injectables that last more than tablet medicines. Some wanted refills of HIV medicines.
“Health insurance companies aren’t just going to give you more medication,” Cuffaro mentioned. “That’s not how it works, so people really are at risk of dying faster.”
A part of what’s being squandered is belief, which is important for getting folks off the streets. “These sweeps are just making our job impossible,” Cuffaro mentioned, looking unsuccessfully for a affected person in an alley.
Politics of Homelessness
The statewide crackdown is taking part in out regardless of a rising physique of proof exhibiting that offering sturdy well being care, together with social companies and intensive case administration, can successfully transfer homeless folks off the streets and enhance well being, whereas additionally saving taxpayer and well being care spending on expensive institutional care.
Democrats are embracing a get-tough strategy as public endurance wears skinny over the intractable disaster. Newsom’s stance isn’t fully new: Throughout his tenure as San Francisco mayor, from 2004 to 2011, he spearheaded controversial homelessness concepts, together with an ordinance referred to as sit/lie, which made it unlawful to sit down or lie on public sidewalks.
Newsom and native leaders, together with Breed, say they have to steadiness guaranteeing public security and clear streets with a humane strategy to clearing camps, whereas making an attempt to get folks indoors. Breed administration officers argue that whereas some homeless folks do settle for shelter, many are opting to remain on the streets whereas declining remedy.
“People won’t accept shelter, and they won’t follow up on their medical care or behavioral health treatment or any of that, often because they need to stay and monitor their belongings, some of which are totally soiled and becoming a health hazard,” mentioned David Nakanishi, a scientific social employee who heads the Breed administration’s Wholesome Streets Operation Heart, which spearheads the sweeps.
In Los Angeles, in the meantime, avenue drugs supplier Brett Feldman is shedding his sufferers amid the sweeps. “It really undermines our housing efforts,” he mentioned.
A metropolis report launched in Could discovered that clearing camps and imposing anticamping legal guidelines that ban folks from sleeping, sitting, or preserving belongings on sidewalks in sure delicate areas, together with faculty zones, parks, or freeway underpasses, isn’t successfully serving to folks into housing. After spending roughly $3 million imposing anticamping legal guidelines from 2021 to 2023, the report discovered, the town positioned simply two folks into everlasting housing and 81% of encampment websites have been repopulated.
In a single central Los Angeles district the place legislation enforcement isn’t aggressively imposing anticamping legal guidelines, avenue homelessness fell roughly 38% in a one-year interval from 2023 to 2024, mentioned Indu Subaiya, interim CEO for the nonprofit Healthcare in Motion, which has been housing and treating sufferers there.
“We’re starting to actually see results and reductions in unsheltered homelessness,” Subaiya mentioned. “However, in Southern California counties aggressively enforcing Newsom’s executive order and clearing encampments, we’re seeing our patients and their medical conditions set back profoundly.”
As soon as Douglass was launched, he was again within the Tenderloin looking for housing and popping his tent up the road from his earlier hangout.
“Every time I try to get my documents to get housing, I get knocked backwards,” he mentioned. “I guess the city thinks we all need to be in handcuffs.”
By the subsequent morning, the encampment had grown twice in measurement.
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This text was produced by KFF Well being Information, which publishes California Healthline, an editorially impartial service of the California Well being Care Basis.
