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Supervisors urge broader COVID 'vulnerable' definition for unhoused people; health officials warn of cost and FEMA limits
Summary
Supervisor Preston urged the city to expand COVID-era 'vulnerable population' eligibility for shelter-in-place hotel rooms to people who are 45 and older and homeless; DPH said available data and mortality patterns support retaining 60 as the cutoff for COVID vulnerability, and HSA/Controller staff warned that lowering the age could exclude many people from FEMA reimbursement and sharply increase city costs.
A heated policy debate over who qualifies as "vulnerable" for COVID-era shelter-in-place (SIP) hotel eligibility occupied the committee on Sept. 17. Supervisor Dean Preston, the item sponsor, argued that people living on the street age more rapidly and urged the city to treat unhoused residents as eligible at age 45 and older for SIP hotel placement and related COVID services.
"The idea is that those on the street age more rapidly than folks who are housed," Preston said, outlining academic research and local observations that motivated the proposed expansion of the definition.
Dr. Deb Bourne, who oversees health policy for people experiencing homelessness, cautioned that COVID vulnerability is primarily driven by specific medical conditions and that the Department of Public Health had set 60 as the operational age cutoff based on local mortality patterns and national data. "COVID is not gonna care if we get this right or wrong," Bourne said, explaining the department’s approach to prioritize those with the highest risk for severe outcomes.
Susie Smith of the Human Services Agency, presenting controller office estimates, warned about fiscal and federal constraints: FEMA will reimburse up to 75% of eligible SIP hotel costs but, under FEMA rules as interpreted for COVID, only people age 65 and above (or people with certain underlying conditions) are reimbursable. The controller’s office estimated that extending eligibility to people aged 45–59 could add roughly 3,000 newly eligible unhoused people and cost the city an additional $250 million to $495 million, depending on hotel-acquisition choices and backfill strategies.
Committee members probed outreach and assessment practices. HSH staff described efforts by the Homeless Outreach Team (HOTT) and Healthy Streets Operations Center to identify and enroll high-risk unhoused individuals. HSH reported about 4,500 active clients in the coordinated entry system and an 80–85% acceptance rate for SIP hotel offers when offered, though committee members asked for clearer, disaggregated data on outreach coverage and acceptance rates.
During public comment dozens of service providers, clinicians and unhoused advocates supported broadening eligibility and improving outreach; they emphasized deaths and worsening health among unsheltered people and urged a more expansive policy. Providers said the current age cutoff fails to capture geriatric conditions that appear earlier in unsheltered populations.
After presentations and public comment the committee voted to recommend the resolution to the full Board as a committee report (3–0). The recommendation urges DPH, HSH and HSA to evaluate expanding definitions and to improve outreach and assessment to ensure vulnerable unhoused people are identified and offered SIP placements.
