Supervisors hear repeated accounts of long waits, access and health gaps in San Francisco shelter system

Dozens of shelter residents, city health and human-services staff and advocates told the San Francisco Board of Supervisors’ Rules Committee on April 5 that the city’s shelter-access system places undue burdens on people seeking emergency and longer-term beds. The testimony — part policy review and part raw street-level testimony — centered on long pre-dawn lines, limited transportation supports and shrinking case-management capacity.

The hearing opened with Chair Supervisor Jane Kim saying the review was “motivated by a stay that I had, personally made at Nextdoor Shelter in January,” and asking city staff to explain bed counts, reservation rules and service availability. HSA Housing and Homeless Division director Joyce Crum told the committee the single-adult system has roughly 1,134 beds: about 700 resource-center 90-day beds, approximately 390 beds tied to the county adult assistance program (CAP), and about 40 beds for veterans and targeted partnerships. On Jan. 18, Crum said, 36 of 1,134 beds (about 3 percent) were vacant; vacancies often result from late passes and no-shows.

But advocates and residents said beds on paper do not match what people experience in the street. Coalition on Homelessness outreach and footage shown to the committee documented people arriving at Glide and Mission resource centers at 3–4 a.m. to secure a chance at a reservation: “You gotta get up extra early in the morning to stand in this line,” one woman told the coalition’s video team. Speakers described walking miles between multiple resource centers, carrying possessions, and, for many seniors and people with disabilities, being effectively shut out by a line-based system.

Bernice Casey of the Shelter Monitoring Committee said the committee’s turnaway counts have shown substantial gaps: earlier counts found roughly 32 percent of people seeking shelter at sampled sites were provided reservations in a given sweep, and more recent methodology adjustments aim to separate ‘turnaway general’ (no system beds available) from preference-based turnaways. Department of Public Health staff told the committee that an estimated 75 percent of shelter clients have chronic medical or behavioral health conditions and that the shelter population includes high rates of trimorbidity (co-occurring medical, substance and mental-health issues).

Several presenters and public commenters flagged declines in case-management capacity. A provider noted that a decade ago 14 case managers handled two large shelters, while current staffing for the entire single-adult system is far lower; START team leaders said their full-time case-management staff levels are inadequate for more than 1,100 shelter beds.

Policy and practical fixes were discussed. Coalition and community speakers urged moving away from in-person line systems and suggested a unified reservation and notification approach using 311 so callers could be placed in a lottery and notified by phone, text or email when a bed is available. Bevan Dufty, director of the mayor’s office HOPE, and Nancy Alfaro, 311 director, said 311’s 24/7 service and language-line capability make it worth exploring. Advocates and supervisors also suggested transit passes or shuttles, peer-to-peer staff models, and contracting reforms that reward occupancy and verified bed availability rather than leaving incentives misaligned.

Supervisors stressed legal and policy constraints. Committee members discussed Care Not Cash (the voter-approved program often called Prop N), which the deputy city attorney said does not mandate specific bed set-asides on its face but does constrain how services are implemented; the board-adopted ordinance that prohibits bed set-asides could conflict with Prop N if implementation created an inability to meet Care Not Cash obligations. Supervisors asked staff to explore options that comply with both voter mandates and local ordinances.

The chair closed by endorsing the idea of a stakeholder working group under the mayor’s HOPE office to examine 311 integration, transportation pilots, capital improvements to make shelter facilities more accessible, and targeted data collection (a DPH health snapshot of shelter populations). The committee moved to continue the item to the call of the chair so staff and advocates could return with concrete proposals and costs.

The hearing combined technical details (bed counts, CAP rules, case-management ratios) with repeated, emotional first-person accounts of people who said they cannot reliably reach shelter without aid. Officials pledged follow-up work and cross-agency coordination; advocates urged timetabled, publicly transparent steps and verification of bed-availability reporting.

The committee continued Item 1 to the call of the chair; staff were asked to return with more detailed proposals on 311 feasibility, transportation options (including eligibility models used elsewhere), verified vacancy reporting, and estimates for capital accessibility improvements.