Direct Access to Housing

DISH provides custom property management services exclusively to the San Francisco Department of Public Health’s Direct Access to Housing Program.  Below you will find some information on the program.  For more information please see the Dept. of Public Health’s website on the Direct Access to Housing program.

Direct Access to Housing – A Project of the Department of Public Health

Established by the San Francisco Department of Public Health – Housing and Urban Health Section (SFDPH-HUH) in 1998, Direct Access to Housing (DAH) is a permanent supportive housing program targeting low-income San Francisco residents who are homeless / at-risk of homelessness and have special needs. A “low threshold” program that accepts adults into permanent housing directly from the streets, shelters, hospitals and long-term care facilities, DAH strives to help tenants stabilize and improve their health outcomes despite co-occurring mental health issues, alcohol and substance abuse problems, and/or chronic medical conditions. Unique in its on-site provision of wrap-around support services, DAH currently houses close to 1,000 formerly homeless persons across 23 sites(1).  By 2012, DAH will expand to house at least 700 additional tenants at seven new housing sites.

Permanent Housing

DAH housing takes many forms including:

Master leased single room occupancy (SRO) hotels. Master leasing allows SFDPH-HUH to engage in long-term leases with building owners who retain responsibility only for large capital improvements after lease-signing; building owners often renovate residential and common areas prior to lease signing as well. Master leasing has allowed SFDPH-HUH to bring large numbers of housing units online rapidly.

Units in new capital developments. An increasing number of DAH units fit this model. Most new capital units take the form of private apartments that afford tenants access to private bathrooms and cooking facilities.

Set-aside DAH units in larger residential buildings owned by nonprofit providers. These units may be in renovated single room occupancy (SRO) buildings or newly developed sites in which the units include private bathrooms and cooking facilities.

Units in a licensed residential care facility. Only one DAH site fits into this category, and tenants share rooms at this facility.

Regardless of the setting, most tenants live independently in their own units, though they have access to on-site support services, property management, and 24-hour desk clerks if needed.

Access and Referrals

DAH’s success relies on staff’s ability to place referred clients in the setting most appropriate to their needs. DAH’s varied portfolio of housing sites allows for such tailored placement as does the access and referral prioritization system maintained by the DAH Intake Team. Overseen by the SFDPH-HUH Medical Director, the DAH Intake Team works with San Francisco service providers to create a pool of potential housing applicants prioritized for housing based on their level of medical acuity, degree of psychiatric need, substance use severity, housing stability, referral agency, and level of match between a client’s needs and services available at the vacant DAH unit. Upon identifying a match between an available unit and a potential applicant, the DAH Intake Team initiates the DAH housing application process via the referring case manager; DAH Intake supports the referring case manager throughout the application process. Property management determines all applicant housing outcomes based on resident selection criteria.

Financial Information

DAH funding comes primarily from the San Francisco General Fund, though State and Federal sources also support the program(4). DAH also generates revenue from tenants, as all tenants pay 30% or 50% of their monthly income in rent(5).  The total cost to provide permanent housing and support services in DAH buildings is approximately $1,500 per month per resident(6). The average rent received from residents is $350 per month, therefore requiring a $1,150 monthly subsidy from governmental sources.

Outcomes

DAH strives to house adults who have histories of homelessness and/or housing instability. Since opening the first DAH site in 1999, almost two-thirds of the residents have remained housed in the DAH program. Of the one-third who exited the program, half moved to other permanent housing; only 4% of all residents were evicted from DAH housing. Evictions most often resulted from repeated non-payment of rent (despite mandatory third party rent payment services), violence or threats of violence, and/or destruction of property. In addition, 4% of DAH residents have died.

Given that DAH is SFDPH-funded, an important outcome measure is health care utilization before and after program placement. Overall, DAH residents used a high level of health care services prior to entering the DAH facility. Each DAH resident averaged 12 visits to outpatient medical services before DAH placement. After placement, there was 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 decreased 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.


(1) As of June 2009

(2) In 2009, HUD defined a single adult as being “extremely low-income” if s/he earned $23,750 or less annually.

(3) While most DAH tenants pay 50% of their monthly income in rent, some (e.g., those living in HUD-supported buildings) pay 30% of their monthly income in rent per funder regulations.

(4) Other DAH funding entities include but are not limited to: HUD (McKinney-Vento), the Substance Abuse and Mental Health Services Administration, the Health Resources and Services Administration (CARE Title I), and the State of California (Mental Health Services Act).

(5) Approximately 80% of DAH residents receive SSI and Medi-Cal benefits. “Medi-Cal” is California’s Medicaid system.

(6) This figure excludes the one residential care facility (RCF) in DAH’s portfolio.