Homeless hospital patients often end up back on the street after they are discharged from local hospitals despite a state mandate to prioritize getting them in shelter.
This often happens because the city of San Diego – home to the region’s largest share of homeless shelter beds – doesn’t have beds set aside for homeless patients leaving hospitals or a way for hospitals to directly refer patients to its shelters or safe sleeping sites.
At least one local hospital system has urged the San Diego Housing Commission, which oversees most city shelter beds, to take its shelter requests. But the city and its housing agency say hospitals need to pitch in financially to make that happen.
In the absence of a way for hospitals to directly move their patients into shelters, newly discharged and often still-fragile homeless patients who want to shelter are forced to compete with dozens of others for a limited number of beds – and end up sleeping outdoors where the conditions that led them to the hospital can fester.
This reality has endured despite a state law requiring that hospitals try to find shelter for their homeless patients. In the five years since SB 1152 took effect, local hospitals have increased their own tracking of efforts to connect homeless patients with shelter and transportation to them. Yet there haven’t been large-scale shelter additions for homeless San Diegans leaving hospitals. The law didn’t bring new resources to deliver them, leaving hospitals to work with an already overtaxed shelter system.
In the aftermath of the law, many homeless patients leave hospitals with transit passes and discharge paperwork that includes phone numbers and addresses where they might find shelter rather than a promised bed. They regularly line up outside the city’s downtown Homelessness Response Center with others seeking shelter. There’s often no room wherever homeless patients check in, even if hospital staff can connect them with outreach workers to help navigate the system.
The leader of a statewide organization that championed SB 1152 said this status quo doesn’t match the intent of the state law.
“We can’t be sending people all over the place on false promises,” said Kiran Savage-Sangwan of the California Pan-Ethnic Health Network. “That’s not helping the situation.”
Savage-Sangwan said hospitals should instead coordinate with shelter providers to ensure they can take their patients.
Scripps Health and UC San Diego Health, two local hospital systems whose Hillcrest facilities treat thousands of homeless patients each year, are adamant that they are following SB 1152 and trying to help patients find shelter with the resources they have.
Scripps has for years pressed the Housing Commission to allow it to directly refer its homeless patients to city-funded beds to make the process easier.
“We’ve advocated,” said Melody Thomas who oversees case management and social services for Scripps’ Hillcrest and Chula Vista hospitals. “We would love if that could be a thing and we want that to happen.”
The city and its housing agency say they need financial help from hospital systems to make that change.
Casey Snell, a Housing Commission senior vice president, wrote in a statement that shelters often don’t have the resources to adequately serve homeless patients.
“Additional financial and health care resources from local hospital systems are needed to be able to provide individuals with the appropriate care for their medical needs after they are discharged from hospitals, combined with the basic amenities of shelter operations,” Snell wrote in a statement. “Insufficient resources currently exist.”
A city spokesman struck a similar tone.
“Medical and financial resources from health systems are needed to ensure clients’ safety,” spokesman Matt Hoffman wrote in a statement.
But Scripps spokesman Steve Carpowich said the hospital system only wants to refer unhoused patients they think shelters can accommodate.
That doesn’t solve the overarching problem. Snell with the Housing Commission said city shelters are already overwhelmed with existing referrals and need.
In the final six months of 2023, only one in five requests for shelter made through the city’s intake system led to a person accessing a bed.
“The limited beds that are available day to day are assigned by mid-morning, and the system currently does not have the resources to support referrals from hospital settings, which occur at various times throughout the day,” Snell wrote.
The Housing Commission has said its intake system is designed to give homeless outreach workers and others a single contact to help connect unsheltered residents with beds that meet their needs, eliminating past confusion about different shelters’ availability and intake processes.
No local hospitals – other than the county’s Midway District psychiatric hospital – are part of this system.
For that reason, Thomas said Scripps prefers the system the city uses during inclement weather. On cold and rainy days, the Housing Commission sends out notifications about when and where additional beds will be available, and Scripps can share details with patients as it discharges them.
Still, inclement weather beds fill up on a first-come, first-serve basis. They aren’t reserved for the most vulnerable homeless residents and those who arrive too late can be turned away.
Under the existing shelter referral system, many homeless San Diegans leaving local hospitals confront the city’s shelter shortage.
I met Michael LaBran, 68, outside the Homelessness Response Center in late October. LaBran, who wore a hospital wristband, said UC San Diego Medical Center discharged him the previous morning after treating his pneumonia. LaBran said UCSD gave him a list of shelters and resources.
LaBran used a bus pass from UCSD to get to the downtown center, which was closed the day I met him. He didn’t expect to get shelter the next morning. After a prior hospital visit within the last couple months, LaBran said he got to the center at 6 a.m. each day for a week and never got a bed. Then he landed in the hospital again.
“I’m going nowhere fast,” LaBran said. “I caught pneumonia.”
CeCe Hughes, 60, slept outside the Homelessness Response Center in East Village for a few weeks this fall when she was in and out of local hospitals with a series of ailments. Like LaBran, she repeatedly left the hospital without an immediate place to stay and got in line at the downtown center. Whenever she wasn’t in the hospital, she made sure to be among the first in line. She finally got a bed on Nov. 11.
Some homeless patients from other parts of the county also show up at the Homelessness Response Center.
On a Monday in December, 69-year-old Joann Alexander waited outside the East Village facility just before 8 a.m., still wearing a wristband from Scripps Mercy Hospital Chula Vista. Alexander, who said she had recently visited the South Bay hospital’s ER for treatment of the flu, said Scripps staff directed her to the East Village center despite the fact that she had been sleeping outside near its Chula Vista hospital.
In a statement, Scripps Health said it gives patients like Alexander information about resources throughout the county and acknowledged when patients ask where they might have the best chance of getting a bed, hospital staff respond based on their experience – and Scripps case managers know the majority of shelter beds and resources for homeless residents are in downtown San Diego.
UC San Diego Health says its ER staff also often direct homeless patients to the downtown center so they can get help navigating the homeless service system.
But Alexander didn’t get shelter via the Homelessness Response Center the first two times she visited. She didn’t get it that Monday in December either. That morning, only one of the 16 people who sought a bed got one.
“Beds are extinct in this town,” Alexander said.
Dimitrios Alexiou, CEO of the lobbying group for local hospitals, has a similar takeaway.
“Post-hospitalization shelter options are severely inadequate to meet the needs of this vulnerable population,” Alexiou of the Hospital Association of San Diego & Imperial Counties wrote in a statement. “This is a tragic national challenge that we see play out on our streets every day.”
He wrote that the Hospital Association and its members are committed to working with local governments, service providers and others to address regional health and shelter needs. Officials from Scripps and the Housing Commission said they also want to work on improvements.
Alexiou and others believe that Medi-Cal insurance reforms still ramping up throughout the state could help. For example, Medi-Cal can now cover stays in recuperative care facilities. These programs provide more support than traditional homeless shelters for patients leaving local hospitals. Medi-Cal can also fund more traditional shelter options for up to six months.
Housing Commission Chairman Mitch Mitchell, who also leads the Sharp HealthCare board, thinks the county should convene a conversation around shelter needs tied to hospital discharges as it discusses new services it needs to implement a state conservatorship expansion bill.
Mitchell believes the county is best positioned to start the discussion.
“There’s not one hospital that is going to call this meeting to order and get everyone to participate. The San Diego Housing Commission can’t call this meeting to order and get everyone to participate,” Mitchell said. “It needs to be led by the county and it needs to be a collaborative. We all need to say to the county, ‘We’re here to work with you and let’s create a plan that we know will meet our needs.’”
At least one county supervisor agrees that the county should step up.
Supervisor Terra Lawson-Remer, who last month successfully urged fellow supervisors to invest $8 million in what could be the second county-backed recuperative care facility for homeless San Diegans with health issues, told Voice that the county needs to do more but didn’t specify what role it should play.
“I think very broadly that we and the county have a moral obligation to do everything we possibly can to help folks that are in our community get the care that they need, get the shelter that they deserve and have a right to,” Lawson-Remer said.
In the absence of an immediate systemic solution, Scripps is working with one homeless service provider and two other partners on a pilot one.
Late last year, the San Diego Rescue Mission agreed to reserve five beds at its Bankers Hill shelter for women and children for Scripps patients. Medi-Cal insurer Community Health Group agreed to pay for a Family Health Centers of San Diego social worker to eventually work with those homeless patients on follow-up care.
Paul Armstrong, the Rescue Mission’s vice president of programs, said the system has been working smoothly so far.
“Our beds are full,” Armstrong said.
Armstrong said Rescue Mission – which is not funded by the city or county – may consider setting aside more beds for homeless hospital patients at the National City shelter it hopes to open this summer if the pilot continues to go well. Armstrong said the Rescue Mission also wants to explore whether it could help fund shelter beds for this population by classifying them as short-term post-hospitalization housing, a Medi-Cal benefit that’s essentially shelter for people with health needs. The catch, according to Armstrong and others: It’s only a six-month, onetime benefit meaning homeless patients can’t repeatedly access it.
Armstrong is hopeful the Rescue Mission pilot could pave the way for more collaboration between the health care and homeless service systems.
“(There) really is an opportunity to do a higher level of coordination,” Armstrong said. “There is a better way to do shelter placement.”
Our entire homeless response system is in chaos. There is no unifying plan, it is like trying to herd cats. Each group advocating for its place in line “Me! Me First!!” There is no coordinated allocation of resources, there is no coordinated plan of housing construction or shelter construction. There is supposed to be, there is a group called the Continuum of Care (CoC) which is supposed to be make up of representatives of all the Stake Holders involved with homelessness. It’s recommendations are regularly ignored by all parties.
This results in what we are seeing on the streets, chaos for the homeless, a system that is almost impossible to navigate, a lack of resources and a haphazard approach to building and allocating those resources, a housing policy that is driven by politics and money without regard to the real need.
This is why our homeless population has grown for 21 straight months with more people becoming homeless than are leaving the streets. This is why HUD shorts San Diego $Millions of funding that our homeless population would warrant. We are fighting each other over each groups little section of turf and don’t care about the people we are not serving. We are incompetent.
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As usual those you interview decline to address the fundamental supply/demand issue. If full services are provided to all in need who show up asking for services in San Diego, what is the demand? What are the ultimate numbers, say, over the next five years? And, what supply of services and facilities is required to meet that demand in five years in real $ terms?
Of course, you have to factor in the reality that if it is broadcast to the world that San Diego provides full services for all who seek them, in that case there would be a predictable and rational response by potential users. They would come to San Diego, literally, from all over the world. By the millions?
The consequence of this reality is that people involved decline to address supply/demand because they all know that over five years the demand could never be met by any government in the world, just as it isn’t today met anywhere in a nation in which people enjoy freedom of movement and, under Biden/Harris, unlimited rights to cross borders to immediately obtain services.
Are there answers? Yes. They come under the heading of “tough love.” But, because it requires the tough side of that equation, current advocates look the other way. It is far more fun to talk a good game than it is to solve the problem.
Hospitals should be helping patients, not securing people’s needs to shelter. We want our dysfunctional government to come up with the solutions they have no idea how to solve within any current economic environment. But, that’s the system, broken all the way up the ladder. Oakland is the poster child for how the Cali gov’t system has failed.
A huge part of the problem is that homeless “experts” keep getting hired by various government entities and these people are totally unqualified. We spend millions on salaries for incompetent talking heads (what did that Hafsa Caca tramp do to help?????) who are just politicians being repaid for past favors. In addition, there is an established group of poverty pimps like Father Joe’s Villages, Alpha Project and PATH that act like they want to help homeless people but they actually do everything in their power to maintain the chaos and fighting because without all of these homeless garbage people littering our streets, they won’t have a paycheck.