HIV Health Services Planning Council
Housing Work Group Draft MINUTES
Thursday, May 5, 2005
101 Grove St, Room 302
4:30-6:30 p.m.

Council Members: Brad Hume (co-chair); Margot Antonetty (co-chair); George Simmons; Raymond Banks;
Council Support: Jack Newby; Skot Jonz; Joe Lynn
Others: Brian Basinger (AIDS Housing Alliance); Sara Malan (ALRP), Dana Van Gorder (SFAF); Pam Sims (SFRA); Sherilyn Adams (LSYS); Elizabeth Colomello (SFRA); Michelle Long Dixon

1. Introductions
CM Antonetty mentioned that Michelle Long Dixon was expected to arrive, and a few others who mentioned that they might be late. Several Working Group members agreed that it was necessary to meet again before the consultant meeting next week. Several people mentioned that they need to leave early.

2. Review/Approve Agenda
The Group reviewed the agenda. There were no changes and the agenda was approved by consensus.

3. Review and Approval of Minutes- April 28, 2005
The Group reviewed the minutes from the April 28, 2005 Housing Work Group meeting and expressed appreciation to Council Support for the level of detail in this important meeting. A request was made to add to the minutes: So far, HRSA has not asked for a return of the funds in Section 6 regarding a response to the question posed by CM Banks. With that change, the minutes were approved.

4. Announcements
Brian Basinger mentioned that the Civic Center Hotel is marked for demolition and described how it is substantial source of housing for people living with disabling HIV and is to be replaced with luxury condominiums. He expressed the need to preserve the housing that people already have and encouraged Council Members and others present to support the effort. Brian also mentioned the activities of AHA in preserving the housing at Trinity Towers to avoid having seniors and disabled persons evicted. He explained the negotiations.

Jack Newby informed the group that the Needs Assessment survey instrument has been finalized and the kick-off has begun. Jack also asked that providers cooperate with any needs assessment requests and reiterated that there is a short turn around time for this project.

5. Public Comment
There were no public comments.

6. Housing Work Group Updates
Update on Provider Presentations and Community Input
• Update on Legal/Political Activities and discussions with City Attorney/Mayor’s Office
• Update from Council Support on length of stay policies from other EMAs

CM Banks discussed the provider presentation and suggested a correlation between homelessness and adherence to medication, to point out when people are housed it directly relates to primary care and Ryan White. He suggested emphasizing that a stable housing environment is the best way to keep people healthy. CM Banks asked if the providers could be directed to emphasize these points to the HRSA consultant.
CM Simmons discussed his activities with Sherilyn, and they each provided the group with an update on the provider presentations, primarily stating that they have not heard a response from anyone. Sherilyn also invited providers to attend this meeting tonight. CM Simmons mentioned that the first two questions are the most important: where do you move people to after transitional housing? And who are the agencies collaborating with to move people into housing?

CM Antonetty discussed conversations with CM Thomas about a meeting on the 11th of May at the lunch with CARE medical providers to make arguments for stable housing.
Brian Basinger mentioned that Willie McFarlan published an article with regard to lack of housing and a 15% increase in death rates, broken down by zip codes. Brian suggested that his information might be useful, and if possible to get him to speak to the HRSA consultant.
CM Antonetty replied that on such short notice it might not be realistic to get this person, but a link to his data could be provided.
Group discussed the short amount of time remaining to contact providers.
Sherilyn mentioned that she is unsure why the providers are not responding and suggested that Michelle send a letter to generate more interest, implying that her signature might hold more weight.
CM Banks suggested a personal meeting to offer an invitation to providers to attend.
Michelle discussed that Baker Places needs to respond and participate. She suggested sending out a similar letter request under her name.
CM Simmons mentioned that the problem is trying to explain the gravity of the situation without being dramatic or understating.
CM Antonetty advised various members of the group on the value of what their presentations can offer the HRSA consultant.

Regarding the legal/political update: Dana discussed the potential value of engaging the City Attorney to review the regulations, as well as advising the Mayor’s Office and their efforts with homelessness and housing. Dana mentioned that the conversation resulted in discovering that the Mayor’s Office is aware of the issue and looking for DPH to resolve it. As for the City Attorney, it was agreed that strategy could have unfavorable consequences, and it is advised to not move in that direction. He concluded that it is necessary to get serious and come up with a policy.

CM Antonetty discussed that there are no other EMA policies and posed the question why San Francisco has to be the first to develop a policy.

Michelle mentioned her conversations with HRSA to postpone this process in light of the OIG findings. HRSA is not where this request is originating. San Francisco has an obligation to the clients to come up with a policy and to work with the HRSA consultant, and if he has information around how these policies work it would be helpful to know this and utilize his expertise in developing a policy.

CM Banks discussed how the option of legal resources might be helpful to expand the knowledge base.
CM Hume mentioned that the focus is to come up with a policy that is acceptable.
CM Banks suggested that the legal research could help in developing a policy.
CM Hume mentioned that anyone is free to do that and reinforced that it is necessary to come up with a policy that is acceptable to HRSA.

Regarding update on other EMA policies: Dana asked if other cities do not have policies if they are simply not available.
Jack Newby updated group that of the three or four responses he has received, there is little detail. Either the service is not provided at the same level as San Francisco or the length of stay amount of money is very limited, such as $500 or $1000 per year. Their policies are limited by the amount of money available.
Dana asked about EMAs outside California.
CM Hume and Antonetty mentioned that they had little success obtaining information from other EMAs.
Jack reviewed his discussion with Lorenzo regarding the agenda for the site visits, and suggested that the consultant would provide some of that information regarding policies in other EMAs.

7. Strategy for Defining Length of Stay Policy
The group will decide on a strategy with regard to defining a length of stay policy
CM Antonetty mentioned that the last working group meeting began developing the initial framework around the policy.

The group discussed the possibility of having the length of stay policy not attached to a client, but to a program, so that it is not cumulative.

The following was written on the white board for those present to review and discuss:

Length of stay Policy: To ensure Eligible clients gain or maintain access and compliance to medical care through stable housing
Length of Stay not to exceed 5 years or 60 months
Length of Stay shall apply to each housing program separately in order for client to maintain access and compliance with medical care
Length of Stay policy or details thereof, cannot contradict federal state and or local laws and regulations

• 12 months’ extension if deemed medically necessary by client’s primary care provider for the sole purpose of maintaining access and compliance with medical care
• Extension: Loss of CARE would cause homelessness.
• Exceptions: Special needs Populations (age, other disabilities, etc).
• Prioritization for special needs populations

Implementation: Extenuating circumstances
• Step up process from CARE support to non-CARE
• Reality of lack of affordable housing to move on to
• Annual percentage of clients to move off CARE in each program
• Maintain spectrum/continuum of care
• Limitations on when implementation starts, and how much time is allocated for implementation
• “Grandfathering in” or “hold harmless” for current clients

CM Antonetty reviewed a list of exceptions and possible extensions put together by Richard Bargetto.
Group discussed.
CM Simmons asked whether loss of housing would result in loss of subsidy, would that trigger an extension until the client could stabilize or find other housing.
CM Banks asked about extensions and exceptions, and what is the cumulative total.
Group agreed that has not yet been discussed.
Brian Basinger discussed the issue with regard to medical necessity as determined by primary medical provider, then nearly everyone will qualify.
CM Hume mentioned that it would not be perfect or meet everyone’s needs.
Brian discussed having several options for having people become eligible for an extension, such as in addition to a letter from a doctor, also include whether they are spending a substantial percentage of their income on housing.
Group discussed that other funding streams for mental health and substance abuse would prevent using that as a compelling argument for an extension on the length of stay policy.
Sherilyn wanted to know about substance abuse or mental health clients, if they lost their subsidy would that impact their health. In terms of strategy, the group discussed that they seem be coming up with ways to qualify for extensions and exceptions, rather than a strategy for coming up with an actual policy
Dana mentioned that something positive needs to be offered.
Brian Basinger discussed an escalator plan so they go from subsidy to no subsidy, and sees this as a positive movement. From deep subsidy, to shallow subsidy, to independent housing. Suggested a backup plan to the primary care physician letter, and suggested objective medical standards.
CM Banks asked if special needs includes the “severe need” as defined by the Council.
CM Hume reiterated comments from Michelle, that these are the elements included in the length of stay policy, such as an upward stepping motion.
Michelle asked if there was any historical information about where people go when they leave supportive housing or subsidized housing.
CM Simmons mentioned that his program at CCCYO tracks where people go.
Michelle suggested trying to do something that is similar to what is already being done.
CM Simmons reviewed the current system of how people obtain different subsidies from vouchers, to HOPWA, to different subsidies with a gradual stabilization, and mentioned that the information could be unreliable.
Once losing a subsidy, clients are often discharged onto the street. Exit strategies have been successful and CM Simmons suggested communicating these issues to the HRSA consultant.
CM Simmons mentioned the development of housing projects with shared money, and the creative ways that have been used to finance new construction, and mentioned that the number of beds has actually increased.
Group discussed various issues with regard to the current situation with short-term and long-term housing and how to present this information to the consultant.
CM Simmons mentioned that the goal for clients who pay more than 80% of their income for housing is to move them to stable, independent housing.
CM Banks suggested that young people get priority and that those under age 25 get an exclusion from the length of stay policy.
Group discussed populations that should be excluded, as determined by the special needs populations.
CM Simmons discussed the wait list issue, and that approximately 95% of people on Section 8 wait list are housed, and simply waiting for subsidized housing.
Sherilyn suggested that working with the consultant may help to identify other exceptions and circumstances with policies in other EMAs.
Group discussed that the consultant visit will result in him writing a policy for review and acceptance.
Group discussed that it is important for the consultant to be aware of the various issues, presented by the providers, the AIDS Office, medical providers, and others.
CM Banks discussed adding education as one of the extenuating circumstances to help people get out of the system.

8. Status of Site Visits with HRSA Consultant
Committee Preparation prior to Meeting with Consultant
CM Antonetty distributed a revised schedule and pointed out the few items that had changed.
Group discussed what actions need to occur between now and the date of the meetings.
Sherilyn expressed concern about the provider presentations. So far CCYO, Baker Places, Larkin Street, and Supportive Services are planned to participate.
CM Hume expressed a desire for presentations to be focused and answer questions for the consultant.
Key points have been communicated to the providers and it was discussed how this should run fluidly.
Group discussed the option of having Council Support available in the event a PowerPoint presentation is needed. Council Support agreed and suggested that if such presentations will be given to notify Council Support in advance so preparations can be made.
CM Hume discussed why the legal/political issue has been put aside for the moment.
A list of items have been identified to share with the consultant, and CM Simmons mentioned that the consultant would be hearing these from different people in different ways throughout the day, specifically that there is a shortage of affordable housing.

CM Antonetty asked Council Support to send out the items listed on the length of stay policy exceptions and exclusions to be prepared and distributed to working group members.

9. Future Implementation of Length of Stay Policy
Group will discuss future implementation of the policy

Group discussed the plan of having the consultant rationalize whatever policy it arrived at.
The implementation could be a long-term plan and will result in a major shift in how things have been done in the past, whether there is a grandfather clause, and other issues.
CM Simmons indicated that it could be discussed with the consultant that the plan drawn up ten years ago is obsolete and needs to be revisited.
Group discussed various options for implementing the length of stay policy, including shifting of funds such as HOPWA and CARE, and that this is something that is not needed right away, but certainly would be good to look at soon.
Portability was another approach to implementation that can be discussed in the future.
Another approach discussed is to bring together all housing providers in the broadest sense to brainstorm on the implementation of the policy.
Brian Basinger discussed how he has been putting together a project which is a vision of AIDS housing in San Francisco by the year 2020. He suggested that as many people as possible get together to become more focused on what is being done.
CM Antonetty closed the discussion.

10. Next Meeting Date & Agenda Items
The next meeting will follow the housing presentation on May 11th at the State Building and will replace the formerly scheduled meeting on May 12th.
Group discussed with Council Support the items to be included on the agenda.

The meeting adjourned at 6:10 pm.

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