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A 2006 federal study commissioned by the Department of Housing and Urban Development (HUD) found that during 2004 a quarter of tenants nationwide left permanent supportive housing after less than two years of residency. Proof that San Francisco doesn’t have the worst record, the same study found low retention rates in Philadelphia, where 385 of 943 tenants, more than 40 percent, in supposedly “permanent” supportive housing left during the 3 1/2-year study period. Two-fifths of those who left were asked to leave for violating program rules or for being “incapable of maintaining themselves in the permanent supportive housing environment,” which, in my experience, simply means a tenant needs more help than a program wants to provide.

San Francisco’s Care Not Cash, which places indigent single adults in supportive housing, has received harsh criticism from tenant advocates who believe too many people housed through the program leave or are evicted. Care Not Cash ostensibly provides housing and supportive services to people with or without disabilities, but advocates complain that the program’s managers neglect tenants with disabilities and then threaten to evict them when disability-related lease violations arise.

In a November 2006 San Francisco Chronicle op-ed, Iranyi called for an audit of Care Not Cash’s evictions and coerced departures. Although Mayor Gavin Newsom claimed in his 2006 State of the City address that 95 percent of the 2,222 people in the program “remain housed,” Iranyi wrote that her own and others’ anecdotal experience made her “extremely concerned about the number of residents who are forced to move out of managed properties through evictions, threats of eviction, or failure to maintain residency for reasons directly or indirectly related to the resident’s disability/history.”

Local advocates have criticized the practices of the John Stewart Company, a large private property manager, and the Tenderloin Housing Clinic, a nonprofit with roots in tenant activism, although several advocates recognize that Tenderloin Housing has become more sensitive to tenants with disabilities in recent years. Deputy director Debbie Raucher says that Tenderloin Housing has established an eviction-prevention protocol that now calls for holding meetings, issuing warnings, and offering a last-chance opportunity in the form of a “housing retention contract” before it begins eviction. John Stewart Company president and CEO Jack Gardner rejected claims that evictions were excessive in the 10 buildings his company manages for the city of San Francisco. The average building, he says, “experiences only 2.6 evictions per year—80 percent of which are for nonpayment of rent and the balance for behavioral issues.” Nevertheless, he acknowledges that mismatches do exist between tenants’ needs and a building’s available services. He says this happens because managers accept tenants who are a bad fit because of the shortage of supportive housing and the urgency of getting people indoors.

Some San Francisco programs have been successful at keeping seriously disabled tenants housed. The city-operated Direct Access to Housing (DAH)—which houses nearly 900 tenants, all frequent users of city medical or mental-health services—does so by providing one case manager for every 15 to 20 tenants. It also provides exceptional access to medical and psychiatric staff. Marc Trotz, DAH’s manager, says eviction is rare, generally related to health and safety concerns, and pursued only after “pretty extraordinary attempts” have been made to rectify problems.

There is no national standard to define supportive housing. It can take the form of small buildings with on-site services or scattered-site housing with visiting service providers, but the more commonplace type is the “big box,” a large residential hotel or apartment building that houses 50 to 100 tenants and has on-site services. Almost all of San Francisco’s programs are big boxes.

Much of the funding for the nation’s supportive-housing programs comes from federal McKinney-Vento grants, frequently serving people the federal government calls “chronically homeless”: those who are mentally disabled or suffer from addiction. A 2001 paper by the Technical Assistance Collaborative suggested that the McKinney-Vento criteria favor big boxes to the detriment of disabled tenants: “To a certain extent, the complexities of aggregating sufficient capital, operating, and supportive-services resources, and the efficiencies that can be achieved with larger site-based models, have driven the most common models of supportive housing for homeless people. However, these high-density approaches are not favored by most housing advocates for people with significant disabilities.”

Paul Boden, executive director of the Western Regional Advocacy Project (a coalition of homelessness organizations), says neglect of serious mental disability is “more common than not” in a big box. Managers often fill buildings with people who share similar disabilities and assume tenants all have the same needs. Such segregation is still legally defensible, even though the 1999 Supreme Court decision in Olmstead v. L.C. held that people should not have to live in segregated places in order to receive treatment. In this environment, it becomes particularly easy to skimp on service spending and to neglect individual needs. If one tenant needs more help than others, the response is not “What else does X need?” but “Does X belong here?”