Community liaison functions.

MARIN COUNTY AIDS PROGRAM ANNUAL REPORT

Introduction

This is the first annual Marin _{County Department of Health and}

Human _{Services, AIDS Program Report. It is intended to accompany} the Marin AIDS _{Advisory Commission's 1994 Marin HIV Action Plan to} give a complete picture of AIDS activities in Marin County. This report is organized into sections which describe the various responsibilities of the AIDS Program staff members and provide the

most current data on staff activities in those areas.

Progam Activities

The Marin _{County AIDS Program has been in existence since 1987.}

The _{Program employs 1 director, 1 physician, 2 public health} nurses, 1 nurse, 1 AIDS social worker, a .7 FTE evaluator/planner,

.5 FTE nurse _{practitioner, 2.5 senior clerk typists, 1 FTE senior}

support service worker bilingual, .5 FTE accounting assistant, and .5 _{phlebotomist. Its program components include: 1) Anonymous HIV} Testing; 2) AIDS Case Epidemiology and Surveillance; 3) HIV

Specialty Clinic medical care; 4) the AIDS Drug Assistance Program;

and _{5) AIDS social work; 6) Grant administration as well as} Community liaison functions.

Anonvmous HIV Testing

Program description. The AIDS _{Program offers free, anonymous} HIV _{antibody testing at two testing sites on two evenings and one} morning a week for a total of 55 hours of testing per month. On a

quarterly basis, testing is also offered in Bolinas and Point Reyes. Testing is offered at additional sites in the community upon request. Individuals must reserve an _{appointment time.} Each appointment takes from 20 to 30 minutes. At the _{appointment, the} individual watches a video about HIV transmission. Then the client talks to a certified HIV test counselor about the test _procedure, the _{meaning of the results, their possible risk factors, and then}

receives educational materials _{and/or condoms. Finally, the client}

has blood drawn _by a phlebotomist. The blood is sent to the County laboratory for testing. The individual makes an appointment to

return at least two weeks later to receive the test results and

post-test counseling in person. Anyone who receives a _positive result is referred to the _{appropriate medical or support services}

in the _community.

Current data. The _{Anonymous Test Sites have conducted over}

12, 000 HIV antibody tests from July 1985 to date. Over 2800 clients were tested in 1993. Of _{these, less than 1% were found to}

have _{serologic evidence of HIV infection. The}

age, gender, racial

ethnic and risk factor distributions for 1993 are as follows:

ANONYMOUS HIV ANTIBODY TEST CLIENTS BY ETHNICITY - 1993

ALL SITES Ethnicitv Number White 2447 87.4% Hispanic 132 4.7% African-American 75 2.7% Asian 64 _2.3% Native American 15 .5% Other 65 2 .3% Unknown 2 .1% TOTAL 2800 100.0%

ANONYMOUS HIV ANTIBODY TEST CLIENTS BY AGE - 1993

ALL SITES Age Number % 10-19 _{years 85 3.0%} 20-29 _{years 825 29.5%} 30-39 _{years 876 31.3%} 40-49 _{years 751 26.8%} 50-59 _{years 185 6.6%} 60-69 _{years 75 2.7%} Unknown 3 .1% TOTAL 2800 100.0%

ANONYMOUS HIV ANTIBODY TEST CLIENTS BY GENDER - 1993 ALL SITES Gender Male Female Unknown TOTAL Number 1324 1475 1 2800 47.29% 52.67% . 04% 100.00% 23

ANONYMOUS HIV ANTIBODY TEST CLIENTS BY SELF-IDENTIFIED RISK-1993 ALL SITES Risk Number % Gay 168 6.0% Bisexual 90 3 . 0% IDU 109 4.0% Gay/Bisexual IDU 15 1.0% Blood transfusion 38 1.0% (incl hemophiliacs) Heterosexual w _multiple 1130 40.0% partners

High risk sexual partner 758 27. 0%

Occupational risk 67 2 . 0%

No identified risk 406 15. 0%

Unknown 19 1.0%

TOTAL 2800 100.0%

ANONYMOUS HIV ANTIBODY TEST CLIENTS' SEROPREVALENCE - 1993

ALL SITES Result Number % Positive 8 .3% Negative 2772 99.6% Indeterminate _{_2 .1%} TOTAL *2782 100.0%

*18 of 2800 clients received _{pretest counseling services only}

AIDS Case Eoidemioloav and Surveillance

Program description. The Surveillance Coordinator engages in active and passive surveillance to _{identify all the}

AIDS cases in the _{County. This activity is necessary to comply}

with the Centers for Disease Control and State Office of AIDS reporting requirements and it is _important for _determining the

need for Federal monies for _{prevention education and care and}

treatment services. On a _{monthly basis, she visits the Medical}

Records _{Departments of Marin General Hospital,}

Kaiser Hospital, and Novato _{Community Hospital as well as the}

County

Specialty

Clinic to review _{patients' records. She also meets with the}

infection control _{practitioners at these hospitals and at one}

rehabilitation _hospital.

She reviews the medical records at the AIDS units in San _Quentin

Prison and the _{Hospice Pilot Care Project. She monitors} pediatric and adult Vital Statistics records for HIV-related information. She reviews the TB and cancer _{registries. In}

conjunction with the expanded CDC definition of AIDS which became

effective _{January 1, 1993, the number of new cases reported for}

each _{quarter of 1993 has at least doubled. The Surveillance}

Coordinator _{compiles the data and produces a monthly AIDS} Statistical Report and a _{quarterly AIDS Bulletin.}

Epidemiological trends are noted and projections of the number of

infected _{persons are made.}

AIDS CASES BY ETHNICITY

-1993 Ethnicity Number % White 218 73 . 0% Hispanic 20 7 . 0% African-American 58 19. 0% Asian 2 . 6% Native American 1 .4% TOTAL 299 100.0%

AIDS CASES BY AGE - 1993

Aoe Number % 10-19 _years 0 0.0 20-29 _years 53 18 . 0% 30-39 _years 116 39. 0% 40-49 _years 97 32.0% 50-59 _years 24 8.0% 60-69 _years 7 2 . 0% 70+ _years 2 1.0% TOTAL 299 100.0%

AIDS CASES BY GENDER -

-1993 Gender Number % Male 286 96.0% Female 13 4. 0% TOTAL 299 100.0% 25

AIDS CASES BY TRANSMISSION CATEGORY - 1993 Transmission categorv Number %

Homosexual/bisexual male 149 49. 8%

Injection drug user 101 33. 8%

Homo/bisexual IDU 27 9. 0%

Transfusion _recipient 6 2. 0%

Hemophiliac/ 0 0.0%

coagulation disorder

Heterosexual contact 14 4.7%

None of the above 2 .7%

TOTAL 299 100.0%

HIV Specialty Clinic

Program description. The HIV _{Specialty Clinic is}

jointly funded by County and Federal Ryan White CARE Act funds. The Clinic is in its third _{year of providing primary}

_medical

_care

to _{low-income, underinsured, and uninsured Marin County residents}

as well as a small _{proportion of privately insured individuals} living with HlV/AlDS. The Clinic is located on the grounds of Marin General _Hospital.

The _{goal of the Clinic is to provide "one-stop shopping." In}

addition to medical _{care, the Clinic offers participation in}

several clinical _{drug trials. Nutritional counseling is}

available on a _{monthly basis and a psychiatrist is available for} consultation one half _{day per week.}

It should be noted that _{patient service data is compiled} according to a funding cycle that begins in April 1993 and therefore _{represents 8 months rather than} a year of data. The caseload has _{grown to more than 150 patients who received 4106}

units of service from _{April through December 1993.}

CLINIC PATIENTS BY HIV STATUS

-1993

HIV status Number %

HIV _positive 58 38. 0%

Disabling HIV/ARC 13 9.0%

AIDS 80 53 . 0%

CLINIC PATIENTS BY ETHNICITY -1993 Ethnicity Number % White 113 75.0% Hispanic 19 13.0% African-American 14 _9.0% Asian/Pacific Is 2 1.0% Native American 1 _1.0% Other 2 1.0% TOTAL 151 100.0%

CLINIC PATIENTS BY AGE - 1993

Aae Number % <12 _years 0 0.0% 13-17 _years 1 1.0% 18-24 _years 6 4.0% 25-29 _years 22 14 . 0% 30-39 _years 57 38 . 0% 40-49 _years 45 30.0% 50-59 _years 17 11. 0% 60+ _years 3 2 . 0% TOTAL 151 100.0%

CLINIC PATIENTS BY GENDER -

-1993

Gender Number %

Male 132 87. 0%

Female 19 13 . 0%

TOTAL 151 100.0%

CLINIC PATIENTS BY PRESUMED TRANSMISSION CATEGORY - 1993

Transmission cateaorv Number %

Homosexual/bisexual male 89 59 . 0

Injection drug user 29 19 . 0

Homo/bisexual IDU 15 10. 0

Transfusion _recipient 1 1.0

Heterosexual 11 7.0

Person born _{country where}

heterosexual contact _primary

source _{3 2}

. O:

Unknown _{3 2}

. O:

AIDS Drug Assistance Program

Program _{description. The AIDS Drug Assistance Program}

is _{federally funded with monies distributed through the State} Office of AIDS. This _{program provides financial assistance to} Marin residents with an income of _{$50,000 or less for 14 specific}

AIDS-related _{drugs. Those with an income of less than $27,240}

are not _{required to contribute} a copayment. There are currently 86 clients _{receiving this assistance. The ADAP Coordinator}

interviews each _{potential client who has been referred by a} physician or a case manager to determine his or her financial eligibility for the program. Once enrolled in the program, the

Coordinator works with the _{client, pharmacy, and physician/case} manager to ensure that the client receives appropriate medication

in a _{timely and cost effective manner. When the individual needs} financial assistance to _{purchase medications that are not on the} State's list the Coordinator refers the individual to _Community

Action Marin.

ADAP CLIENTS BY HIV STATUS - 1993

HIV status Number %

HIV _{positive 48 56.0%}

AIDS 38 44.0%

TOTAL 86 100.0%

ADAP CLIENTS BY ETHNICITY - 1993

Ethnicitv Number % White 66 77. 0% Hispanic 11 13 . 0% African-American 8 9. 0% Asian 1 1.0% TOTAL 86 100.0%

ADAP CLIENTS BY AGE - 1993

Age Number % 10-19 _years 0 0 20-29 _years 13 15.0% 30-39 _years 34 40.0% 40-49 _years 27 31.0% 50-59 _years 9 11.0% 60-69 _years 3 3 . 0% TOTAL 86 100.0%

ADAP CLIENTS BY GENDER - 1993

Gender

Male Female

TOTAL

AIDS Social Work

Program description. The Marin _{County AIDS Program}

employs a full-time social worker whose caseload consists

entirely of persons who are _{permanently disabled with HIV/AIDS} and are low-income _{(i.e., receives SDI or SSI). His caseload is} approximately 24 clients. Potential clients are referred from a variety of sources for In-Home _{Support Services and/or Adult} Protective Services. The social worker assesses an individual's

need for health and social _{services, evaluates the services}

currently received, provides appropriate information and referrals to additional _{services, monitors the reception of}

services, and intervenes to facilitate service _delivery as needed. The social worker makes an initial home visit to all

new clients and then visits clients _{again at least once a year.}

He coordinates services with the HIV _{Specialty Clinic for those}

clients who are Clinic _patients. Grant _{Administration}

The Marin _{County AIDS Program is responsible for}

distributing and

monitoring funds from County, State, and Federal sources to community-based agencies for AIDS-related services. The MCAP

currently manages 12 contracts with _{community-based organizations} and _{approximately $620,404 in Federal, State, and local}

funding for AIDS and HIV-related health care and _{prevention services.}

Federal funds. The AIDS _{Program staff administers} several Federal _{grants i.e., Ryan White CARE Title I and HOPWA}

grants. In this _{capacity, the Coordinator and/or Planner met} monthly with their counterparts in the counties of San _Francisco, San _{Mateo, and Contra Costa to discuss issues of mutual}

interest in the _{Bay area related to CARE Title I funding.}

The _{Program Director and/or the}

Planner/Evaluator regularly

monitor the _{progress of the various CARE and HOPWA-funded} agencies to ensure that _{they are meeting their contracted} objectives with high quality programs. The Program Director

participates with AIDS _{Advisory Commission} members in annual site visits to all these funded _agencies.

In _{addition, either the Program}

Director, ADAP Coordinator, the

social _{worker, and/or the Clinic physician attends}

case

conferences to ensure the coordination of services _{provided by}

Number

79 92.0^

7 8.0^

86 100.o:

'the above-funded _{agencies for Clinic or ADAP clients.}

The Planner is a member of the HOPWA _{Working Group which solicits} and _{analyzes community input regarding housing for persons with} AIDS and makes recommendations to the AIDS _{Advisory Commission.}

State funds. The Planner _{prepares the application to} bring Title II funding into the County and serves as the contact person for the State Office of AIDS. The Program Director is a Consortium member. The _{County coordinates program monitoring}

with the Consortium's Fiscal _{Agent and also participates in the}

annual site visits to some Title Il-funded agencies.

The Planner coordinated the _{preparation of a proposal for HIV}

Prevention Education _{funding from the State Office of AIDS. The}

proposal was approved for three years of funding. The funding is for a collaborative of 5 _{agencies including the Marin County AIDS} Program to provide both street outreach and risk reduction

programs to men who have sex with men, substance users not in treatment, and high risk youth. The role of MCAP is to

facilitate the coordination and evaluation of these services and prepare the required quarterly progress reports for the State

Office of AIDS.

The Surveillance Coordinator _{represents Marin County at State}

meetings. In her role as ADAP Coordinator she meets with other

Coordinators _{regarding issues of mutual interest such as the}

proposed computerization of the AIDS Drug Assistance Program.

Local funds. The Planner _{represents Marin County in a}

Bay Areawide review of proposals for AIDS-related services to be

funded _{by donations to the AIDS Fund of the United Way. The} Planner makes _{funding recommendations for services in Marin,} Contra _{Costa, San Mateo, San Francisco, and Alameda counties.} The Planner monitors the _{progress of agencies supported by County} General Funds to _{provide AIDS-related services.}

Communitv Liaison

MCAP staff also _{represent the interests of Marin County}

individuals _{living with HIV/AIDS to various groups.}

The _{Program Director attends regular meetings of the California} Conference of Local AIDS Directors.

The MCAP _{personnel staff the Marin AIDS Advisory Commission and} attend Commission and most Committee _{meetings. They organize and} facilitate _{bimonthly meetings of the Marin AIDS Task Force.}

The Surveillance Coordinator meets with other _{Bay Area}

Surveillance Coordinators on _{topics of mutual interest. She}

usually attends the annual meeting of the Northern California

Pediatric AIDS Surveillance _{Program participants. She meets with}

. General and Kaiser

Hospital AIDS Task Forces as needed.

The social worker also acts as a liaison to _{community agencies} and _{County departments. He attends the biweekly Hospice}

HIV case

managers' meeting and the HIV _{Interagency Case Management Project}

meetings. He attends meetings of the Direct Services Committee of The Marin AIDS _{Advisory Commission and other HIV-related} community and regional meetings.

Marin AIDS _{Advisory Cominission} 1994 First _{Quarter Report}

The first _{quarter of 1994 opened with the news that Marin County} was _{receiving increased funding from the Ryan White CARE Act,} Title 1 _{Program. In addition to a formula grant, Marin applied}

for _{supplemental funding to augment already existing programs and} to _{support new programs that were needed by Persons Living With}

HIV/AIDS. Increased funding was also received from Title II of

the _{Ryan White CARE Act. Overall funding has almost doubled what}

Marin received last _year.

With increased _{funding, the AIDS Advisory Commission has been} able to continue all of it's _{past AIDS service contracts and} consider _{funding new programs. Some of the new services being} considered include women _{specific AIDS programs, child care} services for AIDS affected _{families, dental care for Persons} Living With HIV/AIDS, Alternative Therapies and a new hot meal delivery program that will be administered by a collaboration of Community Action Marin and Marin AIDS Project. The new hot meal delivery program means that meals will be prepared in Marin

without _{having to rely on an out of county service provider.}

Currently the Commission has recently redefined the roles of

committees and their _{relationships with the Commission as a}

whole. This _{process change will facilitate better communication}

between committees and commissioners. The result should be a more _{cohesive, collaborative body advocating for Persons Living} With _{HIV/AIDS in Marin County.}

The Commission is _{actively recruiting members to represent the}

demographics of Marin County. Once this process is completed the

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Marin

_County

_{Specialty Clinic}

Budget 1992-93

Expenditures

Rvan White

MCF

County

YTD Expend.

12

-3/X

Personnel

Contract

Physician

$119,600

$119,600

Senior Nurse Practitioner _{67,600 58,656 8,944}

Regular Hire

Registered Nurse 1.0

47,237 47,237

Accounting Assistant 0.5

13,500 13,500 Senior

_Clerk-Typist

_1.0

_{26,998 26,998}

Case

_{Manager 2.0, Vol Coord .5}

_{100,000 100,000}

Benefits at _approx.

_17.6%

_{15,441 15,441}

Extra-Hire _{10,000 7,937 2,063}

Contract — On-Call

Physicians

90,800 21,553 69,247

Total Personnel _{$491,176 310,922 100,000 80,254} Line Items

2112

_{Drug &}

_Med

$ _10,000 $ 10,000 3,598.94

2113 Clinic

_Supplies

_{16,000 10,000 6,000 13,777.71}

2115 Lab

_Supplies

_{16,000 16,000} 750.00

2131 Books and Periodicals _{1,000 1,000} 455.25

2133 Office

_Supplies

_{9,000 9,000 5,775.66}

2137 Doc

_Repro

_{1,250 1,250 625.00}

2161 Lab Tests &

_X-Rays

_{5,000 5,000 0.00}

2269 Misc Fees _{1,400 1,400} 100.00

2271 Educ Materials _{1,616 1,616 300.00}

2273

_Training

_{2,050 2,050 2,357.00}

2479

_Mileage

_{1,200 1,200 600.00}

2533 Contract Svcs _{1,200 1,200 600.00}

4880 Data

_{Processing Equipment}

_{1,875 1,875 1,874.73}

5004 Gen Insurance

_Chg

_{15,000 15,000 0.00}

5071

_Telephone

_{4,000 4,000 3,009.50}

Renovation of

_Facility

In Kind Rent,

Maintenance,

and Utilities In Kind

Total Line Items _{$ 86,591 $ 11,200 $ 75,391 33,823.79}

GRAND TOTAL

_$577,767

_$322,122

_$100,000

_$155,645

MARIN COUNTY Ryan White I - 1993-94 Year III - $806,990

Primary care $373,670

Case _management

(Incl. attendant care)

Meal _{preparation & delivery}

+ food

Medication vouchers or _payment

for _{prescriptions not covered}

by insurance

Attendant care augmentation

Advocacy (incl. benefits) Transportation vouchers Substance abuse treatment

entart^health IIIV _opeciajris-t Emergency Voucher Assistance Grand Total 143,507 6^ ^ 9,200 32,948 3:8",400

Ij

O

22,080 22,185 70,000 $806,990

7,

ric e^l/t

MARIN COUNTY AIDS PROGRAM

Ryan White CARE Act, Title I - 1993-94 Year III - $806,990

Primary Care Physician 1.0 Sr. NP 1.0 RN 1.0 Accounting Asst. .5 Sr. Clerk _{Typist 1.0} Benefits _{(approx. 17.6%)} Vacation coverage -Sr. NP 3 wks. _$3384 -RN 3 wks. $2995 -Sr. Clk. 3 wks. _$1558 On call _Physicians (actual cost = 90,800) Total Personnel Billing Sub-contract -$100/mo X 12 mo. Clinic/medical supplies

(Drugs, biologicals, and related

clinic _supplies)

Indirect Costs _{(2.5% of} $806,990) Total _{Primary Care}

$119,600 58,656 47,237 13,500 26,998 $265,991 46,814 7, 937 21,553 $342,295 1,200 10,000 20,175 $373,670 Subcontracts

■ Subcontracts to Community Service

Providers will _{supply direct services}

to _{persons with HIV of case management,} attendant care, food, meal delivery, advocacy, substance abuse treatment,

mental health, emergency vouchers for medications, transportation, and other

urgent needs $433,320

Marin

_County

_Specialty

_Clinic

Budget 1992-93

Expenditures

Ryan

White

MCF

County

YTD Expend

12

-11

-Personnel Contract

Physician

$119,600

$119,600

Senior Nurse Practitioner _{67,600 58,656 8,944}

Regular Hire

Registered Nurse 1.0

47,237 47,237

Accounting Assistant 0.5

13,500 13,500 Senior

_Clerk-Typist

_1.0

_{26,998 26,998}

Case

_{Manager 2.0, Vol}

_Coord

_.5

_{100,000 100,000} Benefits at _approx.

_17.6%

_{15,441 15,441}

Extra-Hire _{10,000 7,937 2,063}

Contract - On-Call

Physicians

90,800 21,553 69,247

Total Personnel

_$491,176

_{310,922 100,000 80,254}

Line Items

Drug

& Med

$ 10,000 $ 10,000 3,598.94

Clinic

_Supplies

_{16,000 10,000 6,000 13,777.71}

2115 Lab

_Supplies

_{16,000 16,000} 750.00

2131 Books and Periodicals _{1,000 1,000} 455.25

2133 Office

_Supplies

_{9,000 9,000 5,775.66}

2137 Doc

_Repro

_{1,250 1,250} 625.00

2161 Lab Tests &

_X-Rays

_{5,000 5,000} 0.00

2269 Misc Fees _{1,400 1,400} 100.00

2271 Educ Materials _{1,616 1,616} 300.00

2273

_Training

_{2,050 2,050 2,357.00}

2479

_Mileage

_{1,200 1,200} 600.00

2533 Contract Svcs _{1,200 1,200} 600.00

4880 Data

_{Processing Equipment}

_{1,875 1,875 1,874.73}

5004 Gen Insurance

_Chg

_{15,000 15,000} 0.00

5071

_Telephone

_{4,000 4,000 3,009.50}

Renovation of

_Facility

In Kind Rent, Maintenance, and Utilities In Kind

Total Line Items $ 86,591 $ 11,200 $ 75,391 33,823.79

*> ^

Cost of _{Livinq Averaqes (Honthiy) for PWAIDS on Social Security in Marin County}

July, 1993 INCOME Social Security/Disabi 1 i ty I 640.00 fotal Income 640,00 EXPENSES Rent I 795.00 Eiectric/Sas 60.00 Phone 40.00 Food 200.00 Viacom 45.00 IransDortation 35.00 Laundry 25.00 Clothes 20.00 Medicine/Alterative Medicine 55.00 * Total Expenses $1,275.00

Cost of _{Living Averages ^Monthly) for PWAIDS on Social Security at ADAMS HOUSE}

July, 1993

INCOME

Social Security/Disabi1itv 1640.00

TOTAL INCOME $640.00 EXPENSES Rent/Gas/Electic/Food/Viacorn/Laundry/Trans. $575.00 Phone 20.00 Medical 30.00 TOTAL EXPENSES $625.00

Seniorswho are _{renting units in theopenmarketfrequentlyarepayingashighas}

70% of their incomes forrent. Oftentheyaredependentonthe charity of their neighbors evenfor food.

EAH_{Report, 1992}

• _{The Ecumenical Association for}

Housing estimates

conservatively that there Is

a minimum need for low income seniors of 3,709 units atthis time.

A

_growing

_{Segment of the}

_{Population has}

_an

Inadequate Income

to meet

Basic living needs

One needs to earn $8-10 an hour to survive, and that's minimum. In iWann, most rent will often eat up 60% of one's incomeif you're earning

$8-10anhour. Really, tolive, you'd need $18anhour.

ShelterResident, HomeBaseReport 1992

• _The

average wages

and salaries of

individuals working in Marin

are ten percent lower than _{average wages}

_{in the Bay Area}

_{(United Way Needs Assessment,}

1992).

•

12,437

(or

14%) Marin households live

with less

than

$15,000

per year.'

Another 14% of households earn between _{$15,000 and $25,000 a year}

_(United

Way Needs Assessment, 1990). This means that almost one in three residents is

_paying

_{at least 42% oftheir income for rent}

_(based

_{on the average housing} cost cited

_above).

•

The fastest

_growing

_labor

_market

_segment

_{in Marin is the service industry,}

closely followed by retail trades. Employment in these industry

sectors

will

not break the

_cyclical

_aspects

_of

_poverty,

_in

_part

_because

_{wages are}

_{less than}

_{half of}

those

_{prevailing in manufacturing}

_sector

_{jobs and there}

_are

_{few if}

_any

_benefits

offered.

• _Marin

county has the

highest

housing

costs

in the

state of

California. Housing

costs are not taken into account for those individuals and families

_dependent

_on

income _{supports such as General Assistance}

_{(locally determined)}

_or

_AFDC

(determined

at the state and federal

levels),

thus rendering such

income

supports

insufficient to _{prevent the loss of}

_housing

_orto

_regain

_{self-sufficiency.}

There is an Dramatic Shortfall in _Emergency

and Transitional _{Housing to Meet the Need}

•

Approximately

729 parents and

childreh (238 families) experienced

an

episode

of homelessness in Marin _{during 1991.}

_This

_{number does not}

_include

_any

_single

homeless adults or

_youth.

_{An estimate}

_{of the total number of people who}

experienced an

episode of homelessness

comes to

2209

people

(HomeBase

•

By

contrast, the total emergency

shelter

capacity

on any

given

non-winter

night

is 86. This includes 54 _emergency

_{beds and 32}

_beds

_{in transitional housing}

programs

(HomeBase Report, 1992).

♦ _{In December}

1991, there were 2200 names on the

waiting list for Section 8

certificates. Of _{those, 556} were homeless and residents of Marin

County,

161

were homeless and from outside of the

_{County, and 823}

_were

_paying

_more

_than

50% of theirincome towards rent or

_{living in}

_{substandard housing (Home Base}

Report, 1992).

Inadequate Support Services exist for Homeless

Families and those at Risk of Homelessness The_{systemencourages us togo without welfare, but there'sno decent child}

care. It'sa catch 22.

ShelterResident,HomeBaseRaport 1992

• _There

are _{only two child care subsidy programs for at risk families,}

_with

₃₆

_slots

and 98 families now on the

_waiting

_{list. With}

₂₃₈

_{families experiencing}

homelessness last _{year, a major}

_{shortfall of}

₂₀₀

_{subsidized slots exists}

(HomeBase

Report, 1992).

•

The 1991-1992 Marin

_{County budget proposal eliminated 50 staff positions}

from _county

_departments,

_{66% of which were in the area of health and human} services _(MCA

_Report,

_1992).

_{Cuts in}

_social

_{services, public health}

_and

_mental

health services

_{disproportionately}

_{affect the poorand homeless, and as has}

repeatedly been

shown, are not cost effective.

• _There

are _{only 40 beds in the entire county}

_{for those}

_who

_need

_{residential drug}

and alcohol _{recovery services.}

_According

_to

_{the Director of}

_{one program,}

_the

_fact

that there is no continuum of care in the

_{county-particularly in mental health}

services-negatively

impacts

substance abusers

who

are

homeless, because

they

often

require

such

supportive services in order

to

effectively benefit from

residential treatment. The result is that few of the homeless _{get access to}

_critical

recovery services.

• _Marin

Community

Clinic

has

experienced repeated cutbacks in local,

state

and

federal

_funding,

_{resulting in three week waits for elective visits and no urgent care}

capacity. Increasingly,

the poor and homeless

have

no

alternative

but to use

the

Emergency

Room at Marin General, which costs taxpayers far more and

provides less comprehensive care.

•

Many

poorand homeless families are not

adequately informed of the

services

to which

_they

_{are entitled. A recent}

_hunger

_survey

_{revealed that 28,000}

_Marinites

did not have

_enough

_{money for}

_{sufficient food.}

_{Of the 28,000, close}

_to

_18,000

were

_{eligible for}

_{federal food assistance, but}

_{only 4,000}

_{used the}

_program

_(United

Way Needs

Assessment,

1990).

Such sen/ices

can

sometimes make the

difference between

_{living in}

_a

_home

_or

_living

_on

_the

_street.

Almost half of poorrentersandonethird ofpoorhomeownersspend

70% of their income on_housing.

UnitedWayReport. 1990

• _Marin

County

faces

a

dramatic shortfai! in

the amount

of

permanent

affordable

housing

that is needed. The Ecumenical Association for

Housing

estimates the

need for affordable

_{housing in Marin}

_County

_at

_11,900

_{units between}

_now

_and

1996 and _{8,000 additional units between 1996 and 2020. Given that a total of}

7,000

_housing

_{units of all kinds have been built in the}

_{County in the}

_{past ten} years, the

majority of which

are very

expensive, Marin

clearly faces

a

crisis

in

affordable

_housing.

• _{In the}

past ten years Marin has added _{22,000 jobs} (a33,5%

increase)

but _{only 7,000 units} of

_{housing (a}

_7.7%

increase).

Population during

this same time period grew

only

3.37%...Most of these

_employees

were forced to locate away from their new _positions,

primarily in Sonoma

County

(EAH

Report).

•

According

to federal standards,

housing is affordable if its

cost

does

not

exceed

30% of the renter's _gross

_income.

_{The average}

_{Marin housing}

_cost

_of

_$875

_a month for a two bedroom _apartment

_makes

_{obtaining affordable housing}

extremely difficult for people in poverty,

particularly homeless

persons.

Looking

at _{maximum affordable}

_housing

_payments

_{(MAHP) for Marin residents}

_who

_are not _poor

_emphasizes

_this

_point;

_A

_{County firefighter with}

_a

_{starting salary}

_of

$29,330 has a MAHP of

_$733,

a shortfalll of $142 per

month

to pay

the

average

two-bedroom rent

_{(EAH Report).}

• _{Even the}

$730 median for the lowest ten _{percent of the}

_rental

_{units requires}

_an annua! income of _{$29,400, not affordable to most in entry level positions (EAH}

Report).

• _The

median

_{purchase price of}

_a

_{Marin County single family home}

_{rose to} $319,000 in 1991.

requiring

an income of over

$80,000. This is

not

affordable

to most _{present homeowners if}

_{they had}

_to

_buy

_a

_{home today and}

_certainly

_is

_not

affordable to _{the average new employee in the county}

_(EAH

_Report).

Who will be homeless next? The mostcommon factors_{precipitating homelessnessin}

Marin_Countyare:

• _{Domestic Violence} (21%) • Unemployment (22%) • _{Mental Illness} (22%) • Substance Abuse (21%) • End of_afinancial

(and sometimes personal) relationship that results in displacement (24%)

Women and children _{representaboutone-third of} Marin's Homeless_{population, and} are the fastest growingsegmentof homeless. Many (approximately 40%) are homeless because of domestic violence.

Post Office Box 803 Mill Valley California 94942 (415) 383-5060

Facts on

_{Poverty &}

_{Homelessness in Marin County}

January 1993

Marin _{county has the highest per}

_capita

_{income of}

_{any county}

_in

_{California, and}

_a mean household income 40%

_higher

_than

_{that of the Bay Area.}

_As

_{a report}

_by

United _{Way points out, however, poverty}

_{exists in significant numbers,}

_its

incidence and

_severity

_made

_worse

_{by the surrounding}

_{affluence. In 1991,}

_some 2200 _people

_experienced

_an

_episode

_{of homelessness}

_{in the}

_county.

_{There is}

_a

growing

gap between the rich and the poor,

with

a

shrinking middle class.

In the

last several _{years, human}

_service

_{providers have experienced}

_a

_{dramatic rise in}

requests for

help from working

individuals

and families who

are

unable

to

provide

the basics of life. Individuals are _{having to make}

_choices

_between

_{food and}

medical _{insurance, between}

_{housing and}

_{car payments,}

_between

_child

_{care costs} and

_leaving

_{children unattended. In many cases an}

_{unexpected financial}

_crisis

_or personal

hardship

can have serious consequences

for these

families, ultimately

resulting in

homelessness

(Marin

County Needs Assessment,

1990).

As in other communities across the _country,

_{increasing homelessness is the}

tragicconsequence of local, state and federal social and economic trends that have decimated the standard of _{living of the working poor while}

_destroying

_the safety-net that could prevent loss

of

housing.

A recent report

released by the

Marin Council of _Agencies

_{summarizes these trends}

_by

_pointing

_out

_{that "In}

_the

last ten _{years, the}

_{hourly minimum}

_{wage has}

_{risen 37%,}

_the

_{median income has}

risen 68%, while annual rental

housing

costs have skyrocketed 155%."

Marin

_{County faces}

_a

_Dramatic

_{Shortage in the}

Supply of Housing that is Affordable

to

its Low and

Very Low Income

Population

The affordable _{housing theyare building in Marin costs $695 to $795a}

month, which is simplynotaffordable to someone on SSI who onlygets $700 a month.

HomelessResident, HomeBaseReport

We have been _{exporting our need for affordable housing-and our} people-to surrounding counties formanyyears...90% ofus areunable to afford themedianpriced home.

EAR_{Report, 1992} During thecourse ofa yearsomewhere between 30-50% of the people

who come _{throughourshelter endup returning. Even for those who}

have stableincomes, theresimplyis no low-costhousingto refer them to.

Managerofa Shelter, Marin County

Pajhtal ListofMembers: Aluance For The mern'atly lu Canal COMMUNrr/ Aixiantx Cathouc CiiARinc;

Crossover Project

Deft ofKealth & Human Services EcumenicalassoaatiohforHousing

Homeiess stauing Committee

Marin AbusedWomen's Services

MarinCenterforCharitble Giving

MarinCenterforIndependent Living

MarinConcerned Citizens

NorthbayEcumenical Housing NovatoHuman Needs Center Planned parerrrnood Project Move