San Francisco is world-renowned for its landmarks—the Golden Gate Bridge, cable cars, Levi Strauss jeans—and as the birthplace of companies like Airbnb, OpenAI, and Uber. Sadly, it has also become well known for the 8,300 people within its boundaries who sleep in doorways, cars, and tents and beneath bridges on any given night.¹ Every year, about 20,000 people in San Francisco are homeless, many sleeping exposed to the cold, wind, and rain or living precariously on the couches and floors of their family and friends. They have no home of their own.

Despite billions of dollars invested over the past two decades and the dedicated efforts of service providers and City officials, homelessness in San Francisco has not improved significantly. In fact, there is no accurate account of the amount the City spends on homelessness, since the official figures do not include items such as the burden on local hospitals, the time and energy of first responders, or the cost to the judicial and detention systems.

We estimate that the City and County of San Francisco, via the expenditures it tracks, spent upwards of $1–2 billion in fiscal year 2023–24 on services related to homelessness—an average of over $75,000–100,000 per unhoused person.² The cost of treating people with the most acute need is likely much higher, at upwards of $250,000 per year.³ The average amount spent per person is equivalent to nearly 25 months of rent for an apartment in San Francisco.⁴ It would be one thing if all this effort and money led to long-term solutions. But they haven’t. Even with individual success stories, no large-scale, lasting solutions to recurrent homelessness have yet emerged. 

The current system is fragmented, marked by service gaps, and hindered by a complex management structure. The system has failed leaders in City government, who are responsible for addressing homelessness via multiple departments, which tap a variety of budgets. It has failed service providers, who must piece together a slew of funding sources to deliver services to people with complex needs. And, most importantly, it fails unhoused people, who are left to navigate a maze of programs that would befuddle those in the best of circumstances.

This report recognizes the hard work of San Francisco’s City departments and service providers; however, it also highlights that the system itself is broken and in need of cohesive reform. Systemic issues, such as fragmented services and insufficient coordination, prevent progress and leave too many vulnerable people—particularly those from marginalized communities, such as communities of color—without effective support.

This report attempts to provide a plan for a mayor to make homelessness rare and brief. And, for the first time, this work presents:

1. A clear portrait of San Francisco’s current homelessness system
2. The overlapping agendas of many City agencies
3. The challenges presented to service providers in their quest for financing
4. Portrayals of people experiencing homelessness in San Francisco that are demographically representative, highlighting the disparities that disproportionately affect people of color
5. The bewildering, poorly marked path to stability with which an unhoused person is confronted
6. Identification of approximately 300 sites available around the City for affordable housing, about 100 sites for interim housing, and about 320 for permanent supportive housing

For readers of this report, we hope it becomes clear that the most effective way to prevent homelessness is to offer help before tragedy strikes. It is easier to keep someone housed than to help them leave a tent, RV, or doorway. For those who have the misfortune of trying to survive on the streets, we need to simplify the way they encounter the large number of San Francisco’s complicated and baffling homelessness services. Readers of this report are accustomed to services that, with the touch of a button, allow us to book a flight, order groceries, or transfer money. By contrast, San Francisco’s unhoused residents are still dealing with systems that require pen, paper, and in some instances, fax machines.

Nonprofit service providers work tirelessly to meet community needs. However, lasting progress requires more coordinated management of government and service provider efforts. For example, while the City aims to reduce the total number of contracts, this does not necessarily imply a reduction in the number of providers; instead, consolidating contracts under lead organizations or having fewer contracts per service provider across and within departments allows for better coordination and efficiency. The system’s fragmented nature—marked by insufficient housing, overlapping responsibilities, and poor coordination—continues to let too many vulnerable people slip through the cracks. Making homelessness rare entails focusing on prevention, offering timely assistance, and ensuring access to affordable housing and, where needed, medical services. For those who do become homeless, a simplified intake process could rapidly connect them to the services they need. With the right support, their path out of homelessness could be permanent.

This report outlines 12 specific recommendations to improve the way people enter the system, the services they receive, and the overall management and support required to help them. If implemented, these changes would allow San Francisco to better support those at risk of losing their accommodations or living on the streets.

Everyone deserves lasting stability, particularly those who have historically faced barriers due to racial inequities and economic marginalization. Making this happen will require clear delineation of the responsibilities of government and service providers, with fewer hurdles and black holes. By embracing a clear, results-driven approach, inefficiencies can be reduced, and progress can be made.

Fancy plans are fine but, by themselves, will not solve anything. If we are to succeed, effective and persistent management is required. Stronger leadership, attention to detail, improved staffing, and a focus on results will be crucial. This report offers a roadmap for delivering the services and care that can help unhoused people move from the streets to stability.

This report recognizes the hard work of many individuals working in City departments and at nonprofit service providers. It also recognizes the shortcomings of the existing system and offers a new road map for more effectively delivering the coordinated care needed to help unhoused residents move from the streets to stability.

Report recommendations:

1. Increase housing supply. Devise plan for permitting 46,000 affordable homes by 2032 (out of the 82,000 required by the State), to help San Francisco become a city where working people can afford to live
2. Keep people housed. To prevent homelessness, people need timely financial support and resources
3. Address reasons, other than income, for homelessness
4. Introduce better case management and care delivery
5. Create easy-to-use digital experiences for people accessing service or providers managing programs
6. Expand capacity and improve existing stock of interim housing and permanent supportive housing solutions
7. Devise employment pathways that break the cycle of poverty and provide a sustainable living wage
8. Directly address the relationship between homelessness and drug use, and provide intensive treatment for severe mental illness (SMI) and substance use disorder (SUD)
9. Revamp the Journey Home program to provide sustainable relocation assistance to other cities
10. Simplify City governance and improve coordination with the broader Bay Area region to reduce waste and improve effectiveness
11. Implement outcomes-based contracting that results in simpler, more effective service provision
12. Increase access to non-City public funding