(Last in a Five-day Series)

San Francisco has the nation's worst problem with hard-core homelessness. Thousands of people are without shelter, and as many as 5,000 spend virtually all their time on the street. Chronicle reporter Kevin Fagan and photographer Brant Ward spent four months among the homeless and those who deal with them. In this series, they explore how one of the nation's wealthiest and most cultured cities came to have so many people living on its streets.

There is a way to get chronically homeless people off San Francisco's streets. It will require a sweeping plan - intensive, sustained and expensive.

It will mean enforcing existing laws against living on the street - but not just rousting people and throwing them in jail. Or giving them a room to get started on normal lives. Or offering walk-in drug and alcohol clinics. Or merely sending counselors out to do on-the-spot triage on the street.

It will mean making sure there is a bed for everyone in need, and comprehensive services right there in the building to treat the drug, alcohol and mental problems that afflict them - a concept called "supportive housing. "

The trouble is there is no such plan. Models exist in other cities, including New York, and San Francisco already has some programs that work.

But there aren't enough services here for everyone who should have them, and too much is left up to the homeless. If the hard core were capable of pursuing follow-up care on their own, they wouldn't be in the gutter to begin with, experts say.

Another major problem is governmental paralysis. City politicians have never committed to a single comprehensive strategy for getting the hundreds of millions of dollars it will take to put the most chronically homeless people in supportive housing.

Now, after two decades of crisis, experts say it will take at least $450 million to build the minimum housing necessary. This will mean at least doubling the city's current stock of 2,500 supportive housing units.

"Keep in mind (supportive housing) is a fairly young industry, only around about a decade," said Maryann Leshin, California program director of the Washington, D.C.-based Corporation for Supportive Housing, a leading nonprofit organization for arranging such housing nationwide. "But while there has been good support for this work in San Francisco, it's really a matter of ramping it up now.

"And nobody has been able to come up with one huge plan to get everything done."

The public clearly would like to see that plan. Last year, voters in San Francisco passed the controversial Care Not Cash initiative to replace welfare payments with services - later shelved by court order. And in November, they approved the anti-panhandling Proposition M as well as Proposition J, which requires the city to provide separate shelters for homeless families, seniors and the disabled. All passed handily.

In Tuesday's runoff, Supervisor Gavin Newsom, who created Care Not Cash, faces Supervisor Matt Gonzalez, who also makes homelessness one of his central campaign issues.

Both advocate cleaning up shelters and providing more supportive housing. But like so many city politicians over the past 20 years, the two men cannot agree on how to do it. And whatever his vision, the winner will face the daunting task of uniting the city's historically fractious collection of advocates and officials.

The lack of a sweeping plan drew fire last year from the office of the controller. An 85-page report lambasted virtually every aspect of San Francisco's strategy on homelessness.

An overarching policy that all officials support would help the city get more funding and provide services tailored to the various needs of homeless people, the report said. But before that can happen, the city needs better data on its homeless population.

The data is so poor now that it is impossible to know how much federal and state financial help the city should be getting, or how much has been lost by inaction.

"There are a lot of nice people doing a lot of decent things, but not with an agreed-upon goal and not with a plan on how to get there," City Controller Ed Harrington said when the report was released.

What the 3,000 to 5,000 chronically homeless people need are clean living spaces with round-the-clock services in the same building, experts agree. That means drug and mental health counselors, job counselors and medical services.

So why hasn't it been done?

"God only knows," said Don Stannard-Friel, sociology professor at Notre Dame de Namur University in Belmont, who studies poverty and homelessness in San Francisco. "The homeless people are just the symptom of the problem."

Stannard-Friel said the crisis in San Francisco is an example of having the best of intentions but being unable to carry them out. But even if the focus improves, it's no easy fix. "If we're going to create a system that works, it's going to take some big money," he said.

And smart, focused thinking. There is already much of that going on. It needs to be even more directed.

San Francisco knows what works.

The Seneca Hotel on notoriously seedy Sixth Street is one of several supportive housing complexes contracted out by the city. It has helped hundreds of people off the street. The same goes for Direct Access to Housing, the city's premier supportive housing program. Westside Lodge, one of the city's oldest and largest residential mental health centers, has been nursing the impoverished mentally ill into permanent housing since 1964.

All are models of treating the most troubled homeless people with an array of services while housing them. And they have a track record of keeping them off the street for years.

Since the program began in 1998, 85 percent of the 650 residents in Direct Access to Housing have stayed housed, and their visits to hospital emergency rooms dropped by 60 percent, saving the city millions of dollars a year. Philip Mangano, executive director of the U.S. Interagency Council on Homelessness, said he considers Direct Access the top model in the nation for ending homelessness.

"The irony of homelessness in San Francisco is that it is as visible a problem as anywhere in the country, but the city has some of the most creative and innovative programs for handling it - Direct Access to Housing and others like it," Mangano said.

But there's not enough money allocated to duplicate these units in sufficient numbers. Because of political inertia and the economic downturn, the city has been unable to summon the money effectively, quickly.

"What most people don't seem to understand is that this is a very long- term commitment," said Marty Fleetwood, director of HomeBase, which studies homelessness throughout California. "It's not like you do supportive housing for a couple years and go away when the budget has trouble. You do it for the long term. It's endless."

With federal and state budgets tight, one promising avenue would be going after private money - an idea pushed in a new report by a consortium of major Bay Area foundations, titled "Ending Bay Area Homelessness: The Philanthropic Role." Co-author Cassandra Benjamin said cities such as Chicago and Columbus, Ohio, have turned successfully to foundations to help create supportive housing.

San Francisco is already getting its fair share of basic federal and state aid, but it would probably get more funding if it had a long-range, unified strategy, she said. Mangano agreed, saying if the city created a single 10- year plan to end homelessness - as New York and Los Angeles have - it could better lobby for help.

Because of its unified plan, New York was able to tap into a variety of federal and state funds - shifting some homeless off local rolls into national programs such as Supplemental Security Income, and capturing more grants from the U.S. Department of Housing and Urban Development.

"If we could create a comprehensive plan, show concrete progress and goals,

we could get more federal and private money," said Benjamin, who oversees homeless programs at the $218 million Charles and Helen Schwab Foundation in San Mateo. "That's huge. We spend an awful lot of time talking about the problem, but not enough about the solutions."

Many point to New York as the example for how to address homelessness, because its streets were cleared of tens of thousands of indigents in the past decade. Now it has fewer hard-core homeless than San Francisco. In New York's most recent head count, in February, workers found 1,780 homeless sleeping outside in Manhattan, where virtually all of its hard core are believed to stay. By comparison, 4,535 were found on San Francisco's streets in a similar count around the same time.

And New York City's general population is 10 times that of San Francisco's:

8 million, compared with 800,000.

One reason for New York's success: The city spends $1 billion a year on helping its homeless people, much of it on supportive housing. San Francisco spends $200 million, only one-eighth of it on supportive housing. More than a third of the $200 million is spent in this city on triage measures-$77.8 million on jail and emergency medical services.

New York City gets up to $200 million per year from the state for its supportive housing services. San Francisco gets up to $6 million per year from California, and spends $25 million to maintain the city's 2,500 supportive housing units.

"If we could find enough housing units, rehabilitate them and put full services in them, that would be the answer - and that would be hugely expensive," said Trent Rhorer, executive director of the San Francisco Department of Human Services, which runs the city's supportive housing programs with the Department of Health and a handful of private organizations. "But you ask what my ideal world would be? That would be it."

What turned the tide for New York was vigorous enforcement of laws against panhandling and loitering - and creating enough shelter for everyone who was rousted, said New York Police Detective Walter Burns, spokesman for the department. State law required the city to have a bed for anyone who asked.

"The important thing is we had places for them to go - supportive housing units and shelters," Burns said. "We were persistent. Our guys went out, and every time we encountered the homeless, we offered them a choice of shelter or moving. And if they didn't want the shelter, we kept them moving.

"We kind of wore them out so much, they finally went inside."

New York has spent $421 million since 1989 building 7,381 new units of supportive housing, said Carol Abrams, spokeswoman for that city's Department of Housing Preservation and Development. With those units, New York now has 36, 000 beds - supportive housing, plus shelters and other transitional programs - occupied by homeless people every night. San Francisco has about 5,500 total beds occupied every night.

"The police basically help point out people for us, and our community groups and counselors are the ones who make the real contact for getting people inside," Abrams said.

Philadelphia has used the same tactic to similar effect.

"If you are homeless here, the police may give you a ticket - but before they give you a ticket, they call us and we dispatch a team within 20 minutes, " said Sister Mary Scullion, who co-founded and runs the city's premier homeless aid organization, Project HOME (Housing, Opportunities for Employment,

Medical Care, Education). "Because we move fast, we can help the homeless person get into housing or a program right away."

In 1997, Philadelphia had 850 hard-core homeless people on its streets. Today 200 to 400 are living outside, depending on how cold it is - out of a total homeless population of 6,500. The city's overall population is 1.5 million.

Since 2001, San Francisco has had a plan for a street-to-success program for solving all homelessness called the Continuum of Care. But it has remained sidelined by political squabbling because it is so far-reaching and potentially expensive, and no one has projected its costs.

For the hard core, however, there is an estimate.

Creating enough supportive housing for the minimum 3,000 most chronic cases would cost about $450 million, estimates the Corporation for Supportive Housing. That assumes that the city builds half the units itself and leases the other half in existing buildings that would be modified. Maintaining those units with full services would cost about $30 million per year, according to figures from the corporation and the San Francisco Department of Human Services.

Leshin, of the Corporation for Supportive Housing, said the city would have to pay about $150 million of the up-front costs, with the rest coming from the federal and state governments, a standard formula for supportive housing projects. Money from charitable foundations could play a role, too. The city would have to strategize and lobby hard, she said.

"If you house the hardest to serve and the most needy (the hard-core 3, 000), you'll see a visible reduction in the number of homeless on the streets -

if not a full elimination," Leshin said. "It's our absolute belief that this is solvable."

The biggest federal grant in some time to the city, however, was awarded this fall. It was just $6 million, to develop or revamp fewer than 200 units of supportive housing.

"Nobody would say this would be easy," Leshin said.

One of the best examples of support and housing mixing effectively is at the 170-room Seneca Hotel, a former Sixth Street dive that was rehabilitated four years ago under a city program that creates supportive housing in existing buildings.

It is run by the nonprofit City Housing Inc., and much of its success can be traced to its manager, Ana Bolton-Arguello. A former homeless heroin addict who cleaned up 10 years ago, she knows every con line in the book and goes nose to nose with drug dealers trying to invade her building.

She is as skilled at detecting whether an addict is backsliding as she is at running the extensive jobs, art therapy and counseling services at her hotel.

"You have to push with one hand, pull with the other," she said. If you try to force troubled people to be helped, they will make you the focus of their rage, she said. The trick is to persuade them, assertively.

That sort of alchemy, however, does no good unless outreach workers spend a lot of time with the troubled. Not just an hour here and there, as often happens now.

"You have to have sustained interaction with the people we're talking about, some of that in clinics, some in outreach, some even with the police," said HomeBase's Fleetwood. "Find them, bring them into the housing, then treat them. All three of those elements are going to have to blend for it to work."

In the early 1980s, when homelessness emerged as a citywide problem, the thinking was to address the underlying issues of the troubled person before finding housing. But now, said city Health Department Director Mitch Katz, most experts nationwide believe it is crucial to get the housing first. Treatment can then begin immediately.

The idea, called "harm reduction," is to work the client into services a step at a time, while keeping a close eye for slips. This is what Bolton- Arguello does.

"We've found this approach works, and it saves money," Katz said. For instance, he said, one day in the hospital costs about $900 - about the same cost as keeping that person in a supportive housing unit for a month.

Jazzmun Groome, 27, could be a poster woman for the Seneca Hotel. She'd still be on the street without it.

She moved into her room three years ago after sleeping in parks, the sidewalk, shelters and cheap rooms for three years before that. An abusive relationship kicked her into homelessness without a job, she said, "and I was too stubborn to take help, so I just stayed wherever I could until I decided I'd had enough."

Employment programs and the stable environment at the Seneca, plus its affordable rent - on a sliding scale up to $450 and heavily subsidized through welfare - made it possible for her to restart her life. This month, she started work again as a carpenter for the first time in seven years.

She and her partner, Sharon Banks, have a 7-month-old baby, and they plan to move as soon as they save enough for their own place.

"It took me a long time outside to get over my pride, to accept help, but once you're willing to jump through the hoops of the system, you can stop being homeless," she said. "You have to follow the building rules, go look for the jobs, take the training. You have to wake up. They help you do that at a place like the Seneca.

"Things are looking up now. They don't have to stay bad."

What it would cost

Estimated funding required to create enough supportive housing to serve 3, 000 hard-core homeless people in San Francisco:

$450 million to build or lease an additional 3,000 units

$150 million of that would probably have to come from city funds

$300 million of that would probably have to come from state and federal funds

$30 million a year needed to maintain the units with services .Sources: Corporation for Supportive Housing, San Francisco Department of Human Service


Find the entire series, more photographs, previous Chronicle stories on the homeless and readers' comments at www.sfgate.com/homeless/ .

Join staff writer Kevin Fagan and photographer Brant Ward for an online chat about the homeless series at 11 a.m. today on SFGate.com.

Chat online with the Silvers, the family profiled Monday who are living in their van, Friday at 3:30 p.m. .

Send your letters and comments about this series to homelessness @sfchronicle.com