A Quarter of SF’s Overdose Deaths Happen in City-Funded Housing

In November 2025, a man named Eric McCain died in his unit at the Jazzie Collins Apartments, a San Francisco permanent supportive housing complex operated by HomeRise. His body reportedly remained undiscovered for approximately 10 to 12 days, until his sister called SFPD for a wellness check. Staff had filed logs indicating wellness checks were conducted. A Chronicle and UC Berkeley Investigative Reporting Program investigation raised questions about whether those checks actually occurred. HomeRise had appeared on the city’s corrective action list four times since 2019. Yet its contracts remained active.

McCain’s death is not an anomaly. San Francisco’s permanent supportive housing program shelters roughly 12,763 people, about 1.5% of the city’s population. In 2024, approximately 26% of all accidental drug overdose deaths in San Francisco occurred inside those same buildings—a 15-times-higher overdose death rate than the rest of the city.

A new Civil Grand Jury report confirms what has been documented, flagged, and ignored for years: San Francisco placed tens of thousands of people with active addiction into housing under a Housing First doctrine that prohibited sobriety requirements, contracted out their care to nonprofits it has never once held accountable for failures, and built an oversight commission that has never conducted a single audit.

The city spends $700 million per year on homelessness, nearly $500 million of it through contracts with 73 nonprofit organizations. That spending has grown at a 20.6% compound annual rate since 2019. The number of people classified as homeless at the start of each year has grown at 33.5% compounded annually over the same period.

The Grand Jury summarized its findings: “This is not a picture of success.”

No Accountability

The core failure documented in the Grand Jury report is not a shortage of money or staff. It is a system that has been structurally designed to avoid accountability.

HSH requires its nonprofit providers to file Critical Incident Reports within 24 hours of deaths, overdoses, violence, and major service disruptions. Thousands are filed every year. The Controller’s Office analyzed them in April 2024 and found they are not systematically aggregated, not used to identify patterns across providers, and not used to trigger corrective action. Two years later, the Grand Jury found nothing had changed. Of provider sites surveyed, 79% said CIR data undercounts actual incidents and 64% said it was unclear when a report was even required. The 26% figure itself came from a single DPH Behavioral Health Commission presentation in September 2025. It is not a regularly published metric. The city does not publish overdose deaths by provider or housing type. It has been flying blind, and that blindness has not been accidental.

The Homelessness Oversight Commission, created by Proposition C in 2022 specifically to provide independent scrutiny of HSH, has conducted zero performance audits in three years of operation, despite explicit charter authority to do so. In May 2025, then-HSH Director Shireen McSpadden quietly stopped submitting contract renewals to HOC for public review, citing administrative burden. By August she had dropped the word “temporary.” Renewals have still not returned to the public agenda. McSpadden announced she wasresigning in March 2026. Mayor Lurie appointed a new HSH director in April. And on May 19, the Board of Supervisors voted to eliminate the Shelter Monitoring Committee, the independent body created in 2004 to inspect shelters and take complaints, gone right as the crisis it was built to watch hit a documented peak.

A $100 Million Housing Empire

The Grand Jury’s two central case studies, taken together, show how a system can simultaneously appear successful on paper while failing the people inside it and the neighborhoods around it. They also illustrate how San Francisco’s nonprofit industrial complex got here.

Urban Alchemy was founded in 2018 with a narrow mandate: deploying formerly incarcerated people as street ambassadors to clean public toilets and calm tense street situations in the Tenderloin. Its revenue in 2019 was $35,000. By 2020 it had hit $10 million. By FY2024 it was pulling in $84.9 million. In FY2025, $101 million. It now operates in five states. This is the standard arc of San Francisco’s homelessness nonprofit complex: begin with a narrow scope, demonstrate just enough competence to win the next contract, expand the service footprint, and become too embedded to fire. Urban Alchemy is simply the most dramatic recent example.

By 2022, Urban Alchemy had graduated to running 711 Post Street, a 280-bed semi-congregate shelter in the Tenderloin under a $22.7 million contract that HSH was seeking to increase to $27.6 million. HSH officially described the site as a success. But neighbors reported persistent safety incidents, disorder, and quality-of-life deterioration in the surrounding blocks. One unnamed PSH facility in the report generated 654 police calls in a single year. A sample of 15 sites generated 5,872 combined calls over the same period. None triggered a formal contract action. In September 2025, the Controller put Urban Alchemy on Tier 2 corrective action for inadequate tracking of employee hours and $800,000 in unauthorized overspending. BART had already canceled their contract. Austin, Texas cut ties over a separate misreporting issue. HSH kept the contract going. 711 Post is now scheduled for closure in March 2027.

The HomeRise story runs parallel. HomeRise has appeared on the Controller’s corrective action list four times since 2019, including a 2024 report flagging “questionable spending.” In November 2025, a McCain died in his unit at the HomeRise-operated Jazzie Collins Apartments. His body reportedly remained undiscovered for approximately 10 to 12 days, until his sister called SFPD for a wellness check. HomeRise CEO Janea Jackson resigned in May 2026 as the city launched a probe into the organization’s operations and finances. Its contracts remain active. Bayview Hunters Point Foundation, which holds a Tier 3 corrective action designation, also continues to hold active contracts. The Grand Jury’s finding is blunt: HSH has never once declined to renew or award a contract specifically because of a corrective action finding.

A Stalled Fix

California’s “Housing First” doctrine, codified in state law and built into every HSH contract, bars drug or alcohol use from being the sole grounds for eviction in government-funded housing. This translated into a system with no meaningful sobriety option, no clinical infrastructure capable of managing active addiction at scale, and performance metrics that that counted beds filled rather than lives stabilized. 30% of single adults served through HSH have substance use disorders. The Grand Jury report was direct about the result: “housing alone, without consistent clinical engagement, harm reduction infrastructure, and rigorous oversight, is insufficient to reduce overdose mortality.”

Supervisor Matt Dorsey introduced legislation in March 2026 to expand drug-free PSH, where residents can be evicted for on-site drug use, and to bar the city from funding new housing that prohibits such evictions. Six supervisors co-sponsored it, including Board President Rafael Mandelman. It is stalled. The San Francisco Marin Medical Society threatened opposition over eviction provisions; the two sides reached an “agreement in principle” in May, but the bill has no scheduled vote.

The deeper obstacle is structural: most PSH is built with a mix of local, state, and federal dollars, and California’s Housing First policy bars drug use from being the sole grounds for eviction in state-funded housing. Assemblymember Matt Haney’s AB 255, which would have created state-funded sober housing, passed the Legislature unanimously in September 2025. Sacramento vetoed it. A revised version is pending.

Mayor Lurie has tapped $7 million in private funds to patch PSH infrastructure as public budgets shrink. The Homelessness Oversight Commission has had legal authority to audit every one of these nonprofits since 2023. It has not used it.

The people who died in PSH sites in 2024 were housed by a city that could not tell you in real time which buildings were dangerous, which providers were responsible for patterns of death, or whether any of the money was producing results. San Francisco built a nonprofit industrial complex so large and so entangled with city government that holding it accountable became, by design, someone else’s problem. The question now is whether anyone in City Hall is willing to make it theirs.