Carmen Marquez fled violence and poverty in Venezuela to come to San Francisco, desperate by almost any measure.
But not to the city, which didn’t find her desperate enough to place in subsidized housing. So, the widowed mother of two wound up in a group shelter, where she fell sick with an illness that led doctors to amputate almost all her fingers, half a leg, and several toes.
Now, on the other end of a medical nightmare, the city is again denying her a long-term home because she still scores low on a priority scale set by an algorithm.
As she prepares to leave the San Francisco General Hospital after five months, she said the city gave her an impossible choice: stay at a hotel without her 14-year-old daughter, or stay with her at the same kind of shelter where she got sick in the first place.
“In this condition, I can’t do that,” Marquez said, referring to her new disabilities.
In San Francisco, an influx of migrants compete with an entrenched homeless population for scarce resources. Marquez’s chances for housing were doomed when she applied late last year because of the way the city’s Department of Homelessness and Supportive Housing assigns services.
Officials ask applicants probing questions about substance use, sexual assault, mental health, transactional sex, domestic violence, and how long they’ve been on the streets. The answers are fed into an algorithm that assigns points to determine what services to provide.
For Marquez, the score was 40 out of 160, making it unlikely that she and her daughter would qualify for a home.
Ineligible for long-term housing, Marquez and her daughter lined up every evening for the only option available: an overnight family shelter at a school gym.
It became their daily routine. They’d sleep at the gym and pack up by dawn so her daughter could head to high school a few miles away and Marquez could work odd jobs for cash.
For a few months, it felt like a better life was within reach — until her sudden, severe sickness sidelined their hopes of stable housing.
The 46-year-old blames spoiled milk she drank at the shelter for the meningitis that poisoned her blood and left her comatose for six days, intubated for 12 more, and bedridden for months of surgeries to remove dying tissue.
Yet when she retook the test for housing just days ago, the fact that she just escaped death as a multiple amputee barely registered on her score.
Gone to code
Scoring algorithms to address homelessness have fielded criticism for replacing, instead of enhancing, individualized case management. Skeptics say agencies often use the calculations to deny more services than they provide.
In San Francisco, 500 families are on the waiting list for shelter — about 300 more than a year ago, reportedly driven by the arrival of migrants.
Because they’re new to San Francisco, immigrants get scored as lower priority than those who’ve been unhoused in the city for longer, according to Matt Alexander, lead organizer for Faith in Action. That’s why his group is calling for authorities to rethink the way they allocate housing resources.
The mayor’s office called Marquez’s case “a tragic situation.” And while privacy laws prevent it from commenting on the particulars of what happened to her specifically, a spokesperson for Mayor London Breed said there have been no disease outbreaks reported at any city-funded shelter.
The head of the nonprofit that runs the overnight shelter where Marquez and her daughter stayed from Dec. 8 through March 12 said staff called an ambulance when the mom fell sick and promptly alerted public health and housing officials.
“We did not receive any information from [the San Francisco Department of Public Health] or SF General medical personnel indicating that the source of the illness was tied to any of the food served within the shelter,” Mission Action Executive Director Laura Valdez told The Standard in an email. “Additionally, none of the other program participants who consumed the milk on site reported any problems.”
What happened to Marquez is distressing, she added, and she trusts the city will find appropriate housing given her current needs.
That’s easier said that done. Local officials acknowledge that migrants are putting pressure on below-market housing and temporary shelters and that more must be done to reconcile services with heightened demand.
“While it’s crucial to respond to newcomers, the city must also balance the existing demand for shelter, which encompasses individuals and families experiencing homelessness including those fleeing violence and gender-based violence,” a Homelessness and Supportive Housing spokesperson told The Standard.
San Francisco’s shelter system wasn’t designed for the growing population of migrant families, the spokesperson added, which is why the city is working with multiple departments to find a more suitable approach.
It’s not that the city’s computerized needs assessment deprioritizes immigrants, according to the city. It just doesn’t weigh immigration status at all.
“That said, length of homelessness is one of the vulnerability factors that we do take into consideration and we do prioritize people with long histories of homelessness before people who more recently became homeless regardless of immigration status,” a Homelessness and Supportive Housing spokesperson explained.
Brenda Cordoba, an immigrant volunteer for Faith in Action, said the system for determining who gets shelter is unjust and inhumane. The city expanded its family homelessness budget by $17 million this year to keep children off the street and out of crowded shelters, she said, so an algorithm shouldn’t deny that to Marquez or others.
“How is it that this system says those funds are available, but this computer says she doesn’t have enough points to qualify for help?” Cordoba asked in Spanish.
‘I don’t want another family to suffer’
Marquez seems remarkably hopeful despite the adversity she faces.
The loss of her fingers and limbs hasn’t made her regret leaving a country in the throes of economic collapse and a hometown gripped by gang violence. She said she plans to bring her oldest daughter, who’s 21, to the U.S. eventually, too.
“God gave me the strength to leave my home so my daughters could have a better life,” she told The Standard through a Spanish interpreter from her hospital bed over the weekend. “And I still have those expectations.”
The instability has taken an emotional toll on her youngest daughter, who lost her father to Covid during the early days of the pandemic in Venezuela, Marquez said. All these years and thousands of miles later, she faced the prospect of losing her mom to illness, too.
“She’s very quiet and closed,” Marquez said.
But things are looking up, she added. Although her hospitalization cut off her daughter’s access to the overnight shelter, the teen has been staying with church friends as she embarks on her second year at Thurgood Marshall High.
In sharing her story, Marquez said, she hopes the city will reexamine the way it determines housing placement.
“I just hope they take better measures and are more vigilant,” she said through the translator. “I don’t want another family to suffer what I’ve suffered.”