On Monday, the city’s Human Services Department released a list of programs, operated by 30 local organizations and agencies, that will receive $34 million in restructured homeless service contracts. The announcement was the culmination of a years-long process to move the city toward performance-based human service contracting and to reward service providers that emphasize moving homeless Seattle residents into permanent housing quickly. Those that provide longer-term housing assistance or other services that aren’t strictly housing-related, like hygiene centers and overnight shelters, were deprioritized.

“I recognize this is a huge change, but it’s a huge change motivated by the scale of the need that we face on the streets of Seattle,” interim mayor Tim Burgess said Monday. (On Tuesday, Burgess was replaced by new Mayor Jenny Durkan.) “Business as usual is really not an option, because we’re not moving enough people off the street and into permanent housing.”

The funding changes announced on Monday could have a major, and highly visible, impact on downtown, because they eliminate or reduce funding for three downtown hubs where homeless people can use the restroom and shower: The Women’s Wellness Center in Belltown, run by Catholic Community Services, the Urban Rest Stop, run by the Low Income Housing Institute (LIHI), and the Compass Housing Alliance’s Hygiene Center in Pioneer Square.

Without access to these restrooms during the day and (in Urban Rest Stop’s case) for part of the night, homeless advocates say unsheltered people will have no choice but to relieve themselves wherever they can—including alleys, parks and business doorways. “It’s going to be another sanitation nightmare,” LIHI director Sharon Lee predicts.

City Council Human Services and Public Health Committee chair Sally Bagshaw says she thinks that once new 24-hour shelters the city plans to fund get up and running, they’ll be able to fill the gaps left by the loss of the hygiene centers. “There are 22 enhanced shelters” in the funding plan, Bagshaw says, referring to shelters that offer case management and help getting into housing, “and of those, 21 have showers.”

Additionally, Bagshaw says, people who need to take a shower during the day already have access to showers at six of the city’s community centers. “Is it perfect? No. But part of the goal here is to use our money in a way that’s going to move people through shelter and into permanent housing.”

According to the brief explanations the human services department provided for why it did not renew some grants, the hygiene centers’ missions were not directly focused on “moving people from homelessness to permanent housing” because they only provided basic hygiene services.

Lee says that LIHI’s Urban Rest Stop, whose funding will be cut by nearly 50 percent, will have to reduce its hours, which are currently 5:30 a.m. to 9:30 p.m. “If you go in there at 5:30 in the morning, it’s packed full of people” showering, washing their clothes and getting ready for work, Lee says. “If you take that away from people, it’s going to lead to more problems and more misery.”

Lee points to a recent Hepatitis A outbreak in San Diego that resulted from a lack of access to showers, restrooms and handwashing facilities for homeless people in that city. The outbreak spread throughout the unsheltered population and is now being called an epidemic. According to a memo the King County public health department sent to service providers in September, “the disease is closely associated with unsafe water or food, inadequate sanitation and lack of access to hygiene services.” In another memo, the department noted, “Good hand-washing is essential.”

The lack of 24-hour public restrooms downtown is a longstanding issue: People have to relieve themselves somewhere and in the absence of public restrooms, they tend to do so wherever they can. The downtown business community, Lee predicts, “is going to be really affected, because no longer can a merchant say [to a homeless person], ‘Go down the street to the Urban Rest Stop.’”

The Downtown Seattle Association, which runs an outreach team of 10-plus people, also lost about half a million dollars a year, initially declined to comment. But after this story published, its senior media relations manager James Sido reached out with a statement.

“Given the concentration of homeless individuals living downtown, and our long-standing relationships with this population and other downtown stakeholders, we were understandably disappointed to learn that we will not be among those organizations receiving city funds as of Jan. 1,” he wrote. “We are currently considering an appeal, and also discussing the program’s future with staff and leadership. Without city funding, the size and scope of our outreach program must shift.”