An Oakland Homeless Shelter Is Showing How a Housing and Healthcare First Approach Can Work: Part 1
By Magaly Muñoz
Hundreds of tents and abandoned vehicles now dot major streets and neighborhoods of the Bay Area. Unfortunately, this problem is expected to worsen as the housing market skyrockets and the cost of living becomes unattainable for most Americans.
As one of California’s biggest public policy challenges, over the past four years, the state has allocated nearly $20 billion to housing and homelessness initiatives. Despite this substantial investment, the issue does not seem to be easing. Instead, the number of people without stable housing is surging.
A 2022 Point In Time (PIT) Count showed that there were 9,747 homeless individuals living on the streets in Alameda County, an almost 22% increase from the 2019 count of 8,022 homeless individuals. Many reports estimate that this number will rise once the 2024 data is released.
Amongst the many initiatives to end homelessness, the 2016 Senate Bill 1380 established California as a “housing first” state that would provide assistance, programs and funding to those experiencing homelessness. The bill recognized that the evidence-based model of prioritizing housing could end all types of homelessness and is the most effective approach to ending chronic homelessness.
In the years following the passage of the law, doctors, county officials and a community organization came together to create a first of its kind shelter to combat homelessness with housing and healthcare: the Oak Days shelter. Located in the Hegenberger corridor of Oakland, this facility, once a Days Hotel, now houses 60 individuals, some who are medically fragile.
As local counties navigated how to isolate people during the start of the COVID-19 pandemic in 2020, the state obtained federal funding to begin Project Roomkey, an initiative providing non-congregate shelter options, such as hotels and motels for people experiencing homelessness, to protect life and minimize strain on the healthcare system.
Dr. Alexis Chettiar, a medical director in Alameda County, witnessed firsthand how the coronavirus disease took over the lives of the most vulnerable populations who were too sick to remain stable unless they had hands-on supportive health care and permanent housing.
She also noticed a trend of medically vulnerable individuals with psychiatric illnesses or substance abuse issues being expelled from nursing homes, often ending up in encampments or unsheltered conditions.
This observation would inspire her, along with fellow medical director Catherine Hayes, to start Cardea Health, supported by county funding.
“What we really wanted to do was to be able to layer on the medical services to a permanent supportive housing environment so that people could age in place, they could stay there, no matter how their care needs change over time. They could stay there through the end of their life,” Chettiar said.
Cardea Health provides medical and personal care for almost 60 patients across two sites. One of these sites is an Old Comfort Inn that was also transformed into a shelter for those experiencing homelessness and chronic illnesses. The medical team assists with tasks such as injecting insulin, administering dialysis, helping patients use the restroom or get dressed.
Chettiar shared that she’s seen people as young as 40 years old with health-related issues mimicking that of an 80-year-old. Some individuals had untreated wounds that led to infections or chronic illnesses that went untreated for years, leading to immense suffering before they were able to receive medical attention.
The harsh conditions of living on the streets have exacerbated what could’ve been manageable situations, into a full-blown health crisis that ultimately put them on the priority list for Cardea’s health assistance.
UCSF Benioff Homelessness and Housing Initiative conducted a survey of 3,200 people to study who is experiencing homelessness, how they became homeless, what their experiences are and what is preventing them from exiting homelessness.
Data from those surveys showed that 45% of those experiencing homelessness reported poor or fair health and 60% reported having a chronic illness. Participants also reported that being homeless worsened their physical and mental health.
Of those experiencing health problems, 23% couldn’t access necessary healthcare in the prior six months. Additionally, 38% visited emergency departments without hospitalization and 21% reported a hospitalization for a physical health concern.
Chettiar stated that the work at Cardea is intended to reduce hospital visits for those living on the streets, providing essential care where it’s needed most.
