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.

The county announced in February that they obtained federal and state grants to transform Oak Days into permanent housing. 140 units will be available to those experiencing chronic homelessness, 60 of those units set aside specifically for those with medical needs.

“It’s very hard for someone to be well if they don’t have a safe place to be and they don’t have a home. So I think the more that we start to think of housing as a health care need, the more successful we’re going to be,” Colleen Budenholzer, Alameda Housing Portfolio Manager, said.

Budenholzer manages sites like Oak Days through the county’s Office of Homeless Care and Coordination. She previously worked for the Coordinated Entry Program, which refers people to resources that assist them in ending their homelessness.

Budenholzer and former Housing Portfolio manager Mona Palacios acknowledged a direct connection to health and housing, saying that the healthcare outcomes and life expectancy rates are much different to that of the average person.

They explained that although some in the shelter who are not under care for the medically frail have transitioned out of Oak Days into other permanent housing, the majority of those under Cardea’s assistance are receiving end of life care to make the time they have left more comfortable.

The county hopes to create and fund programs that will assist with those who are not in such drastic needs, but for now, that is where their resources and focus lies.

In 2020, Alameda announced a new plan called Home Together 2026 to reduce homelessness and housing issues in the county. Researchers and officials estimated that it would take $2.6 billion and the building of over 24,000 units and subsidy slots to achieve their goals.

Palacios stated that although the plan is certainly a step in the right direction, the only thing that will truly help address homelessness is the decrease in the cost of living across the country.

“Housing is just too expensive for people whether it’s homeownership or rental. It’s going to continue to be a problem, not just in the Bay Area, not just California. It seems like a nationwide problem,” Palacios said.

Steve Good, president and CEO of Five Keys, told the Post that while housing-first is key, it is not the end all to help individuals once they’re able to receive those services. He believes more resources should go to address individuals’ complex needs that often stem from their unsheltered times.

“We still need more rooms, but we need a hell of a lot more money pumped into mental health and substance abuse issues. And we need to have better enforcement programs in place to get people off the streets so they’re not dying with needles in their arms or laying in their own feces,” Good said.

Five Keys is a nonprofit that focuses on workforce development, education, reentry and housing, and oversees the staff at Oak Days, who manage the site as it transitions into permanent housing. Staff works directly with the residents at the shelter to help them with their everyday needs, aside from what they require from Cardea Health.

Those involved at Oak Days acknowledged that solutions are far and few in between, citing systemic barriers that force and keep these individuals on the streets, such as lack of access to healthcare, racial barriers, lack of mental health resources, the housing crisis and more.

But despite the continuous struggle to bring more awareness to the issue, Oak Days is showing that empathy and prioritization from county organizations and departments can alleviate the stress on these vulnerable individuals.

Residents can be seen and heard boasting about the staff at the shelter, stating that without Cardea or Five Keys, they would still be on the streets or dead. Some residents have even gone on to finding jobs and leaving the shelter because of the support that was offered to them that allowed them to get back on their feet after years of suffering.

Chettiar reported that the shelter has seen an 80% reduction in use of hospitals, emergency rooms and emergency psychiatric services for people who are assisted by Cardea and Five Keys, which translates to about $8 million in medical and healthcare savings.

New sites, similar to Oak Days, are scheduled to open as soon as 2025. Cardea Health and Five Keys will be a part of assisting these future developments.

“We’ve got a long way to go but it’s been a huge improvement for so many people who really had had no options for a very long time,” Chettiar said.

Oakland Post

Posts by Oakland Post