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In this three-part series, KALW’s Angela Johnston takes us behind the scenes of a San Francisco shelter-in-place hotel to see how housing seniors experiencing homelessness has affected their health. We’ll get a brief history of housing as healthcare and we’ll see how a county is reimagining its public health insurance to keep seniors out of nursing homes and off the streets.

Shelter-In-Place Hotels Offer Unlikely Health Benefits For Houseless Seniors

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Angela Johnston
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Kittrell Warren, 65, has been housed at the Cova Hotel in the Tenderloin for the past few months. It's one of San Francisco's shelter-in-place hotels and a place where he's gotten regular medical care for one of the first times in his life.

This is the first of a three-part series about housing and healthcare. Listen to parts two and three here.

Nurse Practitioner Rory Caygill-Walsh rummages around in the closet of an empty hotel room in downtown San Francisco, grabbing different medical supplies and stuffing them in a roller backpack. Muscle rub. Ibuprofen. A blood pressure monitor and some cortisone cream.

“Then we also always make sure we have NARCAN in the bag ... just in case we have to reverse an opiate overdose.”
Rory Caygill-Walsh

Rory’s worked in the San Francisco General Emergency room for years, but got a new assignment when the pandemic hit: taking care of people in nearly a dozen of San Francisco’s "shelter-in-place hotels" — tourist hotels leased by the city to house thousands of the most vulnerable people living on the streets or in shelters.

Each Monday, Rory comes to the seventh floor, packs the kit bag, and starts knocking on peoples doors.

Today’s tasks include doing wellness checks, taking vitals, changing bandages, talking about meds and encouraging people to take them, and really trying to build relationships with people who aren’t necessarily used to preventative health care, because before they were housed, they were mostly focused on survival.

“Our first room is 716. It looks like the door is open,” Rory knocks and asks if the guest is home. “It looks like he stepped out, but he's probably coming back shortly.” So, we move on to the next patient on the list, a gentleman named Kittrell Warren.

Kittrell is 65 years old and he has style. He has dozens of hats and beanies, and fancy shoes and sneakers, lined up against his wall. He tells Rory he is on the fourth day of a pretty bad withdrawal from Suboxone. It’s a medication to help people get off opiates. Other times, it’s prescribed for pain.

“Can I come in and check your blood pressure?” Rory asks.

Kittrell has some nerve pain left over from a long fight with cancer and he says his doctor gave him Suboxone for the pain. But, he quit cold turkey the other day because it reminded him too much of being on drugs.

Rory says a big part of this job is talking to people about their medications, making sure they take them, and trying to see if switching it up or educating them can help. Like when Rory finds out that Kittrell isn’t taking his blood thinner medications. He had a stroke a few months ago and needs to take two pills a day, in addition to others.

"Too many pills," he says.

The two talk about the most important ones and come up with a plan. Rory refers him to physical therapy, tells him he can expect another visit in a week, and disinfects the gear for the next patient.

Kittrell’s one of many seniors living at the hotels — more than half of the people are over the age of 50. Some of them are dealing with pretty serious conditions that worsen with age, like incontinence, vision or mobility issues, or strokes, like the one Kittrell had. For a lot of people, this is the first time they’re getting regular medical care.

“I never had that. You know, my health was bad and I see it getting so much better. You know, it's getting better.”
Kittrell Warren

A week later, I join Rory on rounds and we visit Kittrell. He’s doing so much better. And compared to a few months ago, when he was living outside in his car, he says he feels like a different person.

“I’m gaining some weight, you know, because I've been eating all three meals ... believe it or not, I was 119. And I'm like 140 now, I lost like 50 pounds being outside,” he says.

Before he got to the hotel, Kittrell was experiencing chronic homelessness for over a decade.

“It's beautiful. It makes you feel some kind of special ... It makes you feel like somebody cares, you know? And I didn’t have that outside.”
Kittrell Warren

“It's beautiful. It makes you feel some kind of special ... It makes you feel like somebody cares, you know. And I didn’t have that outside ... I never had that. That kind of attention, you know?” Kittrell says.

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A Shelter-In-Place Hotel

He knows the shelter-in-place hotels are supposed to close soon. The city has shut down four already and plans to demobilize the rest through next year. The goal is to rehouse every hotel resident, either with rent subsidies and assistance, or spots in permanent supportive housing. And some of that housing will be new. The city now has access to nearly a billion dollars from 2018’s Proposition C and they’re using it to add hundreds of new housing units.

“The fact that we are prioritizing shelter-in-place hotel guests largely for permanent supportive housing means we have an opportunity to rehouse almost all of those older adults permanently,” says Emily Cohen, the director of strategy and external affairs for the Department of Homelessness and Supportive Housing. “This is a tremendous pathway to addressing the crisis of homelessness among among older adults.”

But for people like Kittrell Warren who are frail or have underlying conditions, the nursing support he gets at the hotel isn’t available in every permanent supportive housing building. There’s been a constant worry throughout the pandemic that people will land spots in housing that feel like a step down, or others will return back to the streets. Advocates are calling to keep the hotels open as long as possible. The city says they are slowing the closures because of the Delta variant. They’ve also secured more senior-specific permanent supportive housing and are launching a roving nursing team to provide extra care.

“We are dedicating new resources to supportive services for people in our permanent supportive housing that will increase the level of care we're able to provide. And so this will really help us meet the needs of this particularly vulnerable community,” Emily Cohen says.

Kittrell technically entered the hotels later in the pandemic and his rehousing options weren't clear a few months ago. But Emily says because of the new surge, plans have shifted.

“For folks who are indoors in their own spaces right now, we want to make sure we're continuing to keep them inside and in non-congregate settings, so we will be working to rehouse that group,'' she says.

Kittrell says, no matter what, he can’t go back to living in his car.

“I could work on me, you know, get my health back up ... That's all I want. I want to be inside, you know, I've been out for a long time.”

Kittrell’s blood pressure pills may be one of the most critical things he can be taking for his health right now. But experts think housing, especially with extra support, can be an equally powerful medicine. And they say to take care of aging seniors like Kittrell, the city and state have to find a way to prescribe housing.

Angela Johnston reported this series while participating in the USC Annenberg Center for Health Journalism‘s 2021 California Fellowship.