How a Repurposed Oakland Hotel Is Saving Lives and Easing Hospital ER Overcrowding

Vera Salido nearly died on the streets in the Tenderloin at 46 years old.

To hear her tell it, she developed bed sores from the pressure of sitting in a wheelchair day and night. The injury progressed to sepsis, a life-threatening complication that led to poor organ function. She spent nearly a month recovering at Highland Hospital in Oakland.

When she was ready for discharge, staff at Highland connected her to OakDays, a former motel near the Oakland Coliseum that offers permanent housing to homeless individuals with disabilities or health conditions like terminal cancer.

The facility provides much more than a roof over one’s head, medical care is interwoven into daily life. That was a lifeline for Salido because she had stopped caring for herself.

“I often thought, ‘Maybe I’d be better off not being here.’ Without this place, I wouldn’t have made it,” Salido said as she stroked her straw yellow-colored pet bunny, Provolone.

Soon after residents arrive at OakDays, they receive a medical workup to determine what kind of care they need. Tenants can get help with everything from going to the toilet to daily insulin injections. Nurses make rounds to check vitals and socialize with the 60 residents.

“We’ve successfully housed many of those folks who had cycled previously, like out of the hospital, to the street, to a nursing home, to jail, back to a hospital, back to the street, back to a nursing home,” said Catherine Hayes, a nurse practitioner and cofounder of Cardea Health, one of the nonprofits that run OakDays.

Across the country, emergency departments have seen their homeless patient population double over the last decade. In California, about half of those patients go to the ER multiple times each year, or they’re like Salido, by the time she landed at Highland, her injuries were chronic and required a long-term hospital stay.

The ER has long acted as primary care for people experiencing homelessness for a variety of reasons. Sometimes, they can’t find a physician accepting new patients, they’ve allowed their insurance to expire, or they don’t have transportation to a clinic.

“If the only place that you can go is to an emergency department, then that’s where they will seek care,” said Dr. Renee Hsia, MD, a UCSF professor of emergency medicine. “Whether that’s for a medication refill or whether that’s for your heart attack.”

However, physicians said the problem was further exacerbated by a 2019 California law, SB 1152 (PDF). The policy requires hospitals to provide a meal, clothing and medical referrals to people who are unhoused.

“In a given shift, I’m dealing with multiple patients that are asking me for help with drug or alcohol detox or asking me for help with shelter or asking me for help with mental illness,” said Valerie Norton, emergency medicine physician at Scripps Mercy Hospital San Diego. “And we just have very limited resources to access for them.”

This issue is acute in urban centers in California, with San Francisco at the top. Every year, about a quarter of the patients inside the ER at Zuckerberg San Francisco General Hospital are patients who are unhoused, according to state data analyzed by the Public Policy Institute of California. That’s far higher than at the state level, where homeless patients are 3% of the total.

“There are limited resources in terms of the number of CT scanners or the number of X-ray machines. We are finite human beings,” Hsia said. “And so the more crowded we are, the less able we are to spread ourselves across that number of patients.”

A distinctive funding model

Combining housing and health care is not a new idea to address homelessness. But what’s unique is that OakDays takes advantage of a benefit already covered by Medi-Cal, the state’s public health insurance for people on disability or limited income.

If someone has complex medical issues, like daily dialysis or a chronic wound, they qualify to have a nurse come to their house. The state program intends to help medically fragile people stay at home rather than transfer to a hospital, nursing home or psychiatric institution. But, if you don’t have a permanent home, it’s impossible to access the benefit. Plus, it’s hard to enroll.

“You have to almost speak a different language to be able to navigate all of the paperwork and bureaucracy that it involves,” Hayes said.

OakDays provides housing and helps residents apply.

Hayes stressed that the program is not only good for the health care system, it’s also good for patients.

A streak of bad breaks

In 2015, Salido slipped and fell backward on a slick floor, hitting the ground and damaging her spinal cord. The injury left her paralyzed from the waist down. At the time, she was working as a licensed vocational nurse. However, after the injury, the physical demands were too much for her to continue caring for people in their homes. Her mental health declined, stress rose at home, and before long, her marriage blew up. A nasty divorce followed. Suddenly, Salido found herself homeless.

“I never envisioned myself in a situation like this,” she said. “I always worked. I had my life together. But just one or two catastrophic events can lead to life on the streets that you never thought could happen.”

She spent her days wheeling herself around the Tenderloin neighborhood of San Francisco. She slept upright in her chair inside churches during the day and tried to stay awake at night. “There’s no point in getting a tent because if I get on the ground, that’s a crisis. I can’t get back up in a chair,” she said.

Salido tried to stay in shelters, but she said they often turned her away as a “fall risk.”

“They’d tell me: ‘they’re not a hospital’ as they would wheel me out the door. And I’m like, but the hospital tells me: ‘They’re not a shelter.’ So, what the heck am I supposed to do?”

Soon after arriving at OakDays, the nurses on-site taught her how to move from her wheelchair to a bed. And the facility helps coordinate ongoing medical care and pain management for the wound that still plagues her today.

Good news for overcrowded hospitals

Cardea Health and Five Keys, the two nonprofits behind OakDays, estimated that the facility saved state health plans more than $3.5 million in its first six months of operation. It is a lot cheaper to provide regular home care than acute hospital care. Inpatient stays, ER visits, ER psychiatric visits and nursing facility admissions declined by 78% (PDF) in the first six months of operation among OakDays residents, they told the Alameda Board of Supervisors at a November meeting in 2022.

The founders of OakDays are trying to expand. They just started serving residents at the Kelly Cullen Community in the Tenderloin, which has 174 units. However, the model faces a critical obstacle to significant growth. More than 5,000 people are on the waiting list for the state program that provides its funding.

Salido knows she is one of the lucky ones.

“My physical and mental health are so much better,” she said as she picked up crochet needles to work on a multi-colored hat for her neighbor across the hall. “This place is like Disneyland. It’s just a huge difference. Feeling safe when you close your eyes is a big, big deal. I never felt safe on the streets.”