Medical Respite Villages
Many individuals experiencing homelessness do not receive routine medical care, so by the time they do access health care, it is often for acute incidents treated in emergency rooms. Pūlama Ola is a tiny house medical respite village in Honolulu that receives patients upon discharge from the hospital or ER. Medical respite refers to short-term residential care that allows individuals experiencing homelessness a space to recover and receive needed support. According to a local newspaper article, emergency room care for an unhoused individual costs the state $82,000 per year; the creation of medical respite centers could reduce this cost by 73 percent per year.
Pūlama Ola, meaning “to cherish life,” is the state’s first kauhale for unhoused individuals leaving hospitals. This pilot project, ending in mid-December, serves people released from hospital inpatient beds and those discharged from the emergency room without anywhere else to go. Consisting of 10 tiny homes situated in the parking lot of the Department of Health, the community provides staff around the clock for intake, supervision and care. The project is managed by Project Vision Hawaii, which provides registered nurses for daily rounds and a mobile hygiene unit for individuals to take hot showers or use the restroom. One key component of this model is its drop-in center; residents, as well as neighbors, can drop into Pūlama Ola to receive supportive services and case management, or to speak to the psychologist who visits once a week. Anyone can use these services and resources, whether they are unhoused or not. Through the state’s first medical-legal partnership, Project Vision Hawaii can refer individuals to a local law firm and sponsor all legal costs. The all-encompassing idea is a community and person-centered holistic approach to wellness and health, with resources and services available in a “one-stop shop.”
Even though residents can stay as long as they need, Pūlama Ola was designed for temporary medical stays. In January 2024, Project Vision Hawaii will open two new kauhale communities on Oahu, each with around 30 tiny homes. For the new communities, Project Vision Hawaii staff want to emphasize that these communities can be individuals’ forever homes, should they choose to stay. Both of the new kauhale communities will continue the medical respite model, but with the option and ability for residents to stay long-term as part of the community; additionally, the drop-in center component will continue. One of the two communities is specifically for clients with behavioral health issues that may prohibit them from qualifying for other types of housing. Importantly, Project Vision Hawaii is committed to low-barrier housing, with harm reduction practices as a core component of any kauhale location. Additionally, Project Vision Hawaii has been running a homeless shelter on Maui since the Maui wildfires in August 2023; in February 2024, a medical respite village will open, with construction for the permanent kauhale community anticipated for phase one completion in mid-2024.
Across the country, tiny homes have been utilized to help support individuals experiencing homelessness, with projects serving youth, veterans or other specific populations in need. Although kauhale can include tiny homes, as evidenced by the communities described above, it refers to a broader paradigm of community and can include multi-family dwellings and apartments. Hawaii’s kauhale communities provide more than a place to sleep for unhoused individuals; these projects foster community and interconnectedness, all while providing access to needed social services, care and support.
By NCJA Justice Bulletin
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