HomeMy WebLinkAboutfinal-prk-reportE v a lu a t i n g P r o je c t
R o o mk e y i n
A l a me d a C o u n t y
Lessons from a Pand em ic
R es pons e t o Homel essnes s
C ODY Z E G E R
MAY 2 0 2 1
A r e p o r t for t h e A l a m e da Co u n ty
O f f i c e o f H om e l e s s C a r e a n d C o o r d i n a t i o n
Executive Summary
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Executive Summary
In response to the COVID-19 pandemic, California was the first
state to implement a program specifically designed to protect
people experiencing homelessness. Dubbed Project Roomkey
(PRK), the program began as a way to utilize vacant hotel
rooms as non-congregate shelter to prevent the spread of
COVID-19 among the community. What followed was one of
the fastest expansions of the state’s shelter capacity in its
history and an opportunity to reinvent emergency shelter
provision.
With support from state and federal funding, the state tasked
communities across California with Project Roomkey’s
implementation. Alameda County jumped at the opportunity to
participate in the program and with the help of city, state, and
nonprofit partners, opened 13 hotel and trailer sites, doubling
its shelter capacity in less than six months. Between March
2020 and March 2021, these sites served over 1,700
participants. Given the federal requirement to prioritize people
at higher risk of complications from COVID-19, these
participants were significantly older and sicker than the
population of people experiencing homelessness overall.
To effectively serve these participants, a new form of shelter
was needed: one that could not only bring as many people
inside as quickly as possible, but also meet their medical needs
and put them on a path toward more permanent housing. The
county responded by adding health care and housing
navigation services to the non-congregate shelter
environment. This combination formed the backbone of a new
“PRK model” of shelter provision.
This report seeks to understand the benefits of the PRK model
in order to inform post-pandemic homeless services. Through
quantitative analysis of administrative data and interviews with
service providers and government staff, this is one of the first
in-depth studies of Project Roomkey outcomes anywhere in the
state.
Evaluating Project Roomkey in Alameda County
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The initial lessons from Alameda County are clear:
1. The low-barrier, non-congregate shelter model was
universally preferred by service providers and made shelter
more appealing to many people living outside.
2. The health care services and other amenities provided at
PRK sites helped participants stabilize and address long-
standing medical issues.
3. The focus on housing navigation and the creation of new
housing subsidies for people at PRK sites led to 65% of
exiting participants entering housing—nearly double that of
traditional congregate shelters in the county.
4. The speed at which the program was implemented required
government and nonprofits to collaborate in new, beneficial
ways that could be maintained beyond this program.
This report demonstrates that with a substantial infusion of
state and federal funding as well as coordination between
government and nonprofit partners, long-term progress can be
achieved toward addressing the homelessness crisis.
While the success of Project Roomkey should be celebrated, it
also came at a significant financial cost. Project Roomkey is
estimated to have cost about $260 per participant per night.
This is many times higher than congregate shelter and in line
with other service-intensive environments such as medical
respite centers. Therefore, while the PRK model may be more
effective than congregate shelter at addressing homelessness,
its cost could make it most viable as a short-term intervention,
not a long-term solution for people experiencing homelessness.
In order to understand how to build on the success of the PRK
model, this report delves into which components helped
improve participant outcomes and suggests ways to bring
those pieces forward into future county shelter operations.
While shelter alone is not the answer to homelessness, it is an
important part of meeting people’s immediate needs. This
report shows that shelter can and should be improved in ways
that put people on a path toward stability and long-term
housing
Table of Contents
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Table of Contents
Executive Summary ............................................................................................................. - 1 -
Table of Contents ................................................................................................................ - 3 -
Acknowledgements ............................................................................................................ - 4 -
Introduction ........................................................................................................................... - 5 -
The Pandemic-Fueled Creation of Project Roomkey ............................. - 6 -
Getting Off the Ground ........................................................................... - 7 -
Methods ................................................................................................................................. - 9 -
Project Scope .......................................................................................... - 9 -
Quantitative Analysis .............................................................................. - 9 -
Qualitative Analysis ............................................................................... - 11 -
Limitations and Future Research Needs ................................................ - 12 -
Project Roomkey in Alameda County .......................................................................... - 14 -
Initial Program Implementation ............................................................. - 14 -
Shelter Model Comparisons .................................................................. - 16 -
Participant Demographics ..................................................................... - 20 -
Program Cost Estimates ........................................................................ - 23 -
Lessons Learned ............................................................................................................... - 26 -
Bringing People Inside .......................................................................... - 27 -
Addressing Health Needs ..................................................................... - 32 -
Increasing Access to Housing ............................................................... - 38 -
Improving Collaboration ........................................................................ - 45 -
Bringing the PRK Model Forward: Conclusion and Recommendations .............. - 49 -
Conclusion ............................................................................................. - 49 -
Recommendation 1 ................................................................................ - 50 -
Recommendation 2 ................................................................................ - 53 -
Recommendation 3 ................................................................................ - 56 -
Appendix A: Data Definitions ........................................................................................ - 59 -
References .......................................................................................................................... - 61 -
Evaluating Project Roomkey in Alameda County
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Acknowledgements
This paper would not be possible without the advice, guidance, and feedback I received
from so many individuals.
From Alameda County, Kerry Abbott was immediately willing to let me delve into this
program and is truly invested in understanding how to best serve people experiencing
homelessness. Dr. Kathleen Clanon led me through what it meant to make big change
and was willing take time out of pressing pandemic work to give me feedback. Rachel
Metz jumped into the details with me, always providing incisive comments, asking the
right questions, and guiding me toward making this report as useful as possible. Mona
Palacios was the linchpin in understanding program costs, collecting and sharing every
stray invoice and helping me decode budgets and contracts. Last, but most certainly not
least, Martha Elias was the best data wrangling partner I could have asked for. Her
consistent curiosity in digging for answers and willingness to lend a hand at any time
made all of this data analysis possible.
From UCSF, Cynthia Nagendra helped me design this report from the outset. She shared
invaluable knowledge about shelter provision, guidance on what questions I should ask,
and always helped me keep the big picture in mind. Dr. Gabriel L. Schwartz also
generously volunteered to be my Stata guide, talking me through both strategic and
philosophical data analysis questions.
From Berkeley, Dan Lindheim coached me through this process and consistently posed
questions I hadn’t considered. My APA section provided much needed support and
made my weeks so much brighter.
Of course, this report could not have happened without all those who participated in
interviews. From service providers to county and state staff, their willingness to take
time out of their days doing demanding, vital work and share honest thoughts with me
made this report what it is. I hope reading this makes them appreciate all they have
helped accomplish.
It goes without saying that there are countless others involved in making our homeless
response system function each day, including the people who it is intended to serve. I
hope this project helps move us toward a world where people are served more
effectively to end homelessness as we know it.
The author completed this study as part of a Master of Public Policy Program at the
Goldman School of Public Policy, University of California at Berkeley. This study fulfills the
program’s thesis requirement. The analysis and opinions contained herein belong solely
to the author and are not endorsed by the Goldman School of Public Policy, or any other
organization.
Introduction
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Introduction
On April 3, 2020, California Governor Gavin Newsom stood outside a Sacramento hotel
to announce the official launch of Project Roomkey: a statewide initiative to provide
emergency shelter for tens of thousands of people experiencing homelessness to
prevent the spread of COVID-19 in the community.1 The Governor celebrated Project
Roomkey (PRK) as a “first-in-the-nation initiative” to protect people experiencing
homelessness from COVID-19 and other states soon followed suit. 2
Bolstered by an infusion of state and federal funding for this effort, Newsom set a goal
of securing 15,000 rooms across the state that could be used as non-congregate
shelter.3 In order to jumpstart the initiative, Newsom allocated $150 million to support
local communities in protecting the health and safety of people experiencing
homelessness. By the end of 2020, the state had made a total of $512 million available
that could be used to expand and sustain Project Roomkey.4
While the cities, counties, and tribes participating in PRK designed and implemented
their programs differently, many larger urban communities chose to create both
Isolation & Quarantine (I&Q) rooms where people who had been exposed to COVID-19
could stay for the duration of their illness, as well as Shelter-in-Place (SiP) rooms for
people experiencing homelessness who needed a non-congregate shelter to follow
social distancing guidelines.
It appears to have worked: in just a matter of months, approximately 35,000 people
participated in Project Roomkey.5 Additionally, the widespread creation of the SiP rooms
represents one of the fastest expansions of emergency shelter capacity as well as one
of the first major investments in service-intensive, non-congregate shelter in the state.
Given the program’s success providing shelter for so many people so quickly, it is
imperative to try and understand what lessons can be learned from the design and
implementation of this shelter model.
However, with over a year having gone by since its inception and communities being
overwhelmed with getting these programs up and running so quickly, Project Roomkey
has not been studied in depth. Understanding the impact of the program is crucial to
illuminate the strengths and limitations of California’s various emergency shelter models
in achieving positive outcomes for people experiencing homelessness.
This report represents one of the first studies of Project Roomkey outcomes through an
in-depth analysis of Alameda County’s program design and implementation. It aims to
break down the various components of Alameda County’s Project Roomkey model in
order to identify which components were key to improving health and housing
outcomes for people experiencing homelessness.
Using both quantitative and qualitative research, this report shows that Alameda
County’s Project Roomkey was successful at bringing people experiencing
Evaluating Project Roomkey in Alameda County
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homelessness into shelter quickly, connecting them with necessary services that helped
them stabilize, and moving a large proportion of people from this temporary
intervention to permanent housing.
However, since the program is tied to the pandemic, which opened access to vacant
hotels and new funding streams, it is likely to end this year. Federal reimbursement is set
to run out on September 30, 2021 and with travel beginning again it is likely many hotels
will want to use their rooms again. Without the availability of federal funding and vacant
hotel rooms, questions remain as to how to bring the successful aspects of Project
Roomkey’s non-congregate and low-barrier shelter model into existing shelter programs
to continue improving outcomes for people experiencing homelessness.
The Pandemic-Fueled Creation of Project Roomkey
California’s first case of COVID-19 was documented on January 26, 2020.6 Just over a
month later, on March 4, Governor Newsom declared a state of emergency and directed
state agencies to identify hotels and other facilities that could be used to isolate and
treat individuals who have tested positive for or are high-risk of complications from
COVID-19.7
The size and vulnerability of California’s homeless communities quickly became cause
for concern during the pandemic. As of the most recent estimate, over 151,000
Californians experience homelessness on any given night. Of these, around 72% were
unsheltered while 27% had a disability and faced chronic housing challenges.8 Research
has shown that unsheltered adults experience higher rates of physical and mental health
conditions9 as well as increased vulnerability to communicable diseases.10 So while
homelessness was already a health crisis in California, the addition of a pandemic
threatened to exacerbate the problem.
Further, California has traditionally relied on congregate shelters to temporarily house
people experiencing homelessness. Since congregate shelters are designed for groups
of people to live in one or a few large rooms, they tend to be less expensive and easier
to find space for. The state’s extensive use of congregate shelter, however, posed yet
another risk during COVID-19 due to the airborne transmission of the disease and the
inability to isolate in a congregate shelter setting. In March 2020, the CA Department of
Public Health recommended that communities decrease the density of congregate
shelters and create isolation units for people exposed to COVID-19.11
Communities across California followed these recommendations.12 However, this meant
that suddenly many fewer shelter beds were available, leaving more people
experiencing homelessness with no option but to sleep outside. San Francisco, for
example, lost 75% of its shelter capacity after implementing the recommendations.13
Therefore, the pandemic increased the urgency to create additional non-congregate
shelter space across the state to mitigate the transmission of COVID-19 among people
experiencing homelessness and front-line staff.
Introduction
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Soon after the emergency declaration, a report confirmed the danger posed by these
overlapping risks. Due to the underlying health conditions of the population, state
modeling estimated that over 60,000 unsheltered individuals could contract COVID-19
within a two-month period—quickly overwhelming the state’s remaining hospital
capacity.14 Days later, on March 18, Newsom signed an executive order and a senate bill
that together gave communities access to $150 million to expand emergency shelter
and isolation capacity for people experiencing homelessness.15 Of this, $50 million was
specifically tied to the creation of non-congregate shelter. In November 2020, the state
released another $62 million in one-time funding to continue Project Roomkey
operations while transitioning participants to permanent housing.
This funding was distributed to the state’s 13 largest cities, all 58 counties, all 44
Continuums of Care, and tribal governments through multiple state agencies.16 While
spending was largely left up to recipients, the state recommended certain uses:
● Acquisition and lease of hotels, motels, and trailers for isolation and shelter
● Furnishings, medical supplies and services, and sanitary supplies for these
facilities
● Street outreach to people experiencing homelessness
● Transportation to and from shelters and medical care
● Staffing support and case management for clients
While this funding was an important start, once allocated across the state, it
represented a small portion of overall program costs for some participating localities.
While the state provided guidance to communities on how to use other funding streams
for their Project Roomkey operations, it needed a larger infusion of resources to meet
the goal of securing 15,000 non-congregate shelter rooms. Seeking federal support,
California was the first state that requested FEMA reimburse communities for the costs
of the program.
On March 27, 2020 FEMA approved this request and agreed to reimburse the state for
75% of the costs of leasing and operating non-congregate shelter. This funding was
exclusively meant to serve people experiencing homeless who had tested positive for
COVID-19, been exposed to COVID-19, or were deemed “high risk” of complications
from COVID-19 (such as people over 65 or those with certain underlying health
conditions). On January 21, 2021 the Biden Administration expanded that reimbursement
to cover 100% of the costs through September 30, 2021.17
Getting Off the Ground
With this commitment from the federal government as well as additional funds from the
CARES Act of 2020, participating communities were able to begin implementation of
Project Roomkey. However, due to the complexities involved in billing FEMA for these
costs and the risk of not receiving the full reimbursements, it was difficult for many areas
to provide the upfront capital necessary to initiate Project Roomkey.18 Alameda County,
Evaluating Project Roomkey in Alameda County
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for example, did not start billing FEMA until January 2021, because of the significant
staff time it requires to do so and the uncertainty involved in the process. Additionally,
FEMA reimbursement did not cover any supportive services for the sites (e.g. case
management or mental health counseling)19 so the extra expense could be prohibitive
for many local governments without funding already available for homeless services.
Those that did start Project Roomkey programs were tasked with identifying individuals
that met FEMA the qualifications, negotiating with hotel owners to lease out rooms or
entire buildings, and contracting with service providers to operate the sites. According
to county staff and providers, these communities had just a matter of days or weeks to
start up a program for which they had no previous model.
Finding sites in which to house these individuals, while not without its challenges,
happened fairly quickly. First, the state allowed the use of over 1,300 trailers it had
distributed across California as one option to provide non-congregate shelter. The
majority of rooms, however, were secured through agreements with hotels. Due to the
travel restrictions caused by the pandemic, hotels were facing single digit occupancy
during the spring and summer months, when typical rates would have been closer to
70%.20 Therefore, many hotel owners initially welcomed the offer to lease their vacant
rooms to government agencies.
The state signed contracts with the first two hotels in Oakland to begin the program,
which Alameda County then assumed payment for in August 2020. When the county
ran a request for proposals process to identify more hotels interested in leasing out their
rooms, they received dozens of responses in just a few days. Project Roomkey provided
an opportunity to help hotels, retain some of their staff, and create more non-
congregate shelter opportunities at the same time.
However, according to county staff, some of these hotels changed their minds when
they learned that the rooms were going to be used to shelter people experiencing
homelessness and not first responders, health care workers, or other medical
professionals. This was true across the state as well where concerns about the image of
hotels that chose to serve people experiencing homelessness turned out to be
obstacles to their participation.21 Nevertheless, the communities participating in Project
Roomkey met the state’s goal of securing 15,000 rooms in less than three months22 and
are estimated to have sheltered about 35,000 people since the program’s inception.23
Given the size of Alameda County’s homeless community and their consistent
participation in the program from the beginning, analyzing the county’s implementation
of and outcomes from Project Roomkey can provide insight into what this
unprecedented infusion of resources into the homelessness response system has
accomplished and direction on how to continue that success moving forward. The next
section will describe the methods used in this study to do so.
Methods
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Methods
This report utilizes both quantitative and qualitative methods to investigate the benefits
that the Project Roomkey SiP rooms had for people experiencing homelessness during
the pandemic. While administrative county data provides the basis for the quantitative
analysis, qualitative interviews with shelter providers were crucial in contextualizing the
findings and elucidating what aspects of Project Roomkey were particularly beneficial or
challenging. The study period for all analyses was March 2020 through March 2021 in
order to capture the opening and closing of all PRK sites so far.
Project Scope
As described above, Alameda County created two parallel programs under Project
Roomkey. However, this project focuses exclusively on analyzing outcomes from the SiP
sites, which the county named “Operation Safer Ground.” Herein, any discussion of SiP
or Safer Ground is a reference to this program and all data reported excludes the I&Q
program, unless otherwise noted. The I&Q site model has been studied elsewhere and is
shown to have effectively served people experiencing homelessness outside a hospital
setting and reduced hospital admissions due to COVID-19.24
On the other hand, Alameda County’s combination of non-congregate shelter with
comprehensive onsite health care and housing navigation services is not common for
shelter provision in California, and has therefore not been widely studied in the state.
This report will herein refer to this combination as the “PRK model.”
The PRK model is novel because it combines health care and housing services in a way
other shelter models do not. Therefore it is valuable to use the relatively fast
proliferation of this strategy due to COVID-19 to understand how its outcomes and cost
compare to these other shelter models.
Quantitative Analysis
Participant Demographics and Exits
For the analysis of participant demographic information and exit outcomes, I used data
from Alameda County’s Homeless Management Information System (HMIS). HMIS is a
system mandated by the federal Department of Housing and Urban Development (HUD)
that helps communities to track people experiencing homelessness across multiple
service providers and programs. It assigns unique identifiers to each individual and
updates their record as they move into new programs or complete new surveys. I ran
descriptive analyses on participant demographics (race, ethnicity, age, disability status,
and more), length of stay in Project Roomkey sites, and exit destination for those who
had left the program. I also used HMIS to analyze housing outcomes for participants in
Evaluating Project Roomkey in Alameda County
- 10 -
the county’s shelters between April 2019 and March 2020 in order to compare them
with the housing outcomes from PRK.
While this database contains the most comprehensive information available on Project
Roomkey participants, there are some possible issues with the accuracy of its data. First,
since HMIS is a complex database and service providers input data independently, there
can be differences in the way demographics or exit destinations are coded. This is
especially true with Project Roomkey since programs were created quickly and service
providers had to continually hire and train new staff. Therefore, while HMIS was central
to this analysis, its fidelity should be checked in future studies with surveys of
participants or comparisons to other databases.
For example, looking at participants that entered the same rapid rehousing program
after leaving Project Roomkey, only 63% have the “rapid rehousing” option chosen in
their exit destinations in HMIS. Another 15% of these participants have the “other
ongoing subsidy” option chosen. This could be due to the caseloads of the service
providers entering the data or their depth of knowledge about the programs
participants are entering into after leaving their sites.
In order to resolve these discrepancies I aggregated some of the most granular data
into higher-level groups. Continuing with this example, I created broader exit destination
categories (e.g. “housing,” “shelter,” “medical or treatment facility”) that grouped the
related exit options together. After doing so, nearly 95% of participants who had utilized
this rapid rehousing program were categorized as being “housed.” These categories
were created in partnership with county staff to ensure they matched how the county
defines these statistics in other reports. While there isn’t evidence to suggest these data
discrepancies would bias the results in any particular direction, it points to the need to
check data accuracy in the future by following up with program participants. See
Appendix A for a full data dictionary.
Additionally, because participants can have multiple stays at different shelters and are
often given the same survey multiple times, most participants have many duplicate
records. To address this, I created separate multi-step deduplication processes for
demographic information and for exit information. However, information on self-
reported health conditions could change for a participant between one survey and
another. Given the uncertainty around these surveys, I chose to report that a participant
had one of these conditions if they ever marked yes in any of their surveys. While this is
a standard practice in other research, it demonstrates that health data is not as reliable
coming from HMIS. The county Community Health Record was not available for use in
this report, but should be used going forward as it is a more accurate repository of
participant health conditions.
Last, this report utilizes two-sample t-tests to analyze whether the composition of
certain groups was proportional (e.g. the race and ethnicity of PRK participants versus
those exiting the program to housing). Any mention of statistical significance of specific
data refers to this process. While t-tests may not be the perfect method due to the
Methods
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characteristics of the available data, I believe it provides a conservative estimate of
significance and is therefore useful in identifying the larger statistical trends.
All analysis of HMIS data was conducted using Stata Statistical Software, Version 16.1.
Point-In-Time Count
For comparisons to the broader population of people experiencing homelessness, I used
Alameda County’s 2019 point-in-time count.25 The count estimates how many people are
experiencing sheltered and unsheltered homelessness on a given night. This
methodology is also mandated by HUD and tied to federal funding for homeless
services. However, there are numerous critiques of this strategy, projecting that it likely
undercounts the unhoused population overall.26,27 While imperfect, the point-in-time
count was necessary to understand how proportionately the county was serving people
experiencing homelessness across multiple demographic factors.
Program Cost
I estimated program costs by collecting and reviewing invoices of actual expenditures
provided by Alameda County staff. Using these documents, I was able to estimate the
costs of running the seven largest SiP hotel sites. While I was not able to receive
invoices for all costs, I attempted to get as many as possible in order to estimate
program costs more closely than the initial budgeted amounts, which were generated
early on in the program.
Actual invoices were available for the hotel leases, service provider contracts, nursing
staff, caregiver services, transportation, and security during the study period. When
invoices were not available for each month within the study period, I used average
expenditures for each site from similar invoices to estimate spending. This happened
infrequently, but points to the need to access internal county financial systems to
generate more precise spending estimates for the program.
I was not able to get actual expenditures for miscellaneous costs (e.g. office equipment,
technology, administrative oversight, personal protective equipment), but was
instructed by county staff to estimate those at roughly 10% of overall program costs,
based on miscellaneous costs from other programs. This means that cost estimates in
this report are not exact, but are more likely to overestimate total costs of the program
rather than underestimate them. Therefore the data related to cost is more conservative
and may decrease once more precise data is available.
Qualitative Analysis
For this report I interviewed 25 individuals from 14 nonprofit organizations and
government agencies that participated in Project Roomkey. All interviews occurred
between February and May 2021. These interviews remained anonymous in order to
Evaluating Project Roomkey in Alameda County
- 12 -
allow staff to speak freely about benefits and challenges of the program to the author—
who is conducting this project on behalf of Alameda County. Additionally, this anonymity
allowed providers to discuss anecdotes about program participants without revealing
any information about their location.
To provide a deeper understanding of how the PRK model differed from other forms of
shelter and add nuance to the results of the quantitative analysis, I made it a priority to
interview at least one person from each service provider that operated a Project
Roomkey site in Alameda County. I was able to speak with staff from every site,
including those that had closed. Collectively these staff had decades of experience
running congregate shelter programs and therefore could speak to the differences of
the PRK model. The interviews consisted of asking a set of standard questions about the
organization’s role in Project Roomkey, their perceived advantages and challenges of
the model, and what lessons they wanted to bring forward into future emergency
shelter provision. From these interviews, I identified four common themes, which I have
used to create the Lessons Learned section of this report.
For background on the creation of Project Roomkey statewide, I spoke to staff at the
California Department of Social Services, conducted an exhaustive review of publicly
accessible state documentation, and reviewed as many news articles about the program
as I could find through February 2021.
Background information on Project Roomkey in Alameda County specifically came from
conversations with staff from various county agencies; the cities of Oakland, Berkeley,
and Fremont; and internal county documents that recorded details on program design
and implementation.
Last, I spoke with service providers that participated in Project Roomkey in two other
counties in order to see how their experiences compared to that of the providers in
Alameda County. While these interviews were informative, more work needs to be done
to understand whether the lessons from Alameda County can be extrapolated to other
communities in California that implemented a Project Roomkey program.
Limitations and Future Research Needs
As stated, this report draws on both quantitative data as well as qualitative interviews,
and represents one of the most comprehensive analyses of a Project Roomkey program
to date. There are, however, limitations to this study based on the time and resources
available to the author, which lead to the need for future research.
First, and most importantly, while service providers were able to provide insight into the
difference between running congregate shelter and a PRK site, they cannot speak to the
full experience of their participants. Many of the providers discussed anecdotes and
stories about particular participants, but in order to understand what aspects of Project
Roomkey were better or more challenging from a participant perspective, they would
need to be interviewed directly. Given the short timeline of this project and the lack of
Methods
- 13 -
funding, I was not able to interview participants in a way that would have appropriately
valued their time and expertise. I did reach out to multiple advocacy organizations and
groups that work directly with participants of Project Roomkey, however I did not hear
back in time for the publication of this report. Therefore, future studies should make it a
priority to interview both participants who were successful in the program as well as
those who were not served well in order to add nuance to our current understanding of
the PRK model.
Further, while the analyses in this report use the latest available data to provide
descriptive statistics on Project Roomkey, they do not provide causal estimates of
program outcomes. Future studies could build off of the data in this report by taking an
experimental design approach to the outcomes related to the health and housing of PRK
participants in order to provide a more robust understanding of the effect of the PRK
model compared to other forms of shelter.
Additionally, while HMIS data provides the best available view of participant
demographics and housing outcomes, it is not the best database to use to assess health
outcomes. More accurate participant health information is available via the county’s
Community Health Records, which I did not have access to for this report. However,
county employees are currently using this database to study the health outcomes from
Project Roomkey more deeply and results should be available in the coming months.
Last, since Project Roomkey is ongoing in Alameda County, all of this information will
change and require ongoing updates. This report bounded analyses to a one-year
period in order to take a deeper look at the available data, but participant
demographics, health outcomes, housing exits, and program cost will all continue to
evolve over time. Also, as the program goes on, staff using HMIS may adjust participant
records to more accurately reflect their demographic information or housing outcomes.
Therefore, it will be important to do another deep analysis of the program once it ends
in order to update the findings of this report.
Evaluating Project Roomkey in Alameda County
- 14 -
Project Roomkey in Alameda County
Alameda County is home to a disproportionate share of the state’s population
experiencing homelessness: as California’s seventh most populous county, the most
recent point-in-time count estimated it had the fourth largest homeless population.28
With just over 8,000 people reported to experience homelessness on a given night, it
compares closely with San Francisco and San Diego counties.29 In 2019, the county
reported having 1,160 year-round emergency shelter beds to serve around 6,300
unsheltered individuals,30 nearly all of which were in congregate settings.31
These factors motivated the county to respond quickly to the Governor’s offer of
funding to house people experiencing homelessness through Project Roomkey. The
California Department of Social Services reached out to Alameda County’s Social
Services Agency (SSA) and requested they set up emergency hotels. SSA worked with
the county Health Care Services Agency and General Services Agency to implement the
program, identifying potential sites, creating leasing agreements, contracting service
providers, and coordinating all other logistics. By March 27, 2020, only ten days after
the Governor’s executive order, the county’s first participant had moved into a Project
Roomkey hotel.
The speed at which Alameda County was able to respond to this crisis was due to
recent work in the county that had been done to connect health care and housing
programs. According to county staff, lessons from their Whole Person Care program
implementation helped them design the Project Roomkey shelter model so quickly. The
county had also recently created an Office of Homeless Care and Coordination, which
meant there was a team able to coordinate this type of program. Without this work
already completed, the county may not have been able to design and implement a
program like Project Roomkey with such short notice.
Initial Program Implementation
The first site up and running on March 27, 2020 was a large I&Q hotel with the capacity
to shelter 100 COVID-positive participants. The first SiP site opened soon after on April 2
with 285 rooms (see Table 1 below). By the end of May, the county and partners had
opened eight PRK sites (two I&Q and six SiP) with a total of nearly 800 rooms. However,
the height of the county’s Project Roomkey capacity came later, between August and
December, during which time they were operating 13 sites as well as a scattered-site
voucher program, for a total capacity of nearly 1,100 rooms. This represents a doubling
of the county’s shelter capacity in less than six months.
Separate from leasing the hotel sites, the state had donated trailers to the City of
Oakland. Oakland set up the majority of these as SiP site in an empty parking lot, with
two sleeping areas per trailer. They shared the rest with the cities of Alameda and
Berkeley to do the same. These three cities had to identify locations for the trailers to sit
and coordinate the necessary infrastructure connections (e.g. power, water, and sewer
Project Roomkey in Alameda County
- 15 -
hookups). According to some providers, this setup proved more challenging than
anticipated as some of the trailers broke down and connections could take a long time
to coordinate.
Table 1: Safer Ground Site Information
Safer Ground
Site City Service Provider Site Type Date Opened
Radisson Inn Oakland Abode Services Hotel April 2, 2020
Scattered-Site
Vouchers Countywide Various Various May 1, 2020
HomeBase
Trailers Oakland Housing Consortium
of the East Bay Trailers May 5, 2020
Marina Village Alameda Building Futures Hotel May 7, 2020
Fremont
Islander Fremont City of Fremont Hotel May 10, 2020
SpringHill Suites Newark Abode Services Hotel June 5, 2020
Alameda
Trailers Alameda Various Trailers June 11, 2020
Berkeley
Trailers Berkeley Berkeley Food and
Housing Project Trailers June 22, 2020
Days Hotel Oakland Five Keys Schools
and Programs Hotel July 1, 2020
Rodeway Inn Berkeley Berkeley Food and
Housing Project Hotel July 20, 2020
Quality Inn
Berkeley Berkeley Berkeley Food and
Housing Project Hotel August 13, 2020
Residence Inn Livermore Abode Services Hotel August 24, 2020
The occupancy agreements used to lease the sites not only paid for the rooms, but also
retained hotel workers to run housekeeping, maintenance, and front desk services.
Three meals a day were provided for participants at each site, either through the hotel
lease or a separate contract. Additionally, the county had contracts with various
vendors for shelter operation, security, transportation, nursing and caregiver services,
and pharmaceutical services.
Since federal reimbursement was tied to serving a specific subset of the homeless
community, prioritization of participants was an important step. FEMA would only
reimburse expenses related to non-congregate shelter operations for people who
tested positive for COVID-19, those who had been exposed, or those who were
Evaluating Project Roomkey in Alameda County
- 16 -
asymptomatic but at “high risk” of complications from COVID-19 and without another
way to follow social distancing guidelines.32
Initially, there was an emphasis on identifying those that met FEMA criteria who were
also on the county’s “Priority by Name List,” which is used to prioritize people
experiencing homelessness for housing. Additionally, the county had to moved people
out of existing shelters into the PRK sites in order to reduce crowding per state
recommendations. Homeless and health care service providers worked to refer eligible
participants from the county’s unsheltered population. The county also utilized a tool
that prioritized everyone with an HMIS record by their COVID-19 risk factors and found
over 3,000 people eligible for Project Roomkey.
According to the assessments participants took upon entry to PRK sites, about 58%
were coming from a place not meant for habitation (such as the street, a tent, or an RV),
34% were coming from another emergency shelter, and the remaining 8% were coming
from other situations such as staying with friends or family, institutional settings like
hospitals or jails, or some form of housing.
Shelter Model Comparisons
As described above, Alameda County created the SiP sites to provide medically frail
people experiencing homelessness with a way to reduce their risk of contracting COVID-
19. Although the primary goal was to prevent the spread of COVID-19 among this
community, the county also took the opportunity to include additional services in the
provision of emergency shelter, creating the PRK model. The PRK model differs from
other shelter models available in Alameda County in a variety of ways (see Table 2
below). While shelters are all run differently, Table 2 collects information from publicly
available research as well as interviews with county staff to create a generalized version
of various shelter models in Alameda County and the broader Bay Area.
Table 2: Shelter Model Comparisons
PRK Model
Traditional
Congregate
Shelter
Navigation
Center33,34,35
Medical
Respite36,37,38
Homeless
Populations
Served
High-risk of
complications
from COVID-19
(e.g. 65+ or
underlying health
conditions)
Varies; some
are broad while
others have
populations of
focus (e.g.
Transitional-Age
Youth, survivors
of domestic
violence,
veterans, etc.)
In Alameda County,
prioritized for
people with an
identified path to
housing, either
through rapid
rehousing and
employment, or
permanent
supportive housing
Individuals
exiting the
hospital, or at
risk of entering
the hospital,
with acute
medical
conditions that
make other
shelter
impractical
Room
Occupancy
Non-Congregate:
One household
per room + may
elect to stay with
partners or family
Congregate:
Multiple
households per
room
Congregate:
Multiple households
per room + may
elect to stay with
partners
Congregate:
Multiple
households per
room
Project Roomkey in Alameda County
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Food
Provided
Three meals per
day
One meal per
day One meal per day Three meals
per day
Time Limit None Varies Varies, generally
90 days 90 days
Nursing +
Caregiver
Services
Nursing:
1 nurse + 1 medical
assistant for every
100 residents
Caregiver:
1 caregiver for
every 35
participants at
participating
hotels
Nursing:
Shelter Health
providers
support staff in
accessing
nursing care for
residents with
acute health
needs
Nursing:
Shelter Health
providers support
staff in accessing
nursing care for
residents with acute
health needs
Nursing +
Caregiver:
Varies, some
have light
touch case
management
with few
services,
others have
more intensive
services with 1
nurse for every
20-30
residents
Case
Management
+ Housing
Navigation
1 housing
navigator (or
similar staff) for
every 25 guests
Behavioral health
services assigned
as assessed
Varies, some
on-site housing
services with
undefined ratios
Alameda
County
Behavioral
Health Care
services
provided
directly in
several sites
1 housing navigator
for every 20
participants
Varies, as
above
% of Exiting
Participants
Who Enter
Housing
65% 35% 40% - 90%, varies
by model 20% - 30%
Approximate
Per-Night
Cost
$260 $50 $100
$200 - $250,
varies based
on services
The PRK Model
Project Roomkey’s SiP sites were designed to be low-barrier, non-congregate shelters
that provide participants with access to health care and housing resources. Building off
the county’s prior work with the Whole Person Care program, which brought health care
and housing services together for people experiencing homelessness, county staff knew
how difficult it was to meet people’s medical needs while they were living outside.
Therefore, they used Project Roomkey as an opportunity to bring these services
together again to improve people’s health while they had a consistent place to live.
All of the sites were low-barrier, meaning participants could choose to live with partners,
bring their pets and other belongings, and were not required to abstain from substance
use while on site. The low-barrier nature of the program was intended to provide shelter
that would appeal to as many people as possible and make participant stays more
comfortable, which in turn would make sheltering in place easier.
Evaluating Project Roomkey in Alameda County
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The large majority of participants had their own room or shared with family members.
The exceptions to this were the trailer sites where some participants lived with a
roommate. The sites were open 24-hours and participants were provided with three
meals a day. Most participants had access to transportation to and from the site for
important appointments.
Since prioritization for these sites was given to people at the highest risk of
complications from COVID-19, the participants often came into the program with
significant unmet medical needs. Therefore, the county added clinical services (such as
nursing and caregiving) with the hope of helping participants access necessary care and
creating stability before they moved on, ideally to permanent housing. Specifically,
these clinical services were intended to help participants:
● Strengthen relationships with primary care providers in the community
● Facilitate access to the appropriate levels of care
● Foster independence
● Improve health literacy and management of chronic conditions
The clinical services available at each site varied, with the highest level concentrated at
the largest hotel sites. Nurses were available at most hotels to help participants meet
the above goals. The two largest hotels also had staff assisting with caregiving for
participants who could not take care of their daily needs alone. As the program
progressed, however, the county saw a larger than expected need for caregiver
services. While participants could apply for the state’s in-home supportive services
(IHSS), service providers faced difficulty helping participants access this program due to
long application timelines, uncertainty of approval for all participants, and inconsistent
IHSS staff availability. Therefore, the county increased their own caregiver services for
these participants as they applied this program. In February 2021, the county
concentrated participants with the highest medical needs in one hotel and focused
caregiver services there.
While health outcomes, including preventing the spread of COVID-19, were the primary
goal of the program, connecting people with housing upon exiting the shelter was also a
key part of the PRK model. Therefore, housing navigation services to help participants
find more permanent housing options were built into each service provider contract.
Additionally, the county used funding from the federal Emergency Solutions Grant
program within the CARES Act (ESG-CV) to create hundreds of new bridge housing
subsidies for Project Roomkey participants. The effects of these investments in health
care and housing will be explored more in the next section.
Traditional Congregate Shelter
Congregate shelters in Alameda County are traditionally focused on providing
participants with a place to sleep, with very few, if any, other services. Participants are
Project Roomkey in Alameda County
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typically given a shelter bed for themselves and cannot bring their partners, pets, or
belongings with them. These beds are in a “congregate” setting where participants
sleep in rooms with a number of other participants from other households. Congregate
shelters are often only open at night, requiring participants to leave during the day and
come back to claim their bed again each night. Some congregate shelters also have
limits on participant stays (e.g. 90 days) after which time participants have to leave the
site.
While service providers have leeway in how they operate these shelters, the average
per-night cost for operating shelters is around $50. Given this, many shelter operators
are constrained in what services they can provide participants beyond monitoring their
safety. Alameda County HMIS data on shelter participants between April 2019 and
March 2020 show that around 35% of participants exited to housing.
According to the providers interviewed for this project, many have adjusted their shelter
operations to include access to more services such as housing navigation or connections
to health care. Others have smaller spaces where participants can have more privacy.
However, these factors vary by site, so congregate shelters do not systematically
include these services.
Navigation Center
The navigation center model started in San Francisco in 2015 as an attempt to provide
congregate shelter in a smaller setting that focused on finding housing for people
experiencing homelessness.39 These shelters were designed to be low-barrier and
include access to some medical services, case managers, and meals, among other
services. They also allowed participants to bring their partners, pets, and belongings
with them, unlike traditional congregate shelters.
At first the navigation centers in San Francisco had no time limit on a participant’s stay
and each bed was tied to a permanent housing placement. A 2015 evaluation of the San
Francisco navigation centers estimated that over 75% of participants exited to
housing.40 However, due to a lack of resources and conflicts with the city’s typical
housing prioritization system, the city changed this model in 2017. Shelter participants
were no longer guaranteed a housing placement and participant stays were limited to
one month, unless they were in the highest priority group.41 This makes the navigation
centers operate more like smaller, low-barrier congregate shelters. Exits to housing have
since decreased to around 48%.42
Since then, Alameda County has opened its own navigation centers. While their models
are slightly different from San Francisco’s, they also have an emphasis on finding
housing for participants. These sites prioritize serving people with a path to housing and
have shown to have high proportions of clients exiting to housing. In 2019, the service
provider operating these sites reported that of participants who exited, 64% in Berkeley
and 88% in Oakland left for housing.43,44
Evaluating Project Roomkey in Alameda County
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Medical Respite
The medical respite model is designed for people experiencing homelessness leaving a
hospital inpatient setting, or to prevent hospitalizations. It is intended to serve people
who have acute health needs that would make them unsuccessful in another shelter
environment.45 Medical respite typically provides participants with a bed in a congregate
setting and access to high levels of health care services to allow them to recuperate
from their hospital stay. Some areas have also created medical respite beds for people
who are currently in shelter, but who have medical conditions or functional impairments
that prevent them from living on their own in a shelter setting.46
The level of services available varies based on the site, but can range from only
providing light case management to providing intensive clinical services. Participants are
limited to stays of 90 days and exits to housing are in the range of 20% - 30%,
according to county staff.
Summary
Alameda County’s PRK model was designed to fill a gap in the existing slate of shelter
options. In terms of health care services provided, the PRK model falls between those
offered at traditional congregate shelters and medical respite centers. In terms of
housing navigation services provided, the PRK model falls between those offered at
traditional congregate shelters and navigation centers. The PRK model provides more
in-home caregiver services than any other shelter model. Providing non-congregate
shelter with enhanced health care and housing navigation services was intended not
only help prevent the spread of COVID-19, but also as an opportunity to improve
participants’ health and housing outcomes while in the program. Following sections will
examine the data available on these outcomes.
Participant Demographics
Between March 2020 and March 2021 a total of 1,708 participants stayed in at least one
Safer Ground SiP site. This represents over 20% of Alameda County’s homeless
population (see Table 3 below) and around 50% of those the county originally identified
as the population eligible for Project Roomkey. Referrals to Safer Ground sites initially
stopped in November 2020 due to the program reaching capacity. However, they were
reopened in February 2021 and will continue through the end of the program, so these
numbers will change going forward.
As compared with the 2019 Alameda County point-in-time Count, women and people
identifying as White were slightly overrepresented as participants in PRK sites, while
those identifying as Multi-Racial were slightly underrepresented. Participants of other
races and ethnicities were generally represented proportionately. Additionally, PRK
participants were significantly older and reported longer histories of homelessness. PRK
also served a higher proportion of people experiencing chronic homelessness as well as
people who had ever reported having physical disabilities, chronic health problems, or
psychiatric and emotional conditions.
Project Roomkey in Alameda County
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Table 3: Participant Demographic Comparisons with Overall Homeless Population
Demographic Information 2019 Point-in-Time
Count
Safer Ground
Participants
Individuals 8,022 1,708
Gender
Male 61% 56%
Female 35% 43%
Transgender or Gender
Non-Binary 4% 1%
Race
Black or African
American 47% 46%
White 31% 40%
Multi-Racial 14% 7%
Asian 2% 3%
American Indian or
Alaska Native 4% 3%
Native Hawaiian or Other
Pacific Islander 2% 1%
Ethnicity
Hispanic/Latinx 17% 17%
Age
Under 18 4% 7%
18 - 24 9% 2%
25 - 59 73% 56%
60+ 14% 35%
Sexual Orientation
LGBTQ+ 14% 5%
Length of Homelessness
More than 1 year 63% 90%
Other Conditions
Chronically Homeless 28% 67%
Physical Disabilities 24% 65%
Chronic Health Problems 26% 73%
Psychiatric/Emotional
Conditions 39% 59%
Evaluating Project Roomkey in Alameda County
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The presence of a higher proportion of women in Project Roomkey could be due to the
fact that one hotel (as well as the scattered-site voucher program) prioritized women
and families in order to better serve survivors of domestic violence and people who
were pregnant. Additionally, some of this difference could be due to the fact that the
PRK model focused on keeping couples and families together in shelter. According to a
few of the providers interviewed, women often do not feel comfortable in congregate
shelters, so given the higher proportion of women in the sample, it would be useful for
future research to investigate whether the PRK model was able to provide a better
environment for those individuals.
Participants in Project Roomkey were also generally older with more medical conditions
than the homeless population overall. They also had longer histories of homelessness,
with 90% of participants having experienced homelessness for more than 1 year and a
median length of homelessness just over 4 years. This data is confirmed by the
experience of the service providers running the sites who discussed serving an older
and sicker population than before. One reason for this difference is that the FEMA
eligibility criteria required participants to be “at risk” of complications for COVID-19 as
defined by their age and underlying health conditions. It follows, then, that these
eligibility requirements selected for participants that were older and had more co-
occurring illnesses or disabilities.
The overrepresentation of people identifying as White and underrepresentation of
people identifying of Multi-Racial could be due to multiple factors. First, county staff
reported that they initially had an over-representation of referrals for participants from
areas of the county outside Oakland, which are much whiter overall. This may have had
to do with the referral response times of providers in the various parts of the county and
points to the need to do more targeted outreach to communities that are
overrepresented in the homeless population when new programs begin.
However, given the low representation of people identifying as Multi-Racial, and the
relatively proportionate representation of other racial and ethnic groups, it is also
possible the difference has more to do with data entry than participant demographics.
As discussed in the Methods section of this report, the quick startup of Project Roomkey
could have affected data collection. If staff collecting participant data did not ask
participants to self-identify their race, it is possible they identified multi-racial people as
the one race they perceived them to be and created an unintentional bias in the
available data.
When the county re-opened referrals for PRK sites in February 2021, they received a
higher portion from Oakland. Looking at participants entering between February and
March 2021, it appears the proportion of participants identifying as Black or African
American has gone up slightly, White has stayed the same, and Multi-Racial has gone
down slightly. It will be important for future research to look into the final demographic
breakdown of PRK participants and check the data quality to understand if the program
served all racial and ethnic groups proportionately.
Project Roomkey in Alameda County
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The data also shows people identifying as transgender or gender non-binary and
LGBTQ+ as being underrepresented in SiP sites. While it is important to understand if
these groups are being appropriately served by PRK, their underrepresentation may
also be a result of the HMIS data collection challenges. Given the speed of program
startup and the fact that many participants choose not to answer questions about
gender and sexuality, providers may fill out the answers based on what they perceive
about a participant. Additionally, if people are asked to select between mutually
exclusive gender categories, some individuals may select the option that applies to their
gender instead of the one related to their transgender identity. Due to these factors,
more work needs to be done to determine whether SiP sites served a proportional
number of transgender, gender non-binary, and LGBTQ+ people.
Program Cost Estimates
As described in the Methods section, the following figures represent the estimated cost
of running the seven largest SiP hotel sites in Alameda County: the Radisson Inn,
SpringHill Suites, Residence Inn, Marina Village Inn, Rodeway Inn, Quality Inn Berkeley,
and the Days Hotel. The restriction to these sites was partially due to the cost
information available and partially as a way to ensure cost estimates were inclusive of
sites representative of the full PRK model. These sites had varying levels of services, but
each of them is a full hotel leased by the county as non-congregate shelter sometime
between March 2020 and March 2021. They represent 77% of the total capacity of
Project Roomkey sites in Alameda County.
These estimates do not include any trailer sites, since the costs of purchasing the trailers
was covered by the state. They also do not include the rooms in the Fremont Islander
hotel because they dedicated only a portion of their rooms to Project Roomkey. Last,
they do not include estimates of the scattered-site voucher program as the services
participants had access to did not line up as closely with those in the hotel sites.
The below numbers are estimates of program costs, representing all expenditures
related to Project Roomkey by Alameda County as well as the state and the city of
Berkeley. Since the state covered some PRK costs for the first few months of the
program and the city of Berkeley provided nursing services to Berkeley sites, the
county’s portion of the total costs is slightly smaller than the program costs overall.
While a precise accounting of program costs won’t be available until county financial
records are examined, this report uses both actual expenditures and an approximation
of miscellaneous costs to create the closest cost estimate as possible, but airs on the
side of overestimating total cost to remain conservative.
Based on this process, the total estimated program costs of running the seven SiP
hotels between March 2020 and March 2021 was approximately $58 million. Of the total
program costs, Alameda County spent about $51 million. Prior to December 31, 2020,
specifically, the county spent about $36 million, $3 million of which was covered by state
funding and the rest by the federal CARES Act. Starting January 1, Alameda County
began billing FEMA, which is expected to cover approximately 70% of ongoing program
Evaluating Project Roomkey in Alameda County
- 24 -
costs. The county plans to use state and federal funding sources to pay for the
remaining costs.
These seven sites opened at various points in the summer and fall of 2020 and two have
since closed. While they were open, these sites served 1,456 participants in 775 rooms,
for a total of 223,670 nights (or around 5 months each, on average). Therefore, the
estimated cost per participant per night was around $259 (herein, the “per-night” cost).
The per-night cost estimate can be broken down further to understand which
components required the largest investments (see Figure 1 below). The hotel lease
average of $176 per night includes costs of a room, laundry, and three meals a day. It
falls within the county’s contracted lease rates for the hotels which were between $150 -
$200 per night for occupied rooms and $90 - $120 per night for unoccupied rooms. The
contracts with service providers added about $27 per night, while transportation and
security added another $25. The miscellaneous cost estimate came out to $24 per night.
The nursing and caregiver services made up the smallest portion, only adding $7.
Figure 1: Safer Ground Per Night Costs Disaggregated by Use
Total per-night cost estimated at approximately $259.
The $7 estimate for nursing and caregiving is lower than expected by some county staff.
This is possibly explained by the fact that many nurses were working at PRK sites on a
volunteer basis and only two sites had significant caregiver services. However, even
restricting the cost estimates to look only at months when nurses were being paid or
only sites that had caregivers, the per-night cost only increases by about $2. Therefore,
the overall breakdown of total per-night costs still seems relatively accurate.
The per-night cost of these Safer Ground hotels was much higher than other forms of
shelter (refer back to Table 2 above). According to county staff, lease rates for
congregate shelters in Alameda County are about $50 per person per night, while
navigation centers are closer to $100.
Hotel Lease, $176
Service
Agreement,
$27
Transportation
+ Security,
$25
Miscellaneous Estimate,
$24
Nurse
+
Care-
giver,
$7
Project Roomkey in Alameda County
- 25 -
The PRK model appears to cost a similar amount to programs designed for populations
with high medical needs, like medical respite centers. On average, the medical respite
beds in Alameda County are estimated to cost around $200 - $250 per night. The PRK
model, then, presents a similar cost to medical respite, with less intensive health care
services and more intensive housing navigation.
Summary
Overall, this analysis confirms the assumption of nearly all county staff and service
providers that this program was much more expensive to operate than traditional
congregate shelter and similar to the cost of medical respite. At such a high cost, and
with federal support for these programs set to end this year, the county is unlikely to be
able to sustain this level of expense for leasing hotel rooms to use as shelter indefinitely,
especially if these funds could be going to more permanent housing solutions.
Simply looking at cost, however, ignores improvements in participant outcomes from
this investment in shelter services. If the PRK model is better at helping participants
stabilize and exit homelessness, it may result in long-term outcomes that make it worth
the investment. Therefore, the next section will explore what aspects of Project
Roomkey made the biggest difference in participant health and housing status, in order
to incorporate these components into future shelter or temporary housing programs.
Evaluating Project Roomkey in Alameda County
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Lessons Learned
The following lessons have been compiled from interviews with 25 individuals across 14
organizations representing both service providers operating PRK hotels and government
staff overseeing program implementation. The service providers interviewed had
decades of experience and could therefore speak to the differences between the PRK
model and congregate shelter, in particular. This section attempts to bring together the
most common themes from these interviews while also representing the diversity of
viewpoints among service providers.
All quotes come from interviews conducted between February and May 2021. These
interviews remained anonymous in order to allow staff to speak freely about their
experience in the program and share anecdotes without revealing participant
information. Quantitative data is also embedded within these sections where available in
order to validate or add nuance to the experience of the interviewees.
The major lessons are that the PRK model:
1. Increased shelter acceptability and engaged people experiencing homelessness
who may not have otherwise come into shelter.
2. Facilitated better access to services for participants, but could be better tailored
to work effectively for some populations (such as survivors of domestic violence
and people with higher health care needs).
3. Nearly doubled the proportion of participants exiting to housing, while also
posing challenges for facilitating those exits.
4. Led to the creation of new collaboration between service providers and
government agencies, despite some challenges with program logistics.
Lessons Learned
- 27 -
Bringing People Inside
The PRK model increased shelter acceptability and
engaged those who may not have otherwise used shelter.
“I think non-congregate [shelter] is the way to go in the future.
To me, congregate seems almost barbaric at this point.”
Having private space created autonomy and reduced tension among
participants, compared to congregate shelter.
Allowing participants to stay with their communities made the prospect of
moving inside more appealing.
Removing time limits may have given participants time to stabilize.
One of the most common advantages that service providers identified about the PRK
model was its success in engaging communities that may not have previously wanted to
use congregate shelter. Many providers described that some people experiencing
homelessness are reasonably hesitant to move into congregate shelter for many
reasons, including not wanting to stay in a crowded environment, having to leave their
communities behind, and not being sure if it would help resolve their homelessness.
These and other reasons have been discussed repeatedly by people experiencing
homelessness in various surveys and articles.47,48,49
All of the providers interviewed, however, said that the PRK model was able to better
address the needs of these individuals by offering participants a private room, three
meals a day, and the ability to stay with partners and pets. These factors were key to
moving a large number of people off the streets in such a short time. “If this was
congregate shelter,” one provider noted, “we’d have to spend 50 million years
convincing people to come inside.”
While it is safe to assume that the pandemic was a factor in people’s decision to seek
shelter, providers also thought the PRK model had other advantages that helped bring
people inside for the first time. In Alameda County, the SiP hotels were designed to be
low-barrier in order to encourage as many people to come inside as possible and follow
the county’s shelter in place guidelines. This meant they allowed participants to choose
who they wanted to stay with, keep their belongings, and didn’t put restrictions on
private substance use behaviors. As discussed above, this differs significantly from the
setup of most congregate shelters.
1.
Evaluating Project Roomkey in Alameda County
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Many Alameda County providers acknowledged that it would be unrealistic to get rid of
congregate shelter altogether due to the severe lack of shelter beds to begin with—in
2017 it was estimated that Alameda County had nearly 10 unsheltered individuals for
every 1 emergency shelter bed.50 However, most felt that the PRK model created a much
better living environment for participants.
Since data is not collected in HMIS about a participant’s reason for entering shelter, the
best way to confirm this impression would be through interviews with participants of
Project Roomkey. However, some of the data that is available in HMIS supports this
statement. When a person experiencing homelessness interacts with a provider, they
are typically entered into the HMIS database and given a unique identifier. Among
Project Roomkey participants, around 23% did not have a unique identifier before their
PRK stay. This indicates PRK may have been the first formal interaction with any county
services related to homelessness for nearly a quarter of participants.
Additionally, the data shows PRK residents had longer histories of homelessness than
the population overall. Around 90% of participants reported being homeless for more
than one year (as compared with 63% in the overall population) with a median length of
homelessness just over 4 years (see Figure 2 below). PRK residents having longer
histories of homelessness could indicate that they had more years of experience with
the county’s homeless system, but had yet to find a viable solution to their needs.
Figure 2: Participant Time Homeless Prior to PRK Entry
While these estimates are descriptive of Project Roomkey participants, they would need
to be compared with data from congregate shelters to understand the magnitude of any
improvement. However, providers overwhelmingly reported that the PRK model made a
difference in making shelter a more appealing option for people living outside. They
cited having a private room, getting to stay with loved ones, and not having a strict time
limit on participant stays as important factors for getting more participants inside than
before.
Private Rooms
Being able to shelter people in private rooms was a first for many service providers and
created an increased level of autonomy for participants that was key to keeping many
Less than 1 Year, 10%
1 -5 Years, 48%
5 -10 Years,
27%
More than 10 Years, 16%
0%25%50%75%100%
Lessons Learned
- 29 -
people in shelter during the pandemic. “The [site] was a huge success because you’re
giving people their own room and their own space,” one provider said. “Treating people
like adults, letting them come and go with no curfew, not having set meal times. Also,
they aren’t 32 inches apart, so naturally you’re going to get better results.”
In addition to privacy and autonomy, the individual rooms reduced the tension and
potential risks that exist in a congregate setting. Providers explained that staff in
congregate shelters have to constantly monitor participant behavior in order to prevent
fighting and other interactions that could make the environment unsafe. These actions
can result in participants getting removed from congregate shelter altogether and
potentially being sent to live back outside. In a non-congregate setting, however, many
providers felt they did not have to monitor participants’ every move, which led to a
more positive environment overall.
One provider described a participant who had not succeeded in congregate shelter
before due to conflicts with other participants. “One [participant] in particular has
schizophrenia and a developmental disability. People would steal from him and bully him
in a congregate shelter setting,” she said. “After he moved into the [PRK site] he gained
a lot of weight and lowered his substance use. He started making art and selling it. He
seemed much much happier and more stable.”
Some providers also discussed the potential dangers for women and transgender
individuals in congregate shelter settings. “A lot of people won’t enter congregate
shelters for very good reasons. Including sexual violence, trauma, the risk of being
robbed,” one explained. And while she clarified that the use of private rooms didn’t
completely eliminate the possibilities of those issues, “the risk was much much lower.”
At some of the trailer sites, providers tried pairing people with roommates since the
larger trailers had two bedrooms. This strategy saw mixed success, however, and
created challenges for staff when participants did not get along. While one of these
providers said they were usually able to move people around if they started having
issues with their roommate, another said they had to give up on the idea of roommates
altogether. “We finally realized that it wouldn’t work, even though we spent hours trying
to match people, meeting with them, talking to them beforehand,” she said. “Even if
people had been getting along in encampments, when they moved into the trailers
together that broke down. They are such a small space that it just doesn’t work.”
Keeping Communities Together
In addition to private space, the ability to keep communities together was central to
bringing so many new people inside. Almost all of the providers said that allowing
people to stay with their partners and pets helped make shelter more appealing to
people who may have otherwise avoided going inside.
This held true outside of Alameda County as well. One service provider who participated
in LA’s Project Roomkey program described being able to bring two entire
Evaluating Project Roomkey in Alameda County
- 30 -
encampments inside for the first time, after many prior failed attempts at offering them
shelter. “Those people wouldn’t go to congregate shelters before,” she explained. “That
changed when we offered them spots in a hotel together, though, and they could move
into a private room with their partner, dog, and other possessions.” Through Project
Roomkey, she was able to house two entire encampments, totaling nearly 200 people,
by offering them the option to stay together.
A couple of providers in Alameda County said that community building activities and
creating relationships among participants was crucial to the success of their sites. One
explained that since participants were supposed to be sheltering in place, she had to
come up with community activities in order to keep everyone engaged. While she did
not feel she had the resources to do this as much as participants needed, it allowed her
to keep participants at the site who otherwise may have felt too isolated and left.
“They learn about each other and it turns out many people were neighbors or old
classmates. Some are friends and family,” she described. “There’s a big sense of
community here.” Another provider described a situation in which the community
building events on site led to participants finding people they were willing to live with in
shared housing after leaving the site.
Due to COVID-19 however, some providers were not hosting community activities, which
they said could be a challenge for participants. “We aren’t doing group activities like
children's groups, parenting workshops, and employment workshops that we’d normally
do,” one provider said. “This made it harder for some individuals who struggle with
loneliness because there isn’t a place for them to congregate. It was hard that we
couldn’t get together and have community events.” In addition, some providers said the
physical setup of their site didn’t allow for community events.
This indicates that future homeless service programs should include resources for
community building and consider the physical space of any new shelters or permanent
housing sites to ensure community events are possible.
Removing Time Limits
One of the other major aspects providers said was helpful in bringing more people
inside was the lack of time limits on a participant’s stay. Typically congregate shelters
place a limit on how long participants are able to stay in a bed (e.g. 90 days). Due to the
ongoing nature of the pandemic, however, the Safer Ground sites allowed participants
to stay for as long as they needed. While the lack of time limits also presented some
challenges, providers generally agreed that it made shelters more appealing.
On average, PRK participants stayed at a site for about 7 months. Since the program is
not over, however, this average will likely increase. For those who exited the program
during the study period, though, the median length of stay is closer to 5 months. For
those still in the program, the median is about 8 months. Only 20% of PRK participants
had stays under 90 days (see Figure 3 below). For those who exited the program in less
Lessons Learned
- 31 -
than 90 days, a higher proportion exited to places not meant for habitation, suggesting
their overall outcomes may not have been as positive compared to those who were able
to remain at the sites longer.
Figure 3: Participants by Length of Stay
This data shows that the vast majority of participants relied on the lack of time limit and
suggests that those with shorter stays may have had less favorable housing outcomes.
While this could have again been due partially to the pandemic, providers also think
these longer stays helped participants’ stability.
One provider said that the lack of time limits also helped build trust between participants
and staff on site. “Since we were holding onto people, they learned over time to trust us
and access our services,” she said. “Sometimes with other time-limited services you
don’t build that trust because you know you’re getting kicked out anyways.”
Another provider said that staff had built such good relationships with participants that
even after they moved into housing, the participants would seek their help. “A few
people keep coming back by to try and talk to their housing navigators because they
have built such a strong relationship.” While they couldn’t continue helping participants
who had moved on to another program, this demonstrates the strong relationships
some providers were able to develop through the PRK model’s flexible timeline.
After running a shelter using the PRK model, one provider said she can’t imagine going
back to a congregate setting. “I think non-congregate [shelter] is the way to go in the
future,” she said. “To me, congregate seems almost barbaric at this point.” She quickly
added, however, that congregate shelter may be necessary if we are going to provide
shelter for everyone. “I’d rather have congregate than have people sleeping outside.”
One of the county staff members who helped design Project Roomkey felt similarly,
saying that congregate shelters aren’t healthy for anyone and emphasizing the need to
provide people with appropriate services in addition to housing. She also added that the
county is working to bring more resources to homeless services by getting creative with
health care funding. “There are savings in the health sector when we do this right, so we
can’t think of them separately,” she said.
Less than
3 Months,
20%
3 -6 Months,
20%
6 -9
Months,
33%
9 -12
Months,
15%
More than 12 Months, 11%
0%25%50%75%100%
Evaluating Project Roomkey in Alameda County
- 32 -
Summary
Overall, it appears that the low-barrier, non-congregate design of the PRK model helped
make shelter more appealing for people who may not have wanted to access it before.
The private rooms, ability to stay with community, and lack of timeline were all called
out by providers as particularly beneficial aspects of the PRK model.
Addressing Health Needs
The PRK model facilitated better access to services, but
could be better tailored to serve all populations.
“Once they got into a room, we finally saw their needs being met.
A lot of medical providers would tell us that this was the longest
period of time the person had been inside and consistently
accessing services.”
Participants were able to more easily access necessary health care and
stabilize, especially those who traditionally have less success in a
congregate setting.
The PRK model could be better tailored to work for some populations, such
as survivors of domestic violence and people with higher health care needs.
Once participants were placed in a room, the PRK model emphasized providing more
services to the sites than congregate shelters traditionally do. As described earlier,
Alameda County contracted to provide a variety of health care and other services for
participants. While not every site had the same services available at all times, providers
said the PRK model helped stabilize participants and provide them with much needed
support. However, some pointed out that large, low-barrier shelter sites do not
effectively serve all populations of people experiencing homelessness and identified the
need for more tailored solutions as well.
According to county staff, the health care services at PRK sites were designed to help
improve specific participant outcomes: health-related quality of life, chronic disease
management, service utilization (such as the emergency department or inpatient care),
and connection to benefits and services.
At a descriptive level, clinical teams comprised of nurses, medical assistants, and the
PRK medical directors, completed nearly 700 comprehensive assessments with
participants. These led to connections with appropriate health care, health coaching on
2.
Lessons Learned
- 33 -
chronic disease management, and advanced care planning. Additionally, they enrolled
92 residents in Medi-Cal, connected 89 with a medical home to provide comprehensive
health care, and prevented around 100 avoidable ER visits, among other activities. Once
COVID-19 vaccines were available, these teams administered over 600 vaccinations to
PRK participants and staff, with even more happening beyond the study period.
Providers also spoke to how they saw participants change throughout the course of
their stays, discussing the importance of this care for participant stability as well as the
need to tailor the PRK model to serve some specific groups.
Accessing Care + Creating Stability
While offering health care and other services to participants was not new for providers,
the PRK model committed more resources toward stabilizing participants than other
shelter models. As a baseline, the county was able to fund nursing, caregiving,
housekeeping, transportation, and three meals a day, which are rarely available in a
congregate shelter setting. Building these services into the program allowed participants
to access resources they may have needed but could not get before.
One provider explained that many of the participants at her site had not been receiving
adequate health care for a long time, but their entry into PRK helped address that. “We
saw people come inside who have been on the streets for decades or haven’t seen
doctors or had appropriate serves for so long,” she explained. “Once they got into a
room, we finally saw their needs being met. A lot of medical providers would tell us that
this was the longest period of time the person had been inside and consistently
accessing services.”
This impression is confirmed by the data available on participants’ self-reported health
conditions. Figure 4 below demonstrates that PRK participants reported higher rates of
physical disabilities, chronic conditions, and mental or psychiatric illness than those in
the population of people experiencing homelessness overall.
Figure 4: Comparing Participant Self-Reported Health Conditions
24%26%
39%
65%
73%
59%
Physical Disabilities Chronic Health Problems Psychiatric / Emotional
Conditions
2019 PiT Count Safer Ground Participants
Evaluating Project Roomkey in Alameda County
- 34 -
Providers attributed at least part of this success to people having their own space that
they could return to for a longer period of time. Another provider described a
transformation they saw in the stability of participants at their site overall: “Something
about having your own space is really impactful. It gives [participants] time to think what
their next steps are and go back to their old selves. When we opened in May many
people didn’t have anything. They were just off the street, hadn’t taken a shower, didn’t
have any extra clothes. Between May and now there has been a real change: people are
definitely more stable than when they started.”
Providers also said that giving participants a consistent address and access to reliable
transportation made a big difference in helping them receive the services they needed.
“I can’t tell you how important having transportation has been for us,” one said. “People
can go to their appointments without having to pay or find a bus or a ride.” Another
explained that pharmacies and physicians would call their site every day to confirm a
participant lived there, since they had never had a consistent address at which to
receive their medication before.
One site manager described a participant who is one of the highest users of emergency
services in the county. This participant’s mental health issues had made it difficult for
them to maintain positive relationships with other congregate shelter participants in the
past. “We have someone at [our site] who hasn’t stayed in a shelter for more than a few
days before, but now he’s been inside since September,” she said. “Just the ability to
come back consistently and have his own space has greatly improved his ability to
access services.”
Summarizing their view of the success of the PRK model in reaching those not typically
served well by shelters, one provider noted, “People with severe mental health
challenges are not usually successful in congregate [shelter]. The biggest success here
is that we took a kinder, more empathetic approach to really work with individuals that
had mental health issues and weren’t so quick to exit people.”
Another provider echoed the advantage of getting to work with participants for more
time, saying, “People are more relaxed and calm, getting three meals a day, the
environment itself is much more respectful. With [congregate] shelter you are so busy
just trying to work with people in an environment that isn’t fit to live in. Here we have a
real opportunity to work with people.”
An Alameda County staff member affirmed this perspective, saying the PRK model was
designed to give participants space to worry less about their immediate needs and think
toward the future. “I think there is something about people being able to have their own
space, with a lockable door and a bathroom,” she said. “People get a chance to set
down their burdens and not have to focus on keeping themselves together. It allows
them to focus on themselves in a new way and reach for a different future.”
Lessons Learned
- 35 -
Additional Services Crucial to Success
Aside from health care and housing, many providers called out the importance of having
access to seemingly more basic services such as meals and transportation. One provider
said specifically that the ability to have reliable transportation to take clients to and from
their myriad appointments was invaluable. If a goal of shelter is to help stabilize
participants by getting them access to public benefits and medical care, which often
require multiple appointments at varying times of day, it may be useful to continue
providing transportation options.
Additionally, multiple providers said that being able to provide three meals a day meant
that participants didn’t have to worry about where they would find money to buy food
or wait in line for free meals elsewhere. One staff member who helped oversee health
care resources at the PRK sites said that she could see a significant change in participant
health even before they had accessed medical services. “It is so powerful to give people
food and shelter,” she said.
When asked what services they would have wanted more of, most providers noted the
need for more mental health care workers. While some sites had access to licensed
social workers, others didn’t have consistent behavioral health resources, which they
said many participants needed. Additionally, while the larger hotels had regular access
to nursing staff, staff at other sites said a more frequent presence of nurses or doctors
would have helped participants.
A few providers also mentioned that working with volunteers not accustomed to serving
people experiencing homelessness was challenging and required staff to help oversee
that participant experiences with these services were positive. Last, two providers said
that caregiver services were invaluable, but that they were unable to provide them for
every participant who needed them.
The services provided as part of the PRK model created a space where participants
could reliably access the care they needed, however providers explained that the model
may need to be better tailored to effectively serve some groups.
Communities in Need of More Tailored Support
The ability to access reliable services and remain in one place with no time limit was
clearly a benefit to participants’ stability. However, providers had varying experiences
when it came to actually engaging with all participants.
At some sites, providers said their physical environment made it easy to engage: “Here
at the site we see people every day. If there is something they need, we can easily call
and talk to them. Everyone who passes our office will say hi. We are much more
accessible than at previous sites.”
Evaluating Project Roomkey in Alameda County
- 36 -
For others, however, the physical setup of the site, including the private rooms, created
barriers to engaging some participants regularly. For sites without a central entrance
space, providers said it could be difficult to keep track of participants coming and going,
and therefore challenging to encourage them to engage in services.
While providers described the negative aspects of congregate shelter, as noted above,
some also acknowledged that the non-congregate setting could create added
difficulties in engaging with some participants. “Because people got to stay inside their
rooms, and there was COVID-19 outside, it was harder to engage people,” a provider
explained. “They would just stay in their rooms and by the end some people had not
really engaged at all because they either didn’t have to or had mental health challenges
that prevented them from engaging.”
While no providers stated they would prefer congregate shelters, it does demonstrate
the need to identify new ways to engage participants in a non-congregate setting.
Additionally, providers explained that the PRK model was not necessarily an
improvement over congregate shelter for some groups. The groups mentioned most
frequently were people who needed high levels of care (e.g. those with severe physical
or mental illnesses) and survivors of domestic violence. While PRK was able to get these
people into shelter, it was not necessarily designed to meet their specific needs.
Some providers reported that they had participants who needed much higher levels of
care than they were able to provide. “Sometimes we joke around and we run a skilled
nursing facility, but without the training,” one provider said. “We have people that can’t
get out of bed on their own, use the bathroom on their own, or eat on their own. So
they need our help, but our staff are not trained or paid to be in-home care providers.”
The presence of clinical teams on site was a significant help, but many providers
reported their staff had to spend a lot of time taking care of people’s basic needs
instead of focusing on long-term goals like their housing search. “Twenty to thirty
percent of people require high-touch services,” one provider said. “We don’t have the
capacity to be checking in with so many people all the time. It takes so much just to
monitor and help with the basic survival stuff.”
While this was a significant use of staff time, it also created problems at sites where
people were living with a roommate. As a provider at one of these sites stated, “Anyone
who needs a higher level of care, who cannot take care of themselves or has an extreme
mental health situation, isn’t served well here.”
Two providers reported trying to connect participants with in-home supportive services
(IHSS) through the state, but being unable to access the resource during COVID-19.
“IHSS can be the difference between people making it here or not. It is such an
invaluable resource,” another provider explained. “But there is a lot of paperwork and
not a lot of flexibility with timelines.”
Lessons Learned
- 37 -
In the meantime, the county did attempt to connect people with these services by
contracting with caregivers for participants who were applying for long-term IHSS care.
According to county staff, though, there were not enough of these services available at
the beginning of the program to meet the needs of the participants. In more recent
months, they have reconfigured the sites to focus one hotel on serving those with the
highest health care needs and have ramped up caregiver services there. According to
this staff member, this kind of support can be crucial for people coming out of
homelessness, but is not provided in most shelters. “These people couldn’t have stayed
in shelter without this support,” she said. “They would have been kicked out.”
Additionally, this staff member added that the PRK model may help fill an important gap
in our current slate of shelter services. “Some of the largest gaps we see are individuals
who are institutionally frail, but would prefer not to be in an institutional setting,” she
said, referring to people who may be better served in a skilled nursing facility or medical
respite center, but choose to remain outside because they do not feel comfortable in
those places. “They are happy to be [in Project Roomkey] because they have a similar
level of freedom, are treated respectfully, and can get the care they need.”
While serving people with high medical needs was challenging for providers, the
available data does not demonstrate that any particular condition made participants
statistically less likely to be successful at a PRK site. If a certain group were particularly
unsuccessful in this program, they would likely have higher exit rates to non-housing
destinations (such as medical facilities, other shelters or back to homelessness).
However, looking at participants who exited to non-housing destinations, there is no
significant difference based on self-reported physical or mental health conditions. This
speaks to the possibility that, with the proper level of services available, the PRK model
may be better poised to effectively stabilize and house people with high medical needs.
Another group for whom the PRK model may need to be more tailored was survivors of
domestic violence or people with other significant trauma. While there was one hotel
dedicated to serving this population, it has since closed. Since it was a smaller site, all of
the participants were able to move to another PRK site if they wanted to, but moving to
a larger site created new challenges for some participants. “Some of the clients we had
stabilized went to another hotel and relapsed,” one provider said. “They are used to
living a life where they have a small world that they have created to protect themselves.
If we want to have a hotel that is super low threshold, we should have that, but we need
to have another space for people that need more protection.”
This provider extended this lesson to other groups as well: “When you design a system
based on who the most homeless people are—single men—you miss being able to serve
other people. We have to stop and think, ‘What about the families, what about domestic
violence survivors, what about youth?’ We need to go down the checklist and ask
ourselves what we are going to do for those populations.”
Summary
Overall, providers felt that the PRK model was a significant improvement over traditional
shelters in stabilizing participants and improving their health outcomes. They thought
Evaluating Project Roomkey in Alameda County
- 38 -
future shelter provision should include access to these comprehensive services as well.
However, some discussed the need to have more tailored options for groups that may
not be successful in a large, low-barrier, non-congregate setting.
Increasing Access to Housing
The PRK model nearly doubled the number of
participants exiting to housing, while also posing
challenges to facilitating those exits.
“People are going to pick apart the data for years to come…
But the bottom line is I don’t think there’s ever been a situation
where over 400 people have been housed in this fast of a period.”
65% of PRK participants who exited PRK entered housing, as compared with
35% in congregate shelter last year.
Some participants were initially hesitant to move out of PRK sites, but most
elected to move into housing once the temporary nature of the program
became clear.
Possibly the most striking outcome from Alameda County’s Project Roomkey is the
proportion of participants who moved from the shelters into housing. Even though
connection to housing was a secondary goal of the program—given its focus on
participant health outcomes—the PRK model nearly doubled the percent of participants
leaving to more permanent housing. While some providers reported challenges in
motivating participants to move out initially, nearly all of them stated that this model
housed more participants than they had seen in past programs.
More Participants Exiting to Housing
During the period of study, 65% of the 815 participants who left the program went to a
housing destination (see Table 4 below). As a comparison, according to HMIS data on
exits from emergency shelters in Alameda County from the prior year (April 2019 -
March 2020), around 35% of participants exited to housing. For detail on the HMIS
destinations included in these categories, see Appendix A.
3.
Lessons Learned
- 39 -
Table 4: PRK Participant Exits by Category
Exit Category Participants Percentage
Housing 532 65%
Place Not Meant for Habitation 104 13%
Shelter 71 9%
Other/Data Not Collected 50 6%
Deceased 25 3%
Medical or Treatment Facility 24 3%
Jail 9 1%
Total 815 100%
Around 13% of Project Roomkey participants exited to locations not meant for habitation
(e.g. tents, RVs, etc.) and 9% exited to other shelters. While these numbers are much
lower than usual for congregate shelters, future research would have to speak with
participants to understand the challenges that led them to non-housing destinations.
Further, PRK residents who were exiting to housing accessed potentially more stable
public subsidies at much higher rates than those in shelters in prior years (See Figure 5
below). Only around 29% of participants from congregate shelters in Alameda County
accessed public subsidies in the year prior to PRK, while 43% left to live with friends or
family. In comparison, nearly three-quarters of PRK residents used a public subsidy and
only 11% stayed with friends or family.
Figure 5: PRK Participant Exits to Housing by Destination
Public subsidies tend to be a more reliable form of housing as they often come with
support from a service provider, so a participant’s outcomes are monitored more
closely. Exits to live with friends or family, while possibly beneficial, are harder to
74%
13%
10%
3%
Public Subsidies
No Ongoing
Subsidies
Staying with Family
or Friends
Other Destinations
Evaluating Project Roomkey in Alameda County
- 40 -
monitor long-term. Future studies should follow up with participants and program
administrators to understand the true retention rates of participants who left to these
various destinations.
Exit Demographics
HMIS data shows that the racial and ethnic breakdown of participants exiting from PRK
appears generally proportional to their representation in the program overall. Further,
among participants exiting to housing, no statistical difference could be detected
between the composition of the racial and ethnic groups (see columns 1 and 2 in Table 5
below). This indicates that once participants entered PRK, their housing outcomes were
relatively equal.
Table 5: Exits to Various Categories by Race and Ethnicity combined
Race and Ethnicity
All
Participant
Exits
(1)
Exits to
Housing
(2)
Exits to
Places Not
Meant for
Habitation
(3)
Exits to
Shelter
(4)
Black or African
American 43% 44% 36% 46%
White - Non-
Hispanic/Non-Latinx 28% 29% 34% 10%**
White -
Hispanic/Latinx 13% 13% 11% 18%
Multi-Racial 8% 7% 7% 14%*
Asian 3% 3% 6%* 1%
American Indian or
Alaska Native 3% 2% 4% 7%*
Native Hawaiian or
Other Pacific Islander 2% 1% 3% 3%
Total 100% 100% 100% 100%
Table 5 utilizes two-sample t-tests to test whether the percentage of people from a particular racial or ethnic
group who left to a specific exit category (columns 2, 3 and 4) is statistically different from that group’s
representation among participants exiting PRK overall (column 1).
Those marked with * are statistically significantly different with 90% confidence. Those marked with ** are
statistically significantly different with 95% confidence.
The racial category “White” is split into two groups based on the participant’s ethnicity.
Exits to non-housing destinations like places not meant for habitation and shelter,
however, do see statistically significant differences by race. Participants identifying as
Asian are overrepresented in exits to places not meant for habitation. Participants
identifying as Multi-Racial and American Indian or Alaska Native are overrepresented in
exits to shelter, while those identifying as White - Non-Hispanic/Non-Latinx are
Lessons Learned
- 41 -
underrepresented. These differences are all significant at either 90% or 95% confidence
and should be investigated further to understand why certain racial and ethnic groups
have disparate non-housing outcomes.
Multiple Factors to Housing Success
One reason providers gave for the high percentage of exits to housing was the addition
of funding from the federal ESG-CV program. As previously stated, Alameda County
used these funds to create hundreds of new bridge housing subsidies for Project
Roomkey participants. Through this funding the county was able to subsidize twelve-
month housing placements for participants moving out of a PRK site, with a commitment
to continue funding the subsidies beyond the first year.
Additionally, the county participated in California’s 100-Day Challenge which provided a
structure to collaborate with the cities of Oakland, Berkeley, and Alameda to align
funding around housing exits. Using the ESG-CV funds, the county contracted Abode
Services to provide a centralized housing navigation team that assisted participants
across sites in working with landlords and finding available housing in apartments across
the county. To help ensure participant success after exiting to housing, the county also
funded 11 housing providers to offer ongoing tenancy support.
The data shows that 217 Project Roomkey participants were housed using this specific
subsidy between November 2020, when it became available, and March 2021. This
represents over 40% of the total exits to housing overall and was therefore clearly a
significant factor in the program’s high housing exit rate. Many other participants exiting
to housing with public subsidies utilized the county’s standard process to access
permanent supportive housing.
Some providers affirmed that the resources for these new subsidies as well as the work
of their housing navigators was crucial in helping participants find housing. As one
provider said, referring to the new subsidies, “We would never have been able to house
so many people if not for Abode and the resources they had access to.” Another
provider described the addition of these resources as unprecedented and said, “I’ve
never seen so many people with housing options. In shelter you’re lucky if 25% of
people have real housing options—not just living with relatives. I think the infusion of
housing resources has been awesome.”
Another provider described what it was like to see so many of her participants given the
opportunity to access housing once it was announced that the site was going to close.
“It was magical and intense,” she said.
Providers, however, were more mixed on whether the PRK model, specifically, was
better at preparing participants to move into housing, or if it was the newly available
subsidies alone. According to one, the ability to give participants time to stabilize and
get to know shelter staff was crucial in creating a successful housing search. “Having
people in one place and having time helps,” she said. “The time-limited shelters can be
Evaluating Project Roomkey in Alameda County
- 42 -
hard to get people stabilized and focusing on housing.” Another provider, however, was
less sure that the PRK model had an effect on housing outcomes since most of the
participants at her site who found housing got access to these new subsidies.
One way of understanding the impact of these subsidies on housing exits overall is to
examine what the rate of exits to housing would have been without them. Even when
the participants that used this subsidy are removed from the sample, the rate at which
those who exited PRK sites entered housing was 53%. As stated above, this is still
significantly higher than exits to housing from congregate shelters. Therefore it appears
the PRK model, with its increased housing navigation and case management, may have
had an effect independent from this new subsidy.
One Alameda County staff member observed that, at the very least, the PRK model
made it easier for participants to access housing simply by bringing them inside. When
people are eligible for supportive housing, but are not living in a shelter or other indoor
setting, she explained, “it’s really hard to get them through the process.” Since the PRK
model was appealing to people who may not have chosen to go into congregate
shelter, it made it easier for them to get access to the housing they were eligible for. If
they hadn’t been in a PRK site, she said, they may have lost that opportunity.
While more research is needed to extricate the effect the PRK model had on participant
housing outcomes from the new subsidies, one provider made sure to emphasize the
overall success of the program. “People are going to pick apart the data for years to
come,” she said. “But the bottom line is I don’t think there’s ever been a situation where
over 400 people have been housed in this fast of a period.”
All the providers agreed with this sentiment and felt that the infusion of new funding for
housing subsidies was central to the program’s success. “A shelter program is only as
good as the availability of housing on the other side,” one provider said.
Since this study was conducted while Project Roomkey was still in operation, more time
is needed to understand the retention of participants in their housing. While county staff
had not heard of participants dropping out of the subsidy programs they fund, this is an
important area for future research. Understanding retention rates among Project
Roomkey participants would help illuminate whether people receiving the PRK model
are more prepared to stay in their housing than those coming from congregate shelter.
Finally, one important source of permanent housing not captured in this data is Project
Homekey. Project Homkey is a follow-up initiative to Project Roomkey that provides
state funding for local governments to buy hotels, enabling them to convert the rooms
into permanent housing units. While these sites were not ready to be used during the
study period, they are likely to be a growing source of permanent housing exits for PRK
participants going forward.
While nearly all providers affirmed that more participants left PRK to housing than in
prior shelter programs, some also discussed challenges it posed in moving people out of
the sites and into housing.
Lessons Learned
- 43 -
Challenges Facilitating Exits
Despite the significant increase in the number of participants getting access to housing
through Project Roomkey, providers noted that the PRK model created some difficulties
in facilitating participant exits. Since people had their own rooms, access to numerous
services, and three meals a day, without paying any portion of their income, many
providers reported that some participants were understandably hesitant to leave, even
when they were offered housing.
“People don’t always have a huge motivation to leave because it’s comfortable, safe,
and free,” one provider explained, emphasizing that subsidized housing typically has
participants pay 30% of their income to rent. “They have staff available 24/7, maybe
even partners or romance too. They have created a community and family here on site.”
Another provider said that moving from a service-rich environment like PRK to living
largely on their own, can be daunting for participants. “We see how much support
people need and they can get it at our sites because they are designed to do that,” she
said. “So to move from here to a place where they aren’t getting that support can be
very challenging for people—and rightly so.”
An added challenge was that not all housing options participants were offered were for
individual units. Some were for shared housing where participants would be matched
with others to share a multi-bedroom home or apartment. One Alameda County staff
member explained, “When you’re leaving a situation where you have your own
room...and you’re going to shared housing, and paying some percent of your income, it
is a really hard transition.” Many of the providers noted that while this could be
frustrating, it was understandable, acknowledging that they themselves wouldn't
necessarily feel excited about moving from a room of their own to living with strangers.
This challenge existed in other counties as well. “People liked the space more than
congregate shelter,” an LA County provider said. “Some people come into congregate
sites and say it’s so awful they’ll do anything to get out. This isn’t true in a non-
congregate shelter setting.” However, she explained that those initially hesitant to leave
shelter will eventually make the transition. “In the end, people will leave the hotel when
it’s time and we will do our damndest to make sure everyone has a place to go.”
Most of the Alameda County providers who reported these challenges shared a similar
view about participants’ eventual participation in their housing search. One reported that
when the county told them the site would close, the temporary nature of PRK became
clear to participants and they were more willing to move to housing. “When we thought
we were going to close the site in February, suddenly everybody wanted a case
management appointment,” she said. “It’s hard when you don't have an end date to get
people motivated to have a plan.”
Evaluating Project Roomkey in Alameda County
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Another provider elaborated on this point, saying that the focus of the program at first
was to get as many people inside as possible, so expectations around participants
looking for housing weren’t set up from the start. “Project Roomkey was challenging
because residents weren’t starting off with the expectation that they would have to
participate actively in their housing plan,” he said. “Shifting the focus from getting
everyone into the hotels and being safe, to going out and looking for housing was hard.”
He added, however, that the funding for the new bridge housing subsidies wasn’t
available at the start of Project Roomkey, so expecting everyone to find housing at that
time would have been unrealistic.
Nevertheless, providers clearly had a challenging responsibility to create a space that
was more comfortable and effective at stabilizing participants than traditional shelter,
while also helping motivate them to find housing and move out of the sites. “It feels like
two tensions at the same time,” one provider said. “You want to create that respite from
the strain of sleeping in bunks in a room, but you also want to make it clearly an interim
environment, so people are motivated to find housing.”
The timing of PRK exits backs up the idea that participants were eventually willing to
move to housing. In November 2020, the county prepared to close all PRK sites due to
the lack of long-term program funding. Additionally, this is when the bridge housing
subsidies became available and there was a push to find housing for participants. The
data shows that after this exits to housing more than doubled for the next two months
(see Figure 6 below). While most hotels ended up being able to remain open, this
demonstrates that when the temporary nature of the program became clear and more
housing resources were added, participants were willing to move out of PRK sites.
Figure 6: Exits to Housing by Month
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Housing push begins
Lessons Learned
- 45 -
This was further confirmed by a provider at a trailer site where most participants had
roommates. “[This site is] different from a hotel because a trailer feels more temporary,
so they don’t have the same feeling of just wanting to stay,” she said. “They’re living in a
parking lot and they know it’s just a program that could close any time. People feel
secure right now, it’s better than being out in the street, but at the same time they know
they have to move on. Anytime there is a waitlist opening [for housing] they really come
out to apply.”
While the providers at trailer sites didn’t necessarily think the trailers were preferable to
hotels, this points to a need to find ways to provide shelter environments that both
allow participants to feel comfortable and stabilize, and focus on finding permanent
housing for everyone. Providers named multiple ways to address these “dual tensions,”
including setting better expectations from the start, creating some time limits for
participant stays, or offering more appealing and varied housing options.
Summary
The PRK model nearly doubled the percent of participants exiting to housing as
compared with traditional congregate shelter. This increased access to housing was due
to added resources, including new subsidies and funding for housing navigation. While
some participants were hesitant to leave PRK sites at first, once more housing options
were available and the temporary nature of the program became clear, most were
willing to move on.
Improving Collaboration
The PRK model created new partnerships and
coordination between homeless service providers,
despite challenges with quick program implementation.
“We’ve seen this past year that the local, state, and federal
government can really change policy fast. We’ve been able to
create things that would have taken decades to do otherwise.”
PRK created a chance for new collaboration among service providers and
county staff.
PRK started quickly and was high intensity for staff, but overall was a
successful mobilization of resources.
The last theme consistently highlighted by service providers taking part in Project
Roomkey was that the program created opportunities for providers, government
agencies, and other organizations to work together in new, more effective ways. While
4.
Evaluating Project Roomkey in Alameda County
- 46 -
providers faced significant staffing issues due to the uncertainty of the program’s
timeline and the significant needs of the participants, most agreed that Project Roomkey
was a successful response to the pandemic and presents opportunities for future
improvement to the county’s homeless service provision.
New Collaborations
According to providers, a major benefit of Project Roomkey’s design was that it created
new channels of communication between their organization and the other nonprofits or
government agencies they work with. Because there was such a fast mobilization to get
PRK sites up and running, Alameda County staff were highly involved in meeting with all
the service providers individually as well as regularly bringing them together.
Specifically, providers found the connection between the health care and housing
sectors to be particularly important to participant success.
“We’ve had a lot of support from key players in Alameda County,” one provider stated.
“The medical directors have been very hands on, which has been integral to getting
access to a lot of services and answering important questions.” They went on, giving an
example of one of their participants who isn’t technically qualified for a housing subsidy
yet, but needs one. “The coordination between these groups helps us fill in all the cracks
that this person would otherwise fall through.”
Another provider agreed PRK fostered a new level of collaboration, which was a change
from the way they had worked before. “The teamwork was incredible,” she said. “The
staff that interacted with my staff were so nice and supportive. Even when people were
exposed to COVID-19 and had to move to another hotel and come back, it was
seamless.”
Yet another said that the presence of health care staff was the biggest improvement in
the PRK model. “I’ve been doing this for 27 years and we finally got regular access to
county departments we didn’t have before,” she said. “Having a relationship with
leadership of county health care agencies and the staff there was a game changer.”
Multiple providers also reported that having medical professionals and nursing staff
present made it faster to get necessary documentation participants need for housing.
Clinical teams reported completing 259 Verification of Disability forms for SiP hotel
residents. This can be particularly important, as having this documentation can make the
difference in whether or not a participant can access housing. “Having health care staff
on site made it easier to get a verification of disability, social security cards, and other
documents,” one provider said, adding that she hoped this collaboration would remain
even after Project Roomkey ends.
Providers did report some challenges in accessing critical government services, such as
IHSS or the DMV, due to offices being closed during the pandemic. However, some
reported that the new collaborations resulted in opportunities to make homeless service
programs less rigid. “A lot of organizations have bent over backwards to work with [PRK
Lessons Learned
- 47 -
sites] and be flexible on what documents our clients need,” one provider said. She went
on to explain that the Housing Authority of Alameda County allowed participants to
receive housing subsidies so long as they were working on getting their proper
documentation together, a change from prior requirements that meant many more
people could get housed.
Another provider said that Project Roomkey forced them to collaborate in new ways to
meet the diverse needs of the participants. “Since homelessness affects people of all
ages and races, we brought in experts from our aging unit, family support team,
substance use disorder team, and street health outreach team, who hadn’t necessarily
worked together in this way before,” she said.
County staff agreed that Project Roomkey allowed for new forms of collaboration and
the ability to make change faster than ever before. “We’ve seen this past year that the
local, state, and federal government can really change policy fast,” one staff member
said. “We’ve been able to create things that would have taken decades to do
otherwise.”
While most providers mentioned that they would have liked more consistent
communication from the county through the program, they all acknowledged that the
county faced immense challenges in starting a program so quickly and with such little
certainty from the federal government.
Rocky Start Up, but an Overall Success
Nearly every provider discussed the challenges they faced in starting their PRK sites
with such a short timeline. Many providers had to ramp up staffing and begin work in a
matter of weeks or even days. One described the creation of their site saying, “frankly it
was quite amazing how fast the program got up and running.” Another stated, “I was
basically hiring seven days a week for 4 months straight to get us where we are today.”
Since Project Roomkey was a quick reaction to an unexpected pandemic, providers
generally felt these challenges were unavoidable, however many described the issues
they faced in training and supporting staff appropriately once the program was going.
With the need to hire up so quickly, many providers struggled to bring on new staff
members that were able to handle the intensity of a program like Project Roomkey. One
provider explained, “We were all new. There was so much learning that had to happen
in addition to the service provision.”
Since most sites were low-barrier and provided participants with more autonomy, newer
staff often needed support in learning how to engage with the community. “A lot of
shelter monitors we hired had never worked with this population before,” another
provider said. “We try to have at least one experienced staff person on every shift, but
we had to teach them evidence-based practices fast.”
Evaluating Project Roomkey in Alameda County
- 48 -
One provider explained that the non-congregate setup of their site created some
difficulty for new staff. “It is more challenging to adequately train and oversee staff
because participants are much more spread out,” she said. “There are so many rooms
and a lot of things that can go wrong.”
Even with staff in place, some providers said more resources were needed in supporting
them through the day-to-day operations of the site. One explained that since staff had
to go into people’s rooms to engage them, they could find themselves in many sorts of
situations like helping clean up someone’s room, assisting them with necessary tasks like
going to the bathroom, and dealing with overdoses. “It’s really traumatizing to know you
may find a dead body in a room one day,” she elaborated. “People don’t necessarily
understand that. It weighs on our staff and causes a lot of other related issues to be in
that high-stress environment all the time.” While she acknowledged that this is part of
their work as a service provider, she also said that more resources for training and
supporting staff were needed from the county to effectively run a low-barrier
environment like Project Roomkey.
In addition to the high-intensity situations staff could find themselves in, providers
reported that the uncertainty of Project Roomkey’s timeline made it difficult to retain
staff. The uncertainty of the pandemic caused by COVID-19 case rates and spread, the
term of the federal emergency declaration, and funding availability meant that the
county could never be sure how long the program would last. Even though providers
understood this, they explained that not knowing when their sites would close made it
difficult to keep staff.
“The uncertainty was hard - only being open month to month to month,” one provider
said. “This made it hard to hire people and keep staffing operations going.” Another
provider said they were told a few different times to prepare to close their site, but each
time the dates got extended so the site didn’t have to close. “We started losing staff
because we kept pushing back the date we were going to close,” she said. “If we had
known we were going to stay open, we could have kept people.” Many providers
described losing higher-level staff to more permanent positions inside and outside their
organization.
With the Biden Administration’s commitment to continue reimbursing localities for this
work through September 2021,51 this uncertainty is likely less of an issue going forward.
Providers did say, however, that continuing their new level of collaboration with others
involved in county homeless services as well as receiving the appropriate resources for
training staff to work in PRK-style shelters, will be critical to the success of future
programs.
Summary
Project Roomkey provided a chance for service providers and government agencies to
work together in new, collaborative ways that improved service provision at the sites.
Providers faced some challenges with hiring, training, and retaining staff in a program
that included so much uncertainty, but hope to keep up these new levels of
collaboration in future programs.
Bringing the PRK Model Forward: Conclusion and Recommendations
- 49 -
Bringing the PRK Model Forward:
Conclusion and Recommendations
Conclusion
Alameda County’s Project Roomkey program was a strikingly fast mobilization of
resources to protect the people experiencing homelessness most vulnerable to the
COVID-19 pandemic. In only a matter of months, the county more than doubled its
available shelter beds and created a new model of non-congregate shelter provision.
Based on the data available, the PRK model appears to have been more appealing to
those who may not have wanted to use shelter before, helped participants stabilize
through connection to appropriate health care services, put many more on a path
toward permanent housing, and facilitated new collaborations between homeless
service providers.
This report demonstrates that with significant state and federal investments, clear
outcome goals, and coordination among government and service providers, real
progress can be made in addressing the homelessness crisis. At the start of 2020, Gavin
Newsom proposed the idea of using hotel conversion to augment the state’s pace of
permanent supportive housing production. Just one year later the state had tripled that
production through hotel conversions, due to the funding and coordination propelled by
the pandemic.52
The PRK model was able to quickly address many of the barriers to using congregate
shelter that people experiencing homelessness have long identified. One Alameda
County staff member described how seeing Project Roomkey unfold so quickly has
changed the way she thinks about the possibility of meaningfully addressing
homelessness, saying, “Normally how I think of my work is relentless incrementalism. If
we have the right infrastructure, though, it’s clear we can make changes in leaps and
bounds.”
The PRK model, however, comes at a significant financial expense. At a nightly cost per
person that is multiple times higher than other forms of shelter, continuing the PRK
model at the current scale may not be the most sustainable or appropriate use of
county funds without continued federal reimbursement. Additionally, as COVID-19 cases
decrease and travel reopens, many hotels will likely want their rooms back, leaving the
county with fewer spaces available for non-congregate shelter.
In an attempt not to lose ground on addressing homelessness once funding and space
run out, the state has allocated $800 million to buy hotels and convert them to
permanent supportive housing. This follow-up program to Project Roomkey, called
Project Homekey, has already led to the purchase of 94 hotels with over 6,000 units
across California at a much lower cost than building new supportive housing.53 Using
Evaluating Project Roomkey in Alameda County
- 50 -
these funds, Alameda County has already purchased two of the PRK sites to convert
into permanent housing.
While it is critical to create as many permanent housing opportunities as possible, the
county will continue to operate shelter in some capacity to address the immediate
needs of people experiencing homelessness. Therefore, this report has attempted to
shed light on which pieces of the PRK model can be replicated in other programs and at
what cost—either financially or to the success of participants in the program.
The following section attempts to synthesize these lessons into three complementary
recommendations. While this is not an exhaustive list, it is intended to begin a
conversation about how the county can improve upon current shelter operations in
order to best serve people experiencing homelessness.
While creating a more financially sustainable program is likely necessary for the county,
it is important to do so without sacrificing the quality of shelter services and leaving
participants with interventions that do not serve them well. Therefore, it is important to
be clear about the potential tradeoffs involved in adjusting the PRK model. In order to
do so, discussion of these recommendations will be organized around the following
criteria:
● Effectiveness: Does this recommendation help stabilize people experiencing
homelessness and put them on a path toward long-term housing? What are some
key components to consider in implementing the recommendation?
● Reach: Who does this recommendation serve and who does it leave out?
● Cost: What is the relative cost of this recommendation? At what scale could it be
implemented?
Recommendation 1
Maintain the PRK model at a smaller scale focused on people
with high medical needs who would not be able to stabilize in
congregate shelter but do not feel comfortable in other
institutional settings.
Key Components
Non-congregate shelter offering increased privacy for participants.
Low-barrier design allowing participants to bring their partners, pets, and
belongings with them, with opportunities for community building
Nursing and caregiver services focused on stabilizing participants’ immediate
medical needs and connecting them with long-term care.
Housing navigation from an organization other than the hotel operator, dedicated
to finding appropriate long-term housing options.
Longer participant stays to give time for stabilization, with an emphasis on
housing search and temporary nature of the shelter.
Access to regular transportation and meals.
Bringing the PRK Model Forward: Conclusion and Recommendations
- 51 -
Even with the end of Project Roomkey, it is possible that there are some hotel owners
interested in continuing to lease their rooms to the county as shelter. If this is the case,
the county could continue providing non-congregate shelter and services in the PRK
model while adjusting the program to focus on a higher-needs population that is not
currently served well in a traditional congregate shelter setting.
Effectiveness
As this report demonstrates, the PRK model was able to fill a gap in the slate of shelter
models currently provided in Alameda County. Through its mix of low-barrier, non-
congregate and on-site health care and housing services, it was able to make shelter
more acceptable to people experiencing homelessness, help them stabilize, and put
them on a path toward permanent housing. Since many providers and county staff
noted that people with high medical needs are often not served well in congregate
shelter, but do not want to be in an institutional setting like a medical respite center, the
PRK model should be maintained to serve this group.
The increased privacy and service level of the PRK model may create a more effective
setting in which people with significant medical needs can stabilize and search for
appropriate housing, without the added stress of staying in a congregate setting.
However, even though Project Roomkey served an older and sicker population, if the
PRK model is shifted to focus exclusively on this group, participant outcomes may
change and would need to be monitored.
By definition, this group would have significant unmet medical needs and therefore
would likely show more significant benefits from the increased service level of the PRK
model. If participants are sicker, though, they may need more time to stabilize and
prepare to look for housing, which could decrease the number of participants served
and exiting to housing each year. However, if a clear expectation is set from the start
that the goal of this shelter is to help participants stabilize and find appropriate housing,
people may be primed to move on more quickly.
Additionally, if congregate shelters do not work well for this community, then the
alternative is likely leaving them to live outside where it will be difficult to meet their
health care and housing needs. If we want to make more people comfortable using
shelter, help them stabilize, and prepare them to move into housing, the PRK model may
be the best interim step for this group.
Reach
More research needs to be done as to what conditions to prioritize for people receiving
this intervention. However, based on provider interviews it seems that people with a
number of physical disabilities and/or mental or behavioral health diagnoses may need
more support than they can currently get in congregate shelter, but may not feel
Evaluating Project Roomkey in Alameda County
- 52 -
comfortable in an institutional setting. The PRK model could be continued in order to
serve this population specifically.
The tradeoff of this option is that it would serve a much smaller population of people
experiencing homelessness in Alameda County. Those without significant medical needs
who have been homeless for shorter periods, would likely not be prioritized into this
setting. It also may not be able to keep larger families or communities together, as
people’s needs within these groups may differ. Last, some people may find their needs
are so serious that they do need to be in a more institutional setting in order to receive
appropriate care.
Cost
At a rate of around $260 per person per night, the PRK model may be one of the more
expensive shelter models the county utilizes. Since this recommendation focuses the
PRK model on a smaller population, the costs will be somewhat contained.
Based on the estimate of the PRK program costs, if the county was able to lease 50
beds for this program they could expect to serve about 65 people at a time (given that
the number of individuals served was about 1.3 times that of the number of rooms
available if participants can stay with their partners). At a per-night cost of $260, this
would come out to an annual cost of about $6.1 million for the hotel lease, service
providers, nursing and health care services, transportation and security, and
miscellaneous costs.
While these costs are high compared to congregate shelter, it is estimated that leaving
chronically homeless individuals outside costs taxpayers about $35,578 annually, and
putting them in permanent supportive housing can lower that by about 49.5% due to
reduced utilization of high-cost institutions (e.g. emergency departments, inpatient
hospital stays, jails, etc.).54
By this estimate, providing space for at least 65 people with high medical needs to leave
homelessness, stabilize, and find permanent housing each year, this program could help
save at least $1.1 million annually. Additionally, since this would focus on a population
with high medical needs, it may be possible to utilize health care-related funding streams
to expand the potential funding available for this program
In order to decrease costs and serve more people, the county could consider putting
individuals in these rooms with a roommate (someone outside their existing household).
This would allow the sites to serve more people at a time and may make the
environment feel more temporary, encouraging people to actively seek other housing
opportunities. However, some providers warned that roommate relationships can cause
tension for participants and take significant staff time to manage. Even when staff had
done work to carefully match people with roommates, these relationships could
deteriorate after spending too much time in such a small space together. Additionally,
Bringing the PRK Model Forward: Conclusion and Recommendations
- 53 -
this may not be successful for people who have mental or behavioral health challenges
that make living with another person difficult.
Another option would be to shorten the timeline people are able to stay at the sites. A
strict timeline for participant stays might work against this goal and reduce the
proportion of people exiting to housing, as providers identified it as being important in
improving participant stability. However, if participants were required to actively
participate in a housing search during their stay, this could help increase turnover within
the sites while helping a large proportion of people access more permanent housing.
The potential tradeoff of this strategy is that the lack of timeline for PRK participants
seemed to help them stabilize before moving to housing, so this may not work as well
for participants that need extra time to stabilize.
Recommendation 2
Address drawbacks of congregate shelter by adjusting service
design, including creating or expanding centralized teams to
provide clinical care and housing navigation.
Key Components
Nursing services focused on stabilizing participants immediate medical needs and
connecting them with long-term care.
Mental health services to help address issues related to living in a congregate
setting and prepare participants to live inside long-term.
Housing navigation to find appropriate long-term housing options that will work
based on participants’ medical and mental health needs.
Added privacy within congregate shelters and keeping communities together
when possible.
Access to transportation and food.
Since non-congregate shelter may be difficult to come by and the cost may be
prohibitive to serve large groups of people, the county should focus on bringing the
services that improved Project Roomkey participant outcomes to existing shelter
operations. While none of the providers interviewed said they prefer a congregate
shelter environment, many acknowledged the need for it and discussed how to add
components of the PRK model to congregate shelter.
Without a significant sustained investment in homeless services from the state or federal
government, congregate shelters are likely to be the predominant mode of serving the
immediate needs of people experiencing homelessness. However, providers reported
that the bare-bones nature of a lot of those settings can be detrimental for participants
and discourage them from utilizing the resource. In order to make shelter more
acceptable to people experiencing homelessness, help them stabilize, and create more
opportunities to find permanent housing, the county should create or expand existing
centralized service teams to address participant health and housing needs.
Evaluating Project Roomkey in Alameda County
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Effectiveness
Providers acknowledged the fact that many people have negative experiences with
congregate shelters either due to conflict with other participants or the belief that their
homelessness will not be resolved by moving into shelter. This is confirmed by the
provider stories of participants who were asked to leave congregate settings and the
data showing exits to housing are around 35%, with nearly half of those going to stay
with friends or family. Therefore, investing in improvements to existing congregate
shelters may be crucial to making them a more acceptable option for many people living
outside and could help increase their ability to put people on a path toward long-term
housing.
In order to make congregate shelter an environment that people want to utilize, the
county could try and create more privacy within congregate shelter, either by finding
smaller spaces or by arranging large rooms differently to help give people a sense of
having their own space. Additionally, they could designate some shelters for larger
communities of people who want to stay together, or allow people to move in with their
partners. These solutions do not fully address the drawbacks of a congregate
environment as compared to non-congregate shelter, but could help to mitigate them.
Additionally, since providers discussed the challenges congregate settings pose to
participants’ mental and physical health, increasing the level of clinical services available
could help provide people with support in addressing their own health challenges or
dealing with conflict when it arises.
Some of these health care services already exist in Alameda County congregate
shelters. The county’s Shelter Health providers support shelter staff in accessing nursing
care for residents with higher needs and behavioral health care services are provided at
some sites. However, it could be useful to do an assessment of how evenly these
services are provided across different congregate shelter sites in order to understand
where they could be added or what specific services are missing (such as chronic
disease management or connections to community-based care). This could help shift
congregate shelters to be a healthier environment for participants.
To address concerns about shelter not being effective at resolving their homelessness,
teams of housing navigators could be utilized to assist congregate shelter participants.
The housing navigation services in Project Roomkey were frequently identified as being
important in helping participants understand the options available to them and help exit
the sites successfully. While housing navigation was generally the responsibility of the
service provider operating a site, many providers said this was a piece they could have
used more help with. Since providers were focused on day-to-day needs of participants,
some discussed the need for a group whose sole focus is helping with housing search.
These teams could help increase exits to housing from congregate shelter and focus on
getting people into more stable housing destinations.
Bringing the PRK Model Forward: Conclusion and Recommendations
- 55 -
Last, it is clear from Project Roomkey that there are certain smaller pieces of the
program that may have had an outsized impact on participant outcomes. Access to
transportation and food were consistently referenced as being helpful to participant
stability. Therefore, maintaining some level of transportation available for shelter
residents to get to and from important appointments as well as providing more meals
each day could make participants more comfortable in a congregate environment.
Reach
Since congregate shelters are less expensive and not focused on one population in
particular, they have the potential to address the immediate needs of a large swath of
people experiencing homelessness or focus in on one particular group. Additionally,
since shelter spaces are large and potentially flexible, they could be used to serve
communities or families that want to stay together.
As discussed, congregate shelters may not be appropriate for people with significant
physical or mental health needs and therefore the PRK model or other forms of shelter
may be needed to better serve those individuals. Congregate shelters also may not be
appropriate for serving people with significant trauma, so a non-congregate shelter
focused on the needs of that population may be more effective.
Cost
While each of the components of this recommendation add to the cost of congregate
shelter, they are relatively small in comparison to the cost of the PRK model and may be
able to recreate many of its benefits for participants.
In total the costs of the PRK model not related to the hotel operation (nursing and
caregiver services, service agreements including housing navigation, transportation and
security) added up to about $52 per participant per night. However, the actual costs of
these services are likely lower. Since service agreements with providers included
housing navigation as one piece of their work, it is difficult to estimate exactly how much
that housing navigation cost, but likely less than the total reported here. Additionally, if
people with higher medical needs are being served at separate sites using the PRK
model, this would require fewer nurses and caregivers in congregate shelters, reducing
that cost as well. Further, while transportation was reported as being useful for
participants, congregate shelters likely do not need security in the same way, which
would reduce that estimate. Finally, if these services were centralized and able to serve
shelters across the county, this might result in an even further reduction to the per-night
cost.
Increasing the services provided at congregate shelters would no doubt increase the
costs of service provision. However, if congregate shelters are intended to effectively
serve people experiencing homelessness by helping them stabilize and resolve their
Evaluating Project Roomkey in Alameda County
- 56 -
homelessness, a financial investment along with coordination may be needed to see
improvements in those outcomes for participants.
Recommendation 3
Continue utilizing state and federal grant funding while it
remains available to purchase hotels and create long-term
housing subsidies for people experiencing homelessness.
Key Components
Take advantage of the opportunity to use new funding streams and procure
cheaper permanent housing.
Connect new rooms or subsidies to shelter stays to allow for a more seamless
transition into housing.
Ensure long-term funding is available to maintain subsidies if state or federal
funding runs out.
While the majority of service providers running Project Roomkey sites found that the
PRK model was important to helping stabilize participants and find them housing
opportunities, most acknowledged that having housing subsidies available for every
participant that wants one is critical. Without the subsidies the county created for PRK
residents, many participants may have had to wait longer for housing opportunities or
eventually leave the site back into homelessness.
Even though maintaining some PRK-style shelter beds and improving congregate
shelters are important steps in meeting people’s immediate needs, they are not long-
term strategies to resolve homelessness. Therefore, the county should continue to take
advantage of opportunities to use state and federal funds to purchase hotels or create
additional long-term housing subsidies for people experiencing homelessness.
Effectiveness
Given the recent federal court order requiring Los Angeles to provide shelter to all
unhoused residents of skid row55 and a similar proposal in San Francisco,56 an important
conversation is occurring about the appropriate amount of funding to dedicate to
shelter programs alone. While shelter is important in addressing people’s immediate
needs, many advocates and service providers alike have worked to clarify that it is not a
replacement for permanent housing.57
Purchasing hotels would allow the county to convert buildings into permanent
supportive housing, creating many more long-term housing options for people living
outside. Since building new supportive housing can be prohibitively expensive and take
years, this is an important opportunity to add to the county’s stock of housing for
people experiencing homelessness.
Bringing the PRK Model Forward: Conclusion and Recommendations
- 57 -
If hotels are not available, the county can put funds toward creating scattered-site
supportive housing, where participants are placed in apartments or homes across the
county with long-term subsidies and services are provided to them in place. This is the
method the county utilized in creating its bridge housing subsidies for PRK participants,
and resulted in 217 participants finding housing in the first five months.
Given the well-document efficacy of permanent supportive housing,58 this
recommendation is possibly the most effective at creating stability and putting people
on a path toward housing. The one caveat to using state or federal funds for this
purpose is that they are often one-time grants. Therefore, it is important for the county
to identify long-term sources of funding for any new subsidies created through one-time
funds.
Reach
While permanent supportive housing can be an effective intervention for many people
experiencing homelessness, it is going to take time and many more resources than are
currently available to serve all those who need it. The county already has a system in
place to prioritize people experiencing homelessness for permanent supportive housing
opportunities, so access to these subsidies would likely continue through that system.
This could be adjusted slightly, however, to support the success of the first
recommendation to maintain the PRK model at a smaller scale. Since the population of
people prioritized for the PRK model beds would have higher medical needs and likely
longer histories of homelessness than the population overall, they may overlap with the
group prioritized for permanent supportive housing. If new housing subsidies are tied to
the PRK model site, not only would it ensure those participants have a place to go when
they stabilize, but it would also help open up those beds more quickly for more people.
Additional research is needed to figure out how closely those two groups overlap, but
this could facilitate more movement through the shelter system in a way that makes it
more of a temporary stop, instead of someone’s only option.
Cost
The impetus for this recommendation is the potential to purchase hotels that cost less
than building permanent supportive housing as well as the availability of state and
federal funds to do so. Since these hotels and funds may not be available for long, it is
important that the county act now with the resources that are available and seize upon
any future funding.
Based on the hotels they’ve purchased so far, county staff estimate the cost to
purchase and renovate the hotel rooms comes to under $200,000 per unit. This is
significantly less expensive than building similar units in the Bay Area, which can cost
Evaluating Project Roomkey in Alameda County
- 58 -
upwards of $500,000 per unit.59 Therefore, this is an important opportunity to make
limited funds go further in creating permanent supportive housing.
Also, permanent supportive housing can be relatively inexpensive to operate. County
staff estimate the per-night cost of one unit of permanent supportive housing is around
$100. Separately, Alameda County is spending about $15,000 per household per year
for the bridge housing subsidies they created for PRK participants. This amounts to
about $41 per household per night for the housing subsidy. This cost estimate is a
fraction of the corresponding $176 lease cost for the PRK hotels.
Therefore, while building permanent supportive housing can be one of the most
expensive activities for continuums of care, maintaining it or creating long-term housing
subsidies can be a more financially sustainable investment even compared to some
shelter models. It is crucial, then, that the county take advantage of any opportunities
available now to secure these spaces at a lower cost and utilize state or federal funding
that may not be available going forward.
Recommendations Summary
In order to serve the short- and long-term needs of people experiencing homelessness,
Alameda County should maintain the PRK model at a smaller scale to serve those with
high medical needs that would not be served well in either congregate shelter or
institutional settings. Additionally, they make congregate shelters more effective at
resolving someone’s homelessness by adjusting their design to include components that
made the PRK model successful—such as creating or expanding teams of health care
and housing navigators. Last, the county should utilize the hotels and external funding
available due to COVID-19 in order to add to its supply of long-term housing
opportunities for people experiencing homelessness.
Together, these recommendations can build off the success of Project Roomkey to
improve the slate of services available to people experiencing homelessness in Alameda
County.
Appendix A: Data Definitions
- 59 -
Appendix A: Data Definitions
The following appendix reports the detailed exit destinations selected in HMIS that were
rolled up into broader categories for the sake of this report. These categories were
defined in partnership with county staff to closely match how they already report these
statistics.
Table 4: Participant Exits by Category
Housing
• Foster care home or foster care group home
• Host Home (non-crisis)
• Owned by client, with ongoing housing subsidy
• Owned by client, no ongoing housing subsidy
• Permanent housing (other than RRH) for formerly homeless persons
• Rental by client, with VASH housing subsidy
• Rental by client, with RRH or equivalent subsidy
• Rental by client, with HCV voucher (tenant or project based)
• Rental by client in a public housing unit
• Rental by client, no ongoing housing subsidy
• Rental by client, with other ongoing housing subsidy
• Residential project or halfway house with no homeless criteria
• Safe Haven
• Staying or living with friends, temporary tenure (e.g. room, apartment or house)
• Staying or living with family, temporary tenure (e.g. room, apartment or house
• Staying or living with family, permanent tenure
• Staying or living with friends, permanent tenure
• Transitional housing for homeless persons (including homeless youth)
Place Not Meant for Habitation
• Place not meant for habitation (e.g., a vehicle, an abandoned building,
bus/train/subway station/airport or anywhere outside)
Shelter
• Emergency shelter, including hotel or motel paid for with emergency shelter
voucher, or RHY-funded Host Home shelter
• Hotel or motel paid for without emergency shelter voucher
Other/Data Not Collected
• Client refused
• Data not collected
• No exit interview completed
• Client doesn't know
• Other
Deceased
• Deceased
Medical or Treatment Facility
• Hospital or other residential non-psychiatric medical facility
• Long-term care facility or nursing home
• Psychiatric hospital or other psychiatric facility
Evaluating Project Roomkey in Alameda County
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• Substance abuse treatment facility or detox center
Jail
• Jail, prison or juvenile detention facility
Figure 5: Exits to Housing by Destination
Public Subsidies
• Permanent housing (other than RRH) for formerly homeless persons
• Rental by client in a public housing unit
• Rental by client, with HCV voucher (tenant or project based)
• Rental by client, with RRH or equivalent subsidy
• Rental by client, with VASH housing subsidy
• Owned by client, with ongoing housing subsidy
No Ongoing Subsidies
• Owned by client, no ongoing housing subsidy
• Rental by client, no ongoing housing subsidy
Staying with Family or Friends
• Staying or living with family, permanent tenure
• Staying or living with family, temporary tenure (e.g. room, apartment or house)
• Staying or living with friends, permanent tenure
• Staying or living with friends, temporary tenure (e.g. room, apartment or house)
Other Destinations
• Foster care home or foster care group home
• Transitional housing for homeless persons (including homeless youth)
• Host Home (non-crisis)
• Residential project or halfway house with no homeless criteria
• Safe Haven
References
- 61 -
References
1 Office of Governor Gavin Newsom. “At Newly Converted Motel, Governor Newsom Launches Project Roomkey: A First-
in-the-Nation Initiative to Secure Hotel & Motel Rooms to Protect Homeless Individuals from COVID-19.” Press Release,
April 3, 2020. https://www.gov.ca.gov/2020/04/03/at-newly-converted-motel-governor-newsom-launches-project-
roomkey-a-first-in-the-nation-initiative-to-secure-hotel-motel-rooms-to-protect-homeless-individuals-from-covid-19/.
2 Twitter. “Office of the Governor of California on Twitter,” April 3, 2020.
https://twitter.com/CAgovernor/status/1246154220685815809.
3 Office of Governor Gavin Newsom. “At Newly Converted Motel, Governor Newsom Launches Project Roomkey: A First-
in-the-Nation Initiative to Secure Hotel & Motel Rooms to Protect Homeless Individuals from COVID-19.” Press Release,
April 3, 2020. https://www.gov.ca.gov/2020/04/03/at-newly-converted-motel-governor-newsom-launches-project-
roomkey-a-first-in-the-nation-initiative-to-secure-hotel-motel-rooms-to-protect-homeless-individuals-from-covid-19/.
4 Office of the Governor. “Letter to Project Roomkey Partners Re: Ongoing FEMA Approval,” December 18,
2020. https://www.cdss.ca.gov/Portals/9/FEMA/Gov-Ongoing-FEMA-Approval-Letter.pdf.
5 Conor Dougherty. “One Way to Get People Off the Streets: Buy Hotels.” The New York Times, April 17,
2021. https://www.nytimes.com/2021/04/17/business/california-homeless-hotels.html.
6 Kate Eby. “Coronavirus Timeline: Tracking Major Moments of COVID-19 Pandemic in San Francisco Bay Area.” ABC7 San
Francisco, March 27, 2020. https://abc7news.com/6047519/.
7 Jennifer Hernandez. “Letter to All County Welfare Directors and Federally Recognized Tribal Governments Re: Project
Roomkey Initiative,” June 1, 2020. https://www.cdss.ca.gov/Portals/9/Additional-Resources/Letters-and-
Notices/ACWDL/2020/ACWDL_Project_Roomkey_Initiative.pdf.
8 National Alliance to End Homelessness. “Homelessness Is a Problem in California.” Fact Sheet, May
2020. https://endhomelessness.org/wp-content/uploads/2020/05/CA-fact-sheet-2019-PIT-Count-Data.pdf.
9 Janey Rountree, Nathan Hess, and Austin Lyke. “Health Conditions Among Unsheltered Adults in the U.S.” Policy Brief.
California Policy Lab, October 2019. https://www.capolicylab.org/wp-content/uploads/2019/10/Health-Conditions-Among-
Unsheltered-Adults-in-the-U.S.pdf.
10 Sékéné Badiaga, Didier Raoult, and Philippe Brouqui. “Preventing and Controlling Emerging and Reemerging
Transmissible Diseases in the Homeless.” Emerging Infectious Diseases 14, no. 9 (September 2008): 1353–
59. https://doi.org/10.3201/eid1409.082042.
11 “Approaches for COVID-19 Response for Individuals Experiencing Homelessness.” State of California, March
2020. https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/COVID-19/Protocols-Homeless-
Pop.pdf.
12 Adam Brinklow. “SF Halts Homeless Shelter Admissions over COVID-19.” Curbed SF, March 30,
2020. https://sf.curbed.com/2020/3/30/21199094/sf-homeless-shelters-coronavirus-covid-19-admission.
13 Mallory Moench. “S.F. Debates Controversial Homeless Proposal to Make City Provide Shelter to All.” San Francisco
Chronicle, April 21, 2021. https://www.sfchronicle.com/local-politics/article/S-F-debates-controversial-homeless-proposal-
to-16119058.php.
14 Anita Chabria. “Coronavirus Hitting California’s Homeless Population Could Be What Finally Breaks Hospitals.” Los
Angeles Times, March 18, 2020. https://www.latimes.com/homeless-housing/story/2020-03-18/coronavirus-homelelss-
money-california-risk-150-million.
15 Jennifer Hernandez. “Letter to All County Welfare Directors and Federally Recognized Tribal Governments Re: Project
Roomkey Initiative,” June 1, 2020. https://www.cdss.ca.gov/Portals/9/Additional-Resources/Letters-and-
Notices/ACWDL/2020/ACWDL_Project_Roomkey_Initiative.pdf.
16 California Homeless Coordinating and Financing Council. “COVID-19 Frequently Asked Questions,” April 3,
2020. https://www.bcsh.ca.gov/hcfc/documents/covid19_funding_faqs.pdf.
17 “Memorandum to Extend Federal Support to Governors’ Use of the National Guard to Respond to COVID-19 and to
Increase Reimbursement and Other Assistance Provided to States.” Press Release. The White House, January 21,
2021. https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/21/extend-federal-support-to-governors-
use-of-national-guard-to-respond-to-covid-19-and-to-increase-reimbursement-and-other-assistance-provided-to-states/.
Evaluating Project Roomkey in Alameda County
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18 Nicole Hayden. “Project Roomkey Funding Ends Soon. Over 11,000 Californians Could Become Homeless, Again.” Palm
Springs Desert Sun, October 30, 2020. https://www.desertsun.com/in-depth/news/health/2020/10/30/over-11-000-
californians-could-become-homeless-again/5875241002/.
19 Robert J. Fenton. “Request for Approval of Non-Congregate Sheltering.” US Department of Homeland Security, March
27, 2020. https://www.cdss.ca.gov/Portals/9/FEMA/202005-DR-4482-CA-Non-Congregate-Sheltering-Request-
Response-Letter-03272020.pdf
20 Matt Levin. “Here’s How Putting California’s Homeless in Hotels Actually Works.” CalMatters, April 11,
2020. https://calmatters.org/housing/2020/04/california-coronavirus-homeless-hotels-motels-newsom/.
21 Doug Smith and Benjamin Oreskes. “Program to House Homeless People in Hotels Is Ending after Falling Short of Goal.”
Los Angeles Times, September 22, 2020. https://www.latimes.com/california/story/2020-09-22/homeless-people-hotels-
project-roomkey-phasing-out.
22 Matt Levin. “Can Newsom Use the Pandemic to Beat Back Homelessness?” CalMatters, December 4,
2020. https://calmatters.org/housing/2020/11/newsom-pandemic-beat-homelessness/.
23 Hannah Wiley. “California Took 35,000 Homeless People off the Street for 1 Year. Did the Program Work?” The
Sacramento Bee, April 2, 2021. https://www.sacbee.com/news/politics-government/capitol-alert/article250213025.html.
24 Jonathan D. Fuchs, Henry Clay Carter, Jennifer Evans, Dave Graham-Squire, Elizabeth Imbert, Jessica Bloome, Charles
Fann, et al. “Assessment of a Hotel-Based COVID-19 Isolation and Quarantine Strategy for Persons Experiencing
Homelessness.” JAMA Network Open 4, no. 3 (March 2, 2021):
e210490. https://doi.org/10.1001/jamanetworkopen.2021.0490.
25 Applied Survey Research. “EveryOne Counts! 2019 Homeless Count and Survey,” July 2019.
https://everyonehome.org/wp-content/uploads/2019/07/2019_HIRDReport_Alameda_FinalDraft_8.15.19.pdf.
26 Alastair Boone. “Is There a Better Way to Count the Homeless?” Bloomberg CityLab, March 4,
2019. https://www.bloomberg.com/news/articles/2019-03-04/the-problem-with-hud-s-point-in-time-homeless-count.
27 Doug Smith. “A New Database Gives a Sharper Picture of Homelessness across California.” Los Angeles Times, April 8,
2021. https://www.latimes.com/homeless-housing/story/2021-04-08/a-new-database-gives-a-picture-of-homelessness-
across-the-state.
28 Joe Colletti. “Recent Homeless Count Reports from California Continuums of Care Reveal a Significant Increase in the
Number of Homeless Persons Counted in 2019.” Homeless and Housing Strategies for California (blog). August 4,
2019. https://homelessstrategy.com/recent-homeless-count-reports-from-california-continuums-of-care-reveal-a-
significant-increase-in-the-number-of-homeless-persons-counted-in-2019/.
29 Applied Survey Research. “EveryOne Counts! 2019 Homeless Count and Survey,” July 2019.
https://everyonehome.org/wp-content/uploads/2019/07/2019_HIRDReport_Alameda_FinalDraft_8.15.19.pdf.
30 US Department of Housing and Urban Development. “HUD 2019 Continuum of Care Homeless Assistance Programs
Housing Inventory Count Report,” October 16, 2019.
https://files.hudexchange.info/reports/published/CoC_HIC_State_CA_2019.pdf.
31 Elhalaby, Rawan. “Housing Oakland’s Unhoused.” Advanced Policy Analysis. UC Berkeley, Goldman School of Public
Policy, May 2018.
https://static1.squarespace.com/static/5c09723c55b02cf724c3d340/t/5d5179b42b874d0001b4114c/1565620680179/Fina
l+Elhalaby%2C+Rawan+APA+5-11-2018+for+DISJ.pdf.
32 Robert J. Fenton. “Request for Approval of Non-Congregate Sheltering.” US Department of Homeland Security, March
27, 2020. https://www.cdss.ca.gov/Portals/9/FEMA/202005-DR-4482-CA-Non-Congregate-Sheltering-Request-Response-Letter-03272020.pdf
33 Kyle Patterson, Laura Marshall, Ryan Hunter, Peter Radu, and Peg Stevenson. “More than a Shelter: An Assessment of
the Navigation Center’s First Six Months.” San Francisco Office of the Controller, December 10,
2015. https://sfcontroller.org/sites/default/files/FileCenter/Documents/6994-
An%20Assessment%20of%20the%20Navigation%20Center%27s%20First%20Six%20Months%20-%20Final.pdf.
34 Mayor Jesse Arreguín. “East Bay’s First Navigation Center Shows Success in First Year,” September 25,
2019. https://www.jessearreguin.com/press-releases/2019/9/25/east-bays-first-navigation-center-shows-success-in-first-
year.
35 City of Fremont. “Understanding a Housing Navigation Center for Fremont.” Fact Sheet, September 5,
2019. https://www.fremont.gov/DocumentCenter/View/41463/Navigation-Center-Questions.
36 Department of Health Care Services. “California Advancing & Innovating Medi-Cal (CalAIM) Proposal.” State of
California - Health and Human Services Agency, January 2021. https://www.dhcs.ca.gov/provgovpart/Documents/CalAIM-Proposal-03-23-2021.pdf.
References
- 63 -
37 San Francisco Department of Public Health. “Medical Respite Fact Sheet.” Fact Sheet, December 18,
2017. sfdph.org/dph/files/newsMediadocs/2017PR/Medical-Respite-Fact-Sheet-12-18-17.pdf.
38 Bianca Freda. “Housing Is a Health Intervention: Transitional Respite Care Program in Spokane.” Center for Health Care
Strategies, 2017. http://www.chcs.org/media/Respite-Program-Case-Study_101217.pdf.
39 Kyle Patterson, Laura Marshall, Ryan Hunter, Peter Radu, and Peg Stevenson. “More than a Shelter: An Assessment of
the Navigation Center’s First Six Months.” San Francisco Office of the Controller, December 10,
2015. https://sfcontroller.org/sites/default/files/FileCenter/Documents/6994-
An%20Assessment%20of%20the%20Navigation%20Center%27s%20First%20Six%20Months%20-%20Final.pdf.
40 Ibid.
41 Laura Waxman. “Navigation Center for the Homeless Switches Focus from Housing to Triage.” Mission Local, January
19, 2017. https://missionlocal.org/2017/01/navigation-center-for-the-homeless-switches-focus-from-housing-to-triage/
42 Kate Eby. “San Francisco's homeless navigation centers: 7 questions answered.” ABC7 San Francisco, January 15,
2020. https://abc7news.com/sf-navigation-center-homeless-shelter-vs-nav-centers/5853129/
43 Mayor Jesse Arreguín. “East Bay’s First Navigation Center Shows Success in First Year,” September 25,
2019. https://www.jessearreguin.com/press-releases/2019/9/25/east-bays-first-navigation-center-shows-success-in-first-
year.
44 City of Fremont. “Understanding a Housing Navigation Center for Fremont.” Fact Sheet, September 5,
2019. https://www.fremont.gov/DocumentCenter/View/41463/Navigation-Center-Questions.
45 Bianca Freda. “Housing Is a Health Intervention: Transitional Respite Care Program in Spokane.” Center for Health Care
Strategies, 2017. http://www.chcs.org/media/Respite-Program-Case-Study_101217.pdf.
46 San Francisco Department of Public Health. “Medical Respite Fact Sheet.” Fact Sheet, December 18,
2017. sfdph.org/dph/files/newsMediadocs/2017PR/Medical-Respite-Fact-Sheet-12-18-17.pdf.
47 Greg B. Smith. “Sleeping Behind the Bronx Zoo: Why Some New Yorkers Choose Streets Over Shelters.” THE CITY,
April 5, 2021. https://www.thecity.nyc/2021/4/5/22366758/new-yorkers-choose-streets-over-homeless-shelters
48 Robert Davis. “Why People Experiencing Homelessness Avoid Shelters.” Invisible People, May 20, 2021.
https://invisiblepeople.tv/why-people-experiencing-homelessness-avoid-shelters/
49 “The View From the Outside: A Survey of 300 People Experiencing Homelessness in San Francisco.” Tipping Point
Community, March 2019. https://tippingpoint.org/wp-content/uploads/2019/03/The-View-from-Outside.pdf
50 Steven Brown, Samantha Batko, Josh Leopold, and Aaron Shroyer. “Final Report and Recommendations on
Homelessness in Alameda County, California.” Urban Institute, January 2018.
https://www.urban.org/sites/default/files/publication/96506/final_report_and_recommendations_on_homelessness_in_al
ameda_county_california_0.pdf
51 “Memorandum to Extend Federal Support to Governors’ Use of the National Guard to Respond to COVID-19 and to
Increase Reimbursement and Other Assistance Provided to States.” Press Release. The White House, January 21,
2021. https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/21/extend-federal-support-to-governors-
use-of-national-guard-to-respond-to-covid-19-and-to-increase-reimbursement-and-other-assistance-provided-to-states/.
52 Conor Dougherty. “One Way to Get People Off the Streets: Buy Hotels.” The New York Times, April 17,
2021. https://www.nytimes.com/2021/04/17/business/california-homeless-hotels.html.
53 Ibid.
54 National Alliance to End Homelessness. “Ending Chronic Homelessness Saves Taxpayers Money.” Fact Sheet, 2015.
http://endhomelessness.org/wp-content/uploads/2017/06/Cost-Savings-from-PSH.pdf.
55 Benjamin Oreskes, Emily Alpert Reyes, and Doug Smith. “Judge Orders L.A. to Provide Shelter for Skid Row
Residents.” Los Angeles Times, April 20, 2021. https://www.latimes.com/homeless-housing/story/2021-04-20/judge-
carter-la-city-county-shelter-skid-row-homeless-fall.
56 Mallory Moench. “S.F. Debates Controversial Homeless Proposal to Make City Provide Shelter to All.” San Francisco
Chronicle, April 21, 2021. https://www.sfchronicle.com/local-politics/article/S-F-debates-controversial-homeless-proposal-
to-16119058.php.
57 Ibid.
58 Sarah Hunter, Melody Harvey, Brian Briscombe, and Matthew Cefalu. “Evaluation of Housing for Health Permanent
Supportive Housing Program.” RAND Corporation, 2017. https://doi.org/10.7249/RR1694
Evaluating Project Roomkey in Alameda County
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59 Joshua Sabatini. “Plans in Works to Build 1,700 Supportive Housing Units for Formerly Homeless.” The San Francisco
Examiner, December 2, 2019, sec. News. https://www.sfexaminer.com/news/plans-in-works-to-build-1700-supportive-
housing-units-for-formerly-homeless/.