SACRAMENTO, Calif. — A planned hospice for the unhoused community has been in the works for years now.
ABC10 first reported on the story of Joshua’s House back in 2017 - and its founder’s personal mission to give terminally ill people living on the street a safe and dignified place to die.
Our reporting has found nobody opposed to the idea in general, but some vocal opponents - including the Twin Rivers Unified School District - have objected to the hospice location, across from Garden Valley Elementary School. They also criticize what they say is a years-long lack of communication.
Last week, Sacramento County supervisors approved a grant of $1.1 million to complete construction of Joshua’s House, which is now set to open in the spring and serve up to 15 people at a time, with plans to expand to as many as 24 in the future.
“I would just like to say – if I can say this without crying – this has been my mission and vision since I retired,” said Joshua’s House founder Marlene Fitzwater, speaking at the Oct. 22 meeting of the Sacramento County Board of Supervisors.
“I lost a grandson, who died on the streets in Omaha, Nebraska,” she shared at the meeting. “He and I talked about the needs of the homeless before he died, and it became clear to me that – which I didn’t know before – that there were homeless people who were terminally ill, who were dying on the street.”
The death of her grandson – Joshua – started Fitzwater’s mission to build an end-of-life hospice care facility specifically for people experiencing homelessness.
"This is a very good thing that we do today and something we should all be proud of,” said Supervisor Rich Desmond.
County supervisors voted unanimously to grant $1,137,788 for the completion of Joshua’s House. This is in addition to a $400,000 grant from Anthem Blue Cross.
“We did originally get a grant of $450,000 from the city of Sacramento to support the project [$450,500 in Nov. 2022] and $200,000 from the county of Sacramento [in May 2023] to help us get started,” Fitzwater told ABC10. “We were - with all that money - able to purchase the six ADA-compliant manufactured homes, and because of all the delays, we've had to pay storage and insurance on them, which is another $5,000 a month. And so the delays have caused expenses we weren't planning.”
The site has been under construction for about a year and - as of November first – is still a dirt lot with no structures on it. Eventually, she said, five of those structures will house three patients each, and the sixth structure will be offices for staff and a common area.
ABC10 asked Fitzwater about the timeline.
“It takes an extraordinarily long time to get all the permits. We will have spent almost $100,000 on permits and inspections,” Fitzwater said. “It's a very lengthy process to even start work. And then because there were issues getting the soil in the necessary grade that it needs to be, things like that, so it just took longer than we anticipated.”
The site is directly across the street from Garden Valley Elementary School, in Sacramento’s South Natomas neighborhood.
“We don't know what their efforts are to ensure the safety of our youngest learners,” said Rebecca Sandoval, trustee on the Twin Rivers Unified School Board.
For three years now, she has regularly voiced concerns at Sacramento City Council meetings about the hospice’s location and what she considers a lack of answers about safety concerns.
“We are concerned about the amount of drugs that will be left there, because they are at the end of their life: fentanyl, morphine, ketamine,” Sandoval said. “Are they going to be vetting for sexual offenders right across from our school? How are the bodies going to be transported? Are you going to have safety measures in place and security so that does not fall on Twin Rivers Police Department to patrol that area? What kind of a fence are they going to have?”
A finalized version of a ‘good neighbor policy’ Fitzwater sent ABC10 Friday says the site will be monitored 24/7 with surveillance video and security. It will be enclosed with an 8-foot wrought-iron fence.
“It's going to be fenced, gated, private. You can't come in without the code,” Fitzwater said.
She says professional hospice staff will secure and administer the drugs.
ABC10 spoke with Craig Dresang, CEO of YoloCares. That’s the Joint Commission, Medicare-certified hospice organization that will run and own Joshua’s House once construction is complete.
“There are well-established protocols for handling medication, and there’s no reason for neighbors in the surrounding community to have concerns about that,” Dresang said.
He said YoloCares will not be screening patients for sex offenders.
“It would be like the hospital system—do they do background checks on their patients?” Dresang said. “They have a moral, ethical obligation to provide care to every person.”
In the organization’s experience serving terminally ill unhoused patients, Dresang said, the average hospice stay for someone in that situation is 7 to 12 days.
“If not for us, I’m not sure what would happen to a lot of these folks,” Dresang said, adding this his staff often connects with referred unhoused people along the riverbank or under a bridge, after they have been discharged from the hospital with a terminal diagnosis.
Joshua’s House patients will come referred by local hospital systems, Fitzwater said.
Still, Twin Rivers Unified School District leaders remain concerned, said TRUSD Chief Business Official Ryan DiGiulio.
“We have sent letters and different correspondence through our superintendent, former chief business officials, regarding mitigation efforts,” DiGiulio said. “We've made recommendations, but to our knowledge none have been accepted or acted upon.”
Fitzwater said Joshua’s House has had community input meetings over the years and she believes they have appropriately communicated their plans.
“We worked really hard to address the issues and make sure that the people would be supportive of it,” she said.
City and county leaders – plus neighbors she has heard from – support the project, Fitzwater said.
Others – like Sandoval and TRUSD leaders – remain concerned about the project.
At Joshua’s House, there will be professional staff on site 24/7, Dresang said, but there YoloCares also relies on volunteers.
He encourages anyone interested – including critics – to take the free hospice training YoloCares offers. People will then be able to volunteer at Joshua’s House once that opens.
He said he has overseen the construction and operation of five other residential hospices in his career—and in each case, the project faced opposition, and in each case - once they opened - they proved to be good neighbors.
ABC10 reported in 2023 that Twin Rivers USD tried offering alternative sites for the hospice. By that point, Fitzwater said, The Health Communication Research Institute – the non-profit she founded and which oversees the creation of Joshua’s House – had already invested in the site across from Garden Valley Elementary School and it was too late for her to change locations.
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