A man at the King’s Inn asked the staff to check on his mom who was staying in another room back in August 2021. Just a few months prior, Chief Seattle Club had turned the 66-unit hotel in downtown Seattle into a homeless shelter.
An employee knocked on her door, but no one answered. It was late at night so they waited until the next morning, when they found Lila Stuker, 50, dead from a drug overdose.
A week later, staff knocked on another door during their morning rounds, and again heard no response. This time, they didn’t wait. Inside, they found another woman had overdosed and died.
During the pandemic, Seattle, King County and communities around the nation shifted many of their homeless shelters from large spaces with dozens of people crowded together to individual hotel rooms.
Originally used to prevent the spread of COVID-19, hotels were found to have many advantages over mass shelters, including people being more willing to move into them off the street. The change appears here to stay, as converted hotels and non-congregate shelters are increasingly seen as a best practice in responding to homelessness.
But some providers, including Chief Seattle Club, are raising concerns that a major risk is hidden behind the privacy of a locked door — undetected fatal overdoses.
During the same years that shelters have added doors, drug use has become more dangerous. Overdoses in King County are on track to kill three times as many people as they did four years ago, largely due to the rise of the powerful opioid fentanyl. Homeless people are dying disproportionately. Most overdoses are nonfatal and can be reversed with medication, but if someone uses alone, whether that’s in an alleyway or a converted hotel, their chance of dying increases.
Some providers in other cities have developed new ways to mitigate the risk of overdose deaths in situations where homeless people live alone. But these solutions have been slow to be adopted locally.
Providers raise concerns
Chief Seattle Club Executive Director Derrick Belgarde believes the structure of a hotel-based shelter contributed to the deaths of the women at King’s Inn.
“If somebody is convulsing or puking in a congregate setting, it’s noticeable,” he said. “It’s going to be flagged.”
Compass Housing Alliance began operating a similar hotel shelter in Auburn last year. Executive Director Mary Steele agrees hotels make it more challenging to monitor clients.
“In a congregate shelter you can have eyes on everyone,” Steele said. “In a hotel shelter with the doors closed, you may not know.”
The concern is national. As other cities moved homeless shelters to hotels during the pandemic, the National Health Care for the Homeless Council heard from service providers and clinicians about an increased rate of fatal overdoses.
“I don’t want to paint this as negating the benefits of non-congregate, but all I can say is this was something that people regularly struggled with throughout COVID in multiple cities,” said Barbara DiPietro, senior director of policy for the council.
Whereas some cities ramped down hotel shelter programs after the height of the pandemic, Seattle and King County have ramped up, largely due to their studied benefits.
The original goal of hotel shelters — to protect homeless people and the broader community from COVID-19 — largely succeeded. In addition, people in hotel rooms didn’t have to worry about their belongings being stolen. And they got into fewer fights. One study from the University of Washington found 911 calls dropped 75 percent when people moved from congregate shelters to hotels.
“You can get a lot of people off the streets if you offer them a hotel room who would never enter a congregate shelter,” said Belgarde with Chief Seattle Club.
Providers also say this keeps people inside and on the path out of homelessness rather than churning in and out of shelter.
King County has purchased eight hotels and several apartment buildings for homeless people through its Health Through Housing program. The Regional Homelessness Authority funds a half-dozen hotel shelter programs outside of that.
Benefits vs. risks
King County has opened six hotel shelters thus far through its Health Through Housing initiative and housed 803 people. Nine have died from an overdose. All of them occurred in two hotels operated by the nonprofit Downtown Emergency Services Center.
“It is of great concern to us,” said Executive Director Daniel Malone. “But it’s not possible to know that if they were in a different kind of setting outdoors, congregate shelter, jail, that they would have lower risk.”
The nonprofit serves homeless people with severe health issues, physical disabilities and substance use disorder — the subset of unsheltered people most at risk of overdosing.
In the past year, Malone’s organization has “flooded” its shelters with naloxone, an opioid overdose reversal medication, and beefed up training for staff and clients on how to better prevent, detect and respond to overdoses.
A resident at one of these hotels, Kimberly Liptau, 60, recently experienced both the risks and lifesaving benefits of staying there.
Two months ago, she overdosed in her room after taking a hit of crack cocaine that she didn’t know was laced with fentanyl. Lying on her bed, she stopped breathing. She said she would have died if her boyfriend, who was staying in another unit at the hotel, didn’t happen to stop by. He contacted paramedics and medical staff that work on site who injected Liptau with naloxone and administered CPR until she recovered.
Since her overdose, Liptau has been given a roommate, a strategy some providers are using to prevent clients who are at especially high risk of overdosing from using alone. Doctors on site also started her on an opioid blocker treatment that reduces the chance of an overdose in case she encounters fentanyl again.
Few shelters based in hotels or otherwise outside of the county’s Health Through Housing program have medical staff on site and most shelter staff do not have medical training, according to the Regional Homelessness Authority.
Some providers say that needs to change.
“If we want to reduce overdose deaths, and we want to help people engage in treatment, we need to embed health care into the shelters intentionally, which will also help folks get housing,” said Dan Wise, director of homelessness services at Catholic Community Services, one of the largest local shelter operators.
It’s not clear how many people have died in other hotel shelter programs in King County or how that compares to fatal overdoses in mass shelters. However, data from the county medical examiner’s office shows the majority of deaths of homeless people are occurring outside. Less than 10 percent of fatal overdoses among homeless people take place in either shelters or hotels.
“The benefits of housing always outweigh the risks and harms that are done by being unhoused,” said Kate Gleason-Bachman, a nurse manager for the National Health Care for the Homeless Council.
Turning to technology
Many service providers around the country have developed tactics and technologies to protect homeless people at risk of overdosing alone in single-occupancy units.
Pathways to Housing, a homelessness nonprofit in Philadelphia, has installed technology into rooms where tenants press a button before they start using, and staff are alerted if they don’t press it again in 10 minutes. Pathways also installed reverse motion detectors in bathrooms. If a resident enters and stops moving (such as from an overdose), staff are alerted.
Chief Operating Officer Bill Maroon said the organization has experimented with these technologies “partially because we can’t find staff.”
Room modifications like these are not widespread in Washington state.
Catholic Community Services has recently installed reverse motion detectors in bathrooms at congregate shelters, but not in the hotel shelters it operates. King County has said it is looking at these options, but staff have focused on increasing the number of units available and adding kitchens to hotel rooms that would allow them to become permanent housing units.
“No. 1 is we’re trying to get more units of housing available,” said Simon Foster, King County division director for housing, homelessness and community development.
Experts say hotel shelters can implement policies that protect people from fatal overdoses without installing new technologies. For example, studies show “low-barrier” policies that allow substance use result in fewer fatal overdoses.
“Prohibitive policies on substance use are going to lead to more rushed use, concealed use, use alone, the sorts of things that’s going to increase overdose risk,” said Nick Kerman, a researcher at the Centre for Addiction and Mental Health in Toronto.
Experts also say shelter policies that prohibit guests in hotel rooms can lead to residents using alone.
“Some of those policies — which are also meant, I think, to ensure safety — can actually be detrimental,” said Gleason-Bachman at the National Health Care for the Homeless Council.
Local providers like Compass Housing Alliance, which prohibits substance use in its Auburn hotel shelter, say they have to weigh those concerns against other factors.
“Not everybody is a user on these sites. In fact, in some sites, fewer than half and we want to keep those people safe as well, right?” Steele said. “So it’s a balancing act.”
Chief Seattle Club’s King’s Inn prohibited guests, which Belgarde agrees could contribute to people using alone, but he says, on the other hand, guests can bring more illicit activity.
Belgarde said there’s no tool in the homelessness system that works for every situation, and while he agrees with the region’s turn to hotels and non-congregate shelter, he says it’ll need to keep iterating on ways to reduce the risk of fatal overdoses.