As the leaves on the trees turned from green to gold last fall, Howard and Ann — not their real names — sat outside their room at the Premier Circle emergency shelter in Charlottesville whenever they could. The senior couple loved sitting together on their “perch,” as they called it.
Their time together at Premier Circle wasn’t long. Soon, Ann went to a rehabilitation center for her severe asthma. She was there last month, while Howard attended a cookout put on by a local church. He missed Ann, said he as he pushed a half-eaten chocolate chip cookie around his plate and adjusted his legs in his wheelchair. But he felt that she’d get better.
A couple weeks later, Howard sat on the wheelchair ramp staff had installed outside his door alone. Ann didn’t make it back, he said quietly. He had tears in his eyes.
He’s survived a stroke and cancer and yet he’d outlived his wife.
Ann is not the only Premier Circle guest to die since the emergency shelter opened in May 2021. The People And Congregations Engaged in Ministry (PACEM, pronounced “PAH-chum”) launched the shelter on the site of the former Red Carpet Inn on Route 29 using pandemic relief funds to serve people who are homeless and are also likely to get very sick from COVID-19.
PACEM staff members say that while they knew they would serve a slightly older and sicker group of people than they usually do in their seasonal congregate shelter, they weren’t prepared for how old, or how sick, their Premier Circle shelter guests would be.
“Speaking for myself, it was really kind of startling,” said PACEM Executive Director Jayson Whitehead. “The age of everybody here and the severity of the health issues at times.”
(Howard asked that Charlottesville Tomorrow not publish his and Ann’s story with their real names. Other guests did not give their last names because of the taboo of homelessness, or because they don’t want to be found by people from their past.)
Many of the guests should be in medical or mental health care facilities, not an emergency homeless shelter, staff say. But their guests have nowhere else to go.
That fact is becoming increasingly alarming to the shelter staff. Premier Circle was only meant to operate temporarily, during the COVID-19 pandemic. Operations will start winding down in spring 2023.
Unless PACEM and its partner organizations can move the operation elsewhere, the nearly 100 people served by this shelter — people experiencing homelessness who are elderly, in poor health, or both — might once again have nowhere to go.
Emergency housing — with few rules but still not enough beds
Premier Circle does not require guests to pass drug tests or background checks or present identification. It’s different from other shelters in that way, and often houses single men with no other options.
It owes its existence, in large part, to the COVID-19 pandemic.
PACEM has offered overnight shelter in gymnasiums, church basements, and other community spaces during the colder months since 2004. That model, though, became unsafe in early spring 2020, when the pandemic hit and experts encouraged people to avoid gathering indoors.
Initially, PACEM used COVID-19 emergency funds to shelter medically-vulnerable clients in individual rooms at the La Quinta Inn. Then, in December 2020, the local nonprofit Piedmont Housing Alliance purchased the motel at 405 Premier Circle and quickly planned a multiphase housing project there.
PACEM signed on to run the first phase: an on-site emergency shelter for the medically-vulnerable, similar to its La Quinta operation. PACEM grew its staff of five case managers into a team of 20 case managers and shelter monitors.
All told, PACEM had about six weeks to design the emergency shelter’s case management approach and get ready to launch.
The shelter opened in May 2021 with about 60 beds and a waitlist a few dozen long.
“As soon as we opened it, we were immediately full,” Whitehead said.
Premier Circle filled so quickly because the need for a service like it is huge, said Teresa Radford, a registered nurse and clinical program coordinator for UVA Population Health’s Medicine HOME program. She sees many people who are homeless and sick among her patients. Despite their medical needs, some of her patients have nowhere to go.
The Medicine HOME program provides care to people with chronic, serious, and often complex medical and mental health conditions. HOME patients frequently end up in emergency rooms, or are admitted to the hospital. Radford works closely with a small team to help their patients manage symptoms and medications, to hopefully prevent medical emergencies that require hospital visits.
Right now, nearly one-third of Medicine HOME’s 35 patients struggle with unstable housing, Radford said, something that can significantly affect their mental and physical health conditions.
Some are too physically ill for mental health facilities; others are too mentally ill for healthcare facilities.
Some are denied entry to nursing homes, assisted living facilities, or hospice centers for a host of reasons: lack of insurance; inadequate insurance; age — a nursing home once refused one of Radford’s patients for being too young.
Some may have tried another shelter but did not meet the intake criteria because they have a criminal background. Some disqualify themselves because they use drugs or drink alcohol, which many shelters in town don’t allow. (Premier Circle does not turn people away for substance use.)
Even those who do meet intake criteria for a program or facility do not always get in. Radford’s patients hear it over and over again: There aren’t enough beds.
“It’s just so very hard,” said Radford, who has worked with the HOME program for three years and as a nurse with UVA since 1981. “And it is a real issue. It’s not just a rare thing. I think we have quite a few people struggling with these things in our area.”
Some of Radford’s patients are currently staying at Premier Circle. It’s a great place for them, she said, but it’s not a perfect solution.
Living in a shelter while seriously ill
The PACEM shelter at Premier Circle is for people who are medically-vulnerable, but it is not a medical facility.
“We are not able to medically supervise or medically care for someone, and that includes things like toileting, bathing, ambulating — things like that,” said Liz Nyberg, a PACEM case manager and director of operations at the shelter. “Our staff are not nurses, caregivers. That’s not what we do.”
But some of the guests need medical care.
According to the PACEM website, 75% of the people sheltered at Premier Circle are over the age of 50 and 32% are 62 or older. All the guests, regardless of age, have chronic, serious or terminal illnesses, staff say.
On a few occasions, case managers and shelter monitors have found guests dead in their rooms, either from a medical event or an overdose.
Paul, a guest at Premier Circle, wears a white plastic emergency button on a cord around his neck. A track star in his youth, he suffered a stroke and now uses a wheelchair to get around — including to Food Lion, much to the chagrin of PACEM staff who wish he’d ask for help getting a ride instead. But they respect his independence.
One night, Paul woke to someone banging frantically on his door. It was a PACEM staff member asking if he needed an ambulance. It was a false alarm, Paul said, laughing — he rolled over onto the necklace in his sleep. He felt better knowing a shelter staff member would rush to him if he did need the help.
Phil, who has his name tattooed on his knuckles, was one of the first people to arrive at Premier Circle last year. He came straight from the hospital where he’d undergone chemotherapy for advanced colon cancer. The treatments made him so weak he could barely walk, so staff and other guests brought meals to his room.
Now that he’s in remission, he’s getting stronger and more mobile by the day. Phil feels it’s his turn to help. He brings meals to folks who cannot leave their rooms.
The shelter rarely has an open spot. And when one opens up, shelter staff have to make gut-wrenching decisions about the waitlist. Someone with stage-four cancer? Someone with kidney disease who needs dialysis treatments? Or someone who is on the liver transplant waitlist?
“It’s really, really tough,” said Nyberg. “How do you make that difficult decision? There’s no easy way to do it.”
Even more gut-wrenching, she said, is that soon, there will be no spots.
“We’ve always known that this is going to come to an end,” Nyberg said.
The future of Premier Circle
Guests have known the shelter will close, too, but that hasn’t kept them from turning Premier Circle into their home.
They jokingly refer to the site as “the compound.” They hang out together outside of their rooms and sometimes play cornhole in the parking lot. Their families and friends come to visit. One guest regularly sets up a chair outside and gives free (and quality) haircuts to other guests so they can look and feel good, he said. Some guests decorate their rooms for the holidays, or with their favorite sports teams’ colors and logos. Occasionally, someone will pull a TV set outside and everyone will gather around it to watch a big game.
Nyberg planted little succulent gardens in some of the old tree stumps on the site, and some of the guests tease her about them before admitting that they are actually pretty cute. She also helped fill in the old hotel pool and turn it into a kidney-shaped garden full of plants, flowers and a few vegetables.
“This is better than shelter,” said Phil’s neighbor, Sunshades. “It’s community. We have each other’s backs.” And, he clarified, he counts both staff and guests among that “we.”
“We still call it ‘emergency shelter,’ but it’s such a different version of it than we were used to providing,” said PACEM director Whitehead, who regularly hears both compliments and complaints from guests when he’s on site. “I know it’s going to be great, whatever’s built here, but I would equally champion this — a version of this — continuing.”
The next phase of the Premier Circle project is the construction of permanent apartment-style housing for people with low incomes, and on-site caseworkers to help with counseling and community-building, operated by Virginia Supportive Housing. After that, Piedmont Housing Alliance will construct a variety of income-restricted apartments affordable to households at the lowest income levels as defined by the U.S. Office of Housing and Urban Development.
Both phases will require demolition of buildings currently used for the emergency shelter.
All together, the two organizations hope to build around 140 total units. There are also plans to construct a building that could be rented, or sold, for commercial use.
It’s possible that current Premier Circle guests could qualify for the new units, but those apartments won’t open for another three years, at the earliest.
Parts of the Premier Circle site could remain open during the construction, said Sunshine Mathon, executive director of Piedmont Housing Alliance, but the plans aren’t final yet.
And there could be a longer life for the shelter — if PACEM or its partners can get the money for it. Mathon said the Housing Alliance and the Thomas Jefferson Area Coalition for the Homeless, recently began exploring options. They do not have a solid plan.
Re-inventing the housing-first wheel
It won’t come as a shock to the shelter staff if the groups can’t keep it going. Housing-first and low-barrier programs like this come and go frequently in the Charlottesville area.
From 2007 to 2012, PACEM and the Region Ten Community Services Board ran a program called Step Up that gave housing and support to people who were chronically homeless and disabled.
Rob Hull, a social worker with the City of Charlottesville, worked at Region Ten at the time and was part of the team that wrote the funding request for $238,000 in city housing funds to serve, initially, between 10 and 15 people.
“I literally went out into the woods and put people in the back of a truck,” said Hull. It’s similar to how Nyberg describes people coming to Premier Circle from porches, sheds and other structures not meant for human habitation.
Step Up was one of the first programs of its kind, said Hull, and in 2010, members of the Substance Abuse and Mental Health Services Administration (SAMHSA), a branch of the U.S. Office of Health and Human Services, visited Charlottesville to see it in action.
Hull said that being program manager of Step Up at Region Ten was “the proudest job I ever had.”
The program ran out of funding and shut down in August 2012.
As these programs gain and lose funding, open and close, local organizations and healthcare workers are left to “reinvent the wheel” over and over, said Hull. “You just keep scrambling to create housing-first programs. And you have to have people who are trained to do it.”
‘If it weren’t for Premier Circle, I’d be homeless’
Radford, the Medicine HOME nurse, dreams of the shelter continuing with the funding to add on-site medical staff.
“It would be huge in that people could get their needs met at their Premier Circle home,” she said. “I think you would see less need to go to the emergency room. Hopefully, you would be able to prevent hospitalizations, and then just improve the quality of people’s lives and help them manage their symptoms better. That’s the dream.”
If that doesn’t happen, many of the guests who are now staying at Premier Circle could return to the street, to sheds, to porches. Their health will decline, and that would increase the burden on the already-strained local healthcare system — even finding a primary care physician in this area can take up to six months, said Radford.
“I don’t want to live anywhere else,” said Courtney, another guest. He served in the military and lived all over the world before returning to Charlottesville, his hometown. “It’s beautiful here,” he said, sweeping his hand around to the mountains and the sky. “It’s beautiful. And there are good people. When you say you have a friend here, you have a friend.”
Courtney arrived at Premier Circle about six months ago, and he’s already declared himself “the star of this place.”
“They don’t let you go without anything here,” Courtney said. “When you need something, let them know, and they’ll take care of it.” His best friend at the shelter always has a spare cigarette or an extra drink to share with him.
“I’m not trying to go anywhere,” Courtney repeated, laughing as he touched the delicate silver butterfly dangling from his left earlobe. “They better not put me out too soon!”
Sunshades nodded behind his dark glasses as Courtney spoke. He turned the beer can in the cup holder of his camp chair before lifting his hands, palms up, in the air to declare, “If it weren’t for Premier Circle, I’d be homeless.”