Shelters can be tough, exhausting environments for anyone experiencing homelessness, let alone individuals who are elderly or disabled. Prolonged stress can advance the aging processes by 10-20 years, so mental and physical frailties commonly associated with advanced years, like mobility challenges, failing hygiene, chronic illness, and cognitive losses can appear in younger people experiencing homelessness. They need immediate assessment and care to stabilize medically and build the mental, emotional, and physical capacities necessary to live independently. In some cases, they will continue to need support once safely housed.

At CCS Nativity House Shelter, all guests get beds, lockers, and three hot meals daily. Medical and mental health referrals are available. Shelter case managers work wonders connecting guests to services and housing. However, shelter staff are not equipped to assess a guest’s cognitive abilities and capacities to engage in the essential activities of daily living. They can’t perform nurse-directed care tasks, drive residents to medical appointments, or help with laundry and shopping.

In 2019, CCS used its unique constellation of programs to answer this critical need. Agency leadership asked Tamara Kirkland, Long Term Care (LTC) Homecare Supervisor at CCS Tacoma Family Center, to create a pilot program for Nativity House Shelter next door. A LTC caregiver since 2016, she had followed a few LTC clients from homes into the shelter setting and was willing and uniquely qualified to bridge two distinct service cultures to better serve these special guests.

Edward, Taylor and Tamara at Nativity House Shelter, where the Long Term Care pilot pogram began. It can now be found at four additional sites in Spokane, Seattle and Vancouver.

One guest helped by the shelter Pilot program is Taylor, a thoughtful 39-year-old woman who fell into severe depression following her mother’s death and the loss of her home. Life on Tacoma’s streets accelerated her physical and emotional spiral. A serious fall landed her in the hospital,  where she learned she was at dire risk of losing her legs due to poor circulation and blood clots.

After weeks of intensive care, Taylor was discharged to Nativity House, where she was assigned her own LTC  provider. Taylor has made significant progress over the last few months. At times, the transition has been challenging. “I’ve learned breathing techniques to make it easier to get up and move. But sometimes when they lay out my goals, I say, ‘We’re gonna do what?’” Taylor laughs. “Here, you’ve got to be self-sufficient. I can’t do it all myself right now; sometimes, it’s embarrassing. But there is trust here. There is always someone to back you up when you need it.”

Tamara points out that not every LTC worker is cut out for this work. “You have to have a heart for people, the compassion and understanding of what people have been through. All this could have happened to any of us.” Edward Kinyanjui, a member of the Nativity LTC caregiver team, says, “There are challenges, certainly, working here. Building rapport with a client who has suffered while homeless can take time. But there are many rewards. The culture here is transparent. When you see someone move from shelter to housing by themselves, when they return to visit and say thank you, you see the fruits of what you are doing.”

The Nativity House Long Term Care program has been so successful in helping the most vulnerable people entering our shelter system that the WA legislature has expanded the pilot program to four additional sites in Spokane, Vancouver, and Seattle. Tamara hopes the legislature will confer permanent status on the program in the 2024-25 session. Edward agrees, saying, “This program works. That’s what I want people to know.”

For a quantitative look at the history and effectiveness of this unique program, see Report to the Legislature: Personal Care in the Homeless Shelter Pilot, a December 2022 report to the WA State Legislature. For an in-depth look at the growing trend in senior homelessness, read More Seniors are Becoming Homeless, and Experts Say the Trend is Likely to Worsen. For more information on all CCS services for seniors and people with disabilities, visit

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