Pūlama Ola Kauhale

Pūlama Ola Kauhale – Medical Respite

Project Highlights and FAQ

Project Vision is the contracted operator of Pūlama Ola Kauhale.

Project Highlights:

  • Pūlama Ola Kauhale will provide respite for people discharged from urban Honolulu into homelessness who need additional time and space to recuperate and fully recover.
  • Units will provide space for 10 people at a time, with health and social services, community-building activities, a bathroom, and shower trailer (also accessible to the public), and an office space for 24-7 staffing and security.
  • Pūlama Ola Kauhale is intended to serve people discharged either from Emergency Departments or inpatient hospital stays, who do not need skilled nursing but need a safe, stable place to continue to recover.
  • The target level of care includes checking vitals, assistance with medication, and help getting in and out of bed, if needed.
  • The site will be wheelchair accessible, but eligible individuals need to perform Activities of Daily Living (e.g., showering and using the bathroom) with minimal assistance. Pūlama Ola Kauhale will not provide higher levels of care such as IV medications, oxygen tanks, or skilled nursing.
  • Based on the number of people discharged from Oʻahu hospitals into homelessness, we expect Pūlama Ola Kauhale to fill up quickly. A full Pūlama Ola Kauhale illustrates the need for more space and will provide lessons on effectively providing that space going forward.
  • Pūlama Ola Kauhale will be temporary. It will be constructed quickly, can be relocated, and is intended to operate only until additional medical respite space can be added within hospitals and/or in community-based facilities.
  • While launching Pūlama Ola Kauhale, the State is also working with hospitals and other community partners to open additional medical respite bed space in the community. As these spaces come online, the need for this Kauhale will decline, and units will be relocated to other areas, such as to a long-term Kauhale site.  The estimated duration of this temporary Kauhale is 6 months from opening.
  • HomeAid Hawaii (HAH) is the State’s lead development partner, working on-site planning, construction, and infrastructure for Pūlama Ola Kauhale.
  • Project Vision Hawaii (PVH) is the State’s operating partner for Pūlama Ola Kauhale. PVH will provide a hygiene trailer (toilets and showers), meals, case management, part-time street medicine Registered Nurses, 24-7 intake/management staff, as well as 24-7 security.
  • This is a demonstration project designed to help us pilot and learn, while also helping care for people and address an urgent and obvious need.
  • It is also an opportunity for the Capitol District to practice the “Yes in My Back Yard” ethic that is needed if we are to find permanent solutions to end homelessness.

Frequently Asked Questions & Answers

Project Timeframe

  • What is the timeframe for the project (start/end date)?
    • Construction of the units began at an off-site location in late April. HomeAid Hawaii began delivering the first units the week of May 8, and all site contracting work is anticipated be completed by May 19. We expect operations will begin by the end of May. We anticipate that this Kauhale will be needed for 6 months, while medical respite beds in the community can be opened.  The State is working with hospitals and other community partners to get those community beds open and staffed and estimates it will take 6 months from the opening of the Medical Respite Kauhale to do so.  These Kauhale units are designed to be easily relocated once the project is complete.
  • Are there plans for expanded Medical Respite Kauhale in other locations?
    • If there is a need elsewhere in the community, we may consider relocating these units to another site in need of Medical Respite. However, at this time we expect the units will most likely be relocated to a permanent Kauhale site approximately 6 months from opening.
  • Is there an evaluation plan to assess whether it’s helping the population/area?
    • We’ve all witnessed people suffering when they are discharged from hospitals into homelessness while still medically frail.  This project will address that urgent need.  Medical respite and hospital diversion for medically frail homeless is considered a best practice in homeless services and has been evaluated extensively. With in-patient bed rates for nonprofit hospitals costing an average $2,563 per bed, per day; medical respite facilities significantly reduce healthcare costs to taxpayers, ensure more open beds are available for other people needing hospitalization, and help prevent repeated utilization of medical centers by people experiencing homelessness.
  • What will be done if this seems to be making the situation worse or unsafe?
    • If there is clear evidence that this project is somehow making either housed or unhoused people unsafe, then we will first work to address those issues on-site.  If issues persist, we may increase security measures.  In the worst case, the project may be halted, and lessons learned used to improve future efforts.


  • How will the area and surrounding areas be kept clean?
    • The specific area of use and its immediate surroundings will be kept clean by the provider contracted as part of their daily operations in cooperation with users of the Medical Respite Kauhale.
  • The outside of the DOH building smells like urine, there are already issues with trash, and staff has also seen human feces in surrounding areas. Will this get worse?
    • This speaks to the need for services – Having the Project Vision Hawaiʻi hygiene trailer on the Capitol grounds adds a needed resource for people who are in the Capitol District anyway, but who currently lack regular access to restrooms.
  • I have environmental hygiene (trash, toilets, food, flies, birds, rats) concerns:
    • The rationale for the site location in the parking lot is in large part due to access to infrastructure, including water, electricity, and in-out access for the hygiene trailer.  The facility will provide trash cans and proper hygiene amenities to allow for a safe environment for everyone, including both DOH staff and clients.

Safety Issues

  • What measures are going to be put in place for safety? I have concerns about drug use and other activities.
    • Drug paraphernalia is not allowed in public facilities and will not be allowed in the Medical Respite Kauhale. The Kauhale will have 24-7 security and a fence to ensure the safety both of those in the Kauhale and in the surrounding area.
  • Will the facility be staffed – not just with security?  Will there be personnel overseeing the village, how many, and whom will they be affiliated with?  What will they be tasked with or responsible for?
    • In addition to 24-7 security, Project Vision Hawaiʻi, a health and human services nonprofit organization, will provide medical staff to the Medical Respite Kauhale.  At least one PVH staff will be on-site 24-7 for intake, supervision, and care coordination. In addition, PVH will provide registered nurses who make daily rounds.
  • Due to the proximity of the facility next to DOH and DOE buildings, what steps will be taken to ensure that homeless residents do not accidentally enter State buildings; for example, to use the facilities? In the event of an unauthorized entry, can DOH set up centralized communication to ensure staff safety?
    • There are already many people living unhoused in the Capitol District and sometimes people (both housed and unhoused) make unauthorized entry into State Buildings.  We hope that our community presence can add a new layer of security coordination that can be utilized in these incidences.  As for the medically frail discharged from a medical center, giving them a place to sleep and be safe while healing should reduce their need to enter State buildings.
  • If the Kauhale will be a safer place, why is there need for dedicated security? It is reasonable to assume that there is an associated risk with this project and the personnel that are projected to occupy the units. This appears contradictory.
    • There are clearly concerns from DOH, DOE, and DHS staff about security, so security is being provided to address those concerns.  In addition, we are concerned for the safety of those who will stay in the Kauhale, and security is intended to keep them safe as well.
  • If the bathroom facilities are going to be open to unhoused people not staying in the Kauhale, how will security handle the congregation of people around the area?
    • Staff will make it clear to visitors that the Medical Respite Kauhale units are intended to house people who are discharged from hospitals and in need of medical respite.  As noted above, we hope the presence of showers and bathrooms will provide people an option for sanitation.

General Concerns

  • There are many more than 10 people who are houseless in the area, how are people being decided on to access the pop-up (is it solely for those who have been discharged from Queens)? Will there be additional assistance for those who use the DOH space currently?
    • Bed space at the Medical Respite Kauhale will prioritize medically frail, homeless individuals, discharged from urban Honolulu hospitals, including Queens, Straub, Kapiolani, and Kuakini. The hygiene trailer, with bathroom and shower units, will be available for anyone in the area who needs it, improving cleanliness and health.
  • Is something in place for situations where the demand exceeds the 10 units ?  Say all rooms are occupied and Queen’s or Straub discharges a person who is in need of these services?  What will happen then?
    • The Medical Respite Kauhale may only serve a portion of the immediate need. There may still be people who need medical respite, that the Kauhale cannot accommodate. That is why the Administration is simultaneously working to increase bed space in the community for medical respite.
  • Would appointing “village leaders” help?
    • Yes, our intention for this, and for every Kauhale, is to engage residents to take on responsibilities for operating their “village.” In the case of the temporary Medical Respite Kauhale this may include a nightly neighborhood watch, helping to clean the hygiene trailer or other areas, and checking in on others at the Kauhale who may need support.  What makes a Kauhale a Kauhale is that residents feel both cared for, and that they have a role in the Kauhale’s success.