The new Aala medical respite shelter on North King Street has taken in and treated some of Oahu’s oldest and most seriously ill homeless patients and gotten several lives pointed in positive directions so that 14 have been reunited with their-once estranged families, mostly on Oahu, and another six have gone back to the mainland in barely nine months since opening.
As of last week 147 people had been treated at the 62-bed shelter comprising tiny-home kauhale structures and 30 indoor treatment beds inside the former First Hawaiian Bank branch.
The homeless people who have been treated so far include:
>> Kupuna in their 70s and 80s with Alzheimer’s and dementia who are particularly vulnerable to theft and violence while sleeping on the street.
>> People who have suffered multiple heart attacks and strokes.
>> Many with previously undiagnosed and untreated diabetes whose glucose levels uncontrollably spiked to dangerously high levels that put their lives at risk.
>> Those who needed weekly dialysis treatments but did not receive them until they checked into the shelter.
>> Many who arrived with sometimes lifelong addictions to meth, like Dante Ladines, 57, who didn’t care whether he lived or died for much of his time on the street.
Ladines grew up in Kalihi and Ewa Beach and began hanging out with older kids who started beating him up as a fifth grader.
He never graduated from Campbell High School and began working in construction and as a cook while on his way to years of addiction to meth that sent him in and out of Oahu’s jails and prisons for using and dealing that cost Ladines any relationship with his six children and other family on Oahu.
Asked where he served his time, Ladines told the Honolulu Star-Advertiser while sitting at a picnic table on the shelter’s grounds, “I was in all of them. Once I whack meth, I never turned back.”
He suffered strokes and heart attacks but refused to stop using.
“I never care about nothing,” Ladines said. “I gave up.”
After his third stroke, Ladines could barely walk and checked himself into the city’s HONU pop-up emergency homeless shelter when it set up in Kapolei.
But Ladines did not receive the level of health care he needed until HONU social workers referred him to the new Aala medical respite shelter.
“He was more appropriate for here,” said the shelter’s project manager, Janet Nguyen, who’s also a nurse.
Ladines was diagnosed with high cholesterol and heart disease and also was prescribed mood stabilization medications that began to change his attitude.
But he kept returning to the Aala shelter clearly high, which further endangered his health and set a bad example for other patients working to address their own substance abuse addictions, Nguyen said.
“He came to us barely walking,” Nguyen said. “When his health got better, he started to use, and I gave him an ultimatum. I told him, ‘You’ve got heart failure. You’re either choosing life or death.’”
Ladines reluctantly agreed to outpatient substance abuse treatment at Hina Mauka and has been attending sessions over the past six weeks.
Even though Ladines acknowledged he had little initial interest in getting clean, now he looks back, and said, “It was a blessing in disguise. I’m thriving. I’m not depressed. I’m trying to prove that I’m not that person anymore.”
His health and sobriety are still fragile, and Ladines does not see himself reconciling with his family anytime soon.
But he’s the happiest he’s been in years, and, Ladines said, “Now I can trust somebody.”
Reuniting the first 20 homeless people with their families has taken as little as two months and as long as three, said Dr. Scott Miscovich, whose Premier Medical Group Hawaii runs the Aala shelter.
It begins when patients check in and give their medical backgrounds, along with family contacts.
Shelter staff then contact families to let them know they have their estranged love one and are addressing their issues, which typically include substance abuse and mental health problems that often led them to steal from their families and .sometimes turn violent.
Families are then invited to Aala to see firsthand how their homeless family members are progressing after they begin addressing issues that include post-traumatic stress disorder, schizophrenia and bipolar disorder through medications, along with on-site Alcoholics and Narcotics Anonymous meetings and outpatient treatment for people like Ladines.
Then the homeless patient can visit their families at home to test their new family dynamic.
It’s all done by phone for family members on the mainland.
So far, none of the 20 patients welcomed back by their families have returned, Miscovich said.
The joint state and city shelter represents a new approach to getting homeless people permanently off the street by treating serious health conditions and addressing some of the underlying reasons they became homeless, Miscovich said.
“Unless we do this, the public needs to understand that homelessness isn’t going away,” Miscovich said. “Unless we start providing care for these people with real mental issues, you will not see changes. … All of them have been assaulted. When I say all, it’s 100%, and it’s over and over and over — let alone the sexual assault that happens to women. These people are getting the hell beat out of them. It’s just so incomprehensible.”
Along the way, doctors and nurses at the Aala shelter have saved the lives of people who would have died on the street, like Ladines, who now see better futures for themselves, Miscovich said.
At the same time, they have kept dozens of homeless people out of hospital emergency rooms they disproportionately use, tying up costly ambulance and hospital resources.
Some of the initial solutions to problems have been relatively easy, such as outfitting Apple AirTags on kupuna with dementia and Alzheimer’s to track them down when they wander off, Miscovich said.
But longer-term answers are much more complicated, including finding long-term care beds that specialize in dementia and Alzheimer’s, along with other long-term beds for patients who rely on wheelchairs.
“Some forget to take their meds,” Miscovich said. “They need to go into skilled nursing care facilities because I said, ‘No more homeless discharged to the street.’”
Patients can stay at the Aala shelter indefinitely, but it’s often full and cannot accommodate new arrivals.
And having to turn away patients in need worries Miscovich because of what it means for them to remain on the street with untreated health issues.
“This is beyond a Third World country, to think this is happening in the United States,” he said. “To hear their stories is just really, really something else.”
Take Charlotte “Shorty” Marquez, 46.
She started life homeless when she was born on the streets of Chinatown to a mother who abandoned her.
Her father then took her in, but died of alcoholism when Marquez was just 7, Marquez said.
She never graduated high school and was in and out of foster care and jails for assault and meth.
Finally, Marquez said, a judge told her in 2024:
“‘Don’t come back to Waianae because you’re nothing but trouble. You violent. You got warrants.’”
She also got kicked out of the Institute for Human Services’ shelter and was back on the street using meth.
Then-state Homeless Coordinator John Mizuno referred Marquez to the new Aala shelter before he became a special adviser to Gov. Josh Green focusing on homeless policies and programs.
Marquez checked in Sept. 24 and now sees a different future.
Nguyen said Marquez has been clean and sober ever since and even leads Narcotics Anonymous meetings with other patients and has become a role model at the shelter.
Marquez also receives treatment for schizophrenia, depression, heart failure, sleep apnea and her meth addiction after using it “all my life,” Marquez said.
Now she lives in a tiny home on the shelter grounds and works with Aala shelter case managers on her next step to move into transitional housing on her way to what Marquez and Nguyen hope will be a more stable, sober future.
So far, after just seven months, Marquez said all the support has her suddenly dreaming of a life she never thought possible.
“It’s working for me,” she said. “Before, all I know is the streets and my drugs.”
Miscovich hopes the early success of the Aala shelter’s focus on serious health and underlying reasons people end up chronically homeless leads to a new approach for how Hawaii addresses homelessness.
The concept already has the support of Mayor Rick Blangiardi and Green, America’s only sitting governor who’s also a medical doctor, who has provided wound care for homeless people he encounters on the street.
The Aala shelter has a physician on-site 24 hours a day, along with psychiatric technicians from the State Hospital, nurses and security that includes off-duty and retired Honolulu police officers and state sheriff’s deputies trained in conflict resolution, Miscovich said.
Its operational costs have been budgeted at $4 million annually — which Miscovich called a relative bargain compared with the high cost of frequent emergency visits that end with injured or ill homeless people back on the street.
He called the Aala shelter unlike any other in Hawaii and the first of its kind toward permanent solutions to ending chronic homelessness.
“No one does anything like this,” Miscovich said. “We need more medical respites, and it’s just self-evident to everyone that we need another facility ASAP.”
