By: Emme Dunning, for The Dirt
When you first enter Joshua’s House, a hospice for the homeless in South Natomas, a striking work of art immediately catches your eye. Spanning the north wall of the administration building is a wood cutout of a sprawling tree. Calligraphy scrawled on the trunk reveals its name: “The Tree of Dignity.” Floating down around the tree are dozens of leaves; two of which are inscribed with names.
The names of the first two residents to call Joshua’s House their final home.
The tree represents what the staff at Joshua’s House hopes will be their legacy as the first group on the West Coast to provide hospice care to unhoused community members with terminal illnesses—a place to die with dignity.
Joshua’s House, under the auspices of YoloCares, opened its doors this past July as an end-of-life comfort care provider for the terminally-ill unhoused population in the greater Sacramento area. Although the current model has been open for less than a year, Joshua’s House is far from a recent endeavor.
The plan for Joshua’s House was born from Dr. Marlene von Friederichs-Fitzwater, a longtime educator at UC Davis School of Medicine and Sacramento State. Topics of health care inequities and their tangible health outcomes have been central to her research, inspiring her founding of The Health Communication Research Institute in 1989. The HCRI works to improve communication between doctors and patients with the aim of reducing health disparities for end-of-life care in underserved populations, with an emphasis on homelessness.
This issue became personal for Friederichs-Fitzwater when her grandson Joshua Nielson passed away while he was unhoused in Nebraska in 2014. Spurred by this loss and equipped with decades of experience in the healthcare system, Friederichs-Fitzwater started what would be the ten-year process of building Joshua’s House in his honor.
Today, Joshua’s House works with five major healthcare providers in the region to
place patients with terminal illnesses who would otherwise be discharged to the streets after their hospital stay. In its current form, the hospice can accommodate up to 15 patients at one time.
Dr. Chris Erdman, current director of Joshua’s House and a former pastor of three different congregations across California, has devoted much of his life to issues of social justice and more specifically, housing justice. Through his work, Erdman has become acutely aware of the troubling emotional toll of homelessness, and the added stress that living with an illness can bring.
“Most of us, when we catch a cold, we want a good bed and a pillow,” Erdman told The Dirt. “We want somebody to take care of us. And that’s a cold—imagine having cancer or COPD or something else that is so difficult, and having to deal with it on the street.”
This is the reality for many experiencing homelessness in Sacramento and California at large. In 2024, 234 people died while unhoused in Sacramento County, a number that doesn’t show signs of improving on its own. Joshua’s House organizers hope to make a positive impact on this statistic while prioritizing the dignity and autonomy of their patients.
“I’m hopeful that we can get patients who will land with us, and we can help them die beautifully, die well and die with compassion,” Erdman said. “Our residents who want it will have someone who can sit with them, know them, and help them spiritually and emotionally as they transition through the death vigil into the dying process and beyond it.”
Joshua’s House provides all the standard end-of-life comfort care. Clients receive meals, clothing and a warm bed, among other services. The staff takes great pride in their formal ‘caretaking’, but it is not the heart of Joshua’s House.
This can instead be found in the organization’s mission statement: To give humanity a home.
Caregivers and staff at Joshua’s House work hard to bring this humanity to their patient care. Program manager Adi (Dee) Rasilau reflected on what she hoped to contribute to the culture of Joshua’s House as a founding staff member.
“I wanted to see joy,” Rasilau told The Dirt. “Such a huge part of my life is experiencing joy, and I wanted to incorporate that in what we do here. It is end-of-life, and it is scary. It is a vulnerable time. It’s not always the best of days. But if we can do anything, whether that’s food or putting together a party where our residents can feel some type of joy, we’re going to do that.”
Joshua’s House invites all who enter its gates to be part of this joy, bringing residents together with their family, friends and staff to create meaningful memories through shared meals, movie nights and cultural celebrations.
Haley Felton, a caregiver at Joshua’s House, centers patient interaction and comfort in everything she does. Felton understands the integral role she plays in the last days and weeks of her patients’ lives, and takes this responsibility to heart.
“I want to make sure they feel heard, feel seen and feel loved,” Felton told The Dirt. “It’s amazing to be part of the journey of making sure their last days on earth are filled with just joy and peace. Knowing that they did matter, that there are people who care about them. That’s my goal every day; to show that they mean something to someone.”
Sometimes, the most important work of the day is to listen.
“When you hear the stories of their life—how they grew up, how they raised their kids, the jobs they had—you just see the joy coming out of them,” Felton said. “They’re so excited to tell you about their life. They never talk about being homeless. It’s so fascinating to hear about the person you’re with. As much as it’s sad, you don’t even really think about it because they just have so many amazing stories.”
As Joshua’s House enters its fourth month of operation under YoloCares, they remain committed to bringing this underserved population vital care, and with it, dignity in their final days.
Joshua’s House is located at 3630 Larchwood Drive in Sacramento. Readers who would like to learn more or volunteer with Joshua’s House may go to joshuashousehospice.org or joshuashousehospice.org/volunteer to connect.
