Meet Mr. Rudy. Rudolph Young, if you’d like to use his full name, though no one here does. On a chilly October morning, he rests in a twin-sized bed, wearing checkered boxer shorts and bright yellow safety socks, a plastic thimble of pills perched on his stomach. He gulps down medicine for bone cancer and for blood clots in his legs, both of which cause intense pain that isn’t easy to treat given his history of drug abuse. He also swallows antidepressants; many nights he lies awake in bed, unable to toss and turn because of the pain, unable to sleep because of the fear.

What he wants most is to “get out there and holler at my niece,” who lives nearby in Maryland. He wants to let her know he’s all right, off the street. He smiles constantly. He tells jokes. He uses humor and politeness to mask his mood swings, which manifest during those long nights. What worries him most of all? “That I won’t wake up tomorrow morning,” he says. 

Residents of Joseph’s House are attended to in the home’s living room. | Mary F. Calvert for the Deseret News

His case sounds extreme, but it isn’t. Not where he lives. At Joseph’s House, a home in Washington, D.C., for homeless adults who are either HIV positive or have terminal cancer, cases like Mr. Rudy’s are more normal than they are extraordinary. Which isn’t to minimize his difficulties or his story; it’s just to say that here, amid mahogany doorways and tungsten lightbulbs and dusty old photos hung up crooked, he’s not alone. 

Meet Amílcar. He, too, would surely have a story to tell — if only he could tell it. The staff admits they really don’t know much about his life before he came here. They know he’s from Guatemala, and that he’s undocumented. Perhaps that’s why he didn’t discover his HIV diagnosis until it was past the point of no return; his viral load is “astronomical,” per one person familiar with his situation. He also has toxoplasmosis, a condition caused by a protozoan parasite most often contracted via contaminated meat. It’s not uncommon. But for someone with an immune system as compromised as Amílcar’s, the parasite can have devastating consequences for the nervous system — most of all the brain. On top of all that, Amílcar speaks very little English, while the staff here speaks very little Spanish. They try to make him feel welcome — in their upstairs offices, they’ve printed a list of Spanish phrases to use with him. One staffer says he “gives the best hugs.” But whether because of the language barrier or the effects of toxoplasmosis or some combination thereof, most of Amílcar’s communications revolve around telling staff members where he feels pain. Behind his handsome, bearded face, this man in his 30s is dying. “And he doesn’t deserve to die,” one staff member tells me. “But he will soon.”

Light at the end of the tunnel
Sanctioned camping. More enforcement. Here’s how a Salt Lake business coalition wants to solve homelessness
A look inside the nation's first residential hospice for dying homeless folks

Founded in the rapidly gentrifying Adams Morgan neighborhood in 1990, Joseph’s House was originally meant to provide dignified deaths to homeless victims of the AIDS epidemic. That’s still part of the mission today, but thanks to improved HIV treatments, fewer people are dying from AIDS, and the center has expanded its care. Today, Joseph’s House, named after Joseph, son of Jacob, from the book of Genesis, admits people who are homeless and HIV-positive or diagnosed with terminal cancer. Soon it will also admit compassionate release cases — prisoners who are let out early because of deteriorating health. Some do still die here, but most stay for up to two years, during which time Joseph’s House helps them get onto a medical regimen and transition to permanent housing. Often nearby, because the Joseph’s House community is not limited to these walls; five people live here right now, but the community is some 25 strong.

This is one of the original “medical respite” programs, though others have popped up across the country. Salt Lake City has one. Sacramento will have one early next year. They’re becoming more popular as people recognize the need. Most of them — Joseph’s House included — exist through a complex web of funding, much of it from various government grants and partnerships. But that funding is getting harder to find. “It’s always a struggle,” says executive director Kowshara Thomas, “to see if we’ll stay open.” 

Joseph’s House volunteer Elizabeth Myster attends to a patient in his room. | Mary F. Calvert for the Deseret News.

Homelessness as a national concern dates back to the post-Civil War 1870s, but its modern genesis can be traced to the recession of the 1980s and the accompanying deinstitutionalization of patients at mental hospitals, as well as the HIV epidemic and slashed government funding. Starting in 2007, when the number of homeless Americans stood at just over 647,000, the numbers had been in slow decline. That changed in 2016, and the numbers have steadily risen since then. The most recent estimates show nearly 600,000 unhoused Americans. Their prominence today is always in the news. In San Francisco. In Seattle. In Salt Lake City. Often framed not as a humanitarian issue, but as an inconvenience. That reality infuriates Thomas, who sees Joseph’s House as an antidote not only to the fact of homelessness, but to prejudiced perceptions about homeless people. 

Joseph’s House is different foremost because it is a house; not a facility. With a garden and a dedicated staff and three free meals per day, its reputation is such that some have tried forging medical documents to get a room here. It’s well known in D.C. homelessness circles, though again, almost invisible to anyone else. “When people think of this population we’re serving, they don’t really see them,” Thomas says, noting the obvious truth that most ignore their clientele on the street. “They’re not seen as an individual,” she adds. Their entire identity to passersby is simply “homeless,” and therefore somebody else’s problem. 

What does it say when, in the capital of one of the wealthiest nations in the world, treatment programs for the most vulnerable among us are hardly able to exist?

Yet homelessness is everybody’s problem. In a very literal way, it takes public money to address it, so our taxes contribute. “The government’s budget is a morality question,” says Nathalia Cibotti, one of two full-time social workers at Joseph’s House. “Because what you spend your money on is directly … what you care more about. What you’re prioritizing. And they could be spending so much more on alleviating homelessness. And they don’t.” 

What does it say when, in the capital of one of the wealthiest nations in the world, treatment programs for the most vulnerable among us are hardly able to exist? Especially now, during the holiday season, when charities, churches and corporations alike encourage us to give generously, take care of each other and help those in need, what does it say about us when we have the financial capacity to help people with disease, with addiction, without homes — and collectively choose not to? And what would it mean for people like Mr. Rudy and Amílcar should places like this cease to exist?

Nine people await Tuesday afternoon’s closed-door staff meeting, seated around the dining room table. Several more attend via Zoom. Thomas rings a monastic-sounding bell one time to get the room’s attention — and to set a reflective tone. She likes to check in on her staff, make sure they’re OK. Many of them attend weekly one-on-one and group therapy; this place, these jobs, can take a toll, because to really see the people they work with is to see suffering. “All of us have difficulties,” Thomas tells the room in a voice both patient and ponderous. 

In one corner of the room, two fist-sized goldfish putter around a gurgling aquarium. Along the wall, in a window, a portable Frigidaire unit hums and puffs cool gusts. The buttery wooden floor creaks from the weight of the staff seated in their chairs. A hand-painted tapestry covers one wall; boxes of ashes — four in all — rest on the mantle. Above them, a collage of photographs jut from a mirror. Six photographs, to be precise, featuring the members of the Joseph’s House community who died within the last year. Every May, those who pass are memorialized together in an on-site service, where staff and residents share their favorite stories of the deceased. 

Volunteer Ninika Osuji prepares a bowl of ice cream in the kitchen for a Joseph’s House resident. | Mary F. Calvert for the Deseret News

Hair tied up in a bandana, white shoes bearing black streaks from her constant movement, it’s rare to find social worker Nathalia Cibotti sitting still. Outside of mandatory meetings, she’s downright kinetic — always doing something or going somewhere, always determined. Which she considers both a necessity and a burden. “Going fast creates the impression that I’m too busy to serve you,” she says, “which is the opposite of what I want.”

And yet, oftentimes, that’s the way she has to be. She guides community members through food stamp applications. She reviews legal contracts with public defenders. She once helped a person clean their apartment to avoid a hoarding-fueled eviction. Another time, when one community member stole tens of thousands of dollars worth of packages from neighbors, Cibotti talked with the woman’s property manager to work out a plan where she would no longer have access to packages, but also wouldn’t get evicted. 

She’s been at Joseph’s House since February. She wanted a job where she could go home at night and feel like she was helping — really helping — people in need, and on that count, her current job delivers. But she’s also sick of telling people what she does. They inevitably feign a sense of awe and wonder, and “I don’t need the fawning over,” she says. She didn’t get into this for praise or to feel like a “good person.” She’s here for the simple reason: If she wasn’t, who else would be?

Resident John Barnard in his room. | Mary F. Calvert for the Deseret News

Today, Cibotti has an update about Amílcar. She spoke with his sister earlier about burial arrangements. She was hoping the sister would come with some ideas, but she instead leaned on Cibotti. “So it was really upsetting, without any sort of solution or step forward,” she tells the group. 

“Are they a part of any church, or any social group?” asks one staffer. 

“She is not,” Cibotti answers. 

“Maybe a GoFundMe,” Thomas suggests. 

“I’m trying to figure out how much it is,” Cibotti answers. “Because if a burial is 15k. …”

“Oh,” Thomas says, “you’re not gonna raise that.”

Like the conversation earlier in the day, this one ends without resolution. Only a plan to keep working at it. “I’m gonna have to do more research,” Cibotti says. Aside from the more literal task of burial arrangements, she’s also been talking to her own therapist in preparation for Amílcar’s death. “He’s been here since March,” she says. “And he’s very much a part of daily life here at Joseph’s House. And thinking about him passing away is just difficult.”

Volunteer Elizabeth Myster with resident Rudolph Young. | Mary F. Calvert for the Deseret News

She finds some solace in the fact that when Amílcar’s time comes, and he’s ready to join the faces now looking down at them from the mirror collage, he’ll at least exit this world properly. People don’t die alone at Joseph’s House; when they’re close to the end, someone stays with them 24/7. When the moment arrives, the staff bathes and dresses the body. They walk the body to the street to be transported to the funeral home, offering everyone around a chance to say goodbye as it passes. And later on, they hold a candlelight memorial service. 

They do, in other words, what no one else would. 

In the living room, filled with family photos, mismatched art, a piano, bookshelves, worn couches and a ceiling fan with two burned out bulbs stirring the dust around, the entire Joseph’s House community has been invited to answer a question: What do they appreciate about Joseph’s House?

People don’t die alone at Joseph’s House; when they’re close to the end, someone stays with them 24/7.

Mr. Rudy, for one, is originally from Columbia, South Carolina. He moved to Washington, D.C., around his eighth birthday. He still retains a slight trace of a Southern accent, but the only home he’s ever really known is right here, in this city. At 68 years old, he’s been in trouble for about as long as he can remember, starting when he joined a gang called the “Hussy Hobos” when he was about 12. They’d steal, break into houses and play pingpong. He eventually started abusing drugs, which led to various stints in correctional institutions and rehabilitation programs. 

He’d made progress around the time the pandemic began. He was working as a dishwasher at a D.C. restaurant, living with family in Maryland. But the pandemic made it impossible to get to his job and he got fired. He soon fell back into old habits. “That was a good job, too,” he says with a sigh. “Everybody liked me.” 

Last August, he moved into a homeless shelter on Martin Luther King Jr. Avenue, where he met a city councilman who told him if he wanted to “get himself together,” Joseph’s House might have room for him. “In the shelter, it’s every man for himself,” he says. “You don’t worry about the next man. You worry about yourself.” He was eager to get away from that, and the difference at Joseph’s House was noticeable right away. “They saved my life, because I didn’t know which way to go,” he tells the room from his favorite seat on the couch. “And I really appreciate everybody who helped me out, who took me to this point, who look out for me. I don’t have nobody who looks out for me like they do.” 

His story is his own, but it’s similar to many of the others here. Joseph’s House is a place to reset. A place to rest. A place where you can feel safe and protected from whatever lurks out there. “It ain’t a rat race,” he says. 

“And just because you get away from here,” adds community member Tony Murchison, seated on a couch across the room and sporting a dark fedora, “don’t eeeever feel like you’re not welcome back here. … It’s a healing house.”

Memories and cremated remains of past residents on the dining room mantle at Joseph’s House. | Mary F. Calvert for the Deseret News

The next day, Mr. Rudy is back in the same spot on the couch. He’s watching his usual smattering of old Westerns on the TV, and soon, if he’s lucky, he’ll fall asleep for a midmorning nap. Sleep means less time to worry, and he worries plenty; about the cancer, about his family and about himself, because he knows he’s relapsed many times before. “Every time I come up,” he says, “I do the same thing.” Plus sleep means fewer questions from the well-intentioned staff, who are always asking how he feels. “How do you think I feel?” he says over and over in his head. But, out of respect for the folks helping him, he always just says he feels a little better. 

We all have certain images that come to mind when we think of the word “home.” Perhaps it’s wherever you grew up, or some picturesque mansion from a TV show. But that’s not what Mr. Rudy imagines. “This feels,” he says from his spot on that well-worn couch, beneath the warm glow of that one working bulb, “like home.”  

This story appears in the December issue of Deseret Magazine. Learn more about how to subscribe.