For people experiencing homelessness, dying alone on the streets can be a devastating reality.
Dr. Marlene von Friedricks-Fitzwater knows this issue all too well. After interviewing about 180 people experiencing homelessness about their greatest fears, she heard a common concern.
“What they feared most was dying on the street alone,” she said. “And being eaten by dogs and horrible things.”
She believed people deserved something different: a home, a place where they could be loved and cared for at the end of their lives.
That vision became Joshua’s House, a hospice facility in South Natomas that provides free end-of-life care for people experiencing homelessness.
For von Friedricks-Fitzwater, the mission is deeply personal. The facility was inspired by her grandson, Joshua, who died while experiencing homelessness in Omaha, Nebraska. He had struggled with drug addiction and spent much of his life without stable housing.
“Joshua’s House started when Joshua died,” she said. “He died on the streets of Omaha, Nebraska.”
She did not want other families to experience the same loss.
“It’s why this house exists,” she said. “I didn’t want people to die like that.”
She also wanted to create something that would honor her grandson’s life.
“I wanted it here so he could see what’s going on in his name, because I think he’d be proud of that,” she said.
For Curtis Burdan, Joshua’s House has provided something he struggled to find for years: a place to receive care while facing a terminal illness.
Burdan said he had been living on the streets since 2012. He also has congestive heart failure and described his heart function as being at about 10%.
“My heart hasn’t made up its mind when it needs to stop beating,” he said.
As his health deteriorated, Burdan said he repeatedly sought treatment at hospitals throughout Sacramento. But he struggled to find a lasting solution to his situation.
“I was contemplating suicide. Seriously,” he said. “Because I was going back out to the same thing. There were no answers for me.”
He said he knew people who were seriously ill and dying on the streets without access to even the most basic necessities.
“There are people out there that are actually dying and they can’t even use a toilet,” Burdan said.
At Joshua’s House, he has a private room, access to daily necessities, and a place where he can receive hospice care.
The facility provides food, personal care and other comforts, including items many people take for granted.
Burdan said he has been there for five months. He knows his illness will eventually take his life, but he has found peace in being able to spend his remaining time in a comfortable environment.
“I’m going to tell you what the doctor told me,” he said. “You’re going to fall asleep and you’ll never wake up. I told him there ain’t no better way to go.”
Joshua’s House has six cottages with room for 15 patients. Each cottage has three private rooms, along with shared kitchen, dining and bathroom spaces.
The goal is to provide a safe, comfortable environment for people who otherwise might spend their final days in hospitals or on the streets.
Adi Rasilau, the program manager at Joshua’s House, said the work brings together two things she is passionate about: helping marginalized people and providing end-of-life care.
In the facility’s administrative building, a “Tree of Dignity” honors people whose lives have been lost.
The names serve as a reminder that every person who comes through the doors matters, Rasilau said.
For her, the work also carries personal meaning. She lost her younger cousin during the COVID-19 pandemic and did not get the chance to say goodbye.
“Helping other people walk through their goodbyes every day” has become a way to honor her cousin, she said.
Rasilau said many people are uncomfortable talking about death, but those conversations can help people make the most of the time they have left.
“Being on hospice doesn’t mean that you stop living,” she said. “It opens up the doors if you let it.”
For people who have spent years surviving on the streets, she said, having a comfortable place to rest can make a profound difference. Patients who arrive sick and exhausted may finally have the opportunity to spend their final days in peace.
Joshua’s House did not happen overnight.
Von Friedricks-Fitzwater spent years searching for a suitable property, working through logistical challenges and raising the money needed to build the facility.
KCRA 3 followed that journey over the past decade as she worked with the city and county of Sacramento to bring the project to life.
The project eventually raised about $3.5 million to establish the six cottages, with room on the property for three additional cottages in the future.
The goal, von Friedricks-Fitzwater said, is to eventually expand capacity to serve as many as 25 people.
The facility was built without taxpayer funding, according to von Friedricks-Fitzwater.
Joshua’s House also addresses a broader challenge facing the health care system: caring for people who are unhoused, seriously ill and without a stable place to recover or receive hospice services.
Craig Dresang, CEO of Joshua’s House, said hospice care includes a team of professionals who provide medical, personal and emotional support. That can include nurses, aides, physicians, social workers, trained volunteers and spiritual support when requested.
Dresang said the general reimbursement for hospice care is about $230 per day, while comparable care in a hospital can cost thousands of dollars daily.
“If we didn’t exist, if the patient was not in hospice, they’d be in the hospital,” Dresang said. He estimated that the cost could be between $3,000 and $5,000 per day in a hospital setting.
Joshua’s House is the first facility of its kind on the West Coast, according to Dresang, and one of only a few in the country.
Hospice patients are generally given a prognosis of six months or less, although the length of time someone lives can vary.
Dresang said he hopes the Joshua’s House model will eventually expand to other communities in California and across the country.
“The next step for us is inspiring this in California and in other places around the country that need this kind of support in housing for unhoused individuals who are really, really sick,” he said.
The need for that kind of care remains significant.
More than 100 people experiencing homelessness died on the streets of Sacramento County in 2025, according to data from the Sacramento County Coroner’s website.
For those who are seriously ill, the absence of stable housing can make an already difficult situation even more painful.
Joshua’s House offers an alternative: a place where people can receive care, build connections and spend their final days with dignity.
For Burdan, that means having a place to call home.
For von Friedricks-Fitzwater, it means knowing her grandson’s death has helped create something meaningful for others.
When the two met at Joshua’s House, Burdan thanked her for making the facility possible.
“You’re the grandmother, right?” he asked.
“Yes, I’m the grandma that built this place,” von Friedricks-Fitzwater replied.
“I want to tell you thank you,” Burdan said. “Your grandson didn’t die in vain because he’s helping a lot of people.”
The exchange captured the purpose behind Joshua’s House: ensuring that people who might otherwise die alone on the streets have a place to be cared for and remembered.
“They deserve to go in peace and in love,” von Friedricks-Fitzwater said.
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