By NICOLE WINFIELD, Associated Press

VATICAN CITY (AP) — Pope Francis was resting Wednesday, the start of the solemn Lenten period leading up to Holy Week observances, after sleeping through the night with a ventilation mask as he undergoes hospital treatment for double pneumonia.

In its latest update, the Vatican said that the pope rested well overnight, waking up shortly after 8 a.m. Pope Francis remained in stable condition, with a guarded prognosis, meaning he was not out of danger. He resumed supplemental oxygen delivered by a nasal tube in the morning, alternating from a ventilation mask at night as doctors seek to ease his breathing for a deeper rest.

People attend as Cardinal Robert Francis Prevost, Prefect of the Dicastery for Bishops, leads the recitation of the Holy Rosary for Pope Francis’ health in St Peter’s Square at the Vatican, Monday, March 3, 2025. (AP Photo/Kirsty Wigglesworth)

The 88-year-old pope, who has chronic lung disease and had part of one lung removed as a young man, had two respiratory crises on Monday in a setback to his recovery.

On Tuesday, he was breathing with just the help of supplemental oxygen after respiratory crises a day earlier, but resumed using a ventilation mask at night, the Vatican said.

Francis’ hospitalization began on Feb. 14 and is the longest of his 12-year papacy.

Ash Wednesday

Francis’ treatment continues as the Vatican prepares for Lent, the solemn period beginning with Ash Wednesday and leading up to Easter on April 20. A cardinal has been designated to take Francis’ place at Vatican celebrations, with a traditional service and procession in Rome

On Ash Wednesday, observant Catholics receive a sign of the cross in ashes on their foreheads, a gesture that underscores human mortality. It is an obligatory day of fasting and abstinence for Catholics that signals the start of Christianity’s most penitent season.

Vatican prepares for Lent without Francis

The pope had intended to attend a spiritual retreat this coming weekend with the rest of the Holy See hierarchy. On Tuesday, the Vatican said the retreat would go ahead without Francis but in “spiritual communion” with him. The theme, selected weeks ago and well before Francis got sick, was “Hope in eternal life.”

Francis, who is not physically active, uses a wheelchair and is overweight, had been undergoing respiratory physiotherapy to try to improve his lung function. The accumulation of secretions in his lungs was a sign that he doesn’t have the muscle tone to cough vigorously enough to expel the fluid.

Doctors often use noninvasive ventilation to stave off intubation or the use of more invasive mechanical ventilation. Francis has not been intubated during this hospitalization. It’s not clear if he has provided any instructions on the limits of his care if he declines seriously or loses consciousness.

Catholic teaching holds that life must be defended from conception until natural death. It insists that chronically ill patients, including those in vegetative states, must receive “ordinary” care such as hydration and nutrition, but “extraordinary” or disproportionate care can be suspended if it is no longer beneficial or is only prolonging a precarious and painful life.

Associated Press writer Colleen Barry in Rome contributed to this report.

With costs rising for everything from insurance to elevator repair, Catholic Charities informed residents of St. Christopher Place last year that they’d have to pack up and leave. The last tenant in the 71-unit rooming house moved out at the end of January, ending an era for the dorm-like structure at 268 Marshall Ave. in St. Paul, which the nonprofit has owned and operated as single-room occupancy housing for the impoverished since the mid-1990s. The four-story building, constructed in 1965, remains on the market.

Prior to closure, Catholic Charities subsidized the affordable housing program at St. Christopher Place by about $500,000 annually, a cost the nonprofit found unsustainable.

“As buildings age, it becomes harder to maintain them,” said Elizabeth Lyden, vice president of engagement with Catholic Charities, which maintains more than 900 units across the Twin Cities, most of them targeted to especially vulnerable populations like the recently homeless. She called financial challenges widespread across the affordable housing industry. “The math doesn’t math anymore.”

St. Christopher Place isn’t the only affordable rental housing likely to be sold off to new owners who may have less interest in providing homes for the poor. A new report commissioned by a coalition of 36 housing providers finds that since 2020, rising inflationary costs, skyrocketing insurance, staff shortages and the demands of housing a community hard hit by the fentanyl crisis, among other post-pandemic challenges, have left housing for very low-income residents in tough fiscal and maintenance shape.

That raises the likelihood that more of it will be sold at a time when affordable housing is in growing demand. The challenges of maintaining affordable units in the regulated, charitable market are especially prevalent for older buildings, which tend to need more tender loving care, putting them at particular risk of shuttering.

The 42-page “Distressed Property Data Project,” authored by O’Neil Consulting, studied the financial records behind more than 26,000 housing units situated in more than 450 housing developments across the state, with data culled from 2018 to 2023. The authors noted that while the study focused mostly on residential units run by nonprofits, many for-profit housing providers that serve low- to moderate-income residents are feeling the same stresses. The report included data from at least 88 regulated properties owned by for-profit entities, spanning more than 4,100 units.

Cash flow falls below break-even point

Among 11,400 housing units that provided data, the average cash flow fell to $1,226 per unit below a break-even point in 2023. At properties where all units were eligible for permanent supportive services like counseling, cash flow fell to $1,600 below a break-even point.

“That’s happening to small providers and large ones,” said Kizzy Downie, chief executive officer of Model Cities of St. Paul, which maintains about 75 units of affordable housing in and around the Summit-University and Frogtown neighborhoods. “The story is across the board. We’re all seeing the impacts of what’s happening across the industry.”

The report — which urges financial action by the state Legislature — was commissioned by the Family Housing Fund and the Greater Minnesota Housing Fund. Consultants analyzed various types of affordable housing by category.

All property types showed operating and maintenance cost increases that far surpassed the rate of inflation between 2018 and 2023. The increases by property types ranged from $1,100 to $1,760 per unit, numbers that would have only grown by $500 to $680 per unit had they kept pace with inflation alone. In other words, rising operating costs grew far faster than inflation even at a time of rapid inflation.

For low-income housing tax credit properties that did not offer counseling and other permanent supportive housing services, the report found that annual expenses grew by more than $2,000 per unit, or 33%, during the five-year study period.

“This is clear evidence of substantial operating cost distress, and consistent with interview comments about rapid wage increases for staff of all types, costlier insurance, and higher costs for all types of supplies and services,” reads the report.

Insurance was a major driver of expenses. Across the portfolio of Catholic Charities properties alone, property insurance premiums increased by 30% from 2023 to 2024. And multiple Catholic Charities properties saw water damage deductibles alone climb to $100,000 or even $250,000, meaning flooding from a damaged sprinkler or broken water pipe would likely force the nonprofit to pay cash for repairs, according to a spokesperson for the nonprofit.

Vacancies grow even as cost of housing climbs

At the same time as expenses have climbed, vacancies have grown.

Across the spectrum of affordable housing, all types of properties suffered rent loss beginning in 2021 due to growing vacancies caused when a federal eviction moratorium ran out, staffing shortages and insufficient operating funds made it harder to get units ready for occupancy, and coordinated entry lists maintained by county social service departments suffered delays in placing tenants.

Properties offering permanent supportive housing services have been hit the hardest by vacancy trends, especially in the Twin Cities metro. They tended to experience the highest losses in rent collection as vacancy tripled from 2018 to 2023, equating to about a 15% loss in total project revenue.

As a national labor shortage bites into staffing, “it slows down, in some cases, the process of even getting people moved in,” Downie said. “If there’s a unit that’s vacant, and the costs to get someone to fix that unit up is higher because it’s more expensive to hire somebody, that’s a unit that isn’t being filled as quickly.”

While housing providers in the Twin Cities have been hit hardest by vacancies from a revenue standpoint, the highest number of vacancies in 2023 landed in rural areas in Greater Minnesota. Rural development projects also showed the most distress in terms of bad debt, a problem felt statewide.

The study also looked at the sharp rise in security costs, which began in 2021, a year earlier than many of the other factors cited, and likely related to the pandemic and unrest following the murder of George Floyd in Minneapolis. Utility costs have, in general, risen more moderately than other factors, according to the report, and vary depending upon the property type.

Rising interest rates after 2021 also put pressure on properties needing loans, such as Federal Housing Administration affordable housing mortgages.

Even nonprofit providers like Catholic Charities, which have opened newer housing developments in recent years like the Dorothy Day Residences in downtown St. Paul, “it’s a lot cheaper to preserve units than to bring new units online,” said Keith Kozerski, chief program officer for the nonprofit. “This isn’t a Minneapolis problem or a St. Paul problem. This is a statewide problem that is impacting people all over.”

Housing has been a priority recently at the Legislature.

In 2023, lawmakers and Gov. Tim Walz approved more than $1 billion in funding for a wide array of housing initiatives, on top of a new metro-wide sales tax that goes into effect on Oct. 1. The housing omnibus bill represented the largest single spending on housing in state history. It came in addition to housing efforts backed by the state infrastructure, bonding and tax bills.

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A few years ago, you might have found Debra Gatto living in a tent in the woods near Blaine, or perhaps in the green near the Cathedral of St. Paul. She passed the time sketch-drawing bridges, with the general goal of documenting every major bridge in the capital city. Her five years of unsheltered homelessness offered her a unique vantage point, but not always a safe one.

After a month in a battered women’s shelter in Plymouth, an attorney working on her case directed her toward Catholic Charities’ Dorothy Day Residence in downtown St. Paul.

Debra Gatto. (John Autey / Pioneer Press)

Gatto, who had once managed three Dollar Tree stores at a time and before that test-fired a Patriot missile during her five years in the U.S. Army, was able to secure a small efficiency apartment of her own in late 2019 a few floors above the large Dorothy Day cafeteria that serves the city’s neediest residents. A housing voucher from the U.S. Department of Housing and Urban Development-Veterans Affairs Supportive Housing covers all but about $80 of her nominal monthly rent.

Getting back on your feet while homeless, “it’s almost too scary to try to figure out on your own,” Gatto said. “With the VA saying ‘you don’t have to pay rent,’ that was hard for me to wrap my head around. … It’s downtown St. Paul, and I’m a suburban girl. I was scared. One person told me, ‘That’s where people go to die.’ I’m like, what?”

Found her footing

Gatto, who has enrolled in online data analytics courses, said she’s found her footing at the Dorothy Day Residence, in part by knowing who to talk to and who to avoid.

She now has her own small kitchen, from which she’s prepared a Thanksgiving meal for all the residents on her floor. That alone has been a small blessing, compared to the meals she once ate on the fly while living in tents or on friends’ sofas.

“Homelessness is the most expensive thing anybody could go through,” Gatto said. “We all get food stamps, but none of us have refrigerators. You have to buy gas station food you can eat right away. You can’t put stuff away.”

Her first day in her apartment, she washed every piece of clothing she owned and soaked in the bathtub for four hours. “It’s my zen thing,” she mused, recalling how passersby once avoided her because of her disheveled appearance. “I couldn’t catch a ride across the street from someone if my hair was on fire.”

Homelessness is “more embarrassing for females,” Gatto added. “Nobody wants to sit behind a tree and pee. Guys, they don’t care.”

Art therapy

At the Dorothy Day Residence, Gatto took art therapy classes when they were offered, and led some sessions of her own.

“I’ve learned a lot about myself,” she said. “You have people who are here to help you, or not, because all the services are voluntary. I don’t have to go to my case manager. You have to initiate that stuff.”

“A lot of drama comes with this environment,” she added, noting she’s seen people who own nothing take from others who own nothing. “I don’t understand that, when homeless people steal from each other. It works for you if you want it to.”

She’s hoping someday to relaunch a career and move to a small apartment in Lowertown, like a loft, somewhere near the Mississippi River, with her Mastiff dog Minnie.

‘Until you experience it’

Now her thoughts go toward her four adult children, each of whom have had their own successes and setbacks. Two of them strike her as stable. One son has been in and out of prison — the COVID pandemic upended his progress — but has promised to avoid further trouble. A daughter seems almost unreachable, dead-set on living life on her own terms.

“She’s out there, and she’s just not getting it,” Gatto said. “We’re batting about 75%. I fear for her all the time because I know what it’s like out there, and I worry. She knows she doesn’t have to listen to me because she’s an adult.”

“Everybody in the world knows about homelessness,” Gatto said. “But nobody really knows it until you experience it.”

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