Tomorrow, December 21, will be the first day of winter. The longest night of the year. And the twenty-second annual National Homeless Persons’ Memorial Day.
Communities around the country will sponsor events to honor homeless men and women who died this year and “to recommit to the task of ending homelessness.”
Here in the District of Columbia — and in some other communities also — there will be a reading of the names of the memorialized homeless. These obviously are people whom local service providers and other concerned community members knew.
But some of the people we’ll commemorate are anonymous. No one knew them well enough to wonder why they were missing — let alone care enough to find out they’d died. In some cases, they’re forever officially nameless.
Many of the named and nameless were probably shockingly young. Homeless people die, on average, nearly 30 years earlier than the rest of us, according to a review of the scant studies we have.
But a much larger percent of the untimely deaths are due to untreated or under-treated illnesses — both communicable diseases like HIV/AIDS and tuberculosis and others more common among the population as a whole, e.g., cancer, diabetes, heart problems and hypertension.
Homelessness itself helps explain those communicable diseases. People in shelters can easily contract them, since they’re bedded down with many others, washing up in communal bathrooms and eating shoulder to shoulder with their co-residents.
Both the sheltered and unsheltered are more susceptible to illness generally because their systems are weakened by lack of rest, hunger and/or unhealthful diets, exposure to extreme temperatures and stress.
All these conditions, of course, also tend to make diseases get worse. When we get the flu, we stay in bed. Not an option for homeless people who live on the streets or in shelters, which often kick them out at dawn’s early light.
Not surprisingly, homeless people are more likely than others to lack health insurance — even Medicaid. At this point, those who don’t have children and haven’t been certified as severely disabled often aren’t eligible any way.
Fortunately, we have nonprofits that provide free medical care for homeless people — some of it federally funded.
A very high percent of homeless people nevertheless rely on hospital emergency rooms. They presumably get patched up, given in-patient care if needed and discharged, perhaps with a prescription.
But there’s no continuity of care. And both shelter and street living make following a doctor’s instructions difficult.
How, for example, do you store your medications “in a cool, dry place” — and protect them from theft?
How do you faithfully take one pill every four hours or check your blood sugar regularly when you’ve got to keep moving around and trying to rustle up enough money to get something to eat? How do you keep your bandaged wound sterilized?
These questions all assume you understand what you’re supposed to do — and that it’s on your mind, but just too challenging.
Probably not the case for the relatively high, though unknown numbers of homeless people who have a serious mental illness, substance abuse problem or both.*
The message here, which it’s taken me a long time to get to, is that housing is health care, as one of the cosponsors of National Homeless Persons’ Memorial Day says.
And lack of housing can be a death sentence.
If you think this is overwrought, consider what will happen to the AIDS-infected client that attorney Amber Harding at the Washington Legal Clinic for the Homeless tells us about.
Consider what would have happened if he’d gotten the affordable housing he asked for.
* Figures on the rates of these disabilities among homeless people vary widely and many are far from current. The low-end figure for mental illness is 13-15%, but at least double that for homeless individuals classified as chronically homeless.
The U.S. Interagency Council on Homelessness says it’s estimated that nearly half of homeless people suffer from substance abuse disorders.