University of Portland nursing student Crystal Moran administers a flu shot to a homeless woman last fall outside Blanchet House. Emily Harrington and members of the U.P. nursing program staff a new medical clinic at the Portland nonprofit. (Courtesy Blanchet House)
University of Portland nursing student Crystal Moran administers a flu shot to a homeless woman last fall outside Blanchet House. Emily Harrington and members of the U.P. nursing program staff a new medical clinic at the Portland nonprofit. (Courtesy Blanchet House)

Walter isn’t sure how long he’s lived outside. “When you’re trying to get out of the rain or keep your stuff safe or dealing with pain, you lose track of time,” said the 60-year-old. He sat holding a cigarette under trees bordering a Northeast Portland parking lot, a spot out of people’s way, he explained.

Years ago, Walter lost his job in a warehouse, and he’s dealt with homelessness and health issues ever since.

“Everyone on the street has a medical condition, it’s just a matter of degree,” he said. “I have skin and digestive difficulties. Some have cancer.”

Last year Walter was admitted to the emergency room twice, first for a fractured leg and then for a broken eye socket. “Teenagers came by in the middle of the night and kicked my sleeping bag,” he said. “My eye swelled up like an egg.”

The number of people nationwide who spend their days and nights on park benches, inside tents and in doorways is growing, and most, like Walter, at some point need medical attention.

“Homelessness is not just a local phenomenon and it’s not temporary,” said Terry McDonald, executive director of St. Vincent de Paul of Lane County. The amount of unhoused people “is mounting and there’s going to be many who have health issues.”

Catholic nonprofits, hospitals and individuals in Oregon are among those implementing creative plans to meet the burgeoning need for medical care.

“What’s more elementary to the Gospel mission than helping those who are both homeless and ill?” said McDonald. “It’s work that gets at the heart of Jesus’ teachings.”

‘A failure of society’

Even before the COVID-19 pandemic, houselessness was increasing across the United States. Between January 2019 and January 2020, the number of people experiencing chronic homelessness rose 15%, according to the latest report from the U.S. Department of Housing and Urban Development. Oregon consistently has one of the highest rates of homelessness in the country, and Portland’s homelessness crisis is impossible to ignore as encampments multiply around the city.

Advocates for the homeless say a multitude of factors are driving the increase in the state, including mental illness, addiction, domestic violence, inadequate salaries for the working poor and a dearth of affordable housing.

Sarah Power is regional manager of social work practice and programs for the Catholic-founded Providence Health and Services. She believes the lack of affordable apartments and houses plays a significant role locally.

“As a society we do a lot of shaming of people who are homeless, when the truth is we live in a community without a supply of affordable housing,” Power said. “For those of us in the health care system we see every day that it’s not a failure of character but a failure of society to have affordable options.”

Not surprisingly a lack of stable housing exacerbates existing health issues and creates new ones. A 2016 report by researchers at the University of California at San Francisco found that homeless people in their 50s have physical health conditions typically seen in 70- and 80-year-olds. And the life expectancy of the unhoused is almost 20 years lower than housed populations.

Top health issues

The most common health problems for homeless men and women include heart and respiratory diseases, diabetes, arthritis, severe dental issues, malnutrition, wounds and skin infections, substance abuse disorder, and mental illness. Numerous studies show approximately one-third of homeless individuals have a serious mental illness, while living on the streets can trigger or intensify certain disorders.

With each health condition comes a constellation of challenges and increased risk for an unhoused person, said Victoria Waldrep, lead housing case manager and employment specialist for Catholic Charities of Oregon’s Housing Transitions Program. The program provides housing and other services to self-identified women experiencing homelessness who do not have children in their care.

“Clients who acknowledge mental health conditions and even the need for medication don’t always stay on their meds because the side effects can make them sleep too deeply, which is dangerous if you are living outside,” Waldrep explained.

Medications for diabetes often must be kept at a specific temperature, a nearly impossible task if someone is in a shelter or outside. Arthritis impacts mobility and makes it painful to acquire basic services. Dental abnormities can cause embarrassment and make employment less attainable.

Waldrep recalled how two clients with lung- and heart-related disorders died in recent years during Oregon’s wildfires. “They had the pre-existing conditions but the constant smoke exposure outside was certainly a contributing factor to their deaths,” she said.

 Barriers to care

There are many potential impediments for a homeless person seeking medical services. Most are eligible for the Oregon Health Plan, an insurance option for low-income Oregonians. But the plan must be renewed annually, and without a computer it can be difficult to access the form. “During the pandemic, with libraries and other public spaces not fully open, finding a computer to use is more problematic,” said Waldrep.

It also can be challenging to find a provider who is accepting new Oregon Health Plan patients and to obtain transportation to appointments.

To help, staff at the Housing Transitions Program provide transportation assistance, keep a list of locations for mobile medical and dental clinics, and assist clients applying for Oregon Health Plan benefits.

Even with insurance, however, houseless individuals may be hesitant to see a doctor who could ask them to share past traumas related to their health. “They may not want to relive that pain,” Waldrep said. Or they might fear they will be judged or viewed merely as an addict, not as a patient with additional medical needs.

There’s also sometimes a fear or distrust of authority figures.

Walter said he knows many people who have resisted care for that reason. “There are folks who have had bad experiences with authority, and they sure as hell don’t want to show up for a doctor’s appointment,” he said.

‘Served with grace’

Tony Clayborn, who formerly was homeless, climbed onto the examination table at a new clinic at Blanchet House in downtown Portland. As he waited to have his blood pressure checked, he joked with Emily Harrington, a family nurse practitioner and founder of the Harrington Health Clinic.

“A lot of people on the street have a phobia of doctors or nurses,” said Clayborn, a Blanchet resident. “You run out of reasons you can’t be seen when the clinic is right where you are.”

The nurses listen empathetically and care for your total well-being, he added, holding out his arm for Harrington. “You are served with grace.”

Emily Harrington, a family nurse practitioner and member of All Saints Parish in Northeast Portland, checks the lungs of Tony Clayborn in a new clinic Harrington started at Blanchet House downtown. (Katie Scott/Catholic Sentinel)

Blanchet House was established by local Catholics in 1952 and for decades has provided meals, clothing and housing programs.

Harrington, former board president of Blanchet House and a member of All Saints Parish in Northeast Portland, saw the need for comprehensive, trauma-informed health care “to even more significantly alter and shape the trajectory” of Blanchet residents, many with substantial mental and physical health needs.

The clinic, run by Harrington and University of Portland faculty with assistance from nursing students, is the first nurse-led primary care clinic founded with an academic partner in Oregon. U.P. nursing students have for years served at Blanchet but not as part of a fully staffed program.

The all-nurse cohort creates a unique atmosphere, said Harrington. “There’s a beautiful intimacy and vigilance that’s part of our profession,” she said. “And because there aren’t time constraints on visits, we’re able to learn individuals’ journeys and meet them in stride.”

Creative collaboration

Twenty years ago, “there was a strong boundary between those who worked with the homeless and those in health care,” said Power. “There was finger pointing and the attitude ‘That’s not my problem.’ We’ve since learned they are fundamentally related.”

Reflecting this sense of shared responsibility, Providence and Catholic Charities, along with the Archdiocese of Portland, have teamed up to reduce chronic homelessness in the Portland metro area by 20% over five years. The Healthy Housing Initiative, launched in January 2020, includes several housing developments and connects the newly housed with primary care and mental health help.

Research shows housing and consistent support lead to fewer emergency room visits and lower health care costs.

“We can’t truly work on any issue in life — our long-term health, addiction, employment — if we don’t have a safe place to be,” said Waldrep.

Life-saving efforts

When homeless individuals leave a Providence hospital, they receive a specialized discharge plan, and staff work to place them in transitional housing or a recuperative care program, where residents can recover after a serious illness or surgery. But programs are sometimes full, or patients may opt out if they are worried about a pet or partner remaining on the streets alone.

Despite hospitals’ best attempts, “there are instances when people are discharged back into homelessness,” said Power.

That can turn into “a horrific situation,” said McDonald, with St. Vincent de Paul of Lane County. For example, a patient “could be in a wheelchair and pass through the hospital doors into a bad winter night.”

To limit such occurrences in the Eugene area, St. Vincent de Paul and Catholic health provider PeaceHealth recently came up with an innovative solution.

PeaceHealth funded the construction and operation of six small one-person shelters at St. Vincent de Paul of Lane County’s Dusk to Dawn, one of the nonprofit’s homeless ministry sites. The aluminum and composite-panel structures offer the recently discharged a safe, private space to fully recover following a hospital stay at PeaceHealth. Nearby is a clinic offering basic medical care.

“It’s a beautiful collaboration,” said McDonald. He said staff have heard repeatedly from guests, “You saved my life.” 

Six new personal shelters at a St. Vincent de Paul site in Eugene were funded by a grant from the Catholic health provider PeaceHealth. (Courtesy St. Vincent de Paul of Lane County)

‘More tender toward others’

The new Blanchet clinic addresses medical needs in part to thwart future hospitalizations and health crises.

In the cozy one-room clinic are stethoscopes, otoscopes, a thermometer and a scale. On a wall hang signs with facts about COVID-19 and posters that share inspirational messages — “It’s okay to ask for help,” reads one.

The clinic, serving the men in Blanchet’s residential living program, has been personally transformative for Harrington. “I hope it’s shaped me to be less critical, less judgmental, more tender toward others,” she said.

Harrington, married to former NFL quarterback Joey Harrington, hopes eventually to expand the clinic’s work to the broader homeless community in downtown Portland and add additional services, such as foot care.

“I often think of individuals in chronic pain on the streets,” she said. “These individuals are essentially hauling all their earthy belongings on their backs as pain impacts multiple systems in their body. I think of the endurance and the focus it must take as they set up camp, take it down and keep belongings dry.”

Across the Willamette River in Northeast Portland, Walter knows those burdens well. “Today, whatever day it is, I’m going to try and enjoy the sunshine,” he said, picking up his cigarette lighter. “A lot of people have it worse.”