A numbness washed over Martha Petifer as she packed up her belongings after being evicted from her apartment.
She looked to her partner and with slurred speech said: “Call 911. I think I’m having a stroke.”
Petifer, 56, spent most of January in the hospital. After the stroke, she returned about a week later when she fell and broke her back.
She was released from the hospital shortly thereafter, with a new back brace and a motel voucher good for a one-night stay.
So just days after a spinal injury, Petifer — who now was experiencing homelessness — was sleeping upright in her pickup truck with a brace reaching up to her neck.
How does one heal while homeless?
“You don’t,” said Petifer. “It just doesn’t work.”
Chronic physical and mental health conditions impact many people experiencing homelessness. Yet the realities of living outside create monumental barriers to accessing medical care.
While local street medical teams and homeless advocates attempt to fill the gaps, there are still cavities.
“If they don’t have stability from housing, they’re lurching from crisis to crisis,” said Dr. Richard Kubiniec, a medical director with Sea Mar Community Health Centers in Vancouver. “They visit an E.R., and are told ‘OK, now your blood pressure is normal, here’s a prescription. Go fill it, take it everyday, stop smoking and live healthier.’ Where? They’re expected to do that on the streets, in a car? It’s an impossible task.”
In many ways, homelessness is deadly.
The average lifespan of a person experiencing homelessness is shorter by about 17 years than the general population, according to national estimates.
And with increasing regularity, deaths among people who are homeless are surging.
According to a 2022 study by the Guardian newspaper and a University of Washington researcher, King County saw a 127 percent increase in deaths among the homeless population between 2016 to 2020, and Multnomah County saw a 58 percent growth.
Last year, 23 people died after experiencing homelessness in Clark County. So far, 19 people living unhoused have died, according to Vancouver’s homeless response coordinator Jamie Spinelli.
There are many reasons for these national death jumps — but poor health leads the list.
The difficulty of maintaining the habits of good physical health on the streets — adequate rest, proper medication routines, and good nutrition and hygiene — contributes greatly to early morbidity or serious health concerns.
Eight out of 10 people who are homeless have chronic health conditions, according to several studies.
High rates of substance-use disorders also further health conditions. For some experiencing homelessness, substance use and mental health conditions are borne of the trauma of living outside.
“Living outside is not easy,” said Clark County Public Health director Dr. Alan Melnick. “So there’s an increased use of substances.”
Over 30 percent of people experiencing chronic homelessness have one or more mental health conditions, and about half of the national homeless population struggles with a substance-use disorder.
“Some of the folks who have some of these health conditions also have substance-use challenges, which then exacerbates the physical health conditions,” Spinelli said. “When you have this growth of drug crises, you’re going to see a growth in death rates.”
Homelessness worsens preexisting health conditions, including high blood pressure, diabetes and asthma, according to the National Institute of Health. That’s because it’s difficult to store medications safely when you live on the street. There are other concerns, as well.
“Living outside is very unhealthy as is,” Spinelli said. “Particularly because you don’t have regular access to showers and hygiene facilities.”
She said that when people are living outside something as small as a scratch could lead to serious, long-term issues.
“I’ve seen cuts and small scratches lead to amputations,” Spinelli said.
Tina Pederson should be receiving chemotherapy or radiation for her throat cancer, but her housing status prevents that.
“They said I need to do chemo, but that I need to be in a stable surrounding,” Pederson, who has lived in her R.V since October 2022, said.
The lack of stability that accompanies homelessness often forces people to jump through more hoops to receive care — even then, sometimes it’s not enough.
Because Petifer couldn’t elevate her feet after getting her back brace, she has circulation issues that sometimes leavesher legs numb, other times she experiences shooting pain.
“Many of the people who are unhoused have issues around mental illness, substance-use disorder, alcoholism, diabetes and other health conditions,” Melnick said. “One of the concerns and the risk factors that contribute to these (issues) are the barriers to care.”
Mike, a veteran who has experienced homelessness for about five years and has diabetes and asked that his last name not be used, said most of his meals come from services in downtown Vancouver. But most of those meals are made to be inexpensive and filling, which means that they are often high in carbohydrates, sugars, salt and starch.
“I’m happy to be getting that food, no complaining; but it all turns to sugar for me,” said Mike, who had to have two toes amputated because of diabetes.
Spinelli concedes that maintaining a healthy diet is difficult when people have to turn to soup kitchens and shelters.
Diabetes is a leading health issue among people who are homeless.
Spinelli said she appreciates people donating food, but she notes that sometimes those foods are high in carbohydrates. Meals with meat and vegetables are needed.
But even when people experiencing homelessness have access to healthier foods, they often can’t store meats or vegetables because many don’t have access to refrigerators. So many stick with junk food.
“It’s this perpetual cycle that they can’t get out of,” Spinelli said.
A lack of transportation also can be a roadblock, making medical appointment attendance spotty.
In August, Mike lived near the Share House in downtown Vancouver. He was able to walk several blocks to catch a bus to see a doctor.
But doing that since having two toes removed is a struggle, he said, as he removed a shoe and displayed the tip of his wool sock coated in blood.
“They also don’t always (have) access to computers, sometimes no phone, so it can be impossible knowing when and where your next appointment or follow up is,” said Felicia Hubach, founder and outreach director of Couve Collective.
And sometimes a person is reluctant to leave their home for an appointment.
“They are really unable to leave their possessions,” said Lauryn Sanders, mobile services manager for Columbia River Mobile Health team. “If they do, they are at risk of their belongings being stolen. They come back, and their tent has been ransacked.”
Mike said his insulin has been stolen more than once. He thinks either other diabetics might need it.
Sanders said that the mobile health team — which brings medical care to those living on the street — also often sees clients lose Social Security or other identification cards that they regularly need for medical care. The cards can be stolen or lost when people move camps.
“Appointment availability can be tough. Appointments are often during the work week during business hours. And folks who need to work, taking time off to go to a medical appointment means less money in their pocket generally,” said Rebecca O’Brien, executive director of the Free Clinic of Southwest Washington.
Living unsheltered affects a person’s ability to detect illness, which then can lead to long-term consequences. People living outdoors often operate in a fight-or-flight survival state, Spinelli said.
“When you are in that state, people sometimes don’t feel those aches and pains and then people move inside and start feeling like they’re sick because their body’s resting,” she said.
Survival also presents challenges to accessing care.
In the 1990s, Shawna Marie worked in and out of medical facilities as a certified nursing assistant. But in the last 15 years — the time she’s been homeless — she has stepped into a hospital only three times.
She broke her jaw three years ago, and it didn’t heal properly. She relies on aspirin and sometimes substances to numb the dull ache that lingers. Despite having state insurance, doctor visits are few and far between.
“Being homeless is a full-time job: Harder than raising my kids or my (old) job,” said Marie. “I’m trying to survive. It’s hard to even have a moment where I can make a call and talk to a doctor.”
Earlier this year, Nick Bailes entered an emergency room looking for help. He was in substance withdrawal.
“I couldn’t get a bed to detox,” he said.
Instead, he waited 10 hours in the emergency room before receiving help.
“It was terrible. I was detoxing and they put me with everybody else in the lobby,” said Bailes. “It was embarrassing because I was screaming and yelling.”
Debra Carnes, director of marketing and communications for PeaceHealth said a person’s wait time in an emergency room depends on the urgency of their medical needs and the number of people seeking care.
“A good number of people don’t access health care because of the way they feel they’ve been treated in hospitals,” Spinelli said. “They’re either been treated like they are drug-seeking or just treated a little more poorly because they are experiencing homelessness.”
After suffering a stroke, Petifer said she was denied physical therapy as she disclosed she formally used substances. She said doctors told her they were afraid she would relapse again.
Spinelli has sat in emergency rooms with unhoused people who were having a mental health crisis.
“Imagine sitting in an emergency room with a diagnosis of schizophrenia or something like that. You know you’re needing help at that moment, but you can’t just stop your symptoms, right?” said Spinelli. “They may be exhibiting things like agitation, paranoia, and the security guards, nurses, desk staff may be annoyed by essentially the symptoms.”
Felicia Hubach, co-founder of Couve Collective, once sat with a client, an unhoused woman who had a huge wound on her neck, close to her spine. “A nurse walked by and said: ‘Why can’t you be quiet? There’s normal people here,” Hubach recalled. “Imagine if we weren’t there with her … This is why individuals stop going to the emergency room.”
Petifer placed about a dozen pill bottles onto a stool outside her pallet home.
“I told you I have a lot,” she said, with a laugh.
Her daily routine of taking various types of medication that all work to help with her cancer and diabetes, among other health conditions. Between medication doses, she attends various doctor visits.
After living in her car for several weeks, Petifer and her partner were offered a pallet shelter at the city of Vancouver’s first Safe Stay community, The Outpost. Without housing, she said she isn’t sure keeping up with her health needs would be possible.
As she was settling into the community, Petifer was diagnosed with Stage 1 breast cancer. She recently had surgery to remove the cancer. Next week she will begin radiation.
“I’m glad to be here (in housing),” said Petifer.
Petifer echoes a sentiment made by many advocates and medical professionals — the answer is housing.
“As a physician, I write prescriptions if somebody is unhealthy. But I wish I could write a prescription for housing because you’re not going to be able to treat diabetes adequately if you don’t have housing,” Melnick said.
According to multiple studies, many people are becoming homeless due to health conditions or medical bankruptcy. Without the safety net of affordable housing and rent, many vulnerable groups such as low-income residents or seniors are at greater risk of going from the hospital to the streets.
“Many people are one step away from being unhoused,” Melnick said. “All they need is a health issue that keeps them from working for a few weeks. It’s an urgent situation.”
A name in this story was updated from its original form.
This story was made possible by Community Funded Journalism, a project from The Columbian and the Local Media Foundation. Top donors include the Ed and Dollie Lynch Fund, Patricia, David and Jacob Nierenberg, Connie and Lee Kearney, Steve and Jan Oliva, The Cowlitz Tribal Foundation and the Mason E. Nolan Charitable Fund. The Columbian controls all content. For more information, visit columbian.com/cfj.
