Rural Homelessness Story Archives - West Virginia Public Broadcasting

‘How Can I Self Quarantine?’ The Unseen Effects of the Coronavirus on the Homeless Community

As of Monday, March 23, there are 16 confirmed cases of coronavirus in West Virginia. Medical professionals are worried about what may happen if an outbreak occurs amongst one of the state’s most vulnerable communities: those experiencing homelessness.

Some of the advice that’s been given to smooth the curve of coronavirus infection has been to stay home, reduce the amount of time spent in large groups, and increase handwashing, but for those without permanent housing, all three of those tips can be nearly impossible.

Because of this, keeping those experiencing homelessness safe during this pandemic could prove to be quite the public health challenge, according to Wheeling-Ohio County Health Department Administrator Howard Gamble.

He said the challenges are multi-pronged, and include challenges ensuring those experiencing homelessness receive both testing and treatment.

“One, they could become infected and finding out if those individuals are positive or not can be extremely difficult one, how do you get them into testing? Two, how do you track them back down to say you’re positive or negative?” Gamble said. “If you ever move to a pharmaceutical intervention, how do you make sure that population gets that intervention? Whether that’s a medicine or a vaccination.”

There’s sometimes a stereotype that people who are experiencing homelessness struggle with their mental health or are in active addiction.

Crystal Bauer, Project HOPE director and nurse , said homelessness is caused by a variety of factors such as job loss, house fires, and domestic violence situations. One of the fastest growing segments of the homeless population is families with children. According to the 2018 point in time study on homelessness conducted by the United States Housing and Urban Development, 33 percent of those experiencing homelessness were families.

Project HOPE is a street medicine team based in Wheeling made up of medical professionals who make “street rounds” by traveling to different camps and shelters where those without permanent housing may be staying to offer medical care.

The organization is assembling kits with hand sanitizer, masks, disinfectant wipes, and cough drops to give to those they see on rounds in hopes that these items, along with handwashing demonstrations, will help slow the chances of an outbreak.

The team conducts rounds two times a week.

But even if the group can help successfully slow down an outbreak, Bauer is worried about what may happen when someone experiencing homelessness gets the virus.

Concerns of Quarantine

“I would say the biggest concern once someone has been identified as being diagnosed with coronavirus or COVID-19, what are we going to do with them?” Bauer said. “They do not have the luxury of having some place to quarantine themselves for 14 days.”.

There are options being considered for community medical quarantine and treatment spaces. One option brought up by Wheeling Mayor Glenn Eliott is to use the Ohio Valley Medical Center, which shut its doors in late 2019. The city has expressed interest in purchasing for other purposes.

Even with this possibility, advocates say that still doesn’t address the problems that self-quarantine and social distancing can have in regards to how those suffering from homelessness find jobs, or even get their meals. Sefan Perdue has been homeless for two months. He said he spends a lot of time during the day traveling around town applying for services, which often require in-person interviews.

”How can I self quarantine? I can’t. Like I said, I’ll go stir crazy. I don’t want to sit inside of a tent all day long self quarantining,” Perdue said. “Can I stay away from people when that’s the only way helping me survive?”

Then there are the concerns over how the disease will affect the already weakened immune system of someone who is experiencing homelessness, Gamble said.

”You have an infectious disease that has mortality/morbidity rates that’s of concern [and] that does not have a vaccine or pharmaceutical treatment. You have to consider this as a real threat to society and to public health,” he said.

While everyone should take the virus seriously, public health experts say this is especially pertinent for those without housing. Chronic homelessness has been shown to reduce someone’s life expectancy by about 17 years.

Dr. Thomas Wack, a volunteer with Project HOPE, said as many states move to close non-essential businesses, many Americans may find themselves closer to experiencing homelessness than they might expect.

“Many of us are just a paycheck or two from being homeless ourselves these days,” he said.

A 2018 Federal Reserve Report on household economic well-being has shown around 40 percent of American households would have a hard time paying for a $400 emergency expense. And the coronavirus pandemic is taking a major economic toll on the U.S. economy.

Bauer hopes this experience will show the need for proper planning in case there’s another emergency like this.

“We’re learning as we go. Let us use what we learn from this experience to create a plan for the future. Unfortunately, the homeless population is getting bigger and bigger, and unfortunately the homeless population is including more and more children,” Bauer said. “ So, we really have to be thinking collectively as a community about ‘what is a plan?’ We have to have a disaster plan that includes the most vulnerable in our community. Because if we don’t, shame on us because what will happen is people are gonna die.”

In the meantime, she says, Project HOPE is going to keep making rounds.

Without A Home Can You Be A Good Neighbor?

Homelessness is one of the things that divides us in America. It’s an Us & Them issue that can spring from, and inform our views on other social topics.

The number of homeless people nationally has dropped in the past decade, but there was an increase between 2017 and 2018. A West Virginia man saw a need and is trying to help. He owns and supports a homeless encampment that gives people a place to live. At the same time, he balances the reaction from local residents who worry about homeless people who are now, their neighbors.

For more from WVPB on the topic of homelessness, see these stories:

Kyle Vass, co-produced this report. This episode of Us & Them is presented with support from the CRC Foundation and the West Virginia Humanities Council.

Subscribe to Us & Them on Apple Podcasts, NPR One, RadioPublic, Spotify, Stitcher and beyond. You also can listen to Us & Them on WVPB Radio – Tune in on the fourth Thursday of every month at 8 PM, with an encore presentation on the fourth Saturday at 3 PM.

Homelessness And Health Costs: This Kentucky Mom Faced Cancer While Living In Her Car

Cancer was what finally pushed Kristi Reyes into living in her car.

The mother of four had worked all her life, starting at age 7 when she helped out at her family’s furniture store. Most of her work was in retail. It was paycheck-to-paycheck but she kept her kids together and a roof over their heads.

But then in 2012 she was diagnosed with breast cancer. She started cycling through jobs because of the time she needed to take off for recovery from treatment. Soon, she was too sick to work at all and things continued to slide. She had Medicaid, what she calls a medical card, but it wasn’t enough.

“Even though I had a medical card, there were out of pocket things that medical didn’t cover,” she said. “I don’t care how much money you make,” she said. “Money is never enough when you’re sick like that.”

She and three of her children, who were 11, 13 and 15, all stayed in the car for a while. But soon she was forced to let her children live with other people.

She remembers recovering from surgery to remove cancerous lymph nodes, homeless and alone. Eventually, she was too sick for treatment to even continue.

“I couldn’t even walk up a flight of stairs without being out of breath, almost needing oxygen,” she said. Her diabetes was out of control. She was also having trouble with her kidneys.

But she said she knew other people who had it worse.

“At the same time, I think that was kind of something that kept me going. Right? Like knowing that somebody had it worse than I did.”

At least, she said, she had a car.

Housing and Health

In fact, her case is not unique. The National Alliance to End Homelessness estimates there are 15,000 people experiencing homelessness in Kentucky, West Virginia and Ohio. Many more are living on thin financial margins. The Robert Wood Johnson Foundation reported earlier this year that half of rural Americans say they could not afford to pay an unexpected bill of $1,000, and nearly a third say that they have had trouble paying medical bills.

Jessica N. Sucik directs homeless services for HealthFirst Bluegrass, a federally qualified health center in Fayette County, Kentucky. HealthFirst serves 25,000 patients, many of them poor. It also runs two health clinics for the homeless.

Jessica Sucik, of HealthFirst Bluegrass.

She said there is a saying in public health that “housing is healthcare.”

Just the nature of chronic illnesses such as diabetes or COPD can limit how much people can work.

“So they know they can’t work permanently, 40 hours a week,” she said. “They’re working as they can, but they also can’t afford housing or whatever treatment they need to overcome their condition.”

Circumstances can change quickly.

“With chronic medical conditions, something temporary can very, very quickly turn into a permanent homelessness status,” she said.

That leads to challenges paying the bills. It can be an unrelenting cycle.

“Without that, it’s like, you know, building a house on sand,” she said. ”You have to have that safety and that security blanket of safe, stable and affordable housing before you can take care of yourself and be able to meet your needs.”

In recent years, HealthFirst has adopted a team approach with all patients. There is a medical provider, a social worker, a case manager and psychiatrist to provide medical, psychological and social support instead of leaving patients to fend for themselves.

“The magic that happens when you address not just the physical health issues, but also the things that are preventing them from getting those physical health issues addressed, is really, that’s where it’s at,” she said.

Policy Solutions

But others say homelessness or personal bankruptcy due to medical costs point to a need for more systemic change.

One policy solution gaining traction among Democratic presidential candidates is Medicare for All, a proposal that would eliminate private health insurance and replace it with a government-run system. Leading contenders Sen. Elizabeth Warren and Sen. Bernie Sanders support such a proposal.

Warren estimates her proposed plan would cost $20.5 trillion above expected health care costs over ten years. She says that could be paid for largely with an increase in taxes on the top income brackets and through savings in medical costs, but that claim has met some skepticism from policy experts. Sanders has been less specific about the costs and has said his proposal would find savings through cutting administrative costs.

The Urban Institute has estimated that a switch to a single-payer system would require $59 trillion over 10 years, about $7 trillion more than the costs under the current system.

The debate over the impact of medical bills on bankruptcy has been going on for a decade. Dr. Steffie Woolhandler is co-founder of the advocacy group Physicians For A National Health Program, which argues for a single-payer system. Her group says research shows more than 60 percent of personal bankruptcies are tied to medical bills. She says a single-payer system can reduce costs and relieve families from going into debt, which is why many other countries have such a system.

“Virtually every other developed country guarantees health care to everyone living there,” she said. “This is true in Europe, it’s true in Canada, and it’s true in Australia. The United States is an outlier.”

She said the idea is gaining appeal in the U.S.

“What I’m seeing, really since 2016, is that the idea of Medicare for all has become an issue with non physicians and a lot of people who don’t work in health systems but are users of that healthcare system are actually talking about Medicare for All,” she said.

A Kitchen Table

Reyes doesn’t spend a lot of time considering such policy decisions. Taking care of herself and her family is about all she can handle.

For about four years from the time she was first diagnosed with cancer, she was struggling to keep her employment, living mostly in her car, and separated from her children.

She tried from time to time to get into a shelter but whenever she’d reach out, they were full. One day, she said, she couldn’t take it anymore.

“I was at my wit’s end. Like I didn’t know what else to do. I was tired, worn out. My body felt like I couldn’t handle it anymore,” she said. “Honestly, I just started praying.”

Finally, she found help and a new home.

She called the Salvation Army and was referred to the Housing and Homeless Coalition of Kentucky. Within two months, she was off the street.

Last year, she moved into a house in Frankfort, Kentucky, where she lives with her children, two grandchildren and her boyfriend. Because of her ongoing medical problems she has been approved for lifetime housing assistance and resumed her cancer treatment.

“That made it even better. Because I know no matter the struggles of my health, or the battles that I got to fight with it. I’m always going to have that support.”

About a month ago, she was well enough to start working at a Subway sandwich shop.

A simple, second-hand dining room table is her favorite place to be.

“That’s the thing, that’s my thing,” she said with a laugh. “Because I can come in, I can cook for my children. And we can sit at the table and have a meal together.”

Looking back, she said, she realizes now that she was in denial about just how bad her health was. And she hopes other people will take some comfort in knowing things can change for the better.

“You just have to tell yourself, ‘OK, I’m not going to give in today,” she said. “You know, people just need to know that just because you’re going through things, it doesn’t necessarily mean that you’re going to be stuck there for a lifetime.”

Wheeling Organization Takes Hope To The Streets

Over the last five years in Wheeling, an organization called Project Homeless Outreach Partnership Effort, or Project HOPE, has been giving medical care to people who live in the city without housing.

This regularly brings Project HOPE director and nurse, Crystal Bauer, to some unusual places, like under a certain highway overpass.

“We’re under a pretty busy bridge that is a major interstate, so there’s a lot of traffic overhead,” Bauer said. “It provides shelter, obviously, but it’s certainly not without being exposed to the elements. Like I said, the noise overhead, trying to sleep at night, I can’t even imagine.”

Scattered belongings surrounding Bauer and her team under this overpass. The graffitied concrete is a far cry from the usual sterile hospital room where emergency treatment is administered, but the people who set up temporary living in this spot, and many places like it, may be in need of medical attention. So Bauer visits regularly.

Crystal Bauer and Dr. William Mercer are checking to see if the camp is inhabited to come back another day.

Street Rounds in an Appalachian Rust Belt Town

Bauer explained, bringing medical supplies and expertise to makeshift camps where people without access to housing stay is called street rounds.

In Project HOPE’s case, each week these rounds end at a local shelter where a semi permanent doctor’s office has been set up to be able to give more in-depth and sterile examinations to people who can make it there.

Because living in these conditions often results in shortened lifespans, Bauer said street rounds are critical to this population.

“Sadly enough the average lifespan for a homeless male is 58 years old. The average for a homeless female is 47,” Bauer pointed out. “Living outside is very, very hard on the body, especially when you’re someone who is a smoker, or someone battling addiction.”

Giving Hope to a Forgotten Community

A team of volunteers ranges from a group of three to six who go on the weekly rounds. Bauer is always in the group and so is Doctor William Mercer, the medical director of the Ohio County Health Department.

As Dr. Mercer explains, many of the people he encounters on these rounds end up becoming long term patients.

“A lot of these people I do end up taking care of. I find great reward in having them come to my office, I’m their doctor. It’s special to see them grow,” Mercer said.

Along with emergency medical care, Project HOPE also brings along clean socks, water, and food.

While under the bridge, one man arrived and did not look well. He didn’t want to be tended to medically nor did he want to talk to a reporter. Bauer said it’s very common for people to refuse treatment.

“I look at him and I’ve seen this appearance before and the outcome is usually one that’s not good. We have approximately a dozen people that die every year. And it’s hard, you know?”

Finding Strength in Street Medicine

Bauer said Project HOPE provides more than medical attention. She said visiting every week, you get to know people, their history, what makes them human, and you come to care for them.

“It’s hard for us when they die. We grieve their death. We see things in them that sadly because of mental health and addiction and all kinds of other things they just don’t see in themselves,” Bauer said.

But there are success stories, too. Bauer is especially proud of a couple she met earlier this year.

When Bauer first met Karen and David, Karen’s skin was yellow because of advanced liver disease, and she was using a walker. Now, only four months later, she no longer has that walker, and the couple has just moved into their own apartment.

“Project HOPE has been my lifeline. Honest to goodness, if it wasn’t for Crystal, and Dr. Mercer, and all of the other doctors and nurses involved, I wouldn’t be standing here today,” Karen said. “They just opened up their wings and took us under and ever since then everything’s finally lining back up.”

Project HOPE has recently received funding for a mobile exam room, which will provide a more sterile environment for things like vaccinations, or lancing a wound. Bauer hopes to receive funding to take the program county wide, and hopefully make this her fulltime job.

Right now, only one other well-established organization in the state performs street rounds is West Virginia University’s Multidisciplinary UnSheltered Relief Outreach Of Morgantown or Project Mushroom.

Rural Homelessness, Made Worse By Opioid Crisis, Presents Special Challenges

Charles “Country” Bowers takes long, quick strides down a worn dirt path and is soon in front of a thicket of bushes made deep and tall by spring rains.

He’s leading me on a tour of camps made by homeless people in wooded corners of Fayette County, Kentucky. He stops and lifts a hand to signal that he’s spied something.

Framed by leaves, slightly up the hill, there’s a patch of blue. A tent. He keeps his voice low to avoid startling those inside.

“That’s what you are looking for right there,” he said. “It ain’t as thick as I would like, but you still can’t see it.”

Bowers is tall with a wild beard flecked with gray. His nickname is fitting for someone who figures he’s spent at least half of his 51 years living outside.

He scrambles sure-footed over some rocks to another tent, this one more out in the open.

“Let’s go on down here, my brother might be out here. He’s been out here a lot of years too.”

Bowers calls a lot of people brother. They are mostly men who have been living, as he says, “in the bush” with him for years.

Invisible Problem

Homelessness is often considered an urban problem. But those who work on homeless issues in the Ohio Valley say rural homelessness is a growing problem, too. The Robert Wood Johnson Foundation, NPR, and the Harvard T.H. Chan School of Public Health reported in May that one in three rural Americans say homelessness is a problem in their communities.

As the Ohio Valley’s profound addiction epidemic stresses the social safety net, advocates say more rural people are at risk of becoming homeless. But the scattered and hidden nature of homelessness in rural places makes it an especially hard problem to measure and address.

According to the National Health Care for the Homeless Council, research shows people without any shelter have, on average, drastically shorter lifespans compared to other Americans, as much as 30 years shorter. And a 2018 homelessness assessment report from the Department of Housing and Urban Development found a greater proportion of rural homeless are unsheltered as compared to suburban and urban homeless populations.

Polly Ruddick runs the office of Homelessness Prevention and Intervention in Lexington, Kentucky, and worked for years on homeless advocacy in rural eastern Kentucky.

She said that many homeless camps in the region she serves are in overgrown, thickly wooded areas and hard to find. Many of those camps also pose a health threat.

Some people have tents, but many build a camp from what they can scavenge, like cardboard, or plastic bags, Ruddick said.

Access to clean water is rare. Human waste is, at best, kept in buckets.

“We clean up a lot of buckets with either human solid waste, or human liquid waste,” she said.

Conditions like those contribute to disease, such as the Hepatitis A outbreak which has claimed 58 lives in Kentucky so far and sickened approximately 5,000 people, many of them homeless.

Ruddick sees problems across the state but she said that many elected officials in rural areas are not aware there are homeless people in their communities.

“I had mayors and I had judge executives say right to my face, ‘My community does not have homeless people.’ And my response was, ‘Yes you do. You just either choose to ignore it or you really don’t see it.’”

Support for the homeless in small communities is sometimes provided by churches, she said. But they often lack the money and manpower to create a solution equal to the problem. Ruddick said even counting the rural homeless is challenging, especially if there isn’t a community shelter or established outreach system.

“They are invisible,” she said.

A tent used by a homeless person on the outskirts of Lexington, KY.

“It Was Rough”

“Country” Bowers said he’s met all kinds of people living in camps, and they have all kinds of reasons for being there.

“A lot of people in the world don’t realize it, but they are one paycheck away from being out here with us,” he said.

Jimmy Scott is volunteer coordinator and a board member for the Saving Grace Homeless Shelter in Letcher County, in the rural, southeast corner of Kentucky. He agrees with Bowers. People he encounters in his work might have couch-surfed at first, staying someplace night-to-night with friends or relatives.

But, he said, problems tend to mount. They lose their car. Without available public transportation like a bus, they lose their job.

“When their options are run out, some of them even end up in tents, outside,” Scott said.

When the weather gets bad, things get worse. That is something Bowers knows all too well.

“It’s real, there ain’t no doubt about that. My wife, she passed last year. Technically she froze to death. That’s what they said, it was hypothermia. We had gone to bed about 4 o’clock in the morning, got up about 9:30. I took the blanket off of her and she was froze,” he said, his voice going soft. “It was rough.”

Her name was Cindy Harrison. They had been together for 13 years.

Even after that tragedy, Bowers wasn’t ready to come out of the woods.

“I really don’t like walls too much,” he said. “I never have.” He was also struggling with alcoholism.

“I try to quit drinking out here,” he said. “I’ll tell you what, those seizures, I’ve had four or five in a day sometimes. They ain’t no fun.”

Ginny Ramsey with Catholic Action Center clients during a community meeting.

Ginny Ramsey runs the Catholic Action Center, a Lexington shelter that can hold 400 people. She said plenty of folks, like Bowers, just can’t make themselves come in because of anxiety, PTSD, addiction, or behavior fueled by mental illness that makes it difficult to be around people, what she calls “general orneriness.”

Ramsey said the ongoing addiction crisis makes the problem worse. People from rural communities have long drifted into nearby cities like Lexington, she said. A decade ago, if she had someone come to her shelter from a rural place she’d often be able to find somebody back home who would take them in.

That’s not the case anymore.

“The safety nets that have been in place, they are leaking, they have always been leaking,” she said. “Now, they are getting shredded.”

Sober Living

At Lexington’s Hope Center, another homeless service, development director Carrie Thayer said the increase in opioids has had a dramatic effect.

“Someone can drink and be a functional alcoholic for a long time,” she said. “But the heroin and the fentanyl and all these, they’re so powerful. And so when you get a young person who, you know, starts using, and it can take them down really quickly.”

Thayer said Lexington has a greater number of affordable housing units available than many more rural places. But, she said, much of it is of low quality and in unsafe neighborhoods where the use of drugs and alcohol is prevalent.

Carrie Thayer, left, and Carey Cairo of the Hope Center.

On top of that, a lot of people in recovery have criminal records that may keep landlords from renting to them.

To help combat that, later this summer, the Hope Center is scheduled to open 48 new apartments all designed for sober living.

The studio apartments come furnished with the basics: a bed, a couch and table, appliances and internet service. At least 60 people have applied to live there already.

Thayer said it has all been made possible by a combination of private donations and local, state, and federal government funding.

“When everybody comes together, really amazing things can happen,” she said.

The Hope Center in Lexington is building this 48-apartment sober community near the emergency shelter and recovery treatment center.

A New Role

“Country” Bowers has lived in an apartment for a while now.

It wasn’t until a second friend died, someone he calls “my brother Ray.” Bowers said the man suffered a heart attack just after they’d gotten up early one morning and had a drink to stave off the shakes.

Ray Shackleford was his name.

“I put down the bottle when Ray died,” Bowers said.

It was a little more complicated than that. He went through days of medically supervised detox because he is prone to seizures.

He stayed sober for two weeks, living in the shelter at Lexington’s Catholic Action Center. He spent his days sitting outside the office doors of director Ginny Ramsey.

Eventually, she offered him a job and an apartment.

His new home is in a white wooden house in a poor part of town. He said doesn’t want to show the inside because it needs a good cleaning. His bed was so saggy in the middle he had to put an old door underneath it so it would at least be flat.

Still, he’s grateful.

“You take what’s offered.”

He has found a purpose in his loss by sharing his story and advocating for the homeless community. He has appeared at Lexington city council meetings to urge the approval of a mandatory 21-day notice before city workers tear down a homeless camp on public land.

As we end our tour, Bowers said he still misses the community he lived with for much of his life.

“When I was out here with them we could all stay together.”

ReSource reporter Sydney Boles contributed to this story.