Dead by 53: The high health cost of being homeless

PROVIDENCE — Being homeless is dangerous. Very, very dangerous.

There's exposure to the elements: heat stroke, frostbite.

There's exposure to people: COVID-19, pneumonia, other respiratory illnesses. There's the danger of people, being attacked or hit by a car.

One study out of Boston put the mean age at death for being homeless at 53, compared with 77 for the rest of the country, a reduction of 24 years off of someone's life.

The reasons? Everything. Heart disease, overdoses, falls, cancer.

When the most basic need, shelter, is not met

"I really think of it as a risk exposure," Dr. Catherine Trimbur said. "People who are homeless, it puts a very, very significant toll on their body. There's a significant increase in morbidity, in mortality rates, compared to housed people."

Life expectancy goes as low as 42 years to 52 years, depending on the study, and what risks a person faces depends on their living situation. In a shelter, communicable diseases are more prevalent. People on the street are more exposed to the elements, Trimbur said. She is the assistant professor of medicine at Warren Alpert Medical School at Brown University and an attending physician at Transitions Clinic at Lifespan's Center for Primary Care.

In her work in primary care, Trimbur said sees the effects of chronic medical conditions, like diabetes, exacerbated for everyone.

"Diabetes, it can't just be treated with insulin," she said. "You need good food, psychiatric support, nurse care managers, a whole care team to take care of it. Insulin needs to be refrigerated, so that's complicated."

When someone has housing, treatment is easier. They can cook, are sheltered, have a refrigerator, usually can get to the pharmacy, she said.

"We see the downstream effects in the emergency department, where diabetes complications are worse, like wounds, or worse amputations for frostbite, and usually at the point someone needs to go to the emergency department, it's worse than it would be in other settings," Trimbur said.

Trimbur said many of her patients had been at the Cranston Street Armory shelter, which shut down on Monday. She praised the work of Amos House for creating a robust safety net for the state's most vulnerable and marginalized people.

Trimbur said an important aspect of her work, and the work of nonprofits across the state, is centering and hiring people who have the same lived experiences, of homelessness and incarceration.

Where they are: RI to open more than 100 new shelter beds

Amos House Executive Director Eileen Hayes, in a March community meeting, outlined how vulnerable the state's homeless population is, as, by March, 15 people were sent to assisted living facilities from the shelter.

At the beginning of May, the Charlesgate Nursing Center announced intentions to close by the end of the summer.

Crossroads Rhode Island CEO Karen Santilli said she sees how housing changes people.

"When we move people into apartments and then visit nine months later, there has been a huge physical transformation," she said. "People just look healthier."

Will RI step in? Called 'the social safety net in Providence,' this nursing home is closing.

Mental health

Dina Bruce runs multiple shelters for the nonprofit Open Doors, including 55 new shelter beds at the Motel 6 in Warwick. Sometimes she has to call the police because someone comes in who needs to go to the emergency room, often people with mental health issues who are off their medication, sometimes hallucinating. Sometimes it's people with chest or stomach pains.

Miriam Hospital Emergency Department Director Denise Brennan said often unhoused people come into the emergency room with serious symptoms that are diagnosed as being related to stress, including chest pains, abdominal pain and suicidal thoughts. Anxiety and paranoia are often intertwined with unstable living situations, on the street, in a tent, in a shelter.

The uncertainty, the constant need to focus on survival, makes some people develop mood disorders, Miriam Hospital Behavior Health Patient Navigator Elizabeth Padin said.

The financial argument to provide housing

The nonprofit Crossroads Rhode Island is running a pilot program with a health insurer to get its members into housing, help with rent and general case management, Crossroads CEO Karen Santilli said. So far, the nonprofit has been meeting all of the required benchmarks in health improvement, which means the insurance company is saving money.

Creating better health outcomes by providing housing is not a new concept, as Utah aimed to end chronic homelessness in 2005. In 2006, Malcolm Gladwell wrote in the New Yorker about the high cost of homelessness in his article about "Million-Dollar Murray," a homeless veteran in Reno, Nevada who racked up huge medical bills, charged to the state.

Looking for a safe place

At the emergency room, unhoused people show up with all sorts of maladies but many are a direct result, or severely exacerbated, by a lack of shelter, Brennan said.

"We see vitamin deficiencies, changes in mental status because of malnutrition, dental issues, infections, infestations of bed bugs or lice, all issues people are dealing with when they don't have a home," she said.

People come in, looking for a warm meal, asking for clothes to be laundered, to be able to take a shower.

"We're a safety net," Brennan said. "They know they can come here, and they may be suicidal but they can sleep in a safe environment, eat three meals a day, snacks, have access to a shower and bathroom, may be able to get clean clothes, get things here they may not get elsewhere."

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Reach reporter Wheeler Cowperthwaite at wcowperthwaite@providencejournal.com or follow him on Twitter @WheelerReporter.

This article originally appeared on The Providence Journal: The high health costs, and toll, of being homeless