Unsheltered and sick: Health care services are available, but some houseless people won’t seek help

Robert, 60, frail and hobbled by osteoporosis, spends his nights inside the Nevada Cares campus, the emergency homeless shelter that opened last year in northeast Reno. On some days, he congregates with other houseless people at a nearby closed gas station, shaded from the desert sun.

A reporter asked him whether he sees a doctor about his aching back or other medical needs.

“I do not need anything; I just want to die,” he said.

Robert is among the more than 1,600 people who live on the streets or in homeless shelters. Health care services are available to those folks, but some, like Robert, decline aid. Others wait until medical problems reach crisis levels before seeking care.

“Sometimes they are afraid and anxious of going somewhere completely new and being judged for their condition,” said Alexandra Macrenaris, director of case management at Northern Nevada HOPES, a community health center. Others, she said, may have been mistreated, ignored or embarrassed when they previously sought help.

HOPES, which has two clinics and does outreach, provides medical assistance to houseless people. Some pay a fee, based on their income level, but many receive free, non-judgemental services. “We try to welcome everyone and make them feel accepted,” Macrenaris said.

Once patients receive services, HOPES tries to keep track of them for follow-up care. Many clients are involved in housing programs. Some have cell phones, and the staff calls or sends emails or texts to encourage them to return for continuing health care. The HOPES van provides a needle-exchange service, and the workers can refer people to the clinic. “We (haven’t lately) done a lot of outreach to get patients in to services right now, but are looking at improving that post-pandemic,” Macrenaris said.

Patients who are not enrolled in HOPES programs may get medical services through Hope Springs, a transitional housing service that accepts walk-in clients or community referrals.

The needle-exchange program, called Change Point, provides new syringes and free HIV and hepatitis C testing. HOPES provides follow-up care to HIV-positive patients.

“We understand that if one is houseless and has HIV, they need additional encouragement and a more trusting environment,” Macrenaris said. HOPES works with other agencies to manage services for HIV patients, and its case managers are certified in HIV and case management. Case managers also receive in-service training once a month from insurance agencies, community providers or HOPES personnel.

The pandemic restrictions made it harder to reach houseless people. HOPES is getting back to its full capacity, she said. But sometimes, it can’t provide all the health care services clients need. “If we might not qualify for a certain financial program, we refer patients to the community, and collaborate with providers in the community,” Macrenaris said. “A lot of it is prioritized on the basis of the care that the patient wants.”

According to the February “point-in-time” count, more than 1,605 people in Reno-Sparks lived on the streets and in shelters. That’s a 30 percent increase from 2020, just before the COVID-19 pandemic began. Of the 1,605 people, 1,188 had shelter, including 1,007 in the Nevada Cares campus or at Our Place for women and families, and 181 were in “transitional housing.”

Death on the streets

Melissa Ward, 42, has been houseless off and on since 2007. She said during that time some of her friends died on the streets. In 2021, 54 unsheltered people died, according to the Washoe County medical examiner; 16 of them were women.

“If you are a woman, staying on the streets is just not a safe option for you,” said Ward, who said she doesn’t dare camp alone anymore, because “there are a lot of guys that want to take advantage of you.” The streets have gotten a lot meaner since she became homeless in 2007.

“We may not have liked each other,” Ward said, “but there was more unity even then.”

Ward said some of her friends died of exposure last winter. Despite the dangers of living outside, she avoids going to shelters. She has lived under the sky so long that having a roof overhead makes her uncomfortable. “It can be very claustrophobic,” she said.

Ward experiences occasional seizures and said her medical condition prevents her from holding a job; she cites the seizures as another reason she declines to go to a shelter. “I had been to the Record Street shelter some years ago,” Ward said. “I had seizures, but they would not let me be.”

On the streets, she had a friend who watched over her when the seizures occurred. But shelters separate couples. On the streets, she stays away from large homeless camps and prefers staying with a companion.

When unsheltered people delay or avoid seeking help at clinics until their condition deteriorates, hospital emergency rooms become their “family doctor,” and emergency medical services often are called to assist people hurt or ill at camps or in shelters. The Nevada Cares campus generates about a dozen emergency calls a day for police or medical services. That’s an expensive way to get health care—and taxpayers bear the financial burden.

The Washoe County Commission recently approved a $520,000 contract with MedHealth to provide basic medical care at the Nevada Cares campus. The agreement covers basic health care services for a year.

The county is currently in Phase 2 of campus construction, which will add new laundry facilities, bathrooms and showers, and dorm areas to provide more privacy and security to its clients. Mental health professionals and additional security personnel have been hired, and a new contract is in place with Volunteers of America to manage the daily operations.

The on-site medical services are intended to reduce emergency response calls to the Nevada Cares campus while also providing participants with medical resources. “There are several medical partners on site at the campus,” said Dana Searcy, Cares’ housing and homeless services manager “One of the challenges that we’re finding is that you need insurance in order to work with them, so this bridges that gap allowing for some immediate emergency triage care, so we can stabilize individuals while they’re working with case managers to get on insurance and get them transferred to one of our partners and set up with primary care.”

Though the campus is looking at providing additional sleeping rooms, restrooms, dining spaces and locker areas, the original bed count of 604 beds is not expected to increase. The capacity of the Safe Camp, Cares’ transitional housing, will increase from 44 to 50.

Though the campus is focused on assisting people with permanent housing, staff members also refer clients to other services, including medical care, and mental health and substance abuse services and programs, said Bethany Drysdale, the Washoe County communications manager.

Those resources include Northern Nevada HOPES, Northern Nevada Adult Mental Health Services and the Certified Community Behavioral Health Clinic. The case workers encourage clients to continue their care after transitioning to permanent housing.

Ideally, when patients are discharged from hospitals, workers at the Cares campus would be aware of their medical history and treatments. County officials are working with the facilities to do that. But some houseless patients won’t go to the shelter after leaving the hospitals.

One man in a wheelchair recently sat in Pickett Park across the street from Renown Regional Medical Center, where he had been seen for a routine check up. He declined to provide his name to a reporter. He said he is aware of the Cares campus, but won’t go there.

Sandra Orduno, 33, understands this reluctance to go to shelters. Beginning at age 18, she was houseless for almost 14 years after being evicted from her apartment. Living on the streets led her to alcoholism and drug abuse. She is now helping others who are in the situation from which she escaped.

Orduno is now a certified medical assistant with a degree from Carrington College in Reno. She worked hard to get her life back together with her fiancé. She gives high marks to the health care at Renown and Northern Nevada HOPES.

“These places have great staff who are very understanding,” Orduno said. She also praised Northern Nevada Adult Mental Health Services for its work with houseless people.

The mental health services campus also is scheduled for an expansion. The campus plans to offer mental health and crisis services 24 hours a day, seven days a week, starting in January 2023.

EDITOR’S NOTE: This coverage was made possible by our readers’ generous donations to the RN&R’s Independent Journalism Fund, which is administered by the non-profit Tides Foundation.