Desperate to avoid an early death, Michael Jenkins finally found a doctor willing to operate on his damaged liver. But Jenkins knew all along that it was the recovery that was more likely to kill him out here on the city’s streets.
Within days of the doctor creating a shunt via surgery, the 63-year-old homeless man was back in West Nashville sleeping in an abandoned van with flattened tires, a broken front-seat window and a hornet’s nest in the air vent.
“I couldn’t even move, and I was sore from head to toe,” said Jenkins, who once battled alcohol abuse and suffers from cirrhosis. “I was so cold, but I slept here a couple nights even though I would wake up and everything was frozen solid.”
Jenkins’s struggle to survive reflects a growing crisis in American cities, which have seen a recent surge in deaths of homeless people due to soaring housing costs, extreme weather, the opioid epidemic, violent attacks and deadly viruses.
Across the country, in cities big and small, the hundreds of thousands of people who lack permanent shelter are facing elevated health risks as communities unsuccessfully search for solutions.
In metropolitan Denver, advocates and social workers documented the deaths of 231 homeless people last year, an increase of 35 percent over 2016, according to John Parvensky, president of the Colorado Coalition for the Homeless. New Orleans officials reported a record 60 homeless deaths last year, a 25 percent increase in two years. In Seattle, 169 homeless people died last year, double the number of homeless deaths recorded in King County, Wash., five years ago, according to the medical examiner.
The trend is affecting cities large and small, with many leaders shocked at how quickly the deaths have risen — even in places with relatively low housing costs — and with how many variables are involved.
“If it was one, people around here would shrug it off because they’ve seen it before,” said Steve Allender, mayor of Rapid City, S.D., population 74,000, which has seen five homeless people die since December. “But to have five deaths, I’m not sure we’ve ever seen that, and it highlights so many issues that are hard to get a grip on.”
The deaths come amid a corresponding surge in homelessness across the United States after a lengthy decline. Last year, for the first time in seven years, the U.S. Department of Housing and Urban Development estimated a rise in the homeless population, with an estimated 554,000 lacking permanent shelter in 2017 — directly affecting about 1 in every 600 U.S. residents.
In Nashville, where cash-strapped musicians once flocked to chase their dreams, the homeless population has grown as the economy has attracted robust health-care and technology industries. With about 80 new residents moving to Nashville each day, average rents increased from $882 in 2013 to $1,148 today citywide. That figure jumps to $1,700 for apartments in the center of the city, according to the Greater Nashville Apartment Association.
Based on an overnight census last year, Nashville officials located approximately 2,300 homeless people; local advocates estimate there are 20,000 people in Nashville living on the streets, in cars, camps, motels or in shelters.
“Housing is health care, so a lot of people are dying unnecessarily,” said Ingrid McIntyre, a Methodist pastor and executive director of Open Table Nashville, a nonprofit that documented the deaths of 124 homeless people last year. “Some of it is people getting hit by a car . . . but a lot of it is just chronic health challenges because they have been living on the streets so long.”
Nationwide, neither HUD nor the Centers for Disease Control and Prevention estimate how many homeless people die each year. But the CDC issued a statement in December noting that with 19 million Americans facing “housing insecurity, and 28 million without health insurance, the risk of homelessness and poor health is a concern for 1 out of 8 Americans.”
In many communities, the nation’s opioid epidemic appears to be hitting the homeless community particularly hard. Drug abuse was linked to nearly one-third of New York’s 311 homeless deaths in fiscal year 2017, according to the city’s Department of Social Services.
In the West, unsanitary conditions led to a hepatitis A outbreak among the homeless community in San Diego and several other California cities last year, killing at least 21 people. A strep bacteria outbreak in Anchorage infected 41 homeless individuals, three fatally, in late 2016 through last spring, according to the Alaska Department of Public Health.
Across the South and Midwest, the winter’s frequent — and highly unusual — Arctic blasts caught many people by surprise, and they were deadly for those without safe places to stay. Eight homeless people died of hypothermia in Atlanta during a one-month span between mid-December and mid-January, the Atlanta Journal-Constitution reported. In Oklahoma City, a house fire in January killed three homeless people seeking shelter from the cold — it dipped into the teens that morning — in an abandoned house.
Hypothermia also was responsible for four of Rapid City’s five recent deaths.
“These encampments are just spreading . . . and with an increasing number of people living outdoors, which is inherently a very unhealthy way to live, we are seeing people dying in the streets,” said Megan Hustings, executive director of the National Coalition for the Homeless.
Nashville’s homeless population has been crowding into tent cities, church sanctuaries or parking their vehicles in shopping center lots once the sun sets. At an encampment under Interstate 24, near Nissan Stadium on the banks of the Cumberland River, more than two-dozen tents rest in a soggy field that collects storm water runoff.
After a recent night of heavy rain, 32-year-old Scott Fyke emerged from his tent with drenched sleeping bags. Fyke said he became homeless about a year ago when he and his girlfriend concluded they could not pay $300 a week to live in a budget motel.
Despite sleeping in his tent next to a propane stove and bathing in water he collects in buckets as it runs off the highway overpass, Fyke says he’s still relatively healthy despite the obvious risks.
“I get a sore throat sometimes, but I think that’s from these,” said Fyke, pulling a Marlboro cigarette from his pocket.
Susan Adcock, an Open Table Nashville street outreach coordinator, said she fields up to 50 calls each day from homeless people or their family members worried about critical health needs.
She said many homeless people lack permanent shelter even though they receive Social Security or other government assistance checks, usually about $500 to $700 a month. The cheapest apartments in Nashville rent for about $600 monthly, advocates say.
Jenkins, who is recovering from surgery, became homeless about two years ago after he finished a 10-year prison sentence for theft. He said he got sober in jail but thinks his record has prevented him from getting a job. He lives off $300 in Social Security benefits each month combined with $211 in food stamps, he said.
After his medical procedure, Jenkins just curled up in the back of a van amid a heap of plastic bags, suitcases and empty water bottles. He’s not sure how long he stayed there before moving.
“I want it brought to the forefront that our government will take a prisoner, who is 100 percent disabled because of a terminal illness, with no family, no money and no place to live, and just put them out here,” said Jenkins, who also has been diagnosed with hepatitis C but is back up and walking. “I’m not ready to throw in the towel, yet.”
The van Jenkins is using for shelter might be helping to save two lives.
A few weeks ago, while Jenkins was recovering from surgery, 67-year-old James George showed up also looking for a place to stay.
George says he’s a retired U.S. Army “nuclear weapons specialist” who previously worked for the Tennessee Valley Authority, which operates three nuclear power plants in the state.
George recently became homeless after someone stole his truck and camper, dashing his plan to travel the West during his retirement years. He said he still receives $1,000 each month in Social Security benefits but is unable to find affordable housing.
“I’m ready to go inside because I am feeling pretty low . . . and would like to have a remote control and TV,” said George, pointing to a severe leg infection that has left him hobbled and largely confined to the van.
Acute medical conditions are just part of the dangers homeless individuals face. Bob Erlenbusch, executive director of the Regional Coalition to End Homelessness in Sacramento, said the population also is facing heightened levels of violence.
The threat arises both from hate crimes as well as attacks or fights among the homeless, such as a stabbing at a Salvation Army shelter in Rochester, Minn., last month that killed two people.
“We are talking about gruesome, gruesome deaths, beheadings, people being set on fire,” said Erlenbusch, who estimates one homeless person dies, on average, every six days in Sacramento.
Kimberly D. Gin, Sacramento County’s coroner, said there are generally more deaths in the general population. Her office handled 500 more deaths last year than it did in 2016, which she believes is linked to an aging baby boomer population and the opioid epidemic. Among the homeless, she said, “you have those same issues.”
Allender, the mayor of Rapid City, S.D., said a sizable share of that city’s growing homeless population appear to be people who refuse help in finding housing or won’t enter treatment for alcohol or drug addiction.
“There are people dying on the streets, but, well, if he hasn’t worked for 25 years, he’s got to die somewhere, so he dies in the street,” said Allender, noting his city’s unemployment rate is 3.5 percent.
But Mike Miller, medical and social services coordinator for the New Orleans Police Department, says it is essential that cities count and document each death. Behind each name and cause of death, he said, is a lesson on how to save someone else’s life.
“As much of this is a list of how many homeless people die, it’s not about this,” Miller said. “It’s about who is next.”
In Nashville’s Madison neighborhood, residents would frequently see 58-year-old Janice James using a wheelchair to push around her belongings. But on Dec. 16, during a cold snap, James was found dead outside Madison First Baptist Church. The medical examiner determined she died of cardiovascular disease, with hypothermia and cirrhosis as contributing factors.
Jay Voorhees, the pastor at neighboring City Road Chapel United Methodist Church, retrieved James’s wheelchair. Voorhees said his church receives as many as 20 visits a day from homeless people seeking food, shelter or other forms of support. He said three homeless people died within a quarter-mile of his church this past winter.
“We as a church don’t think that is acceptable,” Voorhees said. “My congregation tries to do as much as we can, but we recognize our limitations — we are not a social service agency.”
In eastern Nashville, the Green Street Church of Christ has placed 15 micro-homes in its courtyard. The vibrantly painted wooden structures — just big enough to fit a single bed and nightstand — house individuals who first take a pledge of “no drinking, no drugs and no drama.” Caleb Pickering, the pastor, said the camp started about six years ago when a woman came to the congregation and asked if she could pitch a tent to avoid sexual predators on the streets.
“I’m sure we have saved some lives,” said Pickering, adding that it often takes more than two years to find government-subsidized housing in Nashville. “The ones who get out of here the quickest are the young ones, who are able to work and have a single-minded drive that they don’t want to stay here long, but everyone has the same story: There is no safety net.”
At Nashville’s charity cemetery, McIntyre thinks about that same question. A new grave is dug here every week or two, she said, when someone dies without someone to claim the body or pay for a burial.
As she walked through the rows of donated headstones, McIntyre cited studies that estimate the average life expectancy in the homeless population is between 42 and 52 years, compared with 78 years in the general population.
“You don’t expect people to live forever,” McIntyre said. “But when the longevity of life is cut by 20 years, easily . . . it’s a breakdown in community, and this is where it shows up.”