Shay Swindall lives in a tent, under a busy Oklahoma City overpass, in a sprawling homeless encampment. When she needed a new albuterol inhaler recently, she tried to ration the last few puffs she had left.
Her health had been fairly good before last winter, though, even at age 64, health care was not something she prioritized. There were times she was taken to emergency rooms for problems that could have been managed at health clinics, she said. But finding a ride to providers can be a real challenge.
Last winter, she became desperately sick with double pneumonia and a supervirus. She lay in her tent for at least three days, wet and freezing, burning with fever.
This was no cold, no simple virus that a few days’ rest would cure.
“It was so bad,” she said. “I was so, so sick. So sick.”
Falling in and out of consciousness, she needed help badly but she was too ill to go find it. Finally, someone noticed her condition and called for help.
“I don’t remember getting on the gurney and I don’t remember getting in the ambulance,” she said.
She does remember fighting off the techs who were trying to insert a device down her trachea. She had no idea what was happening to her.
“It was horrible,” she said, tears spilling down her cheeks.
Swindall’s experience isn’t unusual for people experiencing homelessness, data shows. The stories are individual; some involve COVID-19, HIV, uncontrolled diabetes or high blood pressure. Some people succumb to the ravages of winter with severe frostbite, leaving them without their fingers or toes. Some get too hot under Oklahoma’s blazing summer sun and die.
Without reliable and consistent health care and transportation to appointments, every day is a struggle for people like Swindall. Despite hundreds of health clinics and centers that offer free, or nearly-free services, when people experiencing homelessness get sick, they often suffer until they have no other option than going to an emergency room.
When they are dying, services are even more difficult to obtain.
“When you’re in survival mode, your healthcare is not important to you, because first you’re wanting to make sure you have something to eat, and you have to secure yourself a place to sleep that night,” said Tim Chandler, a licensed practical nurse who heads the Community Health and Wellness Street Medicine program of Mental Health Association of Oklahoma.
A trip to a free clinic means a missed meal at a charity. Being away from camp too long can mean returning to find belongings stolen. A cough or stuffy nose, painful back or headache take a backseat to sustenance and safety.
In 2023, in Tulsa and Oklahoma Counties alone, more than 2,500 Oklahomans lived unsheltered or in homeless shelters, according to that year’s Point in Time counts.
Statewide, a few street outreach teams such as the Street Medicine program, as well as onsite clinics at shelters cater, to the basic health needs of those Oklahomans.
The Homeless Alliance offers onsite clinics through their partnership with Healing Hands, a program of Community Health Charities. They offer transportation to Healing Hands on off days.
City Care’s Mobile Outreach and Engagement program, known as MOE, offers daily rides along a route of nonprofit agencies. Other groups offer similar services.
Still, access to transportation can be a constant obstacle for people experiencing homelessness if they proactively seek healthcare.
“For the most part, when somebody takes suddenly ill in the day shelter or the winter shelter, or is seriously injured, (their option is) EMSA and the closest emergency room,” said Dan Straughan in an email to Oklahoma Watch.
Newly-retired, Straughan is the founder and previous executive director of The Homeless Alliance.
Once a person is stabilized in an ER, most often, they are discharged back to the streets.
According to data that tracked 3,229 cases of hospital discharges of Oklahomans experiencing homelessness in 2022, 172 patients were discharged to a psychiatric hospital, 98 were discharged to a nursing facility and 74 were discharged to an inpatient rehabilitation facility.
A vast majority, 2301, were discharged to home or self-care. Another 331 left against medical advice. That data, provided by the Oklahoma State Department of Health, only includes state-licensed hospitals, and excludes tribal, military and VA hospitals.
We Do What We Can
Nearly every day, Chandler loads up a cargo van with supplies; acetaminophen for pain, saline and triple antibiotic ointment for wounds, blood pressure cuffs, blood sugar tests, bandages, gauze and other over-the-counter medications his clients may need.
Chandler and Chris Allen, a case manager for Mental Health Association Oklahoma, spend their days going anywhere people experiencing homelessness set up camp, to find out how they can help.
The day the Street Medicine team met Swindall, they also met Robert Hairell. At 54, Hairell was recently released from the Jess Dunn Correctional Center. He was more fortunate than some parolees; he had a case manager that set him up with Medicaid coverage, known as Soonercare in Oklahoma.
Hairell was diagnosed with high blood pressure while in prison. Chandler checked his blood pressure, which was 180 over 120; heart-attack territory. Chandler urged him to get treatment that day, but Hairell said he didn’t want to go to an emergency room. He did accept an appointment at Healing Hands.
“It’s an ongoing thing with me,” Hairell said. “It runs in my family. It really doesn’t bother me.”
He hadn’t taken blood pressure meds in months.
About 10 tents were staked under the highway, with 15 to 20 people and several pet dogs living there.
“It’s rough out here,” Hairell said. “We work diligently trying to help each other out, but it’s really hard when you get sick. We need consistency.”
From time to time a church group or other charity-minded people pop in to offer food or clothing, he said, but their energy comes in short bursts. He said people living unsheltered need to build trust with outsiders such as Chandler and Allen.
The two social workers try hard to establish that trust.
Chandler promised he’d be back to take Hairell and Swindall to see a provider at Healing Hands. Allen visited with several people he had been working with to establish Medicaid coverage, obtain replacement identification cards and connect to other resources. Then it was off to the next camp.
Many conditions that send people to ERs can be controlled with medications, diet and lifestyle changes, said Jeanean Yanish Jones, executive director of the Health Alliance for the Uninsured. The nonprofit connects uninsured individuals with primary care doctors, specialists and affordable medication. Jones works to divert people from emergency rooms and help people find the care they need elsewhere.
About 80% of the people Jones serves at HAU are diabetic, she said. Type 2 diabetes is more common among people living homeless than in the general population and it often goes untreated. Without refrigeration, people can’t keep insulin fresh, even if they could afford it. Some clinics opt for insulin in pill form, but the medication is still prohibitively expensive.
Free clinics can be good sources of care for individuals experiencing homelessness. But, Jones said, they are often staffed by volunteers and getting appointments can take time.
Many free clinics and community health centers require ID or social security numbers; for people experiencing homelessness, that can be a problem.
After the ER
After Swindall was discharged from the hospital for her double pneumonia, she recuperated at Cardinal Community House, a respite care facility in downtown Oklahoma City.
Exclusively for those experiencing housing insecurity and physical illness or injury, Executive Director Kelli Ude sees the aftermath of many of people’s unmanaged conditions. One of the only charitable respite facilities in the state, Cardinal House offers a safe place to heal after people with housing instability leave hospitals.
Not all the clients there are homeless, but all have a need for a place to recover. Cardinal House has 40 private rooms that are funded by various hospital foundations and several by Oklahoma County.
Clients recuperating at Cardinal House must be mostly independent in taking care of their personal needs. The respite care facility provides rides to and from treatments such as dialysis and physical therapy, but doesn’t provide medical treatment in-house. Ude is working to break that barrier by expanding Cardinal House’s services.
More than a few people recuperating at Cardinal House on March 28 were recovering from having a foot or lower leg amputated, the result of untreated foot wounds from diabetes.
End of Life on the Streets
When health issues become terminal, there are very few places for people without homes to find end-of-life care in Oklahoma.
People who are homeless and dying might be able to stay in a shelter, but if they can’t take care of themselves because they’re too sick, most shelters aren’t equipped to care for them, Straughan said.
They can go to Gospel of Life Disciples + Dwellings, Oklahoma City’s only completely charitable end-of-life care facility, if there is room. The home has beds for about 5 people but founder Sister Maria Faulkner of the Trinity often makes space for more when she hears about someone in need.
“Some hospices, thank God, will take non-funded patients, but they’re not required to,” Sister Maria said.
Generally, hospice, or end-of-life care is received in a person’s home.
“Those people that don’t have a home to live in can’t receive home hospice,” she said.
When a patient with Medicaid is admitted to a skilled nursing facility for patients with complicated medical needs, or a nursing home, they must stay at least a month or the facility doesn’t get paid. When the outside beckons, people used to living unsheltered may wander off and die, which can be a liability to the nursing facility.
Ultimately, many end up back in emergency rooms.
At the end of life, Chandler said, it’s possible he can help people who are dying find a hospital room if one is available, but if they can’t pay or don’t have insurance, those stays are usually short.
With such limited end-of-life care options for people experiencing homelessness, sometimes Chandler feels deep frustration.
“Where do you go?” Chandler said. “That’s one of my dilemmas here. When you’re unsheltered and have no place to go and you’re at the end of life. Where do you go?”
Heather Warlick is a reporter covering evictions, housing and homelessness. Contact her at (405) 226-1915 or hwarlick@oklahomawatch.org.
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