The door to our Chevrolet Express opened on my left, exposing us to the sweltering heat that rushed into our van. Stepping onto the road felt like being engulfed in an inferno. The unrelenting sun beat down on my head and shoulders, while its rays radiated off the pavement, cooking my legs. My fellow volunteers and I followed our team leader up the steps to the porch of a light blue, dilapidated two-story house. We were in the heart of the Lower Ninth Ward in New Orleans, the neighborhood that had endured the brunt of Katrina and not yet recovered. Devastation was everywhere, as I looked over the block of damaged houses and torn-up roads.

An African-American man wearing a yellow button down shirt with a white towel over his shoulder answered the door. His name was Devin, and he graciously led us into the living room of his home. As part of a two-week service trip in August before my freshman year of high school, I was there with thirteen teenagers like myself to install energy efficient CFL (compact fluorescent lamp) light bulbs in houses across New Orleans, but especially in the impoverished Ninth Ward. Devin explained that his wife and kids were not home, so we could roam freely and get to work; he had forgotten to inform us of his guests.

It was so hot in the house that none of us wanted to work on the rooms upstairs, and my friend, Isaac, and I reluctantly volunteered. We reached the top of the rickety staircase and proceeded to enter the first room to our right. Propping the door ajar, I suddenly jolted backwards. I had stepped into a room where a woman, a short African-American woman wearing a navy tank top and jeans, was sitting in a chair reading a book only a couple of feet away from me. The bedroom was in shambles: clothes lay scattered across the floor, empty suitcases and plastic bags cluttered the corner, and three children slept on an air mattress positioned in the center of the room. It was shocking and troubling. Before I could open my mouth, I heard loud footsteps behind me. Devin trudged up the stairs and threw his hands up, exclaiming: “I forgot to tell y’all bout my friends!” He explained that they were visiting his family for the week. After apologizing for barging into their room, Isaac and I joined Devin for iced tea on the porch; that’s when he told us the truth about his visitors.

Angela was the woman’s name. She was a single mother, stuck with three young children with no place to go; in other words, they were homeless. Devin had worked with Angela at the local Laundromat until she was laid off. Her predicament worsened when her brother was arrested for selling illicit drugs in her home, causing her eviction. Together with her three kids, the oldest being only nine years old, she turned to walking the streets of New Orleans with no roof over their heads. Devin kindly took them into his home. Angela had been diligently job-hunting without success for the past four months, according to him. As he recounted this story, Devin repeated that Angela was his dear friend and that he would do anything to assist her. But I could sense that he was, in part, putting on a charade. His house was small with barely enough room for his own wife and three teenage daughters, and undoubtedly it was inadequate for hosting another family. I imagined the question that raced through his head at night, keeping him awake: when will they leave?

That surprise encounter with Angela was my first interaction with a homeless family. The image of Angela stayed with me: it became my go-to reference for what homelessness looks like. A single black mother with three small children confined in a cramped room within a deteriorating house was instantly engraved in my memory as the face of homelessness. At that age, I came to believe homelessness stemmed from eviction, losing a job, or becoming overwhelmed with debt—all elements of Angela’s experience. To me, homelessness simply meant becoming financially unstable and unable to afford housing.

That perception was incomplete. It didn’t come close to the full picture.

Soon enough, the picture shifted in my mind.  It happened when, later the following year, I volunteered at a health clinic for homeless men in the Adams Morgan neighborhood of inner-city Washington, D.C. Volunteering at this clinic opened my eyes to a more troubling and menacing phenomenon, chronic homelessness. Interacting with clients who were amputees, plagued by bipolarism and schizophrenia, or recovering alcoholics and drug abusers shaped and colored this new picture of homelessness in my mind. What struck me most was that, unlike Angela and her family, the clients at the clinic were loners: they had absolutely no one else to turn to for help and assistance. They were not in it “together.” I came to realize that becoming homeless was not as straightforward and black-and-white as I had assumed, but rather multifaceted and covered in layers of tragedy.

I began volunteering twice a month at Christ House in my sophomore year of high school. My high school required that we complete one hundred hours of community service before we graduated, and my interest in pursuing medical studies in college led me to Christ House’s front door. I did not know what to expect. Founded in 1985 as the first round-the-clock residential medical facility for the homeless in the United States, Christ House is located only two miles north of the White House in Washington, D.C (About Christ House). Once a doctor in rural Minnesota, the founder of Christ House, Dr. David Hilfiker, moved to the nation’s capital in the 1980s with his family and became one of the first doctors to practice what he called “poverty medicine.” At the time, Reagan administration policies had weakened much of the country’s social safety net, spurring on widespread homelessness in cities like Washington. Strongly motivated by the social justice mission of his church, Hilfiker saw the plight of chronically homeless individuals and established Christ House with other congregants from his church to protect them (Levine). With his commitment to the poor, and his interest in providing onsite medical care, Hilfiker moved into a dilapidated house—once a drug den and home for undocumented immigrants—on Columbia Road in Adams Morgan.

In his 1994 memoir, Not All of Us Are Saints: A Doctor’s Journey with the Poor, Hilfiker reflected on the chronically-ill patients he worked with at Christ House by writing: “the causes of poverty must not blind us to the fact that an unjust society produces a kind of brokenness that cannot always be redressed simply by removing the injustice” (Hilfiker, 24). According to Hilfiker, his patients at Christ House were victims of an unjust society, and their mental and physical disabilities prevented them from escaping that system. They probably didn’t understand the weight of the system. They had no idea how to move ahead.

Patients are admitted to Christ House from hospitals, shelters, and various medical outreach programs. A 2012 survey conducted by Christ House reported that 81 percent of their clients suffered from HIV, drug and alcohol addiction, or mental illness. It also discovered that more than 25 percent of its patients were diagnosed with all three disorders (About Christ House). My first day volunteering shocked me: I never expected to meet the number of mentally-ill patients I had encountered that day. The kitchen and dining room were much smaller than I had expected, too. Christ House provides care to roughly two hundred homeless individuals, but less than half are capable of eating downstairs in the dining room without assistance. The rest of the clients have their nurses deliver food to them in their rooms. No one ate until the chef stood in the center of the room and said grace. They began to eat, but the room stayed oddly quiet; many clients would not talk to one another, their mental illnesses hindering their ability to communicate with each other.

The first dinner I helped prepare and serve at Christ House was tuna potato salad and turkey burgers. All the kitchen volunteers like myself were encouraged to share the meal with the clients. My heart raced as I scanned the room, plate in hand, searching for a place to sit. A tall, African-American man with bandages over his arms and burn scars that covered the back of his bald head signaled for me to sit with him at his table.

I shook his hand and sat down to his left. His name was Harold and he had just recently joined Christ House earlier in the month. The man across from me shook my hand too, but he remained silent during dinner and concentrated on his food. Harold was mentally sane, a rarity among the clients, and had come to Christ House because of his physical injuries that caused him to become homeless. As we finished dinner, I asked him why he was here. Harold turned to me, shook his head and muttered: “damn awful luck.” His story was nothing short of remarkable. How he survived baffled me.

Before Christ House, Harold found out that his mattress was infested with bed bugs and so he decided to use kerosene as an exterminator. Alone in his apartment, while his wife was at work, Harold passed out from the kerosene fumes. He woke up two hours later in the midst of flames engulfing his room. The flames reached him, burning him severely over 60 percent of his body. Somehow in the midst of that inferno, he luckily found a way to jump out of a two-story window to escape death. Uninsured, Harold spent two years in a hospital and burn center, bankrupting him and his family and driving him and his wife into homelessness. Acting indifferent and nonchalant about the incident, Harold must have told this story countless times, I imagined. However, he was in the final stage of his recovery and expected to be discharged within a few months. I came to realize that Harold had hope, something difficult to find within Christ House’s walls.

Harold explained to me that about half of the clients who come to Christ House did not even have the mental capacity to know that they were homeless. How could this be? I pondered. How is it that an individual could be so mentally ill that he is utterly unaware of his place and yet left to fend for himself? Picturing the thousands of homeless that roam my city in such an unstable mental state sent chills down my spine. These people form the majority of the chronic homeless. The Department of Housing and Urban Development (HUD) defines a chronically homeless individual as someone who has experienced homelessness for a year or longer, or who has experienced at least four episodes of homelessness in the last three years, and suffers from a disability. A family with an adult member who meets this description would also be considered chronically homeless (“Chronic Homelessness”).

The 2013 Annual Homeless Assessment Report to Congress included a point-in-time (PIT) survey of the sheltered and unsheltered homeless who are homeless on a given night. More than 400 localities and their “Continuums of Care”—coalitions of homeless service providers—participated in the PIT survey nationwide and, on one night in January 2013, conducted the survey by counting the homeless people in their area. On that single January night in 2013, it was reported that 109,132 people were chronically homeless in the United States (“Part 1: Point-in-Time Estimates of Homelessness,” 1). It was also found that more than half—65 percent—of these chronically homeless individuals were unsheltered (“Part 1: Point-in-Time Estimates of Homelessness,” 1).

Over the past decade, as a result of the federal government’s commitment to end chronic homelessness, the number of chronically homeless individuals in the United States has declined dramatically. The annual PIT surveys report that between 2010 and 2013 the number of chronically homeless individuals decreased by 16 percent (“PIT,” 31). The National Alliance to End Homelessness (NAEH) reports that the steepest decline took place between 2005 and 2008 when the country experienced a 28 percent decrease in chronically homeless individuals. The NAEH suggested that the cooperation between the federal and local governments to secure permanent supportive housing for these homeless individuals had led to this steep decline (“Policy Solutions”).

Permanent supportive housing is defined as housing coupled with supportive services like mental health counseling and financial management. In other words, once permanently housed, formerly homeless individuals coming out of shelters will have the time to fix their problems with some professional support. Also known as “Housing First,” the idea of moving chronically homeless individuals rapidly from shelters into stable and permanent supportive housing has proven to be an effective means for ending chronic homelessness (“Chronic Homelessness”).  NAEH data and research show that Housing First (HF) programs lead to a new life for the chronically homeless. 

The nationwide push to end chronic homelessness has been inspired not only by the sense of social justice of individuals like Dr. Hilfiker but also by dollars-and-cents savings. Each day thousands of chronically homeless individuals use costly public services such as ambulances, emergency rooms, or incarcerations for chronically homeless individuals; in other words, taxpayer money is spent to find them housing in the local hospital or even jail. Investing money in permanent supportive housing ultimately saves public money in the long run.

An experiment conducted by a Housing First (HF) program in Seattle, Washington, found that providing permanent housing to chronically homeless tenants with severe alcoholism saved nearly $30,000 per tenant per year in public services (Larimer). Called 1811 Eastlake, this HF program in Seattle is controversial because it permits alcohol consumption by its tenants. Between March 2005 and November 2007, the 1811 Eastlake HF program compared the costs of 95 participants who were housed and a control group of 39 participants who remained homeless on the waitlist. They measured the costs of services related to jail bookings, days incarcerated, alcohol treatment center use, hospital-based medical services, and Medicaid-funded services for the housed participants relative to the homeless waitlisted ones (Larimer). It was reported that, after accounting for the housing program costs, the total cost savings for housed participants relative to controls averaged $2,449 per tenant per month. The study also finds that typical intervention measures like shelters or abstinence-based programs fail to reduce patterns of chronic homelessness among those with severe alcohol problems (Larimer). Thus the results of the 1811 Eastlake HF study support the notion that the longer a client remains in permanent housing, the lesser the cost burden on public services, thereby illustrating how permanent supportive housing lies at the heart of solving chronic homelessness.

The PIT survey divides the chronically homeless into two categories: sheltered and unsheltered. As stated earlier, the survey reports that between 2010 and 2013 the number of chronically homeless individuals has decreased by 16 percent. While this is heartening news, the PIT survey notes that the decrease in chronically homeless individuals overall is driven by a decrease in the number of sheltered chronically homeless by 32 percent, while the decrease in chronically homeless on the streets has only been 5 percent (“PIT,” 32).

Thus, the plight of the unsheltered chronically homeless has remained fairly unchanged, and the initiative to move chronically homeless individuals from shelters into permanent supportive housing has not been able to reach those who are helplessly roaming the streets. The PIT survey results shed some light on the reasons for the inability of the unsheltered chronically homeless to overcome their situation and find housing: their mental and physical disorders keep them from entering a shelter—that is, from getting any kind of help from the system.

A story I heard from Jeffrey Hollywood, the head chef at Christ House to this day, made me understand what this means. Hollywood is one of the most interesting and humblest people I have ever met. He grew up in inner city Washington and experienced several bouts of homelessness as a child, living with his father in their car for months at a time. After receiving a scholarship to attend George Mason University and training at culinary school, Hollywood climbed the ranks and became a chef in the White House during President Clinton’s eight-year term. The last meal he prepared at the White House was the dinner for George Bush’s inauguration. After that experience, he chose to cook food at Christ House. When I asked him about why he made that decision, he responded: “I gotta look out for my people.”

One of Hollywood’s dear friends at Christ House, Gary, would always loiter around the kitchen before dinnertime and chat with him and the other volunteers. He and Hollywood bonded tightly over their love for the Redskins and their hatred for the Dallas Cowboys. Gary was an old man, nearly seventy, when he passed away from AIDS in my senior year of high school. It was unbearable to see Hollywood the day after Gary’s death. I never heard his full story until Hollywood recounted it to me that day. Gary had been addicted to heroin for almost twenty years, and his addiction drove him into homelessness. Even worse, he had contracted HIV from a contaminated syringe and did not know about it. A fire department rescue team picked him up on a sidewalk less than a mile away from Christ House after he had collapsed from his illness. They believed that he had been infected with HIV for over a year.

That is the problem with many chronically homeless individuals: they wander the streets of our cities, oblivious to their condition. They have nobody. They do not walk into shelters or rehabilitation centers to seek out help. They survive only by chance: Gary was one of the fortunate ones. The only way that they can receive help is if they are found. Given a pair of jeans, they are unable to buckle their belt.

Works Cited

Christ House. About Christ House. 2010. Web. 18 June 2014.

Hilfiker, David. Not All of Us Are Saints: A Doctor’s Journey with the Poor. New York: Hill and Wang, 1994. Print.

Larimer, Mary E. “Health Care and Public Service Use and Costs for Chronically    Homeless Persons With Severe Alcohol Problems.” The Journal of the American         Medical Association. April 2009. Web. 18 June 2014.

Levine, David. “The Good Doctor and the Broken Poor: Reflections on Poverty in the 1980s.” DavidHilfiker.com. DavidHilfiker, June 2013. Web. 18 June 2014.

National Alliance to End Homelessness. “Chronic Homelessness.” 2013. Web. 18 June 2014.

National Alliance to End Homelessness. “Chronic Homelessness: Policy Solutions." March 2013. Web. 18 June 2014.

The U.S. Department of Urban Planning and Development: Office of Community    Planning and Development. “Part 1: Point-in-Time Estimates of Homelessness.”          The 2013 Annual Homeless Assessment Report to Congress. (2013): 1-54. Print.