Challenged Every Day
There are many different kinds of topics to report on when it comes to helping the homeless. Some very practical ones center on what the unhoused persons face as challenges and difficulties every single day. While helpers are lucky to be able to “take a break” from the worries of the homeless world, those who are out there living in cannot.
Every day presents its difficulties to the people who do not live indoors, behind a locked door. The “unlocked” can face a variety of stressors—heavy rain, deep snow, hot sunlight, hunger, exhaustion, embarrassment, lack of access to transportation, lack of money, big bags to carry, lots of sadness, too much humiliation, no place to keep clean clothes or leftovers or toothpaste, and the constant aches and pains.
Homeless people seem to always be complaining about their constant aches and pains, aren’t they?!
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Some Causes
Let’s go backwards! Let’s start with the causes—and then go to the examples.
Unhoused persons—watch for generalizations—do not have many different physical positions in any given day. Most of their exercise is in the same “plane,” and they lose muscle strength and agility because of this.
What physical positions are common for the unroofed? What are they doing most of the time? Well, they are often walking. They are standing. They are sitting down. They are sitting down even when sleeping—in a chair, on the bus, on the train, up against the corner of a building, up against a dumpster, in a car, in a van, up against a fence, on a bench.
What are unroofed persons NOT doing most days? They are not climbing or descending stairs. They are not running, jumping, leaping, or stretching. They are simply not involved in those activities. They are not bending—as in getting into and out of a small automobile. They are not climbing rope ladders, climbing up into tree houses, or climbing down rungs into a small basement. They are also not engaged in most activities for an extended period of time--this factor being essential for understanding the lack of energy/resilience aspect of physical demands upon the unprotected.
The above are casual explanations for where the symptoms—like aches and pains—come from.
There are also technical explanations—coming from various research studies—to ascertain the causes for the aches and pains suffered by the unlocked. One such study proves in technical language how the lack of flexibility and mobility negatively impact homeless health. In more technical terms, “Proper musculoskeletal health is dependent on the efficient inner workings of muscles, tendons, ligaments, joints, and bones. The homeless experience can be physically debilitating to these tissues and anatomical structures” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6102196/).
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A Terrible Foe
There is another culprit related to the aches and pains—that can be discussed in both casual and technical terms—and that is lack of a good night’s sleep with the person lying down so that all the systems are “go” and good (or better) circulation can prevail.
Bad sleeping conditions, locations, and quality are all factors contributing to pain for the unroofed. While there are other situations contributing to pain, trouble with sleeping quality seems to come up as a standard reason many homeless cannot manage or treat their pain (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3141516/).
There are many accounts of the difficulties or stiffness and leg problems and the like. One unhoused person, who is elderly and has experience living in her automobile, shares this information: “I have less flexibility, mobility, and energy than younger people. I end up having more hospital visits, which are necessary to treat the blood clots in my lungs and edema, or swelling in my legs, that has formed from prolonged periods of sitting in my car” (https://www.vox.com/first-person/2016/9/29/12941348/homeless-over-50-statistic).
When people sleep sitting up, edema (fluid, water) builds up in the legsThe buildup of edema is misdiagnosed as being a symptom of heart disease on a regular basis. Physicians and nurses not familiar with health issues of the unlocked do not know why there is fluid in the legs. . StreetSense has reported on it in the past and another blog has run the story also. It is explained in the StreetSense article:
“One terribly unfortunate side effect of the swelling is that the legs become compromised – meaning, they are not as sturdy and safe as normal legs that are healthy. Why is this a problem? Legs with edema in them are in danger of not healing well if damaged. An example is: a scratch, tear, or puncture in the leg, leading to edema and blood leaking out of the leg and the sore taking a very long time to heal. A bandaid for dealing with the sore is just that – a bandaid… but it is hard to gets a bandaid or gauze to stick to the leg if it is very wet. This is a major problem” (Swollen Legs and the Homeless, by Thomas Hansen, “StreetSense,” March 20, 2022).
This buildup of edema in the legs is found throughout the literature on homeless health. Important also to distinguish in dealing with health issues of the unroofed is that the edema problem is a result of homelessness. There are different kinds of health issues afoot (no pun) and the buildup of fluid comes after one is living outdoors—or at least not in a consistent dwelling intended for individuals to live in long-term—and is a direct result of the sleeping sitting up instead of lying down (Health Problems of Homeless People - Homelessness, Health, and Human Needs - NCBI Bookshelf (nih.gov)).
The edema leads to painful legs, sores on legs, ankles not working right, and lack of energy because of so much attention given to trying to rest the legs, protect them, and care for them.
One Edgewater (Chicago) resident , “Brandon,” who sleeps on Thorndale Avenue, says he is used to “hobbling around like a drunk all day” (Personal conversation, September 29, 2022). At first, he does not want to talk about what he calls “terrible f**king pains in his leg.” Pressed for more information, he responds, “I am trying very hard to get a walker to hold me up, make it easier to walk, and have a place to keep some of my sh*t too.” He claims he has a bad leg but cannot get any help for it no
matter where he goes. He says the best ER is nearby in what he calls a “little boutique hospital with nuns.” They give out sandwiches that he says are “really worth the trip” and he tries to get there about twice a week. He goes there with general pain complaints and all they give him is aspirin. He refuses to share the name because he doesn’t want “every stupid person going there and ruining it for him.”
Another unroofed person, Sue, reports, “I used to wear heels and sh*t when I was in my twenties, but I wound up homeless. Now that my legs are all messed and I’m 50, I don’t think I’ll ever be wearing heels again.” She laughs and says quietly, “At least that way, I can kinda keep my feet happy.” She tells of having to wear slacks and jeans now always, since she has had so many wounds on her legs from the “water” in her legs. She explains that if she gets a cut or a sore on her leg, it takes forever to heal.
Often, the edema in an unroofed person’s legs leads to pains—and legs that don’t work quite right, to use more informal language. This is why the unroofed “walk funny,” often, favoring one leg over the other, using a cane, limping, and simply avoiding walking. The great danger of the edema problem is that the legs suffer over time and make the person increasingly inflexible and increasing sedentary… leading to and eventual lessening of mobility and closer to the end.
Edema is a direct result of homelessness. There are also health issues that arise before one is homeless (alcoholism, mental illness, cancer causing individual to miss work and become fired, etc.) and health issues that complicate the treatment of other illnesses (Health Problems of Homeless People - Homelessness, Health, and Human Needs - NCBI Bookshelf (nih.gov)).
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An Interesting Solution
One very good solution would be to pass a law such that physicians could prescribe housing for the homeless. At least that is what the governor of one state suggested in 2020 when faced with the high number of mentally ill who are also homeless. This shows the scope of the problem. Governor Gary Newsom of California proposed that solution to helping the mentally ill, shortly after he had highlighted homeless issues in his State of the State address that year. He is quoted as having tweeted that there had been very big “failures in our mental health system and disinvestment in our social safety net—exacerbated by widening income inequality and our housing shortage— has led us to where we are today: too many Californians left to live on our streets’” (https://californiaglobe.com/articles/governor-newsom-suggests-doctor-prescribed-housing-for-mental-health-patients/).
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Some Other Solutions
There are a few solutions—to a few different pieces of the puzzle. Unfortunately, most solutions to be proposed will be “bandaids” to the real problem: Unroofed people do not have a roof. If they had a place to live, sleep lying down, dwell, bathe, cook, and convalesce, the above information would not need to be shared.
One general solution is to endeavor to keep unhoused persons mobile.
The less one exercises and tries to move in different planes, the more flexibility and mobility are lost. Helpers (in whatever role) must find ways to keep unhoused persons active. There are even lists of recommendations for how to help persons living in a shelter. Some ideas include basic low-impact exercise and simply encouraging residents to not become too sedentary (https://nhchc.org/wp-content/uploads/2019/08/ShelterHealthGuide0506.pdf).
Another solution is to get the unroofed persons housed.
Yet another solution is to get health care providers “learned up on” some of the causes and problems discussed above.
It is often through neighborhood helpers—angels on the street—that homeless people can “keep truckin” and move forward.
Let us pray it will be soon that the unroofed can move forward into a real dwelling.