Out in the cold

July 15, 2005

DEBRA TIERNEY was not the easiest client. She was often inebriated and incapable of meaningful conversation. She routinely missed appointments with mental health workers. She sneaked swigs of liquor during counseling sessions as other homeless women in her addiction therapy group poured their hearts out about their hard-knock lives.

Social workers tried to help her nonetheless, hoping to eventually get her into long-term treatment and off the streets. It didn't work.

Ms. Tierney was found frozen to death under the Jones Falls Expressway and counted among the 80 homeless people who died last year. She was 46 years old and, in part, a tragic casualty of an inadequate emergency shelter system.

Ms. Tierney was also hurt by the lack of transitional housing services for homeless people discharged from hospitals, drug rehabilitation centers and corrections facilities. She had been hospitalized at Johns Hopkins Hospital for hypothermia just two weeks before her death.

Although hospital social workers typically try to find housing for those being discharged, they are often unsuccessful because of limited bed space at long-term transitional shelters and overnight emergency shelters. Overall, there are 2,439 shelter beds in Baltimore to accommodate an estimated 3,000 homeless people. The majority of the shelters are for men, who make up 78 percent of the homeless population. The shortage leaves homeless women particularly vulnerable to street assaults.

Worried hospital social workers are increasingly unable to help single homeless women find places to stay. For homeless men who don't get a shelter slot, there is at least a 24-hour drop-in center where they can escape bad weather, take showers, get social service referrals. A much smaller center for homeless women shuts down at 7 p.m.

Providing the homeless with permanent and affordable housing should be a high priority for the city, but until that becomes a reality, it should designate an office or a department charged with knowing how many shelter beds are available every night and helping hospitals and other public institutions coordinate with local shelters before discharging people.

Last year, 16,475 homeless people were provided emergency shelter and 19,344 were turned away. Ms. Tierney could have been among those who got a bed one day and was turned away the next. She first showed up at Health Care for the Homeless, a local agency, in the summer of 2003, but her binge drinking and long disappearances made effective treatment impossible.

It took case workers months to figure out Ms. Tierney's behavior. She had survived a house fire that took the lives of two of her children by jumping out of a second-story window. She spent six months in a hospital recuperating, and nurses dubbed her "the bionic woman" because of the extensive restorative work done to her body. Nothing, however, could fix her broken heart. She suffered from severe depression and numbed her pain in the drugs and alcohol that kept her from being helped and finally killed her.

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