The Disproportionate Cost of Chronic Homelessness

Key Insight

Murray Barr, an ex-Marine, epitomized the severe financial burden of chronic homelessness. A large, six-foot-tall man, he frequently fell, requiring two or three people to help him up. Known as 'Smokey' on the streets of downtown Reno, he preferred vodka and would drink cheap 250-milliliter bottles for $1.50 or scavenge half-empty glasses from casinos. Despite his frequent intoxication and occasional abusiveness, he possessed a great sense of humor and a 'half-toothless grin' that endeared him to police officers and social workers who regularly intervened in his life.

During a structured treatment program akin to house arrest, Murray thrived, stopped drinking, secured a job, and saved over 6000 dollars. However, upon program completion, lacking continued supervision, he relapsed, spending all his savings within a week. Police officers, frustrated by the endless cycle of arrests and emergency room visits for individuals like Murray, investigated the costs. They tracked three chronic inebriates through just one of Reno's two hospitals, revealing staggering bills: 100000 dollars in six months for one individual, 65000 dollars in three months for another, and 50000 dollars for a third who had periods of sobriety.

Murray Barr's case alone was estimated to have cost over 1000000 dollars across ten years, encompassing hospital bills, substance-abuse treatment, doctors' fees, and other expenses. Chronically homeless individuals like Murray often suffer from complex medical issues, including severe pneumonia, lung abscesses from aspiration, hypothermia, head injuries from frequent falls (a subdural hematoma can cost at least 50000 dollars to treat), and devastating liver disease. These conditions necessitate repeated, high-cost emergency room visits and intensive care, highlighting that 'not doing something' about chronic homelessness incurs an immense financial outlay on the healthcare system.