WEEK 6: He Had Heart Surgery. Then He Was Back on the Street.

Last week, I wrote about how decades of housing policy decisions created the shortage we're living with today, and why homelessness is less about individual failure and more about structural math. 

This week, I want to zoom in on another layer of complexity that makes accessing safe and sustainable housing so difficult: healthcare, mental health services, and long-term care for aging or disabled loved ones.

In 2020, during the height of the shutdowns, I met a man who had been sleeping outside while much of the city was closed. He was probably in his fifties, wearing a t-shirt and jeans that were several sizes too big. He told me he'd lost a significant amount of weight after heart surgery and didn't have clothes that fit anymore.

I asked him when the surgery had been. Without hesitation, he lifted his shirt and showed me an incision that still looked fresh. After getting over my initial shock, I told him I wanted to get him into a hotel where he could recover with some dignity, and at least have a private bathroom so he could keep the incision clean and avoid infection.

That moment has stayed with me.

Millions of Americans delay or avoid medical care because of cost, even when they're insured. And if I'm being honest, I'm one of them. I hate going to the doctor. If I told you how long I sometimes wait before scheduling a physical or a dentist appointment, you'd probably shake your head. It's expensive, and if I'm not in real pain, I tend to put it off.

My wife has a chronic health condition, and we're constantly fighting insurance companies and navigating changing rules around medication. Even with resources, phones, and stable housing, the system is exhausting. I can't imagine trying to manage it without a cell phone, without transportation, or without a place to sleep.

Left untreated, health issues worsen. What could have been manageable becomes urgent. Costs rise. People lose work. Medical debt piles up. Too often, illness becomes a direct pathway into financial collapse and housing instability.

Mental health access brings similar challenges. Serious mental illness and substance use disorders aren't always the root causes of homelessness on their own. But when treatment is inconsistent or unavailable, stability becomes incredibly fragile. Long waitlists, fragmented care, and insurance barriers leave many people cycling between crisis and short-term stabilization without sustained support. 

Then there's caregiving, which rarely gets enough attention. Many people experiencing housing instability are caring for aging parents, disabled spouses, or children with complex needs. Over the years, I've met countless people who moved in with an ailing parent, only to find themselves locked out after that parent passed because their name was never added to the lease.

These pressures don't exist in isolation. They compound.

When we ignore these realities, we end up blaming people for "failing" at housing, when what's really failing is the system surrounding them.

This is why shelters stay full, why people cycle in and out of housing, and why solutions focused only on beds or buildings fall short.

Prevention and housing supply still matter, but sustainability matters too.

Stable housing requires stable systems. That means healthcare that is accessible, affordable, and continuous, mental health care that doesn't disappear after a crisis, and caregiving support that doesn't force families into impossible tradeoffs.

Until we address these connected gaps, housing will remain incomplete for many of our neighbors.

Thanks for reading,

Josiah Haken

City Relief, CEO