Darren Ray spent weeks in a room at the Huntsman Cancer Institute this summer, recovering from an operation meant to remove a cancerous tumor from his head.
His stay was longer than expected, as he dealt with surgical complications that left half of his body partially paralyzed. He was eventually deemed well enough to leave, though his treatment would require ongoing, intensive care.
“They said it’s time for you to go home,” the 62-year old recalled, “and I told them I don’t have one.”
Ray’s partner died by suicide before he went into surgery, Ray said. As he healed, no one paid the $964 rent at Ray’s low-income Salt Lake City apartment. He was evicted, according to court records, and lost everything, he said.
On the day of his discharge, the institute confirmed, hospital staff ultimately called Ray a rideshare to a shelter. When he arrived, barely able to carry his belongings and staggering into a scary new chapter of his life, he asked if he could go inside. A woman said no, because he had missed the check-in window, he said.
He spent that first night a few blocks away, sleeping at a familiar park near his old Central City apartment. He was assaulted that evening, he said, but continued to sleep there for about a month, until he finally had some place better to go. All the while, he was making his way up to the University of Utah Hospital for appointments.
People experiencing homelessness are more likely to develop cancer than those who are housed, research has shown. Their increased exposure to the sun and other elements puts them at risk; they may not get adequately nutritious meals, or they may live with long-running infections, such as hepatitis C and HIV; and smoking and drinking alcohol can also be factors, according to a 2022 editorial in the American Society of Clinical Oncology Journal.
They are also more likely to die from the disease, because it’s often caught at a later stage or because they lack proper care, such as preventive screenings, the editorial said.
A new resource center for medically vulnerable Utahns will open in a former motel in Sandy this winter. But the much-anticipated addition comes only after a patchwork of existing safety nets imploded during the pandemic, explained Melody Newey, case management supervisor at Huntsman Cancer Institute.
“The pandemic was essentially an economic, political, public health earthquake,” Newey said, “that just tore everything to shreds.”
‘Cards stacked against you’
Even though Ray was unsheltered and actively fighting cancer, it took several attempts and many referral letters from physicians before he was finally approved in August for a room at The Inn Between, which provides hospice and medical care for unsheltered people with serious illnesses.
He now shares a room there with another patient, their spaces separated by a curtain.
There’s always a waiting list for beds at the inconspicuous center, situated on a steep hill just beneath 1300 East, said Kristiina Rodriguez, the facility’s donations coordinator.
Some emergency space is kept open for people in desperate need. Sometimes, people die less than 24 hours after being admitted, she said. More than 600 people have been in and out of the facility since it opened in 2015, and 122 have died.
“I was hurt bad and living in a park and getting ready to go through radiation. And I got denied here because there was people much worse than than me? Goodness gracious,” Ray said. “How many people are not as bad as me and still need to be housed?”
In Utah, more and more people age 60 and older are seeking shelter, said Sarah Strang, chief operating officer for The Road Home. They’re often on a fixed income and have been priced out of their homes, she said. Many have complicated “health histories.”
”I think a lot of people assume people want to be unhoused and they’re just not doing enough,” said Amy Horyna, manager of patient and family support services at Huntsman Cancer Institute. “But you get enough of the cards stacked against you, it’s really hard to overcome that.”
Take one recent Huntsman Cancer Institute patient — a chronically homeless man with cancer who was also struggling with substance use.
Each patient at the institute is assigned a case manager, and care teams identify gaps that could keep them from getting care, Horyna said. Patients may need transportation, shelter, help finding food or skilled nursing services.
The chronically homeless man needed a reliable way to communicate. The team provided him with a phone so they could update him on his treatment, case manager Sean Hadley said.
Eventually, they were able to find space for him at The Inn Between. The team can also meet people there, or at other care homes, to provide palliative care through a program called Huntsman at Home. And patients can be set up with a Medicaid program called Modivcare, which transports them to and from medical appointments.
“When you don’t have those basic necessities met, it becomes a barrier to completing treatment,” Horyna said, “which for a lot of our patients can be life and death.”
A new place for people to heal
The best bet for surviving cancer is catching it earlier. The Huntsman Cancer Institute recently got funding for a second cancer-screening bus — decked out with a mammogram machine, waiting room and screening area — that travels around the state, providing free screenings to Utahns.
The 4th Street Clinic in downtown Salt Lake City also provides a variety of screenings, including mobile ones, medical director Van Aston said. But some preventive care is harder to provide.
How, for instance, can someone supply a sample for a fecal immunochemical test, to check for colon cancer, if they don’t have a safe, reliable place to use a restroom?
Expecting someone to produce a sample on demand during a walk-in appointment isn’t realistic, he said, and it’s often difficult for unsheltered patients to make follow-up appointments.
“We exist,” Aston said, “because there is a population that needs this kind of service and that needs it desperately, and our current system is woefully incapable of providing it.”
There are steeper challenges for patients seeking long-term care. The Inn Between, where Ray was ultimately placed, has just 50 beds, and 4th Street Clinic can only sometimes temporarily house someone.
In previous winters, medically vulnerable people could try to find shelter at the former Ramada Inn or at The Point, both on North Temple. But such congregate shelters don’t have the staff or bandwidth to help people with serious medical conditions on an individual basis, state homelessness coordinator Wayne Niederhauser said.
At the new center in Sandy, there will be a nurse on staff and other personnel with medical backgrounds. It will offer some of the hundreds more beds that Salt Lake County providers plan to have available to homeless Utahns this winter.
Strang said she is “thrilled” to see the new center, but added that people like Ray and others fighting tough diseases will still need more options. State lawmakers last year allocated tens of millions to fight the state’s homelessness crisis, most of it from the federal government, but since the pandemic, the number of unsheltered people in Utah has increased.
The ultimate solution, advocates say, is affordable housing.
“If we can find the heart, that compassion to care, and make the bigger systemic changes that we need to make housing affordable, reduce the wait lists for public assistance, and housing,” Newey said, “it could really help.”
‘I was unsheltered...because of circumstance’
Ray bustled ahead during a tour of The Inn Between last month, bopping in and out of rooms, offering commentary on the different spaces. Like the music room where he leads piano “jams” with other residents. The laundry room where he washes his clothes — a particular treat after being unable to do so for weeks. And, finally, his own room.
“This,” Ray said, “this is my mansion.”
Before he landed here, he was thrown into a life-on-the-streets crash course. He was too trusting, he said, but eventually met people who helped him survive. His perceptions of unsheltered people changed along the way.
He saw that homelessness “chisels away your identity,” he said, and that many people were like him. They had jobs and families — full, rich lives — and then some unfortunate situation befell them, and they ended up alongside him, on the street.
“Part of the reason why I was unsheltered was because of circumstance,” Ray said, “and I wish I could have, would have, should have done things differently. … I wish I would have saved more money. I wish that I wouldn’t have gotten cancer.”
But he did. And for weeks he fought the disease while living in Taufer Park — the same park he used to pass as he drove to his old apartment, he said, wondering why anyone would choose to sleep outside, and why no one kicked them out.
Correction • Oct. 31, 4 p.m.: This story has been updated to reflect that Huntsman Cancer Institute does not refer unsheltered patients to the American Cancer Society Hope Lodge. It has also been updated to state that the Huntsman at Home program can provide palliative care to homeless patients placed in care homes.