The thermostat dips well below freezing on a recent November morning as a handful of bundled-up men huddle in a shuttered Higgins Avenue retailer's doorway just north of Broadway. The group includes 58-year-old Jimmi Lee, who says he started living on the streets in 1998. Lee sits in a wheelchair wearing a red hat and multiple jackets, carefully keeping his fingers tucked under blankets that cover his legs. At least he still has his fingers. Lee says he lost his toes to frostbite that set in while he slept outside in sub-zero temperatures a few years back.
Incidents like the lost toes have landed Lee, who says he has no source of income outside of panhandling, in the hospital multiple times over the years. Yet, as another Montana winter settles in, the brown-eyed man with a graying beard says he has no plans to take shelter at the Poverello Center. He'd rather sleep here on flattened cardboard boxes beneath a purple awning.
"I survived this long," he says. "I got another 10 years."
Lee doesn't want to go to the Poverello Center largely because the homeless shelter prohibits drinking on the premises. Lee is what social workers refer to as a "serial inebriate," or a chronic alcoholic. Drinking simply isn't a habit he's willing to give up. That's a particularly defiant attitude in light of the fact that a St. Patrick Hospital and Health Sciences Center doctor told Lee two years ago that his habit will significantly shorten his life.
"I walked out of the hospital," Lee says, "and went right to the liquor store."
Lee's periodic jail visits and the fact that he's unable to afford emergency room visits put a significant strain on community resources. According to Maxine Jacobson, a former University of Montana social work professor now performing a homeless needs assessment for Missoula city and county, serial inebriates like Lee constitute a small segment—roughly 10 percent—of the area's overall homeless population. Yet they consume as much as 50 percent of all resources devoted to serving homeless people.
"The serial inebriates, that's what everybody stereotypes about homeless," Jacobson says. "Primarily, they are a small category of homeless people."
Jacobson's firm, PRAXIS: Building Knowledge for Action, has been hired by the city and county for $15,087 to conduct a comprehensive homeless needs assessment. As part of that assessment, Jacobson last week deployed 70 volunteers to shelters, homeless encampments and social service agencies all over town, directing them to ask 35 questions of roughly 300 homeless people. The results will be shared with stakeholders, including Mayor John Engen's Downtown Advisory Commiss-ion and a team appointed by the mayor's office last spring to specifically address homelessness.
"The intent is to find out what services we have that work well for people experiencing homelessness," says Ginny Merriam, the city's communication officer, who is also helping coordinate the needs assessment. "What services do we not have enough of and we need to develop? And, is there such a thing as having too much of something?"
Preliminary survey data won't be unveiled until late December, but Merriam says stakeholders are already zeroing in on specific concerns and areas for improvement.
"There's a prevailing feeling on the Mayor's Downtown Advisory Comm-ission that we as a community are spending an awful lot of money on, for instance, fire fighter medics and ambulance response to people who are downtown," she says.
Don Whalen, Director of Missoula Emergency Services, a for-profit company operating ambulances all across Missoula County, says between Jan. 1 and July 31 this year he wrote off $120,867 in losses tallied transporting transients to emergency rooms. Sometimes, Whalen says, the same individual is taken to the hospital multiple times a day.
"They're just extremely intoxicated. So, the public calls 911, and we show up," he says. "If they can't take care of themselves, then we take them to the hospital."
One alternative to the emergency room used to be the Western Montana Mental Health Center's Share House. The program, however, lost a federal grant in 2008 that paid for an alcohol detoxification program.
"We lost the funding for that," says Share House Program Director Tim Payne.
The loss means emergency rooms are left picking up the slack. Leanne Vreeland, director of safety and emergency preparedness at St. Patrick Hospital, says 42 percent of all visits to St. Pat's Emergency Department are alcohol related. While not all of those visits are from serial inebriates, they make up a significant portion.
"The unfortunate truth is it's either the jail or here," she says.
The discussion surrounding how best to serve chronic alcoholics and the community they live in constitutes just one of many that will take place as Jacobson shares the results of the homeless needs assessment this winter. Stakeholders will likely hold a public meeting to gather citizen comments on Jacobson's findings in February.
As for Lee, he says he'll probably stay right where he is regardless of what's decided, wrapped in blankets under the purple awning.