After learning to walk again, Justin Adkins traded 14 years of on-and-off homelessness and joblessness for a whole other life.
“The top part of my feet had died off. I had real bad arthritis,” Adkins, 37, said. He was diagnosed with a bone disease two years ago.
“I still can’t walk normal. I do need a hip replacement. I will be going to see an orthopedic surgeon this May,” added Adkins.
His May appointment and diagnosis were made through a Memphis clinic run by Baptist Memorial Health Care and Christ Community Health Services. A major player in Adkins’ personal rebound, the clinic helped get him well enough to be hired a year ago to waterproof residential crawl spaces. His paycheck covers his share of premiums on insurance obtained through the Affordable Care Act’s Health Marketplace, popularly known as Obamacare. Adkins’ earnings also pay rent on the residence he shares with two of his four sons. He is proud, he is humbled, he is grateful.
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“All my medications, for the past two years, have been free,” said Adkins, saluting what’s officially dubbed the Baptist Operation Outreach clinic. “I wouldn’t be where I am today without them.”
As Memphis’ only medical facility and mobile unit specifically for homeless patients, Operation Outreach aims to make individuals more aware of and committed to their wellness — even as they face multiple barriers to being safely housed, a key factor in health outcomes.
At a time when homelessness and the needs of homeless patients again are on the rise, the clinic’s nurse practitioners, mental health counselors, physician assistants, social workers, health administrators and support staffers do provide medicine. Equally, they say, they give out necessary doses of moral support, encouragement, even hugs and prayers to patients who are sleeping on the streets or in shelters, on the cusp of not having a roof of their own or recently off homelessness rolls.
Clinic staffers collaborate with caseworkers at Catholic Charities of West Tennessee — its Midtown office building doubles as Operation Outreach’s headquarters — referring patients to potential employers, landlords, food pantries and other essential resources. As needed, patients are connected to optometrists, dentists and physicians who treat diabetes, hypertension, cancer, depression and other disorders that are more prevalent among the homeless community than the housed.
“It’s the little things you do to help them realize their health is important — that ‘Somebody actually touched me today,’” said Kelley Scott, one of the clinic’s nurse practitioners. “Because they’d been to an emergency room where, ‘They came and talked to me, but nobody touched me. You’re touching and listening and asking me to come back.’”
Homeless health needs are substantial but partially known
In 2005, Baptist Health folded the two-year-old mobile unit serving the homeless community into a brick-and-mortar partnership with Christ Community. Ninety-four patients received care that year.
In fiscal year 2023-24, 456 patients were treated through the clinic and mobile unit, which makes stops at The Hospitality Hub, Shelby County Office of Re-Entry, Memphis Union Mission, Willie Mae Brooks Resource Center and Room in the Inn. The Inn temporarily houses patients too fragile to go straight from the hospital back to the streets.
Those 456 patients might or might not have been counted during the Community Alliance for the Homeless’ annual, one-day census of homeless people that critics dismiss as imprecise. In Shelby County, where 75% of the roughly 930,000 residents are Memphians, the count recorded 1,292 homeless people in 2023, 1,022 in 2020, 1,325 in 2019 and 1,566 in 2008. The federal Department of Housing and Urban Development, which oversees the annual homelessness census, has not given the go-ahead for the Community Alliance to publish its 2024 tally.
What’s never been known is just how many of those counted or uncounted who are “experiencing homelessness need medical care … [are] discharged from medical facilities improperly,” the Community Alliance’s Errin Woods wrote in an email to MLK50. “There are many factors and barriers … Those that work with those that are medically fragile and unhoused … do the best they can with very limited resources and funding.”
As planning administrator for this region’s federally mandated continuum of care program, Woods helps coordinate homeless services across varying agencies and organizations.
During the federal government’s one-day survey, 770,000 people nationwide were counted as unsheltered in January 2024, the latest date such data are available. That was an 18% increase over January 2023.
Because the survey is abbreviated, conducted over a few hours, it’s inaccurate and unreliable, some public health researchers contend. The National Homelessness Law Center estimates there are 3.5 million homeless people in the United States. U.S. school districts reported 1.4 million students experiencing homelessness during the 2023-24 school year, according to the most recent federal data.
The perils of living outside of a house
Living or sleeping on the streets, in a car or an accommodation lent by friends or relatives is dangerous in ways most housed people do not understand, said Bobby Watts, chief executive officer for the National Health Care for the Homeless Council, based in Nashville.
“People living on the streets have constant mental stress. And not just a fear of protection or fear for safety, but fear that police may come and jostle you and tell you to get from one place to another,” Watts said. “Every health condition is overrepresented by large margins among people experiencing homelessness. The average age of death for those who die while unsheltered is 20 to 30 years younger than the general population. That is the most fundamental measure of health — whether you’re alive or not.”
Among other initiatives, Watts’ council develops and advocates for health care policy and programs, tracks homelessness and trends in homeless people’s health, and provides technical guidance and support for the nation’s 300 federally qualified health centers for homeless people. Seven are in Tennessee, and three, including Christ Community, are in Memphis. The council also supports 100 respite care centers with temporary beds for those recovering from surgery, radiation or chemotherapy, intravenous antibiotic infusions and so forth.
Since 2021, the 15-bed Room in the Inn has run Memphis’ only such facility. Convalescing patients must be able to eat, dress and do other day-to-day tasks without assistance.
Respite facilities are one of the most important recent innovations for homeless patients. Increasingly those patients are senior citizens, according to a 2024 HUD report also showing a 39% spike nationwide in homeless families with kids between 2023 and 2024. A 2024 University of California at San Francisco study concluded that older adults with disabilities, declining mobility and cognition will require models of care that mostly don’t exist.
Especially during extremely hot or cold weather or environmental disasters, the national health care council’s member clinics ask a flurry of questions about how to aid a diverse demographic of homeless patients, said Cindy Manginelli, community engagement director for the council. It sets recuperative care standards and runs its Institute for Medical Respite Care. “‘Are we going to make everybody come inside?’” Manginelli said, repeating some of those queries. “‘Will we take resources to them?’”
The answers are shaped in light of how homeless people, including the sick and disabled, generally are perceived, Manginelli added. Concerns directed toward her during Kentucky’s deadly floods in February made that plain. “People being helped by the Red Cross may not want to sleep in a tent next to someone who is homeless or who they think is using drugs or may have a mental health condition.”
For homeless people, heeding doctors’ orders is harder
Insufficient data and the need for more medical infrastructure accommodating homeless patients aren’t the only challenges.
More often than those who are housed, homeless individuals have difficulty with everything from adhering to doctors’ orders to securing transportation to medical appointments.
“If you don’t have a safe place to store your [insulin] syringes, that could make you a target, either of people who want to steal them or by the police who may see them as drug paraphernalia,” Watts said.
“The doctor may say, ‘Take this medicine with three meals a day,’ but you may not have access to three meals a day. So, how does that affect your ability to get well? I can go on and on.”
That means patients and their providers must improvise, said Dr. Devora Keller, the national council’s clinical quality and improvement director. “They may have friends or loved ones, where [patients] can go by and pick up a week’s worth of medication at a time,” she said. “Or they may have worked with their clinic to be able to store medications or adjust their medication regimen … ‘We’re going to do once-a-day, instead of three-times-a-day medicine and see how that works.’ It’s tweaking things to see what works.”
For some patients, even agreeing to an in-person meeting with a physician can be fraught.
“There was this one gentleman who watched us for three years before he’d let us see him,” said nurse Janice Taylor, who’s been program director for Baptist Operation Outreach since its inception. “We became his friend, and he became ours. He was a veteran who would not go into the shelters. He had diabetes, hypertension, an intestinal condition that required surgery.”
His death, at age 60, after he’d become an Operation Outreach patient, amplified how widespread and dangerous even preventable diseases are for people without shelter and consistent health care.
That veteran was Black, as are most Memphians and most clinic patients. During the 2023-24 fiscal year, 60% were Black and 70% were male. Regarding their health disorders, for example, 54% of patients had high blood pressure, 48% were chronic smokers and 16% had diabetes.
“By the time we see them,” nurse practitioner Scott said, “a lot of conditions are way past where they should be. Blood sugar is over 600; blood pressure is three digits over three digits. A lot of the conditions go unrecognized and untreated. A lot of that may have to do with their mental health and how they approach their health. Maybe you will be a little more compliant with your physical health if your mental health is under control …
“And if they don’t have insurance, it’s months before we can get them to the pulmonologist or the cardiologist …
“But we’ve got free medications, dieticians, ways to try and take care of you until you get to the proper specialists. We want there to be no barrier for people to come back. We want them to just show up.”
As housing costs soar, having a home remains central to better health
“The first, second and third thing I’d like to prescribe to anyone experiencing homelessness is housing. That is the foundational thing,” said Keller, an internal medicine and addiction medicine physician. “Without that, it’s very hard to fully stabilize someone, no matter how creative or flexible you are with medical care.”
“Some people,” Keller added, “just need a home. Some people need a home and robust services to stay in that home. Maybe they need supportive housing, with mental health and behavioral health and efforts that go into preventing repeat homelessness.”
Yet, 76.5% of people in shelters are, by federal standards, poor. Renting a two-bedroom apartment in Tennessee requires earning $20 to $30 an hour, according to a National Low Income Housing Coalition 2024 report. In Memphis, depending on the neighborhood, the needed hourly wage ranged from $17.88 to $35.
“We have priorities that don’t reflect our care for those who are the least in our society,” said the Rev. Dr. Keith Norman, Baptist Memorial Health Care’s vice president of government affairs and chief community relations officer. “This homeless problem persists and grows as a result of an ever-changing economy and priorities that don’t allow people to maximize their gifts and skills.”
Lack of education or mental health resources — homelessness can trigger and worsen mental disorders — and an array of family crises factor into homelessness, said Norman. “And, then, I have to blame some of it on leaders within the community not putting priority on those who need resources, leaders who choose to develop,” added Norman, pastor of First Baptist Church Broad in Binghampton, one of Memphis’ poorest neighborhoods. Even there, a focus on pricier for-profit commercial and residential projects has overridden the need for affordable housing.
Instilling hope and hoping for healing
When the Holy Spirit moves her, and a patient lets her, formerly homeless Grace Hilton-Young, a spiritual counselor on Baptist Operation Outreach’s payroll, grabs hold of a hand or pulls a quaking body close.
When she leans into those who are leery and afraid, her testimony goes something like this:
“When I came to this clinic, I didn’t have teeth. My kidney was out of order. I had UT infections. I had kidney stones. I needed glasses. I had high blood pressure. I was diabetic. When I came to Christ Community, I hadn’t been to the doctor in 20 or more years. My body was being destroyed by drugs and alcohol, anything that would alter the way I feel. I’d been raped as a kid. I was hurt by the people who were supposed to protect me. After childhood, life happened. And I took the wrong path.”
She stayed on that rough road during 22 years of homelessness.
“Infections in my body were due to my teeth,” Hilton-Young added. “You name it, I had it.
“But, here, I got my first mammogram, my first full physical — and I had had three children. I was 49 at the time.”
Tears fell as she recalled that past. “I went into the clinic,” she said, “thinking people would shun me, that no one would care about me, that I would just be a number, and the more people they saw, the more they would get paid.
“One of the questions they asked was, ‘How many sex partners ‘have you had?’ I had to count the years and multiply the partners. We jokingly laughed about it, but it was one of the things that the doctor took very seriously. And they tested me.”
Health care was an entry point, a pivot that saved her, Hilton-Young said.
At 67, she is a mom reunited with her children and getting paid for what she’d just as readily do for free, she said. Her job is her calling. She is “meeting people where they are,” whether she’s on the mobile van or shuttling between her cubicle and the clinic’s waiting room.
By 10:30 a.m. or so on a mid-winter morning at Baptist Operation Outreach, most of that day’s 20 scheduled patients — from Ph.D.s who’d slammed into very bad luck to persons from generational poverty — had come and gone on to their next stop.
“If they plan to stay at the shelter for free, they have to get there between 9 and 11 a.m. to register,” clinic director Taylor said. “By 12:30, they need to get lunch somewhere … ” For those who don’t want to be on the street overnight, there’s a strict schedule to follow, she added.
Former shelter dweller and ongoing clinic patient Adkins was one of the last to leave Operation Outreach that morning. Moving out of homelessness takes fortitude and luck. It requires patience from the universe of non-homeless people, especially those with the power to make a difference. “Sometimes, people just need a little help,” he said.
Adkins considers himself one of the lucky ones, given the mountain of things homeless people are up against.
“Even as housing has become more limited,” said Baptist Memorial’s Norman, aware of the realities and restating the clinic’s mission, “we’ve seen ourselves go deeper into this area of providing health care.”
With the right medicine and a complement of other resources, he suggested, many homeless patients can experience healing of one sort or another.
“This is an issue of access,” said Tracy McDaniel, Christ Community Health’s CEO. “What we do, with Baptist, is provide that ramp, that runway.”
EDITOR’S NOTE: This story was updated on March 26, 2025, to correct the number of federally qualified health centers for homeless people in Tennessee.
Health and criminal justice journalist Katti Gray’s news coverage has appeared on ABC.com, CBS.com, and in The Guardian US, the Los Angeles Times, Newsday, Reuters, The Washington Post and other publications.
This story is brought to you byMLK50: Justice Through Journalism, a nonprofit newsroom focused on poverty, power and policy in Memphis. Support independent journalism by making a tax-deductible donation today. MLK50 is also supported by these generous donors.