Homelessness costs lives and money. An Omaha team is working, street level, to cure what ails.

The man bowed his head and breathed slowly.

Ba-dump. Ba-dump.

As Wayne Birkholtz’s heart pumped, the nurse listened to the rhythm through the stethoscope placed on the 67-year-old’s tanned forearm.

“One-fifty over 88,” Melissa Neuenfeldt said after a minute of silence. “That’s not too bad for just smoking.”

Birkholtz looked at the stub of his flattened cigarette.

“Shame on me,” he said.

“I’m not shaming you at all,” Neuenfeldt said as she unwrapped the cuff from his bicep. “You got bigger problems, Wayne. We gotta find you a nice place to live.”

Birkholtz was not in a doctor’s office. He got his blood pressure read that September afternoon sitting in a camping chair in the parking lot of a northwest Omaha mechanic shop. 

And Neuenfeldt isn’t your typical nurse. She’s a volunteer with HEAL Omaha, a fledgling nonprofit that treats wounds, manages chronic illnesses and delivers medical care to the rising number of Omahans living homeless and unsheltered.

While street medic groups are common across America, HEAL is Omaha’s first. Only two years old, its leaders say it’s vitally important to Omaha’s homeless – and to the city’s hospitals and justice system, too. Living unsheltered can subtract decades from someone’s life. Frostbite, heat exhaustion and raging infections are common. Keeping track of medication while living in a tent or car can prove nearly impossible.

Sometimes those issues balloon into medical emergencies, said Dr. Dalton Nelsen, another HEAL member. Many people living unsheltered often use emergency rooms like the one Nelsen manages at Nebraska Medicine. That can pack ERs, fill hospital beds and cost hospitals – and taxpayers – serious money. Omaha’s unhoused might also end up in the Douglas County jail, which spends about $1.2 million per month treating homeless and housing insecure people, according to its director Mike Myers.

While there are free clinics in the city, getting there, and keeping your stuff from being stolen while you’re gone, can be challenging. So is making health a priority when food, shelter and safety are rarely guaranteed. 

“When you’re in that survival mode,” Neuenfeldt said, “it’s really difficult.”

‘Do you have a doctor?’

The volunteers met at a parking lot on 24th and Leavenworth streets. As the afternoon sun baked the cracked blacktop, Nelsen hopped in the back of Neuenfeldt’s olive green Subaru and started reviewing notes about the night’s patients.

The group goes out once a week for “street rounds” — driving across Omaha to check on existing patients and meet new ones. By the end of next year Neuenfeldt hopes they’re out four times a week. The 2027 goal: a street medic with every homeless outreach team. 

Neunenfeldt hopes that leads to reductions in hospitalizations, calls to law enforcement and medical expenses — success seen in some of the more than 140 cities globally that already have street medicine teams. That will take more money. Last year the group had a budget of $25,000, said Neuenfeldt, HEAL’s chief operating officer. Neither Neuenfeldt nor Nelsen, HEAL’s CEO, are paid.

Right now, HEAL can only see people with the most serious health concerns. But there’s no shortage of need in Omaha, Neuenfeldt said.

HEAL’s first stop during the September street rounds was a mechanic shop on Maple Street. When Neuenfeldt met Birkholtz outside his white Honda Pilot parked there, she asked some questions: How often and what do you eat? Are you sleeping OK? Do you take any medication? Do you have a doctor? How long have you been homeless?

The North Omaha native and U.S. Marine Corps veteran said he became homeless a few years ago when a man ran him out of his house with a machete. He spent time in the Douglas County jail and a psychiatric recovery center.

“Do you struggle with anxiety or depression?” Neuenfeldt asked.

“Anxiety, yeah,” he said. “I’m wound real tight.”

Nelsen stood nearby, trying to set up a cell phone for Birkholtz. While HEAL’s mission is medicine, the overarching goal is to quell the chaos that surrounds homelessness. If Birkholtz has a phone, he could call a doctor or case manager. Nelsen and Neuenfeldt will be able to find him. Finding housing might get easier.

Nelsen couldn’t figure it out. The instructions that came with the $50 prepaid credit didn’t include a phone number. We’ll try again next time, Neuenfeldt told him.

‘Where else would they go?’

Chipping away at Omaha’s homeless problem is a struggle. About 200 people live unsheltered in Omaha —  the third-fastest growing population of its kind in any major U.S. city, according to a count last year. Omaha’s total number is still much smaller than many other cities.

The city’s housing market is short on affordable options and getting more expensive, squeezing out some of the poorest residents. But that’s merely the newest challenge for many of the city’s chronically homeless.

After leaving Birkholtz, Nelsen and Neuenfeldt maneuvered between cars to get deeper into the mechanic’s parking lot. They found Paul Duis reclined in a gray GMC van wedged in the back corner near a treeline. His belly looked bloated under his striped polo. The 65-year-old’s heart failure was likely leading to fluid buildup, Nelsen said. Neuenfeldt suspected Duis might be abusing alcohol but didn’t push it.

Patients like Duis might distrust doctors. Letting them lead the way can build better relationships, Neuenfeldt said.

Duis asked for compression socks to reduce swelling in his legs. No problem, Neuenfeldt said. She’d drop them off next time. She also left a daily pill dispenser to help Duis take his medications.

Duis has a dissociative disorder and phobia of crowded places: “A fear of nowhere to escape to,” he said. He started crying as he recalled a time he took his mom to their favorite Chinese restaurant after his brother died. Housing still feels out of reach. But HEAL adds hope, he said.

Until then he can stay here, tucked in the labyrinth of cars with shattered windshields and missing wheels. As the HEAL duo leaves, Neuenfeldt thanks a mechanic for not driving Duis and Birkholtz away.

The worker shrugs.

“Where else would they go?”

Studying New Numbers

There have been calls by Douglas County Sheriff Aaron Hanson and others to increase fines and penalties for sleeping outside, arguing that it will keep neighborhoods safer while better deterring unsheltered homelessness. Many in the Douglas County jail are either homeless or on the edge, said Myers, and jailing and treating them costs taxpayers millions. In recent years, hospitals nationally have spent billions treating homeless patients, studies show.

In 2022 Mayor Jean Stothert hired Tamara Dwyer to coordinate the city’s homelessness response. A pilot data project is helping her do that.

After her office gets a report of an encampment through the mayor’s hotline or from a city department, Dwyer’s team investigates. When there is a camp, the city scores it based on 31 different criteria and logs it in an online dashboard. The score helps them decide whether to send outreach workers, vacate the property or try something else.

Of the 103 camps the city assessed in the last few months, most were low-risk according to the assessment tool.

Criminal activity, one criteria, is rarely a problem, Dwyer said. She compares crime data in the area before and after encampments’ arrivals and typically finds little to no impact.

Litter is the biggest issue. Cleanup, from picking up trash to using bulldozers to clear large debris, costs the city about $1,900 per camp, Dwyer said.

As the pilot ends this month, the city will tweak the strategy before the mayor’s office decides whether to make it permanent next year, Dwyer said. She hopes it continues, believing it allows the city to make decisions based on evidence and data, not assumptions or fear, she said.

The city’s network of homeless assistance, including a growing number of street outreach workers, is getting more organized, leaders say. HEAL is beefing up its list of volunteer doctors and nurses this fall.

But even in transition, the group’s leaders believe it’s making a difference. Caring for someone’s health, even in small ways, creates a bond.

‘Not my patient anymore’

Patrick O’Connor became homeless a year ago. The 64-year-old was angry and didn’t want help.

Then he met Neuenfeldt and others from HEAL. They seemed to care. He trusted them. Eventually they helped him move into an apartment. 

Neuenfeldt parks in front of his building at 50th and Dodge streets near the end of her recent street rounds. As she walks toward the front door, she sees O’Connor leaning his lanky frame against the stoop.

O’Connor’s first rent check is due. Neuenfeldt is anxious to see him stay here. She knows he’s eager to do more. He wants to work with HEAL.

He also wants something else, Neuenfeldt senses: a hug. But Neuenfeldt has a rule: No hugging patients. 

As she walks up to the apartment building, O’Connor grins and holds his arms wide open. Instead of turning him away, Neuenfeldt wraps her arms around his chest.

She had thought about it on the drive to O’Connor’s building. Now that he has an apartment, the nurse thought, maybe she can relax her rule.

“He’s not my patient anymore,” she says.

Editor’s note: A previous version of this story misspelled Douglas County Director of Corrections Mike Myers’ name.