As a young worker growing up in the Marshall Islands, Ruby Jetnil dreamed of retiring to a beach paradise where she could spend her days sipping soda and basking in the sun.
Instead, the now 54-year-old Jetnil tools around the concrete corridors of the Institute for Human Services shelter, where she has lived for two years.
"I fear that I might pass here," said Jetnil, whose sad, dark eyes reveal the hardship of being stranded and disabled far from family and friends. "I think one day they just won’t be able to get me up."
While IHS aims to move most of its shelter guests into transitional or permanent housing within six months, Jetnil represents a growing pool of people whose health care needs, special housing requirements and limited income make for exceedingly difficult placements.
State homeless Coordinator Colin Kippen said preliminary results from a new standardized survey given to more than 500 homeless families since March show that some of the state’s most vulnerable homeless are seniors who have spent years on the streets.
"What have we learned so far? The average age is 61.5, and they have been on the streets an average of eight years," Kippen said.
They are filling up the shelters, too, said Jerry Coffee, IHS clinical director, who estimates that about 60 to 70 percent of IHS’ singles are 45 or older, and trending upward.
For example, the percentage of IHS single-male guests age 62 and older swelled to nearly 10.4 percent in 2014 so far, from 6.75 percent in 2010. Likewise, the percentage of women housed in the shelter’s single women and families facilities who were 62 and older rose to 7.7 percent in 2014, from 6.3 percent in 2010. People in Jetnil’s age cohort, from 51 to 61 years old, make up 22 percent of those in the same facilities.
"Our boomers are booming. Hawaii is the white wave ahead of the pack in terms of longevity," Coffee said. "It only makes sense that we would see our homeless population getting older and, by default, sicker, since life on the street leads to all sorts of medical conditions."
That’s especially true for aging people who entered Hawaii under the Compact of Free Association from island nations in Micronesia, including the Republic of Palau, the Republic of the Marshall Islands and the Federated States of Micronesia. These immigrants are allowed to live and work freely in the United States. But the U.S. 9th Circuit Court of Appeals recently ruled that the state is not required to fund their Medicaid benefits and, as they are not U.S. citizens, they are not entitled to Social Security, disability or entry into many housing programs.
As a result, many are becoming homeless in the land of plenty. At IHS alone, more than 6 percent of the 1,156 adults who were sheltered between July 2013 and June had ties to Compact of Free Association islands.
"Ruby is ready for housing. But she is at a standstill because she is Micronesian and only qualifies for state benefits," said Kimo Carvalho, IHS Development & Community Relations manager. "She does not qualify for Shelter-Plus Care because that is a federal program."
The federal government should provide access to the resources Compact members need, said IHS Executive Director Connie Mitchell.
"There aren’t many housing avenues open to a person like Ruby since most require that the participant have some sort of income," Mitchell said. "The city’s public housing would probably work since it’s based on a percentage of income rather than a fixed amount; however, there’s a lengthy waiting list for those units."
Waikiki health officials said Hawaii needs a long-term plan for housing Compact members, whose homelessness erodes their overall health.
"Sometimes we see women come and their husbands pass away and they can’t work. Other times, we see those who need dialysis," said Waikiki Health Executive Director Shelia Beckham. "Right now Medicaid is covering them, but they don’t always, then we end up paying. We are lobbying at the Legislature for different types of funding to cover those who are ineligible for resources."
In the meantime, Carvalho said IHS is working to place Jetnil through a Shelter-Plus Care Couples Grant. "We need to find someone who meets the homeless criteria under Shelter-Plus Care who is an American citizen and who can be housed with Ruby," he said.
Jetnil said she’s unsure about living with a strange family, based on her history in Hawaii. Her hopes were high in 2007 when she left Micronesia, her boyfriend and two grown children to take a job as a housekeeper and nanny for a Marshallese couple in Hawaii.
"It was OK at first. Then they started mistreating me. They ignored when I was hungry. My trust in them faded. I started living in a car. I was there about two months before another friend brought me to this place," she said. "Being in Hawaii is not actually paradise. I’d go home if I could, but the doctor says that if I do it will just be to pass. Our health care is not as good."
Jetnil said she is grateful to IHS for providing a roof over her head and for supplying basic necessities such as food and clothing and access to a caseworker and nurse to care for her advanced diabetes and kidney disease. However, living in a crowded, noisy shelter is less than ideal for someone undergoing dialysis. Navigating the shelter’s myriad personalities, including mentally ill individuals, also has proved challenging.
"It’s hard to rest. The food comes by donations, so some of the things that we get like pancake and doughnuts and even eggs and dairy products aren’t healthy for me to eat," Jetnil said. "It’s difficult, but what can I do? I have no place to go."