John Janosko pets his dog on the makeshift patio constructed outside the city-sanctioned cabin shelter site on Wood Street in West Oakland. Photo by Chris Lee
John Janosko pets his dog on the makeshift patio constructed outside the city-sanctioned cabin shelter site on Wood Street in West Oakland. (Chris Lee)

Homeless deaths have surged in recent years. In Oakland, chronic illness and addictions make up most of homeless deaths by 47% and 31%, respectively.

John Janosko has been on and off methamphetamine for the last several years while being homeless in West Oakland. However, it may not be his addiction that kills the 55-year-old. His heart might give up first.

Janosko is one of thousands of homeless residents with comorbidities that put him at risk of an early death.

Homeless deaths have surged in recent years according to the Alameda County 2021 Homeless Mortality Report, the most recent data. In Oakland, chronic illness and addictions make up most of homeless deaths by 47% and 31%, respectively.

“I could literally die, have another heart attack that could kill me, and that scares the hell out of me,” Janosko said.

Poor access to medical care and lack of stable housing are major factors in the mortality of homeless people, according to research by the National Health Care for the Homeless Council. Black men in their 50s and 60s, like Janosko, are overrepresented in the county’s homeless mortality data and continue to die at disproportionate rates. Alameda County estimates that homeless people die 25 years sooner than the rest of the population.

Jenny Tsang, a nurse practitioner who leads one of LifeLong Medical Care’s Street Health teams, said there isn’t enough housing available for Oakland’s aging homeless population to transition into. LifeLong is one of the nonprofits that the county contracts with to provide care to homeless people.

“Sometimes I see people who have been homeless for so long…I hate to say this, but sometimes people die within a few years of being housed because it took so long,” Tsang said.

In addition to LifeLong, the county has contracts with health providers including Alameda Health System and Roots Community Health, among others. While some providers receive federal funds, the city of Oakland doesn’t provide medical care to its homeless population because the region’s public health care is administered by the county.

One spring morning in 2022, after taking a few drags from his meth pipe, Janosko said it felt like a piece of cake was lodged in his throat. An hour later, the pain intensified to a sharp stabbing sensation in his back. He called 911.

“All I remember hearing was, ‘He’s having a heart attack. He’s having a heart attack.’ Then all of a sudden, I was under, and the next thing you know I was waking up from surgery,” Janosko said. “They told me, basically, you need to get clean because the crystal is not helping you at all.”

An emergency room surgeon at Alta Bates Summit Medical Center performed an angioplasty and placed a stent into one of his arteries. After that, Janosko said he managed to stay clean for about six months until evictions at his encampment on Wood Street began to ramp up.

Janosko had been living at Wood Street, once the largest homeless community in the city, for the last seven years. A rash of encampment fires in 2022 prompted CalTrans to remove homeless residents and their belongings off the land underneath the I-880 freeway, displacing 200–300 people. About 70 people moved onto a smaller adjacent parcel owned by the city. Oakland’s Encampment Management Team (EMT) then removed people from that site, known as the Wood Street Commons, in order to develop a mixed-income housing community which originally included 170 units of affordable housing. But affordable housing developments in Oakland remain unaffordable for residents like Janosko. 

In November, Oakland’s Planning Commission issued new development permits for Phoenix Supportive Housing, a 101 unit affordable housing complex at 821 Pine Street. According to SF Yimby, “The residential units will be available as low-market-rate units for residents earning 80% of the Area Median Income (AMI).” 

None of the housing being developed at 821 Pine Street will be accessible to residents who earn less than 80% AMI, or $78,550 as a one-person household.

In March, when the final sweep was imminent, Janosko relapsed.

“I just sorta fell back into it,” he said.

Janosko is enrolled in Medi-Cal. He carries in his wallet a blue-and-white laminated card distributed by Anthem Blue Cross, one of the insurance providers providing a Medi-Cal plan in Alameda County.

A statewide study conducted by the UCSF Benioff Homelessness and Housing Initiative found that of the 3,200 homeless residents participating in the study, two-thirds were enrolled in Medi-Cal. That study also found that homeless people often have difficulty accessing medical services due to extenuating circumstances. Being unsheltered, losing IDs or other documents in sweeps, lacking a cell phone, or reliable form of transportation are some of the barriers, the study said.

Some homeless people distrust doctors or report experiencing discrimination in healthcare settings, according to Tsang.

In Alameda County, many homeless people also reported having a disabling condition or suffering from a psychiatric condition, according to the 2022 Homeless Count and Survey Report. Only 1 in 5 of surveyed individuals reported receiving Medi-Cal benefits.

The Office of Homeless Care and Coordination of Alameda County Health Care Services Agency said in a statement that the lack of coverage is not a barrier to accessing care.

“Our teams work to support enrollment in as many settings as possible, including during street outreach,” the statement said. “Most people experiencing homelessness are eligible for Medi-Cal, and importantly, everyone regardless of citizenship status may be eligible for county-level HealthPAC medical coverage.”

During the COVID pandemic, Medi-Cal coverage was automatically renewed in compliance with the federal COVID-19 health emergency declaration. Once the declaration was lifted, California began to once again require people to renew their eligibility for Medi-Cal each year. The state estimates that millions of people could lose their coverage as a result of this change.

Tsang’s team sees patients whether they have insurance or not, but if a person needs to see a specialist, their lack of health insurance can delay treatment. She described a homeless patient of hers who suffers from a wound that isn’t healing normally.

“We’re in a position where we need to find him, sit down with him and call Medi-Cal with him, which could take like 45 minutes to an hour, before the specialty clinic can see him and bill for his visit,” Tsang said.

Regulatory changes in 2022 have allowed doctors to administer much needed healthcare services directly to people on the street. That innovation, first reported by CalMatters, allows street medicine teams to reimburse themselves by managing their homeless patients’ Medi-Cal benefits.

That means patients like Janosko, who has now been sober for five months and temporarily sheltered at Oakland’s cabin shelter site on Wood Street, can receive prescriptions directly from the street doctor that visits his area. The same physician can also draw his blood to run tests and refer him to a cardiologist.

Dr. Danielle Williams is one such doctor. She is a primary care physician at Roots Community Health Center who directs their Street Team Outreach Medical Program, also known as STOMP. She currently works with homeless people in East Oakland, many of whom stay in RVs. 

“My goal is to keep them alive long enough to get housed,” Williams said. “There’s only so much you can do in the clinic. A lot of the people I see have a lot of barriers in coming to the clinic.”

Addiction medicine and mental health treatment are the two most critically underserved areas of care among Oakland’s homeless population, according to Williams.

Chris Lee is a freelance journalist and visual artist based in Oakland.