Ron Wright is living a better life. In conversation, he goes out of his way to say that he's not just trying to fly right. "I really don't like saying 'trying' because when you say that, you've got an excuse built right in. But I am doing my best to continue to grow spiritually, to grow physically, and just to give something back. I'll never forget where I've been, but now I'm concentrating on where I'm going."

Where he's been is the streets, drug-addicted, with an injured leg and sick with debilitating asthma. The building he'd been living in burned down, he couldn't find another place, and then he was hit by a car. He wound up in the emergency room, but had no place to go when they patched him up.

Where he's going, he hopes, is a life built on the ten months of sobriety he's already got, a life with a job and an apartment and a faith in God that builds every day, a life whose outlines he can barely make out beyond the work he has to do every day just to get by.

What makes Ron Wright hope for his future is, in fact, his present. Since last October, he has been living in a place called Interfaith House, a rare refuge for a too-small percentage of Chicago's poor. Created in 1994, the same year Ron Wright originally found himself living on the streets, Interfaith House helps homeless men and women who are ill or injured, providing a bed, transportation to hospitals, help in finding a job and a home, as well as spiritual sustenance if the resident chooses to partake. It's a consciously holistic strategy that staff and residents alike are convinced is the key to the facility's unique approach.

The connection between religion and health care for the poor has a rich history. Jews have usually included treating the unhealthy destitute in the injunction to care for "widows and orphans." Jesus' work often entailed healing the outcast and indigent. And the impulse to build hospitals for the poor reaches at least as far back as St. Basil, a Greek Father of the fourth century who constructed a huge facility and frequently berated his wealthy parishioners for not giving enough.

The Sickest of the Sick
One contemporary result of that religiously based motivation to care for the poor, Interfaith House responds to a specific problem: what do homeless people do when they are discharged from the hospital but have no place to go to heal?

When they go back on the streets, they are likely to recover slowly, badly, or not at all. Homeless people like Wright have to be constantly on the move and can't rest properly. Their medications are often stolen, they can't afford to travel back to the hospital for follow-up, and they often end up back in the emergency room.

In fact, even among the poor, whose health is generally worse than the rest of the population, the homeless have significantly greater health problems. Ron Wright's respiratory problem and leg injury turn out to be much more common among those who live on the streets than among the rest of the urban poor, to say nothing of the wealthy, according to a study released last year in the New England Journal of Medicine.

In addition to trauma and lung problems, other ailments with extraordinarily high rates among the homeless include skin disorders and parasites, all resulting from simply not having a clean, dry place to wash off and sleep safely. Other commonalities include extremely high rates of mental illness and substance abuse, both conditions that exacerbate still other health problems.

The study, sponsored by the United Hospital Fund, also focused on the high costs to society of health care for the homeless, who stay in the hospital an average of 4.1 days longer than low-income patients with homes and cost nearly $2,500 more per hospital stay. Those treated for psychiatric problems cost an added $4,000 per stay because doctors and nurses are often reluctant to release a homeless person onto the streets when he is not fully recovered (whereas someone going home usually can rely on family or neighbors for ongoing support).

Advocates for the homeless point out that the way American society effectively turns its back on the poorest of the poor guarantees a cost-inefficient healthcare response to their needs. The Wall Street Journal quoted one of the report's authors as pointing out that "the extra costs for a single hospital admission are as much as the annual welfare rental allowance for a single individual in New York." In fact, a Minnesota study demonstrated that providing housing and social services to 180 homeless people saved the state $9,600 per person, money that would ordinarily have gone to emergency and punitive services like hospital treatments and jails.

Though staff members at Interfaith House are happy to point out that their organization is cost-effective (they are, after all, a non-profit forever scrambling for money to keep the doors open), the institution was founded more as a direct, compassionate response to changing conditions in urban America.

Interfaith House Resident Ron Wright

"Homelessness in the 1980s," says Jeff Pickering, assistant development director at Interfaith House, "was an enormous crisis that people were trying to get their arms around in terms of what were the real causes, what were the real needs, and at first, the response was simply housing, you know, give these people a place to live, which often led to warehousing," providing shelter only without any other supportive human services.

"We began to see that it wasn't just a roof over someone's head that they needed, that there were certain characteristics among the homeless population that required additional assistance and supportive services," says Pickering. In the early '90s, the ecumenical, Chicago-based Interfaith Council for the Homeless began looking around for innovative ways to respond to the problem of illness and injury among the homeless, eventually discovering an abandoned, 60-bed nursing home in a run-down neighborhood on Chicago's West Side.

A Menu of Services
Interfaith House was founded with singleness of purpose: not political advocacy, but service, not long-term housing, but short-term recovery. While advocacy and long-term solutions aren't ignored— staff members are painfully aware of the larger structural causes of homelessness, and in some sense their very presence is a form of advocacy—the focus here is on helping residents, one individual at a time, though always within the context of community.

Residents receive intense attention. After arriving at the two-story 1960s-era brick building in the middle of a tree-lined residential boulevard, each resident is welcomed by a volunteer receptionist and assigned a case manager to facilitate their overall care, which comes from a team of social service and health professionals. They offer, at no cost, food, housing, employment and substance-abuse counseling, educational and financial advice, permanent housing facilitation, transportation, and spiritual sustenance. Residents can even get a little green therapy by helping out in the garden sponsored by the Chicago Botanic Garden (and overseen these days by a former resident, Sally Peterson). There's even an art therapist who volunteers her services.

Not included in that list is direct medical care. Interfaith House is not a medical facility. Two nurses, and soon one doctor, occupy a small corner examining room tucked away on the second floor. But that office is, officially if not spatially, a separate entity, run by outside medical institutions.

Keeping the medical treatment separate and in some ways subordinate has many advantages, not least of which is avoiding the myriad regulations with which medical facilities have to contend. Most of all, though, it allows an entirely different, more caring and humanistic milieu to prevail. Program director Art Bendixen tells the story of a visit from a Boston doctor who came to Interfaith House to offer his advice. He ran a state-of-the-art homeless health clinic, "the best in the country," says Bendixen.

Program Director Art Bendixen

"He gave us some good advice on how to improve . . . but one of the things he told us not to change was the healing, communal atmosphere that he did not have because his is a medical model. There, doctors and nurses rule, here you don't have any of the disciplines rule—it's not a substance abuse treatment or mental health or medical facility. So the model is more holistic. It's the lay people who run the place. Then we can focus on treating the whole person with dignity."

Dignity Rooted in Faith
That word, dignity, is a keystone of Interfaith House's philosophy. It affects everything, according to Bendixen, "even the way we call people over the PA system. We say 'please come' rather than 'please report.' We are very intentional about calling each individual by name." In addition, when residents are discharged, they are always given choices as to where they would like to go. Given the tattered state of the social safety net, they are rarely good choices, but still, it is vital to have options. Indeed, as Bendixen greets the day by walking through the halls, talking to residents, calling them by name, a collegial atmosphere prevails.

The focus on each person's dignity has, for many staff members, a religious basis, Bendixen, a former Catholic priest, says. "My theology is based in the incarnational mode of Christianity. I really do believe that the closest place you can get to God is through other people. I very much believe that God identifies in a special way with those who suffer most in society. I do find that God is very much present in them. When I participate in morning prayer with them, my whole faith gets challenged. Their commitment, their hope, their faith challenges mine. I used to celebrate mass every morning in the parish church, but I find morning prayer here more uplifting, and I think it's because a lot of our residents are struggling with so many issues, that it makes their faith even stronger."

The residents, says Bendixen, "are encouraged to integrate their spiritual life into their healing experience so that it's not a fragmented experience of the body healing here, the psychosocial side healing there, and the spirit healing over there, but an integrated approach."

Indeed, the words "spirituality" and "holistic" fill the speech of both staff and residents alike. "We focus on the whole person," says Tony Hollenback, the social services manager. "We focus on each individual's faith preference, asking them where they're at spiritually, because if you miss that, you're missing something crucial. It helps to understand, for instance, why does that person not take their medication? Why does this person not follow up with the resources available to them?"

Social Services Manager Tony Hollenback

Hollenback says that while many residents report their belief in God has been a source of comfort through the most difficult times of their lives, some forms of quietistic belief can be an obstacle. "Sometimes I get residents and I want to tell them they need to look for housing and avail themselves of services, and they say, 'God will provide' as if it's magic, as if a discharge plan will suddenly appear for them, and that's not the way it works. But that's where they're at, and we need to work with them from that point."

Indeed, personal responsibility and the self-help model—residents staying after they have physically recovered to serve as leaders of the community—are major themes. Ron Wright speaks the language of recovery when he says, "I'm just doing what God's will is today. I'm learning how to be patient, how to be responsible and faithful, and how to listen. When new people come in, I can show them around and show them how this place has helped me, and if they really want it, they can help themselves."

Interfaith House does not require its residents to attend the daily prayer sessions or the impromptu Bible study that takes place most mornings. Respecting each person's dignity requires avoiding coercion. Still, most residents participate, and the gentle, surprisingly upbeat atmosphere of the place seems to result from such constant reminders of God's presence. As Wright says, "A lot of people from here go to church every Sunday. It helps me just to really be uplifted, to be honest with myself, and helps me to help others."

The Rare Success Story
Ron Wright is, so far, an Interfaith House success story. And most of the residents leave looking and feeling better than when they walked in. More than half go on to a shelter or better housing opportunities. That's the inspirational part.

The challenging part is that, as the staff members at Interfaith House will admit, most of the 600 residents they take care of each year end up back on the street. "Sometimes we get residents who are doing great here," says Bendixen. "They're working, they're sober, they're saving money, but then they leave this very supportive living environment, go to an apartment all by themselves, and within a couple of weeks we hear they've been drinking again." The permanent success stories are few.

Still, Interfaith House is making a dent in the universe. If nothing else, it provides a place for homeless individuals to rest up before going out to do battle once again with the forces of an often-uncaring society. And Interfaith House represents a call to fulfill the individual and social responsibilities to care for "the least among us."

And it is not an unwarranted optimism in Ron Wright's voice as he talks about his plans for the future, the calling he says he's got to become a minister. It's possible to hope with him as he says, "Things are going to get better. I believe that. I know that. I'm proud of myself today. I've come a long ways."