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Daniel Lombardi, for KUED
People who are homeless face many challenges. One of the hardest is what to do at the end of life or when one is ill.

SALT LAKE CITY — Candace Cowles was always anxious, but in late January 2016, she was suffering pain and beginning to panic.

Her hospice nurse ordered a pain pump so she’d get more relief from the disease that was eating at her stomach. Cancer had stolen everything that felt familiar to the 62-year-old — her health, her job, her apartment. It would keep stealing until it got her life.

But though she had become homeless, Cowles would not die alone on the street as many in such straits have done. She would be in a real bed with someone dear sitting vigil beside her.

That someone was a woman named Matilda Lindgren, who’d also been homeless for a time and turned things around before volunteering and later joining the staff at The INN Between, the nation's first residential hospice for dying homeless folks, where Cowles spent her final days.

The INN Between provides residential hospice for homeless people who are dying in Salt Lake City. It's the subject of KUED Ch. 7's documentary "Homeless at the End." | Daniel Lombardi, for KUED

“Don’t leave me,” Cowles pleaded. So Lindgren sat quietly beside her for about three hours, stroking her hand.

“She got more quiet and her breathing more ragged, more shallow. Then she stopped breathing. I just held her hand. That was the first time I was with someone at the end,” said Lindgren.

She and the hospice nurse washed Cowles’ body and dressed her in fresh clothes. Lindgren tenderly brushed her hair and rubbed her skin with lotion so she’d smell good when others who loved her said their goodbyes. Cowles had died sooner than anyone anticipated, but not alone — a prospect that had terrified Cowles, who'd been employed and independent nearly her whole life and would not have predicted her final circumstance.

About 50 homeless people die each year in Salt Lake City. As if homelessness were not challenging enough, those with terminal illnesses sometimes must manage serious sickness while living under viaducts, in a camp or in a crowded dorm-like shelter. The INN Between residential hospice opened in 2015 to provide shelter, comfort and dignity to those who lack almost everything else.

Small plaques on a brick wall mark the passing of the 33 individuals who have died there. The markers are simple — just names and years of birth and death — as humble as the final circumstances of the lives they note.

“I never thought, what is it like to be homeless and sick on the streets, let alone what’s it like to be homeless and dying,” said Nancy Green, the lead producer of “Homeless at the End,” a documentary on The INN Between.

That changed as Green and a team from KUED Ch. 7 worked on the documentary, which focuses largely on INN Between resident Jim Adams, 60, who died of bone and bladder cancer a month after Cowles. The film will debut at a free screening Nov. 1 at 7 p.m. at the Salt Lake City Public Library, followed by a panel discussion on homeless issues moderated by KUER’s Whittney Evans.

“Every major community that struggles with homelessness has a population that has a terminal illness,” said Kim Correa, The Inn Between’s executive director who helped establish the residential hospice. “Most people assume there are community-wide systems in place to house those people and take care of them at the end of life. We didn’t have one. Neither did any other community. They were suffering on the street, in hotels, couch surfing. … And people didn’t know because it wasn’t receiving attention.”

James Adams poses for a portrait on a rainy day at The Inn Between after he'd lived there for about a week. | Daniel Lombardi, for KUED

Hospice care usually requires an address, which homeless people, by definition, lack. But at The INN Between, a former convent at 340 Goshen St. converted to a temporary residence for up to 16 terminally ill individuals at a time, they receive comfort, warmth and regular meals in a safe setting.

And they do not die alone.

The story of the story

Sally Shaum, the film’s director and co-producer, was researching homeless families when she learned of The INN Between. Its story of compassionate care for terminally ill homeless people struck her as a “different way of seeing homelessness,” particularly in a time when some view homeless people contentiously because of crime around the downtown homeless shelter. “When they’re sick, where do they go? Who is taking care of their medical needs or helping them with the heat of summer or cold of winter?” she wondered.

KUED's Shaum, Green, freelance photographer Daniel Lombardi and videographer John Rogers started hanging out at The INN Between when they had time, getting to know the people winding down there and the staff that dedicated itself to helping them. That’s where they met program director Lindgren, who speaks candidly of being homeless herself after relocating to Salt Lake. Her then-husband went back to California and she and her kids stayed wherever they could until she got things turned around.

The film crew also met Adams, who had been evicted from his apartment not long before he learned he had stage four cancer and figured he’d die on the street. He liked to joke about his physical resemblance to murderer Charles Manson. A man with a difficult past, he worked hard to be tender and caring and leave a good impression at the end of his life.

"The Jim we knew was an amazingly good man, a caring person who helped out a lot of the time," said Green.

His gratitude for The INN Between was palpable, said Shaum. “I have never felt such gratefulness." He loved the simple things he found at The INN Between, from the small room he decorated with mementos of his brother's military service to a bathroom with a door. He liked being able to shut the world out and be alone, but he was outgoing, too, and happy to share the story of his good fortune to die among new friends, instead of under the viaduct where he’d lived.

James Adams peaces out back to his small room at The Inn Between, a small nonprofit that opened in the summer of 2015 to provide hospice care to the homeless, where he's been living for the past few months in Salt Lake City, Utah. | Daniel Lombardi, for KUED

“He was a sweet, tender guy with a lot of regrets. He just didn’t want to go out a bad person,” said Shaum. “It was a blessing he had time to be his best. I can’t imagine working on that under the viaduct.”

They became friends and she took him home to meet her family. Their last excursion was to buy inexpensive T-shirts for the others at The INN Between. He died in his sleep 10 days later in his little room, sheltered from the cold outside that he'd dreaded.

Shaum’s parents had died not long before Adams. She tearfully added, “I am happy this homeless person that I came to know could have the hospice care that my parents had — that anyone should be able to have. … It changed me in terms of how I look at homelessness and homeless people. I’ve heard your life depends on your zip code.”

Her wish for the documentary? She hopes policymakers will ask questions before they scoop people up and shuffle them around. She wants them to pay more attention to the mental and physical health of the people on the street. Mostly, she said, “I hope people’s hearts grow a little bigger.”

A place to die

The INN Between was born from the experience of a Huntsman Cancer Center nurse practitioner, Debbie Thorpe, who watched repeatedly as dying cancer patients went back to the streets because they were homeless. Many of them die in place, wherever they’ve staked out a spot.

“They come to homelessness from all walks,” she says in the film. “We don’t worry about their past. There but for the grace of God go a lot of us.”

She got others interested, including a doctor and Correa, who was the development director of Community Nursing Services, a large hospice agency. Over time, they formed the skeleton of a program, convincing nursing homes to donate a bed here and there so hospital discharge planners didn’t always have to send dying people into the streets. Finding an actual building proved more challenging.

Eventually, they secured the old Guadalupe School and convent on Goshen Street, but had to climb through red tape and some community opposition, Correa said. Lindgren notes they are very careful to be good neighbors.

Thorpe now chairs The INN Between’s board of directors.

Life on the street is hard. This person huddles in the cold. | Daniel Lombardi, for KUED

The hospice raises its own funding and relies on the community for donations and for volunteer “housemates” to do simple tasks in three-hour shifts: washing dishes and clothes, making food, cleaning up a little. As bonds form with the residents, volunteers sometimes move into companionship roles. The dying choose those who sit vigil beside them. It is an honor, Lindgren said.

When there’s a rare vacancy, the inn takes in homeless individuals who are acutely sick or injured and need a safe, clean place to recuperate briefly. But waiting lists are much more common. And because it’s a two-level building, even the dying residents must be mobile.

Most of them are estranged in some way from their families. Lindgren works hard to help them re-establish family ties. “That’s just so important before they die,” said Correa. It offers closure and opportunity to make amends. If there's no one else, the city pays for cremation and the INN Between claims the ashes after a 90-day waiting period, then keeps them safe in hopes family will one day ask for them.

Sometimes residents are unwilling or afraid to get back in touch with family. Lindgren tells the story of Jimmy Hew, who finally, reluctantly, told her how to reach his so they’d know that he was gone. “They’d been estranged 30 years and his sisters came out and loved him. When they left, they’d call and tell the staff things to remind him of as he was dying,” Lindgren said. “He had tears running down his face, though he couldn’t speak. Such love is powerful.”

Not so different

Homeless people have had challenges, but they come from all kinds of backgrounds, said Correa, who recalls a former Wall Street stock investor, a nurse and many others that buck public perception of who is homeless.

Sleeping on the street in Salt Lake City. | Daniel Lombardi, for KUED

“I call it falling off the ledge, for whatever reason. Maybe they had surgery and developed an addiction when opioids were prescribed. They get down and don’t know how to get out. It’s not a hand up, it’s like winching them out of the crevasse. They have to be dragged out by someone who really cares. We’ve had plenty who lived a regular life and were college-educated," Correa said.

She likens them to starfish, and with 3,000 on the street in Utah, she admits “we can’t help all of them. But there are 16 at a time we can help. It means a lot to them and also to us.”

The INN Between is a place to be warm and die with dignity and know that someone will remember you were there. On a recent crisp autumn afternoon, Mark Carpenter, one of two staffers who live on site, was talking about those whose names are listed on the memorial wall. Most were in their 50s when they died, which is typical. Homeless life is rough, and people don’t usually live to old age.

“That one was the nicest guy ever,” he said, pointing to a little marker. “That one, too. And this guy was so funny. Just funny. And that one? He grew up right there, just across the street.”

Editor's note: The panel discussion after the screening Nov. 1 will feature Salt Lake County Mayor Ben McAdams; The Inn Between’s executive director, Kim Correa; program director Matilda Lindgren, Ben Jones, who was formerly a hospice resident, and Deseret News reporter Lois Collins.

More information on the documentary is available at KUED.org/events. To RSVP for the screening, email LDurham@kued.org by Oct. 29. The event is co-sponsored by the Deseret News, KUER, Catholic Community Services, the Salt Lake City Library and The INN Between.

Email: lois@deseretnews.com, Twitter: Loisco