This post was originally published on Seattle Medium

By Kiana Birge

As cold weather hits the Puget Sound, members of the community who experience homelessness are at high risk for frostbite and burns, as well as ongoing high rates of substance use. 

The University of Washington Medical Center offers medical care to people who are experiencing homelessness, and they are currently accepting winter donations that can help address these issues related to cold weather. Their priority is to create systemic change in the healthcare field by increasing patient access to healthcare services and harm reduction donations.

Dr. Darrell Owens has practiced hospice and palliative care for 30 years and is a certified grief educator and UW clinical associate professor. He has worked on improving palliative care services for numerous medical centers across Washington state and has experience working with patients who were affected by marginal housing and homelessness. 

“If you look at people who are experiencing homelessness, many don’t have safety and security,” Owens said. “Not enough people acknowledge their grief.”

Owens’ work focuses on the symptoms that impact the quality of life, including physical or emotional pain, and guiding patients through difficult decision making processes. Palliative care is for anybody who has a serious or life limiting illness, whether it be in a hospital or outpatient setting.

People’s behaviors make sense, but we have to be curious. We can look back at this as, had they not been experiencing homelessness, would they have then used these substances?

Dr. Darrell Owens, certified grief educator and University of Washington clinical associate professor.

According to the King County Regional Homelessness Authority, data published in 2022 estimated that 51% of people experiencing homelessness identified as having a disability. Additionally, 31% identified as having a mental health disorder, and 37% identified as having a substance use disorder.

“People’s behaviors make sense, but we have to be curious. We can look back at this as, had they not been experiencing homelessness, would they have then used these substances?”

Owens described how people deal with grief and trauma differently. He believes in finding the root cause of a patient’s behaviors and decision making processes so that he can find them satisfactory care, regardless of their financial status.

For 27 years, Dr. Leslie Enzian has worked as a primary care provider for people experiencing homelessness at UW Medicine Pioneer Square Clinic. She has also been the medical director at the Edward Thomas House Medical Respite, since 1996. The Edward Thomas House is located in a Seattle Housing Authority high-rise building across the street from the Harborview Medical Center Emergency Room. 

“Substance use can increase the risk and development of frostbite injuries,” Enzian said. “Alcohol, for example, causes blood vessels to open up or dilate, so there is more heat loss.”

Enzian explained that alcohol, opioids or other sedating substances can also decrease a person’s awareness of cold injuries. This can result in delayed medical care after significant tissue damage has already occurred.

“With cold-related burn injuries, we sometimes treat patients who fell asleep while they were using a substance, and their tent caught on fire,” Enzian said. “Tent fires are common, as are propane flash injuries from stoves used for heating and cooking”

The Edward Thomas House is a place where people experiencing homelessness can stay to get free medical care if they are too sick to be in a shelter environment and do not require hospital level care. Harborview’s Medical Respite Program was established in 1996 and takes referrals from all over King County. These patients can be referred by a nurse or healthcare provider from a hospital, clinic or shelter setting.

Edward Thomas was a vigilant member of the Seattle community who enjoyed sewing and listening to music. While at the Seattle-King County Medical Respite, he was connected to housing, mental health treatment, and a primary care provider. His story inspires respite staff and patients who are working towards stable housing and equitable access to healthcare. (Portrait photography: Mary Mahar)

In 2011, the Medical Respite at Jefferson Terrace was named after Edward Thomas, a member of the Seattle community, who experienced homelessness and mental illness in life. He came to the Medical Respite to recover from leg wounds, and later received assistance in connecting with a primary care provider. Thomas successfully received mental health treatment and obtained housing.

“Many people are surprised to hear that we have so many frostbite cases,” Enzian said. “Every winter, we have patients with severe frostbite injuries. Last year seemed to be the worst I have seen.”

“Frostbite is a tissue injury related to cold weather exposure,” Enzian explained. “We had a young patient last winter who had a severe frostbite injury that extended past his toes and to the forefoot. He was recommended to undergo a below the knee amputation.”

The Edward Thomas House has 34 beds and a bathroom in each common bedroom. A few bedrooms are singles,  while most others are larger and can fit up to three patients per room. (Photo: Kiana Birge)

In the most ideal situation, a patient who undergoes the surgery and heals would also receive a prosthetic and physical therapy in order to walk again. The Edward Thomas House refers these patients to a prosthetics clinic and physical therapy during their stay.

According to the King County Department of Community and Human Services Cross Systems Homelessness Analysis, at least 40,871 members of the community were experiencing homelessness at some point in 2020. 

Lisa Puliafico has been working closely with UW Pioneer Square Clinic to encourage donations from the community and with Harborview staff. She has worked with UW Medicine for almost 11 years and is the current senior program project manager with Airlift Northwest.

The Medical Respite care team consists of a medical director, on-site registered nurses, mental health practitioners, palliative care, mental health specialists, advanced registered nurse practitioners, medical assistants, and a psychiatric provider. Before 2011, the respite was called the Seattle-King County Medical Respite Program.
(Photo: Kiana Birge)

Puliafico said that adults experiencing homelessness rely on Pioneer Square Clinic for various forms of support, such as primary healthcare, medical prescriptions, donations, social services and dieticians. They also have an on-site pharmacy so patients can get many of their needs met at one location.

UW Pioneer Square Clinic is currently accepting donations for cold weather items. This can include hats, coats, scarves, socks, gloves and blankets. Donations are accepted onsite. 

Brandi Mitchell, business operations supervisor at UW Pioneer Square Clinic, suggests calling their location at (206) 744-1599 or emailing her directly at so donors can describe what supplies they have and schedule a time for drop off.

Puliafico said UW Pioneer Square Clinic accepts new or gently used clothing and winter items for adults. She also said that the clinic is hesitant about taking cotton-based clothing items in the winter because it absorbs moisture and holds onto smells and odors. 

“Cotton does not dry quickly and can increase the risk of frostbite at above freezing temperatures,” Puliafico said.

UW Medicine’s Pioneer Square Clinic is open on weekdays at 206 3rd Ave. S. Seattle. This location accepts appointments and also has a walk-in program where adults can be seen on the same day for acute medical issues. (Photo: Kiana Birge)

Numerous Washington state organizations supporting these members of the community are also accepting winter item donations and volunteers. These local organizations can be found at

King County Regional Homeless Authority is also activating Severe Weather Response protocols during the colder weeks. When these protocols are in place, day centers and shelter capacities are expanded to address increased cold weather related injuries and sickness. Outreach workers and service providers can also request emergency funding for cold weather supplies while these protocols are in place. 

Individuals who would like to supply these organizations with cold weather harm reduction items can also donate to these local organizations, directly. A list can be found at

The post Cold Weather Brings Dire Circumstances For The Unhoused; Donations Can Help appeared first on The Seattle Medium.