PORTLAND – About a year ago, Rob Parritt began keeping a three-ring binder in his office at the Oxford Street Shelter to hold the growing stack of doctors’ notes asking the homeless shelter to provide special accommodations for clients with medical issues.

The binder covers now strain to contain the 3 inches of papers that have accumulated over the year.

As Portland’s homeless population continues to balloon – the average number of people on the streets each night jumped by more than 50, to 411, just from May to June – no segment of that population has grown more visibly than those with significant medical needs and physical disabilities.

Parritt’s notes are not always specific; some simply state that the patients should not sleep directly on the floor. Some of the disabled clients have injuries to their feet, to backs, to hips, to heads. Some of those injuries are old, some were incurred on the job.

Some have doctors notes for physical disabilities and undiagnosed illnesses. Kenneth Tilley, a well-dressed man in middle age who said he counseled substance abusers before a back injury forced him to walk with a cane and unable to work, also has a mass in his chest. It would require surgery to diagnose and has gone untreated.

Another man who gave his name as Lawrence, a former clam digger with a lingering, painful foot injury, has a bulge at the base of his neck. It, too, has gone undiagnosed and untreated.

Other chronic and terminal illnesses – HIV, hepatitis, cancer, respiratory diseases, Alzheimer’s – are increasingly represented, said Parritt, who is Oxford Street’s assistant director, and others in the field. There are amputees, homeless people with wheelchairs or oxygen tanks or both, stroke victims.

"Anything that you would associate with a nursing home," Parritt said, but in a population younger by a decade or more.

Most of the people who require beds are in their 50s and 60s, he said, and part of the reason for the drastic increase in their numbers lies in the premature aging of chronically homeless baby boomers.

Some have lived on the streets for years or decades, and the harsh but unsurprising reality of homelessness is that it decreases life expectancy significantly. The few from the older generation who have been on the streets for long periods since the first wave of the homeless epidemic in the 1970s and ’80s are now reaching their twilight years. Others have been in nursing homes, but can no longer afford it.

They keep arriving at the shelter.

"We got three more requests today," Parritt said Friday evening as the shelter’s clients lined up to check in. "You want to accommodate everybody, but we’re out of space."

The care provided by the shelters is limited, almost exclusively, to providing those in need with a bed off the floor. Staffers are not medical professionals, O’Brien said, and they can’t fill the role of a nurse.

Fire codes dictate that the cots must have more space than floor mats, so as more are needed, fewer people can sleep in the shelter.

The shelter opens its doors to the infirm an hour early so that the sick and disabled can avoid the chaos as more than 200 others check in to stay at Oxford Street or the overflow shelter down the street at the Preble Street Resource Center.

In the city’s homeless shelters, able-bodied men and women sleep on green plastic mats, about 6 inches thick, laid on the floor. The Oxford Street shelter once set up five army barracks-style cots each night in an small first-floor laundry room for homeless men whose medical issues prevented them from sleeping on the floor.

Now that room is reserved for men who can’t climb stairs; another 35 beds are kept in two rooms on the second floor for men with doctor’s notes who can climb the steps. Ten more beds are reserved for women with medical needs.

Many of the homeless men and women who need medical accommodations volunteer to give up their beds once they have healed, or give them to those with more pressing conditions, Oxford Street Director Josh O’Brien said.

But healing can take a long time. "Full-time bed rest isn’t an option," O’Brien said. Health conditions that a person with stable housing could recover from are sometimes too much for shelter residents.

The average length of homelessness is higher for people with significant physical disabilities, and it is more difficult to find housing for them, O’Brien said. "If there’s special needs here, that means there’s special needs in whatever housing they achieve."

"The result … is that caseworkers’ time is pulled away from other people" who could perhaps move through the system faster, said Mark Swann, director of Preble Street, where the daytime resource center has become "really more like a MASH unit than anything else."

"Try to find housing for a double amputee with mental illness and a colostomy bag," Swann said.

While some resources are available, including the city’s Health Care for the Homeless clinic, the homeless shelters find themselves overwhelmed by the growth of expanding requests for medical accommodation. Hospitals and other treatment facilities are often reluctant to keep homeless patients for long, and other options are uncertain.

"We feel overwhelmed right now, and if we’re at the tip of this spear," O’Brien said, "… we need to do some significant work to prepare for what to come."

Andrew Cullen can be reached at 781-3661 ext. 100 or acullen@theforecaster.net. Follow him on Twitter: @ACullenFore.