Brandie Barnes doesn’t know where many of the homeless people in Medford have gone.

When she drove her regular route around town on a recent work day — past the Red Lobster toward the greenway — she wondered where they could be. The library? The YMCA? The mall? Anywhere, she hopes, to escape exposure to the cloak of wildfire smoke that’s been hovering over much of Southern Oregon for weeks.

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"They're trying to scramble and see what services happen to be open," said Barnes, a case manager with Rogue Retreat, a homeless services nonprofit in Medford, Oregon.

Barnes, who's rarely in her office, is usually doing outreach in a county where nearly 700 people counted as homeless in 2017.

Health officials advise people to avoid the outdoors during unhealthy smoke conditions. Multnomah County

Nonprofits like the one Barnes works for say permanent, affordable housing is a solution to many of the problems homeless people encounter. But lately Barnes has had to think hard about how to get more homeless people inside — at least temporarily.

The state’s top health agency has advised that the most effective way to limit smoke exposure is to stay inside. That’s often not an option for houseless people seeking respite from unhealthy air.

"They’re miserable," Barnes said of her clients. "They don’t understand why we can’t open a smoking shelter because the air quality is so poor — and really it needs to be 24 hours but we can’t; there's just nowhere to put them."

Rogue Retreat operates a seasonal shelter from January to the end of March, but has been transitioning its focus to case management rather than emergency shelter.

Barnes said Medford city code only allows Rogue Retreat to operate an emergency or temporary overnight shelter for 90 days each calendar year. Rogue Retreat hit that limit over the winter.

Barnes said she works with one homeless woman who has been hospitalized more than once because of dehydration and problems with exposure to wildfire smoke.

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Kirsten Aird, environmental public health adviser with the Oregon Health Authority, said any amount of indoor respite — no matter how long — helps.

Aird said community and public spaces like malls and libraries are important. Even the tiniest smoke particles can have health impacts, causing shortness of breath of watery eyes.

“It’s so important for people to try and find some space indoors if they can,” Aird said.

“More will help, but we understand how difficult and challenging that may be.”

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The challenge is only exacerbated by the lack of adequate access to health care, said Keith Feher, communications coordinator with Union Gospel Mission in Portland.

Feher said there hasn’t been a noticeable change at Union Gospels facilities, where homeless people in Portland go to receive meals and other services. Fatigue and exposure to the elements are part of the nature of homelessness, he said.

“They’re already facing these health concerns on a regular basis, all year around,” Feher said.

Jackson and Multnomah counties are among several counties across Oregon under a Department of Environmental Quality air quality advisory. Josephine, Jackson, Klamath and Lake counties are under the advisory until further notice. In other areas, air quality is expected to improve on Thursday.

Aird with the Oregon Health Authority said conversations are underway in communities across the state about dealing with normalized smoky conditions in the long term. That includes discussions about smoke-related equivalents to warming or cooling shelters.

“It is on people’s minds," Aird said.

Barnes said Rogue Retreat has distributed about 200 masks to homeless people in Medford.

When it can, Rogue Retreat opens a cooling center and times its meals and operations to give homeless visitors time to digest and absorb nutrients and proteins while they are there. The goal is to avoid hunger later in the day.

Addressing hunger, Barnes said, means cooking, and that requires a heat source. The nonprofit hopes that homeless people who have to spend the night under a blanket of smoke will not also need to light campfires to eat.