By Elke Weesjes

With record breaking cold temperatures and wind gusts of 30 miles per hour, officials of major cities in the Northeastern United States are declaring Code Blue.

Many cities have Code Blue procedures that mandate more lenient shelter restrictions during extreme cold (check out codes for New York, Baltimore, and Philadelphia for a better idea). These procedures are designed to help get people indoors, extend shelter opening hours, and increase the number of teams that search for homeless people at risk. They also ease capacity restrictions.

In cities with large homeless populations, such as New York, Chicago, Philadelphia, Boston, and Baltimore, volunteers and outreach workers work around the clock to get people—many who have to be coaxed—from the street into shelters and warming centers where they can get a hot meal and a bed. Those who refuse to go to a shelter are given blankets and other items to help them brave the cold alone.

"We're obviously really concerned when temperatures fall that low,” Patrick Markee, deputy executive director for advocacy at the National Coalition for the Homeless, told Reuters. “It can be a matter of life and death on the streets.”

Those without shelter are at risk of hypothermia, frostbite, and other cold related injuries. According to Markee’s organization, hypothermia alone kills an estimated 700 homeless people each year. Considering the deadly consequences of cold weather, one might wonder why some homeless people refuse to take shelter. The most widely cited explanation is a fear of overcrowded shelters.

David Pirtle, a formerly homeless schizophrenic who now advocates for the rights of people experiencing homelessness and mental illness, explained why he avoided shelters in an interview on National Public Radio’s Talk of the Nation.

“Part of the reason was the paranoia and the fear of large groups of people that comes along with schizophrenia, but part of the reason was also, and I think this is more generally the case with people, that you hear a lot of terrible things about shelters, that shelters are dangerous places, that they’re full of drugs and drug dealers, that people will steal your shoes, and that there are bedbugs and body lice,” he said.

After Pirtle overcame his fear of shelters and stayed in one, he quickly realized that most of his worries were true. For the first time in his life, he contracted body lice and his shoes were stolen, he said.

Alongside the distrust and mental illness, drug and alcohol dependency is another reason it’s difficult to convince people to stay in the shelters. Most shelters do not allow intoxicants on the premises. They do, however, sometimes accept people under the influence—especially during Code Blue. The combination of severe overcrowding and intoxicated residents can lead to dangerous tensions that make shelters even less appealing.

Even with these drawbacks to shelter life, there is still more demand for shelter space than there is supply. Cities and shelters are struggling to provide enough beds and resources for the hundreds of thousands of homeless people in the regions hit hardest by the cold. Because of rapidly increasing homeless populations, most shelters in big cities are always at capacity, even when temperatures are not as extreme—and that means when the mercury drops there is no room for the estimated one-third of U.S. homeless that are unsheltered.

The Chicago Coalition for the Homeless estimated that more than 138,000 Chicagoans were homeless during 2013-14 school year—a 19.4 percent jump from the previous year’s number. Now add to that an increase frigid February temperatures as low as -11 F that forced the homeless to flock to Windy City shelters in large numbers. Between 1,100 and 1,200 people—compared to an average of 600 in summer months—sleep at overburdened shelters during extreme weather, according to Stephen Welch of Pacific Garden Mission in Chicago.

“I think we’re probably the only place in the world that has triple bunk beds,” Welch told The Guardian.

The issue of overcrowded shelters brought on by the artic weather is a big problem, but there could be a solution in small places. All over the Northeast, churches and community buildings are opening their doors to those who need a place to sleep.

Take the Riverside Church in the Upper West Side of Manhattan, for example. Although the church already provided food, clothing, and haircuts, church leaders decided they needed to do more for the increasing number of homeless that showed up at the church’s doors so they converted its gym into a refuge for ten people.

The smaller venues allow homeless people that are too wary to go to traditional shelters to remain in the neighborhoods where they feel most at home. And because of their small size, these overflow shelters can offer safety and are able to tailor assistance to people’s specific needs.

More than that, though, they can fill a niche that addresses more than just the need to shelter people from the cold. As Riverside’s Director for Social Services Rev. Debra Northern told the New York Times, they could eventually lead to less homelessness in general.

“If they have some place to rest their heads, it’s a first step in beginning to reclaim other aspects of their lives,” she said.