We are exposed to this issue a lot in the emergency department. My community has a lot of homeless, and a ton of them suffer in the cold by their own lack of care. We have shelters and they won't let people in who are drunk or high. But they don't let them freeze to death either. The cold exposures we get are almost always people who got wasted outside and just passed out until someone called an ambulance. Most cities of any meaningful size have resources, but a lot of people refuse to comply with requirements or put any effort into their own care. We often have people who refuse to even call their own free ride. We have care plans and things that try to help with learned helplessness, but we rarely have time to deal with it. It's a cycle for us. Back to the streets, back to us. We shouldn't have ended institutions in the US.