Below, is a paper I did on homelessness during my undergraduate days in 1999 at Suffolk Community College in Brentwood, New York. However, I knew I had a burning desire to help stem the tide of homelessness in America, and now I am driven to help our homeless Veterans.

Carol F. Gardener 

HOMELESS PERSON

Who Are The Homeless?

The homeless are younger, more ethnically diverse, and increasingly are more likely to be members of families than is generally believed by the public.

Why Do People Become Homeless?

1. Housing – the supply of housing units for people with low incomes has decreased, while the number of people needing such housing has increased.
2. Income and employment – there has been a tightening of the eligibility criteria for public assistance programs, decline in purchasing power, reduction in benefits.

Samuel Anderson arrived in New York City from his native Oklahoma. He is 24 years old, educated through the 11th grade, and says he left his rural surroundings because there was no opportunity to work. In New York, he is studying for a graduate equivalency diploma and supports himself as an evening security guard; he rented a room in Queens. Five months after starting work, he scuffles with an intruder and suffers gunshot wounds in his right leg and hand. He spent 2 weeks in the hospital. In the meantime, his room in Queens was rented to someone else. After discharge from the hospital, he spends a few nights in a hotel. When his money runs out, he sleeps in a city park, finally going to a shelter. (Taken from Homelessness, Health, and Human Needs, Institute of Medicine).

What Are the Health Problems of the Homeless?

1. Some health problems can cause a person to become homeless, e.g. injury on the job resulting in the loss of employment income. Severe mental illness, alcoholism, drug abuse and recently AIDS (acquired immune deficiency syndrome).
2. Other health problems, e.g. problems resulting from exposure, problems resulting from not being able to lie down, problems such as trauma from being mugged or raped on the streets.

Doris Foy’s varicose veins occasionally result in swollen ankles. When homeless, she sleeps upright, and her legs swell so severely that tissue breakdown develops into open lacerations. She covers these with cloth and stockings enough to absorb the drainage but also to cause her to be repugnant to others because of the smell and unsightly brown stains. An outreach worker eventually brings her to a clinic. When the cloth and the stockings are removed from the legs, there are maggots in the wounds. She is taken to the emergency room of a hospital, where her wounds are cleaned. . (Taken from Homelessness, Health, and Human Needs, Institute of Medicine).

The homeless population is heterogeneous. While there is considerable controversy about the number of homeless people, there is general agreement that the number is becoming larger each year. As the number increases, so do the complexities of the homelessness problem: Why do people become homeless? Which interventions can be used to prevent or resolve the state of homelessness? What strategies must be developed to address the long-term issues involved with this problem?

There are several subgroups within the general population of homeless people: individual adults, families with children, adolescents and young adults, the elderly, and people in rural areas. Together they all share one common problem, the lack of a stable residence; they each have a specific need. The long established system that has traditionally addressed homeless now finds itself confronted with a seemingly overwhelming set of problems.

The causes of homelessness are many and interrelated. The decline in the number of units of affordable housing; the increases in the number of people among the U.S. population who are unemployed; changes in the economy that have reduced employment possibilities for unskilled labor; a tightening of eligibility standards and a reduction in benefit levels for entitlement programs; the change in focus of the mental health system, and change in emphasis from inpatient to outpatient treatment of both acute and chronic physical illnesses. The shelter “system” was never intended to address either the large numbers of homeless people or the complexities of homelessness. Short-term emergency shelter programs including welfare hotels and motels for the homeless are inadequate in response to long-term changes that have caused this problem to grow so dramatically. Homelessness is closely entwined with the aspect of the individual’s well being.

Homeless people experience a wide range of illnesses and injuries and to some extent is much greater than that experienced by the population as a whole. Health problems themselves, directly or indirectly, cause or contribute to a person’s becoming or remaining homeless. The leading health problem with the homeless is mental illness, especially schizophrenia due to the absence of treatment facilities and supportive housing arrangements. Second, the condition of homelessness and the quality of life of a homeless person may cause and exacerbate a wide range of health problems. Ill health can cause homelessness, so can homelessness cause ill health. This includes skin disorders and sequelae of a traumatic injury. The state of being homeless makes the treatment and management of most illnesses more difficult than ever, even if services are available. Examples of this can be found in alcoholism and nearly any chronic illness, such as diabetes or hypertension. As with all other aspects of the problems of homeless people, data on their health problems and health care needs are partial and incomplete. Enough is not known about the health problems of homeless people to provide basic descriptive information and draw inferences for the purposes of programmatic intervention.

Homeless people are a diverse group, the nature of their life situations and the multiplicity of their needs lead to the conclusion that they would benefit from specific approaches in the provision of health and mental health care. Programs have been targeted to certain subpopulations that are delineated by the nature of their health problems.

Just recently William Douglas and Liz Willen (Newsday 12/9/99) did an article “Clash on Homeless”. New York City Mayor Rudolph Giuliani is employing a get-tough policy on the city’s homeless to bolster his likely U.S. Senate bid. Actor William Baldwin and HUD Secretary Andrew Cuomo has accused the Mayor or using this issue to help him politically instead of addressing the needs of these people. Giuliani has threatened to arrest the homeless people who are on the street. Cuomo has not changed his position from 1990 till now by saying “the goal is not just putting someone in a program, it’s making them self-sufficient.”

Recommendations:

1. More than anything else, homeless people need stable residences;
2. People need job opportunities and better income levels to make housing affordable, both to reduce and to prevent homelessness;
3. Supportive services are necessary e.g. job training for homeless people who require assistance and need to establish and maintain a stable residence;
4. Ensuring access to health care for the homeless should be part of a broad initiative to ensure access to health care for all those who are unable to pay;
5. Short-term solutions will not resolve what has clearly become a long-term problem.