The Population of People

who are Homeless

Rosie Anderson, Anna DeCarlo, Abby Kontich, Sam Heidersdorf
April 17, 2019
Definition: Homelessness
● According to the U.S. Department of Health and Human Services (HHS), HOMELESSNESS is defined
as:
○ “An individual who lacks housing… including an individual whose primary residence during the night is a supervised
public or private facility (e.g., shelters) that provides temporary living accommodations, and an individual who lives as a
resident in transient housing”
■ May live on the streets, stay in a shelter, mission, abandoned building or vehicle, or any other unstable or non-
permanent situation (Section 330 of the Public Health Service Act (42 U.S.C., 254b))”
○ May be considered homeless if “doubled up”
■ Situation where individuals are forced to stay with friends or extended family members
○ Previously homeless individuals who are to be released from a prison or a hospital may be considered homeless if they
do not have a stable housing situation to which they can return (National Health Care for the Homeless Council, 2019)
Definition (continued)
● Recognition of the instability of an individual’s living arrangements is critical to the definition of
homelessness

Different agencies use different definitions of “Homelessness,” which affect how various programs
determine eligibility for individuals and families at the state and local level (National Health Care
for the Homeless Council, 2019).
 Demographics of the Homeless
● Total of 552,830 people were
experiencing homelessness on a single
night in 2018
○ 17 out of every 10,000 people
● 67% are individuals, 33% are families
with children
● 7% of homeless population are youth
(age 25 years or younger)
● 7% of homeless population are veterans

(National Alliance to End Homelessness, 2019)

Demographics Continued
● 70% are male, 30% female
● White Americans are largest
group: 49%
● Hispanic: 23%
● African Americans and
American Indians are
largely overrepresented in
relation to their numbers in
the general population

(National Alliance to End Homelessness, 2019)

Homelessness Per State
AZ: 9,865 (2018)

Nationally, has decreased

since 2007 by 15%

(National Alliance to End Homelessness, 2019)

Social Determinants of Health in the Homeless
● Economic Stability
○ On any given night there are over 600,000 homeless people in the United States (Quigley, 2014).
○ Over 1/8th of the low-income housing has been lost since 2001 and leading to less affordable places to rent (Quigley, 2014).
○ There is no place in the US where someone can work a minimum wage job for 40 hours per week and afford a one bedroom apartment
(Green Doors, 2019).
○ In the US one in eight live below the poverty line (Henry et al., 2018).
○ Over 16 million children are forced to skip meals or eat one less meal in order for the household to survive (Family Promise, 2019).

● Neighborhood & Built Environment

○ Over ⅓ of those homeless are living unsheltered either in cars, under bridges or abandoned buildings (Quigley, 2014).
○ More than 90% of women who are homeless are victims of severe abuse including sexual and physical (Quigley, 2014).
○ Violent crimes are 40 times higher to occur in homeless individuals than those who are not (Best MSW Programs, 2019).
○ Nonviolent crimes are 37 times higher to occur in homeless individuals than those who are not (Best MSW Programs, 2019).
Health Disparity of Homeless
Hepatitis A Outbreak (Foster et al., 2018) --

● Most commonly reported among those using drugs or the homeless population due to
unsanitary and unsafe living conditions, transient housing, economic instability, distrust
of government services, other comorbidities, or contamination via needles in living
conditions.
● Over 57% of patients of those with Hepatitis A reported drug use, homelessness or both.
● It is now recommended by the CDC that all individuals who are homeless now receive
the Hepatitis A vaccine.
Health Care Disparity of the Homeless
Lack of Insurance/cost of healthcare:

● 70% of homeless population do not have insurance or a primary care provider

● Treatment and preventative care are difficult to access due to lack of insurance
● Many of the homeless population feel discouraged from seeking healthcare as their main financial
priority is food and basic needs
● (Homeless Hub, 2014)

Lack of walk-in clinics:

● Almost all primary care providers require set up appointments and follow ups
● Homeless population cannot be seen my a primary care doctor due to lack of identification, lack of
access to transportation, and lack of a cell phone or internet to make an appointment
● Homeless population revert to using the ED and end up receiving very fragmented care and only their
immediate needs are assessed
● Has resulted in hospitals and ERs eating a lot of the costs
● More walk-in clinics would allow the homeless population to receive affordable and quick access to care
● (Magnuson, 2017)
Nursing Intervention
Primary Care Provider on Wheels:

● This is in demand due to the limited access to healthcare and a lack of primary providers serving the
homeless population.
● Once a week, a primary care provider will venture out in a provided means of transportation capable
of treating patients. He/she will then travel to the homeless camps to serve as a primary care
provider to the homeless population.
● Brings low cost and effective health care to the homeless population
● Addresses the health care disparity, limited primary care providers
● Minnesota Wheel Public Health Nursing Intervention - Outreach

(Jego, Abcaya, Stefan, Calvet-Montredon & Gentile, 2018).

 References
Best MSW Programs. (2019). Madness in the streets: mental illness, homelessness and criminal behavior. Retrieved
from https://www.bestmswprograms.com/mental-illness-homelessness-criminal-behavior/.

Family Promise. (2019). Homelessness/poverty. Retrieved from https://familypromise.org/homelessness-fact-sheet/.

Foster, M., Ramachandran, S., Myatt, K., Donovan, D., Bohm, S., Fiedler, J.,... Jorgensen C. (2018). Hepatitis a virus
outbreaks associated with drug use and homelessness- california, kentucky, michigan, and utah, 2017. Centers
for Disease Control and Prevention, 67(43), 1208-1210. doi: 10.15585/mmwr.mm6743a3.

Green Doors. (2019). General Homelessness facts. Retrieved from https://www.greendoors.org/facts/general-data.php

Henry, M., Mahathey, A., Morrill, T., Robinson, A., Shivji, A., Watt, R., & Associates, A. (2018). The 2018 annual homeless
assessment report (ahar) to congress. The U.S. Development of Housing and Urban Development. Retrieved from
https://www.hudexchange.info/resources/documents/2018-AHAR-Part-1.pdf.

Homeless Hub. (2014). How can we improve healthcare access to the homeless?. Retrieved from
https://www.homelesshub.ca/resource/how-can-we-improve-healthcare-access-homeless
 References
Jego, M., Abcaya, J., Stefan, D., Calvet-Montredon, C. & Gentile, S. (2018). Improving health care management in primary care for
homeless people: A literature review. International Journal of Environmental Research and Public Health, 15(2), 309. doi:
10.3390/ijerph15020309.

Magnuson, A. (2017). Homeless population faces barriers to health care. Retrieved from
https://downtowndevil.com/2017/10/17/87630/homeless-population-face-barriers-to-health-care/

National Alliance to End Homelessness. (2019). State of homelessness. Retrieved from

https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-home lessness-report/

National Health Care for the Homeless Council. (2019). What is the official definition of homelessness? Retrieved from
https://www.nhchc.org/faq/official-definition-homelessness/

Quigley, Bill. (2014). 10 facts about homelessness. Huff Post. Retrieved from
https://www.huffpost.com/entry/ten-facts-about-homelessn_b_5977946.

The Atlantic. (2016). How health and homelessness are connected - medically. Retrieved from
https://www.theatlantic.com/politics/archive/2016/01/how-health-and-homelessness-are-
connectedmedically/458871/