|
Items in cart [0] |
Questions? Call 888-624-8373 |
| Copyright © 2009. National Academy of Sciences. All rights reserved. Terms of Use and Privacy Statement |
Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 1
1
Who Are the Homeless?
INTRODUCTION
There have always been homeless people in the United States. As
economic circumstances and demographic forces have fluctuated, so have
the size and composition of the homeless population, although relatively
permanent skid rows where homeless people congregate have long been
a feature of many large cities.
In the past decade, however, the problem of homelessness has increas-
ingly captured public attention. Not only has the number of homeless
people increased dramatically within the last several years but the
composition of the homeless population has also changed appreciably
during that period: For example, middle-aged men make up a shrinking
fraction of all homeless people, and families with young children are the
fastest growing component of the homeless population (U.S. Conference
of Mayors, 1987J. Growing public awareness of homelessness is also
connected to changes in the geographic dispersion of homeless people,
who are becoming more visible in neighborhoods and communities that
would not have imagined their presence in the past.
This chapter briefly describes homelessness in the United States. It
begins by defining homelessness, assessing methodologies used to count
homeless people, and reviewing recent scholarly literature on the subject.
The chapter continues by examining the socio-demographic characteristics
of homeless people, with emphasis on adult individuals, families and
children, runaway and throwaway youths,* the elderly, and people in
* "Throwaway" youths refers to children and adolescents who are evicted from their
homes by their parents or another adult in a position of responsibility for them.
1
OCR for page 2
2 HOMELESSNESS, HEALTH, AND HUMAN NEEDS
rural areas. In the course of this discussion the issues relating to the
prevalence of health and mental health problems inevitably arise, but
these are reviewed in greater detail in Chapter 3, Health Problems of
Homeless People.
DEFINITION OF HOMELESS
For the purpose of this report, the definition of homeless or homeless
person is the same as that in P.L. 100-77, the Stewart B. McKinney
Homeless Assistance Act, enacted in July 1987 (U.S. Congress, House,
1987):
(1) an individual who lacks a fixed, regular, and adequate nighttime residence;
[or]
(2) an individual who has a primary nighttime residence that is-
(A) a supervised or publicly operated shelter designed to provide temporary
living accommodations (including welfare hotels, congregate shelters, and tran-
sitional housing for the mentally ill);
(B) an institution that provides a temporary residence for individuals intended
to be institutionalized; or
(C) a public or private place not designed for, or ordinarily used as, a regular
sleeping accommodation for human beings.
This definition refers specifically to homeless individuals, but it is equally
applicable to homeless families.
COUNTING THE HOMELESS
Even within the framework of a relatively straightforward definition,
there is considerable uncertainty about the number of people who are
homeless at any given time in the United States. Conventional methods
of enumerating populations, such as the census, are based upon counting
people where they live. Not only do people move in and out of
homelessness but the methodological problems involved in counting
people without a fixed residence are formidable. Studies that have
attempted to count homeless people have been subject to severe criticism.
For example, samples are generally small and may not be generalizable
to other locales, data are often collected from single sites, samples often
are not systematically drawn, measures and definitions of homelessness
are inconsistent, and the rural population is virtually unidentified. For all
these reasons, the various studies cannot be easily compared or gener-
alized. (Appendix B of this report contains a detailed analysis of the
three most common methods of counting homeless people and the
technical strengths and weaknesses of each.)
OCR for page 3
WHO ARE TH:
TABLE 1-1 National Estimates of the Homeless Populations
E HOMELESS? 3
Source Estimate Assumptions Used
Hombs and 2,200,000
Snyder (1982)
U.S. Depart-
ment of Hous-
ing and Urban
Development
(1984)
1.
2.
3.
192,000
254,000
586,000
Tucker (1987) 700,000
Freeman and
Hall (1986)
Alliance Hous-
ing Council
(1988)
287~000
735,000 on a
given night;
1.3 million
to 2.0 mil-
lion during
1988
Based on a small number of high local
estimates. Apparently uses city popu-
lations to estimate a rate of homeless-
ness. Applies constant rate of home-
lessness to the entire country.
Applies a street-to-shelter ratio to ester
mates of the sheltered population.
Based on estimates for 60 cities. Uses
metropolitan population as the base.
Calculates rates separately for large,
medium, and small areas.
Takes highest local estimates. Uses
metropolitan population as the base.
Assumes a constant rate of homeless-
. .
ness nationwide.
Based on estimates for 50 cities. Uses
city populations as the base. Allows
rates to vary for large, medium, and
small cities.
Applies a street-to-shelter ratio to esti-
mates of the sheltered population.
Based on reinterpretation and extrapola-
tion from U.S. Dept. of Housing and
Urban Development (1984) studies.
Assumes suburban rate of 1/3rd the
city rate. Assumes 20% growth in
homelessness each year.
aAdapted from Alliance Housing Council (1988).
The range of estimates of the number of homeless people is wide (Table
1-1~. At the low end is the U.S. Department of Housing and Urban
Development (1984) estimate of 200,000 to 300,000. At the high end are
advocates' estimates of more than 2 million (Hombs and Snyder, 1982~.
Whatever the absolute numbers, the number of homeless people has
grown appreciably in recent years. Surveys conducted by the U. S.
Conference of Mayors in 25 representative cities in each of the past 2
OCR for page 4
4 HOMELESSNESS, HEALTH, AND HUMAN NEEDS
years identified no city in which the numbers were falling; most cities
reported annual increases of 15 to 50 percent (U.S. Conference of Mayors,
19871. A substantial majority of the cities reported that families were the
fastest growing component of the homeless population.
One recent estimate of the number of homeless people in the United
States, published in June 1988 by the National Alliance to End Home-
lessness, calculates that currently, on any given night, there are 735,000
homeless people in the United States; that during the course of 1988, 1.3
million to 2.0 million people will be homeless for one or more nights; and
that these people are among approximately 6 million Americans who,
because of their disproportionately high expenditures for housing costs,
are at extreme risk of becoming homeless (Alliance Housing Council,
19881.
For the purposes of this study, the question of precisely how many
homeless people there are was not of central importance because home-
lessness is not a static condition; poor people move in and out of a state
of homelessness. Therefore, the committee devoted a major part of its
effort to analyzing the composition of the homeless subpopulations and
the health-related needs of each group.
STUDIES OF HOMELESSNESS
Since the early 1980s, an extensive body of literature about homeless
people has emerged. Although some have described homelessness in the
United States impressionistically, a number of scholars have conducted
substantial surveys and performed extensive data analyses in order to
describe the characteristics of homeless people. The earliest publications
on the "new" homeless have focused on the demographic and social
characteristics of homeless adults living in large cities, such as New York
(Hoffman et al., 1982; Crystal and Goldstein, 1984), Phoenix (Brown et
al., 1982, 1983), Portland, Oregon (Multnomah County, Oregon, Depart-
ment of Human Services, 1984, 1985), Los Angeles (Robertson et al.,
1985; Farr et al., 1986), Chicago (Stevens et al., 1983; Rossi et al., 1986),
St. Louis (Morse et al., 1985), Milwaukee (Rosnow et al., 1985), Boston
(Bassuk et al., 1984), Philadelphia (Arce et al., 1983), and Baltimore
(Fischer and Breakey, 19861. Wider in geographic scope are the studies
of the states of Ohio (Roth et al., 1985) and Vermont (Vermont Department
of Human Services, 19851. Although the sites at which data were collected
often differed shelters, streets, single room occupancy hotels as did
the sampling strategy and operational criteria for studying homelessness,
the data collected from these different areas showed surprising similarities.
Research has also been conducted on subpopulations of homeless
people as well as on specialized topics related to homelessness. A
OCR for page 5
WHO ARE THE HOMELESS? 5
substantial number of reports have focused on the homeless mentally ill
and on homeless people who suffer from alcohol abuse. A much smaller
body of literature exists on other health-related issues. In fact, it was
only 3 years ago that the first book on this issue, Health Care of Homeless
People (Brickner et al., 1985), was published; the importance of the issue
and the growth in our knowledge are reflected by the fact that the authors
already have begun work on the second edition. There is also a growing
body of scholarly work on subpopulations, especially homeless families
(Bassuk et al., 19861.
Studies on the demographic and social characteristics of the homeless
in the United States have almost always been based upon research
conducted in urban areas. Except for the Ohio and Vermont reports,
which included both urban and nonurban areas, very little has been
published on the homeless in suburban and rural communities except
in newspapers (Washington Post, September 27, 1987; New York Times,
October 16, 19871. There is a similar, though less pronounced, paucity
of information about certain subpopulations among the contemporary
homeless, such as the elderly, youths, individual adult women, the
physically disabled, the mentally retarded, and those addicted to illicit
drugs.
CHARACTERISTICS OF HOMELESS PEOPLE
Homeless people are a diverse and varied group in terms of age,
ethnicity, family circumstances, and health problems. Moreover, the
characteristics of the homeless population differ dramatically from one
community to another. Even the recent increase in homeless families is
not uniform throughout the country. Although homeless families headed
by women are predominant among the homeless throughout the country,
there are many more homeless two-parent families in the West and
Southwest than in New York and other large eastern cities (U.S.
Conference of Mayors, 19871. Every city has homeless adults, but the
demographics are not uniform throughout the country. Most cities report
that adult homeless men tend to be long-term residents of the city.
However, during a site visit to San Diego, committee members were
informed by both public officials and advocates for the homeless that
San Diego's adult homeless male population was composed largely of
young men from the West and Midwest who had come to the Southwest
in search of jobs.
To make the needs of homeless people more understandable, we
describe several subgroups separately: individual adult men and women,
families with children, youths, the elderly, and people in rural areas.
OCR for page 6
6 HOMELESSNESS' HEALTH, AND HUMAN NEEDS
Homeless Individual Adults
Although families may represent the fastest growing subgroup among
the homeless, individual adults still make up the single largest group
among the homeless population. The documented characteristics of
homeless adult men and women contradict some popular conceptions of
what such people are like.
The U.S. Conference of Mayors (1987) reported that individual men
made up 56 percent of the homeless population and individual women
made up 25 percent. (The remainder are adolescents or families with
children.) Of the 25 cities in the study, 7 reported recent increases in the
numbers of homeless women. In 1963, homeless women represented only
3 percent of the homeless population (Bogue, 19634. Researchers indicate
that a high proportion of homeless women suffer from serious problems
including chronic mental illness and pregnancy-related problems (Wright,
1987; Wright and Weber, 1987; Wright et al., 19871. In addition, homeless
women are frequently victims of physical assault, especially rape (Brickner
et al., 19851.
Individual homeless men and women have an average age of between
34 and 37 (Morse, 19861; this is significantly lower than those found in
previous decades. Homeless women are from 2 to 6 years younger (both
mean and median) than homeless men (Multnomah County, Oregon,
Department of Human Services, 1984; Robertson et al., 1985; Rossi et
al., 19861. Reports from several cities indicate that the sheltered male
population is younger still and that homeless women appear to be either
very young or elderly. This is important because, unless they are disabled,
the age of homeless adults in many parts of the country helps to determine
their eligibility for entitlements, especially general assistance and Med
. .
calc ..
Homeless adults are likely never to have been married. Reported levels
range from 40 percent in Portland, Oregon (Multnomah County, Oregon,
Department of Human Services, 1984) to 64 percent in New York City
(Hoffman et al., 1982~. Homeless women are more likely than homeless
men to have been married: In the Portland study, only 29 percent of
homeless women had never married compared with 44 percent of homeless
men. Never-married homeless adults are generally not members of
households and often lack strong family ties. The absence of family ties
removes the possibility of finding shelter with family members.
Minorities are overrepresented among homeless people in the nation's
larger cities (TabIe 1-21. This distribution reflects the overrepresentation
of minorities in the poorest strata of American society (Morse, 19861.
The proportion of homeless people with a high school diploma has
increased during the past 25 years. For example, in 1963, only 19 percent
OCR for page 7
WHO ARE THE HOMELESS? 7
of homeless people in Chicago had completed high school (Bogue, 1963),
compared with 35 percent of the general population of Chicago (U.S.
Bureau of the Census, 19634. In 1985, 55 percent of the homeless
population in that city were high school graduates (Ross) et al., 19861;
the comparable figure for the entire population of Chicago was 56 percent,
almost identical to that for the homeless population. While there was a
greater divergence between the educational level of homeless and general
populations in other cities (Roth et al., 1985; Farr et al., 1986), nationally
the proportion of homeless adults with high school diplomas is approxi-
mately 45 percent.
Contrary to the fears expressed by public officials that their city may
attract increasing numbers of homeless people if they do more to help,
several recent studies indicate that the great majority of homeless people
have been long-term residents of the city in which they are sheltered
(Table 1-34. This was confirmed during the site visits. It was also reported
that when a city did attract transients, it was generally not by virtue of
its entitlement programs but, rather, because of a favorable economic
climate and the possibility of employment. People working directly with
the homeless in various cities reported to the committee that transient
persons failing to find employment in one city tended not to stay long
and soon moved on in search of jobs.
Since the mean age of homeless men is approximately 35, it is not
surprising that a large number are Vietnam veterans (Table 1-41. Studies
of homeless veterans in Los Angeles (Robertson, 1987) and Boston
(Schutt, 1985) indicate that they are older than nonveterans, better
educated, and more likely to have been married, factors that normally
would indicate greater stability. They also tend to be white, although the
percentage of ethnic minorities increases substantially among those who
served in Vietnam.
As discussed in detail in Chapter 3, psychiatric problems and alcohol
and drug abuse are common among homeless veterans. The Los Angeles
and Boston studies both reported higher rates of psychiatric hospitalization
than among nonveteran homeless people. The Boston study, as well as
a study of homeless veterans in San Francisco (Swords to Plowshares,
1986), reported that veterans were more likely to identify substance abuse
as a reason for homelessness. The San Francisco study reported that 45
percent suffered from alcohol abuse (19 percent reporting severe alcohol
problems) and 23 percent from drug abuse.
The most recent statistics on homeless veterans come from the
Homeless Chronically Mentally Ill outreach program conducted by the
Veterans Administration as mandated by P.L. 100-6 (Rosenheck et al.,
19871. The program is targeted specifically to mentally ill homeless
veterans (and therefore does not present a valid sample of all homeless
OCR for page 8
8
o
'e
· -
3
Cal
o
._
_'
-
._
._
-
¢
Cal
Cal
-
o
o
o
of
m
.o O
~ ._
~ Cal
~ _
3
o
-
Ct
o
. _
~ _
·— C.,
o
~4
~ C) Ct
·
Z Cal V
o
._
Ct
o ~
it> 0
C~7 or
Ct ~ _
C)
Ct ~ ~
~ .o
.>
Ct
Z ~
O O O O O O O
- 1 - 1 0 Or to ~ 00
. . . . . . .
rat ~ ~ ~ ~
rid ~ ~ rat
O ~
O O ~ _4
~ O
. .
.o
~:
~ ~ O O O
X
~:
C)
-
m
~ 0
. .
.
~ - ~ ~
~i oo
- ~
c)
o
v)
. -
o ~ o
. . .
r~ ~ ~
~ o
. .
c~ o ~ o
. . . .
oo ~ ~ - ~
~ .
. —
· c
OCR for page 9
9
. · · . . .
to to ~ to to to
to to or ON i,,,
. · · · . .
to
~ -
to ~
. .
~ to
o ~
. .
o o
. .
r~
o
.
oo o o
. . .
o ~ o o
. . . .
~ ~ r~ ~
-
oo ^
~ —~ ~ l~,
c'd ^ ~ ON
ct ^
~ ,,, 4, 3 ~ ~
C) ~ ~ o C ~ =0 0 5
O P~ - ~ O ~ S ~ ~ ~ O
O
00
Ct ~
O c^
O
4_
~ (L)
~ O
~;
o
._
._
o
C)
C~
._
U'
S:
o
.=
o
C~
5
3
~ C~
O s~
~ m
~D
o
c~
o
. -
'e
-
o
· -
~:
e
~L
u)
x
- ~
o
~o
-
v:
3
cn
~:
o
3
. .
Ct
Ct
o
._
Ct
-
-
Ct
>>~
o _
~ ~ C
o o ~ °
Z ~ ~ ~
OCR for page 10
10 HOMELESSNESS, HEALTH, AND HUMAN NEEDS
veterans), but it is both the most recent research on homeless veterans
and the most geographically comprehensive. The outreach effort was
conducted in 26 states and included Veterans Administration medical
centers serving rural, suburban, and urban areas. In its first 4 months of
operation (May-September 1987) the program made contact with 6,342
homeless veterans.
Of the veterans contacted, 98.6 percent were men; 1.4 percent were
women. The average age was 43; 75 percent were either divorced or had
never married. Sixty percent were white, 30 percent were black, and 9
percent were Hispanic. In regard to education, 82 percent were high
school graduates. Thirty percent had served in combat, and 1.7 percent
had been prisoners of war; 9 percent were diagnosed as having combat-
related posttraumatic stress disorder. With regard to the time of their
military duty, 38 percent were veterans of the Vietnam era, 21 percent
served in the post-Vietnam period, and 18 percent served in the period
between the Korean and Vietnam conflicts. Only 9 percent served in
World War II and 10 percent in Korea.
Several authors have reported that between 5 and 10 percent of the
homeless are employed full-time and between 10 and 20 percent are
employed part-time or episodically (Brown et al., 1982,1983; Multnomah
County, Oregon, Department of Human Services, 1984, 1985; Rossi et
al., 19864. These people frequently perform unskilled labor; are on the
bottom rung of the economic ladder; and often lack job security, health
insurance, and the skills necessary to succeed in a high-tech economy.
TABLE 1-3 Length of Residency of Homeless Adult Individuals
City or State Percent No. of Years Source
New York Citya 82 ~5 Crystal et al. (1982)
Los Angelesb 74 ~2 Robertson et al. (1985)
New York Citya 75 ~5 Hoffman et al. (1982)
Chicago 72.3 ~10 Rossi et al. (1986)
Milwaukee 71 ~1 Rosnow et al. (1985)
Los Angelesa 64.5 ~1 Farr et al. (1986)
Ohio 63.5 ~1 Roth et al. (1985)
Baltimore 60 ~10 Fischer et al. (1986)
Portland 59 ~2 Multnomah County,
Oregon (1984)
aMen only.
bThe 10.5 percent differential between the studies by Robertson et al (1985) and Farr et
al. (1986) in Los Angeles can be accounted for based on the populations sampled. Robertson
and colleagues sampled the downtown skid row and the Venice Beach/Santa Monica areas;
Farr and colleagues sampled only the downtown skid row area.
OCR for page 11
WHO ARE THE HOMELESS? 1l
TABLE 1-4 Homeless Veterans
Percentage of Homeless Vietnam-Era Veterans as
Men Sampled Who Are Percentage of Homeless
City (Source) Veterans Veterans
Baltimore 51 35
(Fischer et al., 1986)
Boston 37
(Schutt, 1985)
Los Angeles 47 33
(Robertson et al.,
1985)
Los Angeles 33 43
(Farr et al., 1986)
Net York City 32
(Crystal et al., 1982)
Detroit 36 16
(Solarz and
Mowbray, 1985)
Many are homeless because their incomes have not kept pace with the
dramatic increase in housing costs. The loss of a day or two of pay may
make the difference between paying rent and being evicted.
Homeless Families
As mentioned previously, the fastest growing subgroup among the
homeless population consists of families with children. In late 1986, the
U.S. Conference of Mayors estimated that such families made up 28
percent of all homeless people in the 25 cities participating in the
conference's annual survey of hunger, homelessness, and poverty in
America. Most homeless families are headed by women with two or three
children (Bassuk et al., 19861. Most of the children are under the age of
5 and are spending their critical developmental years without the stability
and security of a permanent home (Towber, 1986a,b; Bassuk and Rubin,
1987; Wright and Weber, 19871.
The literature on the characteristics and needs of homeless families is
largely anecdotal, although there are a few systematic studies describing
the status and unmet needs of homeless families and the health status
(Wright and Weber, 1987), emotional problems (Bassuk et al., 1986;
Bassuk and Rubin, 1987; Bassuk and Gallagher, in press; Boxill and
Beatty, in press), nutritional status (Acker et al., 1987), and problems in
education and learning (Bassuk et al., 1986; Bassuk and Rubin, 1987) of
OCR for page 12
~~ if:
12 HOMELESSNESS, HEALTH, AND HUMAN NEEDS
homeless children. To date, the findings are generally descriptive, and
there are large regional differences; only a few attempts have been made
to generate and test hypotheses about the antecedents, course, and
consequences of family homelessness by studying appropriate comparison
groups. Despite limitations of the data base, reports of shelter providers,
clinicians, agencies, advocates, and policymakers (Simpson et al., 1984;
Gallagher, 1986), as well as the committee's site visits to sheltering
facilities, tend to support the findings of existing studies. The combined
information allows for some generalizations about the characteristics and
needs of homeless families.
The vast majority of homeless families are headed by women, but the
percentages vary by region. In western regions there are more intact
homeless families than in eastern regions (Bassuk et al., 1986; Towber,
1986a,b; McChesney, 1986; Dumpson, 19871. Homeless families that
include both parents appear to be more common in rural areas than in
urban areas (see Appendix C). Because there is a lack of systematic
information about the characteristics of intact homeless families, partic-
ularly the fathers, the following discussion concentrates primarily on
mothers and children.
Homeless mothers tend to be in their late 20s (Bassuk et al., 1986;
McChesney, 1986; Towber, 1986a,b; Dumpson, 1987), are either single
or divorced, and have completed at least several years of~high school
(Bassuk et al., 1986; Towber, 1986a,b; Dumpson, 19871. Their ethnic
status tends to mirror the ethnic composition of the area where they are
living, with minorities overrepresented in the cities and whites predom-
inating in suburban and rural areas (Bassuk et al., 19861. The vast majority
of homeless families are recipients of Aid to Families with Dependent
Children (AFDC). A Massachusetts study indicated that long-term AFDC
users (those receiving benefits for longer than 2 years) are overrepresented
among homeless families (Bassuk et al., 19864.
Researchers have reported that homeless mothers typically are quite
isolated and have few, if any, supportive relationships. McChesney (1986)
studied the support networks of homeless mothers with at least one child
who were living in five Los Angeles County family shelters. She described
their slide into homelessness as including ". . . many varied and creative
means to shelter themselves and their children" in an effort to stave off
homelessness. Most striking was the fact that many families could not
call on their own parents, brothers, or sisters as resources. There were
three major reasons: "either their parents were dead, their parents and
siblings didn't live in the Los Angeles area, or their parents and siblings
were estranged" (McChesney, 19861. Bassuk and colleagues (1986), in
their study of 80 homeless families living in family shelters in Massachu-
setts, also described fragmented support networks. When asked to name
OCR for page 13
WHO ARE THE HOMELES S ? 13
three persons on whom the mothers could depend during times of stress,
43 percent were unable to name anyone or could name only one person,
and almost a quarter named their minor child as their principal source of
emotional support (Bassuk et al., 19861. In addition to economic and
support system factors, serious health problems may also increase a
family's risk of becoming homeless.
Many homeless mothers are victims of family violence, which suggests
considerable overlap between families residing in family shelters and
those residing in battered women's shelters (Ryback and Bassuk, 1986~.
Generally, a woman fleeing directly from an abusive mate turns to a
battered women's shelter rather than to a family shelter. According to
Bassuk et al. (1986), 45 percent of the women they interviewed in
Massachusetts family shelters had a history of an abusive relationship
with a spouse or mate, but this was generally not the immediate cause
of their homelessness. In the only study reporting data about probable
child abuse, Bassuk and coworkers found that 22 percent of homeless
mothers were currently involved in an investigation or follow-up of child
neglect or abuse (Bassuk et al., 1986; Bassuk and Rubin, 19871.
Many families had histories of residential instability and moved several
times prior to their current shelter stay; most moved within the community
where they were sheltered. A majority of families had been doubled up
in overcrowded apartments with friends or relatives, while some had
previously resided in other shelters or welfare hotels (Bassuk et al., 1986;
Towber, 1986a,b).
A substantial proportion of homeless families using the sheltering
system can be characterized as multiproblem families (Bassuk et al.,
19861. These families have chronic economic, educational, vocational,
and social problems; have fragmented support networks; and have
difficulty accessing the traditional service delivery system; ". . . these
families use a disproportionally large amount of social services
and . . . traditional techniques of treating them fail or, at best, are only
marginally successful . . . " (Kronenfeld et al., 19801. The multiproblem
family typically seeks assistance when a crisis occurs, but ceases contact
with the agency when the crisis abates (Gallagher, 19861.
Studies specifically describing the characteristics and needs of homeless
children are quite sparse; studies seeking to provide an estimate of the
number of homeless children nationwide are nonexistent. However, the
magnitude of the problem can be seen in even the most conservative
estimates: If there are approximately 735,000 people homeless on any
given night (ICE Inc., 1987), and 25 percent of these people are members
of intact families (U.S. Conference of Mayors, 1986), of whom 55 percent
are children (Barbanel, 1985), then a minimum of 100,000 children are
homeless on any given night of the year. This figure includes only children
OCR for page 14
14 HOMELESSNESS, HEALTH, AND HUMAN NEEDS
of intact families; it does not include runaway, throwaway, or abandoned
children on the streets or in institutions.
Not surprisingly, researchers have reported erratic school attendance
among homeless children. Shelters are frequently located far away from
a school, and transportation may be lacking. Preliminary data reported
by the Traveler's Aid Program and Child Welfare League (1987) indicate
that of 163 families with 331 children in eight cities, only 57 percent of
the homeless children attended school regularly. A study of 52 families
residing in five New York City welfare hotels reported that, according
to parents, 60 percent of their children missed less than 3 days of school
per month, 30 percent missed between 4 and 10 days of school per month,
and 10 percent missed more than 10 days a month, which is over half of
the school days (Columbia University Masters of Public Administration
Program, 19851.
Homeless Runaway and Throwaway Youths
The amount of systematic data describing the characteristics of home-
less adolescents is even scantier than those for other homeless subpop-
ulations. In addition to its site visits, the committee reviewed three recent
studies of runaway and throwaway youths:
· the 1985 Greater Boston Adolescent Emergency Network (GBAEN)
study (1985) of 84 adolescents using 11 shelters throughout Massachus-
setts;
· the 1983 study of 118 adolescents in 7 shelters in New York City
completed by David Shaffer and Carol L. M. Caton (19841; and
· the 1984 study of 149 adolescents in a crisis center in Toronto,
conducted by Mark-David Janus and colleagues (1987) and funded by the
U.S. Department of Justice.
Each study identified running away not so much as an event but as a
process; adolescents leave home several times (each successive incident
being of longer duration than the previous ones) before actually living on
the streets. As Shaffer and Caton (1984) reported, "most adolescents
start running away some years before they start to use shelters." With
regard to throwaway youths, the Boston study found that 17 percent of
subjects who had left home for the first time had been "evicted by their
parents" (for the entire population in the Boston study, the proportion
evicted, including those with multiple running away incidents, was 12
percent). The fundamental issue in trying to determine the extent of the
throwaway youth population is to determine the line between a parent
forcing a teenager out of the home and a parent creating a situation so
intolerable that the youngster has no option but to leave. To quote
OCR for page 15
WHO ARE THE HOMELESS? 15
Reverend Leonard A. Schneider, executive director of The Emergency
Shelter in New York City:
It is just possible that running away may be an indication of a very healthy
mind, and depression may be a very natural response to an intolerable situation.
(Community Council of Greater New York, 1984)
Additional issues regarding the throwaway youth population are dis-
cussed in successive chapters: the dynamics of the running away process
as it relates to homelessness (Chapter 21; the health problems of runaway
youths (Chapter 3~; and the current state of services for this population
(Chapter 5~.
Homeless Elderly People
The percentage of elderly people among the homeless population is
less than that among the general population. In all but one recently
published study, the elderly made up less than 10 percent of the homeless
population (Table 1-5~. The figure of 19.4 percent reported by Rossi et
al. (1986) for the homeless in Chicago is the highest, but it is still low
compared with the 29.6 percent elderly for that city's domiciled popula-
tion. The contrast is even greater in Ohio, where 6.4 percent of the
homeless were over age 60, in contrast to 21.7 percent of the population
of the state as a whole (Roth et al., 19851. In the skid row area of Los
Angeles, 5 percent of the homeless population is over age 61, in comparison
with 17 percent domiciled elderly for the entire county (Parr et al., 19861.
Nationwide, only 3 percent of the homeless people who presented
themselves for care at the Johnson-Pew Health Care for the Homeless
projects were over 65, even though 12 percent of the population of the
United States is elderly (Wright and Weber, 19871.
Three hypotheses have been proposed to explain the small percentages
of elderly homeless. The first suggests that on turning 65, many homeless
people become eligible for various entitlements (Social Security, Medi-
care, senior citizen housing, etc.~. It is possible that such programs
generate enough income in benefits, lower housing costs, or both that
neoole are able to leave the streets or at least are nreventecl from hec~.omin~
homeless to begin with (Wright and Weber, 19874. The second possibility
is that homeless people do not survive to old age, because the realities
of a homeless existence are so severely debilitating (Wright and Weber,
1987~. A 1956 study of men living on Chicago's skid row revealed an
annual death rate of 70 per 1,000, in contrast to the national death rate
for white men of 11 per 1,000 (Bogue, 19631. However, a third explanation
for the small percentage of homeless elderly may be related to sampling.
The subjects of most studies are self-selected and include residents of
OCR for page 16
16 HOMELESSNESS, HEALTH, AND HUMAN NEEDS
TABLE 1-5 Elderly Homeless People
Location (Source)
Age (yr) Men Women Both
St. Louis 60+ 2.5
(Morse, 1986)
Portland 55+ 4 0
(Multnomah County,
Oregon, 1985)
Los Angeles 61 + 4.8
(Farr et al., 1986)
Los Angeles 60+ 6.0
(Robertson et al.,
1985)
Milwaukee 61 + 6.0
(Rosnow et al., 1985)
New York City 60+ 6.0
(Crystal et al., 1982)a
Ohio 60 ~ 6.4
(Roth et al., 1985)
Portland 60 + 7.0
(Multnomah County,
Oregon, 1984)
New York City 60+ 7.0
(Hoffman et al., 1982)a
Chicago 56 + 8.0
(Stevens et al., 1983)
Phoenix 9.0
(Brown et al., 1983)
Chicago 55 + 19.4
(Ross) et al., 1986)
United States 65 + 3.0
(Wright, 1987)
aMen only.
shelters, those who appear for medical treatment, people on the streets
willing to be interviewed, and the like. The homeless elderly are partic-
ularly reluctant to use certain sheltering facilities that they view as
dangerous (Coalition for the Homeless/Gray Panthers of New York City,
19841. To quote Joseph Doolin, the director of the Kit Clarke Senior
House, which operates the Cardinal Medeiros Day Center for the homeless
elderly of Boston, "younger homeless people tend to 'squeeze out' older
street people Efrom the shelters]" (Doolin, 1986~. To the extent that the
OCR for page 17
WHO ARE THE HOMELESS? 17
homeless elderly do not participate in various programs for the homeless,
they will be underrepresented in most studies.
The Rural Homeless
Since its first meeting, the committee has been concerned with the fact
that almost all the scholarly literature describes the urban homeless. Only
two studies, the statewide study of Ohio, Homelessness in Ohio: A Study
of People in Need (Roth et al., 1985), and the statewide study of Vermont,
Homelessness in Vermont (Vermont Department of Human Services,
1985), begin to address the physical and mental health problems of
homeless people living in rural areas. As a result, the committee com-
missioned a special study of this population. Subsequently, the Health
Resources and Services Administration of the U.S. Department of Health
and Human Services, in cooperation with the committee, funded a more
detailed analysis of this issue. This included site visits to rural areas in
Alabama, Mississippi, Minnesota, and South Dakota. The results of this
joint effort of the Institute of Medicine and the Department of Health
and Human Services are included in Appendix C of this report.
Briefly, the problems of the rural homeless differ from those of their
urban counterparts in several important ways. The rural homeless are
far less visible than those in the cities; many live with relatives or others
who are part of an extended family network. Some are officially domiciled
because they pay a nominal token rent for the use of a shack or other
substandard form of housing. However, they are even less likely than
their urban counterparts to obtain assistance during times of economic
or personal crisis. Rural areas do not have the range of social and financial
supports available in most urban areas. Often, homeless people migrate
to the cities in search of work; when they fail in that effort, they become
a part of the growing numbers of homeless people in the cities. Those
who stay in rural areas remain hidden until some event causes them to
lose their housing, at which point they can be found living in, for example,
cars, abandoned buildings, and woods. Even those communities with
previously adequate social service systems are finding it increasingly
difficult to serve the growing numbers of homeless people, especially in
areas where the decline of agriculture, forestry, and mining is severe.
SUMMARY
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 greater as each year passes. As
the number increases, so do the complexities of the homelessness problem:
OCR for page 18
18 HOMELESSNESS, HEALTH, AND HUMAN NEEDS
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?
As has been seen in this chapter, there are several subgroups among
the general population of homeless people: individual adults, families
with children, adolescents and young adults, the elderly, and people in
rural areas. While together they all share one common problem the lack
of a stable residence they each have specific needs.
As will be seen in the next chapter, the long-established system that
has traditionally addressed homelessness now finds itself confronted with
a seemingly overwhelming set of problems.
REFERENCES
Acker, P. J., A. H. Fierman, and B. P. Dreyer. 1987. An assessment of parameters of
health care and nutrition in homeless children. American Journal of Diseases of Children
141(4):388.
Alliance Housing Council. 1988. Housing and Homelessness. Washington, D.C.: National
Alliance to End Homelessness.
Arce, A. A., M. Tadlock, and M. J. Vergare. 1983. A psychiatric profile of street people
admitted to an emergency shelter. Hospital and Community Psychiatry 34(9):812-817.
Barbanel, J. 1985. Judge bars city from using offices to shelter homeless. New York Times,
August 28: A-1.
Bassuk, E. L., and E. Gallagher. In press. The impact of homelessness on families. Journal
of Child and Youth Services.
Bassuk, E. L., and L. Rubin. 1987. Homeless children: A neglected population. American
Journal of Orthopsychiatry 5(2): l-9.
Bassuk, E. L., L. Rubin, and A. S. Lauriat. 1984. Characteristics of sheltered homeless
families. American Journal of Public Health 75(9): 1097-1101.
Bassuk, E. L., L. Rubin, and A. Lauriat. 1986. Characteristics of sheltered homeless
families. American Journal of Public Health 76(September): 1097-1101.
Bogue, D. 1963. Skid Row. Chicago: University of Chicago Press.
Boxill, N., and A. Beatty. In press. An exploration of mother~hild interaction among
homeless women and their children using a public night shelter in Atlanta, Georgia.
Journal of Child and Youth Services.
Brickner, P. W., L. K. Scharer, B. Conanan, A. Elvy, and M. Savarese, eds. 1985. Health
Care of Homeless People. New York: Springer-Verlag.
Brown, C. E., R. Paredes, and L. Stark. 1982. The Homeless of Phoenix: A Profile.
Phoenix, Ariz.: Phoenix South Community Mental Health Center.
Brown, C. E., S. MacFarlane, R. Paredes, and L. Stark. 1983. The Homeless of Phoenix:
Who Are They and What Should Be Done? Phoenix, Ariz.: Phoenix South Community
Mental Health Center.
Clark, A. L. 1985. Health care needs of homeless women in Baltimore. Seminar paper
submitted to the faculty of the graduate school of the University of Maryland, College
Park, in partial fulfillment of the requirements for the master of science degree.
Coalition for the Homeless/Gray Panthers of New York City. 1984. Crowded Out:
Homelessness and the Elderly Poor in New York City. New York: Coalition for the
Homeless.
OCR for page 19
WHO ARE THE HOMELESS? 19
Columbia University Masters of Public Administration Program. 1985. Homeless families
living in hotels: The provision of publicly supported emergency temporary housing
services. Paper prepared for the Human Resources Administration of New York City.
New York: Columbia University.
Community Council of Greater New York. 1984. Runaway and Homeless Youth in New
York City: Findings from Recent Research, R. L. Leavitt, ed. New York: Community
Council of Greater New York.
Crystal, S. M., and M. Goldstein. 1984. The Homeless in New York City Shelters. New
York: Human Resources Administration of the City of New York.
Crystal, S. M., M Goldstein, and R. Levitt. 1982. Chronic and Situational Dependency:
Long-Term Residents in a Shelter for Men. New York: Human Resources Adminis-
tration of the City of New York.
Doolin, J. 1986. Planning for the special needs of the elderly homeless. The Gerontologist
26(3):229-231.
Dumpson, J. R. 1987. A Shelter Is Not a Home. Report of the Manhattan Borough
President's Task Force on Housing for Homeless Families. New York: Manhattan
Borough President's Task Force on Housing for Homeless Families.
Farr, R. K., P. Koegel, and A. Burnam. 1986. A Study of Homelessness and Mental Illness
in the Skid Row Area of Los Angeles. Los Angeles: Los Angeles County Department
of Mental Health.
Fischer, P. J., and W. R. Breakey. 1986. Characteristics of the Homeless with Alcohol
Problems in Baltimore: Some Preliminary Results. Baltimore: Department of Health
Policy and Management, School of Hygiene and Public Health, and Department of
Psychiatry and Behavioral Sciences, School of Medicine, The Johns Hopkins Univer-
sity.
Fischer, P. J., W. R. Breakey, S. Shapiro, J. C. Anthony, and M. Kramer. 1986. Mental
health and social characteristics of the homeless: A survey of mission users. American
Journal of Public Health 76(5):519-524.
Freeman, R. B., and B. Hall. 1986. Permanent Homelessness in America? Working paper
no. 2013. Cambridge, Mass.: National Bureau of Economic Research.
Gallagher, E. 1986. No Place Like Home: A Report on the Tragedy of Homeless Children
and Their Families in Massachusetts. Boston: Massachusetts Committee for Children
and Youth, Inc.
Greater Boston Adolescent Emergency Network. 1985. Ride a Painted Pony on a Spinning
Wheel Ride. Boston: Massachusetts Committee for Children and Youth, Inc.
Hoffman, S. F., D. Wenger, J. Nigro, and R. Rosenfeld. 1982. Who Are the Homeless? A
Study of Randomly Selected Men Who Use the New York City Shelters. Albany: New
York State Office of Mental Health.
Hombs, M. E., and M. Snyder. 1982. Homelessness in America: Forced March to Nowhere.
Washington, D.C.: Community for Creative Non-Violence.
Janus, M.-D., A. McCormack, A. W. Burgess, and C. Hartman. 1987. Adolescent Runaways:
Causes and Consequences. Lexington, Mass.: D. C. Heath, Lexington Books.
Kronenfeld, D., M. Phillips, and V. Middleton-Jeter. 1980. The forgotten ones: Treatment
of single parent multi-problem families in a residential setting. Prepared under Grant
no. 18-P-90705/03. Washington, D.C.: U.S. Department of Health and Human Services,
Office of Human Development Services.
McChesney, K. Y. 1986. New findings on homeless families. Family Professional 1(2).
Morse, G. A. 1986. A Contemporary Assessment of Urban Homelessness: Implications for
Social Change. St. Louis: Center for Metropolitan Studies, University of Missouri-St.
Louis.
OCR for page 20
20 HOMELESSN ESS, HEALTH, AND HUMAN NEEDS
Morse, G. A., N. M. Shields, C. R. Hanneke, R. J. Calsyn, G. K. Burger, and B. Nelson.
1985. Homeless People in St. Louis: A Mental Health Program Evaluation, Field Study
and Followup Investigation. Jefferson City, Mo.: State Department of Mental Health.
Mowbray, C. V., S. Johnson, A. Solarz, and C. J. Combs. 1985. Mental Health and
Homelessness in Detroit: A Research Study. Lansing: Michigan Department of Mental
Health.
Multnomah County, Oregon, Department of Human Services. 1984. The Homeless Poor.
Multnomah County, Oreg.: Social Services Division, Department of Human Services.
Multnomah County, Oregon, Department of Human Services. 1985. Homeless Women.
Multnomah County, Oreg.: Social Services Division, Department of Human Services.
New York Times. October 16, 1987. New Reagan policy to cut benefits for the aged blind
and disabled. Al.
Robertson, M. J. 1987. Homeless veterans: An emerging problem. Pp. 64-81 in The
Homeless in Contemporary Society, R. D. gingham, R. E. Green, and S. B. White,
eds. Newberry, Calif.: Sage Publications.
Robertson, M. J., R. H. Ropers, and R. Boyer. 1985. The Homeless of Los Angeles
County: An Empirical Evaluation. Basic Shelter Research Program, Document no. 4.
Los Angeles: Psychiatric Epidemiology Program, School of Public Health, University
of California, Los Angeles.
Rosenheck, R., P. Gallup, C. Leda, P. Leaf, R. Milstein, I. Voynick, P. Errera, L. Lehman,
G. Koerber, and R. Murphy. 1987. Progress Report on the Veterans Administration
Program for Homeless Chronically Mentally Ill Veterans. Washington, D.C.: Veterans
Administration.
Rosnow, M. J., T. Shaw, and C. S. Concord. 1985. Listening to the Homeless: A Study
of Homeless Mentally Ill Persons in Milwaukee. Prepared by Human Services Triangle,
Inc. Madison: Wisconsin Office of Mental Health.
Rossi, P. H., G. A. Fisher, and G. Willis. 1986. The Condition of the Homeless in Chicago.
A report prepared by the Social and Demographic Research Institute, University of
Massachusetts at Amherst, and the National Opinion Research Center, University of
Chicago.
Roth, D., G. J. Bean, Jr., N. Lust, and T. Saveanu. 1985. Homelessness in Ohio: A Study
of People in Need. Columbus: Office of Program Evaluation and Research, Ohio
Department of Mental Health.
Ryback, R., and E. L. Bassuk. 1986. Homeless Battered Women and Their Shelter Network.
Pp. 55-61 in The Mental Health Needs of Homeless Persons, E. L. Bassuk, ed. San
Francisco: Jossey-Bass.
Schutt, R. K. 1985. Boston's Homeless: Their Backgrounds, Problems, and Needs. Boston:
University of Massachusetts.
Shaffer, D., and C. L. M. Caton. 1984. Runaway and Homeless Youth in New York City:
A Report to the Ittleson Foundation. New York: The Ittleson Foundation.
Simpson, J. H., M. Kilduff, and C. D. Blewett. 1984. Struggling to Survive in a Welfare
Hotel. New York: New York City Department for Services to Families and Individuals
Solarz, A., and C. Mowbray. 1985. An examination of physical and mental health problems
of the homeless. Paper presented at the annual meeting of the American Public Health
Association, Washington, D.C.
Stevens, A. O., L. Brown, P. Colson, and K. Singer. 1983. When You Don't Have
Anything: A Street Survey of Homeless People in Chicago. Chicago: Chicago Coalition
for the Homeless.
Swords to Piowshares. 1986. Transitional Housing Program for Veterans: A Proposal. San
Francisco: Swords to Plowshares.
Towber, R. I. 1986a. A One-Day `'Snapshot" of Homeless Families at the Forbell Street
OCR for page 21
WHO ARE THE HOMELESS? 21
Shelter and Martinique Hotel. New York: Human Resources Administration of the
City of New York.
Towber, R. I. 1986b. Characteristics and Housing Histories of Families Seeking Shelter
from HRA. New York: Human Resources Administration of the City of New York.
Traveler's Aid Program and Child Welfare League. 1987. Study of Homeless Children and
Families: Preliminary Findings. Conducted by P. L. Maza and J. A. Hall.
Tucker, W. 1987. Where do the homeless come from? National Review 39(18):32.
U.S. Bureau of the Census. 1963. 1960 Census of Population. Volume One: Characteristics
of the Population, Chapter B: General Population Charactersitics; Part XV: Illinois.
Washington, D.C.: U.S. Government Printing Office.
U.S. Bureau of the Census. 1980. 1980 Census of Population. Volume One: Characteristics
of the Population, Chapter B: General Population Characteristics; Table 15, Persons
by Race. Washington, D.C.: U.S. Government Printing Office.
U.S. Conference of Mayors. 1986. The Continued Growth of Hunger, Homelessness and
Poverty in America's Cities: 1986. A 25-City Survey. Washington, D.C.: U.S.
Conference of Mayors.
U.S. Conference of Mayors. 1987. Status Report on Homeless Families in America's Cities:
A 29-City Survey. Washington, D.C.: U.S. Conference of Mayors.
U.S. Congress, House. 1987. Stewart B. McKinney Homeless Assistance Act, Conference
Report to accompany H.R. 558. 100th Cong., 1st sess.
U.S. Department of Housing and Urban Development. 1984. A Report to the Secretary on
the Homeless and Emergency Shelters. Washington, D.C.: U.S. Department of Housing
and Urban Development.
Vermont Department of Human Services. 1985. Homelessness in Vermont. Montpelier:
Vermont Department of Human Services.
Washington Post. September 27, 1987. Homeless in the suburbs: They are different from
the street people. D8.
Wright, J. D. 1987. Special Topics in the Health Status of America's Homeless. Special
report prepared for the Institute of Medicine by the Social and Demographic Research
Institute, University of Massachusetts, Amherst.
Wright, J. D., and E. Weber. 1987. Homelessness and Health. New York: McGraw-Hill.
Wright, J. D., E. Weber-Burdin, J. W. Knight, and J. A. Lam. 1987. The National Health
Care for the Homeless Program: The First Year. Report prepared by the Social and
Demographic Research Institute, University of Massachusetts, Amherst.
Representative terms from entire chapter:
homeless families
