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2
Dynam;es of Hon~elessness
INTRODUCTION
As the committee reviewed descriptions and discussions of the causes
of homelessness, two rather different concepts emerged. The first em-
phasizes homelessness as the result of the failures in the support and
service systems for income maintenance, employment, corrections, child
welfare, foster care, and care of mental illness and other types of
disabilities. Homeless people, in this view, are people with the problems
that these systems were designed to help. The increasing extent of
homelessness can be seen as evidence that these systems are ineffective
for various reasons perhaps because of inadequate funding, excessive
demand, or the intrinsic difficulties of responding to certain groups with
special needs.
An alternative formulation emphasizes economic factors in the homeless
person's lack of a regular place to live. As the supply of decent housing
diminishes, more and more people are at risk of becoming homeless. The
tighter the housing market, the greater the amount of economic and
personal resources one must have to remain secure.
When the need for low-income housing exceeds the available supply,
the question is: "Who gets left out?" Some seem to imply that home-
lessness is largely a random phenomenon for those with the lowest
incomes. Others, however, focus on a person's internal and external
resources, arguing that when the housing supply is inadequate, those
individuals and families with the least capacity to cope because they
suffer from various disabilities, have the fewest supports, or are incapable
of dealing with some of the rigors or exigencies of life—will be the ones
left out.
22
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DYNAMICS OF HOMELESSNESS 23
Each of these explanations is only partially accurate. Homelessness is
a complicated phenomenon, in which the characteristics of local human
services systems, public policies, and individuals all play important parts.
PATTERNS OF HOMELESSNESS
Homelessness does not take on a single form or shape. The ways in
which housing markets, employment, income, public benefit programs,
and deinstitutionalization interact to produce and perpetuate homelessness
are complex and vary with the individual. The demographic factors
described in Chapter 1 and the personal factors described in Chapter 3
are also important. For purposes of illustration as well as analysis of
social service issues, however, it may be useful to categorize various
patterns of homelessness: the temporarily, episodically, and chronically
homeless.
Temporary homelessness arises when people are displaced from their
usual dwellings by natural or man-made calamities, such as fires. A family
displaced by a fire or eviction subsisting on a marginal income from part-
time employment may be rehoused relatively quickly if local employment
and housing conditions are favorable. A regularly employed individual
living in a single room occupancy (SRO) hotel or rental apartment who
is laid off may rapidly run out of rent money and become temporarily
homeless. Once a person becomes even temporarily homeless, reintegra-
tion into the community is difficult and may become compounded by
secondary factors (e.g., loss of tools, cars, or other prerequisites to
finding employment; family breakup; reactive depression; or substance
abuse).
Episodically homeless people are those who frequently go in and out
of homelessness. A recipient of monthly disability payments or other
cash assistance who pays for housing on a weekly basis may be out of
funds 2 or 3 weeks into the month. Another example is the chronically
mentally ill young adult who lives with family members, but whose
situation episodically becomes intolerable and who ends up on the street.
A similar situation can develop with runaway and throwaway youths;
several studies (Shaffer and Caton, 1984; Greater Boston Adolescent
Emergency Network, 1985; Janus et al., 1987J indicate that adolescent
running away is not an event but a process involving numerous running
away incidents, often precipitated by physical abuse. Both spousal and
child abuse also play a frequent role as a precipitant of homelessness for
families (Ryback and Bassuk, 1986; Bassuk et al., 1986; Bassuk and
Rubin, 19871. Individuals or families, with the latter usually composed
of mothers and young children, may double up serially with several
relatives or friends but experience episodes of homelessness in between;
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24 HOMELESSNESS, HEALTH, AND HUMAN NEEDS
they are among the "hidden homeless" during periods when they are
temporarily domiciled in other households.
In a Los Angeles study, 15 percent of homeless people interviewed
had spent more than a year on the streets without any intervening periods
of residential stability (Farr et al., 19861. One-quarter of those interviewed
in a Chicago survey had beer homeless for 2 years or more (Ross) et al.,
19861. These people might be described as chronically homeless. They
are more likely to suffer from mental illness or substance abuse than are
those who are temporarily or episodically homeless (Arce et al., 19834.
However, only rarely do even chronically homeless people remain
homeless indefinitely (see Table 2-11; their state of homelessness typically
is interrupted by brief domiciliary arrangements, including institut~onal-
ization.
Any attempt to estimate the relative proportions of these three patterns
of homelessness is complicated by the fact that homelessness itself is a
dynamic phenomenon. Many people live perilously at the socioeconomic
TABLE 2-1 Chronically Homeless Individuals (current length of
homelessness)
City or State (Source)
Period of Homelessness
(years)
Chronically Homeless as
Percentage of Homeless
Population Total
Los Angeles
(Farr et al., 1986)
St. Louis
(Morse et al., 1985)
Ohio
(Roth et al., 1985)
Los Angeles
(Robertson et al., 1985)
Phoenix
(Brown et al., 1983)
Milwaukee
(Rosnow et al., 1985)
Chicago
(Stevens et al., 1983)
Portland
(Multnomah County,
Oregon, 1985)a
New York City
(Hoffman et al., 1982~6
31
32
15
16
21.8
22
27
28
28
41
57
aWomen only.
bMen only.
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DYNAMICS OF HOMELESSNESS 25
margin and are at high risk of becoming homeless. A clear and rigid
boundary does not exist between those who can fend for themselves and
those who cannot; there is a large gray area occupied by millions who
are only barely surviving. In the absence of interventions that help to
reintegrate people into the community, the proportion of chronically
homeless people can be expected to increase over time. On the other
hand, intervention strategies that effectively reduce first-time homeless-
ness would reduce the prevalence of chronic homelessness.
Three factors contributing substantially to the recent increase in the
numbers of homeless people are the low-income housing shortage,
changing economic trends and inadequate income supports, and the
deinstitutionalization of mentally ill patients.
HOUSING
There appears to be a direct relationship between the reduced availa-
bility of low-cost housing and the increased number of homeless people.
Since 198Q, the aggregate supply of low-income housing has declined by
approximately 2.5 million units. Loss of low-incGme dwellings can be
attributed primarily to the extremely slow rate of replacement of housing
resources lost to the normal processes of decay and renewal. Each year,
it is estimated that approximately half a million housing units are lost
permanently through conversion, abandonment, fire, or demolition; the
production of new housing has not kept pace (Hartman, 19861.
From the end of the Great Depression until 1980, the federal government
was the primary source of direct subsidies for the construction and
maintenance of low-income housing. Since 1980, federal support for
subsidized housing has been reduced by 60 percent, and most of the
remaining funds reflect subsidy commitments undertaken before 1980.
Federal support for development of new low-income housing has essen-
tially disappeared (U. S. Congress, House, Committee on Ways and
Means, 19871. Concurrently, there has been a failure to replace SRO
housing lost to conversion, gentrification, and urban renewal. In many
cities, SRO housing has been the primary source of housing for the
elderly poor, for seasonally employed single workers, and for chronically
disabled people (Hope and Young, 1984, 1986; Hopper and Hamberg,
19841. Since 1970, 1 million SRO units—half the national total have
been lost to conversion or demolition (Mapes, 19854. For example, in
New York City, from January 1975 to April 1981, the number of SRO
units and low-cost hotel rooms fell from 50,454 to 18,853; the SRO unit
vacancy rate dropped from 26 percent to less than 1 percent (Mair, 19864.
In Chicago during the relatively short period from 1980 to 1983, SRO
unit capacity declined by almost one-fourth (Ross) et al., 1986~.
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26 HOMELESSNESS, HEALTH, AND HUMAN NEEDS
With less low-income housing to go around, the relative price of the
remaining units has risen dramatically and with it the percentage of people
who must pay a disproportionate share of their income for housing costs.
Thirty percent of one's income is generally viewed by economists as the
maximum one should pay for housing. But, according to the U. S. General
Accounting Office (1985), the proportion of low-income renters paying
70 percent or more of their income for housing has risen from 21 percent
in 1975 to 30 percent in 1983. The 1983 Housing Census reported that 7
million households lived in "overcrowded" conditions (more than one
person per room); 700,000 lived in conditions described as "extremely
overcrowded" (1.5 people per room). Almost 10 percent of all households
with annual incomes of between $3,000 and $7,000 lived in overcrowded
units (Dolbeare, 1983; Hartman, 19864.
Overcrowded housing is directly related to the phenomenon of home-
lessness. In a typical situation, two or more families are doubled up in a
housing unit that should only accommodate one family. For example,
the New York City Housing Authority, relying primarily on readings of
water usage, estimated in 1983 that some 17,000 families were illegally
doubled up in its 150,000 units and described the problem as growing
geometrically (Rule, 19831. The stresses produced by that arrangement,
including tensions in relationships among the various people who are
living together, often lead to displacement of individuals, families, or
both. These people may double up again, turn to the shelters, or find
themselves on the streets.
The nature of the housing market varies dramatically from one com-
munity to another. For example, in the committee's site visits, the
shortage of low-income housing for families was repeatedly cited as the
single greatest cause of family homelessness in most cities, but service
providers in Milwaukee reported an adequate supply of housing for
families receiving Aid to Families with Dependent Children (AFDC). In
Chicago, the loss of SRO units was perceived as being much more
important, although concern was also expressed for the quality of family
housing. The committee concluded that despite the regional variation,
the lack of decent, affordable housing is a major reason why so many
people are homeless in the United States.
INCOME AND EMPLOYMENT
Broad-based economic trends have also contributed to the growing
numbers of homeless people. In the two decades between 1966 and 1985,
the number of people in poverty in the United States rose from a low of
23 million in 1973 to a high of 34 million in 1984, declining slightly to 33
million in 1985, the last year for which figures have been published.
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DYNAMICS OF HOMELESSNESS 27
Concurrently, the composition of the poor population is changing: The
proportion of the poor who are aged is declining, but nonaged adults and
individuals living in female-headed families are both increasing (U.S.
Congress, House, Committee on Ways and Means, 1987~.
At the same time, there have been major shifts in the labor market.
Total unemployment peaked at 10.7 percent in 1982 (Sebastian, 1985),
but a decreasing demand for casual and low-skilled labor has kept the
unemployment rate at or near 6-7 percent. Unemployment among minority
men has remained at historically high levels (U.S. Bureau of the Census,
1986), and although the gap in wages between men and women has
lessened, it still remains. This latter factor has specifically affected
families headed by women. In addition, the national minimum wage has
not been raised since 1981, even in the face of inflation. These factors
have contributed to the recent emergence of a large group of working
homeless.
While the number of poor and unemployed people has increased, the
availability and the real value of publicly financed benefits has declined.
Because of the changes in the character of unemployment, fewer of the
unemployed actually receive unemployment compensation benefits. Cur-
rent estimates are that only one-third of the unemployed are eligible for
such benefits. Welfare programs, such as AFDC and state-operated
general assistance programs for single adults and two-parent families,
have not kept pace with inflation. In terms of eligibility and enrollment,
they have not kept up with the increased needs. Nationwide, between
1970 and 1985, median AFDC benefits declined by about one-third in real
dollars; in only 3 of the 50 states do such benefits exceed the poverty
level (U.S. Congress, House, Committee on Ways and Means, 19871.
Similarly, for adult individuals during the 1970s, the real value of general
assistance benefits, in states that provided them, fell by 32 percent
(Hopper and Hamberg, 19844. In Massachusetts, general relief benefits
for an adult individual are now $268.90 per month (Flynn, 19861; in
Illinois, they are $144 per month. Those amounts, which are intended to
cover all living costs, will not pay for even the most minimally adequate
SRO housing in Boston or Chicago.
Although these benefits are inadequate many homeless ne.onle. rho not
even receive them: For example, only hall of the homeless in Chicago
(Ross) et al., 1986) and only one-third in Boston (Flynn, 1986) receive
them. Eligibility procedures in many jurisdictions are designed to dis-
courage applications; but even when they are not, documentation re-
quirements and waiting periods prevent or discourage people from
applying. The simple requirement of a fixed address has kept many
homeless people from applying or being approved for benefits to which
they are entitled. State and local initiatives and, more recently, federal
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28 HOMELESSNESS HEALTH, AND HUMAN NEEDS
legislation in 1986 and 1987 should reduce that problem; but there is as
yet no evidence of substantially increased participation rates by homeless
people in public assistance programs.
A particularly controversial cash assistance program in relation to
homelessness has been the Supplemental Security Income (SSI) program
for the disabled and low-income aged adults. SSI had been a major source
of income for the mentally disabled and psychiatrically impaired. Between
1981 and 1984, however, because of legislation that was passed in 1980
in order to clarify eligibility on the basis of disability, approximately
200,000 people were dropped from the SSI program. Many of these
people were psychiatrically impaired. Approximately 75 percent of those
people were subsequently restored to the program, and the relevant
federal legislation has beenichanged again. However, even the current
procedures for obtaining and maintaining SSI eligibility based upon
psychiatric disability result in many potentially eligible people going
without coverage (Bassuk, 1984; Hope and Young, 1984, 1986~.
Some people become or remain homeless while they are enmeshed in
the bureaucratic difficulties of obtaining and maintaining eligibility for
various kinds of public assistance. In addition to the documentation and
residency problems mentioned above, concern with budgetary control
and the minimization of fraud and abuse in benefit programs has led to
more frequent recertification requirements, greater demands for contin-
uing documentation, and a greater willingness on the part of agencies to
close cases for administrative reasons. Although benefits are usually
restored, homelessness often occurs during the period when benefits are
suspended (Dehavenon, 1985~.
DEINSTITUTIONALIZATION
Mental Health System
For the most vulnerable among the adult individual homeless or
potentially homeless, the barriers to receipt of cash assistance interact
with another set of public policy pressures: deinstitutionalization. In the
mental health system, this policy has resulted from three factors: (1)
discovery and utilization of psychotropic drugs, (2) concern with the civil
liberties of individuals confined in state psychiatric institutions, and (3)
greater awareness of the dehumanizing aspects of institutional environ-
ments. As a policy, it has been supported and encouraged by federal and
local governments, and has led to the reduction of populations in publi
mental hospitals from a high of 559,000 in 1955 to a low of 130,000 in
1980. It has also been blamed for the large numbers of mentally ill people
on the streets of major cities in the 1980s.
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DYNAMICS OF HOMELESSNESS 29
To what extent are the actions of the reforms of the mid-1960s actually
responsible for the plight of homeless mentally ill people today? The
American Psychiatric Association addressed this issue in a special task
force report (Lamb, 19841: "Problems such as homelessness are not the
result of deinstitutionalization per se but rather of the way deinstitution-
alization has been implemented." The term deinstitutionalization refers
to two interactive and parallel processes. The first involves the transfer
of care for individual patients from an institutional setting to the com-
munity; the second involves the development of systems within the
community that can provide the necessary array of services most
important, housing and treatment, care, protection, and rehabilitation
of seriously mentally ill people (U.S. Department of Health and Human
Services, 1981~.
As part of the movement to develop supportive service systems within
the community and to avoid the ill effects of institutionalization, a
philosophy evolved to reduce dramatically the number of inpatient days
and, whenever possible, to avoid hospitalization altogether. As a result,
a new group of chronically mentally ill adults has matured who, as a
result of increasingly restrictive admission policies, have never been
inside a psychiatric hospital. Additionally, for those adults who wish to
admit themselves voluntarily into public psychiatric hospitals or psychi-
atric units of acute-care hospitals, the resources are often unavailable.
Finally, for those patients with mental illnesses severe enough to warrant
involuntary commitment or for those who are voluntarily admitted, the
rehabilitative value of extremely short hospital stays has been questioned.
Despite all these problems, however, most patients can be maintained in
the community if an adequate range of less restrictive alternatives is
available.
Deinstitutionalization and noninstitutionalization have become increas-
ingly difficult to implement successfully because they depend heavily on
the availability of housing and supportive community services. In reality,
few communities have established adequate networks of services for the
Reinstitutionalized mentally ill. Various specialized community facilities
may be necessary to treat some individuals. This includes, for example,
the "young adult chronic" patient, whose mental pathology, combined
with a reluctance to acknowledge the illnesses and an aversion to a
regular medication schedule, present serious obstacles to effective treat-
ment (Pepper and Ryglewicz, 19841.
There is general agreement that deinstitutionalization has contributed
to the homelessness situation in the 1980s (Lamb, 1984~. The committee
learned of many individual instances in which patients had been discharged
from hospitals with inadequate or nonexistent plans for community care.
Other cases were encountered in which there were no community mental
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30 HOMELESSNESS, HEALTH, AND HUMAN NEEDS
health agencies to provide housing and necessary support or assistance
to mentally disabled individuals. Service providers across the country
expressed dissatisfaction with the extent of community-based mental
health services.
A critical point in the treatment of a person with a severe mental illness
occurs at the time of discharge from a hospital. Extremely careful planning
and coordination are necessary to ensure a smooth transition to outpatient
care and community living; it is essential that there is an appropriate
residence to receive the person. Some people have become homeless
either because discharge planning has been inadequate or because plans
that seemed adequate at the time of discharge broke down weeks or
months later. In some cases patients have been discharged directly to
the streets with no particular destination. In the past, large numbers of
patients were discharged to SRO hotels or cheap apartments. A discharge
plan of this sort seemed to afford a minimally adequate level of community-
based housing, and in these situations many patients were able to manage
some sort of tenuous adjustment. When the demand for housing in cities
led to the destruction or redevelopment of low-cost accommodations,
the mentally ill were least able to find alternatives and were at a particularly
high risk of homelessness.
Once a person ceases to have a fixed address, the community mental
health service system is least effective in providing treatment, mainte-
nance, and rehabilitation services. Thus, mentally ill people who have
been discharged to the streets or who have been displaced from a housing
situation are less likely to continue to receive the necessary array of
services.
As described more fully in Chapter 3, studies of homeless adult
individuals in cities such as Los Angeles, New York, St. Louis, Phila-
delphia, and Boston report that approximately one-third of the homeless
people interviewed suffer from a major mental illness (e.g., schizophrenia
or severe depression). Such findings do not indicate that all these people
would have been considered appropriate for long-term hospitalization,
even before the era of deinstitutionalization. However, psychiatric eval-
uations of a selected group of homeless people in Philadelphia suggested
that a substantial proportion of those interviewed would meet current
criteria for involuntary hospitalization (Arce et al., 19831.
Appropriate housing arrangements are essential for the successful
maintenance in the community of a person with a disabling mental
disorder. The prevailing professional view appears to be that a service
system must include a range of relatively small residential facilities
graduated according to the severity of the patients' problems and the
extent of care and supervision needed, up to and including 24-hour-per-
day support. In every community visited by the committee, this need
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DYNAMICS OF HOMELESSNESS 31
was felt, and service providers reported that there was a greater demand
than could be met by existing facilities. For example, the state of Maryland,
in its Five- Year Plan for Deinstitutionalization (Maryland Department of
Health and Mental Hygiene, 1984), published a conservative estimate of
a statewide need for 3,000 beds in community-based facilities and for
6,500 beds if projections were based on data from other states; current
bed capacity in community-based residences in Maryland is approximately
1,000. In neighboring Washington, D.C., as a result of the recent transfer
of control of St. Elizabeth's Psychiatric Hospital from the federal
government to the municipal government, the District government will
need 47 additional group homes over the ensuing 4 years for a total of
1,750 beds. Additionally, the District must establish and accommodate
the court-ordered closing of an institution for the mentally retarded (133
homes), the court-ordered closing of a juvenile facility (10 homes), and
the reduction of crowding at a correctional facility (214 new beds)
(Washington Post, September 25, 19874.
Other Systems
Deinstitutionalization is not a policy limited to the mental health
system. The general policy has come to be applied to many institutional
settings. Many homeless individuals, particularly single young men, have
histories of encounters with the criminal justice system. Many returned
to the community without adequate housing or realistic hopes for
reasonable incomes. More disheartening are the cases of adolescents and
postadolescents who grow out of foster care or child mental health and
mental retardation facilities because they are no longer eligible for
residentially based services for their age group, yet they have nowhere
to live.
Some homeless people have been discharged directly from general
acute-care hospitals to inadequate living arrangements after they leave
the hospital. The most dramatic of such cases encountered by the
committee involved people with AIDS (acquired immune deficiency
syndrome) who, as a result of their illness, lost both housing and
employment. In the only published report about homeless people with
AIDS,* the Institute of Public Services Performance, Inc. (IPSP, 1986)
reported that among the 377 people with AIDS in metropolitan New York
area hospitals, 77 (including 7 pediatric cases) were homeless at the time
of the study (June 19851. People with AIDS who were in the hospital and
interviewed by IPSP indicated that they were currently living on the
* A study of the problem in New York City done by the Institute of Public Services
Performance, on contract with the New York State Department of Health.
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32 HOMELESSNESS, HEALTH, AND HUMAN NEEDS
streets or in a shelter, and 19 percent listed the hospital as their current
housing situation. Overall, 57 percent reported that they needed assistance
locating permanent housing (IPSP, 19864.
The issues raised in the original movement toward deinstitutionalization
of the mentally disabled for example, the need to transfer treatment
from the institutional setting to the community, the need to have in place
community-based treatment centers, the need to provide assistance (both
financial and professional) to those in the community when necessary to
prevent inpatient admission or readmission—are the same as those in the
current proposals that we Reinstitutionalize our correctional, youth
services, and hospital systems. The critical element, the one without
which any such efforts would appear to be preordained to failure, is that
there must also be a place in the community for each person to live.
Clearly, the size of the current system of shelters and welfare hotels
indicates that such is not the case.
SHELTERING THE HOMELESS
Of those who become homeless, many turn to the nation's growing
number of emergency shelter facilities. It appears that the demand for
emergency shelter often exceeds the supply; of the 25 cities responding
to the 1986 survey by the U.S. Conference of Mayors, 7 reported that
people are routinely turned away from existing facilities (U.S. Conference
of Mayors, 1986~. Advocates for the homeless have asserted that some
homeless people were also turned away in many of the remaining 18
cities as well.
Shelters
Shelter facilities are extremely variable, ranging from 1,000-bed con-
verted armories to church basements with a handful of beds. Many are
traditional missions operated by religious groups in or near the downtown
areas of large cities; others are recently converted public facilities.
Whatever the stated formal capacity, most shelters are occupied at or in
excess of capacity during peak nights, especially during cold weather.
Although generalizations about shelters must be made with care, most
facilities currently operating as shelters for the homeless were not designed
or constructed for that purpose and are barely adequate for their current
use. Rows of closely spaced cots or bunk beds in a large open room are
common; this arrangement permits neither privacy nor any means of
securing personal belongings. Being homeless means no regular place to
sleep, no security for personal property, and often no assurance of
personal safety. In the larger shelters, guests must often be protected
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DYNAMICS OF HOMELESSNESS 33
from physical assault. In many shelters, sanitary facilities are minimal.
In a few states, minimal health and safety standards for shelters are
mandated by state regulations (as in New York) or are a condition for
receiving public subsidy (as in Massachusetts); in some communities,
they have been established by court order (New York City). However,
even in those communities, the relentless pressure of increasing demand
makes compliance with even minimal standards difficult.
Many shelters were established to provide shelter and sometimes food
for only a few days. This was based on the assumption that homelessness
resulted from an acute crisis that would be resolved in a short time.
Shelters were not originally intended to be broad-based human service
systems and are poorly designed to serve that purpose.
Most shelters operate only at night; the most common practice is to
require overnight guests to leave by 6 or 7 o'clock in the morning. In
theory, such practices deter malingering and return people to the com-
munity at a sufficiently early hour to seek daytime employment. However,
such a practice also makes it difficult to provide services and exposes
unemployed people to various hazards during the day. Hence, many
communities have developed "drop in" or day centers where homeless
people can safely spend daytime hours and where services for the homeless
can be concentrated. Many shelters also limit the number of consecutive
nights an individual can remain, reflecting again an ideology of providing
temporary assistance but discouraging permanent reliance on such sup-
port. For chronically homeless people, however, such policies not only
limit their ability to develop relatively more stable patterns of activities
of daily living (e.g., developing a personal grooming routine, maintaining
the cleanliness of their clothes) but also impede their ability to find
employment as a way out of homelessness (homeless people cannot
inform a prospective employer where they can be contacted if they do
not know where they are going to be).
Some shelters provide a single meal, but for most homeless individuals
food is obtained from soup kitchens and other organized food programs.
During the last decade, an enormous network of such programs has
sprung up across the United States; as with many shelters, most are
organized and staffed primarily or exclusively by volunteers. These
programs rely on some mix of donations, government surplus commod-
ities, and purchased goods. The quality of the meals is extremely uneven,
and many sites provide only certain meals, or operate only on specific
days of the week or at certain times during the year.
In most parts of the United States, shelter systems are organized
exclusively to serve adult individuals; most are segregated by sex and
are not appropriate places for children. Therefore, because many com-
munities lack an adequate supply of emergency housing specifically for
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34 HOMELESSNESS, HEALTH, AND HUMAN NEEDS
families, homeless families frequently must break up in order to obtain
shelter. As a result, it is not uncommon for families to place their children
in the custody of child welfare authorities. Many other parents avoid
shelters and any contact with public agencies for fear that custody of
their children will be placed in jeopardy by the parents' temporary
inability to provide housing.
Welfare Hotels and Motels
Federal legislation has provided a program of emergency assistance
(EA) to families receiving AFDC who are temporarily displaced from
their usual living arrangements. EA has become the primary mechanism
for financing family shelters in many communities, largely through
payments for hotel and motel rooms or similar accommodations. States
have had considerable flexibility in their use of EA funds, but EA can
only be used for relatively short-term crises and not for permanent
housing. Only 28 states have even elected to have EA programs (U.S.
Congress, House, Committee on Ways and Means, 19871.
In cities where the housing market for people with low incomes is not
hopelessly tight, EA may effectively bridge the transition into permanent
living arrangements. However, New York City's welfare hotels and
similar facilities in other parts of the country exemplify the limitations of
EA. Such hotels and motels were not designed to accommodate large
families, nor were they designed to house families with children for
extended periods. Most lack facilities for food storage and preparation.
Providing nutritional meals to young children without refrigerators, stoves,
or cooking utensils is almost impossible, and bottle-feeding young infants
is very difficult.
In addition to being inappropriate places to rear children, such forms
of temporary housing are extremely costly. For example, in 1986, the
Commonwealth of Massachusetts paid between $1,350 and $1,600 per
month per family for this type of accommodation; the annual average
was calculated at $16,000 per family (Gallagher, 19861. This amount
would secure a spacious apartment in some of the better neighborhoods
in many American cities.
In addition to shelters and welfare hotels, other forms of shelter have
been created. In many cities, churches have opened their doors to
homeless people. Many homeless people prefer accommodations in
churches over those in large public facilities. Some who refuse (or are
turned away from) shelters use cars, tents, or cardboard boxes as
temporary shelters. Homeless people have also described constructing
rudimentary forms of shelter in public parks, from Fenway Park in Boston
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DYNAMICS OF HOMELESSNESS 35
to Balboa Park in San Diego. What is common to each of these forms of
housing is that none are appropriate as short- or long-term housing.
Extent of the Shelter System
Various conclusions about basic services for the homeless can be
drawn. First, in most cities there is no system. Some cities have established
coordinating mechanisms to mobilize emergency efforts during periods
of cold or otherwise dangerous weather. In fact, the emergency shelter
system was founded on the assumption that the clients, needs and the
services they required would be transient and intermittent. Indeed, like
the growth of the homeless population itself, mechanisms for providing
services to the homeless have mushroomed, but they still lag behind the
constantly increasing demand. Effective planning has been the exception,
and even communication among service providers frequently occurs only
at the most rudimentary level (Wright and Weber, 19871.
The magnitude and nature of the problem of homelessness are unprec-
edented within the memory of most adults, so there are few past
experiences that could guide planning efforts by public officials and
community agencies. Adequate services must be provided, but without
permanently institutionalizing homeless families and individuals through
another human service system that inherently provides second-class
services. Shelters are inappropriate substitutes for long-term housing,
and attempts to respond to immediate needs can deflect energy and
resources from longer term initiatives. Moreover, there are inherent
dilemmas in the siting of facilities. There is a growing pressure from the
business community to reduce the concentration of homeless people in
central downtown areas. However, residents of neighborhoods that might
be more appropriately residential tend to mobilize quickly and aggressively
in opposition to the establishment of facilities for the homeless in their
midst. Dispersion far from downtown areas may further isolate the
homeless from such basic needs as, for example, transportation and
access to health and social services.
Another conclusion that can be made about existing services for the
homeless is that a large proportion of those services rely on the efforts
of volunteers. The selfless energy of volunteers and the magnitude and
spontaneity of their endeavors throughout the nation have been central
to the effective functioning of the shelter network. However, there are
some drawbacks to the reliance on volunteer staffs. The continuity and
reliability of services sometimes suffer. Many volunteers are associated
with religious organizations whose values may conflict with some of the
service needs of the homeless. Moreover, the presence of volunteer
OCR for page 36
36 HOMELESSNESS, HEALTH, AND HUMAN NEEDS
services, even if clearly inadequate in meeting the prevailing needs, may
provide public officials with an excuse to avoid their responsibilities and
obligations.
One final point must be made about the existing shelter situation. At
no point was it determined as a matter of policy that shelters were to be
a substitute for other human service systems, such as those for mental
health, education, foster care, and skilled nursing care. However, that is
what seems to be happening in many parts of the country. As reported
in the Greater Boston Adolescent Emergency Network study of Massa-
chusetts shelters for adolescents, these facilities are not used for emer-
gency shelter as much as they are used to address other problems or to
fill service gaps. The committee concluded that the shelter system cannot
substitute for other systems, nor can it be expected to address problems
for which at least theoretically~ther systems have already been
established.
SUMMARY
As has been seen in this chapter, the causes of homelessness are many
and interrelated: the decline In the number of units of affordable housing,
the increases in the number (albeit a declining percentages 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 a 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 in the 1980s. Various short-term emergency shelter
approaches, including welfare hotels and motels for families, are inade-
quate as responses to the long-term changes that have caused this problem
to grow so dramatically. As will be seen in Chapter 3, the state of being
that is called homelessness is intricately entwined with the aspect of the
individual's well-being that is called health. Solutions proposed to remedy
one cannot ignore the other.
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Representative terms from entire chapter:
mentally ill
