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OCR for page 228
Index
Access to health care
bureaucratic obstacles, 95, 100, 132
documentation obstacles, 95, 100
economic barriers, 40-42, 79-81, 89, 90-
91, 100, 140, 204
entitlement problems, 94, 99, 100, 140
ethical issues, 77
indigent care system, 89-94
lack of fixed address as a barrier, 94-95
location of facilities, 99, 117, 140
through Medicaid, 82-89
by mentally ill, 58, 96-98, l l9
negative experiences with or attitudes
toward service providers, 95-96, 117
private fee-for-service system, 88-89
psychiatric treatment, 58
in rural communities, 20D, 203-205, 206
scheduling of clinic appointments, 95, 100
strategies for increasing, 97, 143, 203
studies/surveys of, 77-78
for substance abuse treatment, 63
transportation barriers, 82, 89, 95, 100,
128, 140, 203
by veterans, 98-100
voluntary inpatient care, 58
Adolescents and youths, homeless
alcoholism in, 213
community-based-facility needs for, 31
crisis center for, 14
eligibility for residentially based services,
31
228
health problems of, 68, 212-213
physical and mental health needs, 126
pregnancy, 67, 212-213
in rural communities, 212-213
shelters for, 14, 36, 126
size of population, 6
targeted services for, 125-127
see also Runaway and throwaway youths
Adult homeless individuals
characteristics of population, 6-11, 62
educational attainment, 6-7
employment status, 10
ethnic background, 6, 7, 8-10
geographic distribution, 8-l l
health problems of, 43-50
marital status, 6, 7, lO
mental disorders in, 50-57
public assistance benefits, 27
residence time in one place, 7, lO
Adult homeless individual men
acute physical disorders in, 44
age, 5-7, 10
alcoholism in, 60, 62
chronic physical disorders in, 46-47
death rates, 15
marital status, 6, 7, lO
population size, 1, 5, 6
veterans, 10
see also Veterans
Adult homeless individual women
acute physical disorders in, 44
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INDEX 229
age, 6, 10, 192-193
chronic physical disorders in, 46
criminal victimization of, 6, 41, 44
health problems, 6, 41, 44, 66
marital status, 6, 10, 192
population size, 6
pregnancy, 66
psychiatric disorders in, 56-57, 125
studies of, 5
targeted services for, 124-125
veterans, 10
Advocates/advocacy, National Alliance to
End Homelessness, 4, 137
Aid to Families with Dependent Children
casework services, 151
deficiencies in benefits, 27
eligibility for, 83-86
emergency assistance program, 34, 145,
158
homeless recipients, 12
housing adequacy for recipients, 26
AIDS
as a cause of homelessness, 31, 40
costs of treating, 91
dementia and, 51
education programs, 126
prevalence among homeless, 48-49, 64, 68
service needs of homeless victims, 124
targeted services for, 124
Alabama
characteristics of homeless in, 17, 205
Medicaid eligibility in, 83, 84
outreach program in rural areas, 203
Alcohol problems
age correlation with, 64
case management, 153
comorbidity with drug abuse and mental
illness, 65-66, 138
geographic patterns, 61, 210-211
housing needs for, 123, 153, 154
mental illness/disorders and, 51, 53
physical disability and, 60
prevalence, 57, 60-61, 104, 138, 152, 207-
209, 210-211, 212, 213
relationship between homelessness and,
40, 62
secondary health effects/risks, 41, 48-50,
60, 62, 154
studies of homelessness and, 5
targeted services for, 123-124, 153-154
treatment, 62-63, 69, 114, 123, 153-154,
206
among veterans, 7
Alliance Housing Council, estimates of
homeless population, 3
American Psychiatric Association, 29
Anemia and related disorders, 46, 66
Anti-Drug Abuse Act of 1986, 166
Arthritis, rates of occurrence in homeless,
46-41
Baltimore
census of homeless population, 171, 172,
178-179
characteristics of homeless in, 10-11, 56,
61, 62
shelters, 56
studies of homeless, 4, 56
Black homeless
geographic distribution of, 8-9, 191
psychiatric disorders among, 57
Boston
Cardinal Medeiros Day Center, 16, 108,
127, 156, 218
characteristics of homeless in, 7-8, 11, 16,
30, 34, 49, 56, 61, 64
Fenway Park, 34
Greater Boston Adolescent Emergency
Network, 14, 36, 68, 126
Johnson-Pew Health Care for the
Homeless project, 125
Long Island Shelter, 220
Pine Street Inn, 106, 220
Project Hope, 125, 220
public assistance enrollments, 27
shelters, 14, 16, 36, 106
SRO housing costs, 27
St. Francis House, 108, 221
studies of homeless, 4, 7, 14, 68
tuberculosis prevalence in, 49
Brief Symptom Inventory, 52
California
Episcopal Archdiocese, 112
estimates of homeless, 198
Medicaid program, 83, 84, 88
Oakland Independence Support Center,
220
Cancer, rates of occurrence in homeless,
46-47
Cardinal Medeiros Day Center, 16, 108, 128,
156, 218
Cataracts, 41, 46-47
Catholic Charities, 124
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230 INDEX
Cellulitis, 45
Center for Epidemiological Studies
Depression Scale, 52
Chicago
census of homeless in, 175-176
characteristics of homeless in, 7-8, 10,
15-16, 24, 52
Cook County Jail, 219
Cooper's Place, 219
Firehouse Annex, 125, 219
Near North Health Center Outpost Clinic,
220
public assistance in, 27
SRO housing, 25, 26, 27
studies of homeless, 4
Children, homeless
characteristics and needs of, 13, 67, 156-
157
education/learning problems, 11
emotional and intellectual impairment, 57,
66, 68, 157, 205
health problems, 66-67, 157, 213
immunization delays, 67
placement with welfare authorities, 34
psychiatric disorders in, 57, 68
in rural areas, 213
school attendance, 14, 67
services recommendations for, 157
size of population, 13-14, 138
Child Welfare League, 14
Christ House, 109, 130, 218
Chronic obstructive pulmonary disease, 46-
47
Clinics
common problems, 82, 89, 95, 107
dental, 108
free-standing, 92, 108-109
funding for, 92, 106-107, 109
hours of operation, 82, 89, 95
importance, 92-93
location, 112, 114-115, 117, 128
mobile, 112, 116-117, 125
nonsectarian, 106-107
physical amenities, 82
public-private, 107
quality of care, 92
religious-sponsored, 106
respite center adjacent to, 109
shelter-based, 106-107, 112
staffing, 115, 117
stationary, 116-117
Veterans Administration, 98
waiting times, 82, 141
Zacchaeus Clinic, 108-109
Community health centers in rural areas,
205
Community Mental Health Centers Act of
1962, 145
Community support services
for Reinstitutionalized mentally ill, 29-30
inadequacies of, 29-30
needs, 142-143
residential placement for disabled, 110
Community Support Systems Program
demonstration grants, 97
rehabilitation services, 120
Connecticut
health care financing in, 91
Medicaid program, 84, 88
Convalescent facilities
for alcoholics, 63
Christ House, 109, 130, 218
COSMOS Corporation definition of case
management, 131-132
Day centers for homeless
Cardinal Medeiros (Boston), 16, 108, 128,
156, 218
day care for children, 157
self-help centers for mentally ill, 121
services offered by, 33, 107-108
So Others Might Eat, 108
St. Francis House, 108
Degenerative diseases of joints, 41
Deinstitutionalization, 28-32
Dental/periodontal disease, prevalence in
homeless, 41, 46-47, 50, 185, 206, 207-
209, 212
Denver Developmental Screening Test, 67
Detroit
characteristics of homeless in, 8, 11, 52
Johnson-Pew Health Care for the
Homeless projects, 111, 114, 115-116
Development disabilities, prevalence among
homeless, 52
Diabetes, 42, 50, 59, 65
Disabled persons
cash assistance program, 28, 59
residential placement programs, 110
Domiciled poor
access to health care, 79, 82, 143
characteristics of, 27, 78-79
clinics for, 109
health insurance status, 80
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INDEX 231
medical services utilization, 78-79
in rural areas, 82
sources of housing for, 25; see also
Housing, low-income
Drug abuse/addiction
age factors in, 64, 123
as a cause of homelessness, 40
comorbidity with alcohol abuse and
mental illness, 65-66, 138, 155
environmental exposure problems, 50
ethnicity and, 64
housing needs for, 123
illnesses/medical conditions related to, 41,
47, 48, 63-65, 155; see also AIDS
mental illness and, 51, 53
prevalence among homeless, 63, 104, 138,
152, 155, 207-209
studies of homelessness and, 5, 63
targeted services for, 123-124, 155
Edema, dependent, 45
Education
Head Start program, 157
health insurance coverage and, 80
medical, subsidization, 93
school attendance by homeless children,
14
status of rural homeless, 193
Elderly homeless people
cash assistance programs, 28
causes of homelessness, 40-41
characteristics of homeless, 15-17
degenerative diseases in, 40-41
facilities for, 16
fear of shelters, 16
geographic distribution of homeless, 15-16
health risks of, 48
outreach program, 108
public assistance entitlements, 41
size of homeless population, 15, 138
studies of homeless, 5, 15-16
Eligibility for entitlements
age and, 6, 15, 31
Aid to Families with Dependent Children,
83
categorically related people, 83
decoupling from receipt of cash
assistance, 88, 89, 147
disability-based, 28
documentation requirements, 27, 28, 95
fixed-address requirement, 27-28, 89, 94,
146, 166
food stamp program, 202
legislation improving, 166
Medicaid, 6, 83-88, 88, 94, 100
mentally ill homeless, 96
recommendations, 146
state discretion in conferring, 83
Supplemental Security Income program,
28, 83, 89, 96, 131
thresholds by state, 84-86
unemployment compensation, 27
Veterans Administration, 98, 99
Emergency Jobs Appropriations Act of
1983, 165
Employment
health insurance coverage and, 80-81
impediments to finding, 33, 203
jobs available to homeless, 10
loss of, by AIDS patients, 31
in rural areas, 185-186, 196-197
status of adult individual homeless, 10
trends, 27
Endocrinological disorders, rates of
occurrence in homeless, 46-47
Eye disorders, 41, 46-47
Families, homeless
age of children in, 11
benefits for, 27; see also Aid to Families
with Dependent Children
causes of homelessness, 13, 23
characteristics of, 11-14
day care for children, 125
doubling up of, 13, 23-24
emotional problems, 11
ethnic status, 12
female-headed, 5, 11, 12, 23, 27, 56, 138,
204; see also Mothers, homeless
health care services delivery, 116
health status, 11, 66
multiple problems of, 13
nutritional status, 11
placement of children with welfare
authorities, 34
population size, l, 4, 5, 6, 138
regional variations in, 12
rural, 189-190
shelter problems of, 33-34, 36, 190
social services contacts, 13
studies of, 5, 11-12
support networks, 12-13
targeted programs for, 125
two-parent, 5, 12, 13, 204
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232 INDEX
see also Children, homeless
Federal Emergency Management Agency
funding for convalescent care, 155
funding for food and shelters, 158, 165,
166-167
Federal funding
for casework services, 151-152
for categorical programs, 93
Florida
health care financing in, 91
Medicaid program in, 84
Food
outreach programs with, 108
preparation and storage in welfare motels,
34
So Others Might Eat, 108, 220
soup kitchens, 33, 112, 117, 152, 166, 199,
200, 210
supplemental food program for Women,
Infants and Children, 207
Temporary Emergency Food Assistance
Program, 165, 166, 167
see also Nutrition
Food Security Act of 1985, 166
Food stamps, 152, 166, 202, 203
Fountain House, 59
Frostbite, 50
Gastrointestinal disorders, prevalence in
homeless, 46-47
General Health Questionnaire, 52
Genitourinary disorders, prevalence in
homeless, 46-47, 65
Hawaii
Medicaid eligibility thresholds, 84
Medicaid enrollments, 87
Health care services
for alcoholics and drug abusers, 123-124
area to be served by, 118
case management, 112, 113, 116, 123, 131-
132, 143, 149, 151-152, 153
categorical programs, 93-94
characteristics of homeless that affect
planning for, 104
communication and coordination in, 105,
109-110, 113, 120, 127-128, 151
contracting versus direct provision, 117-
118
convalescent care, 109-110, 114, 155
day programs, 107-108
discharge planning, 29-30, 110, 130, 143,
147-148, 200
effective models of delivery, 106- 109, 112
funding of, 103, 106-107, 112, 128-129
holistic approach, 113
internal and external resources, 105
for mentally disabled, see Mental health
care
multidisciplinary approach, 113
nonsectarian, 106-107
obstacles to, see Access to health care
prenatal, 66, 114
public-private programs, 107, 126-127
range needed, 129-130
recommendations, 148-158
religious-sponsored, 106
residential placement, 110, 119, 128, 151
respite care, 109-110
rural area resources, 203-207
separation of systems for domiciled and
homeless, 111
size of facilities, 117
stationary clinics versus mobile teams,
116-117
subsidization by paying patients, 91
successful elements, 105, 113-116
targeted approaches, 105-134, 141
utilization rates, 60, 62, 78, 205-207, 208-
211
see also Clinics; Johnson-Pew Health
Care for the Homeless projects;
Medical treatment; Outreach programs
Health care/social service providers, 35
availability in rural areas, 204
characteristics of personnel, 133-134, 141
communication deficiencies/needs among,
35
hours of operation, 82, 89, 95
liability insurance coverage, 107, 132-133
perceptions/attitudes about homeless, 58,
82, 89, 95-96, 113
physical amenities, 82
training for, 141, 149
waiting times for, 82
Health insurance
coverage by age and race, 79-81
effects of lack of, 40, 42, 79, 82
through Medicaid or Medicare, 80, 81
Health problems/illnesses
acute physical disorders, 44-45, 62, 206,
207
of adult homeless, 43-50
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INDEX 233
age factors in, 45, 47, 49
blood disorders, 46, 66, 209
cancer, 46-47
causing homelessness, 39-41, 68, 139-140
chronic physical disorders, 46-47, 49-50,
62, 65, 66, 69, 185, 207
data base on, 69
degenerative diseases, 40-41, 46-47
dental/periodontal disorders, 41, 46-47,
50, 185, 206, 207-209, 212
diabetes, 42, 46-47, 69
ear disorders, 46-47
endocrinological disorders, 4~47
from environmental exposure, 50, 140,
154, 205, 207, 212
ethnic differentials in, 44, 46, 48, 49
eye disorders, 41, 46-47, 209
foot problems, 50
gastrointestinal disorders, 46-47, 2065 209
gender differentials in, 44, 46, 48
genitourinary problems, 4~47, 65, 209
geographic differences in, 44
hepatic cirrhosis, 41
hypertension, 42, 49, 62, 69
infectious/communicable disorders, 41, 48,
64-65, 66
infestational ailments, 44-45
liver disease, 41, 46-47, 65
musculoskeletal disorders, 40-41, 46-47,
209
neurological disorders, 46-47
nutritional deficiencies, 41, 44-45, 66, 185,
206, 207-209, 212, 213
obesity, 44-45
occurrence rates, 44 49
parasitic infections, 41, 209
pregnancy, 46-47, 207, 209
respiratory disorders/infections, 44-49, 62,
65, 66, 154, 206, 209, 212
resulting from homelessness, 41, 140
of rural populations, 206-207
seizure disorders, 46-47
skin ailments/disorders, 41, 44, 45-47, 62,
64, 69, 140, 206, 209
traumatic disorders, 41, 43-45, 62, 69,
140, 209
vascular disorders, 41, 42, 45-47, 62, 64-
65, 140, 209
venereal diseases, 41
see also Alcohol problems; Drug abuse/
addiction; Mental illness/disorders; and
specific illnesses and conditions
Health Professions Training Act, 136, 166
Hepatic cirrhosis, 41
Hepatitis, infectious, 41, 64
Hispanic homeless
geographic distribution of, 8-9
psychiatric disorders among, 57
Homeless Chronically Mentally Ill outreach
program, 7, 10, 65
Homeless Eligibility Clarification Act, 166
Homeless Housing Act of 1986, 167
Homelessness
case studies of causes, 40, 41
chronic, 24, 33
definition, 2, 137, 170
deinstitutionalization and, 25, 28-32, 139
dynamics of, 22-36, 39-43
economic factors in, 11, 22, 23, 25-28, 40,
139
employment trends and, 27, 196-197
episodic, 23-24
family violence/abusive relationships and,
13, 14-15, 23
health care complications of, 42-43; see
also Access to health care
health problems resulting from, 41, 141-
142
health-related causes, 39-41, 50-51
housing availability and, 11, 22, 25-26,
139
income losses and, 11, 25
intervention strategies, 25, 82, 144-148;
see also Recommendations
length of, 194
patterns of, 23-25, 143, 170, 176
risk factors, 4, 12-13, 22, 25, 30, 41, 130,
138
running away and, 13
substance abuse and, 7
support and service system failures and,
22
temporary, 23
Homeless people
with AIDS, 31
barriers to health care; see Access to
health care
changes in, l, 3-4
characteristics affecting health care, 104
common problem, 18
composition, 1, 17-18, 60, 103
counting methodologies, 2-4, 169-181,
198-199; see also Studies of homeless
criminal victimization of, 6, 41, 44, 140
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234 INDEX
demographic characteristics, 5-17, 63,
138, 192-194
distrust of authority, 58, 103, 104
enrollments for public assistance, 27
ethnicity, 6, 138, 192
health risks, 39, 103; see also Health
problems/illnesses
hidden, 24
illness prevalence among, 39
life satisfaction, 212-213
medical treatment of, 42-43, 49-50, 57-60,
140
personal safety, 32
reintegration into community, 23, 25
sheltering, 32-36; see also Housing, low-
income; Shelters
size of population, 1, 3, 17, 137-138, 171
stereotypes, 50, 60, 138
studies, see Studies of homeless
transience, 195-196
transportation needs, 14
see also Adult homeless individuals;
Children, homeless; Elderly homeless
people; Families, homeless; Runaway
and throwaway youths; Rural homeless/
homelessness; Veterans
Hospitals
clinic affiliation, 109-110
closures, 91, 204
community, 90
deficit operation, 91
emergency room utilization, 208-209
public, 90
role in caring for poor people, 90
rural, 204
teaching, 90, 133
uncompensated care by, 90-91, 204
Veterans Administration, 98
voluntary, 90
Housing
for alcoholics and drug abusers, 123
for Reinstitutionalized populations, 30-31
Fountain House, 119
funding for, 119
income percentage paid for, 26
loss of, by AIDS patients, 31
for mentally disabled, 30-31, 60, 119, 121,
145
overcrowding in, 26, 190
quality, 26
substandard, 17, 188, 202, 213
transitional, 200
Veterans Administration domiciliary
facilities, 98
Housing costs
and homelessness, 4, 11, 138, 139, 142
SRO units, 26
Housing, low-income
apartments, 30
causes of losses of, 25, 30
federal support for, 25
impediments to augmenting, 145
recommendations, 144-145
in rural areas, 188, 202
sources, 25
SRO units, 25-26, 30, 62
supply, 22, 25, 139, 142, 202
transition into, 34
Hypertension
in alcoholics, 62
causes, 49
dementia and, 51
rates of occurrence in homeless, 46-47
treatment difficulties and needs, 42, 49-50,
69, 140
Hyperthermia, 50
Hypothermia, 50
Illinois
Medicaid program, 84, 87, 88
public assistance benefits in, 27
services for alcoholics and drug abusers,
123
income
and eligibility for entitlements, 83
and homelessness, 11, 27, 142
minimum wage, 27, 142, 146
recommendations, 146-147
Indigent care system
categorical programs, 93-94
clinics, 92-93
hospitals, 90-92
National Health Service Corps, 93
Infectious/communicable diseases
in drug abusers, 64-65
hepatitis, 41, 64
malaria, 65
rates of occurrence in homeless, 48-49
see also AIDS; Respiratory diseases/
disorders; Venereal diseases
Interagency Council on the Homeless, 156,
167
International Union of Gospel Missions, 106
Iowa, Youth and Shelter Services, 213-214
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INDEX
Job Training Partnership Act, 166
Johnson-Pew Health Care for the Homeless
projects
benefit status of clients of, 87, 94
case management and coordination of
services, 113, 116
characteristics of homeless, 15, 43
common elements, 112-116
effectiveness, 105
holistic approach, 113, 141
issues raised by, 116-118
outreach component, 113-115, 116-117
program guidelines, 111
prevalence/incidence of health problems
among homeless in, 43-49, 57, 63-64,
67, 68
range of services, 114-116
structure, 111-112
Joint Commission on Mental Illness and
Health, 96
Kansas City
City Union Mission, 218-219
coordinated health care services in, 127-
128
Emergency Lodge, 219
Pilgrim House, 125, 220
Restart, Inc., 220
shelter-based clinics, 106
Kit Clarke Senior House, 16, 108
Labor market shifts, 27
Legislation to aid homeless
Anti-Drug Abuse Act of 1986, 166
bedding for shelters, 166
block grant program for chronically
mentally ill homeless, 97
Community Mental Health Centers Act of
1962, 145
Demonstration projects, 167, 168
Domestic Volunteer Service Act
Amendments of 1983, 166
educational programs, 168
on eligibility for entitlements, 27-28, 94
Emergency Jobs Appropriations Act of
1983, 165
food assistance, 165, 166-167
Food Security Act of 1985, 166
Health Professions Training Act, 136, 166
Homeless Eligibility Clarification Act, 166
Homeless Housing Act of 1986, 167
235
housing, 167
Job Training Partnership Act, 166
Mental Retardation Facilities and
Community Mental Health Centers
Construction Act of 1963, 97
Military Construction Authorization Act
of 1986, 166
Older Americans Act, 156
Omnibus Budget Reconciliation Act of
1981, 92, 98-99
for outreach program for homeless
veterans, 98-99
Protection and Advocacy for Mentally Ill
Individuals Act, 151-152
provision of health care professionals, 93
Public Health Service Act, 92
recommendations, 151-152
Runaway and Homeless Youth Act, 156
shelter assistance, 34, 165, 166
Stewart B. McKinney Homeless
Assistance Act of 1987, 2, 93, 97, 105,
153, 155, 156, 167-168
transfer of mental health care to
community-based centers, 96-97
Lexington, Kentucky
coordinated health care services in, 127-
128
Horizon Center for the Homeless, 219
residential placement program, 110, 221
Liability and medical malpractice insurance
difficulty of service providers in obtaining,
107, 132-133, 159
recommendations on, 159
Liver diseases, 41, 46-47, 65
Los Angeles
characteristics of homeless in, 7, 9-11,
15-16, 24, 30, 52, 53, 61
housing for alcoholics and drug abusers,
123
Johnson-Pew Health Care for the
Homeless projects, 128
shelter-based clinics, 106
studies of homeless, 4, 7, 53, 56
Union Rescue Mission, 221
Valley Shelter, Inc., 221
Venice Family Clinic, 125, 221
Maine
health care financing in, 91
Medicaid program, 85
services for alcoholics and drug abusers,
123
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236 INDEX
Maryland
community-based-facility beds, 31
deinstitutionalization plan, 31
estimates of homeless, 172, 179, 198
health care financing in, 91
Medicaid program, 85, 87
Massachusetts
characteristics of homeless in, 12, 57
health care financing in, 91
housing for alcoholics and drug abusers,
123
Lemuel Shattuck Hospital, 220
Medicaid eligibility in, 85
public assistance benefits in, 27
shelters, 33, 34, 57, 123
see also Boston
Medicaid
application process, 87
availability to homeless, 89, 204
benefits, 88-89
coverage, 82, 204
eligibility for, 6, 83-88, 94-95, 146, 147,
204
enrollments, 82, 87-88, 89, 94
health insurance through, 80-82
impediments to receiving, 41, 82
largest groups of recipients, 87
limitations, 88
payment restrictions, 88, 147, 204
recommendations, 147
state-only program, 87
state variation in, 83-87, 88, 94, 146
Medical treatment
characteristics of homeless that affect, 104
continuity of care, 114
detoxification, 62-63
for diabetes, 42
difficulties in compliance with, 42-43, 49-
50, 69, 103, 140
for hypertension, 42, 49-50, 140
overspecialization of, 66
recommendations, 149
Mental health care
ambulatory treatment, 58
case management, 132, 153
clinical problems of providing, 57-60
community-based facilities, 30-31, 57, 96-
97
demonstration projects, 97, 153
discharge planning, 29-30, 130
hospitalization, 30, 58
housing and, 30-31, 57, 119, 153
involuntary commitment, 30, 58-59, 97-98
model programs, 119
negative experiences of homeless with,
58, 98
obstacles to, 58, 96-98, l l9
outpatient commitment, 97-98
outreach programs, 7, 59-60, 98-99, 121-
123, 153
recommendations, 153-154
rehabilitation services, 119-120
residential placement programs, 110, 122-
123, 128
resource allocation needs, 58
Robert Wood Johnson Foundation
project, 120
self-help centers, 120-121
successful elements, 119
targeted services for, 118-123, 153-154
Veterans Administration program, 121-123
see also Psychiatric treatment facilities
Mental illness/disorders
affective disorders, 51, 53-57, 68, 212
anxiety, 51, 68, 212
as a cause of homelessness, 23, 25, 39,
50-51, 53, 68
in children, 57, 68
chronic, in young adults, 29
combat-related posttraumatic stress
disorder, 10
comorbidity with alcohol abuse and drug
abuse, 65-66, 138, 153
as a consequence of homelessness, 50, 51, 53
dementia, 51, 53-55
depressive disorders, 51
disability entitlements, 28
personality disorders, 51, 53-57
phobic disorders, 51
prevalence, 50, 51-52, 53-56, 66, 118, 152,
207-208, 21~211, 212
schizophrenia, 39, 51, 53-57, 59, 68, 104,
138
screening instruments for, 52-53, 56
studies of, 5, 53-56, 138
substance abuse and, 53-56
among veterans, 7, 10
in women, 56-57, 125
Mentally ill
causes of homelessness, 23, 25, 39
community-based facility needs for, 30-
31, 57
deinstitutionalization, 25, 28-32, 97, 119,
139, 210
OCR for page 237
INDEX 237
discharge planning for, 30
eligibility for benefits, 96
gender differences in, 56
housing needs, 30-31, 57, 119
involuntary commitment, 30, 58-59, 97-98
patterns of homelessness, 24
public assistance programs for, 28
reality problems, 58, S9
risk of homelessness, 30
rural homeless, 190, 207-208
treatment histories, 52
veterans, 7, 10
women, 6
Mentally retarded
community-based facility needs for, 31
studies of homelessness among, S. 52
Mental Retardation Facilities and
Community Mental Health Centers
Construction Act of 1963, 97
Michigan
Medicaid eligibility thresholds, 85
Medicaid enrollments, 87
Military Construction Authorization Act of
1986, 166
Milwaukee
characteristics of homeless in, 9, 10, 16,
24, 56
Emergency Lodge, 219
Family Crisis Center, 219
Guest house, 123, 219
Johnson-Pew Health Care for the
Homeless projects, 114
low-income housing availability in, 26, 123
St. Benedict's Meal Site, 221
studies of homeless, 4
Minneapolis, characteristics of homeless in,
61
Minnesota
access to health care in, 204
characteristics of homeless in, 17
Dorothy Day House, 200
Medicaid eligibility thresholds in, 85
transitional housing plan, 200
Minorities
acute physical disorders in, 44
geographic distribution of homeless, 8-9,12
poverty among, 186
psychiatric disorders among, 57
size of homeless population, 6
unemployment among, 27
~ , . . . .
MlSSlSSlppl
characteristics of homeless in, 17
Medicaid eligibility thresholds in, 85
Mothers, homeless
age, 12
educational status, 12
heads of households, 5, 11, 12, 23, 27, 56,
57, 204
health problems, 66
marital status, 12
Medicaid eligibility, 204
psychiatric disorders, 57, 66
substance abuse by, 57
Musculoskeletal disorders, rates of
occurrence in homeless, 46-47
Nashville
census of homeless in, 176
Downtown Clinic, 114- 115, 219
Johnson-Pew Health Care for the
[Iomeless projects, 111, 114-115, 121
Meharry Community Mental Health
Center, 220
shelter-based clinics, 106
Union Rescue Mission, 221
National Alliance to End Homelessness,
estimate of homeless population, 4, 137
National Ambulatory Medical Care Survey,
43
National Association of Public Hospitals, 91
National Center for Health Statistics, 77-78
National Commission to Prevent Infant
Mortality, 91-92
National (Iovernors' Association Task force
on Welfare Prevention, 131-132
National Health Interview Survey, 77-78, 80
National Health Service Corps, 93, 115
National Institute of Mental Health
Community Support Program, 97
demonstration grants, 97
diagnostic interview schedule, 53
Epidemiological Catchment Area program,
56, 60
National Rural Health Association, 199
Native American homeless
geographic distribution of, 8-9
Neurological disorders, rates of occurrence
in homeless, 46-47
Nevada
health care financing in, 91
Medicaid program in, 85
New Jersey
health care financing in, 91
Medicaid program in, 85
OCR for page 238
238 INDEX
residential treatment programs for
alcoholics, 124
New York City
AIDS patients and resources in, 31, 124
Bailey House, 124, 126-127
Bowery, 50
Central Park, 121
characteristics of homeless in, 5, 6, 8, 10-
11, 14, 16, 24, 30, 31, 48-49, 50, 52, 56,
57, 61, 62, 66, 67
Charles H. Gay Shelter Care Center for
Men, 109
Fountain House, 119
Housing Authority, 26
Human Resources Administration, 107,
109, 124
low-income housing, 25, 26, 62, 66, 67
mental health care services, 119, 120, 121
Project Reachout, 121
shelters, 33, 34, 56, 66, 67, 109-110
studies of homeless, 4, 14
St. Vincent's Hospital and Medical Center
SRO and Shelter Program, 107
tuberculosis prevalence in, 48-49
United Hospital Fund, 112
New York State
census of homeless in, 173, 176
characteristics of homeless in, 61
health care financing in, 91
Medicaid program, 85, 87, 88
Nursing homes, Veterans Administration, 98
Nutrition
assistance programs, see Food stamps
deficiencies resulting from homelessness,
41,66,67, 152
recommendations, 152
screening programs, 152
Ohio
characteristics of homeless in, 9, 10, 15-
17, 24, 52, 61, 192-197
Medicaid eligibility thresholds, 85
Medicaid enrollments, 87
studies of homeless, 4, 5, 53, 191-197,
207-214
Older Americans Act, 156
Omnibus Budget Reconciliation Act of 1981
funding for clinics, 92
funding for outreach program for
homeless veterans, 98-99
Outreach programs
for elderly, 108
for families, 125
for mentally ill homeless, 59-60, 98-99,
119-120, 121-123, 150-151
mobile clinics, 112, 125
needs, 143
recommendations, 146, 148, 149-151
street teams, 121
training of workers, 123
see also Johnson-Pew Health Care for the
Homeless projects
Parasitic infestations, 41
Pew Memorial Trust, see Johnson-Pew
Health Care for the Homeless projects
Philadelphia
characteristics of homeless in, 53
Health Management Corporation, 112
studies of homeless, 4, 30, 53
Phoenix
characteristics of homeless in, 9, 16, 24,
52, 56, 61
mental health care programs, 120
studies of homeless, 4, 61
Physically disabled homeless, studies of, 5
Physicians
availability in rural areas, 204
recruitment by National Health Service
Corps, 93
Portland, Oregon
characteristics of homeless in, 6, 9, 10,
16, 24, 52, 61
housing for alcoholics and drug abusers,
123
studies of homeless, 4, 61
Poverty
growth of, 26-27, 186
rural, 186
see also Domiciled poor
Pregnancy
rates of occurrence in homeless, 46-47
President's Commission for the Study of
Ethical Problems in Medicine and
Biomedical and Behavioral Research.
77, 143
Programs for homeless
fears of public officials about, 7
see also Outreach programs; Public
assistance
Protection and Advocacy for Mentally Ill
Individuals Act, 151-152
Psychiatric disorders, see Mental illness/
disorders
OCR for page 239
Psychiatric treatment facilities
bed needs, 31
community-based, 31
discharge planning, 30
rehabilitative value of short stays, 29
restrictive admission policies, 29
St. Elizabeth's Psychiatric Hospital
(Washington, D.C.), 31
Public assistance
availability of benefits, 27, 94
barriers to receipt of cash assistance, 28
benefit levels, 94, 140
budgetary concerns, 28
discouragements of applications, 27, 146
eligibility for, see Eligibility for
entitlements
enrollments, 27, 28
food stamps, 152
fraud and abuse in, 28
negotiation of public welfare system, 41
recommendations, 145-147
rural homeless use of, 17
unemployment compensation, 27, 40
value of, 27
see also Indigent care system
Public Health Service Act, Section 330, 92
Rape/assault of homeless women, 6, 41, 44
Recommendations
alcoholism programs/services, 152-154
case management, 151-152
child support and treatment services, 156-
157
convalescent services, 155
discharge planning, 147-148
drug treatment programs/services, 152-
154, 155
health care and related services, 148-156
housing, 144-145
income and benefits, 145-147
mental health programs, 152-154
nutrition, 152
outreach programs, 149-151
research, 159-160
shelters, 157-158
volunteer efforts, 158-159
Rehabilitation programs
for alcoholics, 63
for mentally ill, 59
Residential facilities
for alcoholics, 63
for families, 67
INDEX 239
for mentally ill, 60
Respiratory diseases/disorders
in alcoholics, 62
asthma, 67
chronic obstructive pulmonary disease,
46-47
infections, 44-45
predisposing conditions, 47-48
rates of occurrence, 44-47
in rural homeless, 206, 209, 212
tuberculosis, 48, 62, 65, 154
Robert Wood Johnson Foundation
chronically mentally ill project, 120
study on access to health care, 77, 78
see also Johnson-Pew Health Care for the
Homeless projects
Runaway and throwaway youths
causes/process of homelessness, 14-15,
23, 68, 126
shelters for, 14
studies of, 5, 14, 23, 68
Rural homeless/homelessness
access to health care, 82, 184-185, 203,
212-213
alcohol abuse by, 210-211, 213
attitudes of community toward, 201-202
campground usage by, 190
causes, 128, 183, 184, 194-195
characteristics of, 12, 17, 184, 189-191
counting, 2, 198-199
definition, 187-188
economic issues, 183, 185-186, 189-191,
202
emergency room utilization, 208-210
employment, 196-197
environmental factors affecting
community response to, 199-203
environmental hazards, 185
extended family network, 17, 187-188,
190, 196
farmers/farm-related workers, 190-191,
200, 202, 212
health care resources for, 203-207
health problems of, 17, 185, 206-213
health status of, 207-208, 212-214
hermits, 191, 198
housing needs, 202
in large communities, 199-201
length of time, 194
magnitude, 183
migration to cities, 17, 186
mental illness among, 190, 210-211, 212
OCR for page 240
240 INDEX
needs of, 191, 212
in Ohio, 4, 5, 53, 191-197
peer counseling program, 200-201
private assistance efforts, 184
problems of, 17
public perceptions of, 198-199
shelter availability and utilization, 189,
190, 195, 199-200
in small communities, 201-202
social services network, 17, 184, 199-202
spouse and child abuse, 213
studies of, 5, 17, 188
substandard housing utilization, 17, 213
suicidal tendencies, 212, 213
temporary housing arrangements, 187-188,
195
transience/transients, 195-197, 201
transportation needs, 203
Salvation Army, 125
San Diego
Balboa Park, 35
characteristics of homeless in, 5, 61
coordinated health care services in, 127-
128
Life Ministries, 220
shelter-based clinics, 106
women's programs, 125, 126, 221
San Francisco
characteristics of homeless in, 7, 44
Folsom Street Hotel program, 124, 127,
219
Johnson-Pew Health Care for the
Homeless projects, 128
Larkin Street Youth Center, 68, 126, 127,
156, 220
residential program for AIDS victims, 124
self-help centers for mentally ill, 120-121
St. Anthony's Clinic, 125, 220
Seattle, housing for alcoholics and drug
abusers, 123
Seizure disorders, 46-47, 51
Shelters
adequacy, 32
for adolescents, 14, 36, 200, 213-214
for alcoholics and drug abusers, 123
burdens on, 139
cars, tents, and boxes, 34
Charles H. Gay Shelter Care Center for
Men, 109
clinical examinations in, 53
clinics based in, 106-107
dangers in, 16
day centers, 16, 33
demand for, 32, 35, 200
design for emergencies, 33, 35, 36, 139,
158
extent of system, 35-36
for families, 13, 33-34, 36, 57, 158, 20O,
219
funding, 109
limit on consecutive nights' stay, 33
location relative to homeless populations'
needs, 14
missions, 32, 34, 56, 106, 196, 218-219
night operation, 33
organization, 33-34
projections of needs, 169
public facilities, 32-33
public opposition to, 35
in public parks, 34-35
recommendations, 157-158
rejection of alcoholics, 62
in rural areas, 189, 190, 195, 200
siting dilemmas, 35
staffing, 35-36
subsidization of, 33
substitution for other systems, 36
standards for health and safety, 33, 158
utilization rates, 144, 190, 195, 210
variability in size and operation, 32
welfare hotels/motels, 13, 34-35, 36
for women, 125, 210
Skid rows, 1, 15, 53
Skin disorders, 45~7, 62, 64
Social and support services, inadequacies
of, 22
Social Security Administration, outreach
efforts, 149-150, 166
So Others Might Eat, 108
South Carolina
health care financing in, 91
Medicaid program in, 85
South Dakota
characteristics of homeless in, 17
Medicaid eligibility thresholds, 85
Medicaid enrollments, 87
Special Supplemental Food Program for
Women, Infants, and Children, 152
St. Anthony's Foundation, 125
St. Elizabeth's Psychiatric Hospital
(Washington, D.C.), 31
Stewart B. McKinney Homeless Assistance
Act
OCR for page 241
INDEX 241
block grant program for chronically
mentally ill homeless, 97, 168
definition of homeless, 2, 137
demonstration projects for drug and
alcohol treatment, 153, 168
food and shelter funding provided by, 97,
141, 167-168
highlights of, 167-168
impetus for, 105
literacy programs for adults, 168
provision of health care professionals, 93
recommended amendments of, 155, 156
St. Francis House, 108
St. Francis Residence, 60
St. Louis
alcohol rehabilitation program, 123
characteristics of homeless in, 8, 16, 24,
30,52
Christ Church shelter, 218
coordinated health care services in, 127-
128
Emergency Lodge, 125
Harbor House, 123,219
Hospitality House, 219
Shamrock Club, 220
studies of homeless, 4
Veterans Administration Outreach
Program, 221
St. Vincent's Hospital and Medical Center
SRO and Shelter Program, 107,109-110
Studies of homeless
biases in, 170,180, 181, 198
capture-recapture methods, 176-180
clinical examinations in shelters, 53
comparative general-population data, 43,
56, 60
comparison/generalization of, 2,43, 44,
51, 176, 181, 191
counting the homeless, 2-4, 169-181, 198-
199
data collection, 2, 53, 170, 171,174-175
data sources, 12,43, 112, 159, 198,208
demographic and social issues as a focus
of, 5
dual-system estimation in, 178
focus of, 4, 160
and health-related issues, 5
indirect estimation of homeless, 170-173,
179
through Johnson-Pew Health Care for the
Homeless projects, 43
maximum likelihood techniques in, 178
methodological problems, 2, 15-16,51,53,
56, 137, 159-160, 170, 171, 176, 180,
188, 198
multiple count, 175-176
national, 3
recommendations on, 160, 180
sample size, 2, 4
- 52-53, 67, 173
15-16
screening instruments,
self-selected samples?
similarities in data, 4
single-contact census, 173-176
sites for data collection, 4, 53,56, 174-
175, 179
snowball sampling, 171
subpopulations, 4-5, 7, 10
survive provider data, 172-173
Substance abuse
by adolescents and youths, 68
comorbidity with psychiatric disorders,
53-57
counseling services, 108
by homeless mothers, 57
patterns of homelessness and, 24
prevalence, 56, 68,206, 212
Veterans Administration program, 98
see also Alcohol problems; Drug abuse/
addiction
Supplemental Security Income
adequacy of benefits, 96
cost-containment measures, 96
early predischarge application and review,
131
eligibility requirements, 28, 84-86, 96,
130, 147,149-150
Medicaid eligibility for recipients, 87
potential of mentally ill for eligibility, 96,
150
recommendations, 147, 150
Swords to Plowshares, 100
Tennessee, Medicaid eligibility in, 83, 85
Texas
Medicaid eligibility thresholds, 85
Medicaid enrollments, 87
Toronto, study of adolescent homeless in,
14
Transportation needs
of children, 14
education-related, 14
health care-related, 82, 141
in rural areas, 203, 205
Traveler's Aid Program, 14
OCR for page 242
242 INDEX
Traumatic disorders
among alcoholics, 62
occurrence rates, 43-44
Tuberculosis
in alcoholics, 62, 154
in drug abusers, 65
predisposing factors, 48
rate of occurrence among homeless, 48-49
United Way, 112, 159
Urban Family Center (New York City), 67
U.S. Conference of Mayors
housing program for mentally ill, 120
surveys of homeless population, 3-4, 5, 6,
32, 144
see also Johnson-Pew Health Care for the
Homeless projects
U.S. Department of Housing and Urban
Development
estimate of homeless population, 3, 171-
172
housing program for mentally ill, 120
Vascular disorders
in alcoholics, 62
arterial vascular disease, 45
bacterial endocarditis, 65
in drug abusers, 64-65
peripheral vascular disease, 45, 46-47, 65
rates of occurrence in homeless, 45-47
thrombophlebitis, 64-65
treatment difficulties, 50
varicose veins, 41
venous stasis, 45
venous valve incompetence, 45
Venereal diseases, prevalence among
homeless, 41, 48-49, 68, 212
Vermont
Medicaid eligibility thresholds in, 86
studies of homeless, 4, 5, 17, 192-193, 214
Veterans
access to health care, 98-100
alcohol and drug abuse among, 7, 65
characteristics of, 7, 10-11
counseling programs, 100
educational programs, 100
eligibility for benefits, 98, 99-100
geographic distribution, 11, 193, 194
Korean era, 10
mental illness/psychiatric problems, 7, 10,
65
outreach program for mentally ill, 7, 10,
65
rural, 214
size of homeless population, 138
Vietnam era, 10-11, 98, 138, 191, 193
wariness of Veterans Administration
medical centers, 122
World War II era, 10
Veterans Administration
benefits enrollments, 87
Community Residence Program, 221
expansion of services for homeless, 98-99
health care system, 98
outreach program for mentally ill, 7, 10,
65, 98-99, 121-123, 150-151, 221
recommendations for, 150-151
Vietnam Veterans of America, 100
Volunteers
drawbacks to reliance on, 35-36
former mentally ill homeless as, 120-121
health care personnel, 106
legislation authorizing use of, 166
recommendations on, 158-159
Volunteers in Service to America, 166
Volunteers of America, 109, 120, 121, 127
Wages
gender differentials in, 27
minimum, 27, 146
Washington, D.C.
census of homeless in, 174
characteristics of homeless in, 61
Christ House, 109, 130, 218
Columbia Road Physician Group, 108, 109
community-based-facility needs for
mentally disabled, 31
House of Ruth, 125, 220
Medicaid eligibility thresholds in, 84
So Others Might Eat, 108, 220
Zacchaeus Clinic, 108-109
Welfare hotels/motels
costs, 34
family residence in, 13, 34, 36, 66, 67
food storage and preparation deficiencies,
34, 67
Wisconsin, Medicaid program, 83, 86, 88
Workers' compensation, 27, 40
Representative terms from entire chapter:
drug abusers
