Homelessness in the United States

Following the Peasants' Revolt in England, constables were authorized under 1383 English Poor Laws statute to collar vagabonds and force them to show support; if they could not, the penalty was gaol.[10]

Vagabonds could be sentenced to the stocks for three days and nights; in 1530, whipping was added. The presumption was that vagabonds were unlicensed beggars.[10] In 1547, a bill was passed that subjected vagrants to some of the more extreme provisions of the criminal law, namely two years' servitude and branding with a "V" as the penalty for the first offense and death for the second.

Large numbers of vagabonds were among the convicts transported to the American colonies in the 18th century.[11]

The Bowery Mission at 36 Bowery in New York City, c. 1880s

Homelessness emerged as a national issue in the 1870s. There are no national figures documenting homeless people demography at this time.[6] Jacob Riis wrote about, documented, and photographed the poor and destitute, although not specifically homeless people, in New York City tenements in the late 19th century. His book, How the Other Half Lives, published in 1890, raised public awareness of living conditions in the slums, causing some changes in building codes and some social conditions.

The growing movement toward social concern sparked the development of rescue missions, such as America's first rescue mission, the New York City Rescue Mission, founded in 1872 by Jerry and Maria McAuley.[12][13] In smaller towns, there were hobos, who temporarily lived near train tracks and hopped onto trains to various destinations. Especially following the American Civil War, a large number of homeless men formed part of a counterculture known as "hobohemia" all over America.[14][15]

By the late 19th century, many American towns and cities had significant numbers of homeless people. In New York City, for example, there was an area known as "the Bowery." Rescue missions offering "soup, soap, and salvation", a phrase introduced by The Salvation Army,[16] sprang up along the Bowery thoroughfare, including the oldest one, The Bowery Mission. The mission was founded in 1879 by the Rev. and Mrs. A.G. Ruliffson.[17]

Unemployed men outside a soup kitchen opened by Al Capone in Depression-era Chicago, Illinois, the US, 1931

The Great Depression of the 1930s caused a devastating epidemic of poverty, hunger, and homelessness. There were two million homeless people migrating across the United States.[18] Many lived in shantytowns they called "Hoovervilles" deriding the President they blamed for the Depression. Residents lived in shacks and begged for food or went to soup kitchens. Authorities did not officially recognize these Hoovervilles and occasionally removed the occupants for technically trespassing on private lands, but they were frequently tolerated out of necessity.

A 1960 survey by Temple University of Philadelphia's poor neighborhoods found that 75 percent of the people that are homeless were over 45 years old, and 87 percent were white.[19]

The Community Mental Health Act of 1963 was a pre-disposing factor in setting the stage for homelessness in the United States.[20] Long term psychiatric patients were released from state hospitals into Single Room Occupancies and sent to community health centers for treatment and follow-up. Never adequately funded, the community mental health system struggled to meet patient needs[21] and many of the "deinstitutionalized" wound up living on the streets, with no sustainable support system.[22][23] In the United States, during the late 1970s, the deinstitutionalization of patients from state psychiatric hospitals was a precipitating factor which seeded the population of people that are homeless, especially in urban areas such as New York City.[24]

Great Fire of 1911 with homeless

Homeless Advocate Mitch Snyder, Actor Martin Sheen, Boston Mayor Raymond L. Flynn

The number of homeless people grew in the 1980s, as housing and social service cuts increased and the economy deteriorated. The United States government determined that somewhere between 200,000 and 500,000 Americans were then homeless.[25] There were some U.S. federal initiatives that aimed to help, end and prevent homelessness; however, there were no designated homeless-related programs in the Office of Management and Budget.[26]

The history of the United States illustrates that this was a time when there was economic distress, high unemployment, and was the period when chronic homelessness became a societal problem. In 1980, federal funds accounted for 22% of big city budgets, but by 1989 the similar aid composed only 6% of urban revenue (part of a larger 60% decrease in federal spending to support local governments).[27] It is largely (although not exclusively) in these urban areas that homelessness became widespread and reached unprecedented numbers. Most notable were cuts to federal low-income housing programs. An advocacy group claims that Congress halved the budget for public housing and Section 8 (the government's housing voucher subsidization program) and that between the years of 1980 and 1989 HUD's budget authority was reduced from $74 billion to $19 billion.[27] Such alleged changes are claimed to have resulted in an inadequate supply of affordable housing to meet the growing demand of low-income populations. In 1970 there were 300,000 more low-cost rental units (6.5 million) than low-income renter households (6.2 million). By 1985, the advocacy group claimed that the number of low-cost units had fallen to 5.6 million, and the number of low-income renter households had grown to 8.9 million, a disparity of 3.3 million units.[28]

In response to the ensuing homelessness crisis of the 1980s and after many years of advocacy and numerous revisions, President Reagan signed into law the McKinney–Vento Homeless Assistance Act in 1987; this remains the only piece of federal legislation that allocates funding to the direct service of homeless people. The McKinney–Vento Act paved the way for service providers in the coming years. During the 1990s homeless shelters, soup kitchens, and other supportive services sprouted up in cities and towns across the nation. However, despite these efforts and the dramatic economic growth marked by this decade, homeless numbers remained stubbornly high. It became increasingly apparent that simply providing services to alleviate the symptoms of homelessness (i.e. shelter beds, hot meals, psychiatric counseling, etc.), although needed, were not successful at solving the root causes of homelessness. The United States Interagency Council on Homelessness (USICH), a federal agency contained in the Executive Branch, was established in 1987 as a requirement of the McKinney–Vento Act of 1987.

A 1990 survey found that most literally homeless people were unable to bathe or shower.[29]

Over the past decades, the availability and quality of data on homelessness has improved considerably, due, in part, to initiatives by the United States government. Since 2007, the US Department of Housing and Urban Development has issued an Annual Homeless Assessment Report, which revealed the number of individuals and families that were homeless, both sheltered and unsheltered.[30] In 2009, there were about 643,000 sheltered and unsheltered homeless persons nationwide. About two-thirds of those stayed in emergency shelters or used transitional housing programs, with the remaining living on the street in abandoned buildings or other areas not meant for human habitation. About 1.56 million people, or about 0.5% of the U.S. population, used an emergency shelter or a transitional housing program between October 1, 2008 and September 30, 2009.[31] Around 44% of homeless people were employed.[32]

According to the US Department of Housing and Urban Development's 2008 Annual Homeless Assessment Report, the most common demographic features of all sheltered homeless people are: male, members of minority groups, older than age 31, and alone. More than 40 percent of sheltered homeless people have a disability. At the same time, sizable segments of the sheltered homeless population are white, non-Hispanic (38 percent), children (20 percent), or part of multi-person households (33 percent). Approximately 68 percent of the 1.6 million sheltered homeless people were homeless as individuals and 32 percent were persons in families.[33]

In 2008 more than 66 percent of all sheltered homeless people were located in principal cities, with 32 percent located in suburban or rural jurisdictions. About 40 percent of people entering an emergency shelter or transitional housing program during 2008 came from another homeless situation (sheltered or unsheltered), 40 percent came from a housed situation (in their own or someone else's home), and the remaining 20 percent were split between institutional settings or other situations such as hotels or motels. Most people had relatively short lengths of stay in emergency shelters: 60 percent stayed less than a month, and a 33 percent stayed a week or less.[33]

Lack of available and affording housing as a cause of homelessness was named by most of the mayors in 2004 when the United States Conference of Mayors surveyed the mayors of major cities on the extent and causes of urban homelessness. The next three causes identified by mayors, in rank order, were mental illness or the lack of needed services, substance abuse and lack of needed services, and low-paying jobs. The lowest ranking cause, cited by five mayors, was prisoner reentry. Other causes cited were unemployment, domestic violence, and poverty.

The major causes of homelessness include:[34][35][36][37][38][39]

• Lack of sufficient urban housing projects to provide safe, secure, and affordable housing to the financially underprivileged.[34] Additionally for low wage workers rents can be unaffordable in areas where their workplace is located.[35][38][39] [40]
• The deinstitutionalization movement from the 1950s onwards in state mental health systems, to shift towards 'community-based' treatment of the mentally ill, as opposed to long-term commitment in institutions.[34][35][38][39] There is disproportionally higher prevalence of mental disorders relative to other disease groups within homeless patient populations at both inpatient hospitals and hospital-based emergency departments.[41]
• Redevelopment and gentrification activities instituted by cities across the country through which low-income neighborhoods are declared blighted and demolished to make way for projects that generate higher property taxes and other revenue, creating a shortage of housing affordable to low-income working families, the elderly poor, and the disabled.[34][35][38][39]
• Nearly half of foster children in the United States become homeless when they are released from foster care at age 18.[42][43]
• Natural disasters that destroy homes: hurricanes, floods, earthquakes, etc. Places of employment are often destroyed too, causing unemployment and transience.[44]
• People who have served time in prison, have abused drugs and alcohol, or have a history of mental illness find it difficult to find employment for years at a time because of the use of computer background checks by potential employers. Also inclusive of registered sex offenders who are considered unwelcome in some metropolitan areas. See prisoner reentry.[45]
• According to the Institution of Housing in 2005, the U.S. Government has focused 42% more on foreign countries rather than homeless Americans, including homeless veterans.[34][35][38][39]
• People with criminal charges at large that are in hiding seeking to evade law enforcement.[34][35][38][39]
• Adults and children who flee domestic violence.[34][35][38][39]
• Teenagers who flee or are thrown out by parents who disapprove of their child's sexual orientation or gender identity. A 2010 study by the Center for American Progress shows that a disproportionately high number of homeless youth (between 20–40%) are gay and transgender.[46]
• Complex building codes which can make it difficult to build and construct. Traditional huts, cars, and tents can be illegal, classified as substandard and may require removal by the owner or be subject to removal by the government.[34][35][38][39]

Homeless soliciting employment, Ypsilanti, Michigan

• Foreclosures of homes, including foreclosure of apartment complexes which displaces tenants renting there.[47]
• Evictions from rented property.[47]
• Lack of support from friends or family.[34][35][38][39]
• Individuals who prefer homelessness and wish to remain off the grid for political and ideological purposes. Often self-identified as gutter punks or urban survivalists. The Department of Housing and Urban Development rarely reports on this counter-cultural movement, since its adherents often refuse to participate in governmental studies and do not seek governmental assistance for ideological or political purposes.[48]
• Lack of resources in place in the communities to help aid in prevention of homelessness before it becomes a crisis.[34][35][38][39]
• Neoliberal policies, reforms to the welfare state and the retrenchment of the social safety net.[49][50][51][52]
• High rents, in particular areas where individuals could pay a substantial portion of up to a third of their income on rent and related costs increase the potential of homelessness.[53]

According to the U.S. Conference of Mayors, the demand for emergency shelter in 270 U.S. cities increased 13 percent in 2001 and 25 percent in 2005.[34][35] Twenty-two percent of those requesting emergency shelter were turned away.

Tents of the homeless in San Francisco, 2017

In response to the Great Recession in the United States, President Obama signed several pieces of legislation that addressed the homelessness crisis. The American Recovery and Reinvestment Act of 2009 addressed homelessness prevention, in which he allocated an additional $1.5 billion to HUD for the "Homelessness Prevention and Rapid Rehousing Program (HPRP)." The purpose of HPRP was to assist individuals and families who are otherwise healthy and not chronically homeless in escaping homelessness or preventing homelessness of the vulnerable population.[54] On May 20, 2009, President Obama signed the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act into Public Law (Public Law 111-22 or "PL 111-22"), reauthorizing HUDs Homeless Assistance programs. It was part of the Helping Families Save Their Homes Act of 2009. The HEARTH act allows for the prevention of homelessness, rapid re-housing, consolidation of housing programs, and new homeless categories.[55][56][57][58]

In the first year of the new decade, the Federal government launched of Opening Doors: The Federal Strategic Plan to Prevent and End Homelessness.[59][60] Opening Doors is a publication of the U.S. Interagency Council on Homelessness, which worked with all Federal agencies and many state and local stakeholders on its creation and vision, setting a ten-year path for the nation on preventing and ending all types of homelessness. This plan was presented to the President and Congress in a White House Ceremony on June 22, 2010.[61]

In New York City, the number of homeless people using nightly shelter services has tripled from approximately 20,000 to more than 60,000 between January 2000 and January 2015.[63] In 2016, homelessness is considered an epidemic in several U.S. cities. "Los Angeles Mayor Eric Garcetti and seven of the 15 City Council members announced they would declare a state of emergency and try to find $100 million to cure what has become a municipal curse."[64]

In September 2018, in MARTIN V. CITY OF BOISE, the United States Court of Appeals for the Ninth Circuit ruled that the city's Camping and Disorderly Conduct Ordinances violated the Eighth Amendment’s prohibition on cruel and unusual punishment. Cities can't punish homeless people for sleeping in public when the homeless shelters are full.[65]

During the COVID-19 pandemic in the United States, mass job loss and unemployment led to fears of mass evictions as tenants became unable to pay rent.[66]

Marines and Sailors sort and organize hundreds of clothing items at the New England Center for Homeless Veterans. The service members spent the day serving meals and eating with many of Boston's veterans during Boston Navy Week. Boston Navy Week is one of 15 signature events planned across America in 2012. The eight-day long event commemorates the Bicentennial of the War of 1812, hosting service members from the U.S. Navy, Marine Corps and Coast Guard and coalition ships from around the world. (U.S. Marine Corps photo by Cpl. Marco Mancha/Released)

Homeless veterans are persons who have served in the armed forces who are homeless or living without access to secure and appropriate accommodation. There were an estimated 57,849 homeless veterans estimated in the United States during January 2013; or 12 percent of all homeless adults. Just under 8 percent of homeless U.S. veterans are female.

Throughout the 21st century, homeless service providers and the Federal government have been able to reduce chronic homelessness and homelessness among Veterans with targeted efforts and interagency cooperation on initiatives like the HUD-VASH program.[68] Indeed, the prominent role of the Department of Veterans Affairs and its joined up approach to veteran welfare help to distinguish the US response to veteran homelessness internationally.[69]

Homeless children in the United States:[70] The number of homeless children reached record highs in 2011,[71] 2012,[72] and 2013[73] at about three times their number in 1983.[72]

The number of homeless children in the US grew from 1.2 million in 2007 to 1.6 million in 2010. The US defines homelessness as "individuals who lack a fixed, regular, and adequate nighttime residence," per McKinney–Vento Homeless Assistance Act.[74] The number of homeless children reached record highs in 2011,[71] 2012,[72] and 2013[73] at about three times their number in 1983.[72] An "estimated two million [youth] run away from or are forced out of their homes each year" in the United States.[75]

One out of 50 children or 1.5 million children in United States of America will be homeless each year.[7] In 2013 that number jumped to one out of 30 children, or 2.5 million.[76]

Texas, California and Florida have the highest numbers of unaccompanied homeless youth under the age of 18; comprising 58% of the total homeless under 18 youth population [8]

Street children in the United States tend to stay in the state, 83% do not leave their state of origin.[77] If they leave, street children are likely to end up in large cities, notably New York City; Los Angeles; Portland, Oregon; and San Francisco.[78] Street children are predominantly Caucasian and female in the United States, and 42% identify as lesbian, gay, bisexual, or transgender (LGBT).[79]

The United States government has been making efforts since the late 1970s to accommodate this section of the population.[80] The Runaway and Homeless Youth Act of 1978 made funding available for shelters and funded the National Runaway Switchboard. Other efforts include the Child Abuse and Treatment Act of 1974, the National Child Abuse and Neglect Data System, and the Juvenile Justice and Delinquency Prevention Act.[81] There has also been a decline of arrest rates in street youth, dropping in 30,000 arrests from 1998 to 2007. Instead, the authorities are referring homeless youth to state-run social service agencies.[82]

In 2020, the National Center for homeless Education reported that over 1.5 million students in the U.S. public education system experienced homelessness during their 2017 and 2018 school year.[83]

College youth that are homeless account for over one million of the young homeless population.[84] According to the Free Application Federal Student Aid, also known as FAFSA, in 2013, over 58,000 students identified as homeless on their application.[84] "The federal government defines these unaccompanied homeless youth (UHY) as individuals who do not have "fixed, regular and adequate" housing and who are "not in the physical custody of a parent or adult."[85] The McKinney–Vento Act is considered the key piece of federal legislation pertaining to educational support for homeless children and teens.[86] The causes of homelessness varies from student to student. There are two types of homeless college students: firstly students that are homeless upon entering college and secondly students who become homeless during college.[86] For the youth that become homeless upon entering college, this situation represents the students that are having trouble sustaining housing due to job loss of their parent or guardian, the lack of a parent or guardian or because youth has been asked to leave the home or decided to runaway.[86]

Two reasons for a college youth to become homeless while attending college are firstly being unable to sustain the financial expenses for housing and food and secondly, by having the financial support given by family revoked.[86] Fortunately, there are programs available at state colleges and universities that provide students with the necessary resources to obtain financial and housing stability and sustainability. There are also organizations such as the National Association For The Education Of Homeless Children and Youth (NAEHCY) that advocate for a higher education so the children and youth can fulfill their dreams.[87] Another innovative model that can be of great help to college students experiencing homelessness is Single Stop USA, which operates in community colleges to help connect low-income students to the resources they need, including housing, to not only stay in school but to excel[88]

According to a survey, Massachusetts Youth Risk Behavior Survey, one in four teens that participated in this survey who identify as gay or lesbian are homeless. Various sources report between 20 percent and 40 percent identify as LGBT. Research shows that a disproportionate number of homeless youth in the United States identify as lesbian, gay, bisexual or transgender, or LGBT. In addition, LGBT youth are at greater risk for risky sexual behavior, substance abuse, and mental health issues.[89]

A homeless camp in Eugene, Oregon, 2013

The topic of homeless families first emerged in the United States during the 1980s when social welfare programs were being cut and high rates of income inequality, child poverty, and the lack of affordable housing were becoming an issue. The issue of homeless families came back in 2009 after the Recession, which replicated the same issues from the 80s.[90] The 2000s saw a new population of those experiencing homelessness: families with children. While an emerging problem at the beginning of the decade,[91] the problem continued to persist through 2010. At the close of the decade the trend continued unabated, with the number of individuals in homeless families increasing from 431,541 in 2007 to 535,447 in 2009.[68] Though the US Department of Housing and Urban Development (HUD) conducts an annual Point-in-Time count of the homeless, including homeless families, its methodology has been criticized for under-reporting the number of homeless families. HUD reported that the number of homeless families decreased by 2% from 2017 – 2018, and by 23% from 2007 – 2018. However, 85% of local services for the homeless reported an increase during the same time. While HUD reported 111,592 homeless minors in 2018, the United States Department of Education reported 1.3 million homeless minors in the 2016 – 2017 school year.[92]

As of 2019, the state of New York had the greatest number of homeless families, at 15,901. California had the second-greatest number of homeless families, at 7,044, followed by Massachusetts at 3,766. Wyoming had the fewest, at 37.[93]

Another study discovered that the three biggest risk factors that contributed to family homelessness in the United States are: ethnicity, lack of resources (specifically funds), and young children/pregnancy.[94] There is also a strong correlation between homeless families and households run and financed by a single female, especially one from a minority group and with at least two children.[94] Single-income families, especially those below the federal poverty line, have a harder time finding housing than other families, especially given the limited affordable housing options. Homeless families do not always take refuge in shelters, but being homeless also does not necessarily mean living on the streets. Homeless women with children are more likely to live with family or friends than those without children, and this group is treated with higher priority by both the government and society.[95] Homeless mothers have a much higher prevalence of depression, at 40 – 85%, compared to 12% in women of all socioeconomic groups. Homeless mothers also have higher rates of substance use, anxiety disorders, and PTSD. Nearly all of them (92%) experience physical or sexual abuse.[92]

As recently as 2017 across the United States, on any given night, there are approximately 85,000 chronically homeless people can be found sleeping on the streets or in shelters.[96] A chronically homeless individual is defined as an unaccompanied person who has been homeless for a consecutive year (or four or more periods of homelessness within the last three years) with a disability preventing them from working.[97] This definition was expanded in 2009 due to the HEARTH act to include families who were experiencing prolonged or repeating homelessness due to a disabled parent. Leaving these individuals to remain on the streets can cost taxpayers up to $50,000 per year for a single chronically homeless individual by them cycling in and out of treatment facilities, jails, hospitals and other institutional care facilities.[96] Since 2007 the number of chronically homeless individuals has decreased by 33% with Utah even reporting to have achieved an end to chronic homelessness.[96]

Homeless individuals report a lack of affordable housing as the number one reason for becoming homeless.[101]

The two main types of housing programs provided for homeless people are transitional and permanent housing. Transitional housing programs are operated with one goal in mind—to help individuals and families obtain permanent housing as quickly as possible. Transitional housing programs assist homeless for a fixed amount of time or until they are able to obtain housing on their own and function successfully in the community, or whichever comes first.[102][103][104]

Some shelters and associated charitable foundations have bought buildings and real estate to develop into permanent housing for the homeless in lieu of transitional Housing.[105]

The United States Department of Housing and Urban Development and Veterans Administration have a special Section 8 housing voucher program called VASH (Veterans Administration Supported Housing), or HUD-VASH, which gives out a certain number of Section 8 subsidized housing vouchers to eligible homeless and otherwise vulnerable US armed forces veterans.[106] The HUD-VASH program has been successful in housing many homeless veterans.[107]

As of 2018, the number of U.S. citizens residing in their vehicles because they can't find affordable housing has "exploded", particularly in cities with steep increases in the cost of living such as Seattle, Los Angeles, Portland, and San Francisco.[108][109] Bloomberg reported in November 2018 that the wealthiest cities in the U.S., in particular those in the Western states, are experiencing a homelessness crisis driven largely by stagnant wages and "skyrocketing rents".[110]

In 2019, Google had pledged one billion USD into funding 20,000 homes over the next decade throughout the San Francisco Bay Area.[111] The metropolitan area of San Francisco has some of the most expensive real estate in the United States.[112]

The Housing First approach recognizes that housing is one of the most impactful social determinants of health that affect those experiencing homelessness.[113][114][115] Housing First has met with success since its initial implementations in 2009 by providing relatively no strings-attached housing to homeless people with substance abuse problems or mental health issues. Housing First allows homeless men and women to be taken directly off the street into private community-based apartments, without requiring treatment first. This allows the homeless to return to some sense of normalcy, from which it is believed that they are better-poised to tackle their addictions or sicknesses. The relapse rate through these types of programs is lower than that of conventional homeless programs.[116][117]

Housing First was initiated by the federal government's Interagency Council on Homelessness. It asks cities to come up with a plan to end chronic homelessness under the assumption that if homeless people are given independent housing immediately with some social and financial support, then there will be reduced needs for emergency homeless shelters.[118][119]

The Housing First approach is currently being used in Chicago, Illinois in the Better Health Through Housing (BHH) Collaborative.The BHH Collective began in 2015 as an initiative in Chicago, Illinois between BHH and University of Illinois Hospital to provide frequent homeless emergency department patients.[120] The housing was paid for by the hospital and federal housing subsidies. The program also provides the individuals with case managers, specialized health services based on the individual’s needs, and other services they need.[120] BHH Collective aims to address the connection between housing and health by providing supportive housing to homeless individuals in order to improve the health of the homeless and address homelessness at the same time.[121]

In 2002, as a part of his FY2003 budget, President Bush made "ending chronic homelessness in the next decade a top objective." The bi-partisan, congressionally mandated, Millennial Housing Commission, in its Report to Congress in 2002, included ending chronic homelessness in 10 years among its principal recommendations. By 2003, the Interagency Council on Homelessness had been re-engaged and charged with pursuing the President's 10-year plan. The Administration has recently undertaken some collaborative efforts to reach its goal of ending chronic homelessness in 10 years. On October 1, 2003, the Administration announced the award of over $48 million in grants aimed at serving the needs of the chronically homeless through two initiatives. The "Ending Chronic Homelessness through Employment and Housing"[122] initiative was a collaborative grant offered jointly by HUD[123] and the Department of Labor (DOL).[124]

Addressing homeless health is difficult in a traditional healthcare setting due to the complex nature of the needs of the homeless and the multitude of health consequences they face.[125] In 2003-04, the proposed Bringing America Home Act was intended to provide comprehensive treatment for many homeless mental and substance abuse patients - it has not been passed or funded.[126] Scholars and public health experts advocate for health care to be tailored especially for homeless patients.

Homeless patients tend to be patients with multiple burdens of “medical, mental health, and substance use problems”.[127][128][115] The Tailored Care approach recognizes the unique situation of homeless people and seeks to provide specialized care to the homeless community.

This approach has been used in the government-sponsored Health Care for the Homeless Model (HCH Model).[127] Each HCH project is federally funded and works as federally qualified health centers that work at the intersection of multiple disciplines. These health centers usually provide their patients access to health services such as primary care, mental health services, and addiction services as well as social services such as after-jail services and case management.[127][128] However, there is no set structure that each health center needs to follow—each health center has the agency to provide a variety of services based on their networks and connections with the local neighborhood, government, or community but are not mandated to do so except for providing primary care.[127]

Public libraries can and often do significantly assist with the issues presented by homelessness. In many communities, the library is the only facility that offers free computer and internet access, so this is where many people experiencing homelessness go to locate services for basic needs such as healthcare, education, and housing. Libraries computers are also necessary for building a resume, searching for open jobs in the area, and completing job applications.[129]

The news article and video entitled, "SF library offers Social Services to Homeless,"[130] speaks about the San Francisco library having a full-time social worker at the library to reduce and help homeless patrons. It mentions that Leah Esguerra, who is a psychiatric social worker, has a usual routine which is done by making her rounds to different homeless patrons and greeting them to see if she could help them. She offers help in different forms that could range from linking patrons with services or providing them with mental health counseling. She also supervises a 12-week vocational program that culminates in gainful employment in the library for the formerly homeless (Knight, 2010).[131] The changes have garnered positive results from all patrons. Since this service started, staff at the library stated that they have noticed a drop in inappropriate behavior. The addition of Social Workers in the library has multiple benefits as they can assist with issues such as education; emergency services (food, clothing, housing, and crisis support); employment; family matters; health improvement (including health insurance); immigration; and support groups for men, women, and teens.[132]

The San Jose University Library became one of the first academic libraries to pay attention to the needs of homeless people and implement changes to better serve this population. In 2007, the merged University Library and Public Library made the choice to be proactive in reaching out. Collaborations with non-profit organizations in the area culminated in computer classes being taught, as well as nutrition classes, family literacy programs, and book discussion groups.[133] After eighteen months, the library staff felt they still were not doing enough and "analyzed program participation trends supplemented by observation and anecdotes" in order to better understand the information needs of homeless people. When it was understood that these needs are complex, additional customer service training was provided to all staff who were interested.[133] Once the staff more fully understood the needs of homeless people, it was determined that many programs in place already, with a few minor adjustments, would be helpful to homeless people. For example, the providing book clubs have proven to be very effective bridges between librarians and the homeless.[134] Programs were tailored to meet these needs. Additional changes implemented included temporary computer passes and generous in-house reading space to counteract the policies in place that may prevent a homeless person from obtaining a library card.[133]

The Dallas Public Library started "Coffee and Conversation" which is part of their Homeless Engagement Initiative. The staff hopes these bimonthly events between staff and homeless patrons will help them better serve the homeless people population in Dallas.[135] They also sponsor Street View podcast, a library produced podcast featuring the stories and experiences of the city's homeless population. Guests often include social service providers.[136]

In May 1991, Richard Kreimer, a homeless man in Morristown, N.J. sued the local public library and the Town of Morristown for expelling him from the library after other patrons complained about his disruptive behavior and pungent body odor. He later won the case and settled for $250,000.[137][138]

The downtown partnership in Nashville, Tennessee conducted a census on businesses. Sixty percent of responded identified public inebriates, transients and vagrants affect their employees, clients and customers. Businesses were solicited to identify issues that need to be addressed. Transients and panhandlers ranked were in the top five issues.[139] Two 7-Eleven locations in Sacramento, California and Portland, Oregon that have been so troubled by panhandler and vagrants briefly employed a high-pitched noise maker to repel them.[140] A local news source 750 KXL in Portland described the sidewalk in front of a Downtown Portland 7-Eleven as being transformed from "barely walkable" to clean and orderly for the first time in years after the repelling device was installed by the building's owner, Standard Insurance Company. The manager of the 7-Eleven told reporters he would see as many as a dozen transients loitering in front of his store all at once.[141]

The building's owner issued a statement that the goal was to protect the "safety of their employees, tenants, and guests in a location that has been consistently plagued by public drug use and menacing behavior."[142] The 7-Eleven told reporters transients loitering in front of his store adversely affects his business. After several complaints were made to the city, the city announced the deterrent device as used in this situation did not comply with the city noise code. The device was shut off when reporters made a follow up visit. The manager commented it was effective for the duration they were used. A manager for a Modesto, California 7-Eleven also attested to the effectiveness of sound for deterring undesirable activity commenting that "Once the music started, the riffraff left".[143]

Homelessness has a tremendous effect on a child's education. Education of homeless youth is thought to be essential in breaking the cycle of poverty. The McKinney–Vento Homeless Assistance Act mandates equal opportunity to a free public education to homeless students. This act is supposed to break down the barriers homeless students have to receiving an education. These barriers include residency restriction, medical record verification, and transportation issues. Once a student surpasses these barriers, they are still subject to the stigma of being homeless, and the humiliation they feel because of their situation. Some families do not report their homelessness, while others are unaware of the opportunities available to them. Many report that maintaining a stable school environment helps the students because it is the only thing that remains normal.[144] Many homeless students fall behind their peers in school due to behavioral disorders, and lack of attendance in school.[145]

Since the United States housing bubble collapse, there has been a rise in the number of homeless students. NAEHCY or the National Association for the Education of Homeless for Children and Youth, has reported a 99% increase in homeless students within a three-month period (San Diego).[146]

Of 1,636 schools, 330 reported no increase, 847 reported an increase of half, and 459 reported an increase of 25 percent or more. Due to underfunding many school districts are struggling to provide the necessary services to support homeless students, as mandated in the provisions of the McKinney–Vento Act, such as rising transportation needs and the greater range and usefulness of services. Wisconsin Rapids Public Schools Homeless Liaison Heather Lisitza says:

One of the biggest challenges our district faces is providing transportation to students who are experiencing homelessness. There are few approaches that our district can utilize to provide transportation for these students. Our city has only one taxi cab service and no public bus system. Our cab company is small and simply cannot fulfill all of our transportation requests. When it's possible, we add students to existing bus routes or set up a contractual agreement with the student's parent/guardian. However, there have been many situations where none of these options have worked. Another challenge our district faces is providing proper outer-wear for students who are homeless. Being that we live in central Wisconsin and have long, cold winters, all students need proper outerwear to go outside. Proper outerwear includes snow boots, hat, mittens, snow pants, and a winter jacket that has a working zipper or buttons on it. This expense adds up quickly and is hard to provide to the increasing number of homeless students.[146]

This is especially worrisome since homeless students are 1) 1.5 times more likely to perform below grade level in reading; 2) 1.5 times more likely to perform below grade level in spelling; and 3) 2.5 times more likely to perform below grade level in math.[146] There are a few worries that there will be false reports of homeless students, but mostly it is not an issue.[144]

Various laws have both directly and indirectly criminalized people that are homeless[147] and people attempting to feed homeless people outdoors.[148] At least 31 cities have criminalized feeding people that are homeless.[149][150]

In 2014, the United Nations Human Rights Committee criticized the United States for the criminalization of homelessness, noting that such "cruel, inhuman and degrading treatment" is in violation of international human rights treaty obligations.[151][152][153][154] A 2018 report by Philip Alston, the U.N. Special Rapporteur on extreme poverty and human rights, found that homeless persons have effectively been criminalized in many cities around the United States, and noted that "punishing and imprisoning the poor is the distinctively American response to poverty in the twenty-first century."[155]

In August 2012, a federal district judge in Philadelphia ruled that laws prohibiting serving food to homeless people outdoors were unconstitutional.[156]

On June 19, 2014 the Court of Appeals for the Ninth Circuit struck down a 1983 ordinance in the city of Los Angeles which "bans people from living in cars or recreational vehicles on city streets or in parking lots" as being "unconstitutionally vague ... Unlike other cities, which ban overnight parking or sleeping in vehicles, Los Angeles' law prohibits using cars as 'living quarters; both overnight and 'day-by-day, or otherwise.'"[157]

Homeless rights advocates are pushing for "Right to Rest" bills in several states in 2015, which would overturn laws that target homeless people for sitting, eating, and sleeping in public places.[158]

Since the 1990s, there has been a growing number of violent acts committed upon people experiencing homelessness. The rate of such documented crimes in 2005 was 30% higher than of those in 1999.[159] Some teens engage in this activity as a source of amusement.[160] CNN reported in 2007 that such incidents were on the rise.[160]

The Center for the Study of Hate & Extremism (CSHE) at California State University, San Bernardino in conjunction with the NCH found that 155 homeless people were killed by non-homeless people in "hate killings", while 76 people were killed in all the other traditional hate crime homicide categories such as race and religion, combined.[161]

Various studies and surveys indicate that homeless people have a much higher criminal victimization rate than the non-homeless, but that most incidents never get reported to authorities. A 2007 study found that the number of violent crimes against homeless people is increasing.[161][162] In 2013, there were 109 attacks on homeless people, a 24 percent increase on the previous year, according to the NCH. Eighteen people died as a result of the attacks. In July 2014, three boys 15, 16 and 18, were arrested and charged with beating to death two homeless men with bricks and a metal pole in Albuquerque.[163]

As in other countries, criminals—both individuals and organized groups—sometimes exploit homeless people, ranging from identity theft to tax and welfare scams.[164][165][166] Homeless people, and homeless organizations, are also known to be accused or convicted of frauds and scams. These incidents often lead to negative impressions of the homeless by the general public.[167]

Homelessness is a public welfare and health epidemic within the United States. Any period of homelessness is associated with adverse health consequences.[168] These adverse health consequences are associated with poor living conditions and a lack of access to treatment facilities. Due to living in extreme poverty it is unlikely for an individual or a family to have a healthcare plan. These healthcare plans are important in obtaining treatment for illnesses or injury from treatment facilities. Without it, individuals and families are left to deal with their ailments themselves or endure further financial burden by receiving treatments without a health insurance plan. Respiratory infections and outbreaks of tuberculosis and other aerosol transmitted infections have been reported. Homeless intravenous drug users are at an increased risk of contracting HIV, and hepatitis B and C infections.[169] The close living spaces of areas such as Skid Row in California provide an environment in which infectious diseases can spread easily. These areas with a high concentration of homeless individuals are dirty environments with little resources for personal hygiene. It was estimated in a report to congress that 35% of homeless were in unsheltered locations not suitable for human habitation.[170]

There is a bidirectional relationship between homelessness and poor health.[171] Homelessness exacts a heavy toll on individuals and the longer individuals experience homelessness, the more likely they are to experience poor health and be at higher risk for premature death.[172] Health conditions, such as substance abuse and mental illness, can increase people's susceptibility to homelessness. Conversely, homelessness can further cause health issues as they come with constant exposure to environmental threat such as hazards of violence and communicable diseases. Homeless people suffer from disproportionately high rates of poly substance abuse, mental illness, physical health problems and legal issues/barriers in attaining employment.[173]

Large number of homeless people work but few homeless people are able to generate significant earnings from employment alone.[174] Physical health problems also limit work or daily activities which are barriers to employment. Drug and alcohol abuse and dependence are positively associated with lower work level but are negatively related to higher work level.[175] Those with physical health problems are substantially more likely than those with mental health problems to be in the more generous disability programs. Substance use disorders are also a barrier to participation in disability programs. Rates of participation in government programs are low, and people with major mental disorders have low participation rate in disability programs.[176]

There are risks to seeking refuge in shelters, which are heightened and more noticeable for children. Such risks include health problems such as malnutrition from lack of access to food with nutritional content, behavioral problems associated with coping, social insecurity from growing up in an unstable environment, and mental illnesses such as PTSD and trauma.[177]

Just as children who come from homeless families are at a higher risk of developing behavioral, mental, and physical health problems than their peers, their mothers are also at a higher risk especially in developing mental illnesses.[178] There are many things that contribute to why homeless women are at a higher rate of developing a mental illness compared to the general population, but there has been a reoccurring three among studies focused on this issue.[179]

Homeless individuals report mental illness as being the number three reason for becoming or staying homeless.[101] Such illnesses are often closely linked with the fourth reason—substance abuse—and therefore it is generally accepted that both of these issues should be treated simultaneously. Although many medical, psychiatric, and counseling services exist to address these needs, it is commonly believed that without the support of reliable and stable housing such treatments remain ineffective. Furthermore, in the absence of a universal healthcare plan, many of those in need cannot afford such services.

US yearly timeline of people experiencing homelessness in January.[2]

Perhaps the most accurate, comprehensive, and current data on homelessness in the United States is reported annually by the Department of Housing and Urban Development (HUD) in the Annual Homeless Assessment Report to Congress (AHAR), released every year since 2007. The AHAR report relies on data from two sources: single-night, point-in-time counts of both sheltered and unsheltered homeless populations reported on the Continuum of Care applications to HUD; and counts of the sheltered homeless population over a full year provided by a sample of communities based on data in their Management Information Systems (HMIS).[33][2]

Over the course of the year (October 2009 – September 2010), the 2010 Annual Homeless Assessment Report found that 1,593,150 individuals experienced homelessness[191][192] Most were homeless temporarily. The chronically homeless population (those with repeated episodes or who have been homeless for long periods) decreased from 175,914 in 2005 to 123,833 in 2007.[193] According to the 2017 AHAR (Annual Homeless Assessment Report) about 553,742 people experienced homelessness, which is a 1% increase from 2016.[194]

According to the NCHWIH report:[195]

• 51.3% are single males.
• 24.7% are single females.
• 23% are families with children—the fastest growing segment.
• 5% are minors unaccompanied by adults.
• 39% of the total homeless population are children under the age of 18.

According to the 2014 NCHWIH report:[195]

• 24% are married.
• 76% are single.
• 67.5% are single males within the single percentage.
• 32.5% are single females within the single percentage.

Homeless tent city in Skid Row, Los Angeles. The 2019 count found 58,936 homeless people living in Los Angeles County.[196]

According to the 2010 SAMHSA report, Among all sheltered individuals over the course of a year (October 2009-September 2010):[191] Gender, Age, Race/Ethnicity

• 41.6% are White, Non-Hispanic
• 9.7% are White, Hispanic
• 37% are Black/African-American
• 4.5% are other single races;
• 7.2% are multiple races

According to the 2014 NCHWIH report:[195]

• 42% are African American (over-represented 3.23× compared to 13% of general population).
• 38% are Caucasian (under-represented 0.53× compared to 72% of general population).
• 20% are Hispanic (over-represented 1.25× compared to 16% of general population).
• 4% are Native American (over-represented 4× compared to 1% of general population).
• 2% are Asian-American (under-represented 0.4× compared to 5% of general population).

According to the 2010 SAMHSA report:[191]

• 26.2% of all sheltered persons who were homeless had a severe mental illness
• About 30% of people who are chronically homeless have mental health conditions.

According to analyses of data from the 1996 NSHAPCxiv:[197]

• Over 60% of people who are chronically homeless have experienced lifetime mental health problems

According to the 2010 SAMHSA report:[191]

• 34.7% of all sheltered adults who were homeless had chronic substance abuse issues
• About 50% of people who are chronically homeless had co-occurring substance abuse problems.

According to analyses of data from the 1996 NSHAPCxiv:[197]

• Over 80% have experienced lifetime alcohol and/or drug problems

According to the 1996 Urban Institute findings of the National Survey of Homeless Assistance Providers and Clients (UIHAC) report[198]

• 53% have less than a high school education
• 21% have completed high school
• 27% have some education beyond high school.

According to the 1996 UIHAC report:[198]

• 44 percent did paid work during the past month. Of these:
• 20 percent worked in a job lasting or expected to last at least three months.
• 25 percent worked at a temporary or day labor job.
• 2 percent earned money by peddling or selling personal belongings.

A 2010 longitudinal study of homeless men conducted in Birmingham, Alabama, found that most earned an average of ninety dollars per week while working an average of thirty hours per week[199]

According to the 2010 SAMHSA report:[191]

• 71% reside in central cities.
• 21% are in suburbs.
• 9% are in rural areas.

According to the U.S. Department of Housing and Urban Development:[200]

• 78,676 homeless in New York City
• 49,955 homeless in Los Angeles
• 12,112 homeless in Seattle

According to the 2010 SAMHSA report:[191] Research on shelter use in New York City and Philadelphia concluded that

• People experiencing transitional homelessness constitute 80% of shelter users
• People experiencing episodic homelessness comprise 10% of shelter users.

In New York City

• Transitionally homeless individuals experience an average of 1.4 stays over a 3-year period, for a total of 58 days on average over the 3 years.
• Episodically homeless individuals, on average, experience 4.9 shelter episodes over a 3-year period totaling 264 days with an average length of stay of 54.4 days.

Data from the 1996 NSHAPC show that about 50% of people who were homeless were experiencing their first or second episode of homelessness, which typically lasted a few weeks or months to one year.

According to the 2017 Annual Homelessness Assessment Report:[201]

• 60.5% are male.
• 39% are female.
• 0.4% are transgender
• 0.2% do not identify as male, female, or transgender.

According to the 2017 Annual Homelessness Assessment Report:[201]

• 20.7% are under 18.
• 9.7% are 18–24.
• 69.6% are over 24.

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