1. Homelessness
Presented by Tedra Estis

2. Homelessness defined
• To be without a home. Lacking a fixed, regular,
safe and secure place to dwell.
• A state of vulnerability
– Health risks due to exposure to the elements
– Violence
– Harassment
– Absence of privacy
– Alienation from society
(Homelessness, n.d.)

3. The Problem
• Homeless is everywhere.
• Estimated 2-3 million homeless people in the U.S.
• Homelessness breaks up families. Some shelters
won’t accept men or children.
• Small illnesses become serious health conditions due
to expose to elements and unsanitary conditions.
• Depression sets in, the homeless become hopeless.
• Violent attacks on the homeless, rape, and cruelty.
• Urban slum and blight.
(Homelessness, 1996)

4. Consequences
The homeless frequently visit hospital
emergency rooms.
– Each visit costs approximately $3,700
– Average of $18,500 in ER stays per year per
homeless person
(The cost, n.d.)

5. Who are homeless?
(HUD, 2012)

6. Who lives in Shelters?
Statistics
• 62% are male
• 38% are female
• 21.8% are under age 18
• 23.5% are 18-30
• 37% are 31 to 50
• 14.9% are 51 to 61
• 2.8% are 62 or older
• 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
(Current, 2011)

7. Homelessness Myths
Myth-The homeless are lazy.
Fact- 45% of homeless work, but do not earn a living wage.
Myth-Homeless people want to be homeless.
Fact-Nobody wants to be homeless. They have often lost faith.
Myth-Homeless people are dirty and smelly.
Fact-Many homeless find ways care for hygiene; in shelters, in gyms, at truck stops.
Myth- The homeless are uneducated.
Fact-Many homeless are educated. Some have Master’s degrees.
Myth-It won’t happen to me.
Fact- 1 out of 3 working individuals are 3 paychecks or less away from poverty.
(Homelessness, n.d.)

8. Vulnerable Populations
• Veterans
• Mentally Ill
• The Working Poor
• Unattached youth
• Elderly
• Alcoholics
• Transients
(At risk, 2011; United, 2012)

9. Health Determinants
Policy Making
– Include the homeless in policy making. Give them
a voice.
– Allow everyone to apply for HEARTH ACT
assistance and be flexible
– Maintain adequate level of outreach, emergency
housing, transitional housing, and supportive
services
– Include rural homeless and let them not be
disadvantaged
(Priority, 2011)

10. Health Determinants
Individual Behavior
– Substance abuse
• About two thirds of homeless people abuse drugs
and/or alcohol
– Domestic Violence
• Half of homeless women have left abusive relationships
(At risk, 2011)

11. Health Determinants
Social
– Available affordable housing
– Safety of environment
• Big city
– Crime rates
– Gangs
• Rural area
– Elements of weather
– Lack of assistance
(HUD, 2012)

12. Health Determinants
Health Services
– Barriers to help
• Language barriers
• Pride
– Unavailable housing or refuge
• Transient housing
• Shelters
• Churches
(U.S., 2012)

13. Health Determinants
Biology and Genetics
– Mental Health- 20 to 25% of all homeless people
have some type of mental illness
• Schizophrenia
• Post traumatic stress disorder (especially Veterans)
• Bi-polar
– Family history of alcohol abuse
(Current, 2012, United, 2012)

14. Housing and Urban Development
• HUD’s objectives:
– Eliminating slum and blight
– Eliminating conditions which are detrimental to
health, safety, and public welfare
– Principally benefiting person of low and moderate
income
(HUD, 2012)

15. HUD Regions in the U. S.
(HUD, 2012)

16. Health Promotion
Homelessness assistance programs
– McKinney-Vento Homeless Assistance Act
– Supportive Housing Program
– Shelter Plus Care Program
– Single Room Occupancy Program
– Title V Program
– Emergency Solutions Grant Program
(HUD, 2012)

17. One Solution
Provide affordable housing
• Health care costs are reduced by 59%.
• Emergency room costs are decreased by 61%.
• General inpatient hospitalizations are
decreased by 77%
(The cost, n.d.)

18. In Springfield, Missouri
One Door (ran out of the Kitchen)
– 11,000 phone calls
– 577 client assessments
– 2,656 requests for shelter
– 3,523 requests for utilities assistance
• Total spent $74,000
Emergency Rent Assistance
62 households assisted
• Total spent $22,900
(B. Griesemer, personal communication, December 4, 2012)

19. In Springfield, Missouri
• Jordan Valley
• The Kitchen
• Victory Mission
• Salvation Army
• Missouri Hotel
• First Step
• New Life Evangelistic
• Community Partnership
(Springfield, n.d.)

20. Get Involved
Become an advocate for the homeless
– Be familiar with community assistance
– Provide information to the homeless
– Refer patients
– Provide tools
– Follow up

21. Get Involved…
• In your local government
– Attend City Council meetings
– Join a council or advisor committee
• In your community
– Volunteer at clothing banks, soup kitchens, and
homeless shelters
– Donate

22. Final thought
I am a mental health nurse who deals with homelessness on a
daily basis in my job and in our community. I have served on the
Citizen’s Advisory Committee to City Council for the last two years.
We allocate HUD discretionary fund money to the City of
Springfield’s non-for-profit organizations. I have worked in our
community and am passionate about our citizens. Homelessness
is everyone’s problem. I implore you to get involved! For more
information about this committee and others like it, please visit:
http://www.springfieldmo.gov/boards/advisory/members.jsp
http://www.springfieldmo.gov/boards/home.jsp

23. References
At risk of becoming homeless. (2011). Destination home. Retrieved from http://www.destination-
home.info/Homelessness/at-risk.htm
Current statistics on the prevalence and characteristics of people experiencing homelessness in the
United States (2011, July). Substance abuse and mental health services administration.
Retrieved from http://homeless.samhsa.gov/ResourceFiles/hrc_factsheet.pdf
Homelessness defined. (n.d.). The suitcase clinic. Retrieved from
http://www.suitcaseclinic.org/homelessness-defined/
Homelessness: Programs and the people they serve. (1996). Urban institute and the national survey of
homeless assistance providers and clients. Retrieved from
http://www.urban.org/publications/310291.html

24. References
Priority recommendations regarding implementation of the homeless emergency assistance and
rapid transition to housing act(2011). National coalition for the homeless. Retrieved from
http://www.nationalhomeless.org/advocacy/HEARTHrecommendations2011.html
Springfield Missouri homeless shelters and services for the needy. (n.d.). HDS helping the needy.
Retrieved from http://www.homelessshelterdirectory.org/cgi-
bin/id/city.cgi?city=Springfield&state=MO
The cost of homelessness facts. (n.d.). Green doors. Retrieved from http://greendoors.org/facts/cost.php
United states department of veterans affairs. (2012). Retrieved from
http://www.va.gov/health/NewsFeatures/20120220a.asp
U.S. department of housing and urban development. (2012). Retrieved from
http://portal.hud.gov/hudportal/HUD