- Younchan Lee, RN
- Brett Littke, RN, BSN, CRRN
- Juanita Manutasna, RN CRRN
- Sean N. Bennett, RN, MSN - Associate Professor - Utah Valley University - Orem, Utah
The word culture is describing the group of people with a certain set of beliefs, social forms and or way of life of a set of people in a certain time frame. It is important to know that the Homeless people make up a diverse group which include all religious sects, all ethinics and men women and families from all walks of life. It is described by government that a homeless person according to the Stewart Mc Kinney Homeless Assistance Act of 1987 is any person who lacks housing and those whose primary residence is in a shelter or private facillity that provides temporary living conditions. This also includes those persons who live in automobiles and buses.
Different countries and organizations define homelessness differently and it directly affects the sort of goals they want to accomplish in relation to homelessness. Though individuals who are homeless are often roofless it is important to make a distinction between the terms rooflessness and homelessness. It is also important to define precisely what it means to have a home. As common wisdom would indicate, a house is not necessarily a home and there are additional components that must be incorporated. Home is more than just a physical place. It is associated with a sense of safety, a feeling of freedom and the ability to be oneself. It is also the most associated with a set of social connections that can be considered family, regardless of blood relation. It is the base which work, friendship and all other activities can be developed. Conversely, a physical place where a person can stay, but feels no social or meaningful connection to the environment is considered a shelter. This becomes important to incorporate because an individual may feel at home on the streets because of their social situation and connection to their environment, regardless of how unconventional it may be. This can have an effect on resettlement and circumstances regarding rehabilitation (Philipps, 2012).
Additionally, there needs to be a distinction between different categories of homelessness. First there is rooflessness, which encompasses those individuals who have no roof over their heads. These people sleep on the streets, park benches and under trees. Rough sleeping is an instance of sleeping on the street. Next, there is houselessness. This includes those who are living in cars, tents, sheds or other places which make them technically not roofless. Next, there is precariously housed which includes those individuals who squat, stay in hostels, hotels, friends floors or those who are about to be evicted (Philipps, 2012).
In the homeless population according the Homeless estimates by state(2007) these statistics were discovered, There is an increase in homeless in urban areas. Children make up 30% of the homeless. Adults between 31 and 50, make up the highest share of homeless at 51%. The Elderly make up between 2.5% and 19.4%. Single men make up 40% of the total homeless with 14% of the total being women. 40% of the homeless men have served in the US armed forces. In the United States 22% of the homeless persons have serious psychiatric disorders.
In January 2013, 610,042 people were homeless on a given night. Most (65 percent) were living in emergency shelters or transitional housing programs and 35 percent were living in unsheltered locations. Nearly one-quarter (23 percent or 138,149) of all homeless people were children, under the age of 18. Ten percent (or 61,541) were between the ages of 18 and 24, and 67 percent (or 410,352) were 25 years or older. Homelessness declined by nearly 4 percent (or 23,740 people) between 2012 and 2013 and by 9 percent (or 61,846) since 2007. Between 2007 and 2013, unsheltered homelessness has declined by 23 percent (or 65,143), and by 7 percent (or 28,283) over the past year (USDHUD, 2013).
Values and Norms
The Journal of Transcultural Nursing describes the homeless as sharing a common theme of survival amongst themselves. This single thread, the will to survive, is what holds them together in the homeless communities. They rely on themselves rather than on others even if the other person is homeless also. They also value relationships because of their need to communicate while having interactions with others. This is also intertwined with the need to be loved or just plain accepted by others, something that is because of their homeless condition may be missing from their lives. (240) There is also that Hope of a better way of life for them that is also important to them. The homlesss also value the basic necessities of life such as the basics that we might take for granted. These might be, but are not limited to, food, clothing and shelter.(239) Problems such as mental illness, drug dependencies and being a victim of abuse can be normal occurrences for the homeless (KnoxHMIS, 2014). As many as 40% of homeless people surveyed in the Knoxville, TN area reported emotional problems. Individuals who have a combination of mental illness and drug dependency are five times as likely to become homeless. In addition, there is an increasing incidence of mentally ill in jails and prisons, which has led to stigmatizing mental illness and homelessness with criminality (KnoxHMIS, 2014). Education feeds into the ability to obtain housing and employment, with emphasis on math and reading abilities. So even if someone completed high school but was weak in math and reading abilities, they would be at higher risk for homelessness. Four major factors in homelessness for women are 1) family dissolution, 2) family violence, 3) lack of affordable housing and 4) low wages. One in four women will experience domestic violence in their lifetime and this can quickly lead to homelessness (KnoxHMIS, 2014). This can be compounded by discrimination by landlords (per previous defaults on rent, etc.), difficulty in securing work and crimes committed against them per their vulnerable status. An example of the latter is a woman who left a relationship with a boyfriend because of a brutal assault. After securing work with assistance from a shelter, she was shocked to learn that her ex-boyfriend had fraudulently used her identity to turn back on utilities in her former residence and she was charged $1200. It was noted that 31% of single female households are poor compared to only 6% of two-parent households. Minorities are also at higher risk for poverty and homelessness. The background and factors influencing homelessness make it difficult to predict or to establish what is normal for a diverse cultural group (KnoxHMIS, 2014).
Traditions, Beliefs and Attitudes
It is known that the homeless population lead an episodic lifestyle, meaning they live from moment to moment, thinking of their immediate survival. It is hard for them to think about how to plan for tomorrow when they have difficulty knowing or providing for their next meal. In the article A Culture of Homelessness?, the lifestyles of the homeless are magnified as "extreme poverty, lack of adequate housing, employment and income, lack of personal hygiene, difficulty with the tasks of daily living, vulnerability to stress, involvement with alcohol and/or drugs, poor physical health, and criminal activity."
In addition to learning to survive on the streets within the homeless culture,one develops their own sense of time, the here and now. Another one of characteristics that is learned among this culture of people is that of invisibilty. According to Davis "Homeless people are in constant danger because of lack of a safe habitat. If a person is "invisible" or not noticeable, that person is less likely to attract attention and may avoid a dangerous life-threatening situation" (Davis).
It is often said that if that Homeless person would just get a job they wouldn't have to beg for a living. According to "Who is Homeless?" 13% of the homeless population are employed. There is the fact that America's wages have been declining, with costs of necessities increasing, if your income is not increasing as well that could make you at risk for losing what you have. It is also true that some people have lost their employment or their jobs have been downgraded so that they are not making enough to compensate for rise in costs. If that person does become homeless than there is the possibility of losing their jobs, which becomes a vicious cycle.
Of the estimated 3.5 million homeless in America, 17% were single women and 30% were families with children (National Coalition for the Homeless, 2008). In a meta-analysis conducted by Finfgel-Connet, black women made up 46% of the female homeless population. A majority of these women have suffered from neglect, poverty, and parental mental health issues from a young age. As a result of these poor conditions, maladaptive behaviors often arise, which helps to perpetuate their circumstances. Some of the behaviors that these women exhibit include: sub-clinical anxiety, substance abuse, low self-esteem, mood disorders and psychosis. Homeless women are more likely to suffer from depression than their male counterparts, but this is also true in the general population (Finfgeld-Connett, 2010). In a meta-analysis conducted by Finfgel-Connet, black women made up 46% of the female homeless population. A majority of these women have suffered from neglect, poverty, and parental mental health issues from a young age. As a result of these poor conditions, maladaptive behaviors often arise, which helps to perpetuate their circumstances. Some of the behaviors that these women exhibit include: sub-clinical anxiety, substance abuse, low self-esteem, mood disorders and psychosis. Homeless women are more likely to suffer from depression than their male counterparts, but this is also true in the general population (Finfgeld-Connett, 2010).
Although the demographics of homelessness are changing with an increase in women and families on the streets over the past several decades, men are still seen in far greater numbers in the homeless population at approximately 67% in America (National Coalition for the Homeless, 2009). In most cultures men and women often play separate but conjoining roles in maintaining society. There are expectations about behavior for both men and women, and an inability to live up to these standards can cause psychological distress. In the case of men, there is an expectation to bring in resources, also referred to as being a “breadwinner”. Status is an integral part of identity in this way. It also revolves greatly around their ability to take care of others, especially a wife and children. An ability to take care of oneself and be independent is also essential. In all these areas of life homeless men have been unsuccessful. As a result uncertainty and distress about their masculinity often arise. Low self-esteem due to life failures can often establish itself as a contributing factor in substance abuse (Philipps, 2012). Lack of control and a decreased ability to fill the role of what a man “should be” can potentially result in dangerous behavior. Violence is seen with much more frequency in homeless populations. Sexual violence is also seen in much higher rates. In some cases, men who become homeless are initially at an increased likelihood to have maladaptive behaviors such as violence; and once homeless, they may feel an increased need to assert power in their lives where they usually have none. Violence in homeless culture is explored further in proceeding sections (Philipps, 2012). Veterans, who are primarily men, are also at an increased risk of becoming homeless. Veterans represent a higher percentage of the homeless population at 32.7% than they do in thegeneral population, which is 28%. Life in war is highly stressful. Techniques for survival in war zones such as hyper vigilance or violence becomes maladaptive in civilian life. Veterans are at a very high risk of Post-Traumatic Stress Disorder. The transition from duty to civilian life can be a very difficult time for many veterans, especially those who came from disadvantaged situations to begin with (Philipps, 2012).
In the homeless community all religions are represented. Also in the groups that organize shelters and safe places for homeless people to obtain refuge it seems that all religions are reaching out to offer relief.
The increased involvement of religious communities in aiding homeless individuals coupled with the extensive teachings of the three major religions in the U.S. creates a strong connection between religion and homeless individuals. Because of the growing connection, this study sought to explore the impact religion has on perceptions of homeless people. Based on religious teachings about homelessness, it would seem that religious individuals would have more positive attitudes toward homeless individuals than would non-religious individuals. The results of the study, however, did not reveal a clear relationship between religious affiliation and perceptions of homeless individuals. There were no significant differences between affiliated and non-affiliated respondents on most of the measures of homeless perception. Religious affiliation was associated with negative measures of homeless perception, such as viewing homeless individuals as dangerous and considering panhandling to be a problem. These findings are consistent with studies addressing associations between religiousness and discrimination previously mentioned. The studies illustrate that religious teachings do not always translate into actions. Religiously affiliated participants were also more likely than non-affiliated participants to believe homeless people have good job skills. While on the surface this appears to be a positive view, it may indicate that people believe homeless individuals have the means to enjoy a better lifestyle than they do. Therefore, they may believe homeless individuals choose to be homeless. Also, although the findings were not significant, religious respondents were more knowledgeable about the Coalition for the Homeless of Central Florida and more willing to give food and money to homeless individuals. These findings are consistent with religious teachings about providing food and aid to the needy (Lindsay Dhanani, 2011).
Religion among youth homelessness Cultures are made up of customs, mores, and ethos that are based on a belief system. The roots of these youth were grounded in the practice of Wicca. The ritualistic religion of Wicca emerged in almost every participant’s interview. Religion, particularly Wicca (a pre-Christian pagan religion), was one of the strongest threads holding these street youth together. Wicca’s major influence was on the rules of conduct and ethics of their culture. These youth felt a connection with pagan rituals that were inclusive and provided a sense of family and community. Experienced members tutored those who were new to the streets in the ways of Wicca. This became an important bonding process and a factor in whether the new member would be accepted into the street family (Joanne O’Sullivan Oliveira, 2009).
Personal story For Bam-Bam, as for many others living on the street, religion (whether mainstream or alternative) played a significant role in homeless “family” ties. Bam-Bam stated he had been practicing Wicca for over 8 years. In presenting a portrait of Bam-Bam, the practice of Wicca was reported as a central component to the structure of the subculture of these homeless adolescents. Divorced from families of origin and mainstream society, these youth have foraged for a sense of structure and organization. Bam-Bam’s religious beliefs in Wicca, as with many of his fellow homeless adolescents, provide a mirror into this culture (Joanne O’Sullivan Oliveira, 2009).
Sense of Self and Space
How homeless people see and identify themselves is an important part of who they are. Unfortunately, veterans have for many years had some of their number homeless. The Veterans’ Affairs (VA) in Utah is committed to helping this group by addressing emotional, social, cultural and financial needs (Utah Housing and Community Development Division, 2013). This includes outreach to shelters, jails and transitional housing that can last up to two years. Other identities reported by the homeless include being single, or part of a family and various ethnic and racial backgrounds. These can each imply very different needs. For example, almost 60 % of those in homeless families are children under the age of 18 and the parents are usually 30 or younger (HCH Clinicians Network, 2012). Homeless individuals are usually white men over 30 and most single parent homeless families are a mother in her late twenties with two young children under the age of six. Some of the factors that contribute to these groups becoming homeless include: lack of affordable housing, inadequate wages, job loss, foreclosures, domestic violence, challenges of raising children alone, and not having a social support network (HCH Clinicians Network, 2012). Family separations and foster care are often related to homelessness. There are a number of agencies like Partnering for Change, Beyond Shelter and HomeStart that work to quickly re-house the homeless and teach basic life skills that restore independence. Simple issues like money management, nutrition, parenting, and home safety help homeless people improve their own situation. A common problem is clinical depression which typically affects young mothers and is treatable. Some programs like the Colorado Coalition for the Homeless have group therapies and other services designed especially for families (HCH Clinicians Network, 2012). Being able to access services from one agency or service is an important benefit for the homeless because services are often fragmented and create a complex challenge to utilize (McKenzie, Pinger & Kotecki, 2012).
Communication Style and Language
Changing communication styles in society from face-to-face verbal exchanges to digital methods is reflected in the homeless population. Homeless people who have access to social support have better physical and mental health outcomes; as many as 44% of the homeless surveyed in the Philadelphia area reported having and using a mobile phone (Eyrich-Garg, 2010). This included voice calling, texting and internet use. Those using a phone reported a greater sense of security, ability to work and carry out personal needs and decreased use of alcohol and drugs. It was recommended that this phone access be used by healthcare providers to disseminate information and maintain contact with this population who have higher than average healthcare needs (Eyrich-Garg, 2010). In addition, it could also be used for research purposes that would indirectly help various organizations to assist the homeless. Some homeless youth use social media and the internet for entertainment and more practical needs (Rice & Barman-Adhikari, 2014). For example, emails are used to communicate with parents, case workers and potential employers. Social media is used to maintain ties with peers. Those who thus used these internet tools were more likely to find job leads and pursue housing opportunities online. The internet was also used for health and general information and recreational purposes. It was reasoned that youth are more comfortable with online resources than adults. Locations where the internet was accessed included school, the library, friend’s house, a youth agency, an internet café or on their own device (Rice & Barman-Adhikari, 2014). Because of the many important uses of internet for this vulnerable population and the impact on their life, it has been recommended that governments devote resources to providing internet access at youth service agencies and similar locations for those without alternative access. Those who had private access to the internet (ie. Their own device or a friend’s) were shown to have better outcomes than those who relied solely on public access.
Food and Feeding Habits
The feeding of the homeless is a challenge. There are homeless shelters as well as places that have been set aside for offering food and other needs. The Food and Care Coalition offers local assistance. The homeless get food from where they can including places that we would not normally eat. It is not surprising for the homeless person to get food from the trash, from the street anywhere they can. They can receive nutritionally sound meals from places that offer food or meals to the homeless, some still panhandle for food as well as money.
As might be expected, finding food is difficult for homeless people. A recent national survey suggests that twenty-five percent of homeless people sometimes or often do not get enough to eat (Baggett et al., 2011). Among this group, 68% reported having gone at least one day without eating in the last month. The percentages were higher among those reporting physical or sexual abuse. Interestingly, those who reported not having sufficient to eat also reported higher rates of hospitalization during the same period. Food insufficiency correlated highest among Hispanics and lowest among Blacks in terms of ethnic background. Chronic homelessness corresponded to higher food insufficiency. This was somewhat surprising as some of the researchers believed that having experience living on the street would make someone more capable of basic tasks like finding food. Being in a situation of worrying about obtaining food adversely affects other areas of life like buying medications or getting needed healthcare, as reported by homeless diabetics. Hypoglycemia was a noted example of this. Going to a healthcare facility simply to obtain food was reported by 12% of those surveyed in San Francisco. A national trend of less available emergency food supplies could be a factor in the experiences of these homeless people. It was recommended to implement public health initiatives to provide more food for this population (Baggett et al., 2011).
The stereotype that homeless people are often underweight is not true, as shown by a recent Massachusetts study that found only two percent of homeless individuals were underweight while 66 % were overweight (Koh, Hoy, O’Connell & Montgomery, 2012). This is a sharp departure from historical findings that homeless people often underweight. It is a paradox that these people have limited access to food but are often overweight. Possible causes for this could be nutrient poor food, over-eating per fear of not having food later, stress and sleep debt which enact physiologic changes in metabolism (Koh et al., 2012). There are as many as 3.5 million homeless people in the United States and their lives are often affected by substance abuse and mental illness. Determining the details of their situation is often made more difficult by their general distrust for researchers (Koh et al., 2012).
The reason people are and will continue to be homeless are a couple of reasons. The lack of affordable housing and assistance programs to obtain affordable housing. Domestic Abuse is a reason for homelessness. According to the Ford Foundation, 50% of all homeless females and children were victims of physical or other abuses by their own relatives. Some miscellaneous statistics
1. 13% of homeless individual were physically disabled
2. 19% of single homeless people are victims of domestic violence.
3. 2% are HIV positive
4. 19% of homeless people are employed(How many people...2009)
The value and sense of time is different for homeless people. This could be because of various disruptions to their life and routine that contribute to mental health, behavioral and academic problems (HCH Clinicians Network, 2012). An environment of constant change requires vigilance and attention and perhaps a focus on what will happen today as opposed to planning far into the future. Something as simple as a job interview can be complicated by the need to find a place to shower, clean ironed clothes to wear and transportation to make the appointment on time. Homeless people have a higher exposure to injuries from things like assault, exposure to the elements, motor vehicle accidents than other members of society as well as additional anxiety about obtaining food and shelter (McKenzie, Pinger & Kotecki, 2012). For those living in a shelter, there is the prospect that it can be dismantled with no advance warning by law enforcement officials (Hewitt, 2014). Information about who is homeless and their conditions is looked upon as a snapshot in time because it fluctuates so rapidly (Hewitt, 2014). Some people are homeless temporarily, or episodically or even chronically depending on various factors. School districts even track students who are “couch surfing,” meaning they are temporarily living at someone else’s house. Children in such unstable situations often have poorer outcomes in academics and health (Hewitt, 2014). If a family has a crisis, having someone to intervene (ie. Rental assistance or healthcare) can make the difference between moving forward with life or homelessness (HCH Clinicians Network, 2012). Even those who have access to a shelter find that conditions there can be unsettling due to lack of privacy, and exposure to disease, etc. Some are forced to look for a shelter outside their current community which can sever ties to schools, jobs and other support (HCH Clinicians Network, 2012).
Relationships and Social Organization
The sociality that exists among the homeless is described as social bonds and are demonstrated by the lack of support and "social Networking". They expericence a alienation from the community at large. They are also socially isolated, according to J. H. Flaskerud and A. J. Strehlow (1152). They do demonstrate a bond by sharing their resources thereby creating a "social support system". The social organization is hard to discover as an outsider says Davis he says this quote sums up the group of the homeless. "by and large, the homelss are characterized by an inability to fit within the social system and a lack of a social network". (Davis) The theme of survival is according to Davis "obtain some sort of food and shelter at the present moment in time is of first priority and is an all consuming activity. Any concept of the future for a homeless person is abstract and nebulous."
I would like to share some interesting thoughts shared on The International Homeless forums (Relationships on The Streets), these are written by some individuals who have lived on the streets at some time in their life.
Life would perhaps be easier if I had never met you.
Less sadness each time we part, Less fear of the next parting and the next after that, And not so much either of powerless longing when you're not there, Which wants only the impossible.
And that right away next minute, And when that can't be and is hurt and finds breathing difficult.
Life would perhaps be simpler if I had never met you... Only it would't by my life. Anonymous
Too many homeless men, not enough women, being single, get propositioned often...Just never met the right guy...it's COLD sleeping alone...it's hard doing everthing yourself...if the person you do it for leaves then where would you be.
I didn't have any romantic relationships while living on the streets-I just don't think I was interested in them, there was too much on my mind.
I did however have some close friends who were also homeless and provided a lot of support. And it's good to have someone to share bodyheat with on cold nights. One of my friends was...quite large, we'll just say, and sleeping next to him used to keep me warm.
With homelessness comes isolation from mainstream society. In order to compensate for this feeling of loneliness and separation, strong bonds are created amongst members of this culture, which can re-establish their ontological security. Due to the circumstances of homelessness, there are few ways they can spend their time. As a result friendships arise out of constant contact with other homeless people. The friendships that arise between homeless people have a quality of understanding that the individual may not have received from mainstream society. They are able to relate to life circumstances and support each other. They gain trust through shared life experiences and the knowledge that the other has also suffered, and will not pass judgment (Philipps, 2012). Since many homeless people suffer from substance abuse and mental health problems, they are most likely familiar with counseling practices and learn to incorporate techniques learned from these organizations to help each other. A deep sense of caring comes about in these relationships and homeless people work to help each other through tough times. With this support also comes dependence, and it has the potential to lock individuals in a cycle of rooflessness as a result; knowing that friendships like these were not available to them in the mainstream culture. Unfortunately, those individuals who are considered strong are especially relied on, and this could cause distress if they are unable to cope. This stress can lead to depression in the relied upon individual and push them towards substance abuse (Philipps, 2012).
Hierarchy in homeless culture
Just like in most human cultures, a hierarchy emerges among homeless individuals. The values and characteristics that create a leader in the homeless community are the opposite of what establishes power in mainstream culture, creating an inverted hierarchy. Those individuals with the most trauma and time spent on the streets were the ones who received the most respect among their peers. Those who are homeless see life as being much more brutal than someone from the mainstream culture might. Therefore the ability to survive no matter what, is seen as the most desirable quality. The longer an individual has been living on the streets, addicted to alcohol or drugs and survived; the more they are admired. This drastically different set of values once accumulated in an individual makes reestablishment into mainstream society highly difficult. Those individuals who continually fail at resettlement are rewarded by their culture, assuring that they are set apart as being truly complex and disturbed. Pain and trauma can become badges of honor, with women bragging about the amount of times they had been raped, or other touting criminal records, especially if they were seen as respectable crimes within the community. Theft is an example of a respectable crime. This attention and authority gained from exceptionally horrid pasts is also seen within the very social services aimed at helping these people. Those with particularly bad cases are set apart and given special attention, inadvertently reinforcing their behavior and gaining more respect from others. Occasionally this is seen to translate to the courts as well, with exceptions or lessening of punishment if horrific childhood events can be sited (Philipps, 2012).
Impact of Homelessness
Homelessness has an impact on society in many different ways. Individuals typically don’t think about all the impacts that homelessness has on society as a whole. Some of the ways in which homelessness impacts society are the amount of money the tax payers spend to give these individuals support services and programs in order for the individuals to survive. Another effect that homelessness has on society is the impact due to increased crimes by homeless individuals to survive. A third impact homelessness has on society is through lack of education and job opportunities for these individuals (Impact of Homelessness, 2012).
Homelessness has an effect on both the individual and society. Society has to pick up the cost for homeless individuals to get very basic services such as treatment for illness, places to sleep in and food to eat. For instance for an individual who is homeless to get treatment for an illness the individual typically has to go to an emergency room instead of just seeing a normal doctor due to lack of healthcare and/or money. A study was done on this issue in Hawaii and was found that “the cost for treating homeless individuals was 3.5million or about 2,000 per person”. Shelters for individuals who have no place to live are also another costly expense for taxpayers. Many times emergency shelters are used as long term housing for individuals who are homeless. This creates a dilemma for many individuals because should government keep paying the extra for shelters or just create essentially free to very affordable housing for the homeless (Impact of Homelessness, 2012).
An issue that seems to go hand in hand with homelessness is criminal activity. Although many of the times the crime homeless people have a tendency to commit is loitering. Society has not looked to kindly upon the issue. Many cities will give a ticket to an individual who is loitering which cost tax payers money because of the police officer and the court time. Whereas other communities will put the homeless individual in prison for 24 hours. The University of Texas did a study on homeless individuals and found out that “each person cost 14,480 per year primarily for overnight jail” (Impact of Homelessness, 2012).
Education and Learning
The devastating impact of homelessness on children has become starkly clear from decades of study. While poverty alone creates health, developmental, behavioral, and educational problems for children, homelessness compounds these problems by adding additional stress, fear, anxiety and instability to children's lives. The statistics stacked against homeless students are staggering: More than 20 percent of homeless children do not attend school. Homeless children are -- on average -- four grade levels below their housed peers. Homeless children are nine times more likely to drop out of school altogether. We have to remind ourselves constantly that a lot of people don't realize there are children who are without a home, without shelter every day in the United States. Lots of them: over 1.6 million. What is even more astonishing is that this number does not represent all of the homeless children and youth in our society. There are also over one million unaccompanied homeless youth aged 16 to 22 living on their own on the streets or in temporary housing situations. These are troubling times, especially for children. More and more children are falling through the cracks and facing hunger, homelessness and abuse. We are not sure when the clichéd picture of homelessness will change, but the drug-addicted man with the cardboard sign panhandling on the streets does not represent the vast majority of homeless people in America. In fact, families are the fastest growing segment of the homeless population. According to the National Center on Family Homelessness, one out of every 50 children in this country faces homelessness each year(Meek, C. 2012).
Work Habits and Practices
Within the homeless population there are those who do maintain a job or place of employment. This is difficult because they have no permanent address. There are opportunities for temporary employment that may be obtained often through a Homeless shelter or group that offers help to the homeless population. Those that are without the resources and funds to make it, become members of the homeless population. They may feel not welcome, or that they do not deserve a place to live and they do not feel that they can do enough to survive in society. These people often avoid crowded areas rather than draw attention to them selves. They also try to avoid confrontation with the public. They are at a high risk for violence, homicide and suicide. It may be believed that that the homeless person is in complete control of their own destiny and if they wanted to they could change their individual situation. In reality many homeless persons feel the opposite, that they have no center of control, that indeed they have NO CONTROL over what happens to them.(Nickasch & Marnocha, 2009, p. 43)
BARRIERS TO EMPLOYMENT FACED BY HOMELESS PEOPLE
As bad as it is for the 44% of homeless people who have jobs and can't escape homelessness, climbing out of homelessness is virtually impossible for those without a job. For those with limited skills or experience, opportunities for jobs that pay a living wage are very limited. Additionally, many members of the homeless population have to combat barriers such as limited transportation and reduced access to educational and training programs (Long, Rio, & Rosen, 2007). In such a competitive environment, the difficulties of job seeking as a homeless person can be almost insurmountable barriers to employment. Mental or physical illnesses also play vital roles in the employment participation of homeless individuals or those at risk for becoming homeless. Research statistics illustrate that a disability, mental or physical, can result in difficulty acquiring work. In addition to mental illness and substance abuse, incarceration also serves as a barrier for employment. Incarceration can decrease the types of employment available to an individual after release from jail or prison. Along with the previously mentioned barriers, the lack of access to technology serves as a handicap for the homeless searching for work. In this job market, some knowledge of computers and technology is essential for every field. Although there are computers available through public access, some homeless individuals lack computer knowledge and fear failure. Much has been learned from programs designed to help homeless people obtain and maintain employment in recent years. Studies indicate that mainstream programs, where the homeless are a minority population, may meet some of the basic needs of some homeless individuals but struggle to encourage employment by these individuals and provide income and support. This shortcoming also highlights that other groups of the homeless receive little income or employment support, i.e. single adults. Programs directly targeted to homeless populations such as the programs funded by the U.S. Department of Housing and Urban Development, The Department of Health and Human Services (Transitional Living Program for homeless youth), or The Department of Labor which funds Homeless Veterans’ Reintegration Program (focusing on employment) are from descriptive accounts fairly more successful in the homeless population than mainstream initiatives. In addition to these programs, mainstream federal employment programs and demonstrations have particular local grantees that target homeless people (National Coalition for the Homeless, 2009).
Because of past legislation, a variety of government funded programs exist to assist the homeless. Studies show that programs designed to assist the homeless should be implemented to cover a variety of concerns. An evaluation of the Job Training for the Homeless Demonstration Program (JTHDP), authorized by the Stewart B. McKinney Act in 1988, found that successful employment programs provide access to a wide variety of services including housing to help the homeless overcome employment barriers. In addition, the evaluation concluded that in order for employment programs to be most successful, they must directly target the homeless or those at risk of becoming homeless (National Coalition for the Homeless, 2009).
The female population of homeless women have their own set of health issues that leave them at high risk. They are not getting the yearly screenings to check for cervial cancer, breast cancer, and sexually transmitted diseases. Some women living on the streets resort to using sex to survie thereby leaving them at risk for getting not only sexually transmitted dieases but they are also at risk for unwanted pregnancies.
According to Nickasch and Marnocha's (2009) research study they feel they are unwanted in the healthcare system, they feel they are being judged for their circumstances and often disrespected. Many health care providers have a sysmtem which excludes the homeless or at best makes it hard for them to get medical care. The first thing is to make the appointment, thereby needing a phone, and then once the appoinment is made it is necessary to get the transportation to get to the Drs office or the clinic. When they are there they neen to fill out paper work, have a form of ID which is often not possible. They need to show that they have insurance or some form of way to pay for the services rendered. If they make it through these blockades they may be give a perscription and have no way to get this filled. If treatments are perscribed again the transportation is the issue.
The homeless population are at risk for same diseases as most Americans such as heart disease, type II diabetes, cancers, mental health issues, but because they have poor nutrition, inadequate clothing, are at risk to exposure from the elements, do not have adequate abode to protect them from the elements all of these disease processes are exacerbated ten fold. The majority of health issues among the homeless are chronic ilnesses that have gone uncontrolled and untreated. According to Savage et al (2009) these include, drug addiction, depression, alcoholism, hypertension, arthritis, asthma, chronic back pain, chronic lung diseases, diabetes, high cholesterol, chronic digestive diesease, mental health conditions, migraine headaches, sexually transmitted diseases, stroke and severe allergies (230). .
As a Registered Nurse (RN), it would be important to recognize:
1. It is important to remember that homeless usually seek health care when there symptoms are severe and out of control. This is mostly because of the the lack of funds and the other obstacles that have been explained thus far.
2. The health care providers need to be aware of the way they are perceived by those they are caring for. In the homeless community it is felt that they are not respected, and that they are judged because of there circumstances. This discourages thes from seeking for medical attention. It is estimated that there are 2.3 to 3.5 million homeless people currently in the United States (Baggett et al., 2010). More than half of them have mental illness. In addition, alcohol and drug use are commonly seen. A significant number of these homeless people had at least one unmet health need during the year. The unmet needs included medical or surgical care, prescription meds, mental health care, eyeglasses and dental care. Victimization during the past year was reported by as many as one-fifth of the homeless. The reasons for unmet needs included being uninsured (the main reason), food insufficiency, employment and vision impairment. One implication is that insurance benefits should be extended to all of the homeless.
It is interesting that employment actually causes a problem to obtain insurance. That is because those so employed no longer qualify for public benefits but cannot afford private coverage. About half of the homeless had employment in the last year. Homeless people will often put employment as a priority over healthcare because they need the money. The types of jobs they perform usually are intermittent and don’t allow flexibility or offer insurance coverage. Lack of coverage at times leads to increased use of emergency rooms, delays in treating conditions and higher rates of hospitalization.
An interesting finding of a national study of homeless (Baggett et al., 2010) was that out-of –home placement as a minor (foster care, group home, etc.) correlated with some unmet medical needs as a homeless adult. About one fourth of homeless people have such a background. Substance abuse, mental illness, victimization and lack of health insurance also correlated with previous foster care history. It is speculated that poor life skills, bad childhood experiences and high rates of incarceration explain some of these results. Federal funding for certain foster care programs increased in 1999, but the services are not being fully utilized.
Vision impairment is an important factor that impacts meeting other health needs. It is speculated that those with such impairment have more difficulty with written information. Accessing healthcare can involve complicated written instructions as well as forms to fill out. Vision screening and services are recommended as a future important offering for the homeless.
- Davis,R(1996). Tapping Into The Homelss Culture. Journal of Professional Nursing, 12:176-183.
- Facts and figures: the homeless. (2009, June 26).
- Flaskerud, J.,& Streghlow, A., (2008). Cultural competence Column. A Culture of homelessness?. Issues in Mental Health Nursing, 29(10), 1151- 1154.
- Homelessness. Encyclopedia of Mental Disorders. Retrieved March 21, 1010, from http://www.minddisorders.com/Flu-Inv/Homelessness.html
- Nickasch, B., & Marnocha, S., (2009). Healthcare experiences of the homeless. Journal of the American Academy of Nurse Practitioners, 21(1), 39-46.
- Savage, C., Lindsell, C.,Gillespie, G., Dempsey, Lee, R., & Corbin, A. (2006). Health care needs of homeless adults at a nurse-managed clinic. Jornal of Community Health Nursing, 23(4), 225-234.
- Spotlight on the Homeless Population/Nursing 322 Spring 2010 http://nursing322sp10.files.wordpress.com/2010/03/homeless-map.gif
- VG. (2004, April 19). Homeless in america. retrieved from http://www.washprofile.org/factsheets/who.html
- Kaitlin Philipps. (2012, October 10). Homelessness: Causes, Culture and Community Development as a Solution.
- The U.S. Department of Housing and Urban Development. (2013). The 2013 Annual Homeless Assessment Report (AHAR) to Congress.
- Impact of Homelessness. (2012, March 25). retrieved from http://smcote.hubpages.com/hub/Impact-of-Homelessness
- Lindsay Dhanani. (2011, January 13). How Religiosity Affects Perceptions of the Homeless#
- Joanne O’Sullivan Oliveira. (2009). Lost in the Shuffle: Culture of Homeless Adolescents retrieved from http://www.medscape.com/viewarticle/708166_4#
- Catherine Meek. (2012, December 26). We Must Help Our Nation's Homeless Children Get an Education. retrieved from http://www.huffingtonpost.com/catherine-meek/school-on-wheels_b_2367327.html#
- National Coalition for the Homeless. (2009, July). Employment and Homelessness. retrieved from http://www.nationalhomeless.org/factsheets/employment.html#
- Finfgeld-Connett, D. (2010). Becoming homeless, being homeless, and resolving homelessness among women. Issues in Mental Health Nursing#
- National Coalition for the Homeless (2009). Who is homeless?. Retrieved December 11, 2011 from http://www.nationalhomess.org/factsheets/who.html#
- Baggett, T. P., Singer, D. E., Sowmya, R. R., O’Connell, J. J., Bharel, M. & Rigotti, N. A. (2011). Food insufficiency and health services utilization in a national sample of homeless adults. Journal of General Internal Medicine 26(6), 627-634. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101971/pdf/11606_2011_Article_1638.pdf
- Koh, K. A., Hoy, J. S., O’Connell, J. J. & Montgomery, P. (2012). The Journalof Urban Health: Bulletin of the new York Academy of Medicine 89(6), 952-964. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3531350/pdf/11524_2012_Article_9708.pdf
- Baggett, T. P., O’Connell, J. J., Singer, D. E. & Rigotti, N. A. (2010). The unmet healthcare needs of homeless adults: A national study. American Jorunal of Public Health 100(7), 1326-1333. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882397/pdf/1326.pdf
- Utah housing and Community Development Division (2013). Comprehensive Report on Homelessness. Retrieved from http://jobs.utah.gov/housing/documents/homelessness2013.pdf
- Eyrich-Garg, K. M. (2010). Mobile-phone technology: a new paradigm for the prevention, treatment and research of the non-sheltered “street” homeless. Journal of Urban Health 87(3), 365-380. Retrieved from http://link.springer.com/article/10.1007/s11524-010-9456-2#page-2
- Rice, E. & Barman-Adhikari, A. (2014). Internet and Social media use as a resource among homeless youth. Journal of Computer Mediated Communication 19(2), 232-247. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/jcc4.12038/full
- HCH Clinician’s Network (2012). Addressing family homelessness. Healing Hands 16(3), 1-6. Retrieved from http://www.nhchc.org/wp-content/uploads/2012/05/Summer2012HealingHands.pdf KnoxHMIS (2014). Homelessness in Knoxville and Knox County, Tennessee 2013-2014. Retrieved from http://vmcinc.org/Homeless%20Coalition_2014_Biennial_Study.pdf
- McKenzie, J. F., Pinger, R. R. & Kotecki, J. E. (2012). An Introduction to Community Health. Sudbury, MA: Jones and Bartlett Learning.