thumb|upright=1.23|The official homeless population counts by state, 2019
thumb|upright=1.23 |As COVID-era protection programs expired and a cost-of-living crisis hit the country, homelessness numbers rose, surpassing 2007 Great Recession levels in 2023.
thumb|upright=1.23|The statewide homelessness population rates as compared with the national U.S. homelessness rate (0.17% or 171 persons per 100,000) in 2019. Of the 9 states ([[Alaska, California, Hawaii, Massachusetts, Nevada, New York, Oregon, Vermont, and Washington) and the District of Columbia that have homelessness rates higher than the United States as a whole, only Vermont did not have median gross rents higher than the United States as a whole in the 2015–2019 American Community Survey 5-year estimates.]]
right|thumb|upright=1.23|A homeless woman in [[Washington, D.C., 2006]]
thumb|upright=1.23|A homeless man sleeping across the street from the [[Colorado State Capitol|Colorado State Capitol Building in Denver, 2018]]
In the United States, the number of homeless people on a given night in January 2024 was more than 770,000 according to the Department of Housing and Urban Development. Homelessness has increased in recent years, in large part due to an increasingly severe housing shortage and rising home prices in the United States. The majority of homeless people in the United States have been homeless for less than one year; two surveys by YouGov in 2022 and 2023 found that just under 20 percent of Americans reported having ever been homeless.
The main contributor to homelessness is a lack of housing supply and rising home values. Interpersonal and individual factors, such as mental illness and addiction, also play a role in explaining homelessness.
Historically, homelessness emerged as a national issue in the 1870s. Early homeless people lived in emerging urban cities, such as New York City. Into the 20th century, the Great Depression of the 1930s caused a substantial rise in homelessness. In 1990, the U.S. Census Bureau estimated the homeless population to be of 228,621, or 0.09% of the 248,709,873 enumerated in the 1990 U.S. census, which homelessness advocates criticized as an undercount. In the 21st century, the Great Recession of the late 2000s and the resulting economic stagnation and downturn have been major driving factors and contributors to rising homelessness rates. Increases in homelessness broke records in 2022 and in 2023. In 2023, record levels of homelessness have been declared in Los Angeles and New York City, and other cities around the country have reported increased levels of homelessness, with the main drivers being a shortage of affordable housing and the increased cost of living.
Health complications are a significant concern for homeless people, as lack of residence inhibits hygiene and access to healthy food, and exposes individuals to both cold and heat stress, violence, and traffic deaths. This contributes to increased mortality rates. In City of Grants Pass v. Johnson (2024), the U.S. Supreme Court ruled that anti-camping laws do not constitute a cruel and unusual punishment under the 8th Amendment even when no shelter is available, allowing cities to jail and fine homeless people for sleeping and camping outside.
Many Americans who cannot afford normal housing live in their cars or recreational vehicles (RVs). About a million people in the USA live full-time in RVs, according to the RV Industry Association, some of them just can’t afford normal housing, but many do it by choice.
History
Pre-colonial and colonial periods
Following the 1381 Peasants' Revolt in England, constables were authorized under 1383 English Poor Laws to collar vagabonds and force them to show support. If they could not, the penalty was gaol.
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.
African American homelessness
According to historian Roberta Ann Johnson, American slavery in the Southern colonies led to homelessness for free Blacks. Runaway slaves represented an early example of American homelessness. Native Americans at times provided a safe haven for runaway slaves. During the Civil War (1861–1865), many slaves escaped and became homeless. The Union Army provided protection and some housing aid and employment to these refugees. During the Reconstruction era after the war, large-scale operations by Freedmen's Bureau provided employment for many homeless until it closed in 1872. Most former slaves became tenant farmers, sharecroppers, or day laborers on cotton or tobacco farms.
Urbanization in the late 19th century
right|thumb|upright=1.2|The [[Bowery Mission at 36 Bowery in New York City, ]]
Homelessness emerged as a national issue in the 1870s. There are no national figures documenting homeless people's demography at this time. 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.
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, 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.
20th century
1930s: The Great Depression
thumb|Unemployed men outside a [[soup kitchen in Depression-era Chicago, 1931]]
The Great Depression of 1929-1939 caused a devastating epidemic of poverty, hunger, and homelessness for one to two million people at any one time, with a great deal of turnover. As local charities and cities were overwhelmed, the homeless created self-governed shantytowns known as "Hoovervilles." Built from scrap materials in vacant lots near railroad yards, these poverty-stricken settlements housed hundreds or even thousands of displaced young men, with some women and children. Residents lived in makeshift shacks and begged for food or went to soup kitchens run by charities and churches. Local authorities did not officially recognize these Hoovervilles, but they were tolerated out of necessity. By early 1933 about 1.5 million people were lacking shelter. Because state laws denied aid to non-residents, the New Deal under President Franklin Roosevelt created the "Federal Transient Program" (FTP) in May 1933 as part of the new Federal Emergency Relief Administration (FERA), run by Harry Hopkins. FTP covered 100% of the local government costs for helping "transients" (those living in a state for less than a year). At its peak, the FTP operated over 600 facilities, providing food, medical care, housing and some jobs to about 1 million people. Most of those served were young, white, native-born working-class men, though women and African Americans were also present. By 1935, the federal government began phasing out direct relief like the FTP in favor of the "Second New Deal". Several factors drove this change. The FTP was so successful at clearing the streets that public urgency regarding homelessness faded. Officials like Harry Hopkins feared direct relief created "dependency" and pulled men away from traditional roles as family breadwinners. The new policy shifted toward public works run by the Works Progress Administration. (WPA) and long-term social safety nets especially Social Security. Shutting down the FTP in 1935 caused a resurgence of "hobo" life and left Dust Bowl migrants—like those famously depicted in the 1939 novel and film The Grapes of Wrath—with little federal support. Finally, the homelessness crisis ended between 1939 and 1941, when the booming World War II defense industries hired as many people as fast as possible.
1960s and 1970s
A 1960 survey by Temple University of Philadelphia's poor neighborhoods found that 75 percent of the homeless were over 45 years old, and 87 percent were white.
The Community Mental Health Act of 1963 was a pre-disposing factor in setting the stage for homelessness in the United States. 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 and many of the "deinstitutionalized" wound up living on the streets, with no sustainable support system. 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.
thumb|Displaced people after the [[Great Fire of 1911]]
1980s and 1990s
The number of homeless people grew in the 1980s, nearly doubling from 1984 to 1987. According to Don Mitchell, this was in part due to the neoliberal reforms of the Reagan presidency, as housing and social service cuts increased and also the economy suffered a recession early in the decade. In 1984, the Federal government determined that somewhere between 200,000 and 500,000 Americans were homeless. 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. Tent cities, which had largely vanished during the post-war period, began to re-emerge during this time. It is largely, although not exclusively, in these urban areas, that homelessness became widespread and reached unprecedented numbers.
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. In the 1990s, homeless shelters, soup kitchens, and other supportive services sprouted up in towns and cities nationally. Despite these efforts and the dramatic economic growth marked by this decade, homeless numbers rose and remained high from 1990 to 1999 according to the "coalition for the homeless" webpage.
It became increasingly apparent that simply providing services to alleviate the symptoms of homelessness, such as shelter beds, hot meals, psychiatric counseling, although needed, were not successful at solving the root causes of homelessness. In 1987, the United States Interagency Council on Homelessness (USICH), a federal agency contained in the Executive Branch, was established as a requirement of the McKinney–Vento Act of 1987.
Historically, the U.S. has approached addressing homelessness through a Treatment First approach, which operates on the idea that housing must be earned through abstinence from substance use or mental health treatment. In the 1980s, the Housing First approach raised a challenge to Treatment First. The Housing First approach, initially developed by homeless advocates, operates on the idea that housing is a right, and individuals have the option to address other underlying issues after they are housed.
In 1992, the National Commission on Severely Distressed Public Housing published a report identifying 6% of public housing as "severely distressed". This led to a 5 billion dollar funding package, HOPE VI, for replacing distressed public housing with mixed-income developments. The demolition of SROs was incentivized by increased real estate prices and neighborhood pressure, resulting in the teardown of more units than were initially identified. Redevelopments did not include nearly as many units of public housing as were demolished, decreasing the total stock of public housing and putting more people on the streets.
21st century
2001–2020
[[File:New Multifamily Units Constructed.webp|thumb|400px|New multifamily units constructed, 1999 to 2021.<br />
For rent:
For Sale:
]]
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.
In May 2009, President Obama signed the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act, 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.
In 2011, the Federal government launched of Opening Doors: The Federal Strategic Plan to Prevent and End Homelessness. 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 on preventing and ending all types of homelessness. This plan was presented to the President and Congress in a White House Ceremony in June 2010.
In New York City, the number of homeless people using nightly shelter service tripled from about 20,000 to more than 60,000 between January 2000 and January 2015. By 2016, homelessness was considered an epidemic in several U.S. cities. In 2016, 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."
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 cannot punish homeless people for sleeping in public when the homeless shelters are full.
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. According to US government sources, homelessness has increased drastically, particularly in the US West, as real estate shortages drove up rents even higher, when people from already lower income levels were laid off from their jobs and evicted from existing housing. The estimates for homeless persons in the US during the COVID-19 pandemic range from 600,000 to 1.5 million people, making the US the worst affected industrialized country with regard to unhoused individuals.
In 2020, local city governments in California and Oregon started to intensify anti-homelessness campaigns, with limited success as local citizens reported extensive sprawls of homeless people in parks and public areas, creating unsanitary conditions with negative effects on small businesses.
Due to COVID, the Department of Housing and Urban Development's 2021 report to Congress on the state of homelessness in the United States was unable to perform an accurate count of unsheltered homeless individuals. Instead, the report focused on point-in-time counts of sheltered homeless peoples.
thumb|A homeless veteran in New York, 2008
Improved data
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.
In 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). About 68 percent of the 1.6 million sheltered homeless people were homeless as individuals and 32 percent were persons in families.alt=A homeless camp under a highway bridge in New Orleans, LA|thumb|A homeless camp in New Orleans, March 2023
In 2008, more than 66% of all sheltered homeless people were located in principal cities, with 32% located in suburban or rural jurisdictions. About 40% of people entering an emergency shelter or transitional housing program during 2008 came from another homeless situation (sheltered or unsheltered), 40% came from a housed situation (in their own or someone else's home), and the remaining 20% 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% stayed less than a month, and a 33% stayed a week or less. Around 44% of homeless people were employed. In 2009, it was estimated that one out of 50 children or 1.5 million children in the United States of America would experience some form of homelessness each year.
There were an estimated 37,878 homeless veterans in the United States in January 2017, or 8.6 percent of all homeless adults, compared with about 7 percent of the U.S. adult population in 2018 that were military veterans. In 2013, Texas, California and Florida had the highest numbers of unaccompanied homeless youth under the age of 18, comprising 58% of the total homeless under 18 youth population. In 2020, New York City reported it had about 114,000 temporarily homeless school children.
From 2007 to 2015, homelessness appeared, from the federal survey, to be in decline. Beginning in 2016, the surveys showed a steady increase in homelessness, particularly among the unsheltered.
The COVID-19 pandemic, and associated economic downturn, housing shortages and housing price inflation, outpacing wage growth, and the end of government protections and assistance to counter the economic effects of COVID-19—along with the explosive growth in addictions to methamphetamine, opioids, and Fentanyl -- contributed to a sharp rise in homelessness in the early 2020s. By 2023, according to the federal survey, a record 653,104 homeless were identified in the annual federal survey—a 12% jump over the previous year, quadruple any other year's increase, with increases in every category and demographic of homelessness. The homeless population in the United States rose by more than 18 percent in a single year in 2024, government officials said, driven by high housing costs, natural disasters and increased migration to big cities. According to the poll, the number of homeless people on a given night in January 2024 was more than 770,000. Children under 18 experienced the largest increase, with nearly 150,000 homeless on survey night. Overall, family homelessness is up 39 percent from the previous year.
Causes
Lack of available and affordable housing as a cause of homelessness was named at the 2004 United States Conference of Mayors, surveying the mayors of major cities on the extent and causes of urban homelessness.
- Lack of affordable housing throughout much of the country is considered the "root cause" of the contemporary homelessness crisis. Writing for The Atlantic in 2023, Jerusalem Demsas says that "homelessness is primarily a function of the broader housing-unaffordability crisis, which in turn is primarily a function of how difficult local governments have made building new housing in the places that need it the most."
- Lack of sufficient urban housing projects to provide safe, secure, and affordable housing to the financially underprivileged.
- 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.
- Redevelopment and gentrification activities instituted by cities, 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.
- Natural disasters that destroy homes: hurricanes, floods, earthquakes, etc. Places of employment are often destroyed, causing unemployment and transience.
- People who have served time in prison, have used addictive substances, 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.
- People with criminal charges at large that are in hiding seeking to evade law enforcement.
- 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.
- Evictions from rented property.
- Lack of resources in place in the communities to help aid in prevention of homelessness before it becomes a crisis. In poor communities, landlords increase the rent burden on tenants in what they perceive to be risky investments, extracting more profits from them than their counterparts in more affluent communities, which according to sociologist Matthew Desmond and his colleague, "directly contributes to their economic scarcity and hardship and is a source of residential insecurity, eviction, and homelessness."
- Low-income workers are at increased risk of homelessness as wages for the typical American worker have stagnated over the last three decades, while housing costs have climbed, according to the National Alliance to End Homelessness.
Adverse childhood experiences
In a study on adverse childhood experiences, "Nearly nine in ten homeless adults have been exposed to at least one early traumatic experience, and more than half of homeless adults have been exposed to four or more early traumatic experiences".
Unaffordable housing
Homelessness is driven by a number of causes, but one of the most direct causes is a lack of affordable housing. According to the United States Interagency Council on Homelessness, "affordable housing shortages" is among the top policy-related causes of homelessness, and 40-60% of homeless people have a job, yet still cannot afford housing. In academic research, homelessness rates are directly correlated with increases in rent, most notably when the cost of rent in an area exceeds 30% of an area's median income. In 2023, the surge in homelessness has been linked to soaring rents eating away at any worker wage gains not only in California and Washington, but also Arizona, Ohio, Tennessee and Texas.
In 2024, in California in particular, high housing costs were found to be a key driver of homelessness. A 2023 survey of homeless individuals in California found that among typical causes of homelessness, many people were driven into homelessness due to high rents and low incomes which could not cover the cost of rent. In San Diego, according to a 2023 report by the Private Equity Stakeholder Project, Blackstone Inc. has contributed to the problem through aggressive evictions and rent increases of some 43-64% on vacant properties in two years.
In a 2022 book titled "Homelessness is a Housing Problem", Clayton Page Aldern, a policy analyst and data scientist in Seattle, and Gregg Colburn, an assistant professor of real estate at the University of Washington's College of Built Environments, studied homelessness rates across the country, along with what possible factors might be influencing the rates. They found that high rates of homelessness are caused by shortages of affordable housing, not by mental illness, drug addiction, or poverty. They found that mental illness, drug addiction and poverty occur nationwide, but not all places have equally expensive housing costs. One example cited is that two states with high rates of opioid addiction, Arkansas and West Virginia, both have low per capita rates of homelessness, because of low housing prices. With respect to poverty, the city of Detroit is one of the poorest cities, yet Detroit's homelessness rate is 20% that of West Coast cities like Seattle, Portland, San Francisco, Los Angeles, and San Diego.
Definitions and categories
The United States Department of Housing and Urban Development acknowledges four categories of people who qualify as legally homeless: (1) those who are currently homeless, (2) those who will become homeless in the imminent future, (3) certain youths and families with children who suffer from home instability caused by a hardship, and (4) those who suffer from home instability caused by domestic violence.
According to the 1994 Stewart B. McKinney Act, a person is considered homeless if they "lack a fixed, regular, and adequate nighttime residence and ... has a primary nighttime residency that is: (A) a supervised publicly or privately operated shelter designed to provide temporary living accommodations... (B) an institution that provides a temporary residence for individuals intended to be institutionalized, or (C) a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings."
Homeless veterans
Homeless veterans are persons who have served in the armed forces, who are homeless or living without access to secure and appropriate accommodation. In January 2020, by HUD point-in-time measurements, there were an estimated 37,252 homeless veterans in the United States, or 8 percent of all homeless adults. In 2020, just over 8 percent of homeless U.S. veterans were 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. 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.
Youth homelessness
[[File:Homeless children in US 2006-10.png|thumb|Homeless children in the United States: The number of homeless children reached record highs in 2011, 2012, and 2013 at about three times their number in 1983. The number of homeless children reached record highs in 2011,
In 2009, one out of 50 children or 1.5 million children in United States of America was homeless each year.
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. If they leave, street children are likely to end up in large cities, notably New York City; Los Angeles; Portland, Oregon; and San Francisco. In 2010, street children were predominantly Caucasian and female in the United States, and 42% identify as lesbian, gay, bisexual, or transgender (LGBT).
The United States government has been making efforts since the late 1970s to accommodate this section of the population. 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. There has 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.
In 2020, the National Center for homeless Education reported that in the U.S. public education system, over 1.5 million students experienced homelessness during their 2017 and 2018 school year.
According to the data, between 2023 and 2024, children under 18 saw a 33% increase in homelessness, with 150,000 children experiencing this crisis.
LGBTQ+ youth
According to the 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. 2015 research shows that a disproportionate number of homeless youth in the United States identify as lesbian, gay, bisexual or transgender, or LGBT.
thumb|A homeless camp in [[Eugene, Oregon, 2013]]
Homeless families
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. The 2000s saw a new population of those experiencing homelessness: families with children. While an emerging problem at the beginning of the decade, the problem continued to persist to 2010.
At the close of the decade the trend continued, with the number of individuals in homeless families increasing from 431,541 in 2007 to 535,447 in 2009.
In 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.
In 2024, the percentage of families with children experiencing homelessness increased by 39%. There is 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.
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. 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. 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. A 2017 study found that 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. Those life events could include losing a job, a medical condition, divorce, domestic abuse, and more. It is likely that people experiencing episodic homelessness are young, and end up staying in shelters for a brief period.
Hidden homelessness
Hidden homelessness goes unreported and undocumented. Individuals who are classified as such are temporarily living with others with no guarantees for the long term.
The community of homeless people in the United States is aided by governmental and non-governmental organizations. According to the United States Department of Housing and Urban Development, in 2017, the number of people experiencing homelessness in unsheltered locations increased for a second straight year by 9% between 2016 and 2017. This issue is partly caused by a lack of affordable housing and is exacerbated by the criminalization of behaviors associated with homelessness. This problem is also costly for the country in supporting these individuals. Multiple studies have demonstrated success in reducing the homeless population as well as its harmful financial and societal effects by providing these individuals with a combination of housing without preconditions and supportive care. These studies include the 2014 Housing first implementation of the Department of Veterans Affairs National Center on Homelessness Among Veterans and a study performed through Brown University.
Employment
Many homeless people in the United States work, both part-time and full-time. Employment opportunities can be useful in providing financial stability to homeless individuals. Estimates of unemployment within the homeless population range from 57% to 90%. Programs seeking to help homeless people find and maintain jobs usually focus on individual characteristics of homeless people as barriers, such as addiction and mental illness.
Research indicates that there are systemic factors that exclude homeless people from the work force, such as expectations, and the overall structure of the labor market. The rise of temporary employment in the modern labor market has made homeless people unable to secure stable employment and income, to ensure their ability to afford and maintain a house. 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.
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. A 2018 report to congress estimated that 35% of homeless people were in unsheltered locations not suitable for human habitation.
There is a bidirectional relationship between homelessness and poor health. Homelessness exacts a heavy toll on individuals. The longer individuals experience homelessness, the more likely they are to experience poor health and be at higher risk for premature death. Health conditions, such as substance use and mental illness, can increase people's susceptibility to homelessness. Conversely, homelessness can cause further health issues, due to constant exposure to environmental threats such as violence and communicable diseases. Homeless people have disproportionately high rates of poly substance use, mental illness, physical health problems and legal issues/barriers in attaining employment.
A 2000 study found that large numbers of homeless people work, but few homeless people are able to generate significant earnings from employment alone. Physical health problems limit work and daily activities, which are barriers to employment. Substance use is positively associated with a lower work level, and negatively related to a higher work level. 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 a barrier to participation in disability programs. A 2015 study found that rates of participation in government programs are low, and that people with major mental disorders have a low participation rate in disability programs.
Homeless deaths
US homeless deaths surged 77% from 2016 to 2020. A February 2022 analysis in The Guardian found that some 18,000 homeless people died on the streets and in encampments and shelters over a five year period, with 5,000 of these deaths occurring in 2020. The non-profit National Health Care for the Homeless Council places homeless deaths at between 17,000 and 40,000 annually. Many are never counted, given that the federal government does not track homeless deaths nationally. A 2002 report by the Los Angeles County Department of Public Health found that homeless persons die at greater rates than the general public from specific causes. They are more likely to die by: 35 times from alcohol or drug overdoses, 16 times from auto accidents, 14 times from murder, 8 times from suicide, and 4 times from heart disease.
In 2023, Judge Milan Smith Jr., an American jurist claimed that homelessness is "presently the defining public health and safety crisis in the western United States." According to 2023 Los Angeles homeless services authority data, on average, six unhoused people die in Los Angeles each day. The causes reported of death are overdoses, heart disease, traffic accidents, homicides, hypothermia, and heat exhaustion. Va Lecia Adams Kellum, Lahsa's CEO, believes "The primary causes of homelessness are economic." This form of holistic care in relation to homeless people is often difficult for them to access, due to issues of location, stigma, etc, and difficult for care givers to perform and manage, as a result of the unpredictability of homeless people day to day.
Tailored care approach
As high-risk and socially disadvantaged persons, homeless patients tend to require a lot of acute care, of short term but active treatment, with poor results. Due to the conditions homelessness creates, acute care and health is difficult to manage and maintain. The Tailored Care approach recognizes the situation of homeless people and seeks to provide specialized care to the homeless community. Studies have found that the tailored approach is good at engaging homeless persons seeking health care for the first time. These health care facilities position themselves in homeless shelters or in areas easily accessible to the homeless population. Some of these health care providers also provide meal kits, on-site showers, transportation, and hygiene kits.
Mother's health
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. 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 theme among studies focused on this issue.
Mental health
In 2006, homeless individuals reported mental illness as being the number three reason for becoming or staying homeless. 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. In the absence of a universal healthcare plan, many of those in need cannot afford such services.
A 2020 representative sample of homeless youth across multiple US cities found that, in each city, more than 80% of the sampled individuals met criteria for at least one psychiatric diagnosis. A 2020 Epidemiological study found that only about 25–30% of homeless persons have a severe mental illness such as schizophrenia. Early studies, comparing homeless persons found that depression and suicidal thoughts were very prevalent, along with symptoms of trauma and substance abuse.
Audio deterrents
In 2019, two 7-Eleven locations — one in Sacramento, California, and one in Portland, Oregon — briefly employed a high-pitched noise maker to repel panhandlers and vagrants. In Portland, a local news source (750 KXL) described the sidewalk in front of the 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 simultaneously loitering in front of his store, and that this loitering adversely affected his business. 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."
In 2019, a manager for a 7-Eleven in Modesto, California, also attested to the effectiveness of sound for deterring undesirable activity, commenting that "Once the music started, the riffraff left."
As of 2011, there were laws that both directly and indirectly criminalized people that are homeless. As of 2012, some jurisdictions had made it illegal to attempt to feed homeless people outdoors. As of 2014, at least 31 cities have criminalized feeding people that are homeless.
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. 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." As of 2023, Missouri, Tennessee, and Texas have passed laws to ban homeless public camping by homeless people, often punishing such behavior with felony charges, with other states considering similar legislation.
Vagrancy
As of 2024, some municipalities in the US make it a crime to provide food or shelter to homeless people. Some local jurisdictions make it illegal for homeless people to use blankets or soap.
In August 2012, a federal district judge in Philadelphia ruled that laws prohibiting serving food to homeless people outdoors were unconstitutional.
In June 2014, the U.S. 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, saying "This broad and cryptic statute criminalizes innocent behavior, making it impossible for citizens to know how to keep their conduct within the pale. ... 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'."
In 2015, homeless rights advocates were pushing for "Right to Rest" bills in several states, to overturn laws that target homeless people for sitting, eating, and sleeping in public places.
In 2018, in Martin v. Boise the Court of Appeals for the Ninth Circuit ruled that city ordinances banning sleeping outside cannot be enforced, if there are not enough shelter beds available in the city.
In 2024, in Grants Pass v. Johnson the US Supreme Court ruled that cities may criminalize homelessness, as homelessness constitutes conduct, not status, and that the precedent set in Robinson v. California does not apply.
Crimes against homeless people
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. Some teens engage in this activity as a source of amusement. CNN reported in 2007 that such incidents were on the rise.
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. 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, New Mexico.
As in other countries, criminals—both individuals and organized groups—sometimes exploit homeless people, ranging from identity theft to tax and welfare scams. 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 homeless people by the general public.
Advocacy efforts
Homeless advocates' importance has been critical in producing humanizing narratives that challenge a traditional media representation of the homeless population. The surge of homeless advocates played a key role in forming the growing Housing First approach. Some scholars attribute the advocacy of Mitch Snyder, one of countless homeless advocates of the 80s, to meaningful federal change in approaches to homelessness during the Reagan era. This includes critical legislation for funding and coordinating aid for people experiencing homelessness, such as the formation of the Low-Income Housing Tax Credit program and the Stewart B. McKinney Homelessness Assistance Act, also known as the McKinney-Vento Homelessness Assistance Act. There is discourse that emphasizes the importance of creating policy solutions developed with and supported by individuals experiencing homelessness.
Efforts towards ending homelessness
Housing
In 2006, homeless individuals reported a lack of affordable housing as the number one reason for becoming homeless.
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.
Barriers in tenant screening processes often prevent housing efforts. Some states have sealed eviction records to make it easier for tenants to become rehoused. Advocates have also campaigned for tenant right to counsel programs that provide free legal counsel to tenants facing an eviction. The goal of these programs is to prevent evictions and public eviction records.thumb|US state legislation on [[tenant right to counsel (NOTE: does not indicate cities with tenant right to counsel) ]]
Some shelters and associated charitable foundations have bought buildings and real estate to develop into permanent housing for homeless people in lieu of transitional Housing.
thumb|US state legislation on [[Eviction record|eviction sealing (NOTE: does not indicate cities with eviction sealing)]]
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. The HUD-VASH program has been successful in housing many homeless veterans.
In 2018, the number of U.S. citizens residing in their vehicles because they cannot 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. 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".
In 2019, Google pledged one billion USD into funding 20,000 homes over the next decade throughout the San Francisco Bay Area. The Bay Area is booming with economically successful people, who end up driving up the price of housing and increases the divide between the people who need the housing and the new houses being built. In particular, the metropolitan area of San Francisco has some of the most expensive real estate in the United States.
Housing First
Housing First is an evidence based approach, that recognizes housing as one of the most impactful social determinants of health that affect those experiencing homelessness. Housing First has been met with success since its initial implementations in 2009, by providing relatively no strings-attached housing to homeless people with substance use disorder 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 homeless people 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.
The BHH Collective is a program that has implemented the Housing First approach. It began in 2015 as an initiative in Chicago, Illinois, between BHH and University of Illinois Hospital to provide for frequently homeless emergency department patients. The housing was paid for by the hospital and federal housing subsidies. The program provides the individuals with case managers, specialized health services based on the individual's needs, and other services they need.
Other transitional housing interventions
Studies have been conducted to demonstrate the ability of homeless people to receive and maintain houses and jobs when provided with adequate support. In LA's Homeless Opportunity Providing Employment (HOPE), for homeless adults with mental illness, individual characteristics in regards to specific mental illness or substance abuse played little role in the systemic difference to the employment outcomes. However, these factors including race and ethnicity, affected individual housing outcomes.
The provision of housing for homeless people reduces healthcare costs, inpatient hospitalizations, and emergency room costs. When provided with supportive housing, many homeless people are eligible for healthcare coverage. People with housing are less likely to need health services, as a stable home provides protection from the elements, prevention from sicknesses, wounds and infections, and a generally safer environment than the streets. This is what Rapid Rehousing programs (RRHP) support. Designed to aid families experiencing homelessness, RRHP provides access to private affordable housing markets for a better transition back into stable housing. The three major parts necessary for the program's success are: finding landlords and appropriate housing, providing move-in assistance; providing case management and support services to ensure the prolonged and eventual permanent rehousing success of each family. However, emerging Permanent supportive housing approaches reversed the requirements, and provided homeless people housing without evidence of treatment for mental illness or substance abuse. These interventions are usually paired with case managers. With the inclusion of income assistance programs, there is a significant increase in number of days spent stably housed for participating individuals.
Permanent supportive housing
Permanent supportive housing (PSH) is an intervention that provides housing that does not limit residents' stays, along with supportive services that residents can opt into. PSH programs typically prioritize chronic homelessness, but can address other subpopulations of the homeless population. The bi-partisan, congressionally mandated, Millennial Housing Commission included ending chronic homelessness in 10 years, among its principal recommendations in its Report to Congress in 2002.
In October 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" initiative was a collaborative grant offered jointly by HUD and the Department of Labor (DOL). With the focus on providing housing and employment for the homeless population, there was not much attention placed on their comprehensive health.
In 2010, under President Obama's administration, a federal strategic plan to end homelessness was released. This plan created four key goals: Prevent and end homelessness among Veterans in 5 years; Finish the job of ending chronic homelessness in 7 years; Prevent and end homelessness for families, youth, and children in 10 years; Set a path to ending all types of homelessness. Capitalizing on these insights, the Plan built on previous reforms and the intent by the Obama Administration to directly address homelessness through intergovernmental cooperation for rehabilitating the homeless population and preventing homelessness to those at high-risk. In 2015, First Lady Michelle Obama called for the collaboration of mayors, governors, and county officials to commit to ending Veteran homelessness in their communities, and reached out to additional mayors and local leaders to participate.
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.
Since the United States housing bubble collapse, there has been a rise in the number of homeless students. In December 2008, NAEHCY or the National Association for the Education of Homeless for Children and Youth, reported a 99% increase in homeless students within a three-month period in San Diego.
Of 1,636 schools in December 2008, 330 reported no increase in student homelessness, 847 reported an increase of half, and 459 reported an increase of 25 percent or more. Due to underfunding, many school districts struggled 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: