According to the US Department of Housing and Urban Development (2009), there were approximately 643,067 women, men and children who were homeless in the United States by the beginning of 2009. Individuals are said to be homeless when they don’t have an adequate, regular and fixed nighttime abode or when where they live primarily in a supervised temporary shelter, any place not meant for regular sleeping accommodation by humans or a temporary place for persons close to being institutionalized. There is no one distinctive type of homeless person. Individuals who do not have stable accommodation are in both rural and urban areas, face a variety of health issues, live in different settings, need a variety of social work services, are in this position for different reasons and are of different ages. As human service professionals in different positions, we offer differing services to this diverse population at a certain point in time. Therefore, it is essential that we be equipped with the various skills and information necessary for us to deal with and understand the individual needs of this population.
The Elderly Homeless
According to research, there is an increase in the number of elderly individuals who experience homelessness. They however keep on being a forgotten population. This poses a lot of challenges to service providers in the homeless service sector. The elderly population is extremely susceptible to physical health issues which in turn complicate the nature of the services rendered to them. In order for them to attain housing stability and the best health care, this group needs a multidisciplinary-team approach that has little or no barriers.
The elderly homeless are faced with a number of problems the major one being difficult to diagnose multiple health problems. According to Schutt and Feldman (2004), elderly homeless adults have an average of four chronic health problems. Some of the common medical conditions that came out of the study included: Hypertension, Major Psychiatric Illness, Tuberculosis, Chronic Pulmonary Disease, Chronic Alcohol Abuse, Urinary Incontinence and Peripheral Vascular Illness. Despite the fact that most of these conditions are easily treatable, the diagnosis and treatment for the homeless elderly might turn out to be hard because: they have no resources required to pay for treatment or care, or they are too afraid to seek help because they don’t know what will happen if they do or even because they have no trust for social service or health care workers.
Another problem faced by the elderly homeless is victimization on the streets. Due to their limitations in mobility and health, those who survive on the streets well into their old age are prone to being at risk of being easy targets for criminals. There is a higher probability that elderly individuals living on the streets will be assaulted or robbed since they have little or no defense mechanisms. The fact that they may be unable or unwilling to get access to public assistance is also a challenge. Many homeless individuals are not aware that they are entitled to benefits like Social Security, Medicaid or Medicare. But at times even those who know about the availability of this public assistance have a difficult task getting any assistance they need due to their poor mobility and health. Others might ferociously cling on to their independence and refuse all help offers (Miller, Herzberg & Ray, 2007).
These problems however do have solutions like emergency shelter, support services, transitional housing, and prevention among others. Prevention in my opinion is the best solution. For the elderly people who risk becoming homeless, the key to ensure stability in housing is finding the necessary resources to prevent eviction. In order to aid in prevention or recovery from an economic crisis, funds are given to localities and states countrywide by the Emergency Food and Shelter National Board Program. The local board members are in charge of distributing money for services which can prevent homelessness such as: emergency food, utility assistance, emergency shelter and rent or mortgage assistance. Housing emergencies for the elderly can often be dealt with by their Adult Protective Services or Adult Services units. Prevention as a solution is the best since it is a cheaper and more convenient method. Another possible solution involves supportive and permanent housing which assists individuals in the long-term. It could consist of a group home, an assisted living facility, a nursing home or a safe haven. This mode of solution is good as it gives an extremely structured surrounding for the elderly.
The Mentally Ill Homeless
One of the greatest problems facing modern day society is the homeless mentally ill. According to Schutt and Feldman (2004), homelessness among the mentally ill is not really as a result of deinstitutionalization but an outcome off how it is carried out. Homelessness among the severely and chronically mentally ill symbolizes the major problems that they are faced by generally countrywide. This problem will therefore not be solved till the fundamental underlying problems are dealt with and an incorporated and integrated care system for those that are chronically mentally ill is laid down. There has been a steady rise in the number of individuals since the 1970s both in major cities and small towns (Schutt and Feldman, 2004).
Low income individuals suffering from mental disorders are at a higher risk of being homeless. To prevent homelessness and assist them get and retain stable housing, an assortment of approaches must be used. As a human services profession it is my belief that programs which ensure access to target and mainstream community-based services for homeless individuals with severe mental illness should be stretched out. There should be expansion of Programs like the Projects for Assistance in Transition from Homelessness (PATH).
Among the problems facing the mentally ill who are homeless is the fact that due to their mental conditions, their ability to undertake the important functions in their day to day lives is disrupted. Things such as household management and healthcare become neglected. People who are mentally ill are also incapable of making and maintaining stable relationships. They may misinterpret the guidance of other individuals and act in an irrational manner. This may in turn push away family, friends and caregivers who might be the only force behind ensuring that person is not homeless. Miller, Herzberg & Ray (2007) are of the view that individuals with a mental condition have a higher chance of becoming homeless in comparison to the general population due to the above mentioned stresses and factors.
On the other hand, for those individuals who are homeless and mentally ill, there is a high chance of them having a problem with their physical health. Due to their mental conditions, these people may neglect the steps necessary in taking precautions against diseases. In combination with lack of proper hygiene due to homelessness, this might in turn lead to physical ills like skin diseases, HIV, exposure to tuberculosis or other respiratory infections. Approximately half of the homeless population that is mentally ill in America additionally suffers from substance abuse and dependence. There is an over-representation of the minority in this group especially African Americans. A number of mentally ill individuals do self- medication using street drugs which in turn leads to drug addictions and also disease transmissions caused by transmission from injection drug use especially. This combination of mental illness, poor physical health and substance abuse makes it very hard for individuals to get employment and residential stability Hombs, 2001).
These problems do however have remedies. Better mental health services would not only effectively deal with mental illness but also homelessness. According to a survey by the
U.S. Department of Housing and Urban Development (2009), 20 per cent of cities that indicated that better co-ordination with the providers of mental health services was among the top three things required to amicably deal with the issue of homelessness. The common belief is that individuals with extreme mental illnesses are not willing to accept services and treatment but this is actually not the case. Human service professionals via outreach programs are more successful in dealing with this homelessness if they build a trusting relationship. This relationship can be cultivated through continuous contact with the individuals they are trying to assist.
Except when they have access to continuous treatment and services, it is highly unlikely for homeless people with mental illnesses to attain residential stability and stay off the streets even if they are provided with housing. For people who are mentally ill, supportive housing is very effective (Redburn & Buss, 1986). This supported housing programs provide services like daily living and money management skills training, peer support, education and employment opportunities, physical health care and mental health treatment. Therefore supported housing programs are a great solution for this problem as they present a high likelihood that mentally ill homeless individuals will recover and attain residential stability.
The field of human service is apt for those individuals who have a strong desire to aid in the improvement of the lives of people. Human service workers help individuals in coping with their everyday issues and solving their personal relationship and family problems. Some human service workers assist clients who are faced with a life-threatening disease, a disability or social problems like unemployment, homelessness or substance abuse. Human service workers also aid clients to become more self-sufficient and this can be done by assisting them to learn new skills or advocating for resources that will allow these individuals to take care of themselves or help them overcome drawbacks.
Human service professionals assist homeless individuals to meet their basic day to day needs. They may refer their clients to various providers based on their different needs. Some of these providers may include: permanent or temporary housing facilities, job centers which can help individuals learn new skills or acquire jobs and organizations which serve meals. These professionals also help some individuals who may require assistance in finding treatment to deal with the underlying causes of their homelessness.
- Hombs, M. E. (2001). American Homelessness: a Reference Handbook (3rd ed.). Santa Barbara, California: ABC-CLIO.
- Miller, K. S., Herzberg, G. L., & Ray, S. A. (2007). Homelessness in America: Perspectives, Characterizations, and Considerations for Occupational Therapy. New York: Routledge.
- Redburn, F. S., & Buss, T. F. (1986). Responding to America’s Homeless: Public Policy Alternatives. New York: Praeger.
- Schutt, K. and Feldman, J. (2004). “Homeless Persons’ Residential Preferences and Needs: A Pilot Survey of Persons with Severe Mental Illness in Boston Mental Health and Generic Shelters”, 2004
- U.S. Department of Housing and Urban Development (2009), The Annual Homeless Assessment Report to Congress, July 2009. Retrieved on 15th January 2013 from http://www.huduser.org/portal/publications/povsoc/ahar_4.html