According to the White House’s State of Homelessness in America report, over half a million people experience homelessness on a given night in the United States. 65% of this population resides in shelters and the remaining 35% oftentimes resort to the streets and other habitable locations such as parks, abandoned buildings, cars, alleyways, and more. Homelessness doesn’t affect one single demographic. In fact, an article published by Endhomelessness.org states that in the year 2018, there were an estimated: 

• 372,417 individuals that experienced homelessness alone

• 180,413 homeless families

• 37,878 homeless veterans

• 36,361 homeless youth

• 88,640 people that experienced chronic homelessness 

People of color are hit the hardest by homelessness — African Americans make up 40% of the homeless population, while Latinx populations make up 22% — both significantly higher compared to the other ethnicities such as Caucasian and Asian. 

The cause of homelessness varies with each case. The White House’s State of Homelessness in America report also mentions a few factors that contribute to an increased homeless population:

• Overregulation of housing markets

• Severe mental illness

• Substance abuse problems

• History of incarceration

• Low incomes

• Weak social connections

Those who are living on the streets often find themselves unable to afford adequate health care services, leaving them to suffer through any condition they may have without proper treatment, and possibly increasing the length of time in which they remain homeless. If, by any chance, they are able to seek out medical services, the chances they receive quality care are decreased due to medical facilities in the United States experiencing nursing shortages. 

Learn about the healthcare options available to those experiencing homelessness, and how you could pursue a medical career that puts in you line to help these individuals. It’s also incredibly important for healthcare workers to know the resources that can refer homeless patients to in order to help them get the help they need.

Shelter-based health care programs are programs that provide low-barrier health care to people living in shelter settings. One of the main issues with health care in shelters is the level of services they are able to offer; the smaller the facility, the smaller the health care quarters, the fewer services they may provide. Staff must be able to provide these services in an efficient way, rather than offering many services with low-quality outcomes. Other questions that may arise with clinical staff include: 

• How do shelter policies affect people experiencing mental health challenges and behavioral issues?

• What does the shelter do when there are health issues that arise for clients overnight, when clinic staff is not available?

• How can shelter staff and the health care team work together to prevent people with health issues, including mental and behavioral health issues, from being evicted from the shelter?

• How can shelter staff facilitate follow-up care for clients? 

Certain health issues affect shelters more than others. These health issues include, but are not limited to:

• Asthma

• Hepatitis

• Hunger and nutrition problems

• Infestations

• Seasonal flu

• Trauma

• Tuberculosis

Having a shelter-based clinic can help decrease these health concerns. Nurses and other healthcare positions are needed for shelter-based healthcare, and a degree can help you qualify for these kinds of positions.

Rescue missions such as the Associate of Gospel Rescue Mission, dedicate their time serving around 66 million meals a year, providing over 20 million nights of shelter and housing, assisting around 45,000 people in finding employment, clothing over 750,000 people, and assisting over 17,000 homeless men and women with recovering from substance abuse. The AGRM is a rescue mission that relies on faith and whose members follow strict religious views. However, AGRM and other religious missions may not be accepted by those who do not have the same religious views. 

Rescue missions do not receive government funds and oftentimes rely on donations from churches, individuals, foundations, businesses, and more. 

Nonsectarian programs operate similarly to religious rescue missions in the sense that they provide meals, housing, and recovery options for those who suffer from substance abuse. They are also privately funded and receive financial support from local businesses, charitable organizations, and foundations. However, they differ because they are not faith-based. 

As homelessness increases, people are finding alternative ways to help in the form of mobile healthcare services. 

Mobile health care for homeless people helps healthcare workers have access to those living on the streets by physically driving healthcare workers to those in need in vans or busses. They travel between communities with higher homeless populations and offer their services, significantly helping the homeless by evaluating and treating them depending on the diagnosis. The types of services they provided include:

• Behavioral health care

• Benefits assistance

• Case management

• Dental care

• Immunizations

• Lab tests

• Medications

• Primary care

• Screenings

• Triage

These mobile health units can often be found and accessed at:

• Churches

• Community health centers

• Drop-in centers

• Hospitals

• Public health departments

• Schools

• Shelters

• Social service agencies

Community health centers (CHCs) are health clinics that provide comprehensive family-oriented preventive and primary health services those who are homeless, and other underserved populations. They provide treatment including, but not limited to:

• Acute medical examinations and treatment

• Comprehensive physicals

• Dental work

• Hypertension

• Immunizations

• Laboratory work

• Mental health counseling

• Prenatal monitoring

• Prescription drugs

• Radiology services

• Sexually transmitted diseases

• Substance abuse treatment

• Tuberculosis screenings

• Well-child care

To fulfill the provisions of the Public Health Service Act (42 USC 254c), the centers must, either through staff and supporting resources, or through contracts or cooperative arrangements: 

• Serve areas designated as medically underserved

• Provide basic primary medical care services plus support and facilities appropriate for the target population

• Have a governing board where the majority of the members are users of the centers’ services

• Adjust the cost of services to the patient’s ability to pay 

CHCs receive federal funding through the Health Resources and Service Administration, an agency of the U.S. Department of Health and Human Services, that aims to improve health care for people who are geographically isolated, or economically/medically vulnerable. The CHC must comply with medical standards prior to receiving a grant, loan, or scholarship from the HRSA. 

It’s important for medical workers to understand how policies and laws can help make healthcare more accessible to the homeless. The Affordable Care Act (ACA) was signed by President Barack Obama on March 23, 2010, and was created to expand affordable healthcare to all American citizens. The ACA also plays a role in preventing and putting an end to homelessness. The ACA benefits the homeless population in three ways:

• It makes health insurance more accessible and affordable

• It ensures coverage for behavioral health care, rehabilitative services, and tenancy support

• It shifts the focus of health care delivery on outcomes and value — not procedures and volume

The ACA does have health coverage for homeless and at-risk youth, but they have to meet specific requirements in order to be eligible. Medicaid and the Children’s Health Insurance Program (CHIP) are health insurance programs that are offered to low-income individuals and children. Eligibility for the programs are based on: 

• Income level

• Citizenship/eligible immigration status

• State of residence

Those who aren’t eligible for even these resources often have to purchase coverage from the health insurance marketplace with financial assistance, or even settle for no medical insurance at all. 

Advocating for and providing support to the homeless within your own community can be extremely effective. Healthcare workers who see the reality facing homeless people every day, and can be great advocates for volunteering and donations to help this population. Luckily, there are many ways to get involved, and healthcare workers can help be a voice for homeless people in their communities. 

There may hardly be a time when rescue centers and homeless shelters don’t need volunteers and donations. In fact, shelters may not have enough volunteers and struggle to keep up with the flow of traffic. Prospecting volunteers should still contact their local homeless shelter to see if there are any specific positions that need to be filled before others — as well as how to apply to become a volunteer. Some of the jobs might include:

• Welcoming newcomers and showing them where to go

• Organizing clothes/laundry

• Handing out hygiene kits

• Cooking

• Cleaning

• Security

• Offering the residents different forms of entertainment 

Nurse educators and advanced-practice nurses can be an extremely helpful resource when it comes to training the volunteers. They can educate the volunteers on the basics of nursing and first aid, which can be beneficial when working in an environment that is at high-risk for medical attention. 

When it comes to donations, homeless shelters are in need of: 

• Non-expired food items

• Personal care items (for men, women, and children)

• Clothing items (for men, women, and children)

• Linens

• Toys and games

• Feminine hygiene products

• Your time

Nurses and nurse educators can play an essential role in addressing the medical issues of the homeless, as well as educating both them and volunteers. Individuals who seek such a degree will position themselves right at the heart of the issue, by providing medical relief to homeless individuals first-hand. Those who enter programs such as Master’s of Health Leadership and Bachelor of Science in Nursing can use their degrees to help the homeless by either volunteering themselves or training other volunteers.  

Health leaders can help coordinate teams, manage institutions, and set standards for care in their community. RNs are the frontline caregivers who may work with or volunteer for direct patient care and clinical positions. Their duties may include providing screenings, helping those in need get referrals to an appropriate specialist, and more. RNs are vital in helping explain medical situations and care routes to all kinds of patients, including homeless patients.

Volunteers aren’t the only ones that work in a shelter. Many healthcare degrees can help you be qualified to work in a shelter or clinic and give aid to people who need help. Homeless shelters also employ:

• Shelter Directors: Oversee all of the home’s daily operations.

• House Managers: Oversee the home’s daily operations if the director isn’t there.

• Case Managers: Work one-on-one with residents — more specifically those who have struggled with domestic abuse, physical/mental illness, substance abuse, and more.

• Counselors: Basic caretakers for residents. May even act as a driver when they need to go to an appointment, help with finding housing or health care, and more. 

Some shelters may even hire those who have a Bachelor’s of Science Degree in Health Service Coordination or Bachelor’s of Science Degree in Health Information Management (HIM) to assist them in health care administration. Implementing HIM services within a homeless shelter can help maintain residents’ records and confidentiality. Individuals in administrative roles such as these can help ensure that vulnerable populations are accessing the same standard and quality of care as what is offered in other medical settings i.e. hospitals and clinics.

LGBTQ+ youth have a 120% greater risk of becoming homeless compared to their heterosexual or cisgendered youth counterparts — which often is a result of a lack of tolerance from their parents or guardians. In fact, over a quarter of youth who identify as LGBTQ+ are disowned by their parents and kicked out of their homes. 

Thankfully, programs have been created to help those who have had to experience these hardships. The U.S Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) have created programs such as:

• Youth on Fire

• Larkin Street Youth Services

• Outside In

• Ruth Ellis Center

• UCAN Host Home Program

• Drop-In Center at Tulane University

All of which were created for a variety of reasons that include but aren’t limited to:

• Creating a culture of respect

• Supporting opportunities for safe and non-judgmental dialogues

• Viewing the experiences of LGBTQ+ youth through a trauma-informed perspective

• Providing safe spaces for transgender youth to develop positive self-images

Substance abuse, aside from the obvious medical side effects, can also lead to homelessness in individuals who are suffering from the disease. However, not all hope is lost if you are one who is suffering from both; there are programs available for those who are both homeless and are affected by substance abuse. It’s important to reach out to your homeless shelter coordinator to see what options are available within the home. Some might have a counselor on-site, while others may not. 

The SAMHSA states in an article on substance abuse and homelessness that “homeless people with both substance disorders and mental illness experience additional obstacles to recovery, such as the increased risk for violence and victimization and frequent cycling between the streets, jails and emergency rooms. Unfortunately, these people are often unable to find treatment facilities that will help them.”

It can be difficult to find a single program that is available nationwide. This is why it’s important to research mental and substance use disorders and homelessness resources in your area. 

SAMHSA created the Projects for Assistance in Transition from Homelessness (PATH) to aid those transitioning from homelessness into a new home with safe and stable housing, allowing them to recover from both substance use disorders and mental health issues. A recent evaluation of SAMHSA’s PATH program — examining 2010-2012 data — showed that “the program achieved its intended outcomes and expanded its reach, providing services to approximately 200,000 people each year, and was highly regarded by the people it served.”

Psychiatric and mental health nurses, two of the fields that need nurses the most, can volunteer their time to help aid those transitioning from homelessness to help them overcome any mental and psychiatric hardships that may come along, such as:

• Stressors from moving (applying for housing, finding furniture, etc.)

• Getting used to paying bills/forming a routine

• Applying for jobs

• Anxiety

• Depression 

Medical professionals often work with veterans in mental or physical health capacity. Medical professionals are key in helping veterans navigate civilian life after they’ve served, and are an important element in decreasing homelessness in veterans. As of January 1st, 2019, there were 37,085 veterans that experienced homelessness — this is a 2.1% decrease since 2018. Veterans may find themselves without a home for various reasons:

• Inability to find affordable housing after returning from combat

• Economic hardships

• Traumatic brain injuries

• Post-traumatic stress syndrome (PTSD)

The Department of Veteran’s Affairs offers a variety of assistance programs for homeless veterans: 

• Domiciliary Residential Rehabilitation and Treatment Programs

• Homeless Grant and Per Diem Program

• Substance Use Residential Rehabilitation Treatment Program

• Post-Traumatic Stress Disorder (PTSD) Residential Rehabilitation and Treatment Program

• Compensated Work Therapy/Transitional Residence Programs

In order to be eligible for any of the veteran’s assistance programs listed above, an individual must be enrolled in the VA health care system — or qualify based on one of the exceptions in the law. Individuals can view the medical benefits package to view more program requirements.

Medical professionals are needed to help fight homelessness in all ages, from children to adults. According to a report from the National Center for Homeless Education, over 1.5 million public school students experienced homelessness during the 2017-2018 school year. Other statistics include:

• 16 states experienced growth in their homeless student populations of 10% or more during the three-year period covered in this report  

• Funding for the Education for Homeless Children and Youth (EHCY) program increased by almost $12 million between fiscal years 2015 and 2017

• Over the three-year period, the number of students in unsheltered situations at the time they were first identified increased by 137% 

Children aren’t able to control their financial status, which can make it particularly hard for them to understand why they don’t have a home. Fortunately, there are federal programs for students and youth to utilize to help them adjust to and transition from homelessness:

• Basic Center Program

• Maternity Group Homes for Pregnant and Parenting Youth Program
  

• Street Outreach Program (SOP)

• McKinney-Vento Education for Homeless Children and Youth Program or Education for Homeless Children and Youth Grants

• John H. Chafee Foster Care Independence Program (CFCIP)

Homelessness is an increasingly difficult problem in the United States and around the world. There are many resources for those experiencing homelessness, but there is always an increased need for volunteers and employees who can help make a difference. A degree in healthcare could be your crucial first step in working to help fight homelessness in your community. RNs, educators, shelter managers, organization leaders, and more are all needed to help continue the programs that are there to help those who are facing homelessness. If you feel the call to this unique career path, get started on your degree today so you can start helping others as soon as possible.