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A homeless man in Paris.

Homelessness (British English: also sleeping rough) is the condition of people and social category of people who don't have a regular house or dwelling because they cannot afford, pay for, or are otherwise unable to maintain regular, safe, and adequate housing, or they lack, "fixed, regular, and adequate nighttime residence" ^[1] The actual legal definition varies from country to country, or among different entities or institutions in the same country or region.^[2]

The term homelessness may also include people whose primary nighttime residence is in a homeless shelter, in an institution that provides a temporary residence for individuals intended to be institutionalized, or in a public or private place not designed for use as a regular sleeping accommodation for human beings.^[3][4]

Some estimate that there are about 100 million homeless people worldwide.^[5]

The United States Department of Housing and Urban Development (HUD) defines a "chronically homeless" person as "an unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or more, or has had at least four episodes of homelessness in the past three years."^[6]

History of homelessness

Great Depression: man lying down on pier, New York City docks, 1935.

Great Britain and the USA

Early history through the 1800s

Following the Peasants' Revolt, British constables were authorised under a 1383 statute to collar vagabonds and force them to show support; if they could not, the penalty was gaol.^[7] 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.^[7] In 1547, a bill was passed that subjected vagrants to some of the more extreme provisions of the criminal law, namely two years servitude and branding with a "V" as the penalty for the first offense and death for the second. One arriving in the American colonies in the 18th century were transported convicts. Large numbers of vagabonds were transported along with ordinary criminals.^[8]

During the 16th century in England, the state first tried to give housing to vagrants instead of punishing them, by introducing bridewells to take vagrants and train them for a profession. In the 17th and 18th centuries, these were replaced by workhouses but these were intended to discourage too much reliance on state help.

A homeless man lives in a sewer, Vienna, Austria, 1900.

The growing movement toward social concern sparked the development of rescue missions, such as America's first rescue mission, the New York City Rescue Mission, founded in 1872 by Jerry and Maria McAuley.^[9]

The Bowery Mission in New York City in the 1800s

Children sleeping in Mulberry Street - Jacob Riis photo New York, United States of America (1890)

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.^[10]

Early 20th century

How the Other Half Lives later inspired Jack London's The People of the Abyss (1903). This raised public awareness, causing some changes in building codes and some social conditions.

These were later replaced by dormitory housing ("spikes") provided by local boroughs, and these were researched by the writer George Orwell. By the 1930's in England, there were 30,000 people living in these facilities. In 1933, George Orwell wrote about poverty in London and Paris, in his book Down and Out in Paris and London.

In general, in most countries, many towns and cities had an area which contained the poor, transients, and afflicted, such as a "skid row". In New York City, for example, there was an area known as "the Bowery", traditionally, where alcoholics were to be found sleeping on the streets, bottle in hand.

The Great Depression of the 1930's caused a devastating epidemic of poverty, hunger, and homelessness. There were two million homeless people migrating across the United States.^[11]

Although The Bowery once was synonymous with homelessness, it has since become an avenue of high-priced luxury condominiums that jockey for space with its past.

In the 1960's, the nature and growing problem of homelessness changed in England as public concern grew. The number of people living "rough" in the streets had increased dramatically. However, beginning with the Conservative administration's Rough Sleeper Initiative, the number of people sleeping rough in London fell dramatically. This initiative was supported further by the incoming Labour administration from 2009 onwards with the publication of the 'Coming in from the Cold' strategy published by the Rough Sleepers Unit, which proposed and delivered a massive increase in the number of hostel bed spaces in the capital and an increase in funding for street outreach teams, who work with rough sleepers to enable them to access services.^{[citation needed]}

Later 20th century

However, modern homelessness, started as a result of the economic stresses in society, reduction in the availability of affordable housing, such as single room occupancies (SROs), for poorer people. In the United States, in the 1970s, the deinstitutionalisation of patients from state psychiatric hospitals was a precipitating factor which seeded the homeless population, especially in urban areas such as New York City.^[12]

The Community Mental Health Act of 1963 was a pre-disposing factor in setting the stage for homelessness in the United States.^[13] Long term psychiatric patients were released from state hospitals into SROs and supposed to be sent to community mental health centers for treatment and follow-up. It never quite worked out properly, the community mental health centers mostly did not materialize, and this population largely was found living in the streets soon thereafter with no sustainable support system.^[14][15]

Also, as real estate prices and neighborhood pressure increased to move these people out of their areas, the SROs diminished in number, putting most of their residents in the streets. Other populations were mixed in later, such as people losing their homes for economic reasons, and those with addictions (although alcoholic hobos had been visible as homeless people since the 1890s, and those stereotypes fueled public perceptions of homeless people in general), the elderly, and others.

Many places where people were once allowed freely to loiter, or purposefully be present, such as churches, public libraries and atriums, became stricter as the homeless population grew larger and increasingly congregated in these places. As a result, many churches closed their doors when services were not being held, libraries began enforcing "no eyes shut" and sometimes dresscode policies, and most places hired private security guards to carry out these policies, creating a social tension. Many public toilets were closed.^{[citation needed]}

Homeless Gipsy woman and her dog

This banished the homeless population to sidewalks, parks, under bridges, and the like. They also lived in the subway and railroad tunnels in New York City. They seemingly became socially invisible, which was the apparent effect of many of the enforcement policies.^{[citation needed]}

The homeless shelters, which were generally night shelters, made the homeless leave in the morning to whatever they could manage and return in the evening when the beds in the shelters opened up again for sleeping. There were some daytime shelters where the homeless could go, instead of being stranded on the streets, and they could be helped, get counseling, avail themselves of resources, meals, and otherwise spend their day until returning to their overnight sleeping arrangements. An example of such a day center shelter model is Saint Francis House in Boston, Massachusetts, founded in the early 1980s, which opens for the homeless all year long during the daytime hours and was originally based on the settlement house model.^[16]

Homeless person in Rome

Many homeless keep all their possessions with them since they have no access to storage. There was also the reality of the "bag" people, the shopping cart people, and the soda can collectors (known as binners or dumpster divers) who sort through garbage to find items to sell, trade and eat. These people carry around all of their possessions with them all the time since they have no place to store them. If they had no access to or capability to get to a shelter and possible bathing, or access to toilets and laundry facilities, their hygiene was lacking. This again created social tensions in public places.^{[citation needed]}

These conditions created an upsurge in tuberculosis and other diseases in urban areas.^{[citation needed]}

In 1974, Kip Tiernan founded Rosie's Place in Boston, the first drop-in and emergency shelter for women in the United States, in response to the increasing numbers of needy women throughout the country.

In 1979, a New York City lawyer, Robert Hayes, brought a class action suit before the courts, Callahan v. Carey, against the City and State, arguing for a person's state constitutional "right to shelter". It was settled as a consent decree in August 1981. The City and State agreed to provide board and shelter to all homeless men who met the need standard for welfare or who were homeless by certain other standards. By 1983 this right was extended to homeless women.

A homeless person's shelter.

By the mid-1980s, there was also a dramatic increase in family homelessness. Tied into this was an increasing number of impoverished and runaway children, teenagers, and young adults, which created a new sub-stratum of the homeless population (street children or street youth).^{[citation needed]}

Also, in the 1980s, in the United States, some federal legislation was introduced for the homeless as a result of the work of Congressman Stewart B. McKinney. In 1987, the McKinney-Vento Homeless Assistance Act was enacted.

Several organizations in some cities, such as New York and Boston, tried to be inventive about help to the swelling number of homeless people. In New York City, for example, in 1989, a street newspaper was created called "Street News" which put some homeless to work, some writing, producing, and mostly selling the paper on streets and trains.^[17]

It was written pro bono by a combination of homeless, celebrities, and established writers. In 1991, in England, a street newspaper, following on the New York model was established, called The Big Issue and was published weekly.^[18] Its circulation grew to 300,000. Chicago has StreetWise which has the largest circulation of its kind in the United States, thirty thousand. Boston has a Spare Change News newspaper, founded in 1992 by a small group of homeless people in Boston, built on the same model as the others: homeless helping themselves.^[19]

Seattle has Real Change, a $1 newsletter that directly benefits the homeless and also reports on economic issues in the area. Portland, Oregon has "Street Roots", with articles and poetry by homeless writers, sold on the street for a dollar. More recently, Street Sense, in Washington, D.C. has gained a lot of popularity and helped many make the move out of homelessness. Students in Baltimore, MD have opened a satellite office for that street paper as well.^[20]

21st century

Homeless person with his dogs playing the recorder, Downtown Amsterdam, 2009.

In 2002, research showed that children and families were the largest growing segment of the homeless in America,^[21][22] and this has presented new challenges, especially in services, to agencies.

Some trends involving the plight of the homeless have provoked some thought, reflection and debate. One such phenomenon is paid physical advertising, colloquially known as "sandwich board men"^[23][24] and another specific type as "Bumvertising".

Another trend is the side effect of unpaid free advertising of companies and organizations on shirts, clothing and bags, to be worn by the homeless and poor, given out and donated by companies to homeless shelters and charitable organizations for otherwise altruistic purposes. These trends are reminiscent of the "sandwich board signs" carried by poor people in the time of Charles Dickens in the Victorian 1800s in England^[25] and later during the Great Depression in the United States in the 1930s.

In the USA, the government asked many major cities to come up with a ten year plan to end homelessness. One of the results of this was a "Housing first" solution, rather than to have a homeless person remain in an emergency homeless shelter it was thought to be better to quickly get the person permanent housing of some sort and the necessary support services to sustain a new home. But there are many complications of this kind of program and these must be dealt with to make such an initiative work successfully in the middle to long term. ^[26][27]

It has been reported that some formerly homeless people, when they finally were able to get their housing and life straightened out and return to a normal lifestyle, have donated money and volunteer service to the organizations which helped them when they were homeless. ^[28] Alternatively, some social service entities that help the homeless now employ formerly homeless individuals to assist in the care process.

Homelessness has migrated toward rural and suburban areas. There are 1.6 million homeless people in shelters in 2009. The number of homeless people has not changed dramatically but the number of homeless families has increased according to a report of HUD.^[29]

The United States Congress appropriated $25 million in the McKinney-Vento Homeless Assistance Grants for 2008 to show the effectiveness of Rapid Re-housing programs in reducing family homelessness.^[30][31][32]

In February 2009, President Obama signed the American Recovery and Reinvestment Act of 2009 part of which addressed homelessness prevention, allocating $1.5 billion for a Homeless Prevention Fund. The funding for it was called the "Homelessness Prevention and Rapid Re-Housing Program" (HPRP), and was distributed using the formula for the Emergency Shelter Grants (ESG) program.^[33]

On May 20, 2009, President Obama signed the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act into Public Law (Public Law 111-22 or "PL 111-22"), reauthorizing HUD's 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 the eighteen months after the bill's signing, HUD must make regulations implementing this new McKinney program. ^[34][35]

In late 2009, some homeless advocacy organizations, such as the National Coalition for the Homeless, reported and published perceived problems with the HEARTH Act of 2009 as a HUD McKinney-Vento Reauthorization bill, especially with regard to privacy, definitional ineligibilty, community roles, and restrictions on eligibile activities.^[36]

Russia and the USSR

After the abolishment of serfdom in Russia in 1861, major cities experienced a large influx of former peasants who sought jobs as industrial workers in rapidly-developing Russian industry. These people often lived in harsh conditions, sometimes renting a room, shared between several families. There also was a large number of shelterless homeless.

Immediately after the October Revolution a special program of "compression" ("уплотнение") was enabled: people who had no own shelter were settled in flats of those who had large (4,5,6-livingroom) flats with only one room left to previous owners, with the flat was declared a state property. This led to a large number of shared flats where several families lived simultaneously. Nevertheless the problem of complete homelessness was mostly solved as anybody could apply for a room or a place in dormitory (the number of shared flats steadily decreased after large-scale residential building program was implemented starting in 1960s). By 1922 there were at least 7 million homeless children in Russia as a result of nearly a decade of devastation from World War I and the Russian Civil War.^[37] This led to creation of a large number of orphanages. By 1930s the USSR declared that it has no homeless and any citizen was obliged to have a propiska - a place of permanent residency. Nobody could be stripped of propiska without substitution or refuse it without a confirmed permission (called "order") to register in another place. If someone wanted to move to another city or expand their living area, he had to find a partner who wanted to mutually exchange the flats. The right for shelter was secured in the Soviet constitution. Not having permanent residency was legally considered a crime.

There were also virtually no empty and unused apartments in the cities: any flat where nobody was registered was immediately lent by the state at symbolic price to others who needed better living conditions. If a person who had permanent registration could not pay for shelter, nobody had right to evict them, only to demand money through a court.

After the breakup of the USSR the problem of homelessness sharpened dramatically, partially because of the legal vacuum of early 1990s with some laws contradicting each other and partially because of a high rate of frauds in the realty market. In 1991 articles 198 and 209 of Russian criminal code which instituted criminal penalty for not having permanent residence were abolished. Since most flats had been privatized and many people sold their last shelter without success to buy another, there was a sharp increase of homeless. Renting apartments from a private owner became widespread (which usually only gives temporary registration and apartment owner could evict the leaser after the contract is over or if the money was not paid). In Moscow, the first overnight shelter for homeless was opened in 1992.^[38] In late 1990s certain amendments in law were implemented to reduce the rise in homelessness, such as prohibition of selling last flat with registered children.

Nevertheless, the state still obliged to give permanent shelter for free to anybody who needs better living conditions or has no permanent registration, since right for shelter still included in constitution. This may take many years, though. Nobody still has right to strip a person of permanent residency without their will, even the owner of the apartment. This makes problems for banks since mortgage loans became increasingly popular. Banks obliged to buy a new, cheaper flat to a person instead of the old one if the person fails to repay the loan, or wait until all people who live in the flat are dead. Several projects of special cheap 'social' flats for those who failed to repay mortgages were proposed to facilitate mortgage market.^{[citation needed]}

Contributing causes of homelessness

Tents for homeless people on the Canal Saint-Martin in Paris, December 2006-January 2007, put there by the Enfants de Don Quichotte NGO (videos available on site).

Homeless street dwellers in Mumbai, India.

The major reasons and causes for homelessness as documented by many reports and studies include: ^{[39][40][41][42][43]}

• Substance abuse
• Mental disorder, where mental health services are unavailable or difficult to access.
• Inavailability of employment opportunities.
• Poverty, caused by many factors including unemployment and underemployment.
• Lack of affordable healthcare.
• War or armed conflict.
• Lack of affordable housing. An article in the November 2007 issue of Atlantic Monthly reported on a study of the cost of obtaining the "right to build" (i.e. a building permit, red tape, bureaucracy, etc.) in different U.S. cities. The "right to build" cost does not include the cost of the land or the cost of constructing the house. The study was conducted by Harvard economists Edward Glaeser and Kristina Tobio. According to the chart accompanying the article, the cost of obtaining the "right to build" adds approximately $600,000 to the cost of each new house that is built in San Francisco. ^[44]
• Domestic violence.
• Prison release and re-entry into society.
• Natural disaster, including but not limited to earthquakes and hurricanes. An example is the 1999 Athens earthquake in Greece in which many middle class people became homeless and are still without a home as of 2009, with some of them living in containers, especially in the Nea Ionia earthquake survivors container city provided by the government, and in most cases their only property that survived the quake was their car. Such people are known in Greece as seismopathis meaning earthquake-struck.
• Forced eviction - In many countries, people lose their homes by government order to make way for newer upscale high rise buildings, roadways, and other governmental needs.^[45] The compensation may be minimal, in which case the former occupants cannot find appropriate new housing and become homeless.
• Mortgage foreclosures where mortgage holders see the best solution to a loan default is to take and sell the house to pay off the debt. The popular press made an issue of this in 2008; the real magnitude of the problem is undocumented.^[46]

A substantial percentage of the U.S. homeless population are individuals who are chronically unemployed or have difficulty managing their lives effectively due to prolonged and severe drug and/or alcohol abuse.^[47] Substance abuse can cause homelessness from behavioral patterns associated with addiction that alienate an addicted individual's family and friends who could otherwise provide support during difficult economic times.

Increased wealth disparity and income inequality causes distortions in the housing market that push rent burdens higher, making housing unaffordable.^[48]

Dr. Paul Koegel of RAND Corporation, a seminal researcher in first generation homelessness studies and beyond, divided the causes of homelessness into structural aspects and then individual vulnerabilities.^[43]

Proposed solutions to homelessness

Housing First / Rapid Re-housing
In the USA, the government asked many major cities to come up with a ten year plan to end homeless problem; and one of the results of this was a "Housing first" solution, also known as "rapid re-housing", which quickly gets a homeless person permanent housing of some sort and the necessary support services to sustain a new home. There are many complications of this kind of program and these must be dealt with to make such an initiative work successfully in the middle to long term. ^[26][27][49]

Supportive housing
Supportive housing is a combination of housing and services intended as a cost-effective way to help people live more stable, productive lives. Supportive housing works well for those who face the most complex challenges--individuals and families confronted with homelessness and who also have very low incomes and/or serious, persistent issues that may include substance abuse, addiction or alcoholism, mental illness, HIV/AIDS, or other serious challenges to a successful life.

Pedestrian Villages
In 2007 urban designer and social theorist Michael E. Arth proposed a controversial national solution for homelessness that would involve building nearly carfree Pedestrian Villages in place of what he terms "the current band-aid approach to the problem."^[50] A prototype, Tiger Bay Village, was proposed for near Daytona Beach, FL. He claims that this would be superior for treating the psychological as well as psychiatric needs of both temporarily and permanently homeless adults, and would cost less than the current approach. It would also provide a lower cost alternative to jail, and provide a half-way station for those getting out of prison. Work opportunities, including construction and maintenance of the villages, as well as the creation of work force agencies would help make the villages financially and socially viable. ^[51][52][53]

Transitional housing
Transitional Housing provides temporary housing for the certain segments of the homeless population, including working homeless, and is set up to transition their residents into permanent, affordable housing. It's not in an emergency homeless shelter but usually a room or apartment in a residence with support services. The transitional time can be short, for example one or two years, and in that time the person must file for and get permanent housing and usually some gainful employment or income, even if Social Security or assistance. Sometimes, the transitional housing residence program charges a room and board fee, maybe 30% of an individual's income, which is sometimes partially or fully refunded after the person procures a permanent place to live in. Federal funding for transitional housing programs was originally allocated in the McKinney–Vento Homeless Assistance Act of 1986.^[54][55]

Problems faced by people who are homeless

The basic problem of homelessness is the human need for personal shelter, warmth and safety, which can be literally vital. Other basic difficulties include:

• personal security, quiet, and privacy, especially for sleeping
• safekeeping of bedding, clothing and possessions, which may have to be carried at all times
• hygiene and shaving facilities
• cleaning and drying clothes
• obtaining, preparing and storing food in small quantities
• keeping contacts, without a permanent location or mailing address
• hostility and legal powers against urban vagrancy.

Homeless people face many problems beyond the lack of a safe and suitable home. They are often faced with many social disadvantages also, reduced access to private and public services and reduced access to vital necessities:^[56]

• Reduced access to health care and dental problems.
• Limited access to education.
• Increased risk of suffering from violence and abuse.
• General rejection or discrimination from other people.
• Loss of usual relationships with the mainstream
• Not being seen as suitable for employment.
• Reduced access to banking services
• Reduced access to communications technology

Violent crimes against the homeless

There have been many violent crimes committed against the homeless. ^[57] A 2007 study found that the rate of such crimes is increasing.^[58][59]

Assistance and resources available to the homeless

Most countries provide a variety of services to assist homeless people. They often provide food, shelter and clothing and may be organised and run by community organisations (often with the help of volunteers) or by government departments. These programs may be supported by government, charities, churches and individual donors.

In 1998, a study by Koegel and Schoeni of a homeless population in Los Angeles, California, reported that a significant number of homeless do not participate in government assistance programs, and the authors reported being puzzled as to why that was, with the only possible suggestion from the evidence being that transaction costs were perhaps too high.^[60]

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 elegible homeless and otherwise vulnerable US armed forces veterans.^[61]

Social supports

While some homeless people are known to have community with one another,^[62] providing each other various types of support,^[63] people who are not homeless also may provide them friendship, food, relational care, and other forms of assistance. Such social supports may be done through a formal process, such as under the auspices of a non-governmental organization, religious organization, or homeless ministry, or may be done on an individual basis.

Income sources

Many non-profit organizations such as Goodwill Industries maintain a mission to "provide skill development and work opportunities to people with barriers to employment", though most of these organizations are not primarily geared toward homeless individuals. Many cities also have street newspapers or magazines: publications designed to provide employment opportunity to homeless people or others in need by street sale.

While some homeless have paying jobs, some must seek other methods to make money. Begging or panhandling is one option, but is becoming increasingly illegal in many cities. Despite the stereotype, not all homeless people panhandle, and not all panhandlers are homeless. Another option is busking: performing tricks, playing music, drawing on the sidewalk, or offering some other form of entertainment in exchange for donations. In cities where plasmapheresis centers still exist, homeless people may generate income through frequent visits to these centers.

Homeless people have been known to commit crimes just to be sent to jail or prison for food and shelter. In police slang, this is called "three hots and a cot" referring to the three hot daily meals and a cot to sleep on given to prisoners.

Invented in 2005, in Seattle, Bumvertising, an informal system of hiring the homeless to advertise by a young entrepreneur, is providing food, money, and bottles of water to sign-holding homeless in the Northwest. Homeless advocates accuse the founder, Ben Rogovy, and the process, of exploiting the poor and take particular offense to the use of the word "bum" which is generally considered pejorative.^[64][65]

In October 2009, the Boston Globe carried a story on so-called cyberbegging, or Internet begging, which was reported to be a new trend worldwide.^[66]

Australia

In Australia the Supported Accommodation Assistance Program (SAAP) is a joint Commonwealth and state government program which provides funding for more than 1,200 organisations which are aimed to assist homeless people or those in danger of becoming homeless, as well as women and children escaping domestic violence [17]. They provide accommodation such as refuges, shelters and half-way houses, and offer a range of supported services. The Commonwealth has assigned over $800 million between 2000-2005 for the continuation of SAAP.

The current program, governed by the Supported Assistance Act 1994, specifies that "the overall aim of SAAP is to provide transitional supported accommodation and related support services, in order to help people who are homeless to achieve the maximum possible degree of self-reliance and independence. This legislation has been established to help the homeless people of the nation and help rebuild the lives of those in need, the joining of the states also helps enhance the meaning of the legislation and demonstrates the collaboration of the states and their desire to improve the nation as best they can.

United States

Housing First is an initiative to help the homeless get re-integrated into society, and out of homeless shelters. It was initiated by the federal government's Interagency Council on Homelessness. It asks cities to come up with a plan to end chronic homelessness. In this direction, there is the belief that if homeless people are given independent housing to start off with, with some proper social supports, then there would be no need for emergency homeless shelters, which it considers a good outcome. However this is a controversial position.^[67][68]

Miami, Florida's Community Partnership for Homeless launched a national outreach program in 2008 to help other communities throughout the United States address homelessness. Since its inception in 1993, CPH has served nearly 76,000 residents with a successful outplacement rate of nearly 62 percent in Miami-Dade County, Florida. The number of homeless people in the county has declined by 83 percent. The national program shares CPH's model of Homeless Assistance Centers, job training programs, on-site childcare, housing assistance and more. The organization also provides background on its unique funding structure and partnerships within the community. ^[69]

In Boston, Massachusetts, in September 2007, an outreach to the homeless was initiated in the Boston Common, after some arrests and shootings, and in anticipation of the cold winter ahead. This outreach targets homeless people who would normally spend their sleeping time on the Boston Common, and tries to get them into housing, trying to skip the step of an emergency shelter.

Applications for Boston Housing Authority were being handed out and filled out and submitted. This is an attempt to enact by outreach the Housing First initiative, federally mandated. Boston's Mayor, Thomas Menino, was quoted as saying "The solution to homelessness is permanent housing". Still, this is a very controversial strategy, especially if the people are not able to sustain a house with proper community, health, substance counseling, and mental health supportive programs.^[70]

In October 2009, as part of the city's Leading the Way initiative, Mayor Thomas M. Menino of Boston dedicated and opened the Weintraub Day Center which is the first city-operated day center for chronically homeless persons. It is a multi-service center, providing shelter, counseling, healthcare, housing assistance, and other support services. It is a 3,400 square foot facility located in the Woods Mullen Shelter. It is also meant to reduce the strain on the city's hospital emergency rooms by providing services and identifying health problems before they escalate into emergencies. It was funded by $3 million in grants from the American Recovery and Reinvestment Act of 2009, Massachusetts Department of Housing and Community Development (DHCD), the Massachusetts Medical Society and Alliance Charitable Foundation^[71], and the United States Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA).^[72]

Refuges for the homeless

A homeless person's shelter under a fallen willow tree in Australia.

There are many places where a homeless person might seek refuge.

• Outdoors: On the ground or in a sleeping bag, tent, or improvised shelter, such as a large cardboard box, dumpster in a park or vacant lot.
• Shantytowns: Ad hoc campsites of improvised shelters and shacks, usually near rail yards, interstates and high transportation veins.
• Derelict structures: abandoned or condemned buildings
• Squatting in an unoccupied house where a homeless person may live without payment and without the owner's knowledge or permission.
• Vehicles: cars or trucks are used as a temporary or sometimes long-term living refuge, for example by those recently evicted from a home. Some people live in vans, sport utility vehicles, covered pick-up trucks, station wagons, sedans, or hatchbacks .
• Public places: Parks, bus or train stations, airports, public transportation vehicles (by continual riding where unlimited passes are available), hospital lobbies or waiting areas, college campuses, and 24-hour businesses such as coffee shops. Many public places use security guards or police to prevent people from loitering or sleeping at these locations for a variety of reasons, including image, safety, and comfort.^[73][74]
• Homeless shelters: such as emergency cold-weather shelters opened by churches or community agencies, which may consist of cots in a heated warehouse, or temporary Christmas Shelters.
• Inexpensive boarding houses: Also called flophouses, they offer cheap, low-quality temporary lodging.
• Residential hotels, where a bed as opposed to an entire room can be rented cheaply in a dorm-like environment.
• Inexpensive motels also offer cheap, low-quality temporary lodging. However, some who can afford housing live in a motel by choice. For example, David and Jean Davidson spent 22 years at a UK Travelodge.^[75]
• 24-hour Internet cafes are now used by over 5,000 Japanese "Net cafe refugees". An estimated 75% of Japan's 3,200 all-night internet cafes cater to regular overnight guests, who in some cases have become their main source of income.^[76]
• Friends or family: Temporarily sleeping in dwellings of friends or family members ("couch surfing"). Couch surfers may be harder to recognize than street homeless people^[77]
• Underground tunnels such as abandoned subway, maintenance, or train tunnels are popular among the permanent homeless.^[78][79] The inhabitants of such refuges are called in some places, like New York City, "Mole People". Natural caves beneath urban centers allow for places where the homeless can congregate. Leaking water pipes, electric wires, and steam pipes allow for some of the essentials of living.

Health care for the homeless

Health care for the homeless is a major public health challenge.^{[80][81][82][83][84][85][86][87][88][89][90]}

Homeless people are more likely to suffer injuries and medical problems from their lifestyle on the street, which includes poor nutrition, substance abuse, exposure to the severe elements of weather, and a higher exposure to violence (robberies, beatings, and so on). Yet at the same time, they have little access to public medical services or clinics.^{[citation needed]}

This is a particular problem in the US where many people lack health insurance: "Each year, millions of people in the United States experience homelessness and are in desperate need of health care services. Most do not have health insurance of any sort, and none have cash to pay for medical care." ^[91][92]

Homeless persons often find it difficult to document their date of birth or their address. Because homeless people usually have no place to store possessions, they often lose their belongings, including their identification and other documents, or find them destroyed by police or others. Without a photo ID, homeless persons cannot get a job or access many social services. They can be denied access to even the most basic assistance: clothing closets, food pantries, certain public benefits, and in some cases, emergency shelters.

Obtaining replacement identification is difficult. Without an address, birth certificates cannot be mailed. Fees may be cost-prohibitive for impoverished persons. And some states will not issue birth certificates unless the person has photo identification, creating a Catch-22.^[93]

This problem is far less acute in countries which provide free-at-use health care, such as the UK, where hospitals are open-access day and night, and make no charges for treatment. In the US, free-care clinics, especially for the homeless do exist in major cities, but they are usually over-burdened with patients. ^[94]

The conditions affecting the homeless are somewhat specialized and have opened a new area of medicine tailored to this population. Skin conditions, including Scabies, are common because homeless people are exposed to extreme cold in the winter and they have little access to bathing facilities. They have problems caring for their feet^[95] and have more severe dental problems than the general population.^[96] Diabetes, especially untreated, is widespread in the homeless population.^[97] Specialized medical textbooks have been written to address this for providers.^[98]

There are many organizations providing free care to the homeless in countries which do not offer free medical treatment organised by the state, but the services are in great demand given the limited number of medical practitioners. For example, it might take months to get a minimal dental appointment in a free-care clinic. Communicable diseases are of great concern, especially tuberculosis, which spreads more easily in crowded homeless shelters in high density urban settings.^[99]

In 1999, Dr. Susan Barrow of the Columbia University Center for Homelessness Prevention Studies reported in a study that the "age-adjusted death rates of homeless men and women were 4 times those of the general US population and 2 to 3 times those of the general population of New York City". ^[100]

In 2004, Boston Health Care for the Homeless in conjunction with the National Health Care for the Homeless Council published a medical manual called "The Health Care of Homeless Persons", edited by James J. O'Connell, M.D., specifically for the treatment of the homeless population.^[101]

In June 2008, in Boston, Massachusetts, the Jean Yawkey Place, a four-story, 77,653 square-foot building, was opened by the Boston Health Care for the Homeless Program. It is an entire full service building on the Boston Medical Center campus dedicated to providing health care for the homeless. It also contains a long term care facility, the Barbara McInnis House, which expanded to 104 beds, which is the first and largest medical respite program for homeless people in the United States.^[102][103]

Tracking and counting the homeless

In the USA, the federal government's HUD agency has required federally funded organizations to use a computer tracking system for the homeless and their statistics, called HMIS (Homeless Management Information System).^{[104][105][106]} There has been some opposition to this kind of tracking by privacy advocacy groups, such as EPIC.^[107] However, HUD considers its reporting techniques to be reasonably accurate for homeless in shelters and programs in its Annual Homeless Assessment Report to Congress.^[108]

Actually determining and counting the number of homeless is very difficult in general due to their lifestyle habits.^[109][110] There are so-called "hidden homeless" out of sight of the normal population and perhaps staying on private property.^[111]

Various countries, states, and cities have come up with differing means and techniques to calculate an approximate count. For example, a one night "homeless census count", usually held in the early Winter, for the year is a technique used by a number of American cities, especially Boston, Massachusetts.^[112][113] Los Angeles, California uses a mixed set of techniques for counting, including the point-in-time street count.^[111][114]

Statistics for developed countries

Homeless man, Tokyo.

In 2005, an estimated 100 million people worldwide were homeless.^[115]

The following statistics indicate the approximate average number of homeless people at any one time. Each country has a different approach to counting homeless people, and estimates of homelessness made by different organizations vary wildly, so comparisons should be made with caution.

European Union: 3,000,000 (UN-HABITAT 2004)

United Kingdom: 10,459 rough sleepers, 98,750 households in temporary accommodation (Department for Communities and Local Government 2005)

Canada: 150,000 (National Homelessness Initiative - Government of Canada)^[116]

Australia: In total, 99,900 people were homeless in 2001

14,200 sleeping rough (In improvised dwellings or tents, or in streets, parks, cars or derelict buildings). 14,300 in emergency or transitional housing. 48,600 were defined as homeless because they were staying with another household and had no usual residence. Finally, 22,900 people living in boarding houses were included in the homeless count. (ABS: 2001 Census)^[117]

United States^[118]: According to HUD's July 2008 3rd Homeless Assessment Report to Congress, in a single night in January 2007, single point analysis reported to HUD showed there were 671,888 sheltered and unsheltered homeless persons nationwide in the United States.^[108] Also, HUD reported the number of chronically homeless people (those with repeated episodes or who have been homeless for long periods, 2007 data) as 123,833.^[108] 82% of the homeless are not chronically homeless, and 18% are (6% Chronically Homeless Sheltered, 12% Chronically Homeless Unsheltered). Their Estimate of Sheltered Homeless Persons during a One-Year Period, October 2006 to September 2007, that about 1,589,000 persons used an emergency shelter and/or transitional housing during the 12-month period, which is about 1 in every 200 persons in the United States was in a homeless facility in that time period. Individuals accounted for 1,115,054 or 70.2% and families numbered 473,541 or 29.8%. The number of persons in sheltered households with Children was about 130,968.^[108]

Japan: 20,000-100,000 (some figures put it at 200,000-400,000)^[119] Reports show that homelessness is on the rise in Japan since the mid-1990s.^[120]

There are more homeless men than homeless women in Japan because it is easier for women to get a job (they make less money than men do). Also Japanese families usually provide more support for women than they do for men.^[121]

Developing and undeveloped countries

A homeless person sleeping at the bus stop in Kuala Lumpur, Malaysia.

The number of homeless people worldwide has grown steadily in recent years.^[122][123] In some Third World nations such as India, Nigeria, and South Africa, homelessness is rampant, with millions of children living and working on the streets.^[124][125] Homelessness has become a problem in the countries of China, Thailand, Indonesia, and the Philippines despite their growing prosperity, mainly due to migrant workers who have trouble finding permanent homes.^[126]

For people in Russia, especially the youth, alcoholism and substance abuse is a major cause and reason for becoming and continuing to be homeless.^[127]

The United Nations, United Nations Centre for Human Settlements (UN-Habitat) wrote in its Global Report on Human Settlements in 1995: "Homelessness is a problem in developed as well as in developing countries. In London, for example, life expectancy among the homeless is more than 25 years lower than the national average.

Poor urban housing conditions are a global problem, but conditions are worst in developing countries. Habitat says that today 600 million people live in life- and health-threatening homes in Asia, Africa and Latin America. The threat of mass homelessness is greatest in those regions because that is where population is growing fastest.

By 2015, the 10 largest cities in the world will be in Asia, Latin America and Africa. Nine of them will be in developing countries: Bombay, India - 27.4 million; Lagos, Nigeria - 24.4; Shanghai, China - 23.4; Jakarta, Indonesia - 21.2; São Paulo, Brazil - 20.8; Karachi, Pakistan - 20.6; Beijing, China - 19.4; Dhaka, Bangladesh - 19; Mexico City, Mexico - 18.8. The only city in a developed country that will be in the top ten is Tokyo, Japan - 28.7 million."^[128]

In 2008, Dr. Anna Tibaijuka, Executive Director of UN-HABITAT, referring to the recent report "State of the World’s Cities Report 2008/2009"^[129], said that the world economic crisis we are in should be viewed as a “housing finance crisis” in which the poorest of poor were left to fend for themselves.^[130]

Homelessness by country

• Homelessness in Australia
• Homelessness in Canada
• Homelessness in England
• Homelessness in Iraq
• Homelessness in Israel
• Homelessness in Japan
• Homelessness in Scotland
• Homelessness in the United States

See also

Other itinerant or homeless people or terms for this condition

Socioeconomic issues or aspects of homeless life

References

Bibliography

Further reading

External links

• FirstStep Guide to getting help for the homeless - US Government HHS, HUD, et al.
• Homelessness Resource Center, Substance Abuse and Mental Health Services Administration
• Homeless Statistics for Australia, Canada, United Kingdom and United States.
• Law Questions and Answers about legal information for the homeless.
• National Homeless Persons’ Memorial Day (USA) - Information on National Homeless Person's Memorial Day, December 21
• PBS, "Home at Last?", NOW series program, first aired on February 2, 2007. The topic was what will most help homeless people reenter the fabric of society.
• Homelessness at the Open Directory Project
• Horizons for Homeless Children - Massachusetts program for homeless pre-school aged children

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