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Beyond shelter
Beyond shelter The homeless in the USA
F. Stevens Redburn and Terry F. Buss
This paper studies the reasons for the increase in the number of homeless in the USA. Their distribution and demography are investigated, as well as the causes and possible cures for the situation. It is concluded that people become homeless for different reasons which each require different measures; merely to increase provision of temporary shelter is to accept rather than attempt to remedy the problem.
F. Stevens Redburn is with the US Federal Government's Office of Management and Budget, Room 9201, Executive Office Building, Washington, DC 20503, USA. Terry F. Buss is Director of the Center for Urban Studies, Youngstown State University, 410 Wick Avenue, Youngstown, OH 44555, USA. The authors accept sole responsibility for the views expressed.
1US Department of Housing and Urban Development, A Report to the Secretary on the Homeless and Emergency Shelters, Washington, DC, May 1984, pp 8-21. 21bid estimated the number of shelter beds in the nation in January 1984 at 111 000, of which 70% were occupied on an average winter night.
Since about 1980, more and more Americans have become aware of and concerned about the many homeless people walking city streets and seeking emergency shelter. Viewed against the backdrop of decades long economic growth and improvement in housing conditions, the appearance of homeless people, on a scale unknown since the Depression, has alarmed citizens and policy makers. Intense debate continues concerning the extent and nature of the problem and of government's responsibility to deal with it. All levels of government have responded by appropriating funds for emergency shelter, thus augmenting services traditionally provided by private charities and religious groups. Beginning in 1983, Congress has appropriated money annually to provide the homeless with emergency food and shelter, a total of $300 million up to and including fiscal year 1986. From 1983 to mid-1986 cities had spent $77 million in Federal Community Development Block Grant funds for shelter acquisition, rehabilitation or operation. The largest states and many major cities have also begun to support shelter construction and operation. It is important to note that a relatively small proportion of this effort is directed at meeting more than the immediate basic needs for food and shelter. For purposes of policy development, we need to understand who the US homeless are and how they came to be that way; perhaps even more important, to specify, for different parts of the homeless population, what particular actions are required to meet their immediate needs and to return them to a more normal life. The primary focus of this discussion is on highlighting what is known about these questions and its implications for public policy. It is useful to begin by presenting some basic facts about the numbers of US homeless, their geographic distribution and their demographic characteristics.
Numbers, distribution, demographics Very roughly, there are some 250 0()l) to 350 000 individuals in the USA who have no regular place to live; they sleep either outside, ill makeshift shelters, in public places, in other unconventional accommodations or in emergency shelters, t Of these, perhaps one-third are, on any given night, in shelters. 2
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3US Conference of Mayors, The Growth of Hunger and Homelessness and Poverty in America's Cities in 1985, Washington, DC, 1986. 4Richard B. Freeman and Brian Hall, Permanent Homelessness in America?, National Bureau of Economic Research, Cambridge, MA, September 1986. 51bid. SOp cit, Ref 1, p 20. 70p cit, Ref 1, p 20. 8F. Stevens Redburn and Terry F. Buss, Responding to America's Homeless, Praeger, New York, 1986. 90p cit, Ref 1, p 29. ~°Op cit, Ref 8. l~Op cit, Ref 1, p 29. lZOhio Department of Mental Health, Homelessness in Ohio: A Study of People in Need, Columbus, OH, February 1985.
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The numbers of homeless appear to have continued to rise between 1983, when the US D e p a r t m e n t of Housing and Urban D e v e l o p m e n t ( H U D ) conducted the only systematic national study of homelessness to date, and 1985. A US Conference of Mayors survey found that the homeless populations had increased from 1984 to 1985 in 22 out of 25 large cities. 3 One careful estimate is that there were 23% to 30% more homeless in 1985 than two years earlier. 4 Scattered local evidence suggests that the n u m b e r of homeless families also increased during this interval. 5 The rate of homelessness differs across regions. The western states account for almost one-third of US homeless, although only one-fifth of the population resides there. This pattern may surprise some who link homelessness either to mass u n e m p l o y m e n t in the north central states or to tight labour and housing markets in the north-east. (' The ratio of homeless population to total population is higher, on average, in larger metropolitan areas than in smaller ones. H U D found that there were 13 homeless people per 10 000 population in metropolitan areas of over one million people; 12 per 10 000 in areas of 250 000 to one million; and just 6.5 per 10 000 in metropolitan areas of fewer than 250 000. 7 Statistical analysis of the relationship between metropolitan area characteristics and the rate of homelessness reveals that the scale of the problem is greater not only in larger areas but in rapidly growing ones. s The same analysis indicates that, contrary to expectations, there is no connection between climate and the rate of homelessness, once population growth is taken into account. Possibly, homeless people are drawn to growing areas by the greater economic opportunity they offer. Perhaps, also, the higher rate of development in these areas displaces more people from their homes because of the destruction of marginal housing or rapid increases in rents. No large scale studies have been made of migration patterns among the homeless. H U D estimated that, nationally, over one-half of the homeless have lived in the' area where they are now located for over a year but noted also that, in a few communities, local observers believe that a majority are transients or newcomers. ') In Ohio, 40% of the homeless describe themselves as p e r m a n e n t residents of the county where found; another 24% have been there for at least one year. 10 It is surprising that the rate of homelessness is not associated with two indicators of local housing conditions - rent levels and rental vacancy rates. In areas where rents are higher than average and where rental vacancy rates are low, it is reasonable to expect that m o r e low income households will have difficulty finding affordable apartments. However, when other influences are considered, there is no independent statistical relationship between the ratio of homeless population to total population and either indicator of housing market conditions. Nationally, about two-thirds of the homeless are single men, one in seven single w o m e n and about one in five m e m b e r s of intact families. H U D found the median age of adult homeless to be between the late twenties and early thirties, with the average being 34. ]1 The only state-wide survey of homeless people, in Ohio, found very similar demographics. 12 It appears that minorities (especially blacks) are overrepresented a m o n g the homeless. H U D estimated that 44% of the homeless staying in emergency shelters were minorities (they form about 20% of the US
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130p cit, Ref 1, p 29. 140p cit, Ref 12. ~Speter H. Rossi, Gene A. Fisher and Georgianna Willis, The Condition of the Homeless in Chicago, Social and Demographic Institute, University of Massachusetts, Amherst, MA and National Office Research Center, University of Chicago, Chicago, IL, September, 1986, pp 62-63.
lelbid. 170p cit, ~aOp cit, 190p cit, 2Olbid. 21Ibid. 220p cit, 230p cit,
Ref 4. Ref 1, p 26. Ref 8.
Ref 1, p 29. Ref 4. For families, the estimated duration was about one year. 240p cit, Ref 8.
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population as a whole. 13 In Ohio, 34% of the homeless interviewed were minority, c o m p a r e d to 10% of the state's population. ~4 In Chicago, 60% of the homeless are blacks, who form 35% of the city's adult population.~5 In Chicago also, American Indians are overrepresented a m o n g the homeless, relative to the total population, but Hispanics are underrepresented, u~ Studies in Boston, New York, and elsewhere have found blacks to be overrepresented a m o n g the homeless but Hispanics to be slightly underrepresented, despite the higher than average incidence of poverty in that population, w Although no comparable data exist for earlier periods, many have asserted that today's homeless population is not only larger.but m o r e diverse and includes higher proportions of families and minorities than in the past. Most of the homeless are u n e m p l o y e d and many have little or no current income. The average rate of e m p l o y m e n t a m o n g the homeless in local studies reviewed by H U D was 22%. ~ In Ohio, 84% of the homeless have had some work experience. However, few of these are currently working, even at part-time jobs. Only 28% had worked within the last month. Only 6% held a p e r m a n e n t full-time job. Of those who had once worked but were now unemployed, fewer than half had worked within the past two years. ~ The financial circumstances of the homeless b e c o m e apparent when their sources of income are c o m p a r e d to those of the much larger class of p o o r people of which they are a part. In 1983, about two-thirds of US householders aged 25 to 60 living in poverty had some earned income; but of the Ohio homeless, only 17% gave earnings as their primary income source and only one-fourth had worked for pay within the month. Of all poor householders 20% have no current income; but 37% of the homeless had none. 2° Unlike most poor people who lack earnings, relatively few of the homeless can rely on public welfare, private charity, pensions or social security. O f the Ohio homeless, one-fourth indicated that public assistance or charity was their primary income source; for another 14%, Social Security or pensions were the primary source. These rates suggest a rate of public welfare use much lower than that for the poor generally, three-fourths of whom report some income other than earnings. Although the different forms in which information on income sources is provided make exact comparisons impossible, it is clear that the homeless are much poorer than the poor in general. Not only are the homeless twenty times more likely than the average poor adult to have no source of current income, the homeless are also apparently less likely than other p o o r to be receiving income from sources that ordinarily substitute for earnings. 21 For those who do receive benefits, payment amounts are not, in most cases, sufficient to pay the rent on a modest dwelling unit. One crucial point on which more evidence is needed concerns whether most of the homeless experience that condition only for short (whether unique or recurrent) spells or for long periods (perhaps lasting months or years). Homelessness of longer duration is likely to be more damaging, to stem from different causes and to be harder to reverse than homelessness of shorter duration. H U D concluded that 'for most people who become homeless, their condition is recent and likely to be t e m p o r a r y ' ; 2: but a study in New York City estimated the typical duration of homelessness at 3.5 years, from first onset. >~ In Ohio, one-fourth of those interviewed were at least one year into their current spell of homelessness. 24
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Causes A m o n g the often advanced plausible reasons for the recent rise in US homelessness are the following: 1. 2. 3. 4.
2Slbid. 2eOp cit, Ref 1, pp 24-25. For a review of the methodological problems, see Ref 8, Chapter 5. 2tOp cit, Ref 4. Most of the Ohio homeless are males who could qualify for state General Relief and for the federal Food Stamps programme. A 1986 US House of Representatives survey of shelter operators found that 45% of the homeless eligible for food stamps did not receive them. 280f Ellen Baxter and Kim Hopper, Private Lives~Public Spaces: Homeless Adults on the Streets of New York City, Community Services Society, New York, 1981.
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a severe recession in 1982 and persistent high u n e m p l o y m e n t in some regions and population segments; reductions in national social p r o g r a m m e spending or new restrictions on p r o g r a m m e eligibility; shortages of low cost housing, perhaps exacerbated by government housing and urban redevelopment policies; and the m o v e m e n t of state governments and the courts away from long term hospitalization of the mentally ill, combined with the failure to create adequate community support systems for those who, in the previous era, would have been institutionalized.
In fact, the available evidence is not sufficient to say with certainty how much of the rise in homelessness is due to each of these or other factors. Many have focused on the change in mental hospital admissions practices as the most likely cause of a short term rise in homelessness. Mental hospital populations did fall, from 505 000 in 1963 to 125 000 in 1981, but have since stabilized. Most research indicates that between 25% and 50% of the homeless are, in some way, mentally ill. 25 Shelter operators surveyed by H U D estimated, on average, that 22°/,, of their clients had such problems; and the rate of mental disorder among those not using shelters may be higher. 2(' Freeman has linked the rise in homelessness to changes in population characteristics and housing markets. First, he argues that increases in the n u m b e r of female headed families and substance abusers, along with deinstitutionalization, have gradually expanded the population at risk of homelessness. Second, he notes a rapid increase, between 1979 and 1983, in the n u m b e r of people with exceptionally low (below $3000) incomes. However, he argues that the continued rise in homelessness after 1983 can best be accounted for by the coincidence of an expansion in the numbers of very poor households with a sharp fall in the numbers of low rent units available in central cities. 27 Others have noted, more particularly, the recent elimination of many cheap boarding houses and single room occupancy hotels that once sheltered the down and O u t . 2s On a personal level, most people b e c o m e homeless not as a result of a single catastrophic event but at the end of a series of misfortunes. Most homeless people, it appears, had been poor and on the margins of the labour force before becoming homeless. Their present condition reflects not only their inability to earn income by working but also a social welfare system that provides haphazard and often inadequate coverage of those unable to support themselves. Still unsettled is the extent to which the poverty and social marginality that characterize the homeless population are products of predisposing personal attributes - specifically mental illness and alcohol and drug addiction - and are not themselves primary causes of homelessness. Longitudinal studies of this population will be needed to fully sort out the most c o m m o n sequences of cause and effect.
Needs Leaving aside the important but unresolved question of aetiology, it is perhaps as useful for policy development, and certainly easier, to
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identify the needs of several categories of homeless people. Our analysis of needs presumes that the goal of public policy should be not only to meet the immediate basic needs of the homeless but, where possible, to return them to the social mainstream. Empirically, it is based on interviews with about 1000 homeless people in Ohio and allows us to estimate the proportions of that state's homeless population which fall into each of four groups needing different forms of help. > T h e r e are three groups of homeless people whose needs for assistance clearly go beyond the need for t e m p o r a r y emergency shelter. First, there are people who are unlikely ever to successfully fend for themselves. In Ohio, by our estimate, three out of ten homeless people cannot reasonably be expected to sustain independent residence over a long period. If they are not merely to survive but be reasonably assured of meeting their needs for shelter, food, health care and emotional support, then they must live in or be closely attached to an institution or agency dedicated to seeing that their needs are met. These include people whose age and e m p l o y m e n t history indicate that they have passed permanently out of the labour force, some who are physically disabled and others with severe, chronic psychological disorders. A second group of homeless have been unable to achieve economic self sufficiency because of a major deficit (such as illiteracy) or a chronic problem (such as alcoholism) with which they cannot cope unaided. About one in four homeless people in Ohio do not need p e r m a n e n t custodial care but have a remediable deficit or problem that must be dealt with before a return to a nqore normal living pattern is likely. Included in this group are those who have had serious problems with alcohol or other drugs, those who have never worked, those with little formal education and those who, while not severely ill, have been in and out of mental institutions. A third category of the homeless includes individuals and families in crisis for a variety of reasons. In most cases, these people will be capable of returning to a more normal situation but need short term crisis care, including counselling and other personal and sometimes financial support. One in five Ohio homeless do not have any apparent need for long term custodial care, nor any m a j o r deficit or problem such as those n a m e d above, but are demonstrably in crisis. These are people who have been homeless for relatively short periods and whose lack of p e r m a n e n t shelter is linked to family conflict or dissolution, an eviction or natural disaster or being fired or laid off from their most recent job. This category has the highest proportion of women. Finally, there are homeless people who appear to have none of the above needs but who nevertheless need a t e m p o r a r y place to stay. This group includes those who simply lack enough income to purchase p e r m a n e n t lodgings, those on the move in search of work and those who prefer to keep moving. It may include some who properly belong in the other need categories but whose need for other forms of assistance is not so obvious. In Ohio, about 20% of the homeless appear to need emergency shelter only. Data are not now available to estimate what proportions of all US homeless fall into each of the four categories. However, if the same proportions of the four need groups found in the Ohio population were to hold nationally, then in the order of 100 000 homeless people sleeping in emergency shelters or on the street properly belong in 29For details of the methods used, see Ref 8. p e r m a n e n t custodial settings ranging from in-community sheltered
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living arrangements to nursing homes, hospitals or other institutions. This number is approximately equal to the total number of emergency shelter beds that existed nationally in 1984. A comparison of the two numbers begins to suggest the limits of current public policies for the homeless.
Alternatives A more differentiated view of the homeless population than that commonly taken implies the need for a new system of services and care, with the goal of minimizing the numbers who, at any one time, are in emergency shelters or without shelter. This might be accomplished, on the one hand, by preventing some people from becoming homeless and, on the other hand, by fostering the reintegration of some homeless with the society and providing permanent custodial care for others. The practicality of each element of such an approach remains to be tested, however. To prevent homelessness, or at least to return people with a capacity for independent living to permanent housing as quickly as possible, requires a combination of services aimed not just at locating housing but at meeting other needs. Depending on the individual, this could include establishing a stable source of income, working through a crisis in personal relationships, or finding daycare for children. Help in finding permanent housing could involve a combination of housing counselling, transport, help in meeting landlords or housing authorities and completing applications, budget planning and help in locating appropriate vacancies. The Red Cross in Cleveland and other cities has had some success in minimizing shelter stays by helping people locate inexpensive permanent housing. A cost effective effort of this sort would pay for itself in reduced shelter operating costs and capital cost savings from the reduced need for shelter space. For those homeless needing prolonged rehabilitative or developmental services, the goal of reintegrating them with the society will be harder to reach. In addition to help directed at remedying deficits such as illiteracy or alcohol and drug abuse, these efforts must inw)lve counselling and close, temporary supervision designed to reverse behaviour patterns that have evolved as an adaptation to homelessness but will only produce rejection by employers or landlords. In any case, a sizable fraction of the homeless population will continue to be homeless until they are given some kind of sheltered living arrangement. This does not, in most cases, mean institutional confinement. For most, it implies congregate or other sheltered housing combined with supportive services. For some, it may mean an independent, self-maintained residence with continuous close monitoring by others. One likely source of new insights on sheltered living arrangements for these homeless is a joint effort by H U D and a private foundation, begun in 1986, aimed at providing rental housing assistance, strengthening the system of community mental health services, better coordinating these with other city services and purchasing and/or rehabilitating properties suitable for the chronically mentally ill who are homeless. If the prospect of meeting the custodial care needs of these homeless seems small in an era of fiscal constraint, it is important to recognize the spending that is associated with the present situation, in which many of
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the ageing and disabled homeless spend an increasing proportion of their existence in and out of hospital emergency rooms and out-patient facilities and claim a disproportionate share of attention from the staff of emergency shelters not designed to a c c o m m o d a t e this range of needs. If the U S A accepts the creation of a p e r m a n e n t massive shelter system as the main response to homelessness, then it accepts also the p e r m a n e n c e of a large population with no place to call home. A society that accepts this as a solution accepts its failure to develop effective approaches to prevention, its a b a n d o n m e n t of reintegration as a goal for most of the homeless who need special help to live independently and its failure to create new p e r m a n e n t custodial settings for those who have been debilitated by poverty and life on the streets.
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F. Stevens Redburn and Terry F. Buss
This paper studies the reasons for the increase in the number of homeless in the USA. Their distribution and demography are investigated, as well as the causes and possible cures for the situation. It is concluded that people become homeless for different reasons which each require different measures; merely to increase provision of temporary shelter is to accept rather than attempt to remedy the problem.
F. Stevens Redburn is with the US Federal Government's Office of Management and Budget, Room 9201, Executive Office Building, Washington, DC 20503, USA. Terry F. Buss is Director of the Center for Urban Studies, Youngstown State University, 410 Wick Avenue, Youngstown, OH 44555, USA. The authors accept sole responsibility for the views expressed.
1US Department of Housing and Urban Development, A Report to the Secretary on the Homeless and Emergency Shelters, Washington, DC, May 1984, pp 8-21. 21bid estimated the number of shelter beds in the nation in January 1984 at 111 000, of which 70% were occupied on an average winter night.
Since about 1980, more and more Americans have become aware of and concerned about the many homeless people walking city streets and seeking emergency shelter. Viewed against the backdrop of decades long economic growth and improvement in housing conditions, the appearance of homeless people, on a scale unknown since the Depression, has alarmed citizens and policy makers. Intense debate continues concerning the extent and nature of the problem and of government's responsibility to deal with it. All levels of government have responded by appropriating funds for emergency shelter, thus augmenting services traditionally provided by private charities and religious groups. Beginning in 1983, Congress has appropriated money annually to provide the homeless with emergency food and shelter, a total of $300 million up to and including fiscal year 1986. From 1983 to mid-1986 cities had spent $77 million in Federal Community Development Block Grant funds for shelter acquisition, rehabilitation or operation. The largest states and many major cities have also begun to support shelter construction and operation. It is important to note that a relatively small proportion of this effort is directed at meeting more than the immediate basic needs for food and shelter. For purposes of policy development, we need to understand who the US homeless are and how they came to be that way; perhaps even more important, to specify, for different parts of the homeless population, what particular actions are required to meet their immediate needs and to return them to a more normal life. The primary focus of this discussion is on highlighting what is known about these questions and its implications for public policy. It is useful to begin by presenting some basic facts about the numbers of US homeless, their geographic distribution and their demographic characteristics.
Numbers, distribution, demographics Very roughly, there are some 250 0()l) to 350 000 individuals in the USA who have no regular place to live; they sleep either outside, ill makeshift shelters, in public places, in other unconventional accommodations or in emergency shelters, t Of these, perhaps one-third are, on any given night, in shelters. 2
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3US Conference of Mayors, The Growth of Hunger and Homelessness and Poverty in America's Cities in 1985, Washington, DC, 1986. 4Richard B. Freeman and Brian Hall, Permanent Homelessness in America?, National Bureau of Economic Research, Cambridge, MA, September 1986. 51bid. SOp cit, Ref 1, p 20. 70p cit, Ref 1, p 20. 8F. Stevens Redburn and Terry F. Buss, Responding to America's Homeless, Praeger, New York, 1986. 90p cit, Ref 1, p 29. ~°Op cit, Ref 8. l~Op cit, Ref 1, p 29. lZOhio Department of Mental Health, Homelessness in Ohio: A Study of People in Need, Columbus, OH, February 1985.
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The numbers of homeless appear to have continued to rise between 1983, when the US D e p a r t m e n t of Housing and Urban D e v e l o p m e n t ( H U D ) conducted the only systematic national study of homelessness to date, and 1985. A US Conference of Mayors survey found that the homeless populations had increased from 1984 to 1985 in 22 out of 25 large cities. 3 One careful estimate is that there were 23% to 30% more homeless in 1985 than two years earlier. 4 Scattered local evidence suggests that the n u m b e r of homeless families also increased during this interval. 5 The rate of homelessness differs across regions. The western states account for almost one-third of US homeless, although only one-fifth of the population resides there. This pattern may surprise some who link homelessness either to mass u n e m p l o y m e n t in the north central states or to tight labour and housing markets in the north-east. (' The ratio of homeless population to total population is higher, on average, in larger metropolitan areas than in smaller ones. H U D found that there were 13 homeless people per 10 000 population in metropolitan areas of over one million people; 12 per 10 000 in areas of 250 000 to one million; and just 6.5 per 10 000 in metropolitan areas of fewer than 250 000. 7 Statistical analysis of the relationship between metropolitan area characteristics and the rate of homelessness reveals that the scale of the problem is greater not only in larger areas but in rapidly growing ones. s The same analysis indicates that, contrary to expectations, there is no connection between climate and the rate of homelessness, once population growth is taken into account. Possibly, homeless people are drawn to growing areas by the greater economic opportunity they offer. Perhaps, also, the higher rate of development in these areas displaces more people from their homes because of the destruction of marginal housing or rapid increases in rents. No large scale studies have been made of migration patterns among the homeless. H U D estimated that, nationally, over one-half of the homeless have lived in the' area where they are now located for over a year but noted also that, in a few communities, local observers believe that a majority are transients or newcomers. ') In Ohio, 40% of the homeless describe themselves as p e r m a n e n t residents of the county where found; another 24% have been there for at least one year. 10 It is surprising that the rate of homelessness is not associated with two indicators of local housing conditions - rent levels and rental vacancy rates. In areas where rents are higher than average and where rental vacancy rates are low, it is reasonable to expect that m o r e low income households will have difficulty finding affordable apartments. However, when other influences are considered, there is no independent statistical relationship between the ratio of homeless population to total population and either indicator of housing market conditions. Nationally, about two-thirds of the homeless are single men, one in seven single w o m e n and about one in five m e m b e r s of intact families. H U D found the median age of adult homeless to be between the late twenties and early thirties, with the average being 34. ]1 The only state-wide survey of homeless people, in Ohio, found very similar demographics. 12 It appears that minorities (especially blacks) are overrepresented a m o n g the homeless. H U D estimated that 44% of the homeless staying in emergency shelters were minorities (they form about 20% of the US
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130p cit, Ref 1, p 29. 140p cit, Ref 12. ~Speter H. Rossi, Gene A. Fisher and Georgianna Willis, The Condition of the Homeless in Chicago, Social and Demographic Institute, University of Massachusetts, Amherst, MA and National Office Research Center, University of Chicago, Chicago, IL, September, 1986, pp 62-63.
lelbid. 170p cit, ~aOp cit, 190p cit, 2Olbid. 21Ibid. 220p cit, 230p cit,
Ref 4. Ref 1, p 26. Ref 8.
Ref 1, p 29. Ref 4. For families, the estimated duration was about one year. 240p cit, Ref 8.
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population as a whole. 13 In Ohio, 34% of the homeless interviewed were minority, c o m p a r e d to 10% of the state's population. ~4 In Chicago, 60% of the homeless are blacks, who form 35% of the city's adult population.~5 In Chicago also, American Indians are overrepresented a m o n g the homeless, relative to the total population, but Hispanics are underrepresented, u~ Studies in Boston, New York, and elsewhere have found blacks to be overrepresented a m o n g the homeless but Hispanics to be slightly underrepresented, despite the higher than average incidence of poverty in that population, w Although no comparable data exist for earlier periods, many have asserted that today's homeless population is not only larger.but m o r e diverse and includes higher proportions of families and minorities than in the past. Most of the homeless are u n e m p l o y e d and many have little or no current income. The average rate of e m p l o y m e n t a m o n g the homeless in local studies reviewed by H U D was 22%. ~ In Ohio, 84% of the homeless have had some work experience. However, few of these are currently working, even at part-time jobs. Only 28% had worked within the last month. Only 6% held a p e r m a n e n t full-time job. Of those who had once worked but were now unemployed, fewer than half had worked within the past two years. ~ The financial circumstances of the homeless b e c o m e apparent when their sources of income are c o m p a r e d to those of the much larger class of p o o r people of which they are a part. In 1983, about two-thirds of US householders aged 25 to 60 living in poverty had some earned income; but of the Ohio homeless, only 17% gave earnings as their primary income source and only one-fourth had worked for pay within the month. Of all poor householders 20% have no current income; but 37% of the homeless had none. 2° Unlike most poor people who lack earnings, relatively few of the homeless can rely on public welfare, private charity, pensions or social security. O f the Ohio homeless, one-fourth indicated that public assistance or charity was their primary income source; for another 14%, Social Security or pensions were the primary source. These rates suggest a rate of public welfare use much lower than that for the poor generally, three-fourths of whom report some income other than earnings. Although the different forms in which information on income sources is provided make exact comparisons impossible, it is clear that the homeless are much poorer than the poor in general. Not only are the homeless twenty times more likely than the average poor adult to have no source of current income, the homeless are also apparently less likely than other p o o r to be receiving income from sources that ordinarily substitute for earnings. 21 For those who do receive benefits, payment amounts are not, in most cases, sufficient to pay the rent on a modest dwelling unit. One crucial point on which more evidence is needed concerns whether most of the homeless experience that condition only for short (whether unique or recurrent) spells or for long periods (perhaps lasting months or years). Homelessness of longer duration is likely to be more damaging, to stem from different causes and to be harder to reverse than homelessness of shorter duration. H U D concluded that 'for most people who become homeless, their condition is recent and likely to be t e m p o r a r y ' ; 2: but a study in New York City estimated the typical duration of homelessness at 3.5 years, from first onset. >~ In Ohio, one-fourth of those interviewed were at least one year into their current spell of homelessness. 24
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Causes A m o n g the often advanced plausible reasons for the recent rise in US homelessness are the following: 1. 2. 3. 4.
2Slbid. 2eOp cit, Ref 1, pp 24-25. For a review of the methodological problems, see Ref 8, Chapter 5. 2tOp cit, Ref 4. Most of the Ohio homeless are males who could qualify for state General Relief and for the federal Food Stamps programme. A 1986 US House of Representatives survey of shelter operators found that 45% of the homeless eligible for food stamps did not receive them. 280f Ellen Baxter and Kim Hopper, Private Lives~Public Spaces: Homeless Adults on the Streets of New York City, Community Services Society, New York, 1981.
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a severe recession in 1982 and persistent high u n e m p l o y m e n t in some regions and population segments; reductions in national social p r o g r a m m e spending or new restrictions on p r o g r a m m e eligibility; shortages of low cost housing, perhaps exacerbated by government housing and urban redevelopment policies; and the m o v e m e n t of state governments and the courts away from long term hospitalization of the mentally ill, combined with the failure to create adequate community support systems for those who, in the previous era, would have been institutionalized.
In fact, the available evidence is not sufficient to say with certainty how much of the rise in homelessness is due to each of these or other factors. Many have focused on the change in mental hospital admissions practices as the most likely cause of a short term rise in homelessness. Mental hospital populations did fall, from 505 000 in 1963 to 125 000 in 1981, but have since stabilized. Most research indicates that between 25% and 50% of the homeless are, in some way, mentally ill. 25 Shelter operators surveyed by H U D estimated, on average, that 22°/,, of their clients had such problems; and the rate of mental disorder among those not using shelters may be higher. 2(' Freeman has linked the rise in homelessness to changes in population characteristics and housing markets. First, he argues that increases in the n u m b e r of female headed families and substance abusers, along with deinstitutionalization, have gradually expanded the population at risk of homelessness. Second, he notes a rapid increase, between 1979 and 1983, in the n u m b e r of people with exceptionally low (below $3000) incomes. However, he argues that the continued rise in homelessness after 1983 can best be accounted for by the coincidence of an expansion in the numbers of very poor households with a sharp fall in the numbers of low rent units available in central cities. 27 Others have noted, more particularly, the recent elimination of many cheap boarding houses and single room occupancy hotels that once sheltered the down and O u t . 2s On a personal level, most people b e c o m e homeless not as a result of a single catastrophic event but at the end of a series of misfortunes. Most homeless people, it appears, had been poor and on the margins of the labour force before becoming homeless. Their present condition reflects not only their inability to earn income by working but also a social welfare system that provides haphazard and often inadequate coverage of those unable to support themselves. Still unsettled is the extent to which the poverty and social marginality that characterize the homeless population are products of predisposing personal attributes - specifically mental illness and alcohol and drug addiction - and are not themselves primary causes of homelessness. Longitudinal studies of this population will be needed to fully sort out the most c o m m o n sequences of cause and effect.
Needs Leaving aside the important but unresolved question of aetiology, it is perhaps as useful for policy development, and certainly easier, to
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identify the needs of several categories of homeless people. Our analysis of needs presumes that the goal of public policy should be not only to meet the immediate basic needs of the homeless but, where possible, to return them to the social mainstream. Empirically, it is based on interviews with about 1000 homeless people in Ohio and allows us to estimate the proportions of that state's homeless population which fall into each of four groups needing different forms of help. > T h e r e are three groups of homeless people whose needs for assistance clearly go beyond the need for t e m p o r a r y emergency shelter. First, there are people who are unlikely ever to successfully fend for themselves. In Ohio, by our estimate, three out of ten homeless people cannot reasonably be expected to sustain independent residence over a long period. If they are not merely to survive but be reasonably assured of meeting their needs for shelter, food, health care and emotional support, then they must live in or be closely attached to an institution or agency dedicated to seeing that their needs are met. These include people whose age and e m p l o y m e n t history indicate that they have passed permanently out of the labour force, some who are physically disabled and others with severe, chronic psychological disorders. A second group of homeless have been unable to achieve economic self sufficiency because of a major deficit (such as illiteracy) or a chronic problem (such as alcoholism) with which they cannot cope unaided. About one in four homeless people in Ohio do not need p e r m a n e n t custodial care but have a remediable deficit or problem that must be dealt with before a return to a nqore normal living pattern is likely. Included in this group are those who have had serious problems with alcohol or other drugs, those who have never worked, those with little formal education and those who, while not severely ill, have been in and out of mental institutions. A third category of the homeless includes individuals and families in crisis for a variety of reasons. In most cases, these people will be capable of returning to a more normal situation but need short term crisis care, including counselling and other personal and sometimes financial support. One in five Ohio homeless do not have any apparent need for long term custodial care, nor any m a j o r deficit or problem such as those n a m e d above, but are demonstrably in crisis. These are people who have been homeless for relatively short periods and whose lack of p e r m a n e n t shelter is linked to family conflict or dissolution, an eviction or natural disaster or being fired or laid off from their most recent job. This category has the highest proportion of women. Finally, there are homeless people who appear to have none of the above needs but who nevertheless need a t e m p o r a r y place to stay. This group includes those who simply lack enough income to purchase p e r m a n e n t lodgings, those on the move in search of work and those who prefer to keep moving. It may include some who properly belong in the other need categories but whose need for other forms of assistance is not so obvious. In Ohio, about 20% of the homeless appear to need emergency shelter only. Data are not now available to estimate what proportions of all US homeless fall into each of the four categories. However, if the same proportions of the four need groups found in the Ohio population were to hold nationally, then in the order of 100 000 homeless people sleeping in emergency shelters or on the street properly belong in 29For details of the methods used, see Ref 8. p e r m a n e n t custodial settings ranging from in-community sheltered
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living arrangements to nursing homes, hospitals or other institutions. This number is approximately equal to the total number of emergency shelter beds that existed nationally in 1984. A comparison of the two numbers begins to suggest the limits of current public policies for the homeless.
Alternatives A more differentiated view of the homeless population than that commonly taken implies the need for a new system of services and care, with the goal of minimizing the numbers who, at any one time, are in emergency shelters or without shelter. This might be accomplished, on the one hand, by preventing some people from becoming homeless and, on the other hand, by fostering the reintegration of some homeless with the society and providing permanent custodial care for others. The practicality of each element of such an approach remains to be tested, however. To prevent homelessness, or at least to return people with a capacity for independent living to permanent housing as quickly as possible, requires a combination of services aimed not just at locating housing but at meeting other needs. Depending on the individual, this could include establishing a stable source of income, working through a crisis in personal relationships, or finding daycare for children. Help in finding permanent housing could involve a combination of housing counselling, transport, help in meeting landlords or housing authorities and completing applications, budget planning and help in locating appropriate vacancies. The Red Cross in Cleveland and other cities has had some success in minimizing shelter stays by helping people locate inexpensive permanent housing. A cost effective effort of this sort would pay for itself in reduced shelter operating costs and capital cost savings from the reduced need for shelter space. For those homeless needing prolonged rehabilitative or developmental services, the goal of reintegrating them with the society will be harder to reach. In addition to help directed at remedying deficits such as illiteracy or alcohol and drug abuse, these efforts must inw)lve counselling and close, temporary supervision designed to reverse behaviour patterns that have evolved as an adaptation to homelessness but will only produce rejection by employers or landlords. In any case, a sizable fraction of the homeless population will continue to be homeless until they are given some kind of sheltered living arrangement. This does not, in most cases, mean institutional confinement. For most, it implies congregate or other sheltered housing combined with supportive services. For some, it may mean an independent, self-maintained residence with continuous close monitoring by others. One likely source of new insights on sheltered living arrangements for these homeless is a joint effort by H U D and a private foundation, begun in 1986, aimed at providing rental housing assistance, strengthening the system of community mental health services, better coordinating these with other city services and purchasing and/or rehabilitating properties suitable for the chronically mentally ill who are homeless. If the prospect of meeting the custodial care needs of these homeless seems small in an era of fiscal constraint, it is important to recognize the spending that is associated with the present situation, in which many of
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the ageing and disabled homeless spend an increasing proportion of their existence in and out of hospital emergency rooms and out-patient facilities and claim a disproportionate share of attention from the staff of emergency shelters not designed to a c c o m m o d a t e this range of needs. If the U S A accepts the creation of a p e r m a n e n t massive shelter system as the main response to homelessness, then it accepts also the p e r m a n e n c e of a large population with no place to call home. A society that accepts this as a solution accepts its failure to develop effective approaches to prevention, its a b a n d o n m e n t of reintegration as a goal for most of the homeless who need special help to live independently and its failure to create new p e r m a n e n t custodial settings for those who have been debilitated by poverty and life on the streets.
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