Spotlight on The Homeless Population

 

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In the United States, the amount of homeless people continually rises. They are considered a social problem many cities experience and need to address. The homeless use a variety of techniques to survive and are continually trying to find the solution to difficult situations. Many do not seek health care due to lack of monetary funds as well as resources. Knowledge of the homeless’ experiences will aid in culturally competent care. Unfortunately more research is needed to better understand this subculture.

  

Section 1: Define the Culture 

Culture can be defined as the customary beliefs, social forms, and material traits of a racial, religious, or social group (2010).  In other words, a culture is any group of people that have a shared set of beliefs, social forms, and material traits.  Based on this definition, the numerous people of varying ethnic, religious, and racial backgrounds making up the homeless population are considered a social group in themselves, and share beliefs, forms, and traits. Thus, this group of people in society is then considered a culture. 

To begin, let’s talk about who exactly is considered to be “homeless.”  From the government’s standpoint, the Stewart McKinney Homeless Assistance Act of 1987 defines a homeless person as any individual who lacks housing, including an individual whose primary residence during the night is a supervised public or private facility that provides temporary living accommodations or an individual who is a resident in transitional housing (Homelessness). While other people may have very different definitions for who they consider to be homeless, this is an easy place to start.

(Homeless man playing music via youtube.com) 

In the next section, we will give an overview of the people making up this culture, and some of their beliefs, traditions, values, and so forth.  Hopefully this will help to solidify the group as a culture in our minds.  For many reasons, the group as a whole is not very respected in society and openly shunned.  We hope to shed a little light on the situation and introduce you to the ins and outs of the “homeless culture.”  Enjoy! 

Section 2: An Overview 

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Values/Norms: According to The Journal of Transcultural Nursing, homeless people value the common theme of self survival (240). They have relied on themselves with no help from others. They value self survival because this is their means of survival. They tend to value relationships because this is a means of communication, interaction and acceptance. Hope for the future was another underlying theme addressed. They value hope, and that one day they will be able to leave the situation they are in (239). The homeless also value the basic necessities we take for granted such as food, shelter and clothing.  

Lifestyles: Most of the homeless population lead a nomadic life, and focus on their day-to-day needs. In the article, A Culture of Homelessness?, the lifestyles of the homeless are illuminated as “extreme poverty, lack of adequate housing, employment and income, lack of personal hygiene, difficulty with the tasks of daily living, vulnerability to stress, involvement with alcohol and/or drugs, poor physical health, and criminal activity” (1152). 

Social Bonds: Social bonds of the homeless are portrayed by the lack of support and social networking. They

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 experience “detachment from the community…and social isolation” according J. H. Flaskerud and A. J. Strehlow (1152).  Although a type of bond between the homeless can be witnessed. They tend to share their resources amongst themselves illuminating a social support system. 

Relationships/Social Organization:  As a whole, I think that this is a culture that has not been extensively studied.   For this reason, their social organization is hard to analyze as an outsider.  However, I did find one quote that I feel really sums up the social organization system of homeless people.  “By and large, the homeless are characterized by an inability to fit within the social system and a lack of a social network” (Davis).  The theme seems to be one of fending for yourself and focusing only on the here and now.  According to Davis, “Obtaining some sort of food and shelter at the present moment in time is of first priority and is an allconsuming activity. Any concept of the future for a homeless person is abstract and nebulous” (Davis). 

We were also able to find some interesting thoughts and opinions of people living on the streets about relationships.  There is an awesome forum online written by people who have been homeless at one time, or are currently homeless, called The International Homeless Forums (Relationships on The Streets).  One thread in particular that was very interesting answered a question about relationships on the streets and whether they were always a blessing or a curse with nothing in between.  The question itself was a bit confusing, but the answers people posted were phenomenal!  I think they will give you a better idea about relationships than I could ever write about, so here goes: 

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Life would perhaps be easier if I had never met you.
Less sadness each time we part,
Less fear of the next parting and the next after that,
And not so much either of this powerless longing when you’re not there,
Which wants only the impossible.
And that right away next minute,
And when that can’t be and is hurt and finds breathing difficult.
Life would perhaps be simpler if I had never met you…
Only it wouldn’t be my life. ~Anonymous 

…too many homeless men, not enough women, being single, get propositioned often….just never met the right guy….it’s COLD sleeping alone…it’s hard doing everything yourself…just to have someone rub your aching shoulders…. 

most men think ‘if I had someone like you, I’d overcome…..” fill in blank….to have someone to do it for…I say, must always do for own self…if person you do it for leaves then where will you be.. 

The relationships i had while homeless were all pretty much out of being lonely and “just need help” and for someone to “protect “… 

I didn’t have any romantic relationships while living on the streets – I just don’t think I was interested in them, there was too much else on my mind.
I did however have some close friends who were also homeless and provided a lot of support. And it’s good to have someone to share bodyheat with on cold nights. One of my friends was… quite large, we’ll just say, and sleeping next to him used to keep me warm. 

Of course, there are many different opinions on the same subject, but the overarching theme I saw was the stress of living in such a situation makes lasting relationships difficult.  Instead, a relationship is someone to lift their spirits every once in a while and someone to help them through the hard times.  It was said, however, that they have seen some relationships work, even ones that have helped the people pull their lives together and get out of their situation.  This just doesn’t seem to be the norm. 

Mental Process/Learning: Due to the nature of the living situation, it seems to be that the majority of the learning that takes place on the streets is in the form of learning what to do to survive.  Within any culture, one thing that is learned is one’s sense of time.  For the homeless population, the present-time orientation seems to be important.  “Present-time orientation is that that is focused on the here and now. Present-time orientation is a common phenomenon for individuals who do not have a bright future, or who believe that their survival is tenuous” (Davis).  The individual’s focus is on how to get enough food and where they can sleep. 

Image via girlsguidetohomelessness.com

Another learned characteristic is that of invisibility.  According to Davis, “Homeless people are in constant danger because of the lack of a safe habitat. If a person is “invisible” or not noticeable, that person is less likely to attract attention and may avoid a dangerous life-threatening situation” (Davis).  Overall, these two concepts of focusing on the here and now of survival and invisibility are two examples of the learning that occurs within the “homeless culture.” 

Work Habits/Practices: The most generalized view about homeless people is that they have no work ethic and just need to go get a job.  This is, however one aspect of the culture that is severely overlooked.  According to “Who is Homeless?” 13% of the homeless population is employed.  Another interesting thing to consider is the declining wages in our country and the resulting inability to afford housing, resulting in the person loosing their job.  It is a vicious cycle that usually isn’t the fault of the individual themselves.  In fact, “in every state, more than the minimum wage is required to afford a one- or two-bedroom apartment at Fair Market Rent” (2009).

(www.youtube.com)

Section 3: Demographics and Statistics 

In a recent study done by the National Law Center on Homelessness and Poverty, approximately 3.5 million people, 1.35 million of them children, are likely to experience homelessness in a given year.  This translates to approximately 1% of the U.S. population experiencing homelessness each year, 38% to 39% of them being children (How Many People…, 2009).

Additionally, homelessness is increasing.  In the U.S. Conference of Mayors report from 2008, 19 of the 25 cities studied reported an increase in homelessness from 2007.  Furthermore, the recent home foreclosure crisis has led to even further increases in homeless individuals and families.  In the U.S. Conference of Mayor’s 2008 Report, 12 of the 25 cities surveyed reported an increase in homelessness due to foreclosures (How Many People…, 2009).

Homeless estimates by state. (2007). [Web]. Retrieved from http://www.docudharma.com/diary/14657/find-out-how-many-kids-are-homeless-in-your-state

Who are these people?  A study by the Urban Institute shows that nationwide, children make up 39% of the homeless.  Adults between 31 and 50, however, make up the highest share of the homeless at 51%.  Other studies show the number of elderly homeless as varying between 2.5% and 19.4%.  Single men become homeless most often (40% of the total), while single women make up 14%.  Homeless families make up 38% of the homeless.  Here is a chart showing estimates similar to above:

Us and uk homeless statistics. (2002). [Web]. Retrieved from http://hubpages.com/hub/Dying-to-Eat

About 40% of homeless men have served in the US armed forces.  Another study has shown that 11% of the homeless in urban areas are veterans of wars.  In addition, about 22% of homeless Americans have serious psychiatric disorders (VG, 2004). 

Oldtimer. (Designer). (2007). Male homeless population. [Web]. Retrieved from http://oldtimer.wordpress.com/fact-43-of-homeless-males-over-25-are-veterans/

In a 2006 study, it was found that minorities are grossly over-represented in the homeless population.   39% are non-Hispanic whites (compared to 76% of the general population), 42% are African-Americans (compared to 11% of the general population), 13% are Hispanic (compared to 9% of the general population), 4% are Native-American (compared to 1% of the general population), and 2% were Asian (Facts and Figures…., 2009). 

(www.youtube.com)

Where do they live?  A recent study of Americans who have been homeless showed that a high number of basically homeless individuals slept in automobiles (59.2%) or sought temporary refuge in cardboard boxes, tents, caves or railcars (24.6%) (VG, 2004).  The rest sought refuge in emergency shelters, transitional housing, or permanent supportive housing.  

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How long are people homeless?  The average length of stay in emergency shelter is 69 days for single men, 51 days for single women, and 70 days for families.  For those staying in transitional housing, the average stay for single men was 175 days, 196 days for single women, and 223 days for families.  Permanent supportive housing has the longest average stay, with 556 days for single men, 571 days for single women, and 604 days for women (How many people…. 2009).

Why are people homeless?  The shortage of cheap housing and housing assistance programs are the main factors in the rising number of homeless in the US.  Domestic abuse is another cause of homelessness.  According to the Ford Foundation, about 50% of all homeless women and children were victims of physical or other abuse by their own family members.  Another study, which surveyed 777 homeless parents (mainly mothers) living in 10 US cities showed that 22% of the respondents left their homes because of domestic abuse (VG, 2004).

Some misc. statistics:

  • 13% of homeless individuals were physically disabled (U.S. Conference of Mayors, 2008).
  • 19% of single homeless people are victims of domestic violence.
  •  2% are HIV positive. 
  • 19% of homeless people are employed (How many people…. 2009). 

Section 4: Health Care Environment 

"Street Nurse" Image via canada.com

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Five things nurses should be aware of according to research done by Nickasch and Marnocha (2009) are: 

1) Provide compassionate care by listening to the patient’s story and concerns. Give them your respect and undivided attention. Ask questions to give the opportunity to find out more about them (p. 45). 

2) Homeless have limited access to resources required to follow discharge advice, like medication regimens, treatments, or referrals. Health care providers should get creative when recommending treatment plans that can be followed (p. 44). 

3) Homeless individuals expend tremendous energy on survival strategies such as obtaining food, shelter, and a place to rest. Only after these basic human needs are met are they able to focus on their other health issues. This results in complications in illnesses of the homeless that may be been prevented if earlier care was sought (p. 39). 

4) Making health care accessible by offering true free clinics, transportation, and time increases the likelihood of seeking care (p. 44). 

5) Taking steps to assist in finding shelters, soup kitchens, and affordable referrals to dentist, mental health providers, and other medical professions are some ways to assist in receiving basic needs (p. 45). 

 Health Risks: 

The homeless are at risk for the same diseases as many Americans like heart disease, type II diabetes, cancers, mental health disorders, and many many others. However, due to a lack of shelter, healthy food, adequate clothing, exposure to the elements, and inability to afford or access health care, these risks are exacerbated greatly. A majority of illnesses experienced by the homeless are chronic illnesses that have been uncontrolled or untreated. According to Savage et al. (2006) these include: drug addiction, depression, alcoholism, hypertension, arthritis, asthma, chronic back pain, chronic lung diseases, diabetes, high cholesterol, chronic digestive disease, mental health conditions, migraine headaches, sexually transmitted diseases, stroke and severe allergies (p. 230). 

Image via flickr.com

Youth homeless, a subculture of the homeless population, have additional, or greater instances of risk factors. Many homeless youth are displaced from their homes as a result of choosing a life on the streets rather then continue living in a physically or sexually abusive home (Oliveira and Burke, 2009, p. 155). Because of this, youth homeless have an increased risk for mental health disorders such as depression, bipolar disorder, self mutilation, and drug abuse. In addition to that, many youth are further exposed to violence and sexual exploitation on the streets. They are at increased risk for sexually transmitted infections (Oliveira and Burke, 2009, p. 160). Just as the adult homeless populations, youth homeless have limited access to health care, sometimes even less so because they don’t fit into the societal roles of children, and tend to avoid places where they will be scrutinized by others. This leaves them open to exacerbated common pediatric health conditions, such as asthma, seizure disorders, anemia, skin problems, and obesity just to name a few (Oliveira and Burke, 2009, p. 160). 

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The female homeless population also have their own unique circumstances that leave them at risk. With out access tohealth care, the female population is at increased risks for undiscovered breast cancer, cervical cancer, and sexually transmitted infections. As some women use survival sex, or prostitution, as a means of getting money they are at an additional risk for unwanted or unplanned pregnancies, sexually transmitted infections, rape or other forms of sexual abuse (Oliveira and Burke, 2009, p.160). 

Perceived discrimination problem: 

According to Nickasch and Marnocha’s. (2009) research study, the homeless culture feel they are unwanted in healthcare. They fear being judged, disrespected, or even thrown out because of their inability to pay or lack of proper identification. Currently, many health care facilities have barriers that block the homeless from receiving treatment. First, with out a telephone or transportation it is difficult just to make an appointment and then get to it (p. 44). Once at the clinic, they may have no form of identification, no health insurance or money to pay for the visit, and difficulty filling out the forms (p. 44). If the person manages to get past all of these blockades, they feel that the health care employees feel like they are nothing or just a number and treat the person as such (p. 45). They feel a lack of respect and compassion, as well as judgment. Even after seeing the doctor, more obstacles are in place. If the homeless client is written a prescription, it may remain unfilled because they cannot afford the medication. If treatments are prescribed, again transportation may not be accessible (p. 45). Health care is simply not set up to meet the needs of the homeless population. 

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Even in their daily lives, the homeless population is continuously made to feel unwanted, undeserving and inadequate. Often, they stick to isolated areas in efforts to avoid confrontation with the public. They are at an increased risk for violence, homicide and suicide (Hubert, 2005, p. 241). Currently, there is a stereotype against the homeless that they lead themselves to their own demise and that if they wanted to, they could better their situation with a little bit of effort. However, many homeless individuals feel they have an external locus of control, or that they have no control over their circumstances (Nickasch & Marnocha, 2009, p. 43). 

Differences between homeless and US culture: 

In the United States, our culture values success, material things, and efficiency. The homeless populations are considered outcasts of this culture despite the fact that they are part of the American population. They have a contrasting set of rules, moral guidelines, and habits. For example, the culture of the homeless is described as extreme poverty, lack of hygiene, a sense of alienation and purposelessness (Flaskerud & Strehlow, 2008, p. 1151). When it comes to health care practices, the American and homeless cultures also have differing ideas. The homeless are more likely to be alcohol or drug abusers, though not much more likely then the general US population. Additionally, rather then seeking health care as soon as possible for ailments as the general American population does, the homeless have a lack of access to health care, causing them to avoid it until conditions are no longer able to be ignored (Nickasch & Marnocha, 2009, p. 44). 

Taboos: 

Upon doing research for the homeless culture, no health care taboos were uncovered. However, general disrespect and judgment was described by this population as additional reasons why health care is not sought out earlier. Some members have described not feeling welcomed or a burden to the clinics they went to, discouraging them from disclosing their needs and situations (Nickasch & Marnocha, 2009, p. 45). As heath care members we need to be aware of this attitude and make it our business to combat it while providing care to the homeless population. 

Section 5: Resources 

Spokane, Washington is home to several homeless shelters. Here is a list of a few, along with their mission statements. (Click on the name to be taken directly to the web site!) 

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The Union Gospel Mission  

“truly helping people return to society as contributing members” 
  • They provide numerous services and have been open since 1951. 
  • Food, clothing, shelter, a medical clinic, recovery programs, etc. 

  The Salvation Army-Stepping Stones 

“Rebuilding lives by rebuilding hope” 

  • They offer a “secure, drug and alcohol free environment for stabilization of families” 
  • Case managers work with families to find the cause of their homelessness and help them work toward permanent housing. 

The House of Charity 

“For the Homeless, for the Hungry, for the Hurting, for the Weary” 

  • “basic necessities for physical survival and include food, medical care, mental health counseling and case management, housing, shower and toilet facilities, laundry, clothing, personal effects storage and more” 
  • Host the only completely free medical service in Spokane thanks to local registered nurse and doctor volunteers. 

Cup of Cool Water 

“empower street youth to become wholehearted followers of Christ and to exit street life” 

  •  They offer outreach programs, meals, laundry, job opportunities, showers, shelter, bible study, etc. for street youth. 

Feed Spokane 

“We care, we share” 

  • This is a non-profit “food rescue agency” whose goal is to eliminate waste and hunger by rescuing prepared food from are resturants and donating it to those in need. 
  • They donate to 30 different sites and serve 3,000 meals every day to those in need throughout our community. 
 

Image via ksl.com

Section 6: How YOU Can Help 

 The resources listed above all take applications for volunteers as well as money and item donations.  Also, sometimes just listening to someone, or referring them to these resources is of great help. 

Image via homelessness.change.org

References:

Culture. (2010). Merriam-Webster Online Dictionary.  Retrieved March 27, 2010, from http://www.merriam-webster.com/dictionary/culture.

Davis, R.  (1996).  Tapping Into The Homeless CultureJournal of Professional Nursing, 12:176-183.

Facts and figures: the homeless. (2009, June 26). Retrieved from http://www.pbs.org/now/shows/526/homeless-facts.html 

Flaskerud, J., & Strehlow, A. (2008). Cultural competence column. A culture of homelessness?. Issues in Mental Health Nursing, 29(10), 1151-1154.

Homelessness.  Encyclopedia of Mental Disorders.  Retrieved March 21, 2010, from http://www.minddisorders.com/Flu-Inv/Homelessness.html.

How many People experience homelessness?. (2009, July). Retrieved from http://www.nationalhomeless.org/factsheets/How_Many.html

Hubbert, A. (2005). An ethnonursing research study: adults residing in a midwestern Christian philosophy urban homeless shelter. Journal of Transcultural Nursing, 16(3), 236-244.

Nickasch, B., & Marnocha, S. (2009). Healthcare experiences of the homeless. Journal of the American Academy of Nurse Practitioners, 21(1), 39-46.

Oliveira, J., & Burke, P. (2009). Lost in the shuffle: culture of homeless adolescents. Pediatric Nursing, 35(3), 154-161.

Relationships on the streets – blessing or curse.  The International Homeless Forums.  Retrieved March 19, 2010, from http://www.homelessforums.org/showthread.php?s=f98f2acedc40723ace4a2c805942a1ce&t=608

Savage, C., Lindsell, C., Gillespie, G., Dempsey, A., Lee, R., & Corbin, A. (2006). Health care needs of homeless adults at a nurse-managed clinic. Journal of Community Health Nursing, 23(4), 225-234.

VG. (2004, April 19). Homeless in america. Retrieved from http://www.washprofile.org/en/node/2295

(2009) Who is Homeless?  The National Coalition for the Homeless.  Retrieved March 19, 2010, from http://www.nationalhomeless.org/factsheets/who.html.

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