Who Experiences Homelessness?
People with Unaddressed Health Conditions
Like many Americans, people experiencing homelessness (and especially unsheltered homelessness) frequently live with one or more chronic diseases. Often, these are common health issues that could be managed with access to primary care and generic medication. In other cases, they are complex or progressive issues — including mental health and substance use disorders — which require more intensive treatment options. Homelessness worsens both, exacerbating health conditions and increasing morbidity associated with cardiovascular, respiratory, and infectious diseases.
The Link Between Homelessness and Health
Although the root cause of homelessness is the lack of affordable housing, health conditions can be a contributing factor in a person losing their housing. Whether it’s a progressive chronic disease, an acute injury or illness, a mental health condition, or addiction, people experiencing homelessness face stark and worsening medical vulnerability without access to housing and healthcare. Complicating matters, most homelessness systems are not equipped to address these health challenges on their own.
Living with Disabilities
Unmanaged disabilities (whether physical, behavioral, or cognitive) can increase the risk of losing housing. Without access to healthcare or supportive services, many people with disabilities find it hard to stay employed or housed. Nearly a quarter of people experiencing homelessness have a disability, and certain health conditions are more common among people experiencing homelessness. For example, people experiencing homelessness are five times more likely to have HIV, five times as likely to have hepatitis, four times as likely to have a stroke, three times as likely to have dementia, and twice as likely to have COPD.
Substance Use Disorders and Homelessness
The stress of surviving on the streets can fuel addiction, just as addiction can contribute to housing loss. Unfortunately, for people housed and unhoused alike, there are high barriers to accessing the limited drug treatment services available in this nation, making it harder to break the cycle. Even when treatment is available, it is not as effective as it could be without the stability of permanent housing.
Mental Health and Behavioral Health Issues
The United States has a massive shortfall of mental health professionals, and difficult systems for accessing the services people need. People with the lowest incomes and without adequate healthcare coverage are particularly vulnerable to managing mental health issues — a devastating situation for people who are homeless or housing insecure.
The Vulnerabilities of Aging
The fastest growing group of people experiencing homelessness are people over the age of 55. As with all people, advancing age is related to a myriad of health issues, which will worsen over time without appropriate treatment.
Those with the Greatest Needs
Chronic homelessness describes people who have experienced homelessness for at least a year — or repeatedly — while struggling with a disabling condition such as a physical disability, serious mental illness, or substance use disorder. This form of homelessness has been on the rise since 2017, and reached a record level in 2024, reflecting the deep unmet housing and healthcare needs for this especially vulnerable population.
What Causes Chronic Homelessness
People experiencing chronic homelessness typically have chronic and lifelong health conditions. Once they become homeless — regardless of what immediately caused them to lose their housing — it is difficult for them to get back into housing without intensive help. As a result, they often face long and/or released episodes of homelessness.
What Solves Chronic Homelessness?
Permanent Supportive Housing pairs a housing subsidy with intensive case management and supportive services, which may include healthcare, behavioral health, and addiction treatment (among several other service options). This solution has been proven to help people stay stably housed, and to improve their health and well-being. Investments in Permanent Supportive Housing have been credited for helping decrease chronic homelessness between 2007 and 2019; it has also been shown to lower public costs associated with the use of crisis services such as shelters, hospitals, jails, and prisons.
Housing as Healthcare
Recovering from a health condition without the safety and stability of housing is impossible for most people. Whether it’s taking medicines as prescribed, keeping wounds clean, getting to appointments as scheduled, or accessing the supportive services that are the foundation for recovery, none of it works as well as it does when people have a safe and stable place to call home.
A Foundation for Recovery
Recovery from any sort of disability or illness can be a lot for anyone to manage. Appointments need to be made and kept. Medications need to be appropriately stored and taken as directed. Records and various forms of documentation need to be available. Managing any of that from the chaos and disruption of homelessness is extraordinarily difficult for people with high needs.
A Pathway to Access
It’s hard to get the care we all need, whether that’s finding a new Primary Care Physician, making appointments with a therapist, getting a referral to a specialist, or getting a prescription refilled at the last minute. When housing is combined with supportive services, however, people have the best shot at accessing the services they need, when they are ready for them.
Better Outcomes
When people are first connected to permanent housing, not only is their homelessness ended, but their health needs are better addressed. This approach has been associated with lower hospitalization rates and reduced use of costly emergency services. It is also more effective at increasing the use of outpatient services, and results in better engagement of clients who are not appropriately served by the public mental health system.
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