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Helping The Homeless Essay | 800+ Words Essay on Helping The Homeless Essay

August 11, 2021 by Prasanna

Helping The Homeless Essay: People are categorized as homeless if they are living on the streets or are moving between temporary shelters, including houses of friends and family. However, the legal definition of homelessness may vary between countries or jurisdictions in the same country. Regardless, being homeless is detrimental to one’s physical and mental health. It has been even linked to higher usage of illicit substances a greater risk of suicide attempts. Such individuals also have limited access to resources and are more susceptible to extreme weather events. Even the current pandemic has left many of the homeless either deceased or facing severe repercussions of the virus. Hence, these individuals need help to get back on the right track. Doing so will at least enable them to have a near-normal life. We shall take a look at the ways we can help the homeless and the needy.

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Moral Support: Homeless individuals often lack access to basic needs and necessities such as food, clothing and education. Moreover, they might be socially, economically and politically deprived. This can cause mental distress and resentment towards others. Giving such individuals moral support and empathy might alleviate their troubles to some extent. It makes them feel like someone actually cares about their condition and wishes to change some aspects of it. Doing so will also open up opportunities that may help them live better lives. Moreover, such people will need help in order to discover their strengths and capabilities. A little moral support can help turn them into self-sufficient individuals who will be able to stand on their own two feet.

Social Platforms: In today’s day and age, the internet has become a platform for connecting with people around the world. Hence, it can also be used to create awareness about certain things. Various social media networks such as Facebook and Twitter helps to spread awareness as well as to reach out when people are in need. Granted, a homeless person may not have access or have limited access to the internet or a smartphone. Hence, helping these individuals to create an online presence is the least one can do. Such social groups can lend a helping hand to the downtrodden and homeless. Moreover, the internet is a place of opportunities and if given proper training, these individuals might be able to make some money to keep themselves from starvation.

Financial Help: Granted, financial help might not be very feasible in the long run, but it might temporarily alleviate the basic problems of living. This can include buying clothing, food, temporary shelter or medications for such individuals. Moreover, taking care of one or two homeless individuals might be feasible, but one should consider associating themselves with charitable houses to donate money or supplies to a large number of homeless individuals. However, the main goal of financial help must be to transform these homeless individuals into self-reliant and useful members of society through skill training or other productive activities.

Raising Funds: Another way we can help the homeless is by raising funds. There are many charitable organizations whose sole purpose is to help homeless individuals relocate and provide assistance so that they can become self-sufficient. Such organisations also impart skill development and training which might enable these individuals to become financially independent.

Collection Drive: One might consider organising a collection drive for food, clothing, or other essentials which might benefit the homeless and the needy. Collection drives can be done at places of public gathering such as offices, schools and even colleges. It is also considered to be one of the most feasible ways to provide help for the poor and downtrodden. People can drop off donations at predetermined locations, and these will be redistributed among the homeless. Even books that might educate or entertain the homeless can be donated as it might improve their morale.

Volunteering: People with marketable skills can volunteer their time and effort to help the homeless. Such noble acts may not bring in monetary incentives but are sure to leave people with boosted morale, empowerment and a sense of gratitude. Many homeless children do not have access to basic education or even learning resources, hence, individuals who can volunteer to teach these children can make a meaningful difference in society. Similarly, homeless individuals lack access to basic healthcare, hence doctors or medical professionals can volunteer to treat these individuals and make their lives a little more tolerant. Granted, volunteering takes a lot of precious time and effort, but sparing just a few hours in a week can make a lot of difference to these homeless individuals. Regardless of the type of volunteering work, any kind of help is a welcome change for this group of people.

Empathy: Showing empathy and understanding is basic human nature. This is due to the fact that nobody chooses to become poor. It is their circumstances and course of action that led to them being homeless. Moreover, making mistakes is human nature, hence, one should see through stereotypes and understand a person before passing judgment. Granted, there are people who never change their behaviour, attitudes and opinions regardless of their situation. But for the people who are willing to change their ways after seeing the error in their ways, all they need is a helping hand to get back on their feet.

In conclusion, homeless individuals are a part of society and they are also the weakest links. Hence, in order to help improve our society, we need to help the homeless and needy. Doing so not only makes our lives better, but it will improve the lives of others and this makes a meaningful difference to society.

FAQ’s on Helping The Homeless Essay

Question 1. Why should we help the homeless?

Answer: Homeless individuals are still humans and they might not be able to live their lives without our help. They may not have access to resources or finance, without which they might perish. Moreover, helping these individuals is like helping society.

Question 2. What are some ideas to help the homeless?

Answer: One can help the homeless through any means. For instance, they can directly donate essentials or provide financial assistance to the homeless. We can also organise awareness drives and perform volunteering work to alleviate the condition of the homeless. Furthermore, we can also use social media to reach a wider audience or to raise funds for the homeless.

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Essays About Homelessness: Top 8 Examples Plus Prompts

Everyone has heard of homeless people at some point in their lives; if you are writing essays about homelessness, read our top essay examples and prompts.

Poverty is one of the greatest evils in the world. Its effects are seen daily, from people begging on the streets to stealing to support their families. But unfortunately, one of the most prominent and upsetting diversity is homelessness. Homelessness is a significant problem in even the most developed nations, including the U.S. and Canada. Despite all the resources used to fight this issue, countries often lack the means to reduce homelessness significantly. With the proper aid, homelessness can be entirely eradicated in the future. 

If you want to write essays about homelessness, keep reading to see our essay examples and helpful writing prompts.

2. A journey with the homeless by Sujata Jena

3. i chose to be homeless: reflections on the homeless challenge by emily kvalheim, 4. my experience being homeless by scott benner, 5. what people get wrong when they try to end homelessness by james abro, 1. causes of homelessness , 2. how can homelessness be reduced, 3. mental illness and homelessness, 4. reflection on homelessness, 5. is homelessness a “personal problem”.

Are you looking for more? Check out our guide packed full of transition words for essays

1. That Homeless Man is My Brother by Megan Regnerus

“But the subtext of my friend’s statement is really Why should I give money to someone who’s lazy; who isn’t willing to work for money like I do?’ And to that I say, her opinion that people who ask for money are freeloaders who could work but choose not to, is based on assumption. It relies on the notion that the two things that shape us into able-bodied adults who can hold down a regular job, nature and nurture, are level playing fields. And they’re not.”

Regnerus writes about a friend’s claim that the homeless are “lazy,” reminding her of her homeless brother. She cites genetics and circumstance as contributing factors to homelessness. Despite the other woman being her friend, Regnerus strongly refutes her belief that the homeless are non-disabled freeloaders- they should be treated with empathy. For more, check out these articles about homelessness .

“I realize that the situation of poverty and homelessness is a huge social problem around the world. But when I meet them, I face fellow human beings, not some abstract “social problem.” The very phrase, “What would Jesus do at this scene?” haunted me.  I ventured to ask their names, age, where they came from, where they live (street, bridges, cemetery) and the reason they are on the streets. Their stories are poignant. Each one has a unique story to tell about his/her reason to be homeless, how they were forced to leave distant rural villages to live on the city streets. I tried to listen to them with empathy.”

In her essay, Jena remembers the homeless people in Manila, Philippines. She can see them beyond some “aspect of society” as human beings. She empathizes with them extensively and recalls the words of Jesus Christ about loving others, particularly the neediest.

“I, too, have not been compassionate enough, and I have allowed my prejudices to distort my view of the homeless. One woman, who sat across from me at a feeding program, talking to herself erratically, may have seemed strange to me before the Homeless Challenge. But when I really saw myself as her equal, and when I took the time to watch her get up and laugh as she danced to the music playing in the background, I thought she was beautiful. She had found her own happiness, amidst despair.”

Kvalheim details her experiences during an immersion challenge with the homeless. She recalls both the discrimination and generosity she experienced and her experiences with other homeless people. She was amazed to see how they could stay positive despite their terrible circumstances. We should be thankful for what we have and use it to help others in need. 

“As my funds dwindled, and the weather got colder, I sought shelter at Father Bill’s in Quincy Ma. When you are homeless, sometimes very small things mean a lot. A dry pair of socks, shoes without holes, a pocketful of change. You begin to realize how much you value your personal space. You begin to realize other people want space too. A lot of people have issues or have suffered in one way or another and you can see their pain. I think that there are people who for a variety of issue are chronically homeless and a larger portion of homeless are transitioning through a series of bad events.”

Benner’s essay, written for the company ArtLifting, reflects on his experience of being homeless for a brief while. Then, he and his wife grew ill, and Benner sought refuge at a homeless shelter after his company shut down. After that, he realized how his struggles were very different from those of others and the value of the more minor things he previously took for granted. Luckily, he escaped homelessness by making art with the help of ArtLifting. 

“The court denied my sister’s request and named me our mother’s legal guardian, but it appointed my sister as guardian of her property.  In 2009, when my mother passed away, my sister evicted me. The day I was scheduled to move out, I stood in a convenience store, dazed, as I stared at microwaveable meals.  These would be my new staple when I moved into the motel room. My phone rang—my sister.  She told me she needed me out of the house in a couple of hours—she was a real estate agent and a client wanted to see the house. ‘No hard feelings,’ she said.”

Similar to Benner, Abro narrates the circumstances surrounding his homelessness. After his mother’s death and a conflict with his sister led to his eviction, he ended up homeless. While his situation was unfortunate, he believes that there are many people worse off than him and that something must change to address the housing and poverty crises in America.

Top 5 Prompts On Essays about Homelessness

For your essay, it would be interesting to write about how people become homeless in the first place. Research the different causes of homelessness and elaborate on them, and be sure to provide sources such as statistics and anecdotes. 

What solutions to homelessness can you think of? In your essay, propose at least one way you think the homelessness problem can be solved or at least reduced. It must be concrete, realistic, and defensible; be sure to explain your solution well and defend its feasibility, backing up your claims with facts and logic. 

Homelessness and mental health can be linked—research into declining mental health and how homelessness can impact a person’s mental well-being. Make sure to use research data and statistics to show your findings. Conclude whether poor mental health can cause homelessness or if homelessness causes poor mental health.

You can write about what homelessness means to you in your essay. Perhaps you’ve heard stories of homeless people, or maybe you know someone who is or has been homeless. Use this essay to highly the effects of homelessness and how we can work together as a society to eradicate it.

Many say that homeless people “choose to be homeless” and are underachievers; otherwise, they would simply “get a job” and lift themselves out of poverty. Is this true? Research this topic and decide on your stance. Then, write about whether you agree with this topic for a compelling argumentative essay.

If you’re still stuck, check out our general resource of essay writing topics .

5 Essays About Homelessness

Around the world, people experience homelessness. According to a 2005 survey by the United Nations, 1.6 billion people lack adequate housing. The causes vary depending on the place and person. Common reasons include a lack of affordable housing, poverty, a lack of mental health services, and more. Homelessness is rooted in systemic failures that fail to protect those who are most vulnerable. Here are five essays that shine a light on the issue of homelessness:

What Would ‘Housing as a Human Right’ Look Like in California? (2020) – Molly Solomon

For some time, activists and organizations have proclaimed that housing is a human right. This essay explores what that means and that it isn’t a new idea. Housing as a human right was part of federal policy following the Great Depression. In a 1944 speech introducing what he called the “Second Bill of Rights,” President Roosevelt attempted to address poverty and income equality. The right to have a “decent home” was included in his proposals. Article 25 of the Universal Declaration also recognizes housing as a human right. It describes the right to an “adequate standard of living.” Other countries such as France and Scotland include the right to housing in their constitutions. In the US, small local governments have adopted resolutions on housing. How would it work in California?

At KQED, Molly Solomon covers housing affordability. Her stories have aired on NPR’s All Things Considered, Morning Edition, and other places. She’s won three national Edward R. Murrow awards.

“What People Get Wrong When They Try To End Homelessness” – James Abro

In his essay, James Abro explains what led up to six weeks of homelessness and his experiences helping people through social services. Following the death of his mother and eviction, Abro found himself unhoused. He describes himself as “fortunate” and feeling motivated to teach people how social services worked. However, he learned that his experience was somewhat unique. The system is complicated and those involved don’t understand homelessness. Abro believes investing in affordable housing is critical to truly ending homelessness.

James Abro is the founder of Advocate for Economic Fairness and 32 Beach Productions. He works as an advocate for homeless rights locally and nationally. Besides TalkPoverty, he contributes to Rebelle Society and is an active member of the New Jersey Coalition to End Homelessness.

“No Shelter For Some: Street-Sleepers” (2019)

This piece (by an unknown author) introduces the reader to homelessness in urban China. In the past decades, a person wouldn’t see many homeless people. This was because of strict rules on internal migration and government-supplied housing. Now, the rules have changed. People from rural areas can travel more and most urban housing is privatized. People who are homeless – known as “street-sleepers” are more visible. This essay is a good summary of the system (which includes a shift from police management of homelessness to the Ministry of Civil Affairs) and how street-sleepers are treated.

“A Window Onto An American Nightmare” (2020) – Nathan Heller

This essay from the New Yorker focuses on San Francisco’s history with homelessness, the issue’s complexities, and various efforts to address it. It also touches on how the pandemic has affected homelessness. One of the most intriguing parts of this essay is Heller’s description of becoming homeless. He says people “slide” into it, as opposed to plunging. As an example, someone could be staying with friends while looking for a job, but then the friends decide to stop helping. Maybe someone is jumping in and out of Airbnbs, looking for an apartment. Heller’s point is that the line between only needing a place to stay for a night or two and true “homelessness” is very thin.

Nathan Heller joined the New Yorker’s writing staff in 2013. He writes about technology, higher education, the Bay Area, socioeconomics, and more. He’s also a contributing editor at Vogue, a former columnist for Slate, and contributor to other publications.

“Homelessness in Ireland is at crisis point, and the vitriol shown towards homeless people is just as shocking” (2020)#- Megan Nolan

In Ireland, the housing crisis has been a big issue for years. Recently, it’s come to a head in part due to a few high-profile incidents, such as the death of a young woman in emergency accommodation. The number of children experiencing homelessness (around 4,000) has also shone a light on the severity of the issue. In this essay, Megan Nolan explores homelessness in Ireland as well as the contempt that society has for those who are unhoused.

Megan Nolan writes a column for the New Statesman. She also writes essays, criticism, and fiction. She’s from Ireland but based in London.

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About the author, emmaline soken-huberty.

Emmaline Soken-Huberty is a freelance writer based in Portland, Oregon. She started to become interested in human rights while attending college, eventually getting a concentration in human rights and humanitarianism. LGBTQ+ rights, women’s rights, and climate change are of special concern to her. In her spare time, she can be found reading or enjoying Oregon’s natural beauty with her husband and dog.

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Persuasive Speech About Helping The Homeless

• Categories: Homelessness Poverty in America Social Justice

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Published: Mar 16, 2024

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Top Reasons Why We Should Help the Homeless

Homelessness

Published October 13, 2023

When you see homeless people on the street, what’s the first thing that comes to mind? Are you one of those people who think they deserve it for making bad decisions in life? Or do you stop and ask yourself how you can help them?

Admit it or not, most of us do the former. We blame the homeless for their plight instead of trying to help them get back on their feet. As a society, we’re wired to distrust people we feel are not contributing well to the community . In the news and even in some movies, homeless people are often portrayed as criminals and spreaders of diseases.

Yet, few people realize that most of us are just one paycheck away from living on the streets . It only takes one failed relationship or the death of a loved one to turn someone’s life upside down.

Even the most level-headed person can lose everything with no one to turn to. So it’s not really about the decisions they make. It’s mainly about the circumstances that they found themselves in, to which there is no easy way out.

Thus, instead of blaming them for things beyond their control, we need to help them. If you’re still not convinced, read along.

Reasons Why We Should Help the Homeless

1. they are humans, just like us.

No matter their skin color, religion, or gender identity, we all belong to the same race: humankind. We share the same experience. We all get hungry, feel cold, and need someone to understand us . This is basic for all humans. The only difference is you don’t have to worry about where to get your next meal. Or where to lay your head for the night .

2. They Need Our Help

We need to help the homeless because they need our help . It’s as simple as that. It doesn’t matter whether they can return the favor or not. You shouldn’t need any reason to help someone other than they need help.

3. When We Do Good, We Feel Good

Have you ever noticed that when you help others, you feel different happiness? It’s like this warm feeling spreading all over you that’s difficult to put a name to. That, my friend, is a rare kind of satisfaction that no amount of material wealth can buy.

4. We Are In A Position To Help

That homeless man you see on the street probably didn’t have the same opportunities that you had. That single mother living in the shelter didn’t have the same support system you had. We need to help them because we are blessed to not be in the same situation that they are in. We have the resources that they don’t. In short, we are in a position to help, and so we should.

5. It’s Our Chance to Make a Difference

Nelson Mandela once said:

We can change the world and make it a better place. It’s in your hands to make a difference.

Homelessness is a global human tragedy. But if we work together, we can make the world better for everyone. No matter how small the effort is, it can make a difference. You don’t have to be a billionaire to inspire change. We can all help end homelessness in our own little ways.

6. It’s Our Moral Obligation

As human beings, it’s our moral responsibility to help the most vulnerable members of our society. Even if your moral compass isn’t that strong, common decency dictates that it’s the right thing to do .

7. What Goes Around, Comes Back Around

You may have a stable job and a roof over your head right now. But there is no guarantee that you’ll still have them tomorrow. Most homeless people had jobs and didn’t imagine finding themselves sleeping on the streets. But then, in the blink of an eye, everything can change. Such is life, and that doesn’t exempt you.

This is why we need to help the homeless because what goes around, comes back around. When the time comes that we’ll be in their shoes, we can hope that someone will be willing to help us, too.

8. You Can Help Them Have a Brighter Future

In a commencement address, Steve Jobs revealed that he was once homeless. Steve Harvey, Jim Carrey, Halle Berry, James Cameron, and many other famous people were once homeless. 

But they rose above their circumstances and became the successful people they are now.

You see, most of the time, homelessness is just temporary. Sometimes, they need someone to help them get back on their feet. Contrary to popular belief, some of them are trying.

Thus, we need to help them become productive members of society again. That homeless kid living from shelter to shelter could be the next U.S. president or the next most notorious criminal in the country. It all depends on you.

Practical Ways You Can Help the Homeless

1. volunteer at homeless shelters or soup kitchens.

Offer your time and skills to local organizations that provide essential services to the homeless. You can volunteer to serve meals , organize donation drives, or provide support in any way you can.

2. Donate Essential Items

Many homeless individuals lack basic necessities. These can be warm clothing , blankets, toiletries, and food . Consider donating these items to shelters or outreach programs. Make sure they directly assist the homeless population.

3. Support Job Training and Education Programs

Help homeless individuals get the necessary skills and education to find stable employment. Support organizations that offer vocational training, job placement services, and educational opportunities.

4. Advocate for Affordable Housing

Advocate for policies and initiatives focusing on affordable housing options for the homeless. Support local and national organizations providing safe and affordable housing for those in need.

5. Raise Awareness

Use your voice and platforms. Raise awareness about homelessness and its underlying causes. Share stories , statistics, and personal experiences. This will help break down stereotypes and foster empathy and understanding.

6. Offer Supportive Services

Many homeless individuals have mental health issues or substance abuse problems. Support organizations that provide counseling and rehabilitation services. As well as access to healthcare for those in need.

7. Engage with Local Government

Contact your local representatives and express your concerns about homelessness in your community. Encourage them to divide resources towards homelessness prevention programs and supportive services.

8. Foster Community Connections

Loneliness and isolation are common challenges for the homeless population. Take the initiative to engage with homeless individuals in your community. Listen to their stories and treat them with dignity and respect.

Effects of Homelessness on the Economy and Society in General

The economic consequences of homelessness are significant. When you are homeless, it will be challenging for you to find employment. This results in decreased productivity and loss of potential contributions to the economy.

Homelessness also often leads to increased healthcare costs. This is because they struggle to access adequate medical care, which falls on the government and taxpayers.

The social consequences of homelessness are profound. The homeless face many challenges that can add to their vulnerability. Lack of shelter exposes them to harsh weather conditions. This leads to health issues, including hypothermia and heatstroke.

Homelessness can also increase the risk of substance abuse. As well as mental health disorders and criminal activity. These factors can also contribute to social instability and strained community relationships.

Homelessness places a significant strain on public resources. Governments must divide funds towards emergency shelters, outreach programs, and healthcare services for those experiencing homelessness . This diverts resources from other essential areas, such as education and infrastructure.

Homelessness can strain public safety systems. This includes petty theft, loitering, and public disturbances.

Donate To The Poor & Homeless Of South Florida

Our Father’s House Soup Kitchen has fed the poor and homeless in South Florida over 900,000 hot meals since 1993. Our tax deductible non profit organization also accepts and distributes donations such as clothing, toiletries, shoes, bicycles, and more. You can donate to help the poor and homeless through our website.

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Experts cite complexity of problem, which is rooted in poverty, lack of affordable housing but includes medical, psychiatric, substance-use issues

It took seven years for Abigail Judge to see what success looked like for one Boston homeless woman.

The woman had been sex trafficked since she was young, was a drug user, and had been abused, neglected, or exploited in just about every relationship she’d had. If Judge was going to help her, trust had to come first. Everything else — recovery, healing, employment, rejoining society’s mainstream — might be impossible without it. That meant patience despite the daily urgency of the woman’s situation.

“It’s nonlinear. She gets better, stops, gets re-engaged with the trafficker and pulled back into the lifestyle. She does time because she was literally holding the bag of fentanyl for these guys,” said Judge, a psychology instructor at Harvard Medical School whose outreach program, Boston Human Exploitation and Sex Trafficking (HEAT), is supported by Massachusetts General Hospital and the Boston Police Department. “This is someone who’d been initially trafficked as a kid and when I met her was 23 or 24. She turned 30 last year, and now she’s housed, she’s abstinent, she’s on suboxone. And she’s super involved in her community.”

It’s a success story, but one that illustrates some of the difficulties of finding solutions to the nation’s homeless problem. And it’s not a small problem. A  December 2023 report  by the U.S. Department of Housing and Urban Development said 653,104 Americans experienced homelessness, tallied on a single night in January last year. That figure was the highest since HUD began reporting on the issue to Congress in 2007 .

Abigail Judge of the Medical School (from left) and Sandra Andrade of Massachusetts General Hospital run the outreach program Boston HEAT (Human Exploitation and Sex Trafficking).

Niles Singer/Harvard Staff Photographer

Scholars, healthcare workers, and homeless advocates agree that two major contributing factors are poverty and a lack of affordable housing, both stubbornly intractable societal challenges. But they add that hard-to-treat psychiatric issues and substance-use disorders also often underlie chronic homelessness. All of which explains why those who work with the unhoused refer to what they do as “the long game,” “the long walk,” or “the five-year-plan” as they seek to address the traumas underlying life on the street.

“As a society, we’re looking for a quick fix, but there’s no quick fix for this,” said Stephen Wood, a visiting fellow at Harvard Law School’s Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics and a nurse practitioner in the emergency room at Carney Hospital in the Dorchester neighborhood of Boston. “It takes a lot of time to fix this. There will be relapses; there’ll be problems. It requires an interdisciplinary effort for success.”

A recent study of 60,000 homeless people in Boston found the average age of death was decades earlier than the nation’s 2017 life expectancy of 78.8 years.

Illustration by Liz Zonarich/Harvard Staff

Katherine Koh, an assistant professor of psychiatry at HMS and psychiatrist at MGH on the street team for Boston Health Care for the Homeless Program, traced the rise of homelessness in recent decades to a combination of factors, including funding cuts for community-based care, affordable housing, and social services in the 1980s as well as deinstitutionalization of mental hospitals.

“Though we have grown anesthetized to seeing people living on the street in the U.S., homelessness is not inevitable,” said Koh, who sees patients where they feel most comfortable — on the street, in church basements, public libraries. “For most of U.S. history, it has not been nearly as visible as it is now. There are a number of countries with more robust social services but similar prevalence of mental illness, for example, where homelessness rates are significantly lower. We do not have to accept current rates of homelessness as the way it has to be.”

“As a society, we’re looking for a quick fix, but there’s no quick fix for this.” Stephen Wood, visiting fellow, Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics

Success stories exist and illustrate that strong leadership, multidisciplinary collaboration, and adequate resources can significantly reduce the problem. Prevention, meanwhile, in the form of interventions focused on transition periods like military discharge, aging out of foster care, and release from prison, has the potential to vastly reduce the numbers of the newly homeless.

Recognition is also growing — at Harvard and elsewhere — that homelessness is not merely a byproduct of other issues, like drug use or high housing costs, but is itself one of the most difficult problems facing the nation’s cities. Experts say that means interventions have to be multidisciplinary yet focused on the problem; funding for research has to rise; and education of the next generation of leaders on the issue must improve.

“This is an extremely complex problem that is really the physical and most visible embodiment of a lot of the public health challenges that have been happening in this country,” said Carmel Shachar, faculty director of Harvard Law School’s Center for Health Law and Policy Innovation. “The public health infrastructure has always been the poor Cinderella, compared to the healthcare system, in terms of funding. We need increased investment in public health services, in the public health workforce, such that, for people who are unhoused, are unsheltered, who are struggling with substance use, we have a meaningful answer for them.”

“You can either be admitted to a hospital with a substance-use disorder, or you can be admitted with a psychiatric disorder, but very, very rarely will you be admitted to what’s called a dual-diagnosis bed,” said Wood, a nurse practitioner in the emergency room at Carney Hospital.

Kris Snibbe/Harvard Staff Photographer

Experts say that the nation’s unhoused population not only experiences poverty and exposure to the elements, but also suffers from a lack of basic health care, and so tend to get hit earlier and harder than the general population by various ills — from the flu to opioid dependency to COVID-19.

A recent study of 60,000 homeless people in Boston recorded 7,130 deaths over the 14-year study period. The average age of death was 53.7, decades earlier than the nation’s 2017 life expectancy of 78.8 years. The leading cause of death was drug overdose, which increased 9.35 percent annually, reflecting the track of the nation’s opioid epidemic, though rising more quickly than in the general population.

A closer look at the data shows that impacts vary depending on age, sex, race, and ethnicity. All-cause mortality was highest among white men, age 65 to 79, while suicide was a particular problem among the young. HIV infection and homicide, meanwhile, disproportionately affected Black and Latinx individuals. Together, those results highlight the importance of tailoring interventions to background and circumstances, according to Danielle Fine, instructor in medicine at HMS and MGH and an author of two analyses of the study’s data.

“The takeaway is that the mortality gap between the homeless population and the general population is widening over time,” Fine said. “And this is likely driven in part by a disproportionate number of drug-related overdose deaths in the homeless population compared to the general population.”

Inadequate supplies of housing

Though homelessness has roots in poverty and a lack of affordable housing, it also can be traced to early life issues, Koh said. The journey to the streets often starts in childhood, when neglect and abuse leave their marks, interfering with education, acquisition of work skills, and the ability to maintain healthy relationships.

“A major unaddressed pathway to homelessness, from my vantage point, is childhood trauma. It can ravage people’s lives and minds, until old age,” Koh said. “For example, some of my patients in their 70s still talk about the trauma that their parents inflicted on them. The lack of affordable housing is a key factor, though there are other drivers of homelessness we must also tackle.”

The number was the highest since the U.S. Department of Housing and Urban Development began reporting on the issue to Congress in 2007 .

Most advocates embrace a “housing first” approach, prioritizing it as a first step to obtaining other vital services. But they say the type of housing also matters. Temporary shelters are a key part of the response, but many of the unhoused avoid them because of fears of theft, assault, and sexual assault. Instead, long-term beds, including those designated for people struggling with substance use and mental health issues, are needed.

“You can either be admitted to a hospital with a substance-use disorder, or you can be admitted with a psychiatric disorder, but very, very rarely will you be admitted to what’s called a dual-diagnosis bed,” said Petrie-Flom’s Wood. “The data is pretty solid on this issue: If you have a substance-use disorder there’s likely some underlying, severe trauma. Yet, when we go to treat them, we address one but not the other. You’re never going to find success in the system that we currently have if you don’t recognize that dual diagnosis.”

Services offered to those in housing should avoid what Koh describes as a “one-size-fits-none” approach. Some might need monthly visits from a caseworker to ensure they’re getting the support they need, she said. But others struggle once off the streets. They need weekly — even daily — support from counselors, caseworkers, and other service providers.

“I have seen, sadly, people who get housed and move very quickly back out on the streets or, even more tragically, lose their life from an unwitnessed overdose in housing,” Koh said. “There’s a community that’s formed on the street so if you overdose, somebody can give you Narcan or call 911. If you don’t have the safety of peers around, people can die. We had a patient who literally died just a few days after being housed, from an overdose. We really cannot just house people and expect their problems to be solved. We need to continue to provide the best care we can to help people succeed once in housing.”

“We really cannot just house people and expect their problems to be solved.”  Katherine Koh, Mass. General psychiatrist

Koh works on the street team for Boston Health Care for the Homeless Program.

Photo by Dylan Goodman

The nation’s failure to address the causes of homelessness has led to the rise of informal encampments from Portland, Maine, to the large cities of the West Coast. In Boston, an informal settlement of tents and tarps near the intersection of Massachusetts Avenue and Melnea Cass Boulevard was a point of controversy before it was cleared in November.

In the aftermath, more than 100 former “Mass and Cass” residents have been moved into housing, according to media reports. But experts were cautious in their assessment of the city’s plans. They gave positive marks for features such as a guaranteed place to sleep, “low threshold” shelters that don’t require sobriety, and increased outreach to connect people with services. But they also said it’s clear that unintended consequences have arisen. and the city’s homelessness problem is far from solved.

Examples abound. Judge, who leads Boston HEAT in collaboration with Sandra Andrade of MGH, said that a woman she’d been working with for two years, who had been making positive strides despite fragile health, ongoing sexual exploitation, and severe substance use disorder, disappeared after Mass and Cass was cleared.

Mike Jellison, a peer counselor who works on Boston Health Care for the Homeless Program’s street team, said dismantling the encampment dispersed people around the city and set his team scrambling to find and reconnect people who had been receiving medical care with providers. It’s also clear, he said, that Boston Police are taking a hard line to prevent new encampments from popping up in other neighborhoods, quickly clearing tents and other structures.

“We were out there Wednesday morning on our usual route in Charlesgate,” Jellison said in early December. “And there was a really young couple who had all their stuff packed. And [the police] just told them, ‘You’ve got to leave, you can’t stay here.’ She was crying, ‘Where am I going to go?’ This was a couple who works; they’re employed and work out of a tent. It was like 20 degrees out there. It was heartbreaking.”

Prevention as cure?

Successes in reducing homelessness in the U.S. are scarce, but not unknown. The U.S. Department of Veterans Affairs, for example, has reduced veteran homelessness nationally by more than 50 percent since 2010.

Experts point out, however, that the agency has advantages in dealing with the problem. It is a single, nationwide, administrative entity so medical records follow patients when they move, offering continuity of care often absent for those without insurance or dealing with multiple private providers. Another advantage is that the VA’s push, begun during the Obama administration, benefited from both political will on the part of the White House and Congress and received support and resources from other federal agencies.

The city of Houston is another example. In 2011, Houston had the nation’s fifth-largest homeless population. Then-Mayor Annise Parker began a program that coordinated 100 regional nonprofits to provide needed services and boost the construction of low-cost housing in the relatively inexpensive Houston market.

Neither the VA nor Houston was able to eliminate homelessness, however.

To Koh, that highlights the importance of prevention. In 2022, she published research in which she and a team used an artificial-intelligence-driven model to identify those who could benefit from early intervention before they wound up on the streets. The researchers examined a group of U.S. service members and found that self-reported histories of depression, trauma due to a loved one’s murder, and post-traumatic stress disorder were the three strongest predictors of homelessness after discharge.

In April 2023, Koh, with co-author Benjamin Land Gorman, suggested in the Journal of the American Medical Association that using “Critical Time Intervention,” where help is focused on key transitions, such as military discharge or release from prison or the hospital, has the potential to head off homelessness.

“So much of the clinical research and policy focus is on housing those who are already homeless,” Koh said. “But even if we were to house everybody who’s homeless today, there are many more people coming down the line. We need sustainable policies that address these upstream determinants of homelessness, in order to truly solve this problem.”

The education imperative

Despite the obvious presence of people living and sleeping on city sidewalks, the topic of homelessness has been largely absent from the nation’s colleges and universities. Howard Koh, former Massachusetts commissioner of public health and former U.S. assistant secretary for Health and Human Services, is working to change that.

In 2019, Koh, who is also the Harvey V. Fineberg Professor of the Practice of Public Health Leadership, founded the Harvard T.H Chan School of Public Health’s pilot Initiative on Health and Homelessness. The program seeks to educate tomorrow’s leaders about homelessness and support research and interdisciplinary collaboration to create new knowledge on the topic. The Chan School’s course “Homelessness and Health: Lessons from Health Care, Public Health, and Research” is one of just a handful focused on homelessness offered by schools of public health nationwide.

“The topic remains an orphan,” said Koh. The national public health leader (who also happens to be Katherine’s father) traced his interest in the topic to a bitter winter while he was Massachusetts public health commissioner when 13 homeless people froze to death on Boston’s streets. “I’ve been haunted by this issue for several decades as a public health professional. We now want to motivate courageous and compassionate young leaders to step up and address the crisis, educate students, motivate researchers, and better inform policymakers about evidence-based studies. We want every student who walks through Harvard Yard and sees vulnerable people lying in Harvard Square to not accept their suffering as normal.”

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How Communities are Building Systems to Reduce and End Homelessness

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• Community & Economic Development
• Race & Equity

Our work has always been dedicated to ending homelessness. But the complex nature of homelessness has challenged our notions of what it takes to solve it, over and over again. 

In 2014, our organization  Community Solutions  announced the completion of an initiative known as the 100,000 Homes Campaign. 186 participating communities aimed to collectively house 100,000 of the most medically vulnerable Americans experiencing homelessness. In many regards, it was a tremendous success. Communities had increased housing placement rates for individuals experiencing chronic homelessness by over 200%, connecting more than 105,000 Americans to a home in under four years. 

But there was a problem: none of those communities ended homelessness for a population.

Instead of helping communities count up to a certain number of housing placements, we needed to learn what it takes to count down to zero people experiencing homelessness. . 

We have now worked with 14 communities that have achieved this aim for a population by achieving a milestone known as functional zero. They are participating in  Built for Zero , a national initiative of more than 80 cities and counties dedicated to measurably and equitably ending homelessness. 

In partnership with these cities and counties, we have had the opportunity to identify four necessary features of a system designed to drive and sustain reductions in homelessness.

A Unified Accountable, Community-Wide Team

One of the key challenges to ending homelessness is the distributed nature of homelessness response. In any community, dozens or even hundreds of organizations may serve people experiencing homelessness, each defining success by their own program measures.

Communities must begin by breaking down these siloes to establish a unified team that creates shared accountability across these efforts . In many Built for Zero communities, these teams are committed to working together weekly to examine how they can connect people to permanent housing, moving from a mentality of “my client” to “our clients.” They can see the system as a whole and collectively remove barriers that are impacting the whole population of people experiencing homelessness. 

One community was able to find that the process for helping individuals into housing had organically and unintentionally been designed as a process that takes 42 steps and 300 days for a person to navigate. Only by working together could they take a line of sight across this entire system and begin to design something different. 

A Shared Aim and Definition of Success

This fragmented system often means that no one has authority over or accountability for whether all those efforts and investments are adding up to overall reductions in homelessness over time — or whether those outcomes are equitable. This unified team must be grounded by a shared aim and operating definition of how they would know that they were making progress toward that goal. 

In Built for Zero, communities start by setting a goal to measurably end veteran or chronic homelessness. Progress is measured by whether the number of people experiencing homelessness is going down, month over month, toward zero. The community knows it has reached its aim when it achieves  functional zero , or fewer people are experiencing homelessness than can be routinely housed. This indicates not only that homelessness is rare across a population, but that resilient systems are in place to continuously reduce and end it. As communities sustain functional zero for a population, they expand their efforts to other populations, working toward systems that end homelessness for all. 

While ending homelessness is a necessary pathway to an equitable future, we know that these efforts are influenced by the racism embedded in and across our country’s systems. Communities in Built for Zero are using a  measurement framework  to understand and improve the racial equity of a community’s homeless response system as it works toward getting to functional zero. The homeless response system — like any other system — must be explicitly set up to identify and respond to racial disparities if it is to avoid maintaining or even deepening them. 

A Feedback Loop Based on Quality, Real-Time Data

In 2019, one community’s annual Point-In-Time count indicated a 24% rise in chronic homelessness. But as it worked with Built for Zero to gather quality, real-time data, the community found that the 24% increase was reflecting a natural variation that happens over the course of a year, depending on the month. In fact, toward the end of the year, the community had been driving steady reductions in homelessness. 

A shift toward using data for improvement requires a more rapid, reliable, and actionable feedback loop to understand the nature and scale of homelessness at any given time. Communities in Built for Zero have quality, by-name data, which means that they deeply understand homelessness in their community in real time. This includes:

• Every person experiencing homelessness at any given time , by name and individual need.
• The total number of people experiencing homelessness,  including sheltered and unsheltered populations.
• The systems dynamics behind those numbers,  like how many people entered or exited from homelessness that month, and how many people returned from housing.
• The racial equity of a system,  like system decision-making power, the experiences of those being served by the system, and disparities in systems outcomes, like length of time or rates of exit to permanent housing.

To better serve individuals, this data is used by agencies and organizations to connect people with the appropriate support and resources. At the population level, this data enables the community to understand whether investments and efforts are truly adding up to reductions in homelessness. Communities can strategize, test, and evaluate changes to their system — whether that requires looking upstream at other systems that are contributing to people entering into homelessness, or targeting barriers that exist for people working to exit homelessness. This data is also critical for equipping decision-makers with the information they need to advocate for and target resources to drive the greatest possible reductions.

Moving to Systems Designed to Get to Zero

The 100,000 Homes campaign was an important lesson for our team. We learned that taking immediate action to increase housing placements for people is worthy work, by many measures. But without deep systems change dedicated to getting to zero, it did not help communities design systems that could achieve or sustain population-level reductions.

Elected and municipal leaders across the country are facing tremendous urgency to act on homelessness. And through their influence, investments, and convening power, these leaders have a powerful role to play. This includes balancing the immediate actions that produce short-term gains with the deep systems change necessary to equitably and sustainably solve homelessness. To that end, we recommend that leaders ask the following questions in any conversation around ending homelessness:

• Are we all aligned behind a commitment to population-level reductions in homelessness as the critical measure of our success as a city/county? 
• How will this support the community’s aim of functionally ending   homelessness?
• Is the community currently driving population-level reductions in homelessness? 
• How will this effort, investment, or intervention   help communities drive population-level reductions in homelessness — and how would we know? 
• Is real-time, by-name data informing these decisions, and where is that data coming from?

We know homelessness is solvable because communities are proving it every day. Together, we must work to help communities establish the resilient, equitable, and data-driven systems that will ensure this becomes the norm, rather than the exception.

About the Authors:

Anna Kim is the Principal of Communications, Community Solutions

Beth Sandor is the Principal of Community Solutions and Co-Director, Built for Zero,

About the Authors

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What’s the Real Reason People Become Homeless?

Most of us have walked or driven by someone camped out on the sidewalk. Those of us who are parents might have heard this question from our kids: “Why do we have a home and that person doesn’t?”

You probably didn’t have a good answer. Bad luck? A shortage of housing supply and exploding prices? Mental illness? Addiction? Some combination of the four? But mostly you wish the answer wasn’t: “Because we live in an unfair society and we look the other way so that we can function.”

Kevin Adler is an activist and author of the book When We Walk By: Forgotten Humanity, Broken Systems, and the Role We Can Each Play in Ending Homelessness in America . He isn’t afraid of our children’s questions. In fact, he believes he has compelling and effective answers. Flying in the face of the learned helplessness that so many of us feel these days about the unhoused neighbors in our cities, Adler argues that we can stop compartmentalizing and actually do something about it.

I spoke with Adler about his book and how each one of us can be part of building a more hospitable country.

Courtney Martin: One of the fundamental arguments of this book is that homelessness isn’t just a result of economic poverty, but relational poverty. Can you explain what that is and why it’s so rampant?

Kevin Adler: Eleven years ago, I met a person experiencing homelessness named Adam who first attuned me to the concept of relational poverty . I’ll never forget his words: “I never realized I was homeless when I lost my housing, only when I lost my family and friends.”

Adam was in a very tenuous situation in life, but had been able to get by for a while through the support of his loved ones—staying with family, relying on friends for a bit of work or money, etc. When Adam’s access to social capital ran dry—perhaps due to an argument with a loved one, the unexpected death of a family member, or the like—his situation went from bad to worse.

Though we often think of poverty as a lack of financial resources, what Adam was describing was relational poverty , or the profound lack of nurturing relationships which, when combined with stigma and shame, leads to nearly unimaginable levels of isolation and loneliness among many individuals experiencing homelessness. As one unhoused neighbor put it in the early months of the pandemic, “You don’t need to teach me about social distancing, that’s my life already.”

Stories like Adam’s are not unique: As many as one in three individuals experiencing homelessness in the United States have lost their social support systems, attributing the immediate cause of their homelessness to a falling-out with or loss of a loved one.

Homelessness is a housing problem, but it is not only a housing problem. Aside from the lack of stable housing, relational poverty may in fact be the most universal characteristic of experiencing homelessness. As Gregg Colburn and Clayton Page Aldern have indicated in their recent book , “Homelessness risk is far greater for people with limited support from a community, low self-esteem, and a lack of belonging.” This is why [the Housing First model is not called] Housing Only: Indeed, one of the five principles of the Housing First strategy is social and community integration.

Finally, to better understand the significance of relational poverty for so many of our unhoused neighbors, we can look upstream toward our housing insecurity neighbors more generally. With 40% of Americans self-reporting that they would not know where to get $400 for an unexpected emergency, and over one in two Americans one paycheck away from not being able to pay rent, it is actually surprising that more people are not experiencing homelessness. Given these stats, how is it possible that “only” 1-2% of people in the U.S. experience homelessness at some point over the course of the year, rather than 10 to 20 times that? I believe one of the main reasons is due to family, friends, faith-based groups, and other forms of social support helping people get by.

To paraphrase Bill Withers, we all need somebody to lean on. We ignore relational poverty at our own peril.

CM: I really appreciated how you delineated the different reasons that this kind of disconnection can go on for so many years—barriers to access, like internet and cell phone, and administrative issues, for example—but also the emotional fractures. Your nonprofit reconnects folks by jumping over some of the accessibility barriers, but how do you help people deal with the emotional depths of reconnection? Seems like a tall order.

KA: We consider our work to be a first step toward reconnection, and try to set expectations and provide support on all sides accordingly.

For example, in most of the reunion cases that our community of volunteer digital detectives work on each week, it has been years or even decades since the last contact occurred. Thus, the messages we deliver (and encourage) from our unhoused neighbors tend to be openers to re-engage: “I love you,” “I miss you,” “I’m sorry,” “I’m thinking of you,” “I want you back in my life,” “I’m still alive.”

Our staff and global community of volunteers have a mantra (well, several, but here’s one of them): You know your relationships better than we do. Sometimes, reconnecting is not appropriate or in the best interest of one or both parties; tragic cases abound of homelessness resulting from domestic violence, LGBTQ+ youth escaping an unsafe home environment, etc. Sometimes, bridges have been burned between a person experiencing homelessness and most of their loved ones, and family members choose not to reconnect. We don’t believe reconnecting is a one-size-fits-all solution to homelessness. But we know that for many of our unhoused neighbors, it is an essential step toward lasting stability and well-being.

Finally, I think it’s important to note that though the process of reconnecting can be incredibly emotional, the experience of homelessness itself is incredibly emotional, physically devastating, and very isolating—the most heartbreaking cardboard sign I ever saw read, “At least give me the finger.”

When I started this journey by spending a year helping a few dozen of our unhoused neighbors share their stories, I was struck by how many folks talked at length about loved ones who often were no longer in their lives—beloved siblings, favorite teachers, children who are now adults. In other words, it’s not like family isn’t on the minds of our unhoused neighbors.

CM: I was so sad to learn that homelessness is growing among those over 65 and that a quarter of people experiencing homelessness are under 25. What does it say about our society that we tolerate such harsh lives for our most vulnerable? Are there contemporary societies where this is not the case, and what can we learn from them?

KA: Homelessness is a policy choice. Thus, there are plenty of other places where homelessness is not nearly as prevalent as it is today in the United States.

As one example, Finland has received widespread recognition for successfully providing permanent housing without preconditions and wraparound support services to most of its people experiencing homelessness. In 1987, there were 18,000 people experiencing homelessness in Finland. In 2023, the figure had dropped to 3,429.

By contrast, in 1987, there were 500,000 to 600,000 experiencing homelessness in the U.S. According to the 2023 PIT Count in the U.S., that figure has increased to 653,104 people. If we prioritized affordable housing and a robust social safety net for our most vulnerable residents, we would have a much smaller population of people forced to live in shelters and on our streets.

CM: Why do we accept such a broken, costly status quo in the United States?

KA: I believe in large part it is due to another form of relational disconnection: Many of us “housed people” are just as disconnected from our unhoused neighbors as many of them are from their loved ones.

When I give a talk, I tend to ask my audience two questions: “First, how many of you care about the issue of homelessness?” Every hand shoots up. “Second, how many of you know someone who is currently experiencing homelessness?” In response to this question, never more than 5–10% of hands remain in the air.

I believe this disconnection is part of the problem, for we don’t know who “they” are, as the mothers and fathers, sisters and brothers, sons and daughters, friends and neighbors that they are. Instead, we largely see people experiencing homelessness as problems to be solved, not people to be loved. I believe we have a duty to keep reminding ourselves of the fundamental humanity of our unhoused neighbors, lest we lose a bit of our own.

Consider the aftermath of a flood or wildfire. For a brief period of time, we tend to rally around those who were affected, organizing food drives, building shelters, creating online fundraisers and advocacy campaigns, or passing emergency ordinances, in what sociologist Charles E. Fritz described as the emergence of the therapeutic community. We don’t look at survivors of these disasters as deserving of their situation—very few would ask, “Well, did they have the right kind of flood insurance? Why did they choose to live in such a vulnerable area?”

“We largely see people experiencing homelessness as problems to be solved, not people to be loved”

And yet, when it comes to homelessness in the U.S., we maintain a mindset of rugged individualism, and wonder what the person did or what is wrong with the person to result in their situation.

I believe the way to overcome this narrow-mindedness is through relationships and storytelling.

CM: You make a lot of structural suggestions, but one of them is guaranteed income, based on your own successful pilot. Tell us more about that.

KA: I began as a skeptic about basic income . Not so much whether our unhoused neighbors would use the money in a way we might consider wise, but whether a few hundred dollars a month would be enough to help people experiencing homelessness meaningfully improve their lives, much less get off the streets.

Fortunately, our volunteer community was wiser than me. In 2020, we created a phone buddy program, which matches unhoused neighbors with trained volunteers for weekly phone calls and texts. Within a few months of its creation, our volunteers began asking whether we could provide some money to their unhoused friend. Through their interactions, trust was built, relationships were built, and, with it, the desire to see their friend succeed and an understanding of the multitude of barriers keeping them from doing so. And so, in December 2020, we created what turned out to be the first basic income pilot for individuals experiencing homelessness in the U.S.

We gave $500 a month for six months to 14 participants in our phone buddy program, all of whom were nominated by their friends. Within six months, 66% of those who were homeless at the beginning of the program had secured stable housing. They used the money better than we could have used it for them: About one-third of funds were spent on food, another third was spent on housing, and the last third was spent on a mix of child care, storage, paying down debt, supporting family, and the like.

The initial “ Miracle Money ” pilot was very small, but it showed us what we needed to know to double down on direct cash. Today, we are in the final months of a $2.1 million randomized controlled trial, funded by Google.org and other foundations and individual donors, with research led by Dr. Ben Henwood and his team from the USC Dworak-Peck School of Social Work.

The preliminary results are very promising: Among people who received the $750-a-month payment, the proportion who reported spending time unsheltered in the past month decreased from 30% at baseline to under 12% at the six-month follow-up, which was a statistically significant change. For those in the control group, a modest decrease from 28% to 23% was not statistically significant.

Today, there are more than 100 communities across the U.S. and Canada that have pilot programs based on basic income, including some with a focus on homelessness such as the Denver Basic Income Project and the New Leaf Project out of Vancouver. We are excited to be part of this movement to trust people with the resources they need to better their lives.

CM: You encourage individuals reading the book to re-humanize “the homeless” in their own lives, neighborhoods, communities. What is the first step to doing that?

KA: If I can be a bit self-promotional in this last question: Consider volunteering with us as a phone buddy or digital detective at Miracle Messages and reading When We Walk By , as this is a major focus of the book! The awkwardness is normal at first, but no need to go through it alone.

About the Author

Courtney E. Martin

Courtney E. Martin is the author of Learning in Public: Lessons for a Racially Divided America from My Daughter’s School and the Substack newsletter, Examined Family .

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Helping the Homeless in the Community Essay

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

My community service project involves helping the homeless in the community. I am involved in a project which is to to feed the homeless. I am involved in the project every Thursday evening, and I volunteer for two hours. The main task during the two hours is preparing cutlery and to serving the food to the homeless people. I am supposed to volunteer for a total of 25 hours, and I have already covered 10 hours of the total time.

During the last meeting, the leader of the project delegated some tasks to the members of the volunteer group. I am in the team that has to visit the grocery store to investigate the prices of the basic foodstuff. This task is geared toward identifying the cost of food for the homeless people. We particularly have to focus on the living conditions of the homeless people to highlight the level of poverty that they face, and to enable the organizers to come up with the most feasible plans to alleviate their situation. According to my findings from the groceries, an average meal for the homeless people costs $20.

A majority of the people we serve can barely afford this amount, hence, they have to skip meals and survive on whatever they get from begging in the streets. Their situation is dire, and our charity project is barely enough to meet their basic needs. My experience with the homeless people has enlightened me about the adverse effects of poverty. I always had a notion that people can easily get away from poverty, but I have learned that the poor people do not always have an easy way out of their challenges.

CST reveals that it is the responsibility of the society to empower the poor. The experience has a direct link with the CST because I am involved in the attainment of the theme of human dignity that forms the core of the concept. I am acquainted with the requirements of a true Christian, and my conduct while attending to the homeless is guided by the requirements of CST.

According to chapter 5 of See, Judge, Act: Catholic Social Teaching and Service Learning by Erin M. Brigham, economic justice should prevail across the society, and this is the main goal of the project. Through the project, I have realized that there are many people in the streets who cannot afford a meal, and I have related to the ideas presented in the CST that the community should be actively involved in helping the poor.

I have witnessed the level of poverty that faces the homeless people, and I am challenged by the CST to look into helping the homeless whenever possible. While our project is intended to feed the homeless, there should be other projects developed to provide employment opportunities and housing for them. The principle of solidarity is emphasized in chapter 6 of Brigham’s book, and it should be at the heart of the community in the course of empowering the poor.

It is sad to see that the current situation of the homeless people is still very bad, whereas there are many people in the community that have the financial ability to help them rise from their impoverished conditions. CST calls for the entire community to integrate the available resources to help the poor. Giving is highlighted as a blessing by the Holy Scripture, and CST emphasizes on helping to the poor. Helping the needy is not limited to giving tangible things. Offering services to the needy is also an act of giving.

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IvyPanda. (2021, March 28). Helping the Homeless in the Community. https://ivypanda.com/essays/helping-the-homeless-in-the-community/

"Helping the Homeless in the Community." IvyPanda , 28 Mar. 2021, ivypanda.com/essays/helping-the-homeless-in-the-community/.

IvyPanda . (2021) 'Helping the Homeless in the Community'. 28 March.

IvyPanda . 2021. "Helping the Homeless in the Community." March 28, 2021. https://ivypanda.com/essays/helping-the-homeless-in-the-community/.

1. IvyPanda . "Helping the Homeless in the Community." March 28, 2021. https://ivypanda.com/essays/helping-the-homeless-in-the-community/.

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IvyPanda . "Helping the Homeless in the Community." March 28, 2021. https://ivypanda.com/essays/helping-the-homeless-in-the-community/.

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• Destitute and dying: interventions and models of palliative and end of life care for homeless adults – a systematic review
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• http://orcid.org/0000-0003-4949-6847 Megan Rose Coverdale and
• http://orcid.org/0000-0003-1289-3726 Fliss Murtagh
• Wolfson Palliative Care Research Centre, Hull York Medical School , University of Hull , Kingston upon Hull , UK
• Correspondence to Megan Rose Coverdale, Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston upon Hull, HU6 7RU, UK; hymc24{at}hyms.ac.uk

Background Homeless adults experience a significant symptom burden when living with a life-limiting illness and nearing the end of life. This increases the inequalities that homeless adults face while coping with a loss of rootedness in the world. There is a lack of palliative and end of life care provision specifically adapted to meet their needs, exacerbating their illness and worsening the quality of their remaining life.

Aim To identify interventions and models of care used to address the palliative and end of life care needs of homeless adults, and to determine their effectiveness.

Methods Standard systematic reviewing methods were followed, searching from 1 January 2000 the databases: Ovid MEDLINE, EMBASE, SCOPUS, Web of Science, CINAHL and PsycInfo. Results were reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and described using a narrative synthesis. Study quality was assessed using Hawker’s Quality Assessment Tool.

Results Nine studies primarily focused on: education and palliative training for support staff; advance care planning; a social model for hospice care; and the creation of new roles to provide extra support to homeless adults through health navigators, homeless champions or palliative outreach teams. The voices of those experiencing homelessness were rarely included.

Conclusion We identified key components of care to optimise the support for homeless adults needing palliative and end of life care: advocacy; multidisciplinary working; professional education; and care in the community. Future research must include the perspectives of those who are homeless.

• Palliative Care
• Terminal care
• Supportive care
• Hospice care
• Quality of life

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:  https://creativecommons.org/licenses/by/4.0/ .

https://doi.org/10.1136/spcare-2024-004883

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WHAT IS ALREADY KNOWN ON THIS TOPIC

Use of palliative care services by the homeless population is limited; there is a considerable lack of end of life care provision specifically adapted to meet their biopsychosocial needs.

WHAT THIS STUDY ADDS

This systematic review provides a detailed understanding of the nature of interventions and models of care currently used to deliver palliative and end of life care to homeless adults, and what interventions are most effective to enhance the support for these marginalised individuals.

HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY

Key components have been identified which are most important for optimising the delivery of palliative and end of life care to homeless adults: advocacy; multidisciplinary working; professional education; and care integrated into the community settings where the homeless population is based. Future research must include the perspectives of those who are homeless, build on the components which we know work, and address the sustainability of these interventions and models of care.

The numbers and needs of people experiencing homelessness while living with a life-limiting illness are increasing, yet these marginalised individuals are restricted from mainstream health and social care, despite often having the greatest needs; this is a pertinent issue that must be addressed within palliative and end of life care. 1 The number of people experiencing homelessness in the UK is rapidly rising; Shelter 2 reports that 1/182 people are homeless, with over 3000 rough sleeping every night. Similarly, rates of homelessness within European countries including Germany, Spain and Ireland are also rising: recent data from FEANTSA 3 (the European Federation of National Organisations Working with the Homeless) report rising levels of homelessness within these countries, reaching 262 645, 28 552 and 11 632, respectively. However, these figures are likely an underestimation due to ‘hidden homelessness’ in which an individual is homeless but missing from the data.

Homelessness, according to Somerville, 4

is not just a matter of lack of shelter or lack of abode, a lack of a roof over one’s head. It involves deprivation across a number of different dimensions—physiological (lack of bodily comfort or warmth), emotional (lack of love or joy), territorial (lack of privacy), ontological (lack of rootedness in the world, and anomie [a theory in which purpose and goals cannot be achieved due to lack of means 5 ]) and spiritual (lack of hope, lack of purpose).

Elements of the ETHOS light criteria 6 have been adopted within this review to describe the different types of homelessness ( table 1 ). Many homeless adults suffer with trimorbidity, explained by Vickery et al 7 as ‘a subset of multimorbidity representing overlap of physical health, mental health, and substance use conditions’; this can make caring for these individuals complex and challenging. Health inequalities are evident for this ostracised community, and life expectancy is exceedingly low: 43 years for women and 45 years for men, compared with the UK national average of 83 years and 79 years, respectively. 8 Most notably, deaths within the homeless community are continuing to rise annually. 9

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The spectrum of homelessness

Somerville highlights the crucial need for a holistic approach to care for homeless adults, yet numerous hurdles exist in the delivery of good palliative and end of life care for this population. Homeless adults often experience a large symptom burden near the end of life, particularly pain, worry, sadness and exhaustion. 10 Many also have growing mistrust in healthcare professionals and underuse healthcare services due to fear of stigmatisation, discrimination and perceived healthcare prejudice. There is a considerable lack of palliative and end of life care provision specifically adapted to meet the biopsychosocial needs of the homeless population; this exacerbates the illness burden for these destitute individuals and worsens the quality of their remaining lifetime.

A systematic review was undertaken to identify the strengths and gaps in the delivery of palliative and end of life care to homeless adults, and make recommendations to bridge these gaps, with the aim of improving health and social care practice. Our review question aimed to determine what interventions and models of care are used to address the palliative and end of life care needs of adults who are experiencing homelessness, and are they effective? The objectives for adults experiencing homelessness, and needing palliative and end of life care, were to: (1) describe the interventions and models of care and (2) consider the strengths and gaps of the interventions and models of care, and discuss their effectiveness.

Preliminary searching was first undertaken using the Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects and PROSPERO. We identified no similar systematic reviews, however, a relevant scoping review by James et al 11 reports that the provision of palliative care to homeless adults is complex with many barriers hindering the delivery of quality care.

We conducted a systematic review using a standard methodological framework, adapted from the Centre for Reviews and Dissemination 12 (CRD) on how to undertake systematic reviews in healthcare. We followed the PEOS (Population, Exposure, Outcome and Study Design) framework to build a focused research question ( table 2 ). Case series and case reports, commentary, review and opinion pieces were excluded due to the high potential for bias within these types of study designs. Research which did not report on interventions or models of care, or include homeless adults for at least 50% of their study population was also excluded. Results were reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. 13

PEOS framework

Our search strategy ( table 3 ) was independently reviewed and refined by a librarian with expertise in information skills. Systematic searches were conducted on electronic databases using MeSH terms employing Boolean logical operators of “AND” and “OR”, in addition to free text searches (identified as key words). Truncations of words using an * was undertaken to enable the inclusion of multiple endings of the specific term. We limited the search criteria to “English language”. Online databases were searched on 22 November 2023 for articles published from 1 January 2000 using Ovid MEDLINE, EMBASE, SCOPUS, Web of Science, CINAHL and PsycInfo.

Search strategy

All identified citations were uploaded into the bibliographic software, EndNote21, and duplicate studies were removed. During initial screening, one author (MRC) oversaw the screening of study titles and abstracts; discussion with the second author (FM) was undertaken on 5% of studies during this stage to determine their relevance to the research question. One reviewer undertook full-text screening of studies (MRC); 30% of studies at this stage were discussed with the second author (FM) to determine suitability for inclusion. Data were extracted into tabular format on the design, context, quality and effectiveness of interventions and models of care.

Quality assessment of individual studies was formally undertaken using Hawker’s Quality Assessment Tool for Qualitative Studies. 14 Nine domains within each individual study were assessed and categorised as being of good, fair, poor or very poor quality. The minimum score that could be achieved for each paper using this tool was 9, the maximum 36. High, medium and low quality studies were determined based on their cumulative score across the nine domains, ranging between 30–36, 24–29 and 9–23, respectively.

A meta-analysis was not completed due to the heterogeneity of studies; instead, we undertook a narrative synthesis due to its appropriateness for organising and summarising the main findings from a varied body of research. We used formal guidance by Popay et al 15 for conducting a narrative synthesis and the following steps were addressed: ‘developing a theory of how the intervention works, why and for whom; developing a preliminary synthesis of findings of included studies; exploring relationships in the data; assessing the robustness of the synthesis’. We selected thematic analysis as the best method to describe the interventions and models of care, and consider their strengths, gaps and effectiveness.

Study selection

The search was conducted in November 2023. 5487 studies were initially identified. After screening and full-text review, nine studies were included ( figure 1 ).

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Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. 13

Study characteristics

Three included studies were qualitative, 16–18 one was mixed methods, 19 three were service evaluations/improvements, 20–22 one was a retrospective cohort study 23 and one was a randomised control trial. 24 Different interventions and models of care and whether they worked were mainly reported qualitatively, however, four studies included quantitative reporting. 19 20 23 24 Qualitative data were collected using questionnaires, 19 24 semi-structured interviews, 18 monthly reporting via email and telephone, 18 focus group interviews 19 and photovoice exploration in which participants photographed components of a model of care found to be most meaningful to them. 17 Quantitative data were collected from tabulation of key performance indicators achieved, 20 review of patient medical notes, 23 evaluation of baseline and outcome questionnaires 19 and uptake of an intervention. 16 24 Results from two studies did not specify how they were collected. 21 22 The locations of these included studies were the UK, 18 19 21 Canada 20 22 23 and the USA. 16 17 24 All interventions and models of care were instigated between the years 2001 and 2021.

Sample sizes were only reported in some studies. Where documented, numbers of participants ranged from 3 to >150. Five study populations primarily reported from professionals 18–22 with roles including non-clinical hostel staff, palliative care doctors, palliative care nurses, social workers and community nurses. Four study populations focused primarily on the care of homeless adults. 16 17 23 24 Financial reimbursement was provided within two studies to homeless adults for their participation. 17 24 Only one study focused on the experiences of a model of care directly from the perspective of the homeless adults involved; this was through interpretation of photos taken by patients during their stay in a social hospice. 17

Demographics of homeless adults were not always reported. However, in studies that did document homeless adult characteristics, most were of white ethnicity; two study populations predominantly consisted of black homeless adults. 16 24 There was a significant male preponderance in all the homeless populations studied; one study included transgender adults. 23 Homeless adults involved in this review were at different stages of their disease trajectories: one study focused on the transfer of terminally ill homeless individuals into a hospice to die in their preferred place of death 23 ; another focused on the provision of care to adults with a predicted life expectancy of under 6 months, 17 and a further study emphasised engagement with homeless adults living with a high degree of frailty. 22

Most homeless individuals were hostel-based. Only two papers included homeless adults that were rough sleeping, couch surfing or vulnerably housed within other accommodations beyond the realms of a shelter. 17 23 Most homeless adults were aged under 65 years due to age limits of sheltered accommodation restricting acceptance beyond this age. 18 Many were living with trimorbidity (overlap of poor physical health, poor mental health and substance use conditions); substance use is a common barrier to being accepted into hostels and hospices. 16 18 23 However, in light of this, three studies were inclusive of patients with addiction: two implemented a harm reduction strategy to minimise the adverse effects of substance misuse 22 23 ; one explicitly enrolled homeless adults living with a substance abuse diagnosis. 16

Quality of included studies

The quality assessment of all included studies can be found within online supplemental table 1 . The highest scoring study in this review scored 33/36, 18 while the lowest scored 17/36. 21 The highest quality score was awarded to an explorative qualitative study. It described the nature of the intervention and its success in detail using interviews and surveys, completed preintervention and postintervention, to gain insight into its impact. Its methodology was clearly ascribed with minimal areas for bias identified. The lowest quality study was a service evaluation on a nurse led homeless project. Despite the model working well to deliver its outcomes, the study had poor internal validity with limited description of its methodology and sampling; and little reporting of limitations.

Supplemental material

Nature of the interventions/models of care.

The nature of the interventions and models of care identified are explored in table 4 , including specification of the types of homelessness included. The included studies primarily focused on education and palliative training for support staff, 18 19 21 22 advance care planning, 16 19 23 24 the creation of new roles to provide extra support to homeless individuals via the introduction of health navigators, 20 homeless champions 18 or palliative outreach teams. 22 One study focused on the implementation of a social model of hospice care based within the community. 17 Three studies were undertaken within hostels, 16 18 19 two within hospices 17 23 and four were embedded directly into the community as in-reach models of care. 20–22 24

The nature of the interventions and models of care

Effectiveness of the interventions/models of care

Outcomes and effectiveness of the interventions and models of care are reported in table 5 (see online supplemental table 2 for a detailed review of the evidence of effectiveness). Multiagency communication and collaboration were common findings which enhanced the quality of palliative and end of life care provided to homeless adults and reduced care fragmentation among the various professionals involved. 18–20 Advocacy was another common attribute of many interventions, enhancing person centred care for vulnerable adults experiencing homelessness. The introduction of a healthcare navigator, with expertise in social work, enabled the social determinants of health to be targeted for homeless adults in receipt of care. 20 Similarly, social worker participation in advance directive completion favourably enhanced uptake of the intervention. 24 Embedding specialist palliative care teams into hostels 18 helped hostel staff to develop an increased awareness of both the social and healthcare needs of their hostel residents. Through collaboration with social workers and palliative care nurses, hostel staff felt this intervention was invaluable and allowed for the provision of individually tailored, holistic care. 18

Outcomes and effectiveness of identified interventions and models of care

Educational programmes 19 21 enhanced the confidence and knowledge of hostel staff on the ethos of palliative care and how to use this within their practice, noting that the training was ‘invaluable’, ‘extremely beneficial’ 18 and ‘empowering’. 21 However, it was mentioned that the increased workload relating to educational programmes risked potential staff burnout. To minimise this, two interventions encouraged hostel staff to optimise their well-being through use of counselling services and psychological support. 20 22

Working within supportive environments enabled hostel staff to improve productivity and become more proactive, liaising with colleagues, and challenging external agencies, when needed, to act in the best interests of their residents. 18 Hostel staff used their new skills to commence discussions on death and dying with hostel residents; they felt empowered having broken down the taboo associated with this subject. 21 Hostel residents emphasised the beneficial impact of these timely conversations, and positively reported that they felt cared for which reduced fear and anxiety. 18 21 Early recognition of health deterioration by hostel staff allowed for a prompt transfer of homeless adults to hospices or hospitals, according to their wishes. This allowed homeless adults to die with dignity and in the place of their choosing with appropriate support. 21

To address the impact of grief and bereavement, spiritual support was offered for both homeless individuals and professionals involved in their care. 23 A chaplain was available to provide religious counsel in one study. 17 Grief circles, 22 death cafes, and vigils were also introduced into hostels. 18 These interventions were used to help ease the loss of fellow residents and improve psychological well-being within supportive and nurturing environments. Pets were encouraged in one hospice to provide invaluable companionship, unconditional love and comfort to their owners who were living with a terminal illness. 17

A key challenge faced when engaging homeless adults in end of life discussions was their concurrent addictions to drugs and alcohol; this was a barrier that professionals involved in their care often struggled to overcome. 19 However, interventions were also identified which actively overcame this struggle and acknowledged the vulnerability of homeless adults, including factors that potentiate their low self-esteem, such as racism, addiction and homophobia. 19 22 23 Harm reduction strategies were advantageous in caring for homeless adults with trimorbidity, and when coupled with the reduction of pain and other symptoms attributable to terminal conditions, homeless adults were able to gradually reduce their intake of illicit drugs. 23

Similarly, the utilisation of trauma informed care for homeless adults 22 (a method which increases professional understanding that many homeless adults have lived through an unsurmountable level of trauma), helped to educate professionals involved in their care as to why they may maintain dependency on substances, despite the severity of their faltering health. Hostel staff was encouraged to build rapport with residents and break down existential barriers (including stigma for selected lifestyle choices) which helped residents to feel secure in their surroundings and improve adherence to medical treatment, 19 while preventing further worsening harmful behaviours, such as the continuing use of drugs and alcohol. 22 Previous research emphasises that understanding and addressing the complexities of the individual is essential within palliative and end of life care to ensure the delivery of personalised, holistic services. 11 24

Two interventions and models of care were cost saving. 16 23 However, others were time consuming to undertake, requiring both investment and dedication from professionals to integrate their newly learnt skills into practice. New interventions sometimes came at the expense and compromise of professionals fulfilling their usual routine tasks. 18 The role of a healthcare navigator 20 was recognised as causing a large workload for one person to manage; additionally, its lack of funding highlighted another potential barrier to sustaining the role and maximising its impact long-term.

We identified several pivotal interventions and models of care which were successful for optimising the delivery of palliative and end of life care to homeless adults, and improving their outcomes. These key components are: advocacy; multidisciplinary communication and collaboration; professional education; and community-based, rather than institution-based (hospital or inpatient hospice), care.

Prior evidence supports our findings. A systematic review by Ahmed et al 25 identified that a lack of palliative care knowledge and education among health and social care staff is a severe limitation to providing support to the homeless when living with a terminal illness. Our review shows that educational programmes are beneficial for improving palliative care delivery to homeless adults in the community. The HEARTH study conducted by Crane et al 26 evaluated the success of specialised primary care services to deliver healthcare to the homeless; it emphasised that homeless adults felt most trusting of healthcare providers working within specialist homeless services, tailored to meet their complex needs. Cook et al 27 identified that homeless adults often have significant comorbidities while living with concurrent addiction, meaning their palliative and end of life care needs often differ from the general population. Our review adds to the findings of both Cook et al and the HEARTH study and recognises that flexible, holistic, multidisciplinary palliative care is paramount in addressing the trimorbid elements (poor physical health, poor mental health and substance use conditions) influencing palliative care needs among the homeless community.

Somerville 4 emphasises that homelessness comprises physiological deprivation (lack of bodily comfort or warmth); a pivotal factor needing to be addressed. The research we identified demonstrated gaps in addressing this; for example, some homeless adults were refused access into homeless shelters due to age, leaving them destitute and in distress, despite living with a terminal illness. Two hostels had an upper age limit of 65 years old, 18 restricting the support accessible to them, yet palliative care provision is most often associated with older patients. 27.2% of adults over 65 identify as homeless, 28 yet limiting access to hostels where palliative needs can be addressed, due to chronological age, is a significant structural hurdle.

Somerville also states that homelessness involves ontological deprivation relating to a lack of rootedness in the world. 4 This lack of rootedness was particularly evident for some groups; for example, 25% of transgender adults experience homelessness in Britain, 29 yet only one study included transgender participants within their study population. 23 Homeless services often fail to support transgender adults culturally; these individuals are less likely to be accepted into shelter-based accommodation, and due to fear of discrimination and lack of understanding, transgender adults have increasing mistrust in health and social care providers. 30 The Office for National Statistics 31 reinforce our findings and document that other homeless populations are also under-recognised, including women and ethnic minorities. Black ethnicities are three times, and mixed race are two times, more likely to be experiencing homelessness than white adults. 28 32 However, inclusion of these ethnicities which are most prevalently affected by social inequalities are limited in research. Hidden homelessness may explain why these subgroups are limited in inclusion within this review. Hospices and hostels must be inclusive within their policies; it is essential that they adopt safe, stable, and welcoming environments to deliver palliative and end of life interventions and models of care to all demographics of homeless adults.

There are more gaps identified in our review. We found that healthcare needs were not always addressed; in one study, only 57.1% of terminally ill homeless patients admitted into a hospice received a palliative consult during their admission. 23 Optimising medical comorbidities, through liaison with medical staff and external agencies (mainly primary care providers), was a significant challenge faced by hostel staff to provide total palliative symptom control. 18

Furthermore, the ability to read and write was a crucial requirement of the homeless adults involved within two interventions, 16 24 yet one-third of homeless adults have no educational qualifications. 28 Both literacy and language barriers can make it difficult to engage with homeless adults directly within health and society. Application of structural interventions within health and social care policy, including access to advocates and translators, is essential to overcome these barriers.

We also recognised that the sustainability of some interventions was uncertain. Frequent staff turnover within hostels can affect the long-term impact of newly implemented educational programmes 19 ; this risks losing knowledgeable staff and the initial successes achieved in improving palliative care delivery to hostel residents. 19 We recommend that hostel and hospice staff participation in these educational programmes is made compulsory within their job specification. This will foster permanency of these interventions and models of care within practice; we found one instance of this which was very successful. 18

This systematic review has strengths and limitations. We have advanced understanding on the interventions and models of care used for homeless adults needing palliative and end of life care, while also considering how well they work in achieving this. The nine included studies have been assessed to be of intermediate methodological quality overall and credible in their findings. However, the synthesis of this review demonstrates that there is a real paucity of research specifically relating to the availability of interventions and models of care used in the delivery of palliative and end of life care to homeless adults. A lack of quantitative data meant that we were unable to numerically quantify the effectiveness of identified palliative and end of life interventions and models of care. We synthesised data, mainly qualitative, from the perspectives of professionals involved in the provision of the palliative and end of life care to homeless adults. Rarely was the viewpoint directly obtained from homeless adults regarding their individual experiences of these interventions and models of care; this is a pertinent barrier which must be addressed in future research.

This paper followed guidance from the CRD 12 for conducting a systematic review. Studies were limited to those published in the English language and the search strategy did not include bibliographic searching or grey literature; this may have prevented identification of unpublished documentation on interventions and models of care used within current health and social care practice. Only one author had undertaken the quality assessment of individual studies; this may have introduced bias into our methodology. Many studies were conducted in the USA, yet homelessness is a global finding; this limits the generalisability of our results within other cultural contexts. Most studies had small sample sizes which highlights the difficulty in recruiting homeless adults for participation in research.

Implications

Recent statistics document the rapid rise in the number of people experiencing homelessness 2 : it is imperative that we identify and implement effective palliative and end of life interventions and models of care into practice for homeless adults immediately. This will reduce health inequalities and promote equitable and accessible care to all, regardless of housing status.

All studies in this review addressed at least one of the critical components of homelessness according to the philosophy of Somerville. 4 However, most failed to equally address and optimise them in their totality. The in-reach support model 18 was the most valuable approach out of all the studies assessed, encompassing a holistic and inclusive approach to support the palliative and end of life needs of homeless adults within the hostel environment. It placed great emphasis on the optimisation of the medical, psychological, social and spiritual aspects of care for homeless adults, including addiction. Its methodological rigour was of high quality and, matched with the success of the model, we recommended that employment in wider health and social care practice is fulfilled to support the homeless population needing palliative and end of life care.

Gaps in the delivery of palliative and end of life care to homeless adults have been highlighted and we indicate where further direction is needed. We acknowledge that there is no specific definition of homelessness; however, perspectives from adults experiencing other types of homelessness, besides shelter-based living, must be of greater focus in future research. The impact of palliative and end of life interventions and models of care must also be sought from homeless women, older adults, LGBTQ+ and ethnic minorities who are underrepresented in the research.

There are key components that help optimise support for homeless adults needing palliative and end of life care: advocacy; multidisciplinary working; professional education; and care in the community. Most studies focused on the professionals involved in the care of homeless individuals; few studies included the voices of those experiencing homelessness. Future research must include the perspectives of those who are homeless, build on the components which we know work, and address sustainability of these interventions and models of care.

Ethics statements

Patient consent for publication.

Not applicable.

Ethics approval

Acknowledgments.

FM is a UK National Institute for Health and Care Research (NIHR) Senior Investigator. The views expressed in this article are those of the author(s) and not necessarily those of the UK NIHR, or the Department of Health and Social Care.

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Contributors Study conception and design: MRC and FM. Screening and data extraction: MRC and FM. Analysis and interpretation of results: MRC and FM. Draft manuscript preparation: MRC. All authors reviewed the results and approved the final version of the manuscript. FM is the guarantor.

Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests None declared.

Provenance and peer review Not commissioned; externally peer reviewed.

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Breaking News

Column: Don’t let Big Tech monopolies kill local news. Democracy is at risk

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It’s not the Harris honeymoon that’s bringing smiles to Democrats. It’s the Biden divorce. Voters are relieved. And they can largely thank the news media.

They can also credit themselves. Unhappy voters had been telling pollsters for months that President Biden was too old to run for reelection and serve a second term. But they were ignored by the president and Democratic leaders.

It was journalists — newspaper, digital and TV — who continually informed the public of Biden’s decline. Who else was going to lay it out straight? Certainly not the government — the White House or Democratic congressional leaders.

And when Biden, 81, performed pathetically in his June debate with Donald Trump , professional journalists did their job: They wrote about and showed the president’s deterioration. Editorial pages — most emphatically the New York Times — pushed hard for Biden to step aside.

That shook Democratic leaders. They finally grew the backbone to pressure Biden into quitting the race.

It’s a good bet this never would have happened if it weren’t for the independent free press performing as the Founders envisioned when they wrote the 1st Amendment. Biden sadly would still be the Democratic standard bearer, not Vice President Kamala Harris.

That’s a very high-profile example of robust journalism’s irreplaceable value to a healthy democracy. Weak journalism leads to a sick democracy. A functional democracy must be fueled by a reliable flow to citizens of credible information. The void created by the decline of factual journalism is filled by misinformation.

But the entire news reporting business is in perilous decline throughout the United States and much of the free world. In America, it’s happening particularly in small and medium size towns where there are always examples of some deteriorating politician needing to be pushed aside and corruption and incompetence are going unchecked.

California’s news industry is in steep decline. Here’s what is at stake

Economic forces and new technology have dramatically reduced local reporting power. This series examines the crisis and California’s novel efforts to save local news.

July 24, 2024

Strong news coverage is vital to hold elected representatives accountable and conversely inform voters of their good deeds. But it has fallen precipitously in county seats and city halls throughout California. And at the state Capitol.

In the last 20 years, the size of the Capitol press corps — and The Times bureau — has shrunk by two-thirds.

Some of the reporting gap has been filled by a nonprofit, foundation-funded organization, CalMatters, that distributes its articles free to traditional news outfits. That’s a possible harbinger of the future and a way to help more regions avoid sinking into so-called news deserts.

Newspapers have been disappearing. Roughly a third — 2,500 — have closed shop across the country since 2005. All sizes. Most of those staying open have cut back severely. Roughly two-thirds of journalists have lost their jobs. More than 100 Times newsroom staffers were laid off in January.

It’s not only newspaper reporting that is shrinking. It’s also broadcast and digital.

The culprit: the big internet and social media platforms that grab news outlets’ work without paying for it and build their own ad programs around the heisted articles. Or they just seize the info and create their own posts. That’s the destructive future of AI.

Newspaper advertising has dried up. And increasingly because of the platforms’ manipulation, the revenue isn’t being replaced by internet ads.

At the Capitol, some Democratic legislators have been trying for two years to craft legislation to compel the largest internet platforms, such as Google, to kick in money to save journalism — to pay at least minimally for the articles they’ve been ripping off.

But time’s running out. The Legislature’s two-year session will end on Aug. 31.

The internet monopolies are fighting hard by pressuring lawmakers and running a barrage of disingenuous TV ads claiming that the Legislature wants to help giant hedge funds rather than local papers. Nonsense. Some papers and TV stations may be owned by large corporations and financiers, but they still cover local news.

California lawmakers advance tax on Big Tech to help fund news industry

The bill would tax Amazon, Meta and Google for the data they take from users and pump the money into news organizations in the form of tax credits.

June 27, 2024

Negotiations between legislators and internet lobbyists apparently have not progressed far. And Gov. Gavin Newsom remains silent.

There are two bills in play. Each has passed its own house and is stymied in the other.

AB 886, by Assemblywoman Buffy Wicks (D-Oakland), is patterned after laws enacted in Australia and Canada. It would require large platforms such as Google to pay news outfits for their products. Fees would be set by arbitration. At least 70% of the money would need to be spent on reporters.

SB 1327, by Sen. Steve Glazer (D-Orinda), would impose a California “data extraction fee” — a sales tax — on platforms that gross more than $2.5 billion annually from advertising to state residents. That would hit Google, Amazon and Meta and generate $1 billion annually. Half would fund partial tax credits for reporters’ salaries. An additional 40% would go to schools.

The platforms contend this would raise advertising rates.

Ridiculous, Glazer says: “It would do the opposite. They’re already getting the maximum rates they can. And it would increase advertising competition [from news outlets], driving down rates.”

“Tech platforms are getting clicks and profiting mightily off the hard work of journalists,” state Senate leader Mike McGuire (D-Healdsburg) said in a statement last week after Wicks’ bill squeezed through a key Senate committee. “These bills would work in tandem to help level the playing field.”

But there’s concern that the Legislature will pass a weak bill that essentially lets the internet monopolies off the hook by tapping them only lightly.

“That could cause harm to journalism rather than help,” says Matt Pearce, president of the Media Guild of the West, the news staffers’ union. “Whatever California does is going to set the pattern for the rest of the nation. We need serious regulation, not a pat on the head.”

Journalism isn’t ailing just locally. It’s a national epidemic. Twenty years from now, another declining president might not receive a strong enough push to step aside.

More to Read

Editorial: Can California save local news? The future of community, democracy is at stake

July 31, 2024

California’s news industry is shrinking while misinformation spreads. Here’s what the numbers tell us

Goldberg: Is replacing President Biden as his party’s nominee an attack on democracy? Hardly

July 23, 2024

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Political columnist George Skelton has covered government and politics for 60 years and for The Times since 1974.

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