Introduction

The homeless problem in New York City is near an all-time high. According to The Wall Street Journal, the homeless shelter population has now reached almost 60,000 (Gay, 2016). That number does not take into account those who are living on the streets, in vehicles, or on public land. Of those who enter the shelter system, they are now staying longer than ever, with an average stay of 439 days as of 2015 (Fessenden, 2016) The increased cost of living, lack of affordable housing, stagnant wages, mental/physical disability, drug addiction, gentrification, and escaping domestic abuse are just a few of the reasons the homeless population has exploded. For those who currently have a residence and are struggling to survive, there is an imminent risk of homelessness.

Homelessness has far reaching implications, affecting society as a whole. Those who are homeless use more healthcare services, have higher rates of incarceration, are at risk for increased violence, and they create an ethical dilemma because no one should have difficulty finding proper housing. The media has been covering this topic on a daily basis as people complain about the quality of life going down because of the homeless population making the street and public spaces their home. Community members complain of homeless people using the street as their bathroom, panhandling, and a storage facility for their personal items. This in turn, increases policing, and arrests.

Targeted Groups

The problem of adequate housing can affect anyone regardless of age or race. Unfortunately, many people looking for secure housing are families, or single female led households with small children. Other groups looking for housing include military veterans, domestic abuse survivors, ex-convicts, drug addicts, and members of the LBGT community.

Growing up in the shelter system can have detrimental effects on the development process of the youth. In an article by Kim (2015), she describes a city-run shelter where a family of 10 live in a 520 square foot room. The environment is described as a place where “sexual predators roam, and mold, roaches, and mice swarm in multitudes.” It has also been cited for spoiled food, asbestos, and sexual misconduct by staff. (Kim, 2015) A child in this sort of setting cannot mature properly when safety is an issue and food sources are tainted. They are at increased risk of academic and behavioral problems.

Many veterans are returning home only to find themselves in a downwards spiral caused wartime trauma during military service. According to Donovan and Shinseki (2013), veterans are at higher risk of because of this trauma which leads to depression, followed by substance abuse, and unemployment. Walking through the streets you often come across signs stating that this person panhandling is a veteran and needs assistance. The government has not done a good job taking care of veterans in this country.

Domestic violence is an unspeakable crime where the majority of the time the victim is female, and must flee the aggressor to save her life. The National Law Center on Homelessness and Poverty posits that an astounding 92% or more of homeless women stated that they had been in abusive relationships where they had to escape and wound up homeless (NLCHP). In most cases, the man is controlling, both physically and monetarily, and the woman has no resources once she leaves the aggressor making her fend for herself and children.

Those who have paid their debt to society by serving jail time and have reentered civilian life have a hard time reintegrating. According to Anderson (2014), many occupations are now unavailable due to their past history and finding housing and employment is difficult. Services to help ex-convicts earn an education or job training are being cut as funding is limited.

A large majority of homeless people suffer from mental illness and substance abuse. Funding for mental health has decreased over the past few years and healthcare spending has increased. In order to provide for proper services for this population, they must be screened for substance abuse, find supportive housing, have access to supportive services, and prospects for future employment. (Maness & Khan, 2014). Without proper support, there is an increased risk of relapse and reentry into the shelter system or back into the streets or jail.

The LBGT community represents a large portion of the homeless youth. By some estimates, roughly 30 to 45% of the population identify as LBGT (Keuroghlian, Shtasel, & Bassuk, 2014). This group is at increased risk of violent crime, suicidal acts, and substance abuse (Ream, Geoffrey, and Forge, 2014).  Special assessment of this population needs to be taken into account as they have come to the forefront of national attention. This subgroup has special needs which must be accounted for, and more research needs to be undertaken.

Challenges and Barriers to Ending Homelessness

New York City is experiencing gentrification, lack of affordable housing, and an increased cost of living which many people cannot afford because of stagnant wages. Gentrification is forcing many long time tenants out of their households as property values go up, and rental prices too. This change can be seen in my own neighborhood of Greenpoint, Brooklyn. This mostly Polish immigrant neighborhood has transformed in front of my eyes. Landlords have harassed tenants in order for them to move because the market rents are much higher than even a few years ago. People are now moving to cheaper areas of the city like Queens (Stabrowski, 2014). This can be seen in many neighborhoods, especially poorer areas. Gentrification makes the area more appealing by upgrading the neighborhood, but it displaces many residents who can’t afford it.

City living has increased in popularity making affordable housing scarce. According to Alcindor (2015), demand is greater than the current supply so those with money will get a place to live. She described rent prices that are $3,150 for a one-bedroom in Manhattan and $2,750 for the same thing in Brooklyn.  Also mentioned, is that “56% of rental households in New York spent more than 30% of their income on housing.” A large portion of New Yorkers income goes toward rent which leaves less money for basic necessities. People have to make a decision of whether they’re going to eat or pay rent.

Increasing costs in housing and consumer goods make it almost impossible for a minimum wage worker to afford. These positions are usually held by unskilled people which keeps them in poverty. According to an article by Clarke (2015), a report found that a minimum wage worker cannot afford the average rent of any neighborhood in NYC. They have been priced out. Even if the hourly wage goes up to $15, it still won’t be enough because rents are too expensive. The article states that “267,000 workers in the city make minimum wage.” (Clarke, 2015).  Some politicians still don’t believe in raising minimum wage.

Literature Review

Housing has been shown to be a determinant of health. Duran, Misa, and Shah (2013) postulate that the majority of money spent on healthcare is due to that fact that there wasn’t enough spent early on “social, environmental, and behavioral factors.” When issues arise later in life, they are usually much costlier. In the the article, they state their case that supportive housing should be combined with a health home to help high risk homeless people who would otherwise frequent hospitals. On-site case management coupled with community resources will improve the health homeless population. This study shows potential as money was saved by providing this service.

The lack of psychiatric funding is causing an increased number of untreatable mental illness and substance abuse problems. These issues put an individual at increased risk for homelessness. According to Pearson and Linz (2011), 26% of the homeless population and more than 50% of the incarcerated populace has mental illness. This population is constantly in and out of psychiatric facilities or jail. They need treatment for psychiatric and/or addiction problems, to ensure complete care. The goal is to get them into permanent housing.

Chronic homelessness has been shown to shorten a person’s life expectancy. The average age of death for a homeless person is 47 (Peate, 2013). Proper screening should be done to check housing status as some patients may not look homeless. This population has mental/physical health problems and also substance abuse issues. They are at a nine times greater risk for committing suicide then the general population (Peate, 2013). External factors like the environment combined with hard living are a recipe for disaster.

Providing unemployed and homeless people financial incentive to attend job training programs has gained momentum. Monetary incentive is based on attendance, performance, skills acquired, and abstinence from alcohol (Koffarnus, Wong, Fingerhood, Svikis, Bigelow & Silverman, 2013). Paying people to take care of themselves has been done before. This system is applied in order to make the participants more marketable and hopefully lead to future employment and a way out of poverty.

Providing housing for homeless families is not enough to ensure their children’s future success.  Lorelle and Grothaus (2015) followed the journey of a few families in supportive housing where counseling and life skills were provided for family members as well as tutoring and extracurricular like dancing and art for the children. Results show promise as the children performed better in school, improved emotional well being, and better social interactions. Some of these improvements may be attributed to the on-site case manager but tutoring allowed the children to get the extra attention and resources that their parents may have not been able to provide.

Eviction is one of the main drivers of homelessness. According to Desmond (2012), eviction splits up families, results in job loss, decreases residential security, and causes periods of homelessness. A disproportionate number of these tenants are African-Americans females who are single mothers. Females are the ones who predominately have custody of their children and life is hard as a single mother, especially when not getting support from the children’s father.

The cost of housing can be such a burden that food insecurity becomes an issue. A study by Kirkpatrick and Tarasuk (2011) examined the percentage of income spent on housing and its association with food insecurity. Subsidized housing and market rate houses both suffered from food insecurity represented by 69% and 42% respectively. The study argues that housing affordability needs to be reexamined to take into account after-shelter income compared to income (Kirkpatrick & Tarasuk, 2011). Many of families may be late with rent and need to get money from lenders or sacrifice food.

Intervention to Help Homeless Problem

New York State has undertaken the monumental task of trying to curb the homelessness problem we are currently experiencing. Governor Andrew M. Cuomo has unveiled the Homelessness Action Plan that would create 1,200 units of supporting housing, and more than 500 beds for homeless individuals which would be available immediately. This is the first stage of what will be a $10.4-billion-dollar initiative to combat homelessness over the next five years. $2.6 would be sent on new supportive housing units while the remaining $7.8 billion would be used to support existing supportive housing combined with additional shelter beds and homeless services (New York States launches homeless action plan).

The project is focused on creating more than 6,000 supportive units of housing, adding over 500 beds in shelter housing. There will also be a council on homelessness to advocate for best practice and create policies that will meet the needs of the community. Money will also be spent on inspecting the 916 homeless shelters in NY state to make sure the conditions are safe. Supportive housing will help those who have special needs in attaining permanent housing and training in skills needs for employment and independent living. There are also going to be health services provided. Those shelter beds that are being added will be done so for emergency situations to alleviate homelessness. These beds will be placed in underused facilities and will be managed by experienced providers (New York States launches homeless action plan).

A multidisciplinary team was created to combine their expertise and come up with solutions to the homeless problem. Members of this council come from the Office of Mental Health, Office of Alcoholism and Substance Abuse Services, Office of Children and Family Services, and the Department of Corrections and Community Supervision. This team of professionals will be working together for the next 24 months to ensure continuum of care through policy and procedure review (New York States launches homeless action plan).

Shelters will be inspected to ensure safety for their inhabitants. Those who receive public funding will be regulated by the state and inspected annually. If deficiency is noted in the facility, they will have a deadline to meet the necessary changes and bring it up to code. Changes that are not made may cause the facility to close. Those which close because of violations will be responsible for ensuring that residents are moved to either another shelter or to permanent housing. This is a huge task as 97% of these shelters had at least one violation (New York States launches homeless action plan).

Stakeholders

Residents of communities where homelessness is a big issue have shown particular interest in this population. Many people have a fear that homeless people may be violent (Laird, 2014). The news has shown instances where people have been attacked by the homeless but this is usually due to mental problems. Another issue that residents have a problem with the homeless is their usage of the street as their bathroom. They also have to store their belongings in various places because they cannot bring everything with them everywhere they go (Laird, 2014). City residents are looking at this problem as a quality of life issue. Many people are sympathetic to their situation but don’t know how to help.

When residents are fed up with a matter, they go to their politicians. Mayor de Blasio has been under attack for the majority of his tenure as NYC mayor when it comes to policing and the homeless problem. According to the NY Times, they describe this as a “political crisis” and that “62 percent of New Yorkers disapproved of his handling of the issue” (Grynbaum and Stewart, 2015). If the mayor doesn’t correct this problem, it may cost him his reelection campaign. No matter what his personal feelings are on the topic, he must correct it because those who put him in power will make sure he doesn’t run another term.

Medical personnel are interest in the homeless population because it poses a public health problem. Although health professionals have good intentions when trying to care for the homeless, many are not trained properly and don’t provide the necessary care (Seiler & Moss, 2012). This is a unique group with special needs. In order to provide quality care, special training must be completed. This will lead to better patient outcomes, less money spent on healthcare, and a better relationship between patient and provider.

 

Policy Recommendations

Government intervention is needed in order to solve the homelessness problem. According to the National Alliance to End Homelessness, $2.480 billion should be spent on the Homeless Assistance Grants programs expanding supportive housing to 25,500 units. A quarter billion should be sent on the Emergency Solutions Grant which helps re-house people. $1.6 billion should be provided to the Department of Veteran Affairs to make sure no veteran is left homeless. Money will also be provided to training and employment services. $21.1 billion should be used on Section 8 Housing Choice vouchers (Policy Priorities).

The most vulnerable population, the youth, need special services to help integrate them back into a normal life. There is a call to increase the capacity of Runaway and Homeless Youth Act (RHYA) programs. Through these programs, the hope is to reunite families. Stable housing is an important base for creating financial independence. Funding will also be spent on researching the topic of homeless youth to improve services.

Summary and Conclusions

Homelessness has become a topic that is being talked about daily in the media. Mental illness, substance abuse, domestic violence, lack of affordable housing, and poor wages have all contributed to the problem. The problem has come to the forefront as these people are filling the shelters to max capacity while some choose to sleep on the street instead. The cost of living has gotten to such a point that a person has to make a choice of either paying their rent or providing food for themselves and family. Earning the current minimum wage in this town, you will not be able to afford your own place. Mental health services are important for this population where a disproportionate number of the population suffer from addiction and poor mental health.

Through policy and continued efforts by local governments and volunteers, we can end homelessness in NYC. Homeless people need to have their voice heard and their needs met. As nurses, we can’t help but to reach out and help. Instead of looking at them as a nuisance, we should look at them as a human.

 

Reference

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