II. Definition: Homeless Person
- Individual without permanent housing
- No shelter in one third of cases
- Other transient shelters
- Living in vehicle or abandoned building
- Living in shelter or mission
- Living in constantly changing housing (e.g. moving between various family or friend's homes)
III. Epidemiology
- Prevalence: 3 million in U.S. (1% of population) per year (0.6 Million on any given night in U.S.)
- At risk for Homelessness in case of single catastrophic event (no reserve): 46 Million in U.S. (14% of population)
- Homelessness lasts for days to weeks in most cases
- Families represent one third of cases
IV. Risk Factors
- Unstable job
- Low wage
- Veteran status
- Mental illness
- Physical Disability
- Inadequate access to affordable housing
- Inadequate access to affordable health care
- Inadequate to public assistance
- Alcohol Abuse
- Substance Abuse
- Domestic Violence
V. Associated Conditions: Children
- Asthma
- Iron Deficiency Anemia
- Lead Poisoning
- Growth Delay
- Developmental Delay
- Learning Disorder
- Childhood Depression
- Childhood Anxiety
- Behavioral Disorders
- Child Abuse
VI. Associated Conditions: Adults
- Domestic Abuse (including sexual abuse, rape)
- Alcohol Abuse or Substance Abuse (20-30% of patients)
- Mental Illness (30-50% of patients)
- Schizophrenia
- Bipolar Disorder
- Major Depression
- Anxiety Disorder
- Post-Traumatic Stress Disorder
- Suicidality is common (especially <30 years old, hispanic, longer Homelessness duration, lower educational level)
- Infectious Disease
- Sexually Transmitted Disease (including HIV Infection)
- Tuberculosis
- Lice Infestation (risk of Bartonella infection such as Trench Fever, endocarditis)
- Scabies
- Foot infections, wounds and related disorders
- Cellulitis
- Pneumonia
- Uncontrolled or premature chronic disease
- Diabetes Mellitus
- Coronary Artery Disease
- Uncontrolled Hypertension
- Uncontrolled Hyperlipidemia
- Peripheral Vascular Disease
- Cancer risk (due to lack of routine cancer screening)
- Exposure related conditions
VII. Labs: Infectious Disease Screening
- HBsAg
- xHCV Antibody
- HIV Test
- RPR (Syphilis Test)
- Tuberculosis
VIII. Management
- Establish rapport with patient and family
- Provide accepting environment
- Establish trust
- Evaluate for significant health conditions
- See Associated Conditions above
- Develop evaluation and management plan
- Emergency contact
- Establish multidisciplinary approach to care
- Primary care
- Mental Health
- Social worker or case manager
- Future lab testing and other appointments
- Medications
- Follow-up plan
IX. Precautions: Medications
- Avoid medications with risk of rebound if stopped
- Avoid medications which predispose to Heat Illness or Dehydration
- Avoid medications that may potentiate Drug Abuse habit
- See Drugs of Abuse
X. Prevention: Immunizations
- Tetanus Vaccine (Tdap or Td) every 10 years
- Influenza Vaccine
- Pneumococcal Vaccine (if indicated)
- Hepatitis B Vaccine
XI. Complications
- Adult Relative Risks
- Illness: 6x
- Hospitalization: 4x
- Early mortality (<52 years old): 3-4x
- Traumatic Head Injury: 5x
- Childhood Relative Risks
- Mortality under age 1 year: 9x
- Illness: 4x
- Delayed development: 4x
- Delayed Growth: 6x
- Learning Disorders: 2x
XII. Resources
- Health Care for the Homeless
- SAMHSA Homelessness Resource Center
- National Center on Family Homelessness
- National Health Care for the Homeless Council
- U.S. Dept of VA - Veteran Homeless Initiative
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSH) | Persons who have no permanent residence. The concept excludes nomadic peoples. |
| Concepts | Population Group (T098) |
| MSH | D006703 |
| SnomedCT | 32911000 |
| English | Homeless Person, Homeless Persons, Person, Homeless, Persons, Homeless, Homeless persons, Homeless person |
| Swedish | Hemlösa |
| Czech | lidé bez domova, bezdomovci |
| Finnish | Kodittomat |
| Russian | BESPRIZORNYE, BEZDOMNYE, БЕЗДОМНЫЕ, БЕСПРИЗОРНЫЕ |
| Polish | Bezdomni, Osoby bezdomne |
| Italian | Senzatetto, Persone senza fissa dimora |
| Norwegian | Hjemløse personer |
| French | Sans-abri, Personnes sans domicile fixe, SDF (Sans Domicile Fixe) |
| Portuguese | Pessoas sem Lar, Moradores de Rua, Morador de Rua |
| German | Heimatlose, Nichtseßhafte |
| Dutch | Dakloze, Daklozen, Personen zonder vaste woon- of verblijfplaats, Thuislozen |
| Spanish | Personas sin Hogar |
Ontology: Homelessness (C0237154)
| Definition (HL7V3.0) | <p>Indication of status as homeless.</p> |
| Definition (HL7V3.0) | <p><b>Definition:</b>Living arrangements lacking a permanent residence.</p> |
| Definition (HL7V3.0) | <p><b>Definition:</b>Living arrangements lacking a permanent residence.</p> |
| Definition (NCI) | Without a stable or permanent residence. |
| Definition (CSP) | persons lacking permanent or reliable shelter, variously due to poverty, lack of affordable housing, mental illness, substance abuse, juvenile alienation, or other factors. |
| Concepts | Finding (T033) |
| MSH | D006703 |
| SnomedCT | 138091007, 42662003, 160699002, 160704005, 138087002, 32911000, 266935003 |
| HL7 | 2.16.840.1.113883.1.11.19893, HL, HMLESS |
| English | Homelessness, Housing lack NOS, homeless (history), homeless, Lack (of);housing, Housing lack NOS (finding), (Housing lack) or (homeless) (finding), (Housing lack) or (homeless), Living on the street (finding), lack of housing (history), lack of housing, Homeless, Living on the street, Housing lack, Homeless (finding), Housing lack (finding), homelessness, housing; lack of, lack of; housing, lack of; shelter, shelter; lack of |
| Italian | Senza tetto |
| Japanese | ホームレス, ﾎｰﾑﾚｽ |
| Czech | Bez domova, bezdomovectví |
| Spanish | carencia de vivienda (hallazgo), carece de alojamiento (hallazgo), carece de alojamiento, carencia de vivienda, carece de hogar, carencia de alojamiento, SAI (hallazgo), vivir en la calle, carencia de alojamiento, SAI, vivir en la calle (estilo de vida) (concepto no activo), Housing lack NOS, persona sin hogar (hallazgo), persona sin hogar, vive en la calle, Sin vivienda |
| Hungarian | Hajléktalan |
| French | Condition de sans-abri, Condition de SDF, Sans-abrisme, Sans domicile fixe |
| Dutch | behuizing; gebrek, beschutting; gebrek, gebrek; behuizing, gebrek; beschutting, dakloos |
| Portuguese | Sem abrigo |
| German | obdachlos |
Ontology: Homeless Health Concerns (C1456561)
| Definition (MEDLINEPLUS) |
Poor health can contribute to being homeless, and being homeless can lead to poor health. Limited access to health care can make it worse. That's why the health of homeless people in the United States is worse than that of the general population. Common health problems include
Many homeless women are victims of domestic or sexual abuse. Homeless children have high rates of emotional and behavioral problems, often from having witnessed abuse. Help such as shelters, health centers, and free meals are available. Contact your local homelessness assistance agency. |
| Concepts | Group Attribute (T102) |
| English | Homeless Health Concerns |
