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Poverty Versus Pathology: What's "Chronic" About Homelessness

Recently, the term "chronic homelessness" has gained currency in Washington and throughout the nation, most prominently in the statements of Bush Administration officials and in federal legislation. U.S. Department of Housing and Urban Development Secretary Mel Martinez has stated that "ending chronic homelessness" is a primary goal of the Department's homeless assistance programs; moreover, a variety of federal legislation now directs federal agencies to prioritize their efforts and target their resources toward the so-called "chronically homeless."

Although the term "chronic homelessness" is rarely defined with any degree of specificity, it is generally used to characterize people who are homeless and who also have mental health or addiction disorders, and who are therefore more likely to experience homelessness for longer periods of time. The National Coalition for the Homeless (NCH) has serious concerns about the "chronic homeless" initiative because 1) the terminology distorts the history, causes, and nature of homelessness; 2) the policies that accompany it pit vulnerable populations against each other in competition for scarce federal resources; and 3) the initiative as a whole - terminology and policy - is short-sighted and likely to exacerbate, rather than end, homelessness.

The "Chronic Homeless" Terminology Distorts the History, Causes, and Nature of Homelessness

  • The term "chronic homeless" treats homelessness with the same language, and in the same fashion, as a medical condition or disease, rather than an experience caused fundamentally by poverty and lack of affordable housing. This move to pathologize homelessness via a new, stigmatizing terminology ignores the history and causes of homelessness, which are fundamentally economic and not medical in nature. It also disregards current social and economic trends, and is especially misguided at a time when the affordable housing gap is at a record high, when the economic recession is forcing many people out of work, and when many families are struggling to meet welfare requirements in the face of impending time limits. [1]

  • The term "chronically homeless" misrepresents the causes of homelessness for people who do have disabilities such as mental illness, addiction disorders or other physical disabilities. While rates of these disabilities are disproportionately high among single adults who experience homelessness, they do not explain homelessness -- people do not become homeless just because they are mentally ill or addicted. Rather, the kind of housing and income supports needed by low-income people with disabilities has decreased sharply since the early 1980s and is in extremely short supply. [2]
  • The initiative to end "chronic homelessness," especially as articulated in policies to shift federal resources to certain kinds of targeted homeless assistance programs, assumes that there is a static population of people who are homeless with disabilities. While targeted homeless assistance programs may help to stabilize people who are currently homeless, they do nothing to prevent future homelessness among low-income people with or without disabilities. As long as the underlying problems of lack of affordable housing, insufficient income, and inadequate health care remain unaddressed, people who are living in extreme poverty -- with or without disabilities -- will continue to become homeless. Moreover, even once their disabling conditions are stabilized and treated, people who have mental health disorders, addiction disorders, or other physical disabilities must compete with all others for a dwindling supply of low-income housing. Only efforts to mend the systemic gaps through which many people living in extreme poverty- including people with disabilities “ fall will homelessness end.

The Policies Accompanying the "Chronic Initiative" are Likely to Exacerbate, Rather than End, Homelessness 

Just as the "chronic homelessness" terminology is misleading and stigmatizing, the policy initiatives accompanying it are misguided and likely to worsen conditions for people living in severe poverty.Recently, a number of such policy initiatives have surfaced. They include 1) a Congressional directive to give preference in the awarding of federal homeless assistance grants to communities that prioritize programs for the "chronically homeless;" and 2) legislative language requiring that at least 30 percent of HUD's homeless assistance funds be set-aside for "supportive housing" for people with disabilities who are homeless. In addition to these federal policies, recent Administration statements about the direction of the Interagency Council on the Homeless imply additional federal policies may be forthcoming.

Taken alone, each one of these initiatives is problematic; taken together, they signal an alarming shift in federal policy that is likely to perpetuate homelessness far into the future.

I.‹‹‹‹‹‹‹‹‹ Preference in Awarding Federal Grants to Communities that Use Funds for‹‹‹‹‹‹‹ "Chronically Homeless, Disabled People."

The majority of federal homeless assistance dollars are administered by HUD through the McKinney-Vento Homeless Assistance Act. These grants provide funding for emergency shelter, prevention activity, supportive services, transitional housing, and permanent housing with support services ("supportive housing"). HUD awards its homeless assistance grants based on communities' ranking of local needs and their prioritization of the gaps in resources needed to meet those needs, through a process called the "Continuum of Care." Last year, Congress directed HUD to use the Continuum of Care process to "give preference to communities that use funds for permanent housing to end homelessness for chronically homeless, disabled people." [3]

  • This directive disregards local needs, realities, and emerging trends, and is therefore in direct conflict with the stated goal of the Continuum of Care. Throughout the nation, a rapid decrease in the availability of affordable housing has led to an increase in homelessness among families, and people without disabilities. [4] As a result, the greatest unmet need in many communities is for assistance for families with children, unaccompanied youth, and other people without disabilities. [5] Despite this trend, the Congressional directive forces communities to prioritize services for people with disabilities in order to get federal funds. The directive thus creates a deep contradiction within federal policy -- rather than allowing local communities to determine their own priorities for the use of HUD homeless program funding, Congress has determined their priorities for them.

  •         By focusing scarce federal resources toward one sector of people who experience homelessness, the directive makes it more difficult for other vulnerable populations to access the resources needed to escape deep poverty and homelessness; ironically, it thus creates the pre-conditions for non-disabled people to develop disabilities and to be at future risk of homelessness. By forcing communities to give higher priority, and therefore allocate greater federal resources, to programming for people who are homeless with disabilities, there will be fewer resources available to programs that serve all people irrespective of disability status. This fact is distressing not only because of the large number of people without disabilities (children and adults) who experience homelessness, but also because by forcing people to go without assistance and endure homelessness longer, they are more likely to develop disabilities. This is especially true for children and youth, who comprise approximately 39% of the people who experience homelessness over the course of a year and who are extremely vulnerable to the ill effects of deep poverty. [6] Many of the horrific conditions of poverty and homelessness directly contribute to physical, mental and emotional disabilities. For example, children who are homeless suffer from: poor nutrition [7] ; inadequate health care [8] ; greater exposure to environmental hazards like lead poisoning [9] ; health problems associated with overcrowded and communal living situations [10] ; increased incidence of other health impairments [11] ; higher exposure to domestic and other types of violence [12] ; and severe emotional stress related to conditions of extreme poverty and instability. [13] In addition, there is evidence that experiencing homelessness as a child is associated with experiencing deep poverty and homelessness as an adult. [14] Thus, rather than "end homelessness" among people with disabilities, the prioritization of scarce homeless assistance dollars toward people with disabilities potentially creates the conditions for more people to develop disabilities and to experience homelessness.
  • Rather than expand federal resources to meet the needs of all people experiencing homelessness, the directive pits vulnerable populations against each other in competition for scarce federal resources. There can be no doubt that people who are homeless and who have mental health disorders, addiction disorders, or other physical disabilities are extremely vulnerable and need special assistance in resolving their housing and health problems. The initiative to target resources to these individuals is based on the argument that such individuals "use up" more resources, and that therefore, if federal resources were directed at supportive housing to help them permanently "exit" homelessness, more resources would be available to help the majority of people who experience homelessness (i.e. the non-disabled). While this argument has other flaws (see below), it is particularly disingenuous in the absence of any proposed expansion in federal resources for homelessness prevention or assistance. Rather than "free up" resources for other vulnerable populations, the mandated prioritization of resources toward people with mental illness, addiction disorders, or other physical disabilities forces an inhumane competition for a scarce pool of funds, and diverts attention from the larger issue, namely a lack of resources for emergency assistance for all people experiencing homelessness -- and the real permanent solutions of adequate housing, health care, and income.

II.‹‹‹‹‹‹‹‹ Required Set-aside for "Supportive Housing" for People with Disabilities who are Homeless

For the past three years, federal legislation has contained provisions that require HUD to reserve 30 percent of its homeless assistance funds for "permanent housing." This term is somewhat misleading, however, because under HUD regulations, only new Shelter Plus Care projects, Section 8 SRO Projects, and new and renewal projects designated as permanent housing for people with disabilities under the Supportive Housing Program, meet the definition of permanent housing. [15] Families without a disabled member are not eligible for permanent housing under this requirement. Furthermore, the only permanent housing program for which both disabled and non-disabled individuals who lack housing can qualify, Section 8 SRO, had only 13 projects funded nationwide during the last round, or less than .005% of HUD McKinney-Vento grants. This 30% requirement, often cited as the means through which "chronic homelessness" will be ended, is the oldest of the policies to accompany the "chronic initiative" and thus has produced the clearest evidence of the short-sightedness of the approach thus far.

  • The premise upon which the set-aside is based - that shifting resources to supportive housing for people with mental illness or addiction disorders will "end homelessness" for that population - is fundamentally flawed. This argument assumes that there is an unchanging number of people who are homeless with disabilities, and that once housed, homelessness will be ended. However, without efforts at addressing the causes of homelessness -- lack of affordable housing, health care, and income supports -- there will continue to be people who become homeless and who have disabilities. Simple math provides further evidence of the absurdity of the notion of ending homelessness through this approach: based on the 30% Congressional mandate and last year's total appropriation for homeless assistance programs, HUD was required to allocate $306 million to permanent supportive housing. Assuming a very conservative cost estimate of $75,000 to produce a new unit of supportive housing, not including related operating subsidies, this set aside will create, roughly, a mere 4,000 units a year, thereby falling woefully short of meeting the need. [16] While permanent supportive housing programs under HUD McKinney-Vento may help many people who are homeless and who have disabilities exit homelessness, they do nothing to prevent people from becoming homeless [17] ; thus, as a strategy for ending homelessness, it is fundamentally flawed and ill-fated. HUD homeless assistance programs are, and always will be, an emergency response to homelessness; only by addressing the underlying causes will homelessness be ended.

  •   The required set-aside has already forced numerous communities to cut funding for programs that serve families, children, and other non-disabled populations. The 30% set-aside for supportive housing for people with disabilities is a national mandate; thus, 30% of the total national appropriation for homeless assistance programs must be used for this end. In 2000, HUD was forced to pass over higher ranked projects for people without disabilities in order to meet the mandate. For many local communities, this meant loss of funding for programs that the communities themselves ranked as more pressing needs -- especially for families with children. For example, 26 Oregon counties lost $1.3 million in federal funding, and $1 million in leveraged funding; these programs would have provided the units and services necessary for 692 people to move into and maintain permanent housing. Other communities nationwide were similarly impacted. [18] In 2001, HUD did not have to pass over projects because communities adapted to the 30% requirement by giving a higher ranking to permanent supportive housing projects, regardless of local needs. In short, this Congressional mandate forced communities to change their priorities or face an outcome like they did in 2000.

III. ‹‹‹‹‹ Future Direction of the Interagency Homeless Council

Congress recently provided funding for the Interagency Homeless Council, the "independent working group" which is charged with coordinating the activities of federal agencies on homelessness. A recently released press release on the naming of a director for the Interagency Council stated that "ending chronic homelessness is a priority goal of HUD's homeless assistance programs." [19] This statement, in the context of a press release on the Interagency Council, causes concern that more federal policies based on the short-sighted, distorted, and politically convenient notion of "chronic homelessness" will appear in the future. In light of the unprecedented numbers of men, women, and children who are experiencing homelessness, it is imperative that the Interagency Council work to meet all of their needs, as well as concentrate on preventing future homelessness by addressing its root causes.


In sum, "chronic homelessness" is yet another stigmatizing label -- a code word for those individuals who are deemed to merit attention and resources because they fit pre-conceived notions of homelessness, and because they enable policy makers to disconnect the issue of homelessness from the acute lack of affordable housing and poverty that underlie it. The "chronic homeless" initiative collapses a wide range of experiences of people who lack housing into a singular, monolithic category, creating a false hierarchy of need based on resource allotment, not the structural underpinnings of homelessness itself. Thus, what is truly "chronic" about homelessness is the lack of political will to address its root causes. For millions of Americans, this "chronic" political inaction results in homelessness -- the most abject form of poverty and deprivation -- in the land of plenty.

For more information, please contact Donald Whitehead, Executive Director, at 202.462.4822, ext. 14 or, or Donald Whitehead, Housing Policy Analyst, at 202.462.4822, ext. 13 or

[1] Joint Center for Housing Studies, The State of the NationĂs Housing: 2001; U.S. Conference of MayorĂs Report on Hunger and Homelessness, 2001, 2002; The National Low Income Housing Coalition, Out Of Reach 2001: AmericaĂs Growing Wage-Rent Disparity, September 2001; Office of Policy Development and Research, U.S. Department of Housing and Urban Development, A Report on Worst Case Housing in 1999: A New Opportunity Amid Continuing Challenges, Executive Summary, 1999, 2.

[2] Koegel, Paul et al. śThe Causes of Homelessness,” inHomelessness in America, 1996.

[3] Department of Veterans Affairs and Housing and Urban Development, and Independent Agencies Appropriations Bill, 2002.

[4] śHomelessness Here Has Gone up 69 Percent,” St. Louis Post-Dispatch, January 24, 2002; "Homeless Problem Outpaces Shelters: Most Worrisome Trend is that Families Make Up the Majority," Denver Post, February 26, 2002; śTaney County Seeks Solutions for Homelessness,” Springfield (MO) New-Leader, January 26, 2002; śScarce Shelter from a Minnesota Winter,” New York Times, January 5, 2002; śA Shelter From LifeĂs Storms,” Muskegon Chronicle, November 6, 2001; śNeeds of Homeless Families Grow: City Shelters Receive More Applications for Limited Space,” Washington Post, November 22, 2001;”Homeless Surge in N.Y. Symbol of New Crisis,” Washington Post; December 23, 2001; śBroader Dialogues on Homelessness, and Hope for Fresh Solutions,” New York Times, January 20, 2002; śNo Place to Call Home: Facing Surge in Families Needing Shelter, District Housing Some in Hotels,” Washington Post, January 23, 2002; śCooling Economy Sharpens Chill In Air: Homelessness, Which Affects Families as Well, Grew as Service Jobs Withered Away After September 11,” Orlando Sentinel, January 10, 2002; śHomelessness Skyrocketing, Shelters Full, Survey finds,” Providence Journal, December 18, 2001; śState Urged to Help Homeless, Providence Journal, February 7, 2002;Also, a survey of 27 U.S. cities found that requests for emergency shelter increased by an average of 13 percent in 2001; requests for shelter by homeless families alone increased by 22 percent. U.S. Conference of Mayors, Status Report on Hunger and Homelessness, 2001.

[5] A 2001 NCH Technical Assistance Project survey of 143 Continuum of Care systems and local coalitions, covering 41 states, Puerto Rico and Guam, permanent housing for families without disabled members was ranked Śhigh priorityĂ by 62% of those surveyed. Supportive housing for people with disabilities as a Śhigh priorityĂ ranked second (59% of respondents), followed by transitional housing for families without disabilities (50%). Further evidence of unmet needs among families include the US Conference of MayorsĂ survey of 27 cities; the survey found that 52% of all requests for emergency shelter by families went unmet due to lack of capacity

[6] Burt, Martha, America's Homeless Population II: Population and Services, 2000.

[7] Homeless children go hungry more than twice as often as other children. The Better Homes Fund, Homeless Children: AmericaĂs New Outcasts,1999.

[8] Nearly 20% of homeless children lack a regular source of medical care in some regions of the country.Pareker, R.M., et al., śA survey of the health of homeless children in Philadelphia shelters,” American J. of Diseases of Children 145(5) (1991): 520-6.70% of children living in New York City shelters had delays in their immunizations.Fierman, A.H., et al., śStatus of immunization and iron nutrition in New York City homeless children,” Clinical Pediatrics 32(3) (1993): 151-5.

[9] 10% of homeless preschoolers have lead poisoning, substantially higher than the national rate.U.S. DepĂt of HHS, Trends in the Well-Being of AmericaĂs Children and Youth (1998).A third of homeless children under the age of six have never been screened for lead poisoning.Better Homes Fund, supra,: note 8.

[10] Better Homes Fund, supra, note 8.

[11] Children in 40% of homeless families have an average of 2 or more chronic illnesses within a single year, including twice as many ear infections, six times more speech and stammering problems, and four times more cases of asthma; Weinreb, supra, note 5.

[12] Bassuk, E.L., et al., śThe characteristics and needs of sheltered homeless and low-income housed mothers,” Journal of the American Medical AssocĂn 276(8) (1996): 640-6.

[13] Better Homes Fund, supra, note 8.

[14] Interagency Council on the Homeless, Homelessness: Programs and the People They Serve, 1999.

[15] Shelter Plus Care (S+C) is designed to provide support services and rental assistance to people with disabilities who lack housing; Section 8 Moderate Rehabilitation SRO Program funds public housing authorities and non-profits to provide rental assistance for individuals who rent rehabilitated SRO units; SHP- Permanent Housing for People with Disabilities program helps develop housing and support services for people with disabilities who lack housing.

[16] In its explanation for the 30% requirement the Senate VA-HUD/IA Committee offered śHUD and local providers need to increase the supply of permanent supportive housing for chronically homeless, chronically ill people over time until the need is met at an estimated 150,000 units.” Even assuming the identified population does not increase, and that such an estimate is reflective of the need, the creation of 4,000 units a year falls absurdly short of achieving this stated goal; Department of Veterans Affairs and Housing and Urban Development, and Independent Agencies Appropriations Bill, 2002, Senate Report 107-43

[17] To prevent homelessness among people with disabilities, NCH supports increased funding for and strengthening of permanent housing programs such as Section 811, Section 202, Section 8, and HOPWA.

[18] The state of IowaĂs estimated pro-rata share for the 2000 round was $4.3 million. Because of the limited funds remaining after the 30% rule was implemented, Iowa received only $3.2 million. As a result three projects that would have provided housing and support services to 40 single men, 39 women and their 59 children, and 26 single women were not funded; Dallas, Texas lost $3.2 million in homeless assistance grants- a 64% drop in its funding- after its Continuum of Care was determined to have an inadequate permanent housing component. Numerous providers and agencies, including AIDS projects, legal services, the CityĂs śmed van” and domestic abuse group homes were severely impacted by the 30% requirement; In Indiana, after renewals and the 30% requirement were accounted for, the stateĂs pro-rata share only allowed one new transitional housing project to be funded.

[19] HUD News Release, January 10, 2002