Week 3

Question 1

Who do we expect to be homeless? What is the reality?

Answer 1

we expect single males that are alcoholics or drug addicts

the reality is homelessness is diversifying over time

• families, women, youth
• people marginalized from housing market
• working poor
• special circumstances (mental illness, Indigenous, disabilities)

not confined to the poorest countries

Question 2

What is absolute versus relative homelessness?

Answer 2

absolute = those living on the streets and victims of disaster with no homes at all, complete absence of shelter

relative = has a place to go but it is inadequate, fails to meet basic needs

Question 3

What are the UN’s 5 standards used to determine adequate housing?

Answer 3

adequately protects from elements

safe water and sanitation

secure tenure and personal safety

lie within reach of employment, education, health care

affordable

Question 4

What types of situations are included within absolute homelessness?

Answer 4

people living on the streets

those using shelters

those provided with shelter in conditions bearing little resemblance to a home (i.e. welfare motel)

anyone with no fixed address

Question 5

What is the average age of a homeless person in Canada?

Answer 5

39.5

vast majority is 25-49 age group

Question 6

What proportion of homeless people are women and children?

Answer 6

30% women

23% children and youth

Question 7

How many people experience homelessness in Canada each year? On any given night?

Answer 7

129,000 each year

14,000 on any given night

Question 8

How many shelter users are Indigenous?

Answer 8

34%

but only make up 4.3% of total population

Question 9

What is hidden homelessness?

Answer 9

people that don’t look like the stereotypical homeless person

may look clean, go to school/work

but still don’t have a place to live

affecting more than we think!
- study showed 8% of Canadians over 16 have had to live temporarily with family, friends, or in their car because they had nowhere else to live

Question 10

What are some risk factors for hidden homelessness?

Answer 10

Aboriginal identity

childhood maltreatment
- physical and sexual abuse

disability status/mental illness

limited social safety net

sexual orientation
- homosexual or bisexual individuals more likely to be homeless

education
- less than high school diploma is highest risk for homelessness

Question 11

How does mental illness lead to homelessness and vice versa?

Answer 11

trend to de-institutionalize has provided a patchy infrastructure of care

debilitated: can’t handle organizational and financial issues to maintain/establish a permanent place of residence

lack of services leaves them vulnerable to morbidity of predisposing mental illness AND morbidity associated with being homeless

Question 12

What social factors predict homelessness?

Answer 12

highly related to number of times moved

low belonging to community

as number of relatives/friends they feel close to decreases

Question 13

What negative effects do children living in welfare motels experience?

Answer 13

acute and chronic illness

developmental delay/slowing

unwillingness to form relationships with peers

difficulty trusting, aggression

significant barriers to school success

Question 14

What are some primary triggers of homelessness?

Answer 14

job loss
bills > earnings
abuse
prior incarceration
sick/disabled/mentally ill
change in family status
drug/alcohol abuse

Question 15

How does homelessness usually arise?

Answer 15

from cumulative impact of a number of factors

complex interaction of factors at the individual level and societal level

Question 16

What are some individual level factors that can lead to homelessness?

Answer 16

adverse childhood experiences
low education
lack of job skills
family breakdown
mental illness
substance abuse

Question 17

What are some societal level factors that can lead to homelessness?

Answer 17

poverty
high housing costs
racism
discrimination
labour market conditions

Question 18

What is systems failure?

Answer 18

when systems of care/support fail
- ex. institutional discharge leads to lack of living skills

nowhere to go, leads to homelessness

immigrants, hospital discharge, incarcerated, child welfare, etc.

Question 19

What is the 2-way relationship between health and homelessness?

Answer 19

ill health predisposes homelessness, homelessness leads to adverse health effects

increased mortality, morbidity, diminished QOL

Question 20

How do the homeless experience illness in comparison to non-homeless?

Answer 20

rates of nearly all chronic illnesses and physical ailments are higher
- particularly hepatitis, diabetes, heart and lung disease, cancer, psychiatric conditions. infectious diseases

more likely to experience depression, drug addiction, stress, and suicide

unintentional injuries (falls, struck by vehicle) also more common

more visits to emergency department and more hospitalizations

complex barriers with health care providers may prevent homeless from seeking help

Question 21

Why may homeless people have difficulty obtaining health care services?

Answer 21

need physician to get specialist appointments and harm reduction materials

no treatment available for people who want to quit an addiction, perpetuates cycle

lack of information about available services

Question 22

What is meant by the “fragmented nature of supports” for homeless people?

Answer 22

disconnection between different areas of health care

ex. hospital recommends mental health supports but person doesn’t have a way of accessing them on their own
ex. hospital prescribes medication that costs money or needs to be taken with food that they can’t afford to eat

housing, employment, food, water, and income are primary concerns > health status

Question 23

In what ways do homeless people face discrimination and stigmatization when receiving health care?

Answer 23

negatively judged by health professionals

ignored and excluded from communication

being ignored generates feelings of failure -> social isolation and depression

Question 24

How does health insurance affect the ability for homeless people to receive health care?

Answer 24

health care cards can be stolen in shelters

no longer covered through parents’ health insurance

no benefits through work

Question 25

What issues do homeless women face in terms of health care?

Answer 25

more vulnerable to physical and sexual assaults -> significantly associated with increased levels of unmet health care needs

often predisposed to turning to sex trade, leads to further issues

pregnancy resources, feminine hygiene, STDs, or birth control often unavailable

Question 26

How does the tertiary level of care in our health care system affect homeless people?

Answer 26

feel unfixable and abandoned

seek care at the emergency department where health care professionals have a goal of fixing patients and discharging them promptly

sensation that they are given up on

Question 27

How can moral worth play a role in homeless people’s experience with the health care system?

Answer 27

treated inhumanely during verbal and non-verbal interactions with some health professionals

felt like foreigners, strangers, and worthless

Question 28

What is the cost of homelessness to the Canadian economy? What could it be?

Answer 28

costs $7.05 billion annually in emergency shelters, community supports, health care, criminal justice system, and emergency services (fire, police, EMS)

would pay far less per night to implement more shelter beds versus jail beds or hospital beds

most effective use of government spending would be on rental supplement or social housing to solve the issue in the first place

Question 29

What would prevention of homelessness look like? What does the current situation look like?

Answer 29

national strategy to address and prevent homelessness complemented by local strategies accounting for local needs

we have little effort in prevention and accommodation supports, and more efforts on emergency response, however this is very backwards
- if we put effort into prevention/accommodation, emergency responses would naturally go down

Question 30

What are the 3 components necessary to address homelessness?

Answer 30

adequate, affordable housing

sufficient money to live on
- cash from work or social assistance

treatment/support services

Question 31

What are some of the services that may be included for homeless people?

Answer 31

housing support 
job training
education
substance abuse treatment
counselling
assistance in job search
transitional shelter
physical and mental health care

Question 32

What is housing first theory?

Answer 32

how is someone who doesn’t have a home supposed to deal with addiction, health issues, finding a job, or anything else

finding a home will start a cascade of events

3 themes support housing longevity:

• community
• control
• stability