There have always been homeless people in the United States, but their plight has only recently stirred widespread public reaction and concern. Part of this new recognition stems from the problem's prevalence: the number of homeless individuals, while hard to pin down exactly, is rising. In light of this, Congress asked the Institute of Medicine to find out whether existing health care programs were ignoring the homeless or delivering care to them inefficiently. This book is the report prepared by a committee of experts who examined these problems through visits to city slums and impoverished rural areas, and through an analysis of papers written by leading scholars in the field.

Contents

• Committee on Health Care for Homeless People
• Preface
• 1. Who Are the Homeless?
  • Introduction
  • Definition of Homeless
  • Counting the Homeless
  • Studies of Homelessness
  • Characteristics of Homeless People
  • Summary
  • References
• 2. Dynamics of Homelessness
  • Introduction
  • Patterns of Homelessness
  • Housing
  • Income and Employment
  • Deinstitutionalization
  • Sheltering the Homeless
  • Summary
  • References
• 3. Health Problems of Homeless People
  • Types of Interactions Between Health and Homelessness
  • General Health Problems of Homeless Adults
  • Mental Illness, Alcoholism, Drug Abuse, and Comorbidity of Homeless Adults
  • Health Problems of Homeless Families, Children, and Youths
  • Summary
  • Key to Abbreviations and Explanatory Notes for Tables 3-1 to 3-6
  • References
• 4. Access to Health Care Services for Homeless People
  • Introduction
  • Health Care of the Indigent
  • Medicaid
  • The Indigent Care System
  • Additional Barriers to Access for Homeless People
  • Mental Health Care
  • Veterans
  • Summary
  • References
• 5. Health Care Services for Homeless People
  • Introduction
  • Pre-Johnson-Pew Models
  • Specialized Health Care Approaches
  • The Johnson-Pew Health Care for the Homeless Projects
  • Targeted Services for Populations with Special Needs
  • Other Issues in Health Services for the Homeless
  • Summary
  • References
• 6. Summary and Recommendations
  • Origin of this Study
  • Study Process
  • What was Learned
  • Conclusions and Recommendations
  • References
• Appendixes
  • A Legislative Efforts to Aid the Homeless
  • B The Methodology of Counting the Homeless
  • C The Rural Homeless
  • D Site Visits and Meetings with Local Providers of Services to the Homeless
  • E Acknowledgments
  • F Biographical Notes on Committee Members

The work on which this publication is based was performed pursuant to Contract No. 240-86-0073 with the Health Resources and Services Administration of the Department of Health and Human Services. Additional support for this study was contributed by the Veterans Administration and the National Research Council (NRC) Fund. The NRC Fund is a pool of private, discretionary, nonfederal funds that is used to support a program of Academy-initiated studies of national issues in which science and technology figure significantly. The NRC Fund consists of contributions from a consortium of private foundations including the Carnegie Corporation of New York, the Charles E. Culpeper Foundation, the William and Flora Hewlett Foundation, the John D. and Catherine T. MacArthur Foundation, the Andrew W. Mellon Foundation, the Rockefeller Foundation, and the Alfred P. Sloan Foundation; the Academy Industry Program, which seeks annual contributions from companies that are concerned with the health of U.S. science and technology and with public policy issues with technology content; and the National Academy of Sciences and the National Academy of Engineering endowments.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.