Improving Health Care for the Homeless Starts with Communication

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According to the National Health Care for the Homeless Council, “People who are homeless have higher rates of illness and die on average 12 years sooner than the general U.S. population.” This statistic should be enough to bring attention to the need for health care for the homeless, but this complex issue requires a multifaceted solution – one that begins with communication.

To learn more, check out the infographic below created by the Rider University Online Master of Arts in Health Communication program.

How communication and advocacy can help improve a health care facility’s ability to treat the homeless.

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A Bleak Picture of Homelessness in the U.S.

One study estimates there are 564,000 individuals living in homeless shelters and on the streets in the United States. Others estimate as many as 3.5 million individuals experience homelessness each year. Regardless of the exact number, one thing is certain: Homeless individuals have faces and stories that can’t be captured in one statistic.

Who Are America’s Homeless Individuals?

A high proportion of homeless individuals are minorities. That said, homeless individuals fall into a wide range of categories, including LGBT youth, veterans, migrant laborers, the elderly, and individuals discharged from mental hospitals.

The Effect of Adverse Childhood Experiences (ACE) on Homelessness

Statistics indicate a correlation between homelessness and ACEs on a family and a community level. Family-level ACEs include emotional, physical, and sexual abuse, emotional and physical neglect, and household domestic violence. Community-level ACEs include economic hardship, bullying, and discrimination.

Individuals with four or more ACES are two to five times more likely to develop clinical depression, suicidality, and chronic health conditions. Children with high ACE scores are more likely to experience anxiety, depression, and developmental delays. ACEs also increase the likelihood of poor educational attainment, adult unemployment, and homelessness.

Homeless Individuals’ Mental Health

On a given night in 2017, 20% of homeless individuals had a serious mental illness and 16% had conditions related to chronic substance abuse. Additionally, more than 10,000 had HIV/AIDS.

Studies indicate homeless LGBTQ youth are twice as likely to commit suicide as homeless heterosexual youth. They also show more than 10% of individuals seeking substance abuse or mental health treatment in the public health system are homeless. Furthermore, it’s been determined that housing stability contributes to long-terms recovery from substance abuse and reduces depression struggles among teens.

Healthcare Challenges For the Homeless

For the general population, the process of obtaining health care typically presents fewer obstacles compared with the challenges faced by homeless individuals. Furthermore, homeless individuals may not prioritize health care when they need to search for food or shelter.

The Health Dangers of Being Homeless

Homeless individuals are exposed to violence, malnutrition, and harmful weather. They’re also exposed to communicable disease, including tuberculosis, respiratory illnesses, influenza, and hepatitis. Additionally, they can experience to frequent emergency room visits and hospitalization due to poor health, high stress, and unhealthy and dangerous environments. Ultimately, homelessness can lead to the development of behavioral issues like depression and alcoholism.

Unfortunately, there are several obstacles homeless individuals face when obtaining health care. These hurdles include lack of transportation, lack of personal identification, lack of health insurance, a need to prioritize safety, food, and shelter, and the stigma of homelessness itself.

There are also several challenges homeless individuals face in recovery, such as storing medication in a safe place and monitoring a healthy diet. Studies also show recovery is strained and more difficult without housing. Compared with the general U.S. population, homeless individuals have higher rates of poor health conditions, including diabetes, high blood pressure, HIV, hepatitis C, depression, and substance abuse disorders.

The First Step in Advocating for Health Care for the Homeless

Health care organizations can do a lot to increase the quality of care homeless patients receive. The first step in improving care involves communication, as this can provide solutions to numerous challenges. For instance, communicating the complexities of homelessness via health care staff training can overcome tendencies to blame someone’s homelessness on substance abuse. Developing a communication system that creates connectivity between homeless-focused health care entities can also improve patient outcomes and lower costs. Additionally, developing a communication plan clearly defining care employees’ responsibilities and help create interventions that address the unique characteristics of a homeless population.

Characteristics of Homeless-Friendly Health Care Organizations

There are numerous underlying traits that can be found within an organization that embraces health care for the homeless. These traits include homeless-specific primary care delivery systems, clinical integration of primary care, mental health, substance abuse, and social services, free clinics that provide care at no cost, and interpersonal interactions that demonstrate empathy, cultural sensitivity, and acceptance.


Homeless individuals have unique health needs and face complex barriers to obtain health care. To increase homeless individuals’ access, health care organizations must do their part in improving communication.