A Primary Care Approach to Treating Women Without Homes

Roseanna H. Means, MD, MSc

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Definition and Numbers of Homeless

Homelessness is loosely defined as lacking "fixed, regular, and adequate night-time residence."[1] Homeless persons include those in shelters as well as those who are precariously housed -- ie, those facing eviction or doubled up with friends or relatives. Women in battered women's shelters, although technically and legally having a home to go to, are included by many homeless advocates as part of the homeless population, because these women lack a safe place where they can escape from physical pain or abuse.

Two methodologies are used to study the homeless. Point-in-time studies count people in shelters on a certain day of the year. This counting method includes many with mental illness and chemical dependency -- those for whom the shelters are fixed locations of last resort. Period prevalence counts of homeless are retrospective surveys of general populations and include those who have been homeless at any time during a given study period. These studies include a broader cross-section of persons affected by homelessness, such as battered women, families, and others affected by government support cutbacks or job layoffs. Whereas point prevalence studies help elucidate the chronic and persistently homeless, period prevalence studies provide insight into the breadth and depth of the social problem.[5]

In the United States, the point prevalence of homelessness has been reported to be as low as 500,000 people, whereas the 5-year period prevalence of homelessness for the years 1985-1990 has been reported to be 4.6% of the population, or 5.7 million Americans.[6,7,8,9] A telephone survey of Americans conducted in 1990 revealed an estimated total of 13.5 million people who had ever in their lifetimes experienced literal homelessness. Demographics of homelessness derived from a selected sample are shown in Table 1.

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