Unsafe and Unwell: How Homelessness Affects Women and How to Help
A homeless woman with a long history of childhood sexual abuse was so malnourished that her system was trying to compensate for chronic stomach problems by producing fine hair all over her body.
Another woman, discharged from a hospital with a full leg cast and substance use disorder, spent the night in an abandoned home and was attacked by a group of men.
Kathleen Becker, DNP, a clinical associate professor in the USC Suzanne Dworak-Peck School of Social Work Department of Nursing, has seen cases like these when treating patients diagnosed with many different traumas and pain. She has worked with high-need populations in Baltimore for years and characterizes homeless women as her most vulnerable patients.
“Homeless adult women were really the sickest of all my patients because so many of them had experienced violence throughout their lifetime,” Becker said. “It is so prevalent and such a predictor for homelessness.”
Women without housing face unique health challenges and outcomes that require specific types of care and support. Domestic and sexual violence are the leading causes of homelessness among women (PDF, 416 KB). Additionally, women affected by homelessness are also more likely to have a mental illness, not to mention that proper pre- and postnatal care may be difficult to access for mothers without stable housing.
How Many Women Are Homeless?
The District of Columbia has the highest rate of homelessness among women in the United States — 42 women per 10,000 people are without housing. On average, states have 4.37 homeless women per 10,000 people. North Dakota has the fewest women in unstable housing, with 1.28 per 10,000 people.
According to a 2018 Point-in-Time survey, more than 216,000 women are homeless on a given night in the United States (PDF, 89 KB). But not every woman’s encounter with unstable housing is the same.
refers to people who fluctuate in and out of homelessness. It is sometimes quantified as experiencing three or more episodes of homelessness within the past year. Recurring trauma such as assault or intimate partner violence is often the cause of episodic homelessness for women.
refers to people who are homeless as a result of some sort of crisis or displacement, such as an eviction or a natural disaster. There’s a high turnover for this kind of housing instability, because people usually spend a short amount of time in a shelter. Therefore, it’s the most prevalent type of homelessness.
refers to people who have gone without housing for an extended period of time, usually at least a year. People experiencing chronic homelessness often have a chronic condition substance use disorder, or disability that makes finding housing even more difficult and contributes to the continuous and lengthy absence of shelter.
in remote areas means that distance makes it difficult to access already scarce health care infrastructure. Additionally, limited resources are allocated to rural communities for shelters. Families in rural areas make up a disproportionately large part of the unsheltered homeless population and inadequate access to transportation makes it difficult for them to reach emergency shelters.
About half of people experiencing homelessness in the United States are in emergency shelters, and another 15 percent are in transitional housing. The likelihood of living unsheltered varies by group: 50 percent of unaccompanied youth are unsheltered, as opposed to about 5 percent of parents 24 and younger. People with chronic substance abuse or severe mental illness are also more likely to live unsheltered, while women are more likely to live in emergency shelters.
What Health Outcomes Do Women Experiencing Homelessness Face?
Social determinants of health not only trigger homelessness but also contribute to it.
“Everything is work,” said Breanna Lathrop, chief operations officer of Good Samaritan Health Center. “Finding food, finding clothes, finding a place to take a shower. Those millions of little things that can be easy to take for granted just aren’t there.”
Chronic stress can contribute to health complications such as hypertension, heart attacks, asthma and chronic pain. Without stable housing, women confront additional pervasive challenges and negative outcomes including intimate partner violence and mental illness.
Intimate Partner Violence and Assault
In a report from the National Center for Children in Poverty, more than 80 percent of mothers with children experiencing homelessness reported previous encounters of some type of abuse or assault (PDF, 283 KB). And while women can become homeless because they are escaping a dangerous home environment, the fear of instability can make them stay in dangerous situations.
“The lens through which we deliver all our services is really trauma-informed,” said Bryce Moffett, clinical director at N Street Village. “For women, trauma is overwhelmingly a part of their story.”
*If you or someone you know is experiencing domestic violence, you can visit The National Domestic Violence Hotline online or call 1-800-799-7233.*
A quarter of all people in homeless shelters have some kind of mental illness (PDF, 206 KB), adding an additional layer of trauma to their lives.
In fact, almost half of all women who are homeless also have a major depressive disorder — twice the rate of all other women. And women are more likely than men to experience trauma, assault and PTSD when they do not have stable housing.
The average woman spends up to $300 a year on pads and tampons. The additional costs of a menstrual cycle, like birth control and pain medication, can balloon into thousands of dollars over a lifetime.
Some organizations are dedicated solely to providing women with pads and tampons, but Megan Thomas, director of donor relations and engagement at N Street Village, noted that donations are most useful when women want to use them. For example, environmentally sustainable hygiene products (e.g., menstrual cups) may make sense for many women but aren’t necessarily desired by the women they assist.
“Most of our clients don’t want to use tampons, let alone a menstrual cup. If you’re in a public restroom, changing a menstrual cup is not ideal,” Thomas said.
And other needs with regards to hygiene aren’t as obvious but still pose major problems for women. “We do need menstrual supplies,” Thomas said, “but we also need incontinence supplies.”
Data from the aforementioned Point-in-Time survey show that, on a given night in 2018, more than 10,000 people experiencing homelessness reported having HIV/AIDS.
A disproportionate number of those without housing have a substance use disorder, making it more likely that they will contract HIV. The resulting health care needs are complex and costly — a USC study found that antiretrovirals for HIV patients cost an average of $18,668 per patient.
Additionally, the conditions of homelessness put people living with HIV/AIDS at a higher risk for diseases that can target their weakened immune systems and result in life-threatening outcomes.
Child Care and Families
The annual average cost of child care in the United States is $8,700, making child care not only a potential cause of housing instability but also incredibly difficult for the homeless.
The responsibility of child care often falls to women: 85 percent of homeless families are headed by single women, who are more likely to have thin social networks or have exhausted their existing network.
As women face these challenges in tandem with housing instability, authority and control over their own outcomes can start to disappear. That’s why Becker says that decision-making and autonomy are important opportunities clinicians can give these women.
“Where I always start is, ‘What's most important to you today?’” Becker said.
The role of the clinician is to minimize harm, not necessarily to solve all of the patients’ problems. Becker recommends working with women to tackle the health problems they care about most. Allowing patients to direct their care creates better outcomes for everyone: Patients receive the help they’re looking for and clinicians are able to enact solutions.
What Can Be Done to Help Women Experiencing Homelessness?
It may seem simple, but the solution to homelessness — and the health challenges that accompany it — is housing. Intricately linked with health care, access to affordable and quality housing affects an individual’s health outcomes in ways that may not seem immediately obvious.
“The average homeless person is dealing with multiple issues — mental health issues compounded by chronic conditions and diseases,” said D. Michael Durham, technical assistance manager for the National Health Care for the Homeless Council. “And it’s often impossible to get into housing when you have such chronic issues.”
According to Durham, even when people affected by homelessness access health care, clinical guidelines present new challenges. Do they need rest and recuperation? Does an injured limb need to be elevated? Should medication be refrigerated?
But at the individual level, helping can be as simple as donating time, money or useful items.
Here are a few ways you can give to women without stable housing:
Consider setting up a recurring donation to an organization to show continued support. Financial contributions allow women’s shelters and organizations to allocate funds where they need them most. All donations, from $5 to $500 can positively contribute to the lives of women experiencing homelessness.
How Far Does Your Donation Go?
Financial contributions help shelters fund everything from food to comprehensive health care for women without housing. The impact of a donation varies from location to location, but here are some examples of ways that shelters around the country can make the most with what they’re given:
provides two support group sessions to a woman in Denver, CO.$37
pays for 30 meals for women in Washington, DC.$50
funds a welcome basket for a survivor of sex trafficking in San Francisco, CA.
pays for a mammogram for a woman in Los Angeles, CA.$130
supports 10 counseling sessions for a woman in Dallas, TX.$250
provides a night of safe shelter and meals for a family of four fleeing violence in Chicago, IL.
Items and Goods
What are products women’s shelters are looking for? Consider gathering some of the following new or gently used items to donate:
- Everyday clothes — sizes XL and up are most needed
- Professional clothing for job interviews
- New bras and underwear
- Winter coats
- Shoes — suitable for walking
- Socks — especially in the winter
Toiletries and hygiene products
- Tampons and pads
- Incontinence supplies
- Travel-size toiletries — deodorant, toothpaste, mouthwash, etc.
- Cosmetics and makeup — for all skin tones
- Hair care products — for all hair types
- Children’s clothing and coats
- Toys, art supplies, etc.
- Bus passes
- Metro cards
- Old cellphones
Please be mindful to not donate expired makeup or unsanitary products, such as used mascara.
When in doubt, ask. Contact your local women’s shelter and see what they need at the moment. Follow organizations on social media to stay up-to-date on their donation drives.
Nonprofits need all hands on deck to make the most of donations. Volunteers are an integral part of making sure that shelters stay organized and ready to serve as many people as possible.
Some ways you can spend your time helping include: organizing supplies and taking inventory, distributing donations, making welcome kits, serving food or teaching classes.
Search for shelters in your area that specifically help women experiencing homelessness or intimate partner violence.
Understand where you can affect change based on your social and professional networks and take action. Educators, small business owners and community members can all play a role in bettering the health of their neighbors.
Advocating for better education services and employee training along with voting for improved transportation access can create better social determinants. Lathrop says it’s important to remember that the work is best done as a collective, when people use their power to help chip away at the root causes.
“You don’t have to fix it all. One clinic or one organization doesn’t have to find a way to solve all the social determinants,” Lathrop said. “Focus on the one that you already have experience or connections to, and then partner with and support other organizations that are doing the work.
The following section contains tabular data from the graphics in this post.
Number of Women Experiencing Homelessness Return to infographic
|State||Homeless women per 10,000 people (total resident population)|
|District of Columbia||42.14|
Types of Homelessness Return to infographic
|Demographic||Emergency Shelter||Transitional Housing||Unsheltered|
|All homeless individuals (average)||49.87%||14.95%||35.18%|
|Chronic Substance Abuse||34.67%||17.69%||47.64%|
|Severely Mentally Ill||39.15%||13.90%||46.96%|
|Victims of Domestic Violence||49.65%||13.24%||37.11%|
|Parent under the age of 25||67.54%||27.02%||5.44%|
Citation for this content: Nursing@USC, the online FNP program from the University of Southern California