Perspectives of Persons Who are Homeless on the Perspectives of Persons Who are Homeless on the Impacts of Homelessness on their Health and What Impacts of Homelessness on their Health and What

they Need to Escape Homelessnessthey Need to Escape Homelessness

Perspectives of Persons Who are Homeless on the Perspectives of Persons Who are Homeless on the Impacts of Homelessness on their Health and What Impacts of Homelessness on their Health and What

they Need to Escape Homelessnessthey Need to Escape Homelessness

A research study supported by a A research study supported by a Small SSHRC GrantSmall SSHRC Grant

P.I. Isolde Daiski, RN, EdD, associate P.I. Isolde Daiski, RN, EdD, associate professor, professor,

York University, TorontoYork University, Toronto

Central Questions

From the Perspectives of Persons Who Are Homeless:

• What is the impact of homelessness on individuals’ health?

• What supports do persons who are homeless need to successfully get off and stay off the street?

Research Design

• Qualitative descriptive exploratory • Semi-structured interviews with 25 homeless

participants, living in shelters or on street• Setting: Park, street and drop-ins• Time: June to September 2005• Method: Taped Recordings, Verbatim

Transcriptions, Thematic analysis• Researcher and 2 student assistants• Ethics Review by York University’s ORA• Each participant got a honorarium of $ 15

Impacts on Health

• Physical attacks common in shelters and on the street

• Arthritis, foot problems, back pain, Tuberculosis, bedbug bites, frequent pneumonia

• Lack of healthy foods and exercise• Lack of sleep, lack of privacy • Fears of violence, particularly of dying alone• Worries about mental health, particularly

depression• Feelings of invisibility and marginalization

Comments on Health

“I got an alcohol problem, when I start drinking to escape my reality, pain and loneliness, it washes it away” (man, 39, living on street)

“I have pain all over. Especially my back. My health has deteriorated a lot” (man, 64, cycled in and out of homelessness all his life)

Comments on Health

“I feel physically ill… I think mostly from stress but um… I’m worried I’ll get hurt and…or some of my stuff stolen or my health will deteriorate emotionally mentally” (woman, 29, sleeps in park)

• “You can get so stuck in deep dark depression that you conjure up yourself” (man, 40, sleeps in park)

• “I feel sad, disappointed in myself, I want to do better”(woman, 40, couch surfs)

Comments on Health

“Sometimes you have problems with the other person you share [a room] and that affects your mental health…I go to drop-ins I get the food I need, it is not like I am starving… My physical health is okay, I guess” (Female, 40, stays with friend)

• “Someone can come with a baseball bat and beat the living crap out of you. I got beaten up and I went to the cops and they said: what would you like us to do?” (Man, 29, sleeps in shelter)

Comments on Fears, Including the Fear of

Death

• “My biggest fear is death. I don’t want to die alone, homeless in the gutter in a slow sad way.” (man, 37, sleeps in park)

• “I don’t want to be in a shelter in my fourties with no one to love me.” (man, 29, sleeps in shelter)

Essentials for Housing• Secure full-time job that pays enough• Higher welfare rates and increasing minimum wage to

a livable income• Educational and training opportunities• Start-up money for furniture and first and last months

rent• A safe place that is maintained and livable, ‘not a dive’• Most believe they will be fine if they can pay rent and

food• Those homeless for a long time would possibly

temporarily or permanently need help with money management, shopping, etc. to get back into a housed life.

Comments: Housing Prerequisites

“Affordable housing. If you can’t stay there and buy food, you are gonna just end back in the system. Who wants to pay $ 500 for a room that is like being in prison” (Male, age 37, alternates between park and shelters)

“Maybe $ 200 more welfare or a room for $ 350 – 400. If it is too far [from services] it won’t work, as you then add transportation costs…” (Male, age 54, lives under bridge)

Comments: Housing Prerequisites

“I have worked in jobs like Motorola, many are physically dangerous, unsafe conditions… Once I almost lost my face due to a dangling piece of metal. The physical labour left me too exhausted to look for better job opportunities. With panhandling I make $15.- / hour. Minimum wage should be at least $15.-/hour, so people can live not in a subhuman way…However, with every ‘no’ you hear, when panhandling, you sink down a little more…” (Female, 41, lives in park with her 20 year old daughter).

Comments: Housing Prerequisites

“If they said a helicopter is going to take you to a logging camp out west, I’d do it. Now they go by a piece of paper. And then they take some kid with 3 months experience at Burger King instead. I have done all kinds of things, welding, rigs, heavy construction, jack hammer, I love to work…They want to pay you some chump wage like $ 9/ hour. No, I want $ 16 at least. And Labour Ready (employment agency) takes money off your cheque and you work your ass off. Look at me, what a waste of a man…!” (Male, 47 sleeps in park)

Systemic Barriers to Housing

• Inflexible bureaucracy of welfare system• Complicated paperwork / red tape• Different workers / counselors each visit • Lack of financial and job security• Poor, unsafe conditions of cheap housing• Lack of support during transition into

housing of ‘longtime homeless’ • *Disrespectful treatment by workers

Comments: Systemic Barriers

“I found getting welfare hard. My worker wanted [too much information]. And leaving the shelter was really hard for me, because there was so much paperwork. Then I just go, forget it and I go back to the shelter, or prostituting, and I don’t have to sign this, get this, get that… Even if I get them what they want, they always want something else…I always feel like I am getting money from their pocket…” (Male, 32, sleeps in shelter)

Comments: Systemic Barriers“Well, maybe if there is no humiliation no

dehumanization in the way we are treated, sure, why would I say no? …there are some hours at night where we like to come in” (Female, 41, lives in park)

“If you apply for welfare, they make you apply for EI…I was waiting and waiting and then I lost the appeal for EI…Welfare paid me $ 800.- and then they made me pay it back…Then we are all back where we started” (Male, 32, sleeps in park)

Comments: Systemic Barriers“If you get a place …it’s a whole new way of dealing with

things. You develop all these habits out here… not very sociable habits… Get me off the street and put me in some dive -- we got you off the street, end of story…You drop off the face of the earth until you’re back in the line up, it’s very isolating” (Male, 60, lives in park)

“I lived in a rooming house before. Some girl turned it into a crack house. 3 years ago she got my boyfriend into crack. I couldn’t handle it no more. So, I became homeless [again]” (Female, 33, stays with a friend)

Recommendations: Jobs and Dignity

• Resources for training / education of those who are homeless to gain job skills and self confidence

• Safe, clean, affordable housing• Livable incomes for all working and on welfare• Interventions to prevent loss of housing, ‘housing

first’, before health is compromised and homelessness becomes a way of life

• Humanize and streamline support systems • Respectful and consistent services around needs

Implications for Health and Social Service

Workers• Political activism / advocacy by individuals and

professional associations for – housing as a ‘right’, a prerequisite for health– social assistance and minimum wage at

levels to afford housing and necessities of life– institutional policies considering special

needs of clients to support clients effectively by humanizing and streamlining services

• Education of professionals, students, politicians and the public on issues of homelessness

References on which presentation is based

• Daiski, I. ( 2008). Perspectives of homeless people on their housing needs and approaches to ensure success. The International Journal of Interdisciplinary Social Sciences, 3(6), 53-61.

• Daiski, I. (2007). Perspectives of homeless persons on their health and health needs priorities: suggestions for health promotion strategies. Journal of Advanced Nursing, 58(3),273-281.