Typologies of Need that have Surfaced
(chronic homeless, high utilization)
TYPOLOGIES OF NEED
Behavioral Health
“I have a social anxiety thing…I’m on fixed income, I get disability because get degenerative arthritis, nerve disorder, mental disabilities… and I don't even barely get 800 bucks a month…I ended up getting a little misdemeanor charge while I was up here so I’m paying a fine for that. I never even had a record until I came up here. And that’s because I got pushed to the limit to where – normally I can hold my composure, that day I couldn’t. I got pushed too far.”
Josh is 58 years old with a long history of bipolar schizoaffective disorder. His paranoia and lack of consistent housing have made it difficult to focus on medications. His delusions and behavior have resulted in him being kicked out of local shelters, and he has failed in housing placements because of his paranoia. He is often taken to the emergency room with behavioral health crises.
Shelter
Angelo is a 66-year-old man who has been homeless for eight years. He has been unable to obtain housing, and the shelters feel chaotic and unsafe to him. He has learned that if he tells local staff or police officers that he is suicidal, he will be brought to the emergency room for psychiatric evaluation, which can take several hours. While there, he will be warm and receive a good meal.
Photo: Centre for Homelessness Impact/Jeff Hubbard
End of Life
Joseph is 59 years old and has been unhoused for more than 10 years. He has a long history of substance use, heart disease and kidney disease. He has nowhere to store his meds for his health conditions and no transportation to regularly get to appointments for his medical care. He is rapidly declining from end-stage heart and kidney failure. Because of his substance use, people often overlook his medical decline and miss that he actually qualifies for hospice care and is in the last six months of his life.
Complex Medical
Marge is 68 years old with a long history of COPD from smoking, diabetes, and complex heart disease. She requires multiple medications to stabilize her illnesses, but has no where to store them, so they are often lost. The local shelters don’t allow the oxygen tanks that she requires at night. She also needs a place to rest during the day, which isn’t available, so she is living outside. She is repeatedly brought to the emergency room with end stage heart disease symptoms and complications from her diabetes.
Cognitive Dementia
Gerald is a 73-year-old former engineer who became an alcoholic following the death of his 8-year-old child. After his wife divorced him, he became homeless at 69 years old. He has developed vascular dementia from years of chronic alcohol abuse, but no one is noticing his cognitive decline. He is well spoken when he is clear and has a history of visits to the ED related to alcohol, so his change in mental status is often missed. He was found by case workers inside a dumpster eating garbage and has been found wandering the city without shoes.
Photo: Centre for Homelessness Impact / Christopher James Hall Foundation
Cognitive Traumatic Brain Injury
Jeff is a 59-year-old former boxer and chronic alcoholic. He has been homeless for 10 years, and his difficulty with decision-making and follow-through started after his boxing career ended at 35 years old. On the street, he has been sent to the emergency room multiple times due to public drunkenness and belligerent behavior. In the hospital, people attribute his behavior to alcohol, but Jeff was actually assaulted on the street and has a traumatic brain injury. This impacts his ability to make decisions and would qualify him for support from a guardian if he were assessed and diagnosed properly.
Photo: Centre for Homelessness Impact / Christopher James Hall Foundation
Assistance with Activities of Daily Living (ADLs)
Sol is 64 years old and is permanently in a wheelchair as a result of a gunshot injury. Most of the local shelters do not have wheelchair accessibility, and some require that residents are able to climb up into a top bunk for shelter. He is also incontinent as a result of the injury, and his local recuperative care settings require that clients are independent in their activities of daily living (ADLs), so he has been refused admission. His need for support with ADLs has also limited his options for housing.
Multi-Factor Complex
Kevin is 50 years old and dealing with decline and cognitive changes from Huntington’s disease. His mental status is very compromised because he was also assaulted on the street resulting in a skull fracture and traumatic brain injury.
His ability to walk is limited because of paralysis from Huntington’s and also cellulitis in his leg from a fracture that isn’t healing. He has PTSD and has been using Meth to self medicate while living on the street.
His family is not involved and he has a friend as payee who may be taking advantage of him. There are no guardians available in the community.
He has case managers (CMs) from multiple agencies who have tried to place him in a safe environment, but he has run away from several placements and assaulted the staff in some settings. He has no continuity in care coordination due to changes in the CM related to change in location or insurance.
Typologies of Need that have Surfaced
(newly homeless)
TYPOLOGIES OF NEED
Domestic Violence
“Well I decided that I should leave literally years before I could get an agency to connect and say they would take me for the domestic abuse…the first cause of becoming homeless was domestic violence”
Margie is 62 years old and married to a powerful local businessman. After years of physical and verbal abuse, she got up the courage to leave him, but has no experience with work outside the home and no financial support to afford housing.
Domestic Violence
“Well I decided that I should leave literally years before I could get an agency to connect and say they would take me for the domestic abuse…the first cause of becoming homeless was domestic violence”
Linda is 62 years old and married to a powerful local businessman. After years of physical and verbal abuse, she got up the courage to leave him, but has no experience with work outside the home and no financial support to afford housing.
Divorce
“I wanted a divorce. I got tired of his lies…he finally gave me one. I had a trailer, a four bedroom trailer. I was barely making the rent. Now [I live in] a vehicle.”
Eleanor is 77 years old, and after 50 years of marriage, her husband decided to divorce her to pursue a younger woman. She has no family to turn to for support, no pension plan and can’t afford housing on Social Security.
Family Caregiver
Jeannette is 63 years old and has been the family caregiver for her mother for more than 20 years. They lived together in her mother’s home. After her mother passed away, Jeannette lost her mother’s Social Security income as well as her housing. Jeannette has no siblings and is experiencing no response when she applies for jobs. She has no resources to afford housing.
Work-Related Injury
“Health challenges, yeah. I guess I do. Um, I don't know if is directly related but I just got back from [a]...hospital over here. And, um, I have a hernia. And so I went and had that checked, and it’s sufficient that they decided that it would be worth a surgical consult. That it was enough of concern that yeah, you probably should have this looked at right…so now I’m going I can’t even go get a job now…Yeah, you can’t work – basically you are done. You don't qualify for workman’s comp”
Arturo is 62 years old and always prided himself on his capacity to earn a good living doing construction work. A work-related injury led to months in the hospital and a cycle of complex medical needs. His company refused to provide workers’ compensation, and the medical bills became overwhelming. He lost his house and lives in his car, hoping he can find another job but experiencing no luck with new employment.
Inability to Afford Housing on �Social Security
Georgia is 69 years old and retired from a career in public service as a city office administrator. She has no pension, and her Social Security income of $1,500 per month isn’t enough to afford housing, food, and medical expenses in California. She lived with a younger roommate for a while, but was taken advantage of by her and lost what savings she had to a scam concocted by the roommate’s boyfriend. She was found in the park by city workers, embarrassed and newly homeless.
Released from Incarceration
George is 62 yrs old and was released after several years in prison. Ten years ago, while experiencing delusions when off his psychiatric medications, the police were called. When officers arrived he fought back and kicked one of them leading to a felony assault charge for violence against an officer. He is not in touch with family and has no ability to get employment with a felony record. He was released from prison with no ID, no phone and no access to medications for his behavioral health diagnosis. Housing is out of reach in this scenario.
Photo: Georgia Innocence Project
Additional Typologies of All Ages
(complex needs)
TYPOLOGIES OF NEED