Background
Rural communities are beginning to resemble urban in terms of population mix, demographic trends, social and economic structures. There are however some differences. Compared to urban counterparts, some rural groups have higher poverty rates, in particular, racial minorities, families headed by single women, children and the elderly. Unemployment rates consistently exceed the urban rate and a higher proportion of rural families are without health care insurance. Considering these demographic features, it is not surprising that homelessness, inexorably tied to economic factors, prevails in rural America, too.
In 1987 the Stewart B. Mckinney Homeless Assistance Act (Public Law 100-77) defined homelessness as a lack of shelter and a homeless person as someone who lacks a fixed, regular and adequate nighttime residence. A homeless person’s primary night time residence could be a supervised public or private shelter designed to provide temporary living accommodations; or, in an institution that provides temporary residence for individuals intended to be institutionalized; or, in a public or private place not designed for, or ordinarily used as, a regular sleeping accommodation for human beings (APHA, 1997; NIMH, 1992, NRHA, 1996). Using that definition, the number of homeless in the United States is estimated to be from any where from 350,000 to 2.5 million people; rural makes up at least 7%f the group. However, demographers estimate the actual rural rate to be about 14% (70,000 to 84,000) of the homeless. Reasons for the wide disparity in rural estimates are examined in subsequent paragraphs (NCH, 1987; 1989; NRHA, 1996).
Definitions of homelessness are further blurred by the growing number of transient persons who view their homeless situation as temporary. They travel the highways and byways seeking steady employment, barely eking out a subsistence with part-time or casual labor. In the strict sense of the definition, transient people are not homeless nor can they be categorized as migrant or seasonal workers. Mostly, transient families are anecdotal reports in small town newspapers, as they travel from town-to-town trying to improve their plight in life. None-the-less, they remain poorly and insecurely housed. These anecdotal reports further substantiates that the homeless in rural areas probably are significantly undercounted (Larson, 2000).
The rural homeless: Who are they?
Americas rural homeless include families with children, children who have been abandoned and runaways, single women and female heads-of-household, unemployed adult males - often times substance abusers, recently released prison inmates without job skills or money, unemployed migrant and seasonal farm workers, elderly persons with no one to care for them, individuals with chronic mental illness and veterans. These are the same types of homeless people as in urban settings, however, those in rural areas seem to differ in some respects (APHA, 1997; NRHA, 1996).
Images of the rural homeless are either absent or poorly defined. A study conducted by the Ohio Department of Health (ODH, 1985) provides some insights into the rural homeless population. These findings cannot be generalized to all rural areas but are supported by anecdotal reports from professionals who work with rural homeless people in other states. Compared to urban, the rural homeless include a larger proportion of the working (near) poor, whites and women with children. There also seems to be a higher proportion of intact two-parent families. Adult males among them are more likely to have been recently employed, less likely to have been in the military or spent time in a correctional institution. The rural homeless are less visible often taking up temporary residence with extended family, in a vehicle or camping in the yard of a friend or relative. Compared to metropolitan, demographers report that rural people are homeless for a shorter length of time. Family dissolution and marital conflicts are the most often cited reasons for their current situation. ‘Family’ seems to be an important theme among rural homeless. Yet, the role and impact of family in the rural context is not fully understood. The incidence of chronic drug and alcohol abuse also seem to be lower in rural homeless than in urban counterparts.
Counting the homeless
It is important to stress there are regional variations in the incidence and the demographic features of the homeless. For example, even in rural communities that are located in a warmer climate, one is more likely to see homeless people in parks, walking along the highway or going through restaurant’ dumpsters. While in colder climates the homeless often have temporary living conditions with family or friends. Some leave their community to find work all the while living out of their vehicle. Overall, the homeless are not easy to count because they are not easily seen. Once located, respondents may refuse to be interviewed or deliberately hide the fact that they are homeless. Some people are intermittently homeless; making it difficult to count them during a national census (NRHA, 1996).
To determine the number of homeless in the United States, the Bureau of the Census counts the number of people staying in shelters and at recognized congregation sites. Census-takers are instructed to avoid dangerous areas and only to count individuals seen at pre-assigned locations. To not place themselves at risk, census takers avoid ‘out-of -the-way’ sites where the homeless often seek shelter, such as in abandoned buildings, hidden doorways in alleys and rooftops, under via-ducts, dumpsters, in under ground tunnels and abandoned vehicles. This methodology yields an enumeration of persons who could be counted at a given time in a given place; thus, reflected in census reports.
Unlike metro areas, shelters are virtually non-existent in rural areas and the homeless are even less likely to congregate at predictable sites. Furthermore, the curious subculture of the urban homelessness with its primitive informal support system does not have a similar counterpart in small towns. Here residents tend to be tight-knit where most have a shared inter-generational history and a tradition of mutual aid and cooperation. Consequently, when someone among them is dislocated, they may temporarily move in with extended family, friends or coworkers (First, Toomey & Rife, 1990; Patton, 1988; NRHA, 1996).
More specifically, from 1979 to 1983 the Federal Housing Assistance Council monitored rural household size and found increased rates in rural ‘working’ poverty correlated with an increase in household size. Interestingly, during that time households did not increase by one or two, but by three or more persons. These changes were explained by the widespread doubling-up, in a single household (Patton, 1988). Furthermore, the faith community (church congregation) often is the first (and last) resort for rural families in need. It is not unusual for several families to informally agree to house other congregation members who are in desperate financial need. Some take refuge in abandoned farmsteads or seasonally-vacated homes. Others use public camping facilities as a temporary residence. At one national park, for example, more than half who were at the site indicated they were homeless in search of a job (Patton, 1988). Families facing farm foreclosure often live in their house until the property is sold and they are evicted. Subsequently, they go in search of a job in their only tangible asset - a vehicle.
All of these families perceive their homeless situation to be temporary. Precariously, they survive on low-paying odd-jobs and seasonal-work by one or both adults along with charity provided by private and public entities. It is unlikely, too, that any of them were counted as ‘homeless’ by census takers. While these families do not fit the federal definition of ‘homelessness’, their living situations are unstable with uncertain future prospects. Given the limitations of census methodology, demographers speculate the rural homeless population probably is at the high end of the estimated range (7% to 14%) (Foster, 1993; NRHA, 1996)).
Causes
Poverty is a recurrent theme in the preceding examples of the homelessness. Generally, rural economic infrastructures are fragile with a pervasive ‘trickle- down effect’ to the community as a whole (DAERS, 1993; USDHHS, 1998). For instance, the decline of family farms and low prices for agricultural products often are identified as a precipitating cause. Less than two percent of Americans live on farms. Yet, in small towns, main-street businesses are indirectly, sometimes directly, impacted by the success or failure of the region’s predominate industry, be it agriculture, timber, fishing, mining, manufacturing, or tourism. Along with enhancing social and health care services, creating new jobs with living wages may be the most effective approach to dealing with the rural homeless problem (DAERS, 1993).
Affordable housing, especially rental properties, is more difficult to obtain for the poorest of the poor. The housing situation in small and rural communities is a contributing factor to homelessness. Homeless shelters, for example, are virtually non-existent because building and maintaining one may not be cost-effective. Furthermore, small towns with limited tax revenue are reluctant to offer generous public assistance programs for fear of becoming a magnet for homeless people. Comparing types of ‘housing vacancies’; in metro areas these are more likely to be rental units (39%) compared to nonmetro areas (15%). Closer analysis reveals that rural vacancies are not really ‘vacant’; rather, they are for seasonal or recreational use, tourists, or migrant workers. More stringent building codes have unintended consequences for poor people, too. For example, the cost of renovating and upgrading construction is passed on to renters. The intended beneficiaries of new building codes, in effect may inadvertently be forced into homelessness because of increased housing costs (Bolda, Salley, Keith, Richards, et al., 2000).
The Agency of Housing and Urban Development (HUD) reports that nearly half of all rural minorities (about 1.4 million) live in substandard housing and many pay more than one-third of their annual income for it. Of all rural residents earning from $5,000 to $9,999 who were able to afford rent, about 34% (770,000) pay more than 30% for rent. For those earning less than $5,000 who were able to afford rent, 28% (625,000) paid 30% or more of their income on rent (NRHA, 1996). Rent rates have risen both in relative and absolute terms. The erosive power of inflation also has undercut entitlement programs targeting those on fixed incomes, especially, the elderly, single female head-of-households with children, veterans and the mentally ill. The last two groups are discussed in some detail since these individuals usually need an array of resources which tend to be less available in rural areas (Bushy, 2000). Issues related to health status and resources are examined in a subsequent article, Part II: Health and service needs, and resources of the rural homeless (see RMH Spring 2001).
Veterans
Veterans are a significant segment of the homeless population and face additional challenges in remote rural areas, especially those from the Vietnam era. It is not unusual for veterans to have a dual diagnosis, i.e., chemical dependency along with post traumatic stress disorder or some other mental illness. Frequently they have problems in accessing services provided by the Department of Veterans Affairs (VA) associated with geographic distances, transportation barriers and social isolation. Homeless veterans’s needs often are basic, including food, shelter, clothing, transportation, and safety. Sometimes, the VA contracts with acute care and community-base agencies to provide services to rural veterans. Additionally, counselors in Vietnam Veteran Counseling "Vet’ Centers provide outreach services in some rural areas. Generally, they are aware of less-well known resources in frontier and under served regions and may be able to connect veterans with other VA sponsored programs and services (Loy, 1997; Mooneyhan, 1997).
The chronic mentally ill
A significant proportion of the homeless are mentally ill and society must consider the needs of this particular population. On any given night, the Bureau of Census estimated that there are up to 600,000 homeless people in our nation. Of the adults, about one-third have a chronic mental illness such as schizophrenia or manic depressive disorder (APHA, 1997; NIMH, 1992; Sobel, 1998). Untreated, these disorders can cloud the person’s thoughts, sap motivation and turn emotions into engines of terror, rage and despair. Chronic mental illness often means a lifelong waxing and waning of symptom for the afflicted person which can impact every aspect of life. Many are not able to complete personal hygiene, manage their money, work, maintain meaningful relationships and, rear children - for those having them. Often, the debilitating symptoms could be managed with ongoing medical treatment and rehabilitation. Yet, for a variety of reasons, the most severely ill often refuse to take medication.
The mentally ill must contend with of other factors that contribute to uncertain living arrangements (Wagenfeld, 2000). Foremost, is the lack of an adequate income and diminished social support, often complicated by the use of alcohol and/or other drugs. Those who are of another racial and ethnic origin are hampered by cultural and sometimes language barriers. Another barrier in rural settings is the lack of affordable and appropriate housing coupled with fragmentation of health care and social services, stigma and discrimination. Once housed, the mentally ill often do not have adequate support systems to sustain community living that might prevent another lapse into homelessness.
Responsive care for this high risk group involves the integration of an enormous range of services. In rural areas, however, these systems may not work well together or may not exist. In other words, health care, social and mental health services, substance abuse treatment, legal assistance, income support, housing, rehabilitation, and employment services are uncoordinated entities. Often these systems are not user-friendly either. Essentially, resources must not only be accessible but easily maneuvered by the target population, in this case a homeless persons whose judgement may also be impaired.
Compared to urban areas, the chronically mentally ill probably constitute a smaller segment of the rural homeless but they present special challenges. For instance, veterans may isolate themselves in some of the most remote areas of rural counties (Loy, 1997; Mooneyhan, 1997). As for those with chronic mental illness, they tend to gravitate to communities in closer proximity to the state hospital. However, that place may not be the individuals ‘home’ town; thus, leaving him or her without a support system. It may be best for some who are mentally ill to be placed in a semi-custodial living arraignment near their home. In urban settings, establishment of group homes for the mentally ill, rehabilitating substance abusers, and released prisoners often are met with public opposition - cynically referred to as "not-in-my-backyard".
It is unclear whether or not such initiatives will be similarly challenged in rural neighborhoods. On the one hand, an economically depressed rural county might welcome the additional jobs and potential income generated by such a facility. On the other, the cost of housing and treatment-per-person probably will be higher in a sparsely populated region rural than in metro areas. Recruitment of qualified health professionals also tends to be more challenging in some rural areas. Be it rural or urban, effectively responding to homeless person who are mentally ill requires a dedicated ongoing and commitment by many entities to coordinated an array of formal and informal services (DAERS, 1993; NRHA, 1996; Wagenfeld, 2000).
Research needs
The research needs are unlimited since little is known about rural homelessness. Most important is identifying and describing the rural homeless. Methodological approaches must be developed to better assess the extent of the problem. Empirical data on the incidence of rural homelessness, their lifestyle and coping strategies are critically needed. Quantitative data must be augmented with qualitative information to provide the human perspective for rural homelessness phenomenon.
For instance, census data could be supplemented with personal interviews to have a better understanding about the distribution of homeless by age, ethnicity, gender, family structure, duration of homelessness, most recent place of residence along with a more comprehensive description of their health status. Accurate and complete data on the homeless in general, and in rural areas in particular, is needed by policy developers, health planners and health professionals. Unfortunately, coupled with the cost of conducting a survey of this magnitude, elected officials and taxpayers probably are not eager to pay for new entitlement programs that might arise from the findings. Even so, without reliable data, appropriate and accessible community-based services can not be developed at the local level to meet the needs of a rural population with special needs that for the most part is not visible (Bushy, 2000).
Legal and ethical issues
There are many unresolved legal and ethical issues surrounding homelessness in general, and the rural phenomenon in particular. The most often discussed center on threats to the public’s’ health versus personal safety of the homeless coupled with the need for appropriate and equitable dispersion of scarce resources (APHA, 1997; Bushy, 2000; NIMH, 1992; NRHA, 1996).
In respect to the chronic mentally ill, society must deal with the fact that deinstitutionaliztion did not yield the intended outcomes many hoped for. Public discourse continues on the need to protect citizens from the dangerously deranged while at the same time protecting the basic liberties of a person who is mentally ill, and who may also be homeless.
Welfare reform, also known as the welfare-to-work program, is recent federal initiative of which the full ramifications are yet to be determined. Short-term, most of the 50 states have reduced the number of recipients on public assistance rolls. However, the long term outcome of welfare reform and its impact on rural homelessness remains to be seen. As advocates for the vulnerable and poor, health professionals must actively participate in policy-related discussions for that program at the state and local level.
Another growing concern are United States immigration policies and their relationship to homelessness. More specifically, what proportion of the rural homeless are documented versus undocumented agricultural workers? Are additional regulations needed to control the influx of immigrants? Or, do the existing policies need to be better enforced? If so, how? Migrant workers in many instances take the jobs which no one else wants and at a much lower salary, such as meat packers and farm workers. In turn, their labor keeps the market price of fruits and vegetable quit low. Yet, immigrants especially agricultural workers often are among the poorest of the poor. Are other national and global forces impacting this phenomenon? Or, is poverty a symptom of human readjustment in a global economy?
In summary, the list of research topics related to rural homelessness could go on infinitum since so little is known about that population. Since they tend to be less visible, demographers speculate their numbers to be under estimated. The subsequent article in this two-part series will focus on the health status of the homeless and resources that are available in many rural areas to address those needs.
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