This is an excerpt of All In: The Federal Strategic Plan to Prevent and End Homelessness. Read the full plan at usich.gov/all-in.
Housing is a social determinant of health, meaning lack of stable housing has a negative impact on overall health and life expectancy. Tens of thousands of people die every year due to the dangerous conditions of living without stable housing—conditions that have worsened due to climate change and the rise in extreme weather. For those who survive, the trauma caused by homelessness can have a lasting impact—even after a person moves back into housing. Children who have experienced homelessness are more likely to experience serious health conditions and to become more vulnerable to abuse and violence.
According to HUD, on any given night, more than half a million people sleep in shelters and unsheltered places not meant for human habitation, such as cars and encampments. But this single night datapoint only provides part of the picture of who experiences homelessness. While some people experience it for extended periods, most experience homelessness in shorter episodes. Over the course of a year, more than a million individuals and families experience homelessness, and many more experience housing instability placing them at risk for homelessness. For the first time since data collection began, more individuals experiencing homelessness in the U.S. are unsheltered than sheltered. When considering households that are “doubled up”—where multiple families or generations are living together out of necessity—or households that are severely rent-burdened, the number of households experiencing homelessness or housing instability surges even higher.
Given the pervasiveness of homelessness, most Americans—often unknowingly—have friends, family, coworkers, or neighbors who are experiencing homelessness today or who have experienced homelessness at some point in their lives.
Homelessness in the United States has surged and receded throughout our nation’s history.* The early 1980s marked the emergence of what now may be considered the modern era of homelessness. While there have been many structural drivers, the evidence shows that homelessness is largely the result of failed policies. Severely underfunded programs and inequitable access to quality education, health care (including treatment for mental health conditions and/or substance use disorders), and economic opportunity have led to an inadequate safety net that fails to keep individuals and families from falling through the cracks when they fall on hard times. Underinvestment in both affordable housing development and preservation has led to severe shortages of affordable, safe, and accessible housing. Wages have not kept up with soaring housing costs for many working Americans, leading to persistent housing insecurity and in some cases exacerbating poverty.
Central to many of these systemic failures are policies and programs that led to discriminatory practices against people of color and members of marginalized groups. For example, during the 20th century, federal and local governments implemented discriminatory housing, transportation, and community investment policies, such as redlining, ** that segregated neighborhoods, inhibited equal opportunity and wealth creation, and led to the persistent undervaluation of properties owned by people of color. These federal policies eroded intergenerational wealth creation for individuals and families across the United States, leaving many people of color more vulnerable to housing instability and homelessness. Similarly, policies like forced relocation have put American Indians and Alaska Natives at greater risk of housing insecurity and homelessness. At the same time, discriminatory policies and practices against marginalized groups— such as LGBTQI+ Americans, people with disabilities, and people with HIV—have resulted in inequitable access to economic opportunity, housing security, and an inclusive social safety net.
The impacts of systemic racism and discrimination can be seen in federal homelessness data. While homelessness impacts people of all ages, races, physical and cognitive abilities, ethnicities, gender identities, and sexual orientations, it disproportionately impacts some groups and populations. Compared to their overall proportion of the U.S. population, people of color are overrepresented in the homeless population. Black Americans are especially overrepresented at a rate of 3 to 1 compared to the general population. For American Indians and Alaska Natives, the ratio may be as high as 5 to 1. Latinos and some sub-groups of Asian Americans, including Native Hawaiians and Pacific Islanders, also experience homelessness at high rates. Latinos, however, are routinely and drastically undercounted. Building an efficient and effective homeless services system will require partners at all levels to understand and address these racial disparities.
The COVID-19 pandemic has further exacerbated homelessness, putting more people at risk of losing jobs and homes, and putting people already living without a home at greater risk of disease and death. People experiencing homelessness are more likely to have chronic disease, increasing their vulnerability to COVID-19 and other infectious diseases. The experience of homelessness can also make it more challenging to access and receive necessary care, which can exacerbate homelessness and poor health conditions.
During the height of the COVID-19 pandemic, many agencies that provide vital supportive services and benefits closed their offices to protect the health of employees and the public; public restrooms were locked; and agencies faced severe staff shortages as the trauma of homeless services work intensified and turnover increased. In the early days of the pandemic, many communities heeded the CDC’s guidance to avoid clearing encampments. But more recently, in response to unsheltered homelessness becoming more visible in many communities, there has been a sharp rise in the number of local laws and ordinances that reverse course and criminalize homelessness.
The pandemic has also made it even more difficult for some to find shelter. Traditional, congregate shelters drastically cut the number of people that could be served to comply with public health guidelines for mitigating the spread of COVID-19. To account for that limitation, many communities have implemented innovative solutions to expand non-congregate shelters by moving people into hotels, motels, and other previously vacant spaces where they could socially distance from others. This expansion of non-congregate shelter has provided an opportunity to rapidly and effectively address the needs of people experiencing homelessness and has advanced new models that could be sustained and replicated.
People with preexisting health issues are more likely to experience homelessness, and they are more likely to live in unsheltered locations than shelters. Children who experience homelessness are more at risk for poor health conditions and developmental delays. Health problems—coupled with lack of access to quality health care—can contribute to risk of homelessness, and in turn, homelessness can worsen health, including mental health conditions and/or substance use disorders. While rates of homelessness for people with mental health conditions and/or with substance use disorders are high, the majority of people experiencing homelessness do not have a mental health condition and/or substance use disorder. Furthermore, the majority of Americans with mental health conditions and/or with substance use disorders do not experience homelessness.
Through the comprehensive input process to inform the development of this plan, USICH heard about the key challenges to implementation as well as opportunities to advance progress, which are highlighted below.
While housing is the solution to homelessness, the United States suffers from a severe shortage of safe, affordable, and accessible rental housing. Prior to the pandemic, there was a shortage of 7 million affordable and available homes for renters with the lowest incomes. The shortage is caused by many factors, including a shortage of available land and labor, increased costs of raw materials, local zoning restrictions, land-use regulations, opposition to inclusive development—which is commonly referred to as “Not In My Back Yard” (NIMBY), and the destruction of homes in climate change’s path. Compounding this, people with housing vouchers or other rental assistance compete for limited housing in a highly competitive rental market, and they often face stigma, barriers, and/or discrimination from landlords. In addition, many landlords deny housing to people based on their criminal records and/or credit history. And many renters of color, LGBTQI+ renters, and renters with disabilities continue to face outright discrimination when they apply for housing. The lack of accessible housing for some people with disabilities further complicates the situation.***
Wage growth has been slow for the lowest-paid workers for decades, and for many Americans, rental housing is unaffordable because wages have not kept up with the fast rise of rent. According to a 2021 report, in no state can a person working full-time at the federal minimum wage afford a two-bedroom apartment at the fair market rent. As a result, 70% of the lowest-wage households routinely spend more than half of their income on rent, placing them at risk of homelessness if any unexpected expenses or emergencies arise. Housing unaffordability disproportionately impacts people with disabilities, LGBTQI+ people, and people of color. Discriminatory employment practices toward these groups further contribute to these disparities. Similarly, there is no housing market within the U.S. in which a person living solely on Supplemental Security Income (SSI) can afford housing without rental assistance.
“Low-barrier,” culturally appropriate, readily available, and accessible supportive services—including treatment for mental health conditions and/or substance use disorders—often are not available or funded at a level to meet the need. This is particularly true in rural areas. As a result, people seeking these services may face long waits or may not receive them at all, and service providers may only be reimbursed for a fraction of the cost of care. Furthermore, collaboration and coordination between homelessness response and other systems—including health, victim services, workforce development, aging- and disability-related services, early care and education,**** K-12 and higher education—is often not as strong as it could be, creating silos in service delivery. People of color, especially Black people and other marginalized populations face greater barriers to receiving the supports they need, which leads to severe health inequities and disparities in health outcomes.
The number of people living in unsheltered locations is rising, yet there are often not enough safe, low-barrier shelter or interim housing options for people waiting for permanent housing and support. Many shelters are full or deny entry to people who are struggling with a mental health condition and/ or who have a substance use disorder, have criminal records, live with a disability or chronic condition, or identify as LGBTQI+—despite regulations that prohibit this discrimination. People who have disabilities, pets, partners, or older children (especially male teenagers) have fewer options for sheltering together. Additionally, shelters often fail to meet the needs of people either because they are not culturally appropriate or do not have the capacity to provide adequate support and accommodations for people with significant physical disabilities, mental health conditions and/or substance use disorders. As unsheltered homelessness increases in some communities, the impact on surrounding neighborhoods has eroded support for further investments in homeless services.
In some communities, a rise in encampments has resulted in harmful public narratives and opposition to development of affordable housing and programs that serve people experiencing homelessness. As elected leaders respond—and not always in the most effective ways—some have resorted to clearing encampments without providing alternative housing options for the people living in them. Many communities have made it illegal for people to sit or sleep in public outdoor spaces or have instituted public space design that makes it impossible for people to lie down or even sit in those spaces. Unless encampment closures are conducted in a coordinated, humane, and solutions-oriented way that makes housing and supports adequately available, these “out of sight, out of mind” policies can lead to lost belongings and identification which can set people back in their pathway to housing; breakdowns in connection with outreach teams, health care facilities, and housing providers; increased interactions with the criminal justice system; and significant traumatization— all of which can set people back in their pathway to housing and disrupt the work of ending homelessness.
The pandemic has strained the capacity of service providers—many of whom earn wages low enough to qualify them for the programs they help administer. Even before the pandemic, housing and service programs had high staff turnover. These essential workers provide life-saving crisis services while dealing with staffing shortages, navigating evolving guidance for protecting themselves and their clients, and doing their best to implement best practices and quickly deploy new federal funding. Many are overwhelmed and exhausted from the pressure and trauma associated with supporting not only the people they serve but also themselves and their families during a sustained global pandemic.
The American Rescue Plan—along with the Coronavirus Aid, Relief, and Economic Security (CARES) Act—provides billions of dollars for new and existing programs that can move people into housing and increase the availability of housing and housing subsidies. Section 2001 of the ARP also created new funding to directly connect students experiencing homelessness with educational and wraparound supportive services. These resources provide communities with a historic opportunity to innovate and improve existing systems. Moreover, President Biden’s budget request for Fiscal Year 2023 includes significant increases in funding for targeted programs, vouchers, and Low-Income Housing Tax Credits, as well as new funding to increase the affordable housing supply.
The CARES and American Rescue Plan Acts created regulatory flexibilities that spurred greater innovation, strengthened partnerships, and created new collaborations. Furthermore, the Biden-Harris Administration has taken critical action to address the challenges outlined in the previous section. President Biden has issued several executive orders focused on bold and ambitious steps to root out inequity within the economy and to expand opportunity for people of color and other marginalized groups. The White House has also initiated whole-of-government action plans and strategies that address the nation’s most pressing needs, such as the Housing Supply Action Plan, the National Mental Health Strategy, and the National Drug Control Strategy.
COVID-19 has spurred a sense of urgency and innovation across government to keep people safe and healthy. Federal programs have found ways to rapidly waive requirements that were impeding mitigation and recovery. As a result, new partnerships have been created and new approaches have emerged, including the conversion of previously vacant hotels to non-congregate shelter and housing; expansion of unemployment benefits; use of eviction moratoriums; launch of emergency rental assistance; and provision of direct cash transfers. The expansion of non-congregate shelter, in particular, and the greater coordination among public health, health care, aging and disability network organizations, and other supportive services has provided an opportunity to improve housing stability and health outcomes.
The murder of George Floyd during an encounter with law enforcement in 2020 sparked greater awareness of historic and ongoing racism—especially anti-Black racism—and its impact. A nationwide discourse on racial justice ensued, demanding urgent change and accountability at all levels of government in public policies and programs that either intentionally or unintentionally perpetuate racism. Since then, awareness of racial disparities has risen, along with efforts to correct these inequities, at all levels of government and in the homelessness sector. While homelessness impacts people of all races, ethnicities, gender identities, and sexual orientations, it disproportionately impacts some groups and populations, particularly people of color, and especially Black people. This increased focus, as well as the Biden-Harris administration’s commitment to a whole-of-government approach to advancing equity, provides an opportunity to hold federal, state, and local governments accountable for achieving more equitable outcomes for people of color.
The homeless services sector is comprised of many passionate and compassionate people—many of whom are volunteers—who dedicate every day of their lives to the work of preventing and ending homelessness in their communities. This work is difficult under any circumstances, and the pandemic made it exponentially more difficult. But people continue to show up, persevering through the toughest circumstances.
This is an excerpt of All In: The Federal Strategic Plan to Prevent and End Homelessness. Read the full plan at usich.gov/all-in.
