• Lacking a fixed, regular, and adequate nighttime residence
  • Chronic homelessness: lacking fixed, regular housing for at least 1 year or at least four episodes of being unhoused in the past 3 years for a combined length of at least 1 year
  • People struggling with homelessness often have complex and chronic medical illnesses such as mental illness, substance use disorders, and physical disabilities (1).



  • Increasing since 2016 nationwide
  • The COVID-19 pandemic disrupted accounting of unsheltered people, but conditions during the pandemic may have increased the incidence (1).

In 2019, 0.17% of the U.S. population (approximately 580,466 individuals) experienced homelessness on any given night: 61% in sheltered locations, 39% in unsheltered locations (1).

  • 6% are veterans, 30% are families with children, 6% are unaccompanied youth (age <25 years), and 19% are chronically homeless individuals.
  • 48% of the homeless population is white.

Risk Factors

  • Poverty
    • 2022 federal poverty level: $27,750 annual income for four-person household in the lower 48 states and District of Columbia, slightly higher in Alaska and Hawaii (2)
    • In 2020, 11.4% of U.S. population below federal poverty line (1% increase from 2019)
  • Unemployment: U.S. rate 3.7% in August 2022 (U.S. Bureau of Labor Statistics)
  • Lack of affordable health care: In 2022, 8.6% of U.S. population (280 million) were uninsured for the entire calendar year (3).
  • Lack of affordable housing: <30% of gross income for housing costs, including utilities; roughly 37.8 million U.S. households spend >30% on housing costs; 18.2 million households spend ≥50% of income on housing.
  • Intimate partner violence (IPV): 12% of overall persons experiencing homelessness and about 20% of families experiencing homelessness report IPV; IPV often involves exertion of psychological and financial control that leaves survivors with poor credit, limited support, and few resources.
  • Veterans: decreasing due to policy changes; decreased by 10% from 2020 to 2021 (2)
  • Transgender individuals: 0.4% identify as transgender and 0.2% as gender nonconforming (2)
  • Addiction disorders: 46% report substance use as a major factor contributing to homelessness (1).
  • Psychiatric illness: 25% of adults experiencing homelessness (1)
  • Post-incarceration: 50,000 people each year enter homeless shelters from jails/prisons (1).

General Prevention

  • Policy and funding for community programs to provide emergency/rapid housing, housing stabilization, and case management services. The CARES Act of 2020 and the American Rescue Plan Act of 2021 provide funding for permanent housing. Over the past 5 years, the fastest growing forms of assistance include rapid rehousing and “other permanent housing.”
  • Increased Medicaid eligibility, expanded home- and community-based services, and case management for people experiencing homelessness
  • HUD: increasing permanent supportive housing units, increasing services for veterans, families with children, and those with disabilities
  • Social justice policy recommendations: permanent affordable housing, foreclosure and homelessness prevention, increased funds for HUD McKinney-Vento programs (emergency, transitional, and permanent housing) and National Housing Trust Fund, rural homeless assistance, universal health care, universal basic income, employment/workforce services, prevention of hate crimes against the homeless, decriminalization of homelessness

Commonly Associated Conditions

  • Hunger and malnutrition
  • Exposure-related conditions (frostbite, heatstroke)
  • Substance use disorders and their associated conditions
    • Liver disease (alcohol, hepatitis B and C)
    • Abscesses (intravenous drug use)
    • Overdose
  • Dental problems
  • Psychiatric illness
  • Trauma (increased risk of assault, victims of hate crime)
  • Infectious diseases
    • Skin/nail infection and infestation (lice, bedbugs, and scabies)
    • Tuberculosis, HIV/AIDS, STI
  • Worsening of chronic medical conditions: lack of healthy food, places to store medications, or medical equipment; lack of restful sleep; decreased health literacy; limited transportation to appointments

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