This month, local homeless advocates are doing a survey in Grand Junction as part of a nationwide effort to identify vulnerable individuals and prioritize them for housing. Volunteers for the Vulnerability Index Survey will reach out to people on the street and ask them 45 questions about health status, institutional history (jail, prison, foster care, hospital and military), length of homelessness, patterns of shelter use, healthcare and income sources.
The survey seeks to identify vulnerable individuals as well as build a composite picture of a community’s homeless population. The idea is that people who have more markers* indicating mortality risk should receive more immediate assistance.
This is the first year the city will participate in the annual effort. It will be conducted by the local coalition for the homeless, which includes most of the institutions that address homelessness here — from the shelters and soup kitchens to the library, police department and VA.
While I think this is a good effort, I can see why some are suspicious and may resist questions about mental health, substance abuse, sources of income, etc. Attaching their names and faces to the answers may facilitate help, but it can also give the impression a dossier is being compiled.
And believe me, many homeless people feel targeted already. I saw one of them in the library today. Mike frequently helps me with cleaning at the Day Center. He was returning two statute books he’d studied to inform his ongoing battle over being hassled for being on the street with a pack on his back.
For people who are trying to get back into housing, the tradeoff between privacy and help is probably a good one. But for many among the chronic homeless who simply don’t feel comfortable in tight quarters — and who may have outstanding warrants, a drug problem or some other part of their past they’re trying to escape — a five-page, face-to-face survey may feel like more of what Mike meets on the street each day.
So far, I haven’t found a national compilation of past survey results. Though each participating locality asks the same questions, they report to their communities in slightly different formats and may omit some data.
Nevertheless, I’ve looked at reports from Portland, Hartford, Nashville and Charlotte. While the populations vary, a few points stand out:
The percentage of homeless veterans is high relative to their 7% portion of the population, ranging from 30% in Nashville to 14% in Hartford.
Most have been jailed. In Portland, 80% reported spending jail time and 30% have been in prison. They’ve also been victims. 45% of those reporting in Portland said they’d been a victim of a violent attack since becoming homeless.
Close to half are medically vulnerable. Both Portland and Charlotte had 47% of their populations who reported at least one of the eight high risk factors. In Portland, more than a third of those surveyed had a chronic medical condition co-occuring with psychiatic and substance abuse issues. Hartford reported 25% had a tri-diagnosis, and 93% “reported or were observed to be suffering from mental illness or substance abuse problems.”
Few have health insurance. The rates of the uninsured ranged from 63% (Portland) to 74% (Charlotte). Not surprisingly, then, the homeless are frequent users of emergency room medical services. (Hartford reported 16% in 2011, which is close to the national rate for the uninsured. I don’t know what accounts for the difference.)
Despite the stereotype, most don’t panhandle. Hartford broke out sources of income, which I’ve converted to percentages of those responding.
- Food stamps: 66%
- Social Security Benefits of some sort: 20%
- Working “off the books”: 18%
- Working “on the books”: 17%
- Public Assistance: 17%
- Recycling: 7.5%
- Panhandling: 4%
- No income: 10%
Of course, anyone’s free to decline, but I hope the survey gets good participation. It’ll be interesting to see how our smaller community stacks up against these cities. And maybe someone who hasn’t yet gotten help will find what they need.
If homeless people are going to count in our communities, it helps if they’re counted,
The eight Vulnerability Index risk markers are:
- More than three hospitalizations or emergency room visits in a year
- More than three emergency room visits in the previous three months
- Aged 60 or older
- Cirrhosis of the liver
- End-stage renal disease
- History of frostbite, immersion foot, or hypothermia
- Tri-morbidity: co-occurring psychiatric, substance abuse, and chronic medical conditions