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Healthcare of homeless persons in the United States

Travis P Baggett, MD, MPH
James J O'Connell, MD
Section Editor
Thomas L Schwenk, MD
Deputy Editor
H Nancy Sokol, MD


Homeless people have a heavy burden of medical and psychiatric illnesses and use acute healthcare services at high rates.

This topic presents an overview of homelessness in the United States, discusses common health conditions seen among homeless people, and provides recommendations for providing clinical care to this vulnerable population.


In 1987, the Stewart B. McKinney Homeless Assistance Act defined a homeless person as someone who lacks a fixed, regular, and adequate nighttime residence and who lives in a shelter or a place not designed for human habitation [1]. In 2009, the Homelessness Emergency Assistance and Rapid Transition to Housing (HEARTH) Act expanded this definition to include people at imminent risk of housing loss within the next two weeks and people fleeing from domestic violence with inadequate resources to obtain other permanent housing [2].

A chronically homeless person is defined by the United States Department of Housing and Urban Development as an individual with a disabling condition who has been either continuously homeless for at least one year or homeless at least four times in the past three years [3].

The phrase "homeless people" conveys a certain homogeneity that belies the remarkable diversity of this population. In our practice, homeless patients range from those who have spent their entire lives in poverty to those with advanced degrees and once-successful careers cut short by mental illness, addiction, personal tragedy, or bad luck.


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