Homelessness in the U.S. is at a record high. On a single night in January 2024, more than 771,000 people were experiencing homelessness, the highest count since national data collection began in 2007 and an 18% jump over the prior year, according to HUD's 2024 Annual Homelessness Assessment Report. Family homelessness rose 39% in that same span. Rising housing costs and a shortage of affordable units are the main drivers. Nurses see the downstream effects: patients who arrive in poor physical and mental condition, often after long stretches without care.
Barriers to Care
Several barriers limit access to care and raise the risk of chronic disease and premature death:
- Poor access to reliable transportation
- Discrimination
- Poverty and affordability
- No reliable access to clean water or electricity
- Substance misuse
- Poor mental health
- Negative past healthcare experiences
- Competing priorities like housing, safety, and food
- Low trust in providers and weak therapeutic relationships
Providers who have never lacked these basics often miss them. If you prescribe a medication that needs refrigeration, or order a wound dressing changed twice daily with clean water, ask where the patient will store it and how they will do it. A patient without a safe place for supplies, or without reason to trust you, will not follow a plan that ignores their reality.
How to Care for Patients Experiencing Homelessness
Use a holistic approach
Nurse-led models of care for people experiencing homelessness improve outcomes. Treat the mental, physical, and social problems together, not in isolation.
Establish trust first
Trust is the foundation of every other intervention. Listen, take the patient's account seriously, and learn how they actually manage their health day to day before you hand them a plan.
Assess immediate and long-term needs
Address the urgent problem in front of you, then look further out. Simple steps at the bedside can start case management, substance use treatment, housing referrals, or income assistance.
Provide trauma-informed care
A trauma-informed approach helps you connect patients to a medical home and advocate for the broader supports they need.
Advocate on both levels
At the individual level, advocacy can mean arranging clothing, transportation, a phone call, job leads, or weather survival kits. At the system level, it means working through legislation and community partnerships to close the housing gap and address the causes, not just the symptoms. Both matter.
Frequently Asked Questions
How many people are homeless in the United States? HUD counted more than 771,000 people experiencing homelessness on a single night in January 2024, the highest figure since national data collection began in 2007 and an 18% increase over the prior year.
Why is homelessness rising? Rising housing costs and a shortage of affordable units are the main drivers. Family homelessness rose 39% between 2023 and 2024.
What are the biggest barriers to care for patients experiencing homelessness? Unreliable transportation, no safe place to store medication or supplies, no clean water or electricity, poverty, discrimination, substance use, poor mental health, low trust in providers, and competing priorities like food and safety.
Why do standard discharge plans fail these patients? Many plans assume a refrigerator, clean running water, or a safe place to sleep. When those basics are missing, instructions like refrigerating a medication or changing a dressing twice daily are not realistic. Ask where and how the patient will actually carry out the plan.
What approach works best? A holistic, trauma-informed approach that builds trust first, treats physical, mental, and social needs together, addresses urgent and long-term needs, and connects the patient to case management, housing referrals, and a medical home.
How can nurses advocate for patients experiencing homelessness? At the bedside, arrange practical supports like transportation, clothing, or a phone call. At the system level, work through community partnerships and policy to close the housing gap and address root causes.