Posthumously Assessing a Homeless Population: Services Use and Characteristics.

Area of Science:

• Public Health
• Urban Health
• Social Epidemiology

Background:

• Estimates of homeless populations often rely on conventional counts and surveys.
• These methods may not capture the full spectrum of individuals experiencing homelessness.
• Understanding the characteristics of those not engaged with services is crucial for accurate assessments.

Purpose of the Study:

• To analyze the characteristics and service utilization patterns of deceased homeless individuals in Philadelphia.
• To compare individuals with varying levels of engagement with homelessness services.
• To assess the impact of "hidden homeless" populations on demographic and health estimates.

Main Methods:

• Utilized data from the City of Philadelphia Medical Examiner's Office for decedents from 2009-2011.
• Classified 141 adult decedents into three groups: known users, occasional users, and nonusers of homelessness services.
• Employed descriptive and multivariate statistical methods to compare group differences.

Main Results:

• 49% were known users, 27% occasional users, and 24% nonusers of homelessness services.
• Nonusers and occasional users were more likely to be white, less likely to have severe mental illness, and less likely to receive disability benefits or Medicaid.
• Nonusers and occasional users were more likely to die in outlying city areas compared to known users.

Conclusions:

• Conventional homeless surveys significantly underestimate the homeless population by missing individuals not utilizing services.
• Including these "hidden homeless" individuals would alter perceptions, potentially decreasing estimated rates of psychiatric disability and increasing estimates of racial diversity.
• Findings highlight the limitations of traditional enumeration methods for understanding the complex reality of homelessness.