RESPONSES TO THE PROBLEM Both public and private organizations and agencies are developing programs to help homeless

people. The community health nurse needs to be aware of both types of programs and how they can be used individually and collectively to meet the needs of the homeless population. Responses from the Private Sector Until the 1960s, much of the help that homeless people received was carried out by volunteer civic and church groups who founded shelters and soup kitchens. Some were small independent efforts; others, such as the Salvation Army, had a national network (Bogue, 1963). Shelters Shelters vary greatly from one to another. They range from those that supply only a place to get in out of the weather to those that deliver a wide range of services, including meals, individual counseling, advocacy, health services, day programs, employment training, and rehabilitative facilities. Some shelter providers believe that the provision of a wide range of services legitimizes shelters as an acceptable alternative care system for the homeless and that this type of shelter takes the pressure off other agencies to recognize and work with homeless people. Others think that unless the shelters provide the services, homeless people will go without. Shelters also vary in terms of who is eligible to receive their services. Some may screen by age, sex, diagnosis, or behavior. Some of this screening is clearly spelled out in written policy, and some is done by more subtle means. Shelter guests themselves often have a good feel for who is and is not welcome at the various shelters. Rules and requirements also vary, making some shelters more or less acceptable to individual guests. Some shelters are specialized, set up to deal with specific problems. One example is shelters for battered woman, where women seeking refuge from abusive situation can find protection and support for themselves and their children. Soup Kitchens and Outreach Vans Food services to homeless people are also provided in a variety of ways, and many are specialized to meet the needs of certain groups. Soup kitchens are places where food is offered either free or at a greatly reduced price. These services often provide emotional as well as physical nourishment. Soup kitchens and outreach vans try to meet the needs of homeless people where they live or where they congregate. Soup and a sandwich are generally served by a person who knows and cares about the individual being served. Meal sites might cater to a specific population, such as the elderly or women, by offering meals at greatly reduced prices. Being allowed to help with the preparation and serving the meals family style often help a homeless person to feel that this is more than just a handout.

Day Programs Some sites combine luncheon services with a wide range of social, recreational, and health services. Many shelters close their doors during the daytime. Day programs fill the gap and provide much needed services for many. Responses from the Public Sector As the homeless population increased in the 1980s, it became apparent to the private sector groups that their efforts were no longer sufficient to meet the growing demand for services. Much of the early lobbying for increased public awareness and governments response was the result of the work done by grass-roots organizers. In the mid 1980s, the Robert Wood Johnson foundation, in partnership with the Pew Charitable Trusts, provided seed money to 19 major cities to help deal with homelessness. The program was cosponsored by the U.S. Conference of Mayors. The purposes of the grants were to develop program to meet the basic health care needs of homeless people, to improve their access to care and benefits, and to encourage citywide involvement and response. The money was earmarked to be spent in direct care to homeless people with the expectation that services would continue, supported by public funding, when private grant monies ran ouu. In the first four years of this program, primary care, assessment, and referral services were provided to more than 200,000 homeless persons, and all funded cities found the resources to continue after foundation funding had ended (Somers, et al., 1990). Local Programs Many local municipalities have now become active in providing shelter services for their homeless citizens. Both state and local funds are being used to support them. It is becoming increasingly common to have health clinic at these sites. State Programs Zuckerman (2000b) points out that decisions regarding welfare reform had little to do with research, although statistics were used. Studies on the effects of the law are showing that many of the mothers who have left welfare are doing poorly and the number of children living at less than half of the poverty level has increased. She questions whether this new research will be used to influence welfare policies in the future. She also expresses concern that policy changes will now be even more difficult to enact and evaluate because decisions are being made in 50 different states rather than by the federal government.