Homelessness Education and Resources

Alaska experiences higher rates of tuberculosis (TB) compared to the rest of the country, with particularly elevated infection rates among people experiencing homelessness (PEH). To help prevent the spread of TB in homeless shelters, the following guidelines are available:

• Alaska Homeless Shelter Infection Control Recommendations
• National Health Care for the Homelessness Council

People experiencing homelessness are at increased risk for hepatitis A infection, but it can be prevented with a safe and effective vaccine. It is recommended that individuals experiencing homelessness receive the hepatitis A vaccine to protect their health.

• Hepatitis A vaccine information

There is broad recognition that housing is a crucial social determinant of health. People Experiencing Homelessness (PEH) (particularly single adults), cycle in and out of hospital emergency rooms, jails, and other public services . There is ample evidence that shows that housing, specifically permanent supportive housing (PSH), can reduce utilization and costs of emergency care and corrections for chronically homeless and disabled single adults. Affordable housing should be prioritized across community systems, and we should prioritize the highest utilizers of costly emergency services among the PEH population for new and existing affordable housing and supportive housing opportunities.

Eviction prevention programs are focused on working upstream to prevent people from losing their homes through efforts to stop or reduce the inflow into the homeless service system while helping vulnerable individuals and families maintain housing stability.

• This includes prevention and diversion programs that incorporate financial aid, counseling, and legal assistance for at-risk tenants. 
• Permanent rental housing subsidies have proven very effective to prevent homelessness among low-income families.
• Rental subsidies can be utilized to rapidly rehouse those who recently lost their housing as well.
• The Housing Vouchers for Welfare Families study assigned random families eligible for Temporary Aid for Needy Families (TANF) to a voucher or put them on a waiting list for a voucher. Among the 67% of families who successfully used their voucher to lease housing, homelessness was entirely prevented. 

The 2024 Point-In-Time (PIT) count for the State of Alaska showed a total of 2,684 individuals experiencing sheltered and unsheltered homelessness. This is a record high for the past 13 years. This included:

• 1,740 individuals utilizing Emergency Shelter
• 465 utilizing Transitional Housing
• 479 unsheltered
• 1,707 of those clients were in the Anchorage CoC

Note: The PIT count occurs in January, when our unsheltered population is much lower due to Cold Weather Emergency Shelter mandates in Anchorage.

• 44.6% of Alaska’s population of people experiencing homelessness (PEH) are American Indian/Alaska Native, yet they comprise only 15.2% of our state's population according to the 2020 Census.
• 46.2% of the PEH population self-report a disabling condition.
• 21.1% of the PEH population have a history of domestic violence.
• 16% of Alaskans live in poverty.

According to the 2016 Housing Inventory Count (HIC), 15 of the 29 census areas in Alaska have no year-round emergency shelter, transitional housing, rapid re-housing, or permanent supportive housing facilities.

Sources:

• Alaska CoCs: PIT Overview
• Anchorage Coalition to End Homelessness: Anchorage Built For Zero 

Alaska needs an estimated 27,500 housing units over the next ten years across the income spectrum.

Units needed (new and rehabilitated) by community

• Kotzebue: 150 units
• Bethel: 500 units
• Mat-su: 7,000 units
• Anchorage: 7,000 units
• Kenai-Peninsula Borough: 1,500 units
• Sitka: 300 units

Wages needed for housing in Alaska

• Hourly wage necessary to afford a 2 bedroom (BR) Fair Market Rate (FMR) in Alaska: $26.32
• Salary needed to afford a 2BR FMR in Alaska: $55,740
• Full-time jobs at minimum wage to afford a 2BR at FMR: 2.4

On a given night in 2022 in the U.S, 16% of PEH reported conditions related to chronic substance use. 

Total drug overdose death rates have increased annually since 2018 in Alaska, largely driven by narcotic and psychotropic drugs. 

About 2% of visits to the ED in Alaska among PEH involve an overdose. 

About 17% of visits to the ED among PEH involve alcohol or alcohol related problem:

• This is complicated by the fact that alcohol use causes a wide range of immediate and long-term health conditions and can cause direct (e.g. alcohol poisoning) and indirect consequences (e.g. DUI accidents), so this number is not all encompassing, but an estimate.
• Alaska has the 10th highest prevalence rate of adult binge drinking in the country and the second highest age-adjusted rate in the U.S. of alcohol induced mortality. 

Sources:

• Alaska Mental Health Trust Authority: 2024 Alaska Scorecard
• Substance Abuse and Mental Health Services Administration  

Household crowding is a condition where the number of occupants exceeds the capacity of the dwelling space available, whether measured as rooms, bedrooms, or floor area, resulting in adverse physical and mental health outcomes.

The rates of overcrowding (more than 1.5 persons per room--including living room/kitchen) in every region of Alaska are higher than the rest of the US.

According to a 2018 Alaska Housing Finance Corporation study, nearly 40% of homes in the Calista and NANA regions experience overcrowding and severe overcrowding. The town of Savoonga experiences a 60% rate of overcrowding.

Source: Alaska Housing Finance Corporation: 2018 Alaska Housing Assessment Statewide Housing Summary

To examine the impact of high service utilizers on hospitals and the local health care system, and to use data to exemplify the need for increased investment in affordable housing, communities enact data matches between homeless management information systems (HMIS) and health system data such as that from hospitals, managed care, and Medicaid. This allows a view into the intersections between homelessness and high utilizers of health care services.

According to the US Department of Housing and Urban Development, the five most common goals for dating sharing between health care and homeless services are:

• To more quickly provide housing to PEH who are most vulnerable and to improve the ability to provide health care documentation such as Verification of Disability (VOD).
• To improve coordination and collaboration between health care, homeless services, and housing providers, which improves both health and housing outcomes for patients and clients. Real-time data integration leads to ease in finding those who are engaged in a variety of services, allowing those in a hospital to identify a patient who has an open referral in Coordinated Entry (CE), for example.
• To understand the complexities of the medical and social needs of the target population. This will also better help address policy concerns related to rising health care costs and the disparate outcomes by race.
• To identify the costliest and most vulnerable subset of high utilizers, allowing providers to prioritize them for housing opportunities.
• To make the case for supportive housing interventions, showing a potential return on investment based on analyzing utilization costs versus the costs of housing and services.

Source: U.S. Department of Housing and Urban Development: Homelessness and Health Data Sharing 

Housing is a crucial social driver of health. Efforts to address homelessness and health-related social needs are ongoing and multifaceted. By recognizing the interplay between housing and health, communities can work towards providing comprehensive support and improving the well-being of vulnerable populations.  According to the National Health Care for Homelessness Council, persons experiencing homelessness (PEH) have higher rates of illness and experience mortality rates 3-4 times higher than the general population. PEH also are:  

• 3-4x more likely to die prematurely  
• 2x more likely to have a heart attack or stroke  
• 3x more likely to die of heart disease if they are between 25 and 44 years old  
• Experience an average life expectancy of 48 years  

Experiencing physical or mental illness or injury can also lead to homelessness

• At least 25% of people experiencing homelessness have a serious mental illness, such as schizophrenia, bipolar disorder, post traumatic stress disorder or major depression.
• A majority of these individuals also deal with addiction.
• An injury or illness can start out as a health condition but can lead to loss of employment.
• Medical debt is the leading cause of personal bankruptcy filing in the US.
• >20% of Americans between 19-64 years old struggle to pay their medical bills.
• Drug-, alcohol-, injury-, and mental health/psychiatric-related diagnoses are the most common reasons a PEH presents to the ED. 

Source: Health Care for the Homeless: Homelessness Makes You Sick

PEH often have limited access to preventative and primary healthcare, leading to:

• Delayed diagnosis and treatment of medical conditions\Worsening preexisting medical conditions
• Higher risk of contracting and/or spreading infectious disease (TB, Hepatitis, HIV)
• Frequent mobility and lack of a stable address can also hinder follow-up care and medication adherence. 

Prevalent Health Conditions Among PEH

• Mortality and unintentional injuries
• Musculoskeletal disorders and chronic pain
• Malnutrition
• Wounds and skin infections
• Infectious diseases
• Dental problems
• Lung diseases (TB, Bronchitis, pneumonia)
• Chronic diseases and disorders
• Sexual and reproductive care
• Mental health issues 

Homelessness is closely related to mental health challenges, as individuals experiencing homelessness are more susceptible to depression, anxiety, and substance abuse due to the stress and trauma associated with their situation. 

Limited access to mental health services and medications further exacerbates these issues. 

On a given night in 2023, 31% of PEH reported having a serious mental illness, according to data from the U.S. Department of Housing and Urban Development. 

According to data from Alaska statewide emergency department (ED) visits, it is estimated that 20-30% of visits among PEH include some mental health concern (depression, anxiety disorders, PTSD, bipolar type disorders, schizophrenia spectrum disorders, etc.) 

An average of 14% of visits among PEH involve some aspect of suicidality or self-harm. 

Source: HUD 2023 Continuum of Care summary report