literature review about homelessness

• Open access
• Published: 25 April 2022

A qualitative systematic review on the experiences of homelessness among older adults

• Phuntsho Om 1 , 2 ,
• Lisa Whitehead 1 , 3 ,
• Caroline Vafeas 1 &
• Amanda Towell-Barnard 1  

BMC Geriatrics volume  22 , Article number:  363 ( 2022 ) Cite this article

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Adults who experience homelessness for an extended period of time also experience accelerated ageing and other negative impacts on their general health and wellbeing. Homelessness amongst older adults is on the rise, yet there are few systematic reviews investigating their experiences. Thus, this review classifies and synthesises qualitative research findings of studies published between 1990 to 2020 that have examined the needs and challenges of homeless older adults to elucidate their journey of homelessness. Seven papers met the requirements for inclusion. Three main themes were identified in the review: - (1) Pathways to homelessness, (2) Impact of homelessness, and (3) Outcomes and resolutions. This review collates current evidence on what is known about the experience of homelessness among older adults. In this study, homeless older adults identified a wide range of challenges associated with the experience of homelessness.

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The population globally is ageing. Although, ageing is truly a triumph of development, this demographic change presents both advantages and challenges. The concept of successful ageing is to “add life to years” rather than adding days to life and is about maximizing wellbeing and happiness for the older adult [ 1 ]. The risk of developing physical and mental health issues among older adults along with associated costs are linked to a higher demand for health and social care [ 2 ].

Theories on ageing have been developed with the goal of understanding the ageing process and how best to support “healthy ageing at home” and “ageing-in-place” [ 3 ] however these do not consider older adults who do not live in a supportive environment or adults who are homeless. The home setting can be a place associated with poor subjective well-being and some older adults may feel compelled to leave the home setting as a result [ 4 ].

There is no consistent definition of homelessness, rather it has been confined to socio-historical, geographical, and cultural contexts from which the term is drawn [ 5 ]. Homelessness can be defined by a range of categories: absolute and or hidden with homelessness defined as sleeping in parked cars or parks, in emergency shelters, or in temporary shelters (couch surfing) with no or minimal health and safety requirement standards, and risk to personal safety [ 6 , 7 , 8 ]. This includes people residing in sub-standard housing such, as single-room occupancy hotels, or cheap boarding houses, as well as low-cost tiny, lodgings with minimal amenities [ 9 , 10 ].

There is an increasing rise in homelessness among older adults and older homeless adults have been identified as the “new homeless”, a “forgotten group” and a “hidden group” [ 9 , 11 , 12 ].

The reasons for homelessness amongst older adults are diverse. These can include: the impact of natural disasters; the availability of affordable housing, including rising rental costs, a decline in social welfare and support programs; financial insecurity; a lack of social amenities; and increasing rates of mental health issues, combined with various addictions, including gambling [ 2 , 9 , 11 , 12 , 13 , 14 , 15 , 16 ]. In addition to this, family relationship breakdowns, or the death of loved ones, can cut people’s social connections, resulting in older adults experiencing homelessness for the first time. This displacement of older more vulnerable adults can lead to deprivation including the basic need for a place they can relate to as home, subsequently leaving them homeless [ 3 , 7 , 15 , 17 ].

Molinari, Brown and Frahm et al. (2013) found homelessness was unanimously perceived as a humiliating experience by homeless older adults [ 13 ]. According to a survey conducted by the United States Department of Housing and Urban Development, over 15% of 634,000 homeless individuals were 50 years or older, where the number of homeless people aged over 65 has been projected to double by 2050 [ 13 ]. The same survey reported that in the United States alone, adults as young as 50 years of age were facing challenges of homelessness, effectively accelerating ageing processes. Further to this, homeless older adults face a greater threat of age-related disease burden, where they are more likely to experience: functional, auditory, visual, and neurological impairments, frailty, emotional distress, and urinary incontinence, at higher rates than in the general community [ 18 ].

Similarly, van Dongen et al. have reported within a longitudinal cohort study, that older homeless adults, unlike their younger counterparts, reported a higher incidence of cardiovascular disease and visual problems, as well as reporting limited social support from family and friends or acquaintances, and limited medical or hospital care use in the past [ 19 ].

However, there is limited published research identifying the distinct needs of homeless older adults. This is a critical gap in the literature, where a deeper understanding of the experiences of older adults who have been or are currently homeless is required.

The main aim of this qualitative systematic review is to synthesise the evidence on the experience of homelessness of older adults.

Using Joanna Briggs Institute (JBI) guidelines, a meta-synthesis of global qualitative evidence was undertaken. Studies with titles and abstracts that met the analysis goals were retrieved and chosen, based on inclusion and exclusion criteria. These studies were further appraised to evaluate methodological validity by analysing evidence relevant to viability, appropriateness, meaningfulness, and effectiveness [ 20 ]. Qualitative and mixed-method studies with ample qualitative data in their results sections to allow secondary data analysis met the inclusion criteria. The sample comprised of older adults aged between 45 and 80 years that had experienced homelessness for at least one period. The search was restricted to studies that were published in English and available in full-text form, where studies with participants below 45 years, older adults in housing facilities, and aged care residents were excluded.

Search methods

This analysis followed the Joanna Briggs Institute (JBI) method for systematic reviews [ 20 ]. A qualitative assessment and review instrument (JBI-QARI 10 item tool) [ 20 ] was used to facilitate the meta-synthesis. Results from the studies were extracted, categorised, and synthesised. Searches were conducted in PsycINFO, Web of Science, Google Scholar, Medline, PubMed, and CINAHL using appropriate search terms. Additionally, important citations were searched from reference lists of relevant articles. Searches were limited to published studies from 1990 to 2020 (see Fig.  1 ).

PRISMA flowchart

Quality appraisal

Two reviewers independently assessed 21 articles for methodological quality in their design, conduct and analysis using the JBI-QARI 10 item tool [ 20 ]. Any discrepancies were discussed within the team. Out of the 21 articles, seven were included in the synthesis. Each selected study was re-read several times, discussed within the review team and data were abstracted for interpretation.

Data abstraction

Findings relating to both current and past experiences of homelessness among older adults were extracted from the seven selected studies. A total of 56 findings were extracted. Each finding was reviewed and further compared and manually coded to identify themes. Table  1 lists the author and year, sample size, design, setting, and participant characteristics of the selected studies.

Analysis of the seven reviewed articles was carried out using the qualitative evidence synthesis method [ 20 ] developed by JBI (2014). Qualitative findings from each study were first read and reread, followed by an identification of common themes. Recurring themes across studies were then grouped together in a meta-synthesis of the findings. This process comprised critical appraisal, data extraction, analysis, and a meta synthesis involving organisation and categorisation through decoding and encoding of the extracted data to produce a final summation of the findings. The qualitative evidence summation and synthesis were deliberated, cross-checked, and then reviewed by all the authors.

Of the seven studies identified for review (see Table 1 above), four studies directly explored pathways to homelessness amongst older adults. Individual study sample sizes ranged from 14 in Reynolds, et al. (2016) [ 21 ] to 60 in Viwatpanich (2015) [ 24 ]. Three studies applied in-depth face to face interviews, with three studies using semi-structured interviews, and one study conducting focus groups to collect data. The studies were conducted in three countries: Canada, USA, and Thailand.

Data synthesis commenced using open descriptive coding to search and identify concepts and finding relationship between them. Next using an interpretive process, the meaning units were categorised within each domain using labels close to the original language of the participants. The categorization of the data for each case was then followed by a cross-case analysis that examined the similarities and differences. Following categorisation, themes were conceptualised for each category. An overarching theme was identified: ‘the journey of homelessness’. Within this context, three core themes were identified: 1) Pathways to homelessness; 2) impact of homelessness; and 3) outcomes and resolutions, where each of these 3 themes had relevant sub-themes. (see Fig.  2 ).

The Journey of Homelessness Model

The conceptual model depicted in Fig. 2 represents the overarching theme of the ‘journey to homelessness,” and key concepts and relationships between variables from the synthesis of the literature. Unlike other conceptual models that involve causal and directional relationships, this model is both directional and non-hierarchical. The model illustrates the pathways to homelessness, the associated impacts of homelessness and the outcomes of homelessness. The following section explores the three themes and sub-themes in more detail.

Theme 1. Pathways to homelessness

The causes of homelessness were shown to be multifaceted, where pathways to homelessness revolved around a combination of individual, social, and structural factors. The reviewed data suggested that becoming homeless involved two distinct pathways: one that was gradual and one that was rapid.

Sub-theme 1.1: gradual pathway to homelessness

Findings from six studies contributed to this subtheme. This sub-theme captured the factors contributing to gradual pathways into homelessness amongst older people. These factors were identified as accelerated ageing, poverty, rising housing costs, failing and uncommitted social security systems, a lack of social programs and services, social distress, rural-urban migration, substance abuse and addiction, as well as estrangement from family or lack of living relatives [ 13 , 14 , 21 , 22 , 23 , 24 , 25 , 26 ].

The following quotations from these studies illustrate both estrangement from family and the impact of a lack of support from social services:

Many conflicts we had at that time, we never talked … never talked in normal way … nothing clear between us, emotion never came clear...they did not want to talk to me, not even to look at my face … I could not stand it, I surrendered. Beating and scolding by descendants is not in our tradition, no respect, if they did not want me to stay with them, I moved out [ 24 ] .

I submitted applications for low-income housing, I’ve been on the waiting list, seven years is a long time, especially at my age [ 22 ] .

Personal vulnerability to difficult familial relationships, neglected needs and unstable housing were the most cited causes of homelessness amongst these older adults [ 3 , 9 , 14 , 25 ].

Two studies [ 15 , 21 ] described a pathway to homelessness as related to alcoholism and drug abuse, as highlighted in the following quotation:

I got into crack cocaine, I got into hooking, I got into anything you could think of I guess . . . So it was my addictions that brought me down, and unhealthy relationships [ 25 ] .

Feeling ‘homeless at home’ [ 27 ] due to loneliness was noted by some older adults as their reason for ‘living on the streets’. For example, homeless older adults that experienced social rejection and conflicts with housing management, neighbours, and roommates, noted this to ultimately lead them to homelessness. For example, one participant stated, “I have lived alone and never really felt at home, because to me home is a place that includes other people, your family” [ 23 ].

Sub-theme 1.2: rapid pathway to homelessness

Some older adults described the process of homelessness as ‘rapid’. A rapid pathway to homelessness was associated with abrupt life changes such as losing a loved one, divorce, and the impact of these losses on their lives. The two quotes below highlight rapid pathway process:

Losing them, let’s just say it evaporates over time. It’s the fact that I wake up like I am here that I can’t accept … homeless … in the street. I sold everything, every single thing! I never thought I’d end up like this. It’s like starting from zero [ 23 ].

I had a wife, then she died, I did not know where to go, what to do, I turned homeless [ 24 ] .

Older adults that faced a series of losses and a rapid deprivation of social support systems noted the experience of disrupted circumstances. Accordingly, they noted their fear of losing their independence and ‘sense of self’ resulted in their resistance to any help that was offered, in turn contributing to their homelessness.

Theme 2. Impact of homelessness

Findings from five studies contributed to this subtheme. Homelessness and ageing were presented to form a ‘double jeopardy’ where homelessness aggravated the challenges of old age [ 15 , 21 , 22 , 23 , 24 ].

This theme included the subthemes of: unmet needs, coping strategies, and the realities of housing availability.

Sub-theme 2.1: unmet needs

‘Unmet needs’ amongst older homeless adults were categorised as involving physical, emotional and social needs leading to despair and destitution. As this quote below highlights:

I’m supposed to get a pneumoscopy, but where am I, where do I stay? How can they get a hold of me? I don’t have money to get around [ 15 ] .

Sub-theme 2.1.1: lack of physical wellbeing

Findings from six studies [ 14 , 15 , 18 , 21 , 22 , 24 ] contributed to this subtheme. Physical decline and physical disability were described as exacerbated by the experience of being homeless. Participants described a relationship between age and frailty, fatigue, poor physical health, and impaired mobility while homeless, as these quotes demonstrate:

Ah! Walking all day, for me, it’s very hard on the body, ok. Sleeping outside on a park bench, that’s very, very hard on the body. The bones, the humidity. Just leaving in the morning and then not going to work. … You’re always faced with the outdoors, and always faced with walking, walking. It’s not easy walking from downtown [ 15 ] .

My health was very poor. I was very prone to pneumonia. I was taken out of the shelter in the ambulance and it was later determined that I had actually contracted tuberculosis [ 22 ] .

At that time, I got Psoriasis, I knew that it was disgusting … . It looked scary. I am much too old. It is so difficult to find a job … nobody needed me … so I decided to stay and sleep here [ 24 ] .

Homelessness in later life was shown to often be linked to a multitude of health problems. Most studies described older homeless people as living with physical health problems including chronic diseases such as hypertension, diabetes, bone and joint diseases, respiratory illness, and skin diseases [ 14 , 21 , 22 ]..

Sub-theme 2.1.2: lack of emotional wellbeing

Findings from five studies contributed to this subtheme. Accordingly, homelessness was described as contributing to poor emotional health related to social exclusion and isolation amongst older adults. Further, homelessness was associated with cognitive impairment, stigma, shame, stress and anxiety, as well as depression amongst homeless older adults [ 15 , 21 , 24 , 25 ]. Homelessness was described as a humiliating and degrading experience, as evident in these quotes:

At my age, I don’t see life ahead of me anymore. You see, I don’t know, I don’t see the end of the tunnel, … … It’s as if I wanted to erase myself [ 15 ] .

All I could think about was suicide. How did I end up here? When I think a lot to myself, what the hell am I doing? [ 23 ] .

Feelings such as shame, demoralisation, and loss of dignity were described and these impacted on emotional health.

Opportunities to improve emotional wellbeing were rarely described, however one example stood out as an exception and this was related to volunteering:

One thing I didn’t expect was when I helped people with whatever issues they were having on their bicycle, I really enjoyed that. It gave me a chance to teach someone [ 25 ] .

Examples such as these were rare, with social exclusion and the lack of opportunity to contribute and connect with others more commonly described.

Sub-theme 2.1.3: lack of social relationships

Findings from four studies contributed to this subtheme. Social relationships were described as central to creating a life that had meaning and familial interactions. Disconnection from loved ones was associated with feelings of unhappiness [ 13 , 15 , 27 ], while companionship was shown to improve wellbeing [ 25 ]. Social relationships were shown to decline, leading to the experience of social exclusion and isolation.

I am a walking dying woman. I walk until I can’t walk anymore, and then I sit. The busses pass me by. We are untouchables and I do not think anybody’s going to do anything about it [ 25 ] .

At my age, I don’t see life ahead of me anymore. Because everywhere I go: “Ah! He’s homeless.” It is as if I wanted to erase myself. I think that it’s more “society,” as such, that rejects homeless people [ 15 ] .

I think that living homeless, you exclude yourself, and a lot of other people exclude you. I was on the other side before becoming homeless. So, you know, the perception that people have, it plays a big part. … So that together makes it so that, if you don’t have family either, let’s say, you don’t have … close friends or a strong social network. Well, you experience all that, you live with loneliness and isolation [ 15 ] .

Sub-theme 2.2: impaired coping strategies

Findings from four studies contributed to this subtheme. Older homeless adults described a range of factors as impacting their ability to cope. These included moving to shelters, challenges to adapt to their unique requirements, limited housing options, limited income supports, social exclusion, isolation, and a lack of coordination and access to community health and support services [ 13 , 15 , 23 , 25 ].

As the quote below shows, there were expressions about the fear of homelessness and how long it will last:

Struggling to get your basic needs met, scrounging, just trying to get by as best I can, and feeling desperation, humiliation, despair, a shocking feeling, full of fear, and turmoil. What’s tomorrow gonna bring? Why am I in this situation? How do I get out of it? [ 13 ]

Coping with the harsh realities of homelessness in later life was described as being increasingly challenging for most older adults because older homeless individuals experience mental health disorders and acute or chronic physical illnesses.

Sub-theme 2.3: realities of housing availability

Findings from three studies [ 13 , 15 , 23 ] described the challenges experienced in accessing housing services and fulfilling requirements for safe, secure, and affordable housing. This theme captured impacts of poor coordination and communication between homeless veterans and housing intervention providers in regard to information for service availability, gaining access to homeless shelters and a lack of training and education by some housing providers especially with regard to homelessness.

He … got this rule book and threw it at me. Find a place! [ 13 ]

You know, I’m 60, I’m not 20 anymore. So that’s what makes you tired, you get stressed. So, after that, they give you pills as a solution. I told the doctor, sorry I didn’t come here for pills, I came for housing [ 23 ] .

I submitted applications for low-income housing, I’ve been on the waiting list, seven years is a long time, especially at my age [ 23 ] .

I want a space where I can be well. I wasn’t well when I was young. I’ve never been well anywhere. I need a simple place … where I can have peace, and quiet … but not be all alone [ 15 ] .

Older homeless adults described a need to create stability and escape homelessness through the provision of services, and in particular, housing. Older adults described how oscillating in and out of shelters prevented senses of safety, stability, or autonomy.

Theme 3. Outcomes and resolutions

In four studies [ 13 , 15 , 21 , 24 ] homeless older adults described how the outcomes and resolutions of homelessness involved overcoming both complex challenges and habituations. This theme encompassed the finding of directions and strengths to improve difficult situations and overcome challenges that occurred at the intersection of homelessness and ageing.

Three subthemes were identified within this theme: building resilience, strength, and hope; seeking spiritual meaning; and exiting the cycle of homelessness.

Sub-theme 3.1: exiting the cycle of homelessness

Some older adults moved out of the phase of homelessness and described facilitators and barriers to this transition whilst other described choosing to stay homeless until the end of their lives.

Sub-theme 3.1.1: factors facilitating the exit

Two studies [ 13 , 15 ] contributed to this sub-theme, where older adults described means of overcoming challenges and establishing priorities in order to exit homelessness in later life. The results suggested that the creation of autonomy, flexibility, and privacy helped people feel belonging and often this meant living in a place where they could continue to drink and/or occasionally use drugs, have access to a health system to manage health problems; and have access to food and shelter facilitated exits.

They listen to you and they help you with . . . your transition, your program. You sit down and you work the program out with them;” “If you have a question, you can walk in anytime and ask them what’s going on [ 13 ] .

In the next couple years, I hope to find myself an apartment for the few good years I have left, before the big pains of “aging” come [ 15 ] .

Fulfilling financial support, housing and health care services was identified facilitate older adults exiting homelessness.

Sub-theme 3.2: remaining homeless

Some older adults experienced homelessness at a younger age and described continuing to be homeless in older age, where they oscillated between living in shelters and on the streets.

I am used to being in this way, moved from place to place … me alone, without father and mother since childhood … it become normal and I feel happier, than to stay with others [ 24 ] .

It’s just a continual cycle. I just got sucked down into it, you know. It’s hard to describe because when I found myself there, I was just like, wow. How did I get here? [ 21 ]

Participants described the chronic nature of homelessness as involving a challenge of disentangling themselves from the cycle of homelessness. A lack of tailored intervention programs to respond to homelessness in later life also prevented older adults from exiting homelessness.

Sub-theme 3.2.1: perceived barriers to exiting homelessness

In two studies [ 21 , 24 ], older adults described experiences of vulnerabilities and challenges to exiting homelessness. Shelters were described as constraining and not being able to adapt to the unique needs of older adults. Where limited housing options were seen as available, income supports were described as limited, with a lack of coordinated and, accessible community health and social support services, impacting on participants’ ability to ‘feel in place’.

My health pretty much stayed the same as when I was homeless. The conditions I have aren't gonna improve [ 22 ] .

It’s harder to keep a place, especially when you keep falling back in the same circle and you’re in the same crowd. I am finding out today, you keep falling back in the same circle, the same circle is not gonna change [ 21 ] .

One participant described the difficulty of obtaining employment as a barrier to exiting homelessness:

You know being 50 years old, it’s going to be really difficult to be able to reintegrate into the workforce [ 21 ] .

Housing facilities and transition to housing shelters were shown to present challenges for homeless older adults. A lack of privacy, autonomy, rigid rules, and challenging interpersonal relationships within housing and shelter programs were identified as leading older adults to feel homeless at home.

Sub-theme 3.3: building resilience and strength

This sub-theme captured the life lessons, resilience, strength, and hope of older homeless adults, described as having formed through experiences and skills developed whilst living on the streets. This theme also suggests how individuals cope with difficult symptoms related to social support and, addiction, relying on positive things learned while living with other homeless people on the streets. Some older adults chose to stay homeless accepting homelessness as their fate.

In the next couple years, I hope to find myself an apartment for the few good years I have left, before the big pains of “aging” come. I really want a normal life, get up in the morning, go to work, think about vacation. Hang out with other people … I don’t have a girlfriend but would like to start a life with someone else [ 15 ] .

What does ageing mean to you, getting older on the streets? A: Experience. Q: Ok. A: Wisdom. Q: Getting older on the streets, that’s how you see it, it’s the wisdom that you have gained. A: Yeah, that’s where I learned to be wise. Because there are several people who told me I am wise [ 15 ] .

I think because of karma … I accept it as punishment from bad deeds in my former life, but only in this life okay! Next life I am looking forward for a normal life, like others [ 24 ] .

Most studies [ 3 , 8 , 13 , 17 ] cited that wisdom, experience, and optimism were necessary in order to help older adults exit homelessness. Optimism instilled future hope and self-worth back into the self-esteem of homeless older adults.

Sub-theme 3.3.1: seeking spiritual meaning

In two studies [ 24 , 25 ], older adults described finding meaning in life through adopting and accepting religious faith with a belief to achieve higher self-actualisation.

I want to be closer to Dhamma (Buddhist teaching), I want to be a monk till I die [ 24 ] .

Meditate, just being by myself. Living the night, just being alone and listening to my music, that makes [my pain] feel better. I like jazz but I just listen to my music, just go away to myself. That makes me feel - I like being alone. I love being alone [ 25 ] .

When I feel [anger over my situation] I go to the water and I pray hard. I just start praising God until I can feel the spirit come over me to comfort me. I pray until He comes and allows his spirit to wrap his arm around me; I feel a lot better. A psychiatrist can’t tell me what’s wrong with me. For someone to try to help would mean a lot. I do not have nobody but to trust God. He’s my only psychiatrist [ 25 ] .

Homeless older adults recognised and confirmed that psychosocial and existential symptoms caused as much distress as physical symptoms triggering negative changes in personality, energy, and motivation. Some homeless older adults viewed their age as a source of strength, wisdom, and experience in learning to manage their symptoms, describing themselves as survivors who had overcome significant hardships. Higher levels of wellbeing were likely to be achieved when older people sought spiritual meaning through religion, socialising, reading, meditating, volunteering, and introspection practices.

This review synthesised evidence generated from qualitative studies to provide a glimpse into the experiences of homeless older adults. The review has shown that while drivers related to entry into homelessness were diverse, two distinct trajectories underpinned the experience of becoming homeless amongst older adults. Older people that faced a sudden series of losses that completely overturned their circumstances fell into the ‘rapid pathway’ to homelessness. Participants on a ‘gradual pathway’ were shown to become homeless due to a range of factors, for example - addiction problems, physical and mental health issues, relationship break-ups, foster care, poverty, unemployment, and greater housing instability [ 13 , 24 ]. Further to this, homeless older adults were shown to include a significant percentage of separated, divorced, or single individuals [ 28 ]. Likewise becoming single in later life was shown to be associated with homelessness amongst older people. Other studies found that ageing, its associated factors and a lack of stable housing were prominent reasons for homelessness [ 15 , 22 , 23 ].

Housing was perceived to offer a sense of security and a stable environment conducive for safe ageing. Further, housing was identified as offering protection from harsh weather and other dangers. Similar accounts relaying how the health of homeless older adults declined during episodes of homelessness was also reported [ 9 ]. Stable housing played an influencing role in physical health and general wellbeing. Although homeless older adults expressed satisfaction with life, they linked secure housing with healthy dietary habits, proper sleep patterns, enhanced self-care and reduced feelings of stress and anxiety [ 22 ]. In addition, this review found that most homeless older adults were more able to prioritise their health care needs when other necessities such as food and shelter were met. However, research has also suggested that living in scattered-site apartments can reinforce the process of social exclusion, and thus they are not appropriate for older adults living alone, with regard to their additional health and social needs [ 3 , 10 , 28 ].

Ageing intensified the adversities of homelessness experiences and presented a twofold risk where homelessness aggravated the challenges of old age and vice versa [ 15 ]. Old age and its associated conditions intensified older adults’ perceptions of homelessness later in life, including feelings of shame, anxiety, and worry. Studies by Cohen [ 9 ], Kwan, Lau and Cheung [ 29 ], and Molinari et al. [ 13 ], have unanimously shown older adults to perceive homelessness as a dehumanising experience. Homelessness was described as: struggling “to get your basic needs met,” “scrounging, just trying to get by as best I can,” and feeling “desperation,” “humiliation,” “despair,” “a shocking feeling,” “full of dread, turmoil,” “what will tomorrow bring? why am I in this predicament and how can I get over it?” [ 13 ]. For most participants, homelessness was not a preferred option.

The limitations of this review include the predominance of data collected in North America which may reduce the generalisability of the findings. Another drawback is that it presents only a cursory review of issues related to gender, race, and ethnicity. Finally, the qualitative data analysis applied by the majority of studies here is subjective, where outcomes could be affected by authors’ personal biases.

Despite these limitations, the review has conceptualised two divergent pathways into homelessness in later life, as well as the impacts of homelessness, drawing attention to a greater understanding of homelessness experienced by older adults.

The review sought to provide insight into the needs of homeless older adults. Awareness of the complexities faced by homeless older adults need to be acknowledged if policy and research are to support the population and improve access to resources and support. The review has highlighted areas for future research to expand knowledge and understanding of the unique needs and challenges of homeless older adults.

Synthesis of seven studies resulted in the identification of an overarching theme relating to the ‘journey of homelessness’ and three major themes, each with subthemes, to describe older adults’ experiences of homelessness. A broad range of diverse settings, cultures, and countries with a particular focus on homelessness in later life were included. The review has revealed homogeneity of experiences amongst homeless older adults, with the need for access to appropriate and affordable housing and adequate support systems.

The findings have identified pathways to homelessness require different prevention and support measures. People in the study who described a gradual pathway needed social support to address distress, which might have helped them avoid losing their homes. Those individuals with rapid pathways unanimously concluded that homelessness could have been avoided if independence and self-sufficiency were less regarded as a norm by society.

Availability of data and materials

The authors declare that all data generated or analysed during this study are included in this published article.

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Acknowledgements

We would like to acknowledge Lisa Webb, Librarian, Edith Cowan University Library for her support in the literature search and Dr. Michael Stein, HDR Communication Advisor, Edith Cowan University for editing.

There are no separate funding source for this review as it is part of my full-time PhD study with the School of Nursing Midwifery, Edith Cowan University.

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Phuntsho Om, Lisa Whitehead, Caroline Vafeas & Amanda Towell-Barnard

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PO, LW, CV, and ATB substantially contributed to the conception and design of the article. All authors critically appraised the searched literature, discussed each item in the appraisal instrument for each study included in the review and interpreting the relevant findings. The primary author PO drafted the article and LW, CV and ATB revised it critically for important intellectual content. The author(s) read and approved the final manuscript.

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The study was classified as exempt from ethical review approved by the Human Research Ethics Committee of Edith Cowan University. All material included in this review are in the public domain and not applicable as it is a review article. Accordance: We declare that this systematic review was conducted in accordance with Joanna Briggs Institute (JBI) method for systematic reviews using the qualitative assessment and review instrument (QARIs) to facilitate the meta-synthesis. This review was followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (2009).

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Om, P., Whitehead, L., Vafeas, C. et al. A qualitative systematic review on the experiences of homelessness among older adults. BMC Geriatr 22 , 363 (2022). https://doi.org/10.1186/s12877-022-02978-9

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The psychological impact of childhood homelessness—a literature review

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• Saskia D’Sa   ORCID: orcid.org/0000-0003-3016-9299 1 , 2 ,
• Deirdre Foley 1 , 2 ,
• Jessica Hannon 1 , 2 ,
• Sabina Strashun 3 ,
• Anne-Marie Murphy 1 , 2 &
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In August 2019, 3848 children in Ireland were faced with emergency homelessness [ 1 ]. In recent years, lack of affordable housing, unemployment and shortage of rental properties have been the primary driving factors for the potentially devastating impact of familial homelessness in our society [ 1 ]. Our aim was to evaluate current knowledge on the psychological impact of homelessness in children. Using the PRISMA model, we performed a review of the currently available literature on the psychological impact of homelessness on children. This concept was explored under two different categories—‘transgenerational’ and ‘new-onset homelessness’. Hidden homelessness was also explored. Our literature review revealed several psychological morbidities which were unique to children. This includes developmental and learning delays, behavioural difficulties and increased levels of anxiety and depression [ 66 , 77 , 40 , 81 , 42 ]. This has been demonstrated by poorer performance in school testing and increased levels of aggression. Anxiety in children within this cohort has been shown to peak at time of dispersion from their stable home environment [ 67 ]. Our study highlights violence, aggression and poor academic learning outcomes to be just some of the key findings in our review of homelessness in childhood, worldwide. Unfortunately, there has been minimum research to date on paediatric homelessness within the context of the Irish population. We anticipate this review to be the first chapter in a multipart series investigation to evaluate the psychological morbidity of paediatric homelessness within the Irish Society.

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Saskia D’Sa, Deirdre Foley, Jessica Hannon, Anne-Marie Murphy & Clodagh O’Gorman

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D’Sa, S., Foley, D., Hannon, J. et al. The psychological impact of childhood homelessness—a literature review. Ir J Med Sci 190 , 411–417 (2021). https://doi.org/10.1007/s11845-020-02256-w

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• Int J Environ Res Public Health

LGBTIQ+ Homelessness: A Review of the Literature

Lesbian, Gay, Bisexual, Transgender, Intersex, and Queer (LGBTIQ+) people’s experiences of homelessness is an under-explored area of housing and homelessness studies, despite this group making up 20–40% of homeless populations. Despite this, much of the existing literature focuses on specific elements of LGBTIQ+ homelessness, and often does not consider the intersections of these elements, instead placing them into individual siloes. Our approach is an intersectional one; this paper identifies the key themes in the existing research, and analyses how these themes interact to reinforce the discrimination and stigma faced by LGBTIQ+ people who experience homelessness. This intersectional-systems thinking approach to LGBTIQ+ homelessness can be used to develop well-informed, culturally sensitive support programmes.

1. Introduction

The aim of this review is to explore the intersections of factors associated with both homelessness and Lesbian, Gay, Bisexual, Transgender, Intersex, Queer, and other diverse sexual orientations and gender identities (LGBTIQ+) in order to examine their role in experiences of LGBTIQ+ homelessness. Multiple studies have shown LGBTIQ+ people are more likely to be homeless than non-LGBTIQ+ people [ 1 , 2 , 3 , 4 ]. LGBTIQ+ people comprise an estimated 20–40% of homeless populations, whilst only comprising 5–10% of the wider population [ 5 , 6 ]. Despite this, much of the existing literature focuses on specific elements of LGBTIQ+ homelessness, and often does not consider the intersections of these elements. In researching factors of LGBTIQ+ homelessness in siloes, we are at risk of falling into scattered, disjointed understandings of the issue, resulting in piecemeal solutions [ 6 , 7 ]. Intersectional research conversations need to occur. The goal of this review is to identify the key themes in the existing research, and analyse how these themes interact to reinforce the discrimination and stigma faced by LGBTIQ+ people who experience homelessness.

Edgar [ 8 ] defines homelessness as exclusion from physical, social, and legal domains, and exclusion from any one or two of these domains is defined as housing exclusion. Amore et al. [ 9 ] argue homelessness should be replaced by the concept of severe housing deprivation, which includes two main criteria; (1) that a person is living in severely inadequate housing due to (2) a lack of access to housing that meets a minimum adequacy standard (rather than living in such circumstances by choice) [ 9 ]. Severe housing deprivation consists of experiencing any two of three categories; inadequate privacy and control; inadequate security of tenure; and inadequate/uninhabitable structure [ 9 ]. Homelessness thus includes rough sleeping, couch surfing, living in shelters and women’s refuges, and living in cars, caravans, and tents [ 9 ]. The Amore et al. definition is used in this paper, as it is a more comprehensive definition of homelessness.

This literature review aims to clarify the relationships between LGBTIQ+ identity and the key themes in the literature. The key themes are; poverty, ethnicity and racism, substance use, mental health, sexual abuse, foster care, LGBTIQ+ discrimination and stigma, family, survival sex and sex work, physical ill-health and Human Immunodeficiency Virus (HIV), and shelter inaccessibility. This review focuses on the interconnections between these experiences, using Kimberlé Crenshaw’s [ 10 ] theory of intersectionality, which argues people experience different and multiple oppressions in response to their different identities—for example, a person living in poverty, a person’s ethnicity, their gender—which compounds negative health and social outcomes. The concept of intersectionality highlights the interactions between people’s multiples identities and systems of oppression and the resulting complex outcomes [ 11 ]. This paper examines the interactions between multiple identities, such as LGBTIQ+, ethnicity, and systemic failures such as discrimination and stigma, in order to explore experiences of LGBTIQ+ homelessness. It is necessary to understand these identities and experiences together, as the way in which people identify is not based solely on one category, but rather, is a collection of multiple identities and experiences [ 12 ]. Intersectionality encourages us to consider how upstream social determinants (such as racism, sexism, classism, transphobia, and queerphobia) form interlocking systems of oppression which shape the experience of people with multi-dimensional identities [ 13 ].

Literature searches were performed using PubMed, ProQuest, ScienceDirect, Scopus, MedLine, and Google Scholar. Four searches were run in August 2017 and again in August 2018. These were; “LGBT Homelessness;” “Queer Homelessness;” “LGBT Housing First;” and “Queer Housing First.” Most results came from the searches containing ‘homelessness’ as a key term, with searches including ‘Housing First’ adding a few more results. It was decided to use LGBT, instead of LGBTIQ+, in the searches as LGBT is the more commonly used acronym, and thus more likely to return searches. The searches returned a total of one hundred articles with relevant keywords. The article abstracts were reviewed for relevance, which was determined by coverage of LGBTIQ+ identity and homelessness; a total of 27 articles were used in this review. An additional 26 articles were found via their reference lists. Due to the limited amount of relevant research, it was decided not to have a specific start date for articles. Each article was coded for the key themes it covered; this created a “literature map” that enabled a visualisation of the 12 most prominent, or key, themes and their prevalence [ 14 ].

3.1. Key Themes

The key themes in the literature were; poverty, ethnicity and racism, substance use, mental health, sexual abuse, foster care, LGBTIQ+ discrimination and stigma, family, survival sex and sex work, physical ill-health and HIV, and shelter inaccessibility. The relationships between them are displayed in Figure 1 :

Intersections of LGBTIQ+ Identity and Experiences of Homelessness. The groupings from left to right are; proximate causes of homelessness, systems failures in early life, and experiences during homelessness.

Figure 1 displays the relevance of each theme to LGBTIQ+ identity along the horizontal axis, and homelessness along the vertical axis. The themes are positioned in order of least relevant to most relevant; themes closest to the inner bottom left-hand corner are least relevant, and those closest to the outer edges are more relevant. The arrows between the themes and groupings indicate their relationships. Single-direction arrows indicate a one-way relationship, and multi-direction arrows indicate a two-way relationship. The groupings were produced through examination of the literature to determine how strongly each was linked, firstly to homelessness, and secondly to LGBTIQ+ identity. The first grouping is proximate causes of homelessness, including poverty, ethnicity and racism, substance use, and mental health. The second grouping is failures of support systems in early life, including sexual abuse, foster care, discrimination and stigma, and family. The third grouping is experiences during homelessness, including survival sex and sex work, physical ill-health and HIV, and shelter inaccessibility. Figure 1 shows the relationships between the themes that act to produce LGBTIQ+ homelessness. Analysing these relationships produces a holistic conceptualisation of LGBTIQ+ homelessness. In the following analysis, the themes are discussed in the order in which they fall within their groupings.

3.2. Proximate Causes of Homelessness

3.2.1. poverty.

Poverty is the main driver of homelessness; it is ubiquitous among people who experience homelessness and escaping poverty becomes more difficult when people are homeless [ 15 , 16 , 17 ]. Poverty and economic instability create a state of precarity, which can lead to a number of difficulties such as a difficulty maintaining housing, poor mental health, and addiction [ 16 ]. Thus, the relationship between poverty and homelessness is a complex one; it moves in multiple directions and is intimately connected to the aforementioned factors [ 18 ]. High levels of income inequality and low levels of social welfare are associated with increased rates of homelessness [ 16 ]. Poverty is a structural factor that is intimately linked to homelessness [ 16 , 18 ]. There is, thus, a strong link between poverty and experiences of homelessness. There is a weaker link between poverty and LGBTIQ+ identities. This relationship is nuanced; different demographics within the wider LGBTIQ+ community have varying experiences of poverty; white lesbian women are likely to be high earners, while white gay men and gay and lesbian people of colour are more likely to be lower earners [ 19 , 20 ]. Poverty is also connected to the other issues within the proximate causes of homelessness grouping; it is both a driver and a consequence of addiction and/or mental health issues [ 16 ]. Poverty directly influences how people experience homelessness.

3.2.2. Ethnicity and Racism

Racism, systematic inequality, and historical trauma mean that ethnic/racial minorities are more likely to experience homelessness in comparison to dominant ethnic groups. In the USA, for example, roughly 42% of people who are homeless are African American, and roughly 20% are Hispanic, despite each group compromising just over 12% percent of the total population [ 12 ]. This over-representation occurs due to a myriad of complex factors such as social exclusion in the areas of wealth, income, housing, and imprisonment [ 16 ]. For LGBTIQ+ ethnic minorities, the intersection of minority identities increases the odds of adverse experiences through the greater likelihood they will also suffer poverty, discrimination, and victimisation. Page [ 12 ] argues this intersectionality gives homeless LGBTIQ+ people of colour disproportionately high chances of experiencing hardship and emotional distress. Multiple intersecting identities can result in a host of negative health and social outcomes [ 12 , 13 ]. Exploring these intersections is necessary to fully understand the experiences and needs of ethnic--minority LGBTIQ+ homeless people as the discrimination racial and sexual minorities face is intensified when they are homeless; homelessness becomes an added stressor [ 12 ].

3.2.3. Substance Use

Substance abuse is a proximate cause of homelessness, and can be exacerbated once people become homeless [ 21 ]. People who are homeless use drugs and alcohol at far greater rates than the wider population, with studies finding 40–70% of people who are homeless reporting alcohol and drug dependence [ 21 , 22 , 23 , 24 ]. Substance use is a broad issue across all demographics of homeless populations [ 24 ]. However, LGBTIQ+ homeless people have higher rates of substance use when compared to non-LGBTIQ+ homeless people [ 2 , 25 , 26 , 27 , 28 ]. In addition to this, transgender homeless people have even higher substance use rates than Lesbian, Gay, and Bisexual (LGB) homeless people [ 28 ]. Both Gattis [ 2 ] and Van Leeuwen et al. [ 25 ] found homeless LGBTIQ+ people were more likely than homeless non-LGBTIQ+ people to have reported usage of 20 out of 21 illicit substances. Whitbeck et al. [ 29 ] found lesbian females were more likely than heterosexual females (61.4% versus 35.5%) to meet criteria for alcohol abuse. Flentje et al. [ 1 ] reported similar findings amongst homeless populations: LGBTIQ+ males had lower rates of drug or alcohol abuse in comparison to heterosexual males, whilst LGBTIQ+ women had 6.33 times the odds of drug and alcohol abuse in comparison to heterosexual women. These studies indicate the relationship between substance use and homelessness is stronger than that between substance use and LGBTIQ+ identity in and of itself; LGBTIQ+ identity is an added factor that intersects in a complex way with the other two.

3.2.4. Mental Health

The relationship between homelessness and mental illness is bi-directional; homelessness can directly undermine mental health, and mental illness can directly lead to becoming homeless [ 30 ]. Homeless populations have high rates of mental illness, with studies finding between 42–80% of people who are homeless experience mental health struggles [ 24 , 31 , 32 ]. Non-homeless LGBTIQ+ populations experience mental health issues at somewhat lower rates of about 40% [ 33 ]. This indicates poor mental health is an enormous issue for homeless populations, and a significant issue for the LGBTIQ+ population. Whitbeck et al. [ 29 ] compared LGB homeless youth to heterosexual homeless youth on levels of mental disorders such as major depressive episodes and post-traumatic stress disorder (PTSD), suicidal ideation, and suicide attempts. Overall, LGB participants had significantly higher rates of depression (41.3% versus 28.5%), PTSD (47.6% versus 33.4%), suicidal ideation (73.0% versus 53.2%), and suicide attempts (57.1% versus 33.7%). Noell and Ochs [ 34 ] also found LGB youth had higher rates of depression, suicidal ideation, and suicide attempts in comparison to their heterosexual counterparts. LGBTIQ+ people who are homeless thus face greater long-term mental health issues. This may result from prior experiences of strained family relationships, high levels of sexual and physical abuse, and can be reinforced by intersecting identities. Flentje et al. [ 1 ] found cisgender Gay, Bisexual, and Queer men were 2.68 times as likely to have a psychiatric condition and 3.47 times as likely to have PTSD compared to their heterosexual counterparts. Amongst homeless cisgender women, those who identified as LGBQ had 5.16 times the odds of a psychiatric condition in comparison to homeless heterosexual cisgender women [ 1 ]. Transgender men were 3.78 times as likely to have a psychiatric condition and 3.92 times as likely to have PTSD in comparison to cisgender men [ 1 ]. In comparison to cisgender women, transgender women had 3.31 times the odds of PTSD [ 1 ]. The experiences of homelessness and poor mental health combine with LGBTIQ+ identity to deepen the systems failure for LGBTIQ+ people who are homeless.

3.3. System Failures in Early Life

3.3.1. sexual abuse.

Sexual abuse is both a driver to, and consequence of, homelessness. People who are homeless experience higher levels of sexual abuse (including rape, sexual assault, and sexual victimisation) than the wider population both before and during episodes of homelessness [ 35 , 36 , 37 ]. This relationship is even stronger among people with LGBTIQ+ identities [ 37 , 38 , 39 ]. Compared to non-LGBTIQ+ homeless people, LGBTIQ+-identifying homeless people face higher levels of sexual assault—particularly youth and transgender/gender diverse people [ 23 , 25 , 28 , 29 , 40 , 41 , 42 , 43 , 44 ]. Cray et al. [ 44 ] found homeless LGBTIQ+ youth had been sexually assaulted at three times the rate of non-LGBTIQ+ homeless youth. Whitbeck et al. [ 29 ] found 44.3% of LGB adolescents reported sexual abuse by an adult caretaker, in comparison to 22.3% of non-LGB adolescents. Furthermore, 58.7% of LGB homeless youth reported sexual victimisation on the streets, compared to 33.4% of heterosexual youth [ 29 ]. It is clear LGBTIQ+ homeless youth face disproportionately high rates of sexual abuse and sexual victimisation. Sexual abuse is connected to other themes in this review; notably, family, foster care, drug use, and mental health. Sexual abuse is a key reason as to why young people run away from home and become homeless [ 15 , 35 , 38 , 45 ]. Children and young people in foster care are susceptible to sexual abuse, often resulting in them running away from such environments [ 46 , 47 ]. Links have been found between childhood sexual abuse and substance use [ 48 , 49 ]. Sexual abuse also has a significant impact on mental health and wellbeing [ 29 ]. Sexual abuse is thus an example of how the key themes of this review intersect with each other, creating poor outcomes for LGBTIQ+ people who experience homelessness.

3.3.2. Foster Care

Family breakdowns and unsafe family environments are major drivers to young people entering the foster care system. Being in foster care, and the instability associated with it, is a driver to becoming homeless: disproportionately high levels of young homeless people have been in foster care [ 3 , 7 , 45 , 50 , 51 , 52 ]. Due to higher levels of family breakdown, those with LGBTIQ+ identities are over-represented in foster care systems [ 53 , 54 , 55 , 56 , 57 , 58 ]. LGBTIQ+ youth in foster care experience unique risks to achieving permanency and wellbeing such as rejection by foster families and lack of competency by caregivers and social workers [ 53 , 59 ]. Wilson and Kastanis [ 53 ] found 19.1% of the foster care population they surveyed identified as LGBTIQ+. This suggests LGBTIQ+ youth are more likely to have been in situations where it is safer for them to be placed into care. Furthermore, LGBTIQ+ foster youth were more likely than non-LGBTIQ+ youth to have been homeless at one point [ 53 ]. Feinstein et al. [ 60 ] found 56% of LGBTIQ+ foster youth had spent time sleeping rough because they felt safer on the streets than in their foster homes. Placing youth in foster care is intended to remove them from unsafe situations; it is worrying that such high levels of LGBTIQ+ youth do not feel safe in their foster homes. Clements and Rosenwald looked at foster parents’ perspectives on LGBTIQ+ youth in the foster system. They found four common themes about LGBTIQ+ youth in care; misconceptions regarding LGBTIQ+ identity, fears of LGBTIQ+ children molesting their own children, differences in attitudes towards children of differing LGBTIQ+ identities, and anti-LGBTIQ+ religious beliefs [ 61 ]. The intersection of foster care and LGBTIQ+ identity place these youths at greater risk of experiencing homelessness than non-foster and non-LGBTIQ+ youth.

3.3.3. LGBTIQ+ Discrimination and Stigma

Everyone has a right to be free from discrimination and valued for who they are; homeless LGBTIQ+ people face a huge barrier to realising this. While the global movement for LGBTIQ+ equality is growing and achieving significant gains, the LGBTIQ+ community still faces discrimination and stigma. Kidd [ 36 ] found a relationship between LGBTIQ+ identity and the amount of guilt, shame, and self-blame directly related to levels of stigma reported, which influences mental and emotional wellbeing. This can stem from issues such as family- and/or foster-care-related conflicts—often the first LGBTIQ+-related discrimination people face is from within their families. Discrimination based on homelessness then compounds this, which could result in greater levels of self-blame amongst LGBTIQ+ people who are homeless. High levels of self-blame suggest homeless LGBTIQ+ youth are internalising stigma, which is a central aspect of how discrimination affects mental health [ 36 ]. LGBTIQ+ homeless people face discrimination regarding their LGBTIQ+ identity, and their homelessness status [ 2 ]. These factors can intersect with other factors such as ethnicity, mental illness, and disability. Gattis [ 2 ] found LGBTIQ+ respondents faced higher levels of stigma related to being homeless compared to non-LGBTIQ+ respondents. He also reported homeless LGBTIQ+ youth had experienced more discrimination in the past year when compared to homeless non-LGBTIQ+ youth [ 2 ]. LGBTIQ+ homeless people experience greater levels of discrimination and stigma than non-LGBTIQ+ homeless people, both on the basis of homeless status and LGBTIQ+ identity. Stigma can lead to feelings of isolation, loneliness, feeling trapped, and low self-esteem. This can, in turn, make it difficult for people to escape homelessness due to the negative effects of stigma and discrimination.

3.3.4. Family

The breakdown of family relationships is an important risk factor for homelessness. This is especially so for LGBTIQ+ people; it is the main driver of homelessness for LGBTIQ+ youth [ 5 , 41 , 55 , 62 , 63 , 64 , 65 , 66 , 67 ]. Castellanos [ 62 ] reported three main pathways into homelessness amongst LGBTIQ+ youth. The first was disclosure of LGBTIQ+ identity exacerbating existing family conflicts, resulting in the young person being kicked out of the home, or choosing to leave [ 62 ]. The second was that youth left home, or were forced to leave, over their LGBTIQ+ identity [ 62 ]. The third emerged where young people had been released from state supervision back into the care of their family, and family conflict became intolerable due to disclosure of their LGBTIQ+ identity [ 62 ]. All three pathways are linked to negative family responses of the young person’s LGBTIQ+ identity. Shelton explains that for some youth, episodes of homelessness saved their lives due to the discrimination they experienced within their family homes; several transgender and gender-expansive youth stated they would likely have committed suicide if they had not left their families and become homeless [ 68 ]. Abramovich [ 65 ] found the most common cause of LGBTIQ+ youth becoming homeless was identity-based family conflict that arose as a result of these youth coming out. Thus, it is important service provision does not rely on young people reconnecting with their families; for many, improving family relationships and communication is not possible due to the discrimination they face from their families. Negative family attitudes towards LGBTIQ+ identity are a strong driver of homelessness.

3.4. Experiences During Homelessness

3.4.1. survival sex and sex work.

Poverty and homelessness create a lack of options that may lead to survival sex and sex work. Survival sex is defined as trading sex to meet one’s survival needs [ 5 , 29 , 69 ]. Survival sex is often a non-cash exchange, rather than a more straightforward transaction, that is a response to poverty, and may result in economic dependence (instead of a professional transaction), the term survival sex is used [ 69 ]. LGBTIQ+ homeless populations engage in riskier behaviours and survival strategies while on the street when compared to their non-LGBTIQ+ counterparts [ 29 , 70 ]. Existing literature indicates LGBTIQ+ people who are homeless engage in survival sex and sex work at consistently higher rates than non-LGBTIQ+ people who are homeless [ 31 , 34 , 43 , 69 , 71 ]. Childhood sexual abuse and entry into sex work have been linked by Lankenau et al. [ 26 ]: previously abused youth know there exists a demand for certain types of sexual activity. Ream et al. [ 57 ] found LGBTIQ+ youth were very aware of the risks associated with survival sex and sex work. Marshall et al. [ 43 ] found in comparison to their heterosexual peers, homeless sexual minority youth who engaged in survival sex reported significantly higher numbers of clients, as well as inconsistent condom use with clients, putting them at greater risk of contracting sexually transmitted infections. Survival sex and sex work is thus a common experience for LGBTIQ+ people who are homeless.

3.4.2. Physical Ill-Health and Human Immunodeficiency Virus

Physical ill-health is a concerning issue amongst homeless populations. Despite homeless people’s many vulnerabilities to poor health—such as injuries, harsh weather exposure, and assault —there are numerous barriers to care—such as cost, lack of transport, and fear of judgement [ 30 ]. This suggests homeless people can be reluctant to use health services and delay seeking help until their conditions deteriorate, increasing the risk of hospitalisation [ 30 ]. Despite this, there is limited information on the experiences of those who identify as LGBTIQ+. Chang et al. [ 30 ] looked at hospitalisation rates amongst homeless youth who used drugs; 75.9% of the respondents who had been hospitalised in the past six months identified as LGBTIQ+. Gattis [ 2 ] found LGBTIQ+ homeless youth were significantly more likely to be the victims of physical assault than heterosexual homeless youths. This suggests the disproportionate levels of discrimination LGBTIQ+ homeless people face is resulting in higher levels of physical assault [ 2 ]. A specific physical health issue both LGBTQ+ and homeless populations face is HIV, and interestingly, the literature did not focus on other Sexually Transmitted Diseases, despite them being serious diseases. LGBTIQ+ homeless people have a disproportionately high rate of HIV infection when compared to the non-LGBTIQ+ homeless population [ 71 , 72 ]. However, the literature also indicated LGBTIQ+ people who are homeless are more likely to have recently been tested for HIV than non-LGBTIQ+ people who are homeless [ 73 ]. Improved public education and awareness, targeted at both homeless and wider populations, as well as accessibility of testing, has increased the levels of testing [ 72 , 74 ]. Greater levels of HIV testing can result in earlier detection and safer sexual practices [ 73 ]. Thus, homeless populations are vulnerable to physical ill-health, and LGBTIQ+ homeless populations are particularly vulnerable to HIV infection, despite their high rates of testing.

3.4.3. Shelter Inaccessibility

Shelters are intended to be a place of support and refuge for people experiencing homelessness, however, for LGBTIQ+-identifying people they can be a site of vulnerability and danger. Despite the overrepresentation of LGBTIQ+ people in homeless populations, service providers are often under-prepared to work with LGBTIQ+ homeless people [ 75 ]. Maccio and Ferguson [ 75 ] argue the result of this is a dearth of services meeting the needs of LGBTIQ+ people, such as private showers and LGBTIQ+ sensitivity training for staff, and the available supply of services are alienating to LGBTIQ+ clients due to their heteronormative and cis-normative bias. Abramovich [ 76 ] found LGBTIQ+ people going into shelters are fearful due to the danger resulting from discrimination that they are likely to face. The lack of training and understanding from staff can result in staff being queerphobic, and/or not prioritising intervening in incidents of queerphobia [ 76 ]. Transgender and gender-diverse people are often denied access to shelters due to their gender identity, particularly in single-gender shelters that lack policy regarding gender diversity [ 76 , 77 , 78 ]. They have historically been excluded from single-gender shelters, which leaves them vulnerable to violence, murder, and other safety risks [ 79 ]. When transgender and gender-diverse people are admitted into shelters and assigned placement based on their anatomic sex, they are vulnerable to aggression and sexual assault [ 79 ]. In models used in addressing homelessness, shelters are often the first step in accessing support; new models such as Housing First have the potential to work better for LGBTIQ+ people as secure housing is the starting point in addressing homelessness, instead of the end point [ 80 ].

4. Discussion

This paper builds on existing LGBTIQ+ homeless literature, examining the intersections of key themes faced by both people who identify as LGBTIQ+ and people who are homeless. We propose a new way of categorising and visualising the key themes, as presented in Figure 1 . This diagram places the themes in relation to each other, thus enabling them to be understood synergistically.

The first grouping was of proximate causes of homelessness and included the poverty, ethnicity and racism, substance use, and mental health themes. The racism that ethnic minorities face can directly contribute to poverty and poor mental health, which can, in turn, lead to a person becoming homeless [ 12 ]. Similarly, poverty can lead to poor mental health and substance use, just as poor mental health and substance use can lead to poverty [ 16 , 81 ]. Thus, the relationship between all these factors is bi-directional; each can lead to the other. These amplifications of multiple negative factors that cause homelessness show a clear failure to care for those who are most vulnerable.

The second grouping was of systematic failures and included sexual abuse, foster care, discrimination and stigma, and family. LGBTIQ+ identity has a considerable role within this grouping and its relationship to these themes acts as longer-term drivers of homelessness. As shown in the results, unsafe family situations can result in foster care placement. Foster care has a bi-directional relationship with sexual abuse. The literature showed that sexual abuse (particularly within family structures) can result in a young person being placed into foster care [ 29 ]. Youth might then experience sexual abuse within the foster care system [ 82 ]. Foster care has a bi-directional relationship with discrimination and stigma; young people might experience high levels of discrimination and thus be placed into foster care; where they might experience further, or initial, discrimination and stigma due to their LGBTIQ+ identity [ 53 , 59 , 82 , 83 ]. Failures in care systems have the potential to induce substance abuse and poor mental health. Additionally, they can produce economic and social vulnerability which encourages people to engage in survival sex and sex work [ 59 ]. Survival sex may also enable people to provide for themselves in order for them to be able to leave untenable family or foster care situations. Mental health is affected by all of the themes in this grouping; experiencing any of these four systematic failures can result in poor mental health [ 2 , 29 , 59 , 68 ]. Thus, interventions targeted at addressing these factors must also consider the ways in which they impact on people’s mental wellbeing, and ensure the intersectional nature of these issues is considered. It is primarily as a result of failures in these systems that LGBTIQ+ people experience poor mental health. The overlapping nature of these systematic failures shows a need for an inclusive, intersectional system to prevent homelessness.

The third grouping was of experiences during homelessness and included survival sex and sex work, physical ill-health and HIV, and shelter inaccessibility. This grouping has a strong immediate relationship to LGBTIQ+ identity, which indicates both direct and indirect discrimination in the ways in which the right to housing is realised. Survival sex and sex work have a bi-directional relationship with physical ill-health and HIV. Survival sex and sex work puts people at greater risk of contracting HIV and experiencing ill health [ 57 ]. Physical victimisation and ill health can result in people engaging in survival sex and sex work in order to meet their survival needs [ 84 ]. Survival sex and sex work also have a bi-directional relationship with shelter inaccessibility. When shelters are inaccessible to LGBTIQ+ people, they are more likely to engage in survival sex in order to find accommodation and/or money to meet their needs [ 84 ]. On the other side of this relationship, shelters have the potential to become inaccessible to people who are engaging in survival sex or sex work due to strict shelter policy regarding illegal behaviours. Both the proximate causes of homelessness and systematic failures lead to these experiences LGBTIQ+ people have while homeless.

Focusing primarily on negative aspects of LGBTIQ+ homelessness provides an incomplete, one-dimensional understanding of the issue [ 68 ]. This undermines the resourcefulness of these people and the instances of affirmation, connection, growth, and self-sufficiency they experience [ 68 ]. Reframing understandings of LGBTIQ+ homelessness has the ability to prevent us from confining interventions to risk-reduction models, and instead move towards strength-based models [ 68 ]. The relationships between the key themes indicates LGBTIQ+ people are willing to risk their health, and safety, in order to meet some of their needs, such as a place to sleep, food, money, and drugs. This suggests LGBTIQ+ people are often brave and resourceful in their engagement in behaviours that enable them to maintain their identity and to meet their survival needs. For example, this bravery can be seen when LGBTIQ+ people leave family and/or foster care situations in order to look after their physical and mental wellbeing. In viewing the survival strategies of LGBTIQ+ people as bravery and a lack of timidity, we are able to move from a purely deficit-focused view, to one that acknowledges their resiliency. Further research is needed to continue to expand upon this strengths-based understanding of LGBTIQ+ homelessness.

Literature from Hunter [ 85 ], Shelton [ 86 ], Abramovich [ 76 ], and Maccio and Ferguson [ 75 , 87 ] indicated a need for service providers to be aware of the particular issues LGBTIQ+ homeless people face, and work towards addressing these concerns. Hunter [ 85 ] identifies four main changes service providers should implement: private showering facilities, low-occupancy limits, housing programs that are prevented from discriminating on the basis of sexual orientation and/or gender expression, and specific LGBTIQ+ non-discrimination and sensitivity training for all staff. Ensign and Bell [ 88 ] found street-based people are more likely to visit emergency departments than shelter-based people. Thus, those in the shelter system have access to greater social and cultural capital than rough sleepers and other homeless people outside of the shelter system. It is possible LGBTIQ+ people are missing out on the support and knowledge provided by shelters, due to their often adverse feelings towards, and experiences of, shelters. With LGBTIQ+ people so over-represented in homeless populations, shelter staff need to undergo cultural competency training in order to provide culturally sensitive support [ 75 ].

As shown in Section 3.3 , systems failures in early life are a key driver of LGBTIQ+ homelessness, particularly in early life. The interconnected nature of these system failures means we cannot address the failures in one system without addressing the failures in the others. The intersectionality of LGBTIQ+ people’s experiences with homelessness, poverty, and ethnicity makes them particularly vulnerable to these systems failures. This indicates a need to rethink and redesign these early-life systems, with targeted interventions for LGBTIQ+ people kept at the core of any changes. Such changes could include LGBTIQ+-specific protections in government policy, and LGBTIQ+ cultural competency training for those who work in related fields. Failing to address these needs breaches one’s right to housing and results in unequal outcomes, as evidenced by the high rates of LGBTIQ+ homelessness. This represents a failure in both policy and social wellbeing to support our most vulnerable.

The main limitation to this paper is related to the literature search; namely, that the initial search terms were somewhat inefficient at finding relevant research. As discussed in the Methods section, 27 relevant articles were obtained from the literature searches, and a further 26 came from reviewing the reference lists of those articles. Thus, almost half of the relevant articles did not come from the literature searches. Search terms could have thus been broadened and altered to capture a larger proportion of the relevant articles. It is possible that we have missed articles which use alternate terms and keywords such as “sexuality” or “sexual orientation” instead of “LGBT” and “Queer”, as we have used, which have only been rising in usage in recent decades. Another limitation of this study is the narrow geographic range of the literature; most articles come from North America, with a few from Australia and Europe. Further research would benefit from exploring the issue of LGBTIQ+ homelessness in a wider range of locations. This would broaden our understanding of the issue and allow us to see how LGBTIQ+ people’s experiences of homelessness differ across a range of social, political, cultural, and economic contexts.

5. Conclusions

People who identify as LGBTIQ+ experience homelessness at far greater levels than their non-LGBTIQ+ counterparts. This paper outlines the relationships between factors relating to LGBTIQ+ homelessness and proposes a systems-thinking approach through which to view them. We place these themes into three main groupings; proximate causes of homelessness, systems failures in early life, and experiences during homelessness. This systems-thinking approach to LGBTIQ+ homelessness can be used to develop well-informed, culturally sensitive support programmes, particularly in relation to early life intervention in order to prevent systems failures. Despite the increase in academic scholarship on the issue, more research is needed.

Author Contributions

Conceptualisation, B.F., N.P., E.C., and H.C.; writing—original draft preparation, B.P.; writing—review and editing, B.P., N.P., E.C., and H.C.

This paper was supported by funding from the New Zealand Ministry of Business Innovation and Employment, Endeavour Fund.

Conflicts of Interest

The authors declare no conflict of interest.

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Homelessness is a growing problem nationwide. According to the U.S. Department of Housing and Urban Development (HUD), the number of people experiencing homelessness rose 12% from 2022 to 2023 (HUD Exchange, 2024b). Low vacancy rates, increased rent costs, and income inequality all comprise difficult structural factors locking people out of the housing market. Those who most harshly bear the brunt of this crisis are people with social vulnerabilities. This paper analyzes the social problem of homelessness from the perspective of an urban hospital Emergency Department (ED), Yale New Haven Hospital (YNHH) in New Haven, Connecticut. Social workers in these settings have a dual role: working directly with individuals and families to connect them with available services and resources and advocating for structural interventions that can ultimately ease this problem. Social workers are also at the forefront of combating any stigma unhoused persons face by both approaching patients experiencing homelessness with dignity and respect while educating others that this problem is not one of the individual, but is rather a consequence of multiple other social problems we have collectively failed to address.

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Homelessness and mental illness: a literature review and a qualitative study of perceptions of the adequacy of care

Affiliation.

• 1 Institute of Community Health Sciences, Barts and The London School of Medicine, Queen Mary University of London. [email protected]
• PMID: 16615247
• DOI: 10.1177/0020764006062096

Background: Homelessness and mental illness together confer significant morbidity and mortality because of physical health problems. Healthcare provision is undergoing significant review, and, as part of the Department of Health's policy reforms, the service user's view is central to the future restructuring of NHS services.

Material: A literature review of homeless service users' perceptions of services for homeless mentally ill people was supplemented by a qualitative in-depth survey of 10 homeless people. This article reports on their views about the services they receive. Mismatch between expectations and provision, disputes with healthcare providers, dissatisfaction with the degree to which they have choice in their care, and suspicions about the intentions of health professionals demonstrate the extent to which powerlessness and social exclusion are replicated in healthcare economies. The inadequacy of hostels and their staff are also emphasised, with some recommendations for services.

Discussion and conclusions: There are few data on homeless people's perceptions of services for mental health problems. Homeless people have strong views about the adequacy of services to meet their needs. They were particularly concerned about stigma, prejudice and the inadequacy and complexity of services that they have to use. This article reports their recommendations for change.

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• Research Support, Non-U.S. Gov't
• Attitude to Health*
• Ill-Housed Persons / statistics & numerical data*
• Mental Disorders* / epidemiology
• Mental Disorders* / psychology
• Mental Disorders* / therapy
• Mental Health Services / standards*
• Quality of Health Care / standards*

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CHARLOTTE HIGGINSON Contributing Reporter

The policy theme that I will be discussing is poverty in Delaware. I am specifically interested in homelessness and how rising levels are calling for change, but adaptations have not been made to better aid individuals within this crisis. This topic is particularly interesting as college students are not regularly in contact with homelessness, and I feel as though bringing awareness to this issue is a step towards making a difference in the lives of the impoverished. The rates of homelessness are significantly high, and action must be taken to address this issue. The homeless population in Delaware is rapidly increasing, and Delaware Gov. John Carney has suggested expanding affordable housing. He hopes to bring attention to rising homelessness and provide economic assistance to unhoused individuals through efforts to boost economic productivity. Affordable housing programs include assistance with rent, down payment assistance when home-buying and, in recent years, subsidies for developers to create affordable housing units, according to a paper on the Assessment of Homelessness . The state of Delaware supplies interim housing – which includes emergency housing, transitional housing and motel vouchers – in an attempt to support people in immediate need, as found by the Assessment of Homelessness . In reality, all homeless people are in immediate need, but not all have access to the resources available to pull themselves out of the poverty cycle. As homeless rates increase, the supply of affordable housing and interim options has declined, making safe living spaces for the impoverished scarce. “Homelessness in Delaware” is a University of Delaware paper by Stephen Metraux and Steven Peuquet, of the School of Public Policy & Administration, through The Center of Community Research & Service. The paper analyzes general trends in homelessness within the state of Delaware since 2007. In addition to an increase in homelessness, there has also been an upward trend in unsheltered homelessness, since access to interim housing has become more meager, as indicated by “ Homelessness in Delaware .” There are numerous changes that must be made in order to address homelessness in Delaware and across the country. The most prominent is a need for more numbers in vouchers and shelters, according to Delaware Public Media . Shelter numbers have increased, but the number of those experiencing homelessness, and therefore a need for shelter, is rising at a faster rate. Interim housing is not meeting the demand, per DPM . This can be achieved through a stronger system established to fund interim housing. The homeless community needs more funding to provide more consistent housing resources. Carney puts a strong emphasis on the potential that homelessness is impacted by weak communities. Without well-knit groups of people and proper support and resources, individuals fall through the cracks, resulting in poverty and homelessness. COVID-19 catalyzed a climb in homeless individuals, forcing people who were on the brink of poverty out onto the streets. During a time of less paid labor opportunities, many who were already fighting to stay in their homes were left with no other option and joined the homeless count. It is proven that housing disparities are outnumbered by Black individuals, according to Delaware Online . Black Delawareans accounted for 61% of people experiencing homelessness in 2022. Historical racist practices continue today and impact the lives of many. Redlining is a racist governmental tactic in which certain areas of communities are deemed poor. This targets predominantly Black areas of neighborhoods and limits them from taking out loans due to financial risk. Within the realm of homelessness, racism prevents Black families from owning homes in wealthier communities. These changes can not be made overnight; systemic disparities must be addressed in order to properly overturn the racism rooted in our history. Poverty is everywhere. Whether we as college students see it or not, poverty leads to homelessness, and it is rooted in our society and government as a whole. There is a hierarchy of money and funding priorities that homelessness has not yet reached. As the number of homeless individuals continues to rise, the number of interim housing steadily declines. We need a strong funding system to provide safe and affordable housing for the impoverished and homeless. It is also imperative that as a society, we look inward at the systemic racism causing disparities on all fronts. COVID-19 worked against us, pulling people out of work and into poverty, but those days are passing. Through a more connected community and proper funding to supply more motel vouchers to those in need, homelessness could be a thing of the past. Charlotte Higginson is a sophomore human services at the university. Her opinions are her own and do not represent the majority opinion of The Review staff. She may be reached at [email protected].

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Study reveals five common ways in which the health of homeless pet owners and their companions is improved

A rapid scoping review has been conducted, which reveals five common ways in which the health of homeless pet owners and their companion animals is improved.

Ten percent of homeless people keep pets. However, little information exists on specific intervention strategies for improving the health of homeless people and their pets, who are often the only source of unconditional love or companionship in their lives.

The study, published in the Human-Animal Interactions journal, found that the most common ways in which homeless people and their pets are supported to live healthier lives include free veterinary clinics, joint human/animal clinics, stigma reduction, interdisciplinary relationships, and pet-friendly lodging.

Lead authors Dr. Michelle Kurkowski and Dr. Andrew Springer said research on homeless people and their pets showed significant heterogeneity, but they stress that further program intervention is needed to recommend intervention best practices.

Promising avenues for evaluating interventions and improving health

They suggest that joint human/animal clinics and interdisciplinary partnerships are promising avenues for evaluating interventions and improving health outcomes.

A study by Ramirez et al (2022) that investigated 44 homeless pet owners in Seattle, U.S., for example, found that 61% of respondents were interested in health care for their pets, compared to 43% for themselves. Furthermore, 86% indicated they would attend a joint veterinary/human health clinic, with convenience frequently mentioned.

Studies that the researchers drew upon for their findings—from the PubMed and Embase databases—include those focused on homeless pet owners across the U.S., Canada, and the UK.

Dr. Kurkowski wrote the paper while at the University of Texas Health Science Center at Houston School of Public Health (UTHealth) but is now a Veterinary Medical Officer for the USDA Animal and Plant Health Inspection Service.

A source of friendship and physical safety

She said, "Research has shown that companion animals are a source of friendship and physical safety, and homeless persons with pets report significantly lower rates of depression and loneliness compared to non-pet owners."

"Studies show that pet owners experiencing homelessness are also subjected to unique challenges in caring for both themselves and their companion animals. Individuals, for instance, are often forced to choose between accessing lodging and keeping their pets with them."

"Similarly, our review reveals that this group is less likely to utilize needing assistance, such as health care or career services, potentially due to difficulty using public transportation of lack of safe places to leave pets."

However, Dr. Kurkowski and Dr. Springer said that despite the growing body of literature on both the benefits of pet ownership for the unhoused community—as well as the needs and challenges that homeless pet owners and their pets face—little attention has been given to developing interventions to address the challenges facing this group.

More comprehensive and effective care package

Dr. Springer, associate professor in the Department of Health Promotion and Behavioral Sciences at UTHealth, "Our purpose was to describe the study designs, measurements, and outcomes of relevant primary research studies to identify knowledge gaps in the body of literature on this topic."

"Additionally, common intervention characteristics were highlighted to create a 'road map' of prior interventions to assist individuals interested in creating similar programs."

"The ultimate goal of this assessment was to summarize key intervention strategies for pet owners experiencing homelessness to help direct future funding, research, and outreach efforts among this unique population."

The researchers conclude that a more comprehensive and effective care package for homeless people and their pets will require the combined efforts of health care providers, social workers, animal welfare workers, and governmental and nonprofit organizations to develop innovative One Health solutions for the challenges currently facing this population.

More information: Exploring Strategies for Pet Owners Experiencing Homelessness: A Rapid Scoping Review, Human-Animal Interactions (2024). DOI: 10.1079/hai.2024.0002

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Alice Munro, acclaimed short-story writer and Nobel Prize winner, dies at 92

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Alice Munro, the Canadian short story writer who lent mythic proportions to the lives of ordinary people from small, rural towns like those in the Ontario countryside where she spent most of her life, has died. She was 92.

The author’s publisher, Penguin Random House Canada, confirmed on its website Munro died Monday evening at her home in Port Hope, Ontario. A cause of death was not revealed, though the author had been in frail health since undergoing heart surgery in 2001.

Kristin Cochrane, the chief executive of Penguin Random House Canada, paid tribute to Munro in a statement published on the website. “Alice Munro is a national treasure — a writer of enormous depth, empathy, and humanity whose work is read, admired, and cherished by readers throughout Canada and around the world,” Cochrane said.

The statement continued: “Alice’s writing inspired countless writers too, and her work leaves an indelible mark on our literary landscape. All of us at Penguin Random House Canada mourn this loss and we join together with our colleagues at Penguin Random House in the U.S., the U.K., and globally in appreciation for all that Alice Munro has left behind.”

Considered by many to be the finest short fiction writer of her generation, Munro was awarded the Nobel Prize in literature in 2013 , only months after publishing a collection of stories that she said would be her last. She had already received the Man Booker International Prize, the National Book Critics Circle Award in the United States and every top literary prize offered in her native Canada, including its most prestigious, the Governor General’s Award.

Alice Munro, reviewed by L.A. Times: ‘casually impeccable,’ ‘genius’

Alice Munro, who won the Nobel Prize in Literature on Thursday, lives a quiet life in a small town in Ontario, Canada.

Oct. 10, 2013

“Alice Munro is our Chekhov, and is going to outlast most of her contemporaries,” author Cynthia Ozick said some years ago, comparing her to Russia’s 19th century master of the short story. Reviewers often linked the two writers’ names, partly because both had mastered a subtle peeling back of layers to reveal their characters.

Munro wrote about country folk who knew how to gut a turkey, breed foxes and sell medicine door to door, but also knew about unreliable love, family violence and failed attempts at social climbing. Her stories unfold, often in the fictional towns of Jubilee or Hanratty, with a direct simplicity paired with painstaking craftsmanship. She made no secret of the dozens of drafts it took her to complete a story.

“She’s become a virtuoso,” author John Updike, the literary critic for the New Yorker, said in a 2001 interview with the Montreal Gazette. “She manages to get into people’s skin without seeming to dive in, without being ostentatious.”

Several of Munro’s collections were made of linked stories where characters leap across years or decades before the last page. In “Lives of Girls and Women” (1971), she identified some of her favorite kind of women. They were “dull, simple, amazing and unfathomable — deep caves paved with kitchen linoleum.”

A look at the work and life of author Alice Munro

News that Alice Munro, 82, was the winner of the 2013 Nobel Prize in Literature was met with tremendous enthusiasm from her fans in America.

She once explained her attraction to such lives, saying they only appear to be dull. “The complexity of things, the things within things, just seems to be endless,” Munro said. “I mean, nothing is easy, nothing is simple.”

Her best works compare with classic tragedy written in prose form.

“I want to tell a story in the old-fashioned way — what happens to somebody,” Munro said in a 1998 Vintage Books interview. “But I want the reader to feel something is astonishing. Not the ‘what happens’ but the way everything happens.”

There aren’t many happy endings in Munro stories. But there is basic goodness, clearly exposed, in nearly all of her characters. If they lose, they usually lose in love, and carry their disappointments with quiet dignity.

Alice Munro, Nobel winner and a writer’s peerless teacher

The Nobel laureate in literature imparts the invaluable lesson of how to be in the moment as a writer.

“The bleakness of its vision is enriched by the author’s exquisite eye and ear for detail,” Joyce Carol Oates wrote in the New York Times in 1986. “Life is heartbreak, but it is also uncharted moments of kindness and reconciliation.”

Munro attracted international attention without ever leaving home. She lived most of her life in rural Ontario, surrounded by woods and farmland. She noted in interviews that she was raised on the wrong side of the tracks in her hometown of Wingham. As a young girl she could hardly wait to get away from that life, but years of writing fiction set in small towns changed her view.

“I am at home with the brick houses, the falling-down barns, the occasional farms that have swimming pools and airplanes, the trailer parks, burdensome old churches, Wal-Mart, and Canadian Tire,” Munro wrote in the introduction to “Selected Stories” (1996). “I speak the language.”

She vaulted into the mainstream by sheer force of will. Increasingly she was included in the lofty league with her friend Margaret Atwood as well as Carol Shields and Timothy Findley, Canada’s leading fiction writers among her contemporaries.

She referred to herself as compulsive and driven about her work. She wrote every day and set the highest goals. As a beginner in the early 1950s she submitted her work to the New Yorker and was rejected again and again. Her first story for the magazine was published in 1979. After that she became a frequent contributor.

Daniel Menaker, who was Munro’s editor at the New Yorker and later the editor in chief at Random House, referred to her as “a modern and experimental writer in the clothing of a classical writer.”

“You get the feeling she’s trying to help you get at some true emotional psychological insight,” Menaker said in a 2003 interview with the Guardian. As often as not, he said, it leads to “a dark existential uncertainty about what makes people tick.”

Born Alice Laidlaw on July 10, 1931, and raised on a fox and mink farm, a failing family business, Munro was the oldest of three children. Her mother, Anne, was a stickler for “pure” and ladylike behavior, which cramped Alice’s imagination.

Anne Laidlaw developed Parkinson’s disease when Alice was 10. Long-term illness only made their strained relationship worse. Alice left home at 17, torn by guilt, and did not return home during the last two years of her mother’s life.

In “The Peace of Utrecht” (1959), she described a young woman who goes home after her mother’s death. She is defiant but not entirely convincing about the choice she made to leave.

The story, one of Munro’s first blatantly autobiographical works, freed her. From then on she wrote personal stories, a number including uneasy mother-daughter relationships.

Alice Munro has retired from writing. Or has she?

Before winning the Nobel Prize in Literature, Canadian short story master Alice Munro announced her retirement in an interview with Mark Medley of Canada’s National Post.

Oct. 23, 2013

“The problem, the only problem, is my mother,” she wrote in the autobiographical “The Ottawa Valley” (1997). “She is the one of course that I am trying to get. … To mark her off, to describe, to illumine, to celebrate, to get rid of her.”

When Munro did leave home, it was to attend the University of Western Ontario. There she met her future husband, James Munro, and they married in 1951. The couple moved to Vancouver, where he worked as an executive at a department store. They had three children, Sheila, Jenny and Andrea. Another girl, Catherine, was born without kidneys and died hours later.

While her children were young, Munro wedged fiction writing between housework and her daughters’ naps. Time constraints steered her toward short stories. “I wrote in bits and pieces,” she said in a 2001 interview with Atlantic Monthly. “Perhaps I got used to thinking of my material in terms of things that worked that way.”

In 1963 the Munros moved to Victoria, British Columbia, and opened a bookstore — Munro’s Books — which eventually became a literary landmark.

Family commitments slowed Munro’s writing career. It took her close to 20 years to finish enough stories to fill her first collection, “Dance of the Happy Shades,” published in 1968. She was 37. The book won the Canadian Governor General’s Literary Award in 1969. Munro won the prize again in 1978, 1979 and 1987.

“I feel that I am two rather different people, two very different women,” she said in an interview with Graeme Gibson for “Eleven Canadian Novelists” (1973). “In many ways I want a quite traditional role and then of course the writer stands right outside this, so there’s the conflict right there.”

The social upheavals of the 1960s gave Munro new material to write about. She grew dissatisfied with her husband, and the couple divorced in 1973 after 22 years of marriage. She took an appointment teaching at the University of Western Ontario and reconnected with Gerald Fremlin, a geographer she first met while they were students. They married and in 1976 moved to Clinton, Ontario; each had been raised within a few miles of the town.

Place became a character in Munro’s stories. “I am intoxicated by this landscape,” she wrote, “by the almost flat fields, the swamps, the hardwood bush, by the continental climate with its extravagant winters.”

In dozens of short stories set in Ontario, she combined the “intractably rural” region with the human commotion it hosted — “gothic passions, buried sorrows and forlorn mysteries,” a reviewer for the New York Times magazine wrote in 2004.

At age 60, Munro began writing stories about her contemporaries as they looked back over the past. In “Friend of My Youth,” a collection published in 1990, a number of men and women from Munro’s generation are portrayed as grudging survivors of the sexual revolution, the peace movement and the feminist movement of the 1960s and ’70s. Critics referred to her “mature vision.”

Alice Munro’s quiet, precise works lead to Nobel Prize in literature

By 1998 Munro was at the height of her success. She won the National Book Critics Circle Award that year for “The Love of a Good Woman.” Three years later, she completed “Hateship, Friendship, Courtship, Loveship, Marriage,” her 12th book. It sealed her reputation. She followed it in 2004 with “Runaway,” a collection of three stories that follow the main character, Juliet, from a bumbling 21-year-old with a degree in classics through 30 years of bad love affairs, money problems and a daughter who no longer speaks to her.

“The moments she’s pursuing now … are moments of fateful, irrevocable, dramatic action,” Jonathan Franzen wrote in a review for the New York Times Book Review. “What this means for the reader is you can’t even begin to guess at a story’s meaning until you’ve followed every twist; it’s always the last page or two that switches all the lights on.”

Munro’s final story collection, “Dear Life,” was published in 2012. The following year, she won the Nobel Prize in Literature.

“I write the story I want to read,” Munro told the New York Times. “I do not feel responsible to my readers or my material. I know how hard it is to get anything to work right. Every story is a triumph.”

Munro is survived by her daughters Sheila and Jenny. Fremlin, her husband, died in 2013.

Rourke is a former Times staff writer.

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