Karen Creed’s walk is a limp. As she moves down the concrete path near southeast Portland’s St. Francis’ church, she heavily favors her right leg. Her left one sticks out to her side. She explains that her knee is fused, and she cannot bend it.
Creed, 49, has arthritis and osteoporosis. Her ankles are clearly swollen, and her fingers are becoming gnarled. “I’m a mess, physically,” she says.
Sleeping outside, most often times on concrete, exacerbates her physical health. Creed feels bruised and sore each morning she wakes up, and has problems standing up because she can’t bend some of her joints. “I have to get up like a crab, go sideways,” she says.
Her voice is deeply raspy, which Creed says is caused by breathing in the fumes and dust of cars driving by each night. She often wakes up multiple times a night, and has headaches in the morning because of it.
Creed says she has been homeless off and on since she was a child. Her most recent episode of homelessness began four years ago when her son died. And she says her health has dramatically deteriorated because of her homelessness.
Creed’s condition, like that of homeless women across the country, is what concerned a group of University of Nebraska-Lincoln sociologists who have embarked on a long-term study of the issue. They recently completed a survey of 40 homeless women in Portland to help further highlight the health problems faced by homeless women.
The survey’s results are disturbing, and demonstrate — even from a small sample of 40 women — that homeless women are extremely vulnerable to sexual trauma, domestic violence, lack of physical and mental health care, and suffer significantly from mental illnesses and substance abuse.
Of the more than 18,000 people who accessed homeless or housing services in Multnomah County last year, 45 percent were female.
Researchers interviewed the women between August 2010 and May 2011. The women answered a questionnaire on their own, and they were also interviewed by a researcher.
Portland is one of three cities in the survey, along with Pittsburgh, Penn., and Omaha, Neb., that included 200 women. It is the initial step in a two-year project funded by a $400,000 grant from the National Institute of Child Health and Human Development, a division of the National Institutes of Health.
Homeless women were questioned on a wide range of topics, including how they became homeless, their mental and physical health, their risk of HIV infection, and histories with trauma and domestic and sexual violence.
The survey, says Les Whitbeck, a sociology professor at the University of Nebraska-Lincoln and principal investigator in the survey, is the first of its kind done in the nation, focusing specifically on women’s health and comparing the results between cities.
Whitbeck says he and his colleagues got the idea to survey homeless women after doing a similar survey on homeless youths. In that survey, the youths reported similar experiences and concerns while homeless, until they grew older. By the time the youth were 18, 19, and into their early 20s, homeless females began reporting higher rates of sexual trauma and domestic violence.
Whitbeck said the main goal of surveying homeless women was to get a more detailed understanding of the prevalence of specific physical and mental health problems, as well as HIV risk, among homeless women. The sample is preliminary, and the researchers are committed to interviewing women multiple times over a longer period of time to get stronger data. But themes and trends have already emerged, they say.
“Homeless people have very gendered experiences,” says Devan Crawford, University of Nebraska-Lincoln sociology professor and researcher.
The survey revealed that high numbers of homeless women have physical health problems, mental health disorders, suffer from substance abuse, or a combination of all three. While that is something homeless service providers already know, researchers emphasize that the data creates a clearer picture of homeless women being extremely vulnerable with major barriers to ending their homelessness.
“There are a lot of very damaged women,” Whitbeck said.
More than half of the 40 women surveyed showed symptoms of borderline personality disorder or anti-social disorder. Twenty-five reported going to an emergency room in the past 12 months to receive basic medical care.
Seventeen women who wanted medical treatment did not receive it. More than half said they had not seen a dentist in the past two years. That was noted as a particular concern to women. One anonymous woman who took the survey described being able to access dental care as “a huge thing” for homeless women. As one 36-year-old woman told researchers, “Losing teeth really affects self-esteem and (a woman’s) ability to go out and interview for jobs,”
Twenty women reported seeking some sort of help for mental illness, whether calling a hotline, being admitted to a hospital, or being part of a support group. Twenty-five women, or 62.5 percent of the sample, reported having a major depressive episode in their lives.
Numerous women also reported using illegal drugs.
Asthma was the physical health problem women reported the most, and 13 reported that they had inflammatory lung disorder. Other physical health problems reported include high blood pressure, lung disease, diabetes, thyroid disease and neurological problems such as Parkinson’s disease.
Women also reported feeling that they were in physical danger. “We are constantly at risk while sleeping, men wanting to rape or molest us,” said a 51-year old woman.
“Staying alive” was another woman’s main concern.
One notable difference with the Portlanders surveyed, as compared to those in Omaha and Pittsburg, was that only five women reported being homeless for a year or less, Crawford said. Portland’s homeless women, she said, were homeless for “much longer” than the other women.
Another statistic that stands out is the number of women, 12, who are not working or not looking for work. Some reasons women gave to surveyors included not having a place to shower, dress, get ready for work, as well as being unhealthy or disabled.
“It is hard to get clean underwear and bras. (We) need more places to get a haircut,” reported a 23-year-old woman in the survey.
Creed says it is hard to access services that may seem secondarily important to housing and case management, like places to get glasses, for example. Transportation is a huge obstacle for her, because of her arthritis. It would be nice, she says, if there were more places like St. Francis where she can put a “cup of coffee between my very cold hands.”
“No one is going to hire someone who is looking dirty, carrying their baggage. It makes them look unstable,” says Sister Cathie Boerboom, the executive director of Rose Haven, a resource center for homeless women.
That dynamic may change. The Bud Clark Commons, which opened in June, provides showers, lockers and other basic resources to homeless men and women. JOIN, a homeless outreach agency, provides showers and lockers to men and women. Still, the resources are far outstripped by the demand.
Rose Haven provides a clothing closet for women, as well as a day space — but not necessarily a place where women could leave their belongings. And the Gateway Center for Domestic Violence, which opened last year, provides access and referral to other services.
Martha Strawn Morris, the program director of the Gateway Center for Domestic Violence, says the Gateway Center has had 4,000 visits in the first year of operation.
“I’m still a little bit overwhelmed by the terms of the number, realizing how many people are actively experiencing this in our community,” Strawn Morris says.
When the study was presented to the city’s Coordinating Committee to end Homelessness, it drew gasps from the members in attendance. “I thought it was really spot on,” says Shannon Singleton, the manager of the Salvation Army’s Female Emergency shelter. “There’s not a lot of data out there on women experiencing homelessness.”
Rebecca Peatow Nickels, the executive director of the domestic violence hotline Portland Women’s Crisis Line (PWCL), says PWCL answers 23,000 calls per year and serves 400 individuals. The first reason women call PWCL, she says, is to seek help in relation to domestic violence. The second is related to housing and homelessness. “There is a very large link between domestic violence and homelessness,” she says.
Peatow Nickels says domestic violence and homeless services are too “isolated” from one another to effectively serve victims of domestic violence and reduce homelessness.
Many survivors of domestic violence, she says, more often than not become homeless as a result of fleeing their home. Women fleeing domestic violence, she says, leave behind many of their belongings, may lose access to bank accounts, and may have no money of their own. They cannot necessarily live with friends, because their abuser would know where to find them.
Despite the strong link between domestic violence and female homelessness, Peatow Nickels says the communication between domestic violence and homeless services providers is inadequate.
If adequate domestic violence services were provided in Multnomah County, she thinks, the numbers of women becoming homeless would dramatically decrease. “If there were suddenly 150 more beds, it would almost be double what we have today,” she says. “It would be an amazing help.”
There are approximately 170 women on the Salvation Army’s wait list, according to Singleton. Jean’s Place, the women’s shelter operated by Transition Projects, Inc., has a similarly long wait list.
Seventy-five shelter beds are reserved for domestic violence victims. According to Strawn Morris, approximately 16,000 to 18,000 calls are made to a variety of crisis lines in Multnomah County each year, all requesting shelter.
Strawn Morris says that shelter is important for the people who need it, but it alone cannot solve homelessness among domestic violence survivors. “Are some of those people asking for shelter who would ask for something else if they knew there was another option?” she wonders.
Increasing the amount of shelter for women was something almost all of the women wrote at the bottom of the questionnaire they took without an interviewer.
“There are not a lot of places for women, at least in the Portland area,” agreed a 37-old woman.
Building more shelter for women without children, a 49-year old woman wrote, would “get them stabilized and trying to make them not feel they’re worthless.”
The “inadequate” services, Peatow Nickels says, are a direct reflection of the 10-Year Plan to End Homelessness not prioritizing domestic violence. “You have this very narrow definition of who the plan was going to impact the most, or at all,” she says, referring to the 10 Year Plan’s emphasis on housing people who are “chronically homeless.”
No one from the Portland Housing Bureau would comment on the survey for this story. “We might in the future when we have more knowledge about (the survey), or about what the findings are,” said Maileen Hamto, the Bureau’s public information officer.
Boerboom calls the services available to homeless women “horribly inadequate.” Like Peatow Nickels, Boerboom thinks more shelters for domestic violence victims are needed. She also says there needs to be additional funding for mental health treatment. On average, she says the 2,000 encounters Rose Haven has with women each year reveal that the great majority of them suffer from mental health disorders and traumatic histories.
Boerboom worries that many women do not seek services, choosing instead to hide themselves as much as possible, in order to escape from abusers. Creed thinks many women are hesitant to tell their story or access services, to reveal something personal, “and then that abuser will go, aha, there you are,” Creed says.
Singleton, who says the sample size of the women surveyed is “too small to draw conclusions from,” thinks more needs to be done to integrate and connect the variety of services that exist in Portland. She points to some changes in the intake procedure at the Salvation Army’s shelter that takes into account a woman’s particular needs, such as asking about prior relationships and how those relationships currently impact the women.
Agencies not sensitive to the needs and worries specific to homeless women will not be able to adequately help woman end their homelessness, according to Singleton.
“You relive what happened,” Creed says. “You just don’t have someone to talk to who knows what’s going on.”
Singleton also thinks service agencies can lower barriers to their programs in order to attract more women “There are still a lot of programs that (require) sobriety,” she says, which “keeps a lot of doors closed.”
And subsequently, women continue to remain homeless and not access services.
Whitbeck and his fellow researchers plan to do a larger, two-year survey that would involve interviewing at least 100 women at three or four month intervals. Whitbeck wants to continue to do the survey in Portland, Omaha and Pittsburg, but also add Boston and New Orleans.
By tracking women across time, he told the group, themes and stronger data will begin to emerge as to what distinguishes homeless women from other homeless populations. More details about their physical and mental health will also emerge.
“If we can pull this off … this will be the first study to focus only on women,” he said.
And he emphasized that the survey is not just for the sake of academic research and esoteric data crunching.
“This data needs to be put into practice.”
Artwork faux street revisited by Christine Hanlon