Several years ago emergency housing shelters became unfashionable in favor of long term housing.  This makes sense; each time a homeless person is permanently housed, then there is one fewer homeless person on the streets.  But since the process of finding permanent housing for the homeless is a long, expensive, complicated one, and often involves matching patients with case managers, finding landlords willing to take homeless renters, and finding open units in a very tight rental market, this process is not likely to make a significant dent in the number of people living outdoors for some time. Moreover, new homeless people are appearing – released from prison, aged out of foster care, losing jobs or being kicked out of homes related to substance use disorders.

I frequently meet patients asking me to help them get into a shelter.  I very often have to tell them that there are no openings, that it could be a few weeks before they can get in somewhere.  Often, when homeless individuals stay in a shelter for a while, they are able to build trust with staff, social workers, and healthcare professionals.  Some benefit from a quieting of the chaos of homelessness enough to eat, sleep, and take medications more regularly; I have often seen substance use disorders and mental illnesses stabilize during these times.  It can be a time when they can become prepared for the complex psychosocial adjustment of moving into housing after being outside for years.