Submission to The Social Lens: A Social Work Action Blog by Sarah Canham, University of Utah / Simon Fraser University
Early on in my training as a gerontologist, I was introduced to ideas of ageism – discrimination against a person based on their age. As it turns out, the term ageism is not that old. Only as recently as 1969 did Dr. Robert Butler propose this term and research begin to explore the phenomenon.
The related terms of racism and sexism have longer histories, yet still point to the stigmatization and discrimination against individuals based on categories of race and gender. When we think about these terms together, the ways in which intersections of disadvantage affect individuals become apparent. For instance, an older woman is stigmatized not only because they are old or because they are female, but are multiply stigmatized for these intersectional identities. What’s more, with each additional marginalized identity, individuals are likely to experience additional discrimination.
I often have the opportunity to listen to the stories of people who are experiencing homelessness. Trained in qualitative methodologies, the research I conduct often elicits stories of discrimination – even when this is not the focus of the questions I’m asking. Having heard stories of discrimination over and over, I recently went back to data from one study on experiences of hospital discharge for people who do not have a permanent address. I examined the dataset in its entirety – this time looking for specific references to stigmatization and discrimination – and saw a pattern in the stories being shared. What I found were experiences of injustice. Unfairness. Differential treatment. There was a clear pattern of discrimination against individuals who are homeless. I found these experiences contributed to hesitance to engage with healthcare providers for fear of being treated poorly.
The stories of discrimination were not based on an individual’s age, race or gender. An altogether different kind of discrimination was being described – discrimination based on experiences of homelessness. What struck me was that this was a form of discrimination that we don’t yet have a word for. And without a word, how can we begin to put parameters around this concept? How can we examine the nuances of the experiences and ultimately take the steps needed to dismantle an unnamed phenomenon?
I offer the term homeism. Homeism can be defined as the discrimination towards an individual who is homeless. And while homeism is distinct from other forms of stigmatization and discrimination, it undoubtedly intersects with stigmas based on age, race, gender, physical ability, mental health and more. While homeism occurs daily, experienced by a wide range of people, homeism took place in my data when people experiencing homelessness were seeking healthcare. Homeism took place when people were seeking housing. Homeism took place as an unhoused person internalized society’s label as inferior to those who are housed.
While there are likely a host of reasons that homeism occurs, the data showed that homeism is largely related to stereotypes; that is, the negative stereotypes that individuals (and society) have towards those who are experiencing homelessness. Homeism results from negative perceptions and false presumptions that society has assigned to substance use, and to persons who use substances – attributes often associated with homelessness. Homeism results from expectations that to be respected and treated well, one must appear clean and groomed. Minimal exceptions are given, despite significant challenges for persons who are living unsheltered or staying in congregate homeless shelters to regularly shower, clean clothes or maintain personal hygiene.
The data also suggested that homeism can occur because of provider burnout. Compassion fatigue and feelings of burnout can occur when providers have heavy workloads, few opportunities for restorative breaks, and minimal support to carry out the tasks demanded of their position. In healthcare settings that are overburdened – as has become apparent during the pandemic – addressing the multiple (often chronic) health needs of persons experiencing homelessness can feel especially challenging. Stressful, demanding positions can contribute to fatigue and ultimately compromise standards of care.
Data from the study indicated that there were numerous ways in which homeism contributed to worsened health outcomes – from treatment disparities to patient disengagement from the healthcare system. Being treated poorly, being labelled as less worthy of care, not listening as well to patients’ concerns, communicating in ways that are not understandable to certain patients – all contribute to treatment disparities. Given this inadequate care and treatment as less-than other patients, it should come as no surprise that some patients who are experiencing homelessness are hesitant to engage with the healthcare system and often choose to avoid certain healthcare locations. They can become frustrated with how they are treated and leave places that are traumatizing.
Where does this leave us? Now that we have a word, what’s next? First, we need ways to challenge negative perceptions of people who are experiencing homelessness. Interventions that have been used to reduce discrimination include educational efforts to replace myths about a group of people with accurate information, sometimes through discussion or film, or encouraging group contact.
There is also a great deal of work that can be done in specific sectors. For instance, in healthcare settings, there is a significant need to reduce provider burnout, train healthcare providers in trauma-informed care, and offer de-stigmatization training. Supporting providers to build skills around working with patients and people experiencing homelessness “where they’re at” can result in non-judgmental care that promotes self-determination and improve health outcomes.
While the simple adoption of a new word can feel trivial, there has never been a more urgent need to find new ways in which to prevent, reduce and end homelessness. If one path forward is to generate the political will to adjust the levers necessary to increase supportive and affordable housing stock, we need more people to care about homeless persons. We need more people to recognize homeism as a distinct experience from other -isms. We need to address the ongoing discrimination and societal disinterest in finding ways to end homelessness.
In looking back on the early days following the naming of ageism, we can see that the small act of providing a word for something that hadn’t previously been named planted the seed for scholarship, advocacy and action. I hope that introducing the term homeism can spur similar efforts against discrimination of people experiencing homelessness.
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