Rural communities lack resources, plans for dealing with the homeless

They may be harder to spot than their urban counterparts, but thousands of rural folks don't have a place to call home. 

"Rural America has nearly 29 million homes, but experts say that’s not enough to house the roughly 46 million people who live there," reports Kristi Eaton for Barn Raiser. A Housing Assistance Council report that analyzed data from 2010 to 2023 concluded that “rural America is losing affordable housing at an alarming rate, fueling a growing housing crisis." A lack of affordable rural rental property is adding to the problem.

Even when rural residents find a home, high mortgage or monthly rental costs can take up a big percentage of their income. Eaton explains, "The report found that over 5.6 million people, or about a quarter of rural households, pay more than 30% of their monthly income on housing costs, and less than half of rural homeowners own their houses outright."

With rural housing in short supply and home ownership or rental costs beyond the reach of many, rural homelessness has become more prevalent and its solutions harder to come by. Liam Niemeyer of the Kentucky Lantern shares the story of Mallie Luken as an example of what homelessness can look like in rural America. 

Neimeyer begins Luken's story as many homeless stories begin -- with the local police attempting to manage homelessness without needed resources. He writes, "Pastor Jennifer Banks was still a relative newcomer to this Western Kentucky town on the night in September when she watched through a security camera as a police officer brought a woman in a wheelchair to the church and 'dumped her in our parking lot.'"

Pastor Banks recognized the woman. Banks had met Luken the day before at an Arby's parking lot where she'd given Luken a plate of food and they prayed together. Now police were bringing her to her church's parking lot. Banks told Neimeyer, “I had to leave her there [in the Arbys's parking lot] because I didn’t have anywhere for her to go. And then the next day was when they dumped her in our parking lot."

Luken and her faithful dog, Blaze.
(Photo by Austin Anthony, Ky. Lantern)

Luken hadn't planned on being homeless or sleeping in parking lots. Neimeyer explains, "Luken, 70, a widow, was down to her last few dollars. She had asked her former pastor to drive her from the nearby county where she was living to Muhlenberg County because she remembered an old ad for the Central Inn, a motel in Central City, and thought she could afford a night there."

Luken didn't make it to the Central Inn and ended up sleeping in parking lots, despite several people knowing she didn't have a place to stay. Neimeyer reports, "Banks’ community was ill-prepared to respond to that kind of housing emergency. That realization has served as a catalyst for the Bankses and others in Muhlenberg County who want to fill gaps they see in services and housing. They have met resistance and support. . ."

To read more about Luken's story and how Muhlenberg County is grappling with homelessness services, click here.

Could sleeping in a public park be a crime? A decision about the nation's homelessness crisis goes to the Supreme Court

The Grants Pass decision could change how homelessness
is handled by communities. (Adobe Stock photo)

As the number of homeless people in the U.S. continues to climb, many communities face conflicts over homeless campers and encampments. The rural town of Grants Pass, Oregon, "has become the unlikely face of the nation's homelessness crisis," reports Claire Rush of The Associated Press. The fate of the town's anti-camping laws is in the hands of the U.S. Supreme Court, which heard the case on April 22. 

Grants Pass, like many communities, has "struggled for years with a burgeoning homeless population. A decade ago, City Council members discussed how to make it 'uncomfortable enough. . . in our city so they will want to move on down the road,'" Rush explains. "From 2013 to 2018, the city issued 500 citations for camping or sleeping in public, including in vehicles, with fines that could reach hundreds of dollars."

The Supreme Court's decision hinges on their review of a 2018 decision by the 9th U.S. Circuit Court of Appeals, which blocked anti-camping laws for individuals as violations of the Eighth Amendment's ban on "cruel and unusual punishment." Rush reports, "Officials across the political spectrum — from Democratic Gov. Gavin Newsom in California, which has nearly 30% of the nation's homeless population, to a group of 22 conservative-led states — have filed briefs in the case, saying lower court rulings have hamstrung their ability to deal with encampments."

Homeless people and advocates insist that more housing is the answer to homelessness, not citations and punitive actions. "Civil rights groups and attorneys for the homeless residents who challenged the restrictions in 2018 insist people shouldn't be punished for lacking housing," Rush explains. "Grants Pass has just one overnight shelter for adults, the Gospel Rescue Mission. It has 138 beds, but rules including attendance at daily Christian services, no alcohol, drugs or smoking and no pets mean many won't stay there."

At the heart of the problem in Grants Pass is the encampments found along the town's scenic public parks that frame the Rogue River. "They host everything from annual boat-racing festivals to Easter egg hunts and summer concerts," Rush reports. "They're also the sites of encampments blighted by illegal drug use and crime, including a shooting at a park last year that left one person dead."

For details on the case's oral arguments, click here and here. The Supreme Court's decision is expected by the end of June.

Delving into rural homelessness, an anthropologist's new book takes an in-depth look at this often-hidden issue

Families on the Edge was published August 15.
(Photo from MIT Press via The Daily Yonder)

Homelessness looks different depending on where you live. In the case of rural homelessness, it's often hidden, complex and surprisingly prevalent. Author and researcher Elizabeth Carpenter-Song is a medical and psychological anthropologist who has studied homelessness for more than a decade. Her new book Families on the Edge: Experiences of Homelessness and Care in Rural New England is an "ethnographic study of housing insecurity in an under-studied region," reports Olivia Weeks of The Daily Yonder. A condensed version of Weeks' question-and-answer interview with Carpenter-Song is shared below.

What are the most important differences in experiences of rural and urban homelessness?
Homelessness in urban areas of the U.S. is much more visible. In many American cities, it is common to see and interact with people who may be unhoused. . . . In our rural towns and villages in New England, there are encampments of unhoused people, but these tend to be out of sight. People experiencing homelessness in rural areas . . . may camp in the woods, sleep in cars, or double-up with friends or family for periods of time.

In the context of families, which was the focus of my research, parents go to great lengths to avoid literal homelessness with their kids and, as a result, move frequently between different settings to access shelter. In rural areas, challenges related to housing are compounded by transportation challenges when people move to more remote towns to gain access to more affordable housing. But, this places people at risk of being isolated from support networks and creates challenges for finding employment and meeting basic needs within small rural towns.

Are there any commonalities that might seem surprising to an outsider?
The main commonality between experiences of homelessness in rural and urban areas is that homelessness is a housing problem. As a society, we are now experiencing the consequences of decades of underinvestment in affordable housing. Runaway real estate valuations and high costs of living, coupled with a lack of adequate housing stock, have created a common scenario across the U.S. in which safe and affordable housing is out of reach for more and more people.

You outline this problem in the book in which, as housing gets cheaper in your subject area, it inevitably gets further from crucial services and opportunities. Are there any good models for reversing that trend? Do you know of any small towns that have become more walkable or developed more reliable public transportation networks?
This is one of the big challenges we face in rural areas. In the book, I advocate for increasing housing density closer to town centers to mitigate transportation challenges and create more opportunities for accessing services and being integrated in the community. In the region I write about, the towns of Lebanon, New Hampshire and White River Junction, Vermont, are good examples of efforts to have mixed-use residential and commercial space, greater housing density, walkable downtown areas, and access to the local free bus service.

It is important to note that these two towns are relatively larger than many of the small villages in rural New England and are proximate to the major centers of employment in the region. Yet, I think these two settings can still serve as useful examples of how to create vibrant and accessible town centers in a rural region.

Homelessness and housing insecurity rose much more in rural areas than the rest of the nation in the last two years

Rural homelessness looks different depending on where you live. "In Southwest Oregon it looks like a city of under 25,000 residents with nearly 150 people on a waitlist for temporary housing. . . . In Eastern Kentucky, it looks like a severe shortage of affordable housing made immeasurably worse by a natural disaster. . . . For many tens of thousands of individuals and families in rural America, it looks like another anxiety-ridden night," reports by Taylor Sisk and Jan Pytalski of The Daily Yonder. "Nationwide, homelessness rose less than a half percent from 2020 to 2022 but almost 6% in rural communities. The reasons are many and varied."

One problem is the lack of "large-scale development in rural communities; construction costs are often higher and there’s therefore less incentive for private investment," Sisk and Pytalski write. "But some rural communities are rising to the challenge, recognizing that getting people into at least temporary housing is critical to the health and well-being of the entire community." Lance George, director of research and information at the Housing Assistance Council in Washington, D.C., told the Yonder, "They’re incredibly resourceful and ingenious [community organizations] and work on shoestring budgets and get amazing amounts of work done."

Roseburg, Oregon, pop. 23,700, shows community resources in action. "Located on the southern edge of Roseburg’s downtown is the Gary Leif Navigation Center, a shelter that provides a place to sleep and a variety of wraparound services for the unhoused," the Yonder reports. "During the 2023 Point-in-Time Count, 150 people showed up to be counted and another 200 were counted across homeless encampments in the county. . . .The center provides 10 pods that offer an air-conditioned and heated safe environment for individuals to sleep and store their belongings . . . .The shelter’s guests can also cook and store their own food in a communal kitchen in a separate building. . . . An extreme shortage of affordable housing is a primary source of homelessness in Roseburg."

Eastern Kentucky offers another example. "Angela Crase is the director of residential property management for Kentucky River Community Care. She said that in the most recent Point-in-Time Count, they were surprised to document more than 40 unhoused people in Perry County," where Hazard is the seat. "KRCC is a nonprofit community mental health center, part of a network of such facilities the state established in the 1960s after John Kennedy signed the Community Mental Health Act of 1963. Today, KRCC provides housing opportunities not only for those with behavioral health issues but anyone in need. . . . KRCC oversees 114 apartments throughout its region."

Phillip Hardin, KRCC’s facilities director, told the Yonder, “The basic premise was that in order to have healthy clients, they had to have a clean, decent, affordable place to live." Crase told the Yonder, “We follow a housing first model. This approach recognizes the need for the most fundamental necessities to be met before addressing substance use, mental health concerns or employment."

Rural homelessness increased over the past two years; addressing the causes takes regional understanding

An emergency tent shelter in Arcata, a town in Northern California, helped unsheltered people get medical and other services early in the pandemic. (Photo from Arcata House Partnership via The Daily Yonder)

Inflation, transportation and affordable housing are troublesome for many Americans right now, and these stresses have a deeper impact on rural residents. "The number of people overall experiencing homelessness in the U.S. rose by less than 1% from 2020 to 2022," reports Kristi Eaton of The Daily Yonder. "But those in rural continuums of care, local planning bodies responsible for coordinating the full range of homelessness services in a geographic area, which may cover a city, county, metropolitan area, or an entire state, saw an increase of nearly 6%, according to the U.S. Department of Housing and Urban Development. . . . Causes of the increase include housing stock shortage, lower wages, and lack of public transit."

Reasons for rural homelessness are regional. “Every community is different. The housing markets are different, the access to health care and behavioral-health services are different. Wages as compared to housing are different," Jeff Olivet, executive director of the U.S. Interagency Council on Homelessness, told Eaton. "So it’s likely that if you go to one rural part of the country, there might be one story to tell about the loss of economic opportunity and jobs to pay a livable wage. In another area, maybe there’s a dramatic increase in the cost of housing."

Because rural homelessness is multifaceted, it requires different safety nets. Eaton writes, "Steve Berg, chief policy officer at the National Alliance to End Homelessness, said rural homelessness is distinct from homelessness in other regions, and it’s imperative to have systems in place to respond to those unique needs." Berg told Eaton, "For example, outreach providers often have to canvas much larger geographic territories, and people will sometimes live in more remote areas where it is more difficult to identify and serve them . . . . It’s also important to know that wages tend to be lower in rural areas and the total inventory of housing also tends to be limited. Even in a region with lower rental prices, this creates enormous strain on people’s abilities to stay in their homes.”

Eaton reports, "Olivet also said transportation barriers can also be a factor in rural areas. He said he’s worked in areas like western Massachusetts or rural Pennsylvania, places that people don’t always think of when they think of vast rural areas like Appalachia or in the West." Olivet told Eaton, "But even in those kind of smaller geographies in the northeast, a transportation barrier of 10 miles, 20 miles to get from a place that’s affordable to live to a job that pays a living wage, if you don’t have a vehicle, there’s just not the public transportation infrastructure, or any way to get there. And so even a 10 or 20 mile distance can be a huge barrier. That could mean the difference between a job and no job for somebody.”

U.S. count of rural homeless is 'a seemingly simple task that isn't that simple,' but it determines local aid allotments

The rural homeless live in autos, abandoned buildings and friends'
couches. (Photo by Michael S. Williamson, The Washington Post)

Rural America has homelss people, but they are further apart and harder to find, reports Justin Wm. Moyer of The Washinton Post. Moyer points to Beth Kempf, executive director of the homeless services nonprofit Community Cares, in Cumberland County, Pennsylvania: "Kemp was among about two dozen advocates and volunteers seeking out the unhoused in a recent 'point-in-time' count — a nationwide census of homeless people conducted each January that helps advocates track demographic data, which the federal government can use to decide where funds meant to combat homelessness should be spent."

The sheer area that rural advocates had to cover compared to urban counters made the task daunting. "In Washington, D.C., for example, advocates must search a jurisdiction of about 68 square miles to find thousands of homeless people. Homelessness is visible," Moyer writes. "Cumberland County is a 555-square-mile region about 120 miles west of Philadelphia. Here, a much smaller number of homeless people — fewer than 100 in 2022 — are dotted across a great swath of land in locations unlike urban underpasses and encampments. Small towns. Woodlands. State parks. Farms. Truck stops. Abandoned motels. . . . If unhoused people aren’t counted, they won’t count."

The rural homeless have often been ignored. "Biden’s December plan said homeless people living outside cities are 'historically undercounted," Moyer reports. "On Thursday, the Department of Housing and Urban Development announced $315 million in grants to address homelessness among people in unsheltered and rural settings in 46 communities." HUD Secretary Marcia L. Fudge said in a statement, "For the first time the federal government is deploying targeted resources to meet the needs of people experiencing homelessness in unsheltered settings or in rural areas."

For advocates like Kempf that meant "Counting people — a seemingly simple task that wasn’t that simple," Moyer reports. Regional homeless-systems manager Chris Kapp explained that the point-in-time count was not just a census, but also a search: “You’re not going to see people with a neon light that says, ‘I’m homeless.’”

Point-in-time counters had to identify possible homeless individuals and approach them. "Some people didn’t want to be found. Those who refused to talk or wouldn’t acknowledge that they were homeless became 'observational' counts — counters would record why they suspected a person was unhoused along with the person’s location and estimated age, then move on," Moyer reports. "Those who did consent to an interview would be peppered with, depending on their patience, dozens of questions," and and the counters faced risks: "They were reaching out to those who had been exiled or exiled themselves to society’s fringes. The vast majority were harmless. Some weren’t."

Moyer writes, "Advocates counted about 80 homeless people, including about 10 children, in Cumberland County that night — about 10 percent higher than the number last year — and everyone in the tally had the same problem:" poverty. Kempf said, “Poverty is poverty.”

Rural students are about as likely to be homeless as urban students, but have fewer resources to keep them in school

A school bus in southern Ohio (Photo by Danna Slinger, NYT)

Limited resources and research have made student homelessness a hard-to-tackle issue in rural areas, writes Samantha M. Shapiro for The New York Times Magazine, with several examples of children uprooted and rootless in southern Ohio.

The funding, rules and priorities of America's "homeless industrial complex" does not generally focus on rural areas, often leaving public school districts as the only local resource for students and families in need, Shapiro writes: "The limited data that exists suggests that rural students face homelessness in roughly the same proportion as their urban counterparts — and with far less in the way of a support system."

The 1987 McKinney-Vento Act requires public schools to have a homeless liaison. Shapiro reports that iImperfect reporting from these liaisons often represents the only count of homeless students in rural counties. That data is aggregated by the Department of Education, which has a wider definition of homelessness than the Department of Housing and Urban Development. In 2019, HUD counted 53,692 parents and children experiencing homelessness on a single night whereas the DOE counted 1.4 million children as homeless over the course of the school year. 

A national survey of McKinney-Vento liaisons conducted by School House Connection and the University of Michigan found that roughly 420,000 homeless students did not enroll in school during the first year of the pandemic. In response, the American Recovery Plan Act allocated $800 million to public school districts to help fund projects countering student homelessness.

HUD opens up funding to fight rising rural homelessness

"The Department of Housing and Urban Development has opened up millions of dollars in funding for groups serving unhoused people in rural areas — an unprecedented move by the agency, say housing advocates," Casey Quinlan reports for the Iowa Capital Dispatch. "Continuums of Care, the planning bodies that address homelessness within specific regions, have until Oct. 20 to apply for a portion of $54.5 million targeted at rural homelessness. HUD could not provide an estimate for how many organizations would benefit from this funding but said 127 of them are eligible to apply." HUD has $267.5 million targeted to unsheltered homeless in "non-rural areas."

The funding is targeted at people who are unsheltered, meaning those who sleep outdoors or in their cars, as opposed to those who couch-surf or stay at shelters, for example. According to a HUD spokesperson, unsheltered homelessnesses has increased nationwide, including in rural areas, Quinlan reports.

"According to the department’s January 2021 report to Congress, 2020 was the first year since it began collecting this data in 2005 that there were more unsheltered, unhoused people than people living in shelters," Quinlan reports. "The report also noted that 'largely rural [Continuums of Care] had the largest percentage of people experiencing homelessness in unsheltered locations' at 44%, compared to 39% in Continuums of Care that include major cities. From 2019 to 2020, there was an 8.3% increase in unsheltered homelessness in largely rural Continuums of Care."

Thursday webinar will review new federal resource package that is meant to address rural homelessness

The Rural Health Information Hub will host a free webinar at 2 p.m. ET Thursday, June 30, to discuss a new federal resource package meant to help rural communities address unsheltered homelessness. The webinar is free and is expected to last about an hour. Click here for more information or to register.

From the website: "The U.S. Department of Housing and Urban Development (HUD) recently released a first-of-its-kind package of resources to address unsheltered homelessness, with a unique opportunity for rural communities. This Initiative for Unsheltered and Rural Homelessness being made available by HUD strongly promotes partnerships with health care organizations, public housing authorities and mainstream housing providers, and people with lived experience and expertise of homelessness.

"This $365 million package will help communities pursue a public health approach and they can use this opportunity to coordinate and scale up efforts to sustainably solve unsheltered homelessness, create a unified approach with shared responsibility among local governments, homeless services organizations, health care providers and housing agencies.

"Existing Continuum of Care programs can apply, and see Appendix B of the Notice of Funding Opportunity for the rural areas that are eligible for the $54.5 million rural set aside. We encourage health partners to check to see if their area qualifies and connect with the CoC partners. These grants will fund projects for three-years, after which they will be eligible for renewal through the annual Continuum of Care (CoC) program competition."

Pandemic roundup: Long Covid explained; some Christians with weak immune systems worry about attending church

Here's a roundup of recent news stories about the pandemic and vaccination efforts:

Federal pandemic assistance will soon end, and some experts worry rural health care could suffer as a result. White House policymakers say they're taking that into account. Read more here.

As states, counties and municipalities increasingly lift pandemic restrictions, Americans with weakened immune systems say they feel left behind. Attending church during the pandemic has been a source of anxiety for many immuno-suppressed Christians, The Washington Post reports.

Millions of Americans have developed long Covid, which is an umbrella term for various long-term complications from the coronavirus infection. That's caused many to become homeless. The Post has a great explainer on long Covid, including current understanding of its risks, symptoms, and recovery.

Social workers are the unsung heroes of the pandemic, but many are feeling burned out and leaving their positions. Read more here.

In Nomadland, about a homeless rural migrant worker, 'a ghost of a Western' and maybe 'The Grapes of Wrath'

Frances McDormand in Nomadland

Nomadland, which won big at the Academy Awards last night—Best Picture, Best Lead Actress (Frances McDormand), and Best Director (Chloé Zhao) — presents a complicated portrait of the rural West and the gig economy.

The film follows Fern, a widowed former teacher in her 60s, who becomes a van-dwelling migrant gig worker after the factory shutters in her rural Nevada town. It's based on the 2018 nonfiction book of the same name by journalist Jessica Bruder, who lived in a van for three years and followed itinerant gig workers to research it.

Critics and Nevadans have praised the film for its authenticity, saying it faithfully depicts rural Nevada. And if the characters are realistic, it's because many are actual migrant gig-workers, not actors. Nomadland also manages to avoid common Hollywood tropes that show rural areas as full of simple bigots, dangerous freaks, or salt-of-the-earth down-home folks; a feat Oscar contender Hillbilly Elegy could not duplicate, Stephen Humphries writes for The Christian Science Monitor.

But the film pulls its punches in showing how dangerous menial gigs can be, especially for seniors, and ignores Bruder's pointed economic critiques. In the book, she describes the nomads as "plug-and-play labor, the epitome of convenience for employers in search of seasonal staffing. They appear where and when they are needed. They bring their own homes … They aren’t around long enough to unionize. On jobs that are physically difficult, many are too tired even to socialize after their shifts." One 77-year-old worker told Bruder that "They love retirees because we’re dependable. We’ll show up, work hard, and are basically slave labor."

"Because the film is primarily a character study of [Fern], it exchanges Bruder’s sharp indignation over capitalist exploitation for a muddled message about individual freedom that downplays the real stakes of gig labor," Wilfred Chan writes for Vulture.

Anthony Lane wrote in The New Yorker in November, "Somewhere, inside this lovely and desperate movie, there’s the ghost of a Western. Though people still gather around a campfire, their talk is of cancer and P.T.S.D.  Instead of cowboys driving cattle to high pastures, Fern and her kindred spirits converge, in certain months, on an Amazon warehouse—still obeying the rhythm of the seasons, I guess, as they bubble-wrap junk and box it in time for Christmas. . . . It maintains a fierce sadness, like the look in its heroine’s eyes, alive to all that’s dying in the West. That is why Zhao so often films at daylight’s decease, catching enormous skies of violet and rose, and why her fable speaks to us, in 2020, as John Ford’s “The Grapes of Wrath” did to audiences eighty years ago. Fern’s needs and rights are as basic as those of the Joad family, yet there was a breadth and an uplift to their yearning that has since dwindled to a speck. “Fellow ain’t got a soul of his own, just a little piece of a big soul,” Tom Joad said. “The one big soul that belongs to everybody.” Some hope. Fern has her own soul, and it’s hers alone, packed away tight in the van, together with her toothbrush and her chicken-noodle soup. On she goes."

15% SNAP boost extended; states to get more than $1 billion over 3 years in other hunger aid; state data available

The Agriculture Department confirmed Monday that it will extend the 15 percent increase in benefits for the Supplemental Nutrition Assistance Program, once known as food stamps, through September with funds from the $1.9 trillion pandemic relief-and-stimulus bill. Without the funds, the extension would have ended in June. The bump will add up to about $3.5 billion of assistance to an estimated 41 million food-insecure Americans. That means $28 more per person, per month, or more than $100 more per month for a household of four, Shawna Chen reports for Axios. Rural households are more likely to use SNAP benefits than their suburban and urban peers.

"An additional $1.135 billion will be provided to U.S. states over three years, which they will not be required to match," Joseph Choi reports for The Hill. Of that, USDA will get $25 million to expand online SNAP purchasing, develop mobile-payment technologies, and provide technical assistance to retailers and farmers' markets in adopting the new platforms. "With these investments, we hope to make it easier for participants, especially individuals in rural areas, as well as those with physical limitations, to order and pay for their groceries online," according to USDA's fact sheet, which provides a state-level breakdown of the estimated increase in SNAP benefits.

The fact sheet details how the rest of that $1.135 billion will be divided: nearly $900 million will go to the Women, Infants and Children program; $37 million to the Commodity Supplemental Food Program, which feeds low-income seniors, and an unspecified amount will fund meals for young adults in emergency shelters participating in the Child and Adult Care Food Program.

"We cannot sit by and watch food insecurity grow in the United States," Agriculture Secretary Tom Vilsack said. "The American Rescue Plan brings help to those hurting the most due to the pandemic. It increases SNAP benefits so households can afford to put food on the table. It invests in working people and small towns and small businesses to get the economy back on track. And it makes the most meaningful investments in generations to reduce poverty."

The SNAP boost is "a sharp contrast to the Trump administration's attempt to block states from giving emergency food stamps to low-income Americans during the pandemic last year," Chen writes.

White House hikes states' coronavirus vaccine shipments, ensures some go to rural community health centers

In an effort to make sure under-served and rural areas get their fair share, "The Biden administration will boost the number of Covid-19 vaccines distributed to states next week to 11 million doses and begin allocating a portion of the weekly shipments directly to community health centers," Andrea Noble reports for Route Fifty. "At least one federally qualified community health center in each state will begin receiving allocations of the vaccine next week, and the goal for the initial phase of the project is to distribute 1 million vaccines to 250 centers, said Marcella Nunez-Smith, the head of the administration’s Health Equity Task Force."

The health centers serve about 30 people nationwide, two-thirds of whom live at or below the federal poverty line. Patients include homeless people, people who live in public housing, and migrant farm workers, Noble reports.

"The White House has sought to increase the number of vaccines shipped to states each week, from 8.6 million doses during President Biden’s first week in office to 11 million doses next week," Noble reports. "In addition to setting aside allotments of vaccine for community health centers, the federal government will also set aside 1 million doses of vaccine for pharmacies participating in the Federal Retail Pharmacy Program—a previously announced public-private partnership with 21 national pharmacy chains."

Pandemic slows or cancels counts of homeless population

Thousands of volunteers and outreach workers count the nation's homeless population each year. But "communities are worried this year that such interactions could exacerbate the spread of the coronavirus, putting both volunteers and homeless individuals at risk," Pam Fessler reports for NPR. "So with the permission of the Department of Housing and Urban Development — which requires the survey for federal grants — many places are scaling back."

That could leave a big gap in nationwide data about the homeless, a population that has been growing steadily in rural and urban areas since 2015, Fessler reports. The delayed or canceled count could also make it harder to get congressional funding for homeless assistance programs.

Eviction wave looms without another virus relief package

Nearly 16 percent of the nation's 43 million renters were behind on their rent in October, and about half of  renters surveyed say they're not confident or only moderately confident about paying on time next month. 

"Recent estimates found that between 6.7 million and 13.9 million households could be at risk of eviction," Emma Coleman reports for Route Fifty. "If 25% of newly evicted people become homeless, the costs to public health and social safety net programs would be astronomical—between $62 billion and $129 billion, according to a new report from the National Low Income Housing Coalition and the Innovation for Justice program at the University of Arizona."

"Without another stimulus package providing renters with a direct infusion of cash or allocating money to local rent relief programs, housing advocates say they are worried that renters’ situations could grow more dire in winter months and lead to a wave of evictions," Coleman reports. "This is especially true if local or federal eviction moratoriums expire."

Princeton University's Eviction Lab has an interactive map and raw data files showing state- and county-level eviction data; click here to see how your county ranks.

Opioid overdoses rising during pandemic despite expanded telehealth

Opioid overdoses and related deaths are on the rise in most states, despite hopes that expanded telehealth implemented during the pandemic would make obtaining addiction treatment easier, Heather Kagan reports for ABC News. Kagan is an internal medicine resident physician at The Johns Hopkins Hospital and a contributor to the ABC News Medical Unit.

The problem is widespread. On Aug. 14, the American Medical Association reported that more than 40 states had reported an increase in opioid-related mortalities. There are several likely reasons expanded telehealth hasn't spurred a decline in such deaths, according to Caleb Banta-Green, a principal research scientist at the University of Washington's Alcohol and Drug Abuse Institute.

Telehealth isn't "the magic solution," Banta-Green told Kagan. It's "great" for people who already receive addiction treatment, he said, but most people with opioid addictions aren't receiving treatment. 

Also, Kagan notes, many people struggling with opioid use are homeless or have other mental-health disorders. Many people with mental-health disorders don't seek help, and many don't have access to a phone, wi-fi, or other devices that could help facilitate telehealth addiction treatment, according to Farzan Sasangohar, director of the Applied Cognitive Ergonomics Lab at Texas A&M University. The pandemic has exacerbated that lack of access, he told Kagan.

Pandemic shutdowns at universities leave some rural students homeless

For many college students, a dormitory room is the only place they can reliably sleep. But many universities have gone to online-only instruction during the pandemic, leaving such students with nowhere to go. For rural students, the lack of broadband access can make it even harder to complete online coursework, Jamie Fields and Katie Surma report for Arizona State University's Cronkite News. The U.S. Department of Education classifies an estimated 1.5 million American students as homeless due to unstable living situations.

"Rural homeless people, especially students, are largely invisible, and estimates of their numbers vary," Fields and Surma report. "For example, [the Department of Housing and Urban Development] estimated in 2019 there were about 100,000 homeless people living in rural America. But that same year, the nonprofit Institute for Children, Poverty and Homelessness reported the number of homeless students alone was more than 162,000." The rural homeless are less visible (and less countable) because they often couch-surf and are less likely to stay at shelters. 

Since universities can't keep an eye on homeless students as easily, such students may not receive meals, basic health care or other critical services, Fields and Surma report.

Human trafficking is on the rise, and rural health-care providers are uniquely positioned to identify victims

Human trafficking may sound like a faraway problem to many, but it happens in rural areas, and rural health-care providers must be alert to it. That's because up to 88 percent of trafficking survivors said they interacted with health-care providers while they were trafficked, Jenn Lukens reports for the Rural Health Information Hub's Rural Monitor.

Human trafficking involves force, fraud or coercion to obtain labor or commercial sex acts, and it's on the rise. According to the federally funded nonprofit Polaris, which maintains a hotline and one of the largest data sets on human trafficking in the U.S., "Human trafficking has continued to rise, from 7,748 confirmed cases reported to the hotline in 2016 to 10,949 in 2018. Polaris’s demographic breakdown shows that nearly half of survivors are minors, there are five times more females trafficked than males, and minorities are more likely to be trafficked," Lukens reports. "It has been identified as a public-health concern by researchers, federal agents, and healthcare professionals alike."

Both sex trafficking and labor trafficking have been identified as problems in rural America, though sex trafficking is nearly eight times more common. There are no definitive statistics on the incidence of human trafficking in rural areas, but the secluded nature of many rural areas makes them attractive to traffickers, Lukens reports.

"While cinematic portrayals of human trafficking may resemble reality in some parts of the world, research has found that what is true in rural America can look much different," Lukens reports. "Those trafficked commonly have vulnerabilities, such as recent migration or relocation, single motherhood, recent contact with the child-welfare system, a substance dependency, homelessness, or mental-health conditions. Often, the victim already has a relationship with the perpetrator who has taken advantage of their trust and targeted their vulnerabilities to create dependency."

Rural health-care providers are uniquely positioned to identify human trafficking victims since health-care facilities are one of the few places trafficked people may be allowed to visit. Some states, hospital systems, and federal agencies have released guides or begun programs meant to help providers identify victims, like this one from the Nebraska Hospital Association. Lukens' article has a list of resources.

Rural homelessness could go up once federal pandemic measures expire; study ranks states by risk

"With federal unemployment benefits ending soon and moratoriums on evictions soon to follow, social services organizations are bracing for a homelessness crisis to hit rural Americans," Liz Carey reports for The Daily Yonder. "The agencies and churches that would normally help are already stretched thin by the pandemic, says one nonprofit administrator."

Nationwide, around 20 million renters are at risk of eviction once the expanded unemployment insurance expires, according to a study from the Covid-19 Eviction Defense Project, an organization founded in March to study the looming problem and suggest solutions. According to their research, "mass evictions would be a disaster," The Aspen Institute reports. "For both individuals and families, evictions result in severe harm; when they become widespread, there are also significant consequences for entire communities and even the speed of economic recovery."

In more than a dozen states, governors halted evictions, but federal guidelines in the CARES Act lift some eviction moratoria on Aug. 24, and that could increase pressure on renters. In Kentucky, which has a moratorium, landlords are still trying to evict tenants who can't pay rent, sending them threatening texts, letters, or even disconnecting utilities, according to Adrienne Bush, executive director for the Homeless and Housing Coalition of Kentucky. Landlords have filed suit against the moratorium and Gov. Andy Beshear's administration is in mediation with them on the issue.

Quick hits: Appalachian New Deal offered; rural homelessness could rise after federal pandemic aid runs out

Here's a roundup of stories with rural resonance; if you do or see similar work that should be shared on The Rural Blog, email us at heather.chapman@uky.edu.

A coalition of left-leaning environmental and economic policy groups have published an "Appalachian New Deal" meant to give federal lawmakers ideas on how to bring more jobs and clean energy to the region as they consider the next stimulus bill. Read more here.

Drillers are increasingly declaring bankruptcy and sticking taxpayers with the cleanup costs, while executives pocket millions and workers lose jobs. Read more here.

Will rural homelessness hit after benefits and eviction moratoriums end? Read more here.

Because rural physicians are older on average, they could be at an increased risk of severe outcomes if they catch covid-19. Read more here.