Article
Change
Community
Development
6 min read

Tackling homelessness needs much more than promises and policies

While homelessness generates statistics and strategies around the world, Jane Cacouris asks what really is home.

Jane Cacouris is a writer and consultant working in international development on environment, poverty and livelihood issues.

A mother sits with a toddler standing in front of her. The father appears from the side lying on his back reaching an arm out.
A family play in a Rio favela.

“Mummy, are we homeless?” asked our six-year-old as we pulled away in the taxi. We had just eaten a final meal - a KFC family bucket of fried chicken - sitting on a sarong on the floor of our empty apartment in Rio de Janeiro, our home for almost four years.  

The question left me momentarily winded. Homeless. A word that instantly conjured up feelings of anxiety and uncertainty, of sands shifting under our feet. Technically, yes, we were. My husband had just left his job in Brazil, and we had two months with nowhere to live before we relocated back to the UK. With no permanent base anywhere in the world, we were about to use the time to travel in South America as a family. Whilst I did feel somewhat insecure, my husband in contrast found it freeing; the first time in his life that he didn’t carry a set of house keys in his pocket. We had nowhere to live, but we were free to go wherever we wanted. And this is where the analogy of us actually being homeless broke down. We had a freedom of choice in a way that the vast majority of people who experience homelessness do not.   

World Homeless Day on the 10th October was marked with the recent release of a landmark UN report on global homelessness. The UN define homelessness as:  

“where a person or household lacks habitable space with security of tenure, rights, and ability to enjoy social relations, including safety. [It] is a manifestation of extreme poverty and a failure of multiple systems and human rights.”  

According to UN-Habitat, a staggering 1.6 billion people in the world are estimated to be in inadequate housing and over 150 million have no housing at all.  

Global homelessness has been rising for the past decade, with temporary homelessness being increasingly caused by conflict and climate-induced displacement. However, according to the UN report, Covid-19 exacerbated the issue, deepening existing inequalities and causing already marginalised people to be even more vulnerable.  

In developing countries, the informal economy – self-made microentrepreneurs who sell everything from popcorn to shoe polishing - usually sustains the poor urban majority. But with many informal jobs vanishing during lockdowns, and with few assets and limited social safety nets, many urban dwellers were rapidly plunged further into poverty. Women and children suffering from domestic and gender-based violence had to remain in unsafe environments, with abuse escalating during lockdowns and curfews. Issues that encouraged migration and homelessness. 

There are approximately 150 million children living and working on the streets worldwide. Almost impossible to imagine, and so the number sometimes doesn’t compute with our hearts.

The extent of homelessness worldwide is notoriously difficult to quantify accurately, partly due to what is known as hidden homelessness. The hidden and isolated nature of children and adolescents living on the street, for example, makes statistics difficult to gather. A 2023 UNICEF report of street children in Dhaka estimated that the number of children living on the street just in Bangladesh could be in the millions. And according to UN sources there are approximately 150 million children living and working on the streets worldwide. Almost impossible to imagine, and so the number sometimes doesn’t compute with our hearts. The true horror of the isolation of child homelessness only truly hit me a few years ago… 

The residents in our block had finally had enough of the noise and called the police. They arrived in the middle of the night with their guns and shot at the children who dispersed.

Living at the top of a high-rise block in the middle of an urban neighbourhood in Rio, we were kept awake for a number of nights in a row. It started as a disturbance – children yelling in the street outside that would continue from the early hours until dawn. But as the days went on, the disturbance at night became more acute. One morning as I stepped out of our apartment in the morning, bleary-eyed and irritated, I was confronted by a small group of sleeping children lying huddled together in a row on the pavement next to a tree. Several pairs of bare filthy feet were sticking out of a blanket they were sharing. I looked down at them as I passed – they varied in age from about eight to twelve years old. The youngest was probably younger than my son at the time. He had knotted black curly hair and a streaked face. The next night we heard gun shots and then an eery silence. Another sleepless night, this time from worrying about the children, and then we discovered that the residents in our block had finally had enough of the noise and called the police. They arrived in the middle of the night with their guns and shot at the children who dispersed. The children never came back. 

The government pledge to end rough sleeping in England by the end of 2024 is woefully off track. 

Although homelessness is an overwhelmingly larger problem in poor countries, it also affects affluent nations, including the United Kingdom. This year the Kerslake Commission, an expert panel set up to scrutinise how rough sleeping is being addressed across England, pointed out that data on rough sleeping in London last year showed a 16 per cent increase in numbers of people sleeping rough. And that almost half (48 per cent) were sleeping rough for the first time. It concluded that the government pledge to end rough sleeping in England by the end of 2024 is woefully off track. According to Crisis, the homelessness system in England is at breaking point and the Homelessness Monitor 2023 reported that the cost-of-living crisis, rising rents and a lack of affordable housing are making it harder for councils to provide homeless people with effective support.  

It is about where you feel valued and understood… where you feel loved… and where you want to come back to. 

So, the problem of homelessness really is global. And what is the answer? Yes, governments must act; social safety nets and public policies to help alleviate poverty are critical. But even the richest countries with the most advanced governments have never been able to fully tackle this issue. Homelessness and poverty were rife in Biblical times. As Jesus said in the Gospel of John, “‘You will always have the poor with you”. And Jesus himself understands homelessness in a way many of us don’t; he started life in a stable, born to parents who were sleeping rough. He became a baby on the run to flee King Herod, homeless and seeking asylum in Egypt. When Jesus was older, after he was baptised by John the Baptist, he became homeless again, living life on the the road and in the open. In Luke, he says: “Foxes have dens and birds have nests, but the Son of Man has no place to lay his head.”  

He emphasised that his followers leave the trappings of “home” to follow him.  

I used to volunteer at a Christian charity, Casa de Maria e Marta, in a favela (slum) community in Rio, known for gang violence and drug trafficking. A larger-than-life Brazilian lady, Edimea, has run the charity for over twenty years. Almost a hundred children come to the charity each day, which provides three meals as well as extra tuition and care for the children. All of those who attend are either living in inadequate housing or are homeless. One day I asked Edimea whether she still sees the children after they leave her charity at age twelve. She laughed and said yes of course, they still come back to eat! And then she said, 

“I do an assessment before I take a new child in, to understand what they know, and work out how we can best help them. And I always say to them – we take beautiful children, and so we are taking you, because you are beautiful inside and out. They come back because they don’t forget those words.” 

Like Jesus, Edimea shows endless concern and love for those on the margins. She can’t solve all the practical problems she comes across or offer a permanent roof over a head, but she does provide a place where everyone feels a sense of safety and belonging. Perhaps home means more than the UN’s definition. It is about where you feel valued and understood… where you feel loved… and where you want to come back to.  

Article
Ageing
Care
Change
Death & life
6 min read

A Tolkien poem helps a nurse understand the ravages of dementia

'Not all who wander are lost.'

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

An elderly woman wearing headphone looks up and to the side with a big smile.
Playlist for Life

Not all who wander are lost.

Often written on a care home wall, on an inspirational poster, these words are usually set against a forest background, or compass, for added effect. They have also been used as the title of a conference paper discussing so-called smart trackers for people with dementia, whilst, Not all who wander need be lost is the title of a concise guide to navigating the heartbreaking challenges when a loved one is diagnosed with Alzheimer’s disease or other dementia.

As a care home nurse for more than ten years, I have seen residents wander - not lost but “walking with purpose”, as it is sometimes known in the caring community. “Nobody gets up and walks without a reason,” says Suzanne Mumford, Care UK's Head of Nursing, Care and Dementia; perhaps they are easing pain, or boredom, or looking for something that they can’t describe. I remember residents exploring, enquiring into self-made mysteries solvable only by themselves, examining everything from door handles to another resident’s buttons, even escaping with surprising speed. Walking with them, often in silence, can bring a sense of relief, comfort and companionship.  

What I didn’t know was that this is a quotation from a poem by JRR Tolkien, published in The Fellowship of the Ring seventy years ago. The actual line is - “Not all those who wander are lost”. 

All that is gold does not glitter, 
Not all those who wander are lost; 
The old that is strong does not wither, 
Deep roots are not reached by the frost. 
 
From the ashes a fire shall be woken, 
A light from the shadows shall spring; 
Renewed shall be blade that was broken, 
The crownless again shall be king.” 

We first hear this poem in Chapter Ten of Book One, as Frodo reads it in the postscript of a letter from Gandalf. As I read it, the imagery of being lost, withered, frost-bitten, in darkness, burned and broken, speaks something, in poetic picture language, of the ravages of dementia, the harrowing losses, the valley of tears. It brings to mind residents unaware of familiar objects or surroundings, looking straight through loved ones without a flicker of recognition, losing also language, continence, mobility and the ability to swallow. 

The TV presenter Fiona Philips recalled an agonising decline in her mother as she succumbed to Alzheimer’s, describing how, in the final stages, her mother “spent whole chunks of time just sitting and staring ahead, only able to give out a series of sounds”. Fiona herself now lives with dementia. “'It’s devastated my family and it’s the biggest health and social care challenge we face as a country,” she says. 

I once interviewed retired doctor Jennifer Bute, who lives with dementia. She talked of time travel (perceiving herself as living in a time from her past); disorientation to place and person; frightening hallucinations when old memories are seemingly ‘unlocked’; and ‘emotional unzipping’ when agitation and anxiety increase, often in the late afternoon or evening in something poorly understood as a symptom, known as ‘sundowning’. 

Yet there is something more to this poem – each of the pains has a promise – not all who wander are lost; the old that is strong does not wither; and, most poignantly, deep roots are not touched by the frost. In dementia, it is true that deep roots are untouched, that an enduring aspect of a person’s identity never truly withers, though it may be mostly unseen. Something remains. Oliver Sacks the famous neurologist emphasised that, even in the late stages of Alzheimer’s, the person is still ‘alive inside’ (the inspiring documentary with this title is recommended). In stunning real-life stories, he has shown how music appears to ‘call back the self’, awakening moods, memories and thoughts that had seemingly been lost. He refers to music’s extraordinary ‘neural robustness’ and describes one man, unable to tie his tie or find his way to the stage, yet able to perform a perfect piano solo. In one life-affirming, must-watch, tear-jerking video, gospel music was shown to enliven, calm, focus and engage a man simply known as Henry.    

Watch Henry

Singing can “provide islands of arousal and awareness like nothing else can”, according to Alicia Clair, Professor of Music Therapy. I’ve seen singing bring the person into the present for a passing moment, illuminating a face that seemed far away. One otherwise-silent lady completed the chorus of ‘Daisy, Daisy’ before descending into dementia again. Others have laughed, clapped, danced, embraced and even shed a silent tear during music therapy sessions, when music elicits memory. Doll therapy meanwhile has sometimes restored and revealed a sense of nurture, purpose, care and pride, with residents feeding their new friend before accepting their own food, folding its clothes and taking care of it cradled in their arms. Though it divides opinion, a doll can preserve dignity if it de-escalates agitation or engagement in physical or verbal abuse; a sense of dignity also comes from the person being able momentarily to give care rather than receive it. 

“From the ashes a fire shall be woken, A light from the shadows shall spring; Renewed shall be blade that was broken,” continues Tolkien's poem, and, though not the original intention, these powerful images of renewal and restoration paint a picture of something known as “paradoxical lucidity”, or unexpected cognitive lucidity and communication in some patients with severe dementia, especially around the time of death (though sometimes long before).  

Anecdotes are recorded of “unexpected, spontaneous, meaningful, and relevant communication or connectedness in a patient who is assumed to have permanently lost the capacity for coherent verbal or behavioral interaction due to a progressive and pathophysiologic dementing process”.  Some scientists are seeing them as a paradigm shift in the understanding and perhaps even treatment of dementia. I will never forget when a woman in the late stages of dementia, with little spoken language, was brought back to the nursing home weeks after hospital admission; she had been perilously ill. With bright eyes, she took my arm and, as if the mist had cleared for a moment, spoke warmest words of thanks to me for helping her on the day she collapsed. In another fleeting and irreproducible moment, a lady wished me happy birthday, before continuing her silent walk around the home. Witnessing such an event is ethically and emotionally transformative. 

The concept of remaining ‘alive inside’ even when abilities, language and memory are eroded by dementia is taken to the next level in Christianity, which teaches that life continues even after death itself. The Bible speaks of new life beyond the grave; the fire shall be woken, a light shall spring. And there will be a crown (and the gold will glitter). The Crown of Life is referred to, being bestowed upon "those who persevere under trials." Dementia is one of life’s severest trials; a cross to bear. In the 1912 hymn “The Old Rugged Cross”, another cross is spoken of, being the cross of Christ at his crucifixion. Clinging to that cross, living out a Christian life, the hymnwriter wrote of “exchanging the cross for a crown” at life’s end. After ashes, hope awaits the Christian. 

 

Playlist for Life is a charity encouraging people to create playlists for people living with dementia.