Hidden Homelessness Is on the Rise in Rural Eastern Kentucky

rural homelessness

After Hazel Reed’s mother passed away, family members sold her mother’s house, which stood in a rural eastern Kentucky county. Reed had been living there but soon found herself on the street with nowhere to go. She ended up in a psychiatric ward but desperately needed housing. She was eventually placed on a shelter waiting list. When her name was called she had hours to respond, and it was either the street or the shelter.

Homelessness is often seen as a problem endemic to the nation’s urban centers, but it has insidiously evolved in rural America. The difference is the nation’s rural homeless aren’t in plain sight. Eastern Kentucky is a prime example.

But the homelessness in this region of Appalachia, once known for its prodigious coal mining industry but regarded as one of the country’s poorest areas, is clearly not as noticeable as it is in downtown Los Angeles. This makes homeless or housing-insecure people in eastern Kentucky hard to see and count. They are easy to miss in counts.

“The point-in-time count does not work in rural areas because rural homelessness looks very different in rural areas…people aren’t out on the streets, sleeping on the streets,” April Ballard told Invisible People. “They’re living place-to-place, they’re couch surfing, they’re living in trailers or houses that don’t have running water or electricity, they’re living in RVs.”

Ballard is an Emory University doctoral student who works on the CARE2HOPE project undertaken by the University of Kentucky and Emory University to improve the health of rural Kentuckians impacted by opioid abuse.

The primary driver for homelessness in eastern Kentucky is the lack of affordable housing, said Adrienne Bush, executive director of the Homeless & Housing Coalition of Kentucky (HHCK).

“I think the narrative around housing and high cost of housing focuses a lot on our coastal cities and that’s not wrong. That’s accurate. But the lack of affordable housing is a nationwide issue, and eastern Kentucky is not immune to it,” she said.

The National Low Income Housing Coalition estimates that Kentucky is about 75,000 units short in terms of affordable low-income homes. None of the counties in the state have a sufficient supply of low-income housing, Bush added.

Other contributing factors are:

  • Wage stagnation (eastern Kentucky is a highly impoverished region)
  • Easing of housing starts (the number of new residential construction projects that commence during any particular month)

Plus, “the housing that we do have, if it is aging and has plumbing issues or electricity issues then your utilities generally aren’t affordable. Utilities are definitely a significant part of whether someone’s housing is affordable to them or not,” Bush said.

Nationally, private construction of homes is primarily geared for higher-end markets, as opposed to moderate or low-income housing, Steve Berg told Invisible People. Berg is the vice president of Programs and Policy at the National Alliance to End Homelessness.

“The basic issue is…the United States has set up a system where housing, for the most part, is treated like a commodity rather than as a public good that everyone has access to,” Berg said. “The thing about treating it like a commodity is that some people don’t have money. And if you don’t have enough money, you can’t afford housing and that’s what it gets down to.”

There are also significant issues with the homeless management information system, particularly in rural regions, Bush added.

She indicated that the Census Household Pulse data has helped develop a somewhat accurate assessment of the housing situation. (The experimental Household Pulse Survey is designed to quickly and efficiently deploy data collected on how people’s lives have been impacted by the coronavirus pandemic.)

“It shows the number of folks who are worried about being evicted within the next two months, who are behind on rent,” Bush said. It’s aggregated by race and reflects the racial disparities that exist in housing security, she added. “We don’t have as many shelters in eastern Kentucky. So a lot of our folks are not your literal shelter-homeless but are probably doubled-up or couch surfing. So it’s harder to capture those numbers.”

Berg agrees that optics might be absent but homelessness in rural areas is pervasive. “Maybe it’s not as visible because they don’t have big homeless programs or big homeless shelters a lot of times, but it’s still definitely there.”

Ballard echoes Bush’s assessment of the situation in eastern Kentucky where homeless folks could be sheltering in several inconspicuous places. She said there is a glaring underestimation of homeless people there.

“They’re living place-to-place, they’re couch surfing, they’re living in trailers or houses that don’t have running water or electricity, they’re living in RVs,” Ballard said.

Another contributing factor to the escalating homelessness crisis in the Ohio Valley, which includes eastern Kentucky, is the opioid epidemic.

“As the Ohio Valley’s profound addiction epidemic stresses the social safety net, advocates say more rural people are at risk of becoming homeless,” the Ohio Valley Resource reported. “But the scattered and hidden nature of homelessness in rural places makes it an especially hard problem to measure and address.”

April Young, an associate professor of epidemiology at the University of Kentucky and a principal investigator with the CARE2HOPE project, said that homelessness is not synonymous with drug use.

“I think that it’s really, really important to emphasize that not all people who are experiencing homelessness are using drugs. That sort of doubles the stigma for people who are experiencing homelessness,” Young told Invisible People. “And then of course people who are experiencing homelessness or housing instability, they experience other challenges – stigma, employment – all sorts of things and that can stack the cards against them in a way in terms of trying to deal with their substance abuse disorder.”

Young said the establishment of more shelters in eastern Kentucky is crucial but the current policies of some of those in existence are discriminatory and need to be changed.

“For example, not letting people in who have some sort of charges in their past …sometimes they are not letting people in with medications for opioid use disorder … and that is really unfair because these are people using medication to get back on their feet and get into remission and yet they can’t get into shelters,” she said.

Ballard is careful to point out that shelters aren’t implementing these policies to intentionally discriminate against people who are simultaneously battling housing insecurity and substance abuse disorder. However, individuals in these situations are marginalized and often experience violence due to their situation.

“These policies are meant to protect people but they actually discriminate,” Ballard said, adding more money needs to be spent on housing.

“We’re seeing, in fact in rural areas across the U.S., there are people who use drugs that are experiencing homelessness at a much higher rate than we previously thought,” Ballard said. “And I think to then add a pandemic on top of that, I just see this crisis get much worse and I think just thinking through what the implications of that are is really important.”

Solutions are out there. Bush said rental assistance — emergency and on-going — is the most effective due to its universal components. Everywhere from rural Kentucky counties to urban sprawls need it.

“I’m a big proponent of increased rental assistance, whether it is for folks who are currently housed or to get people moved from shelter into a rental home. I think with the way our housing market works now … that’s where you’re going to get the biggest bang for your buck,” she said. “Fundamentally, at the base level, we need a shift in thinking about housing as a public good.”

Programs that target the housing accessibility issue such as the federal Section 8 Housing Choice Voucher Program are available, Berg said. However, there isn’t a comprehensive, universal policy that addresses housing insecurity in our capitalistic economy. He said it covers about 25% of the need.

“If you call up your local housing authority and say, ‘I need a housing choice voucher because I can’t afford rent,’…you get put on a waiting list,” he said. “Depending on where you live that waiting list will be a year or two years or five years or the rest of your life.”

Bush said permanent housing is the ultimate solution but shelters do play a role in the homeless solution paradigm.

Reed, the woman who found herself on the street after her mother passed away, chose a shelter over the street. It was a godsend. Located in another county, she stayed there nine months finally securing her own apartment where she has been living for five years.

“Things keep getting better,” Reed said. “There’s a lot of people in the homeless situation and not enough homeless shelters.”

The eastern Kentucky shelters that are presently operating require great support, Bush said. Many cities or areas throughout the nation receive more local and state funding than federal dollars from the Continuum of Care and Emergency Solutions Grants (ESG) program, Bush continued. But not Kentucky.

“In contrast, if I am a provider in Hazard or Prestonsburg, I’m totally dependent on the federal government,” Bush said. “My local city and county are not providing general fund dollars, and the state is not providing general fund dollars.”

Glema Ambugey has a traumatic past including molestation as a child, enduring abusive relationships, and a history of drug use. She eventually found herself at the intersection of long-term incarceration and drug court. The Perry County, Kentucky drug court, and the homeless shelter in Hazard, Kentucky, agreed to take her case, ultimately sheltering Amburgey for seven months. This led to permanent housing and enabled her to regain full custody of her son and find faith in God along the way.

“If it hadn’t been for the homeless shelter, I would have been totally lost,” she said. “You don’t always have to be a drug addict…things just happen and people get down on their luck.”

Bush said when you have people in crisis with only a handful of shelters for an entire region, it becomes a serious problem. “Kentucky is a very poor state. That’s been documented. Eastern Kentucky is the poorest part of a poor state.”

Talk to your representatives in Congress about the escalating homelessness and housing insecurity crises in their states. “It’s very important that people understand the depth of this problem in rural areas,” Berg said.

Chris Adams

Chris Adams


Christopher Adams is a Texas-based freelance writer and former newspaper reporter who has written on a plethora of subjects from culture, agriculture and digital privacy to criminal justice, politics, music and art.

Related Topics

Get the Invisible People newsletter


homeless woman grants pass


disabled homeless man in Grants Pass


Elderly homeless woman in Grants Pass, Oregon


Homeless woman on the sidewalk in Miami



restrictive zoning laws hinder development of affordable housing

Restrictive Zoning Laws Exacerbate the Housing Shortage Crisis in D.C.

Mental Health Crisis, Homelessness

From Hippocrates to Homelessness: A Journey Through Medical Ethics and Social Neglect

Tiny Homes under construction for homeless people

Homeless Housing Projects Face Delays as Need Grows

public bathrooms

Adding Public Bathrooms in NYC is a Small Step in the Right Direction

Get the Invisible People newsletter