Families on the Edge: Experiences of Homelessness and Care in Rural New England, by Elizabeth Carpenter-Song

Families on the Edge highlights how poverty, social systems, and access to care shape the daily lives and struggles for stability for families facing homelessness in rural New England. Some key words that stuck with me are “grasping at straws,” “good parent,” and “striving for the ordinary”. “Grasping at straws” shows how families make difficult choices in the setting of very limited options in an uncertain future. It highlights the constant effort needed just to have basic housing or childcare. The idea of being a “good parent” reflects how parents view societal and self-imposed expectations of care, often experiencing guilt or anxiety when structural barriers prevent them from meeting these standards. “Striving for the ordinary” captures the desperation for simple things like steady routines, safe housing, living with family and social support, in uncertain circumstances. These words deeply resonated with me, pointing to the heartbreaking reality of families striving for stability amid uncertainty and limited options.

Dr. Carpenter-Song’s description of these fundamental insecurities helps to shift the focus from individual choices to ongoing systemic instability in understanding rural homelessness and how it shapes the lives of rural families beyond the shelter. Instead of seeing housing loss, substance use, or family disruption as individual failures, it shows how unstable housing, limited support systems, poverty, social determinants of health and poor access to services combine over time to create constant uncertainty. In Chapters 5–7, parents dealing with child removal, recovery, and reunification show that even when they make strong efforts, they are navigating slow complex systems, often trapping them in a vicious cycle of ongoing instability. Stigma further worsens this, as families are often judged as “unfit,” limiting access to housing and support.

The experiences of families, like the crushing story of Vermonters Jim and Hannah, show how challenges like lack of affordable housing, unstable jobs, and strict child welfare rules create ongoing insecurity, even when parents follow all the requirements. These structural barriers often prevent success, putting them in a “double bind” where efforts are visible but rarely rewarded. Trying to get help can sometimes make things worse. For example, asking for childcare or support may lead to more monitoring or even loss of custody instead of help. While stable housing is a key part of stability for children and parents, it remains hard to access.

Even when subsidized housing is available, Abigail’s story shows how loneliness, a lack of social   support, and repeated moves are disruptive. Tara, mother of two young children, faced challenges balancing childcare, housing, and employment while trying to provide a safe environment for her children. Jim and Hannah were devastated by the removal of their children, which led to a loss of housing and immense emotional strain. These stories demonstrate that families are constantly “grasping at straws,” trying to meet social expectations despite obstacles.

Patients with substance and housing problems facing challenges like those described in Families on the Edge often present to the hospital with severe infections. If patients don’t have transportation or stable housing, discharge planning becomes complex, which leads to incomplete treatment and recurrent infections. Many of these patients are really motivated to seek help but are unable to overcome barriers due to fragmented resources that cannot stabilize their life outside the hospital. That just erodes trust in the medical system.

Carpenter-Song’s book is so effective because she allows us to get to know the people experiencing these complex, devastating problems, and to empathize with them. She eliminates blame from the equation and explains why homelessness feels so achingly unfixable at times. The lessons we learn from this book need to be applied using empathetic communication to better understand patients’ perspectives, needs, and reasons behind their actions, without viewing their behaviors as noncompliant. Looking at rural homelessness and health at a fundamental level, with case studies, proves that prolonged instability often comes from larger systemic challenges. This incredible book highlights the importance of creating interventions that support patients and families by stabilizing housing, improving access to services, and addressing social needs rather than blaming people for challenges that are beyond their control. Increasing collaborations with case management, social work, and community resources can help create care plans that address both medical and social needs, reduce hospital readmissions, and support more stable outcomes that align with patients’ goals. 🏡