The issue . . .
It is a sad tragedy of modern America that nearly 50,000 of our older citizens live without stable housing. Living either on the streets or in temporary shelters, these extremely vulnerable individuals suffer from physical and mental health problems even more than does the older population at large or homeless people of younger age groups. This post examines the facts about this demographic group, notes the forces of oppression that render their circumstances especially challenging, and describes efforts to meet their special needs.
A profile of the older homeless population . . .
Somewhere between 30% and 50% of the American homeless population is estimated to be comprised of individuals age 50 or over, with the number of individuals age 65 and older in the shelter system having increased by about 250% between 2004 and 2017. In New York City alone, the number of single adults age 65 and older in the city’s main shelter system more than doubled between 2014 and 2022, and the number of older adults in shelters is growing significantly faster than the broader population of older people is increasing. And the ranks of older people among the homeless is only expected to grow further. In fact, it is projected that by 2050, some 95,000 elderly Americans will be homeless. However, the homeless system is not designed to address the special physical, social, and psychological needs of this cohort.
The leap in the number of older homeless finds its roots in the 2008 economic crisis, when many older Americans lost their homes and were unable to find jobs in the ensuing recession. The aging of the baby boom generation, the dwindling number of jobs for unskilled workers, deinstitutionalization of the mentally ill, and the shrinking availability of affordable housing have only exacerbated the problem. Mental health problems (including substance abuse), household conflicts, poor health, loss of a spouse, hospital discharge, and the effects of incarceration are also to blame (Lee et al., 2015.
However, the elderly homeless have it especially rough. The physical, psychological, and social conditions of this group are considerably worse than those of the general population and even of the homeless population at-large, as they are more isolated from society and less able to withstand the conditions of life on the streets or in shelters. Thus, homeless individuals aged 50 and over have mortality rates that are three to four times higher than the general population. Of course, the homeless population generally contends with health and psychological conditions that are worse than those of the general population. For example, one-third to over one-half of homeless adults are estimated to suffer from serious mental illness, including depression, substance abuse, schizophrenia, and personality disorders. Life on the streets only exacerbates the health problems of the elderly. One study found that 90% of elderly homeless had at least one chronic medical condition, compared with 48% for younger homeless people. Thus, those with chronic health conditions, such as diabetes and heart conditions, have less access to medical care, proper nutrition, and medication. In addition, they suffer from serious stress that renders them more vulnerable to falls and cognitive impairment, such as dementia. Many elderly homeless people cycle through repeating periods of time on the streets, followed by periods of institutionalization in nursing homes or psychiatric hospitals.
The rates of mental illness and substance abuse among the elderly homeless are particularly high, yet there is a paucity of services available to address these problems. In one study, 50% of older homeless people had histories of substance dependence or other mental health issues, though this was considerably lower than the rate for younger homeless. Older men are more likely to present with alcohol abuse problems, while older women are more likely to present with mental health problems, and older men are more likely to experience longer spells of chronic homelessness.
As for the composition of the elderly homeless, few are married and most are estranged from family. Most are racial or ethnic minorities, have low levels of education, and worked in unskilled jobs. Although one study in Bakersfield, CA found that elderly homeless had higher economic resources than younger homeless individuals, the former had longer periods of homelessness, perhaps because elderly homeless have fewer social connections that might assist them in climbing out of homelessness.
The role of discrimination . . .
Ageism, or discrimination or prejudice against a person because they are older, is undoubtedly behind much of this dismal picture. Two areas of ageism are of particular note in this regard: age discrimination in health care and in hiring.
It is certainly the case that the elderly have a less-favored status in our health care system. To begin with, older people have less access to health care resources, and doctors are less adept at dealing with the health problems of the elderly, as training in geriatric medicine lags behind that for other groups of patients. In addition, older patients are accorded less preventive care under our system and are less likely to be screened for medical conditions. Elderly people with medical conditions are more likely to be written off and left untreated. Moreover, medical research focuses on the conditions of younger groups at the expense of older patients. Thus, there should be little surprise that the health of older homeless people is so much worse than that of younger homeless cohorts, as well as that of the general population.
Although it is against federal and state law, age discrimination in hiring remains prevalent and insidious. Sadly, six out of ten older workers report having seen or experienced discrimination (the figure is even higher in the technology sector), and 90% find it to be common. Negative stereotypes exclude older workers from jobs for which they are qualified, even as growing numbers of older workers need employment in order to make ends meet as the age for social security creeps up and traditional sources of retirement funds dwindle. Only 50% of older workers have saved enough to cover their basic needs into their 80s and 90s; over 25 million older Americans are characterized as economically insecure. This lack of employment opportunities explains at least in part the swelling ranks of elderly homeless people.
Housing and other prescriptions . . .
Fortunately, a growing gamut of programs over the past several years – perhaps best exemplified by The Hearth Program in Boston — is establishing housing programs for the elderly homeless specifically designed to address the special needs of this population, and they are showing success. So-called permanent supportive housing combines affordable housing with services aimed at the special needs of an older population. Among the services provided by these programs are assistance with daily living, 24-hour crisis assistance, nutritional services, transportation to medical appointments, trained counselors and psychiatrists on site to address mental health and substance abuse needs, financial management services for residents, assistance with accessing social safety net programs such as social security and veterans’ benefits, job training and search assistance, and a welcoming environment where residents are made to feel part of a community. These on-site services reduce the need to resort to emergency medical services and placement in nursing homes or convalescent care facilities. Rental assistance programs are also serving to keep people in permanent housing.
In addition to an expansion of these housing programs and an increase in the stock of affordable housing generally, a number of other initiatives are needed to assist this vulnerable group. First, social welfare programs, such as Social Security, Medicare, and Medicaid, need to be expanded and modified to better address the conditions of the elderly homeless and to prevent older Americans from falling into the abyss of homelessness in the first place. Likewise, community health centers need to be enhanced to meet the health needs of this population. And while these measures may be expensive, savings on expenditures for nursing homes, health care costs, and additional shelters could more than make up for the costs of such initiatives.
In conclusion . . .
Clearly, the statistics regarding the elderly homeless are daunting. But with the resources, political will, and effort to construct communities and programs that cater to their particular needs, as well as to reduce sources of discrimination that contribute to the problem, we stand a chance of ensuring that these most vulnerable of Americans have a better shot at a safe, comfortable, and dignified existence.
