Introduction
For many gerontologists and health care and social care professionals in developed countries, vulnerability among older people is associated primarily with physical and mental health problems, poverty and social isolation. Some older people, however, are much affected by changes in housing markets, and others by retirement or redundancy, and subsequently struggle to pay the rent. Others have difficulties maintaining a home because of mental health problems or following widowhood or marital breakdown. Some who cannot cope abandon their accommodation or are evicted for rent arrears. As seen in several natural disasters earlier in the decade, older people also become homeless as a result of earthquakes, tsunamis and severe floods. Although homelessness affects all age groups and there is a tendency to dissociate older people from the problem, in the United Kingdom, Australia, Canada and the United States many experience this demeaning and often damaging state in later life.
This paper reviews the prevalence of homelessness among older people, their problems and needs, and the service responses. It draws mainly from studies in and reports from the United Kingdom, the United States and Australia. Compared with other age groups, there have been few studies of homeless older people. The first of substance was of older homeless men living on The Bowery, a district of the lower east side of New York City.Reference Cohen and Sokolovsky1 The first in England was Crane's ethnography during the early 1990s of older homeless people living on the streets and in hostels in London and three provincial cities.Reference Crane2 Reports about the problems and needs of the group have since been published in Australia and Canada.Reference Kavanagh3–Reference McDonald, Donahue, Janes and Cleghorn5 An incipient interest is also evident in Japan, for the country's protracted recession has resulted in many middle-aged and older workers becoming homeless.Reference Aoki6–Reference Okamoto8
There is no consensus among policy makers, service providers and researchers as to the age at which ‘older’ homelessness begins. Cohen and SokolovskyReference Cohen and Sokolovsky1 argued for a threshold of 50 years, because many homeless people in their fifties have chronic health problems and disabilities normally associated with old age and view their lives as over. This cut-off has been widely adopted by researchers and voluntary sector service providers but not by statutory agencies, principally because they are constrained by the customary age thresholds for eligibility to social housing, state pensions and other income benefits, and even for some health care entitlements (such as free prescriptions). In the United Kingdom, for example, local authorities tend to apply the state pension eligibility age (currently 60 years for women and 65 for men) when assessing whether a homeless person is entitled to housing on the grounds of ‘old age’. Likewise in the United States, most programmes for seniors cannot be accessed until 62 years for housing and 65 years for Supplemental Security Income.
The number of older homeless people
During the first half of the twentieth century, most single homeless people in the United Kingdom and the United States were middle-aged or older men: around two-thirds were over the age of 50 years, and one-quarter over 60 years. The profile of homeless people changed during the 1970s and 1980s, with more young adults and women entering the population. Nonetheless, older people are still a large proportion of single homeless people in many developed countries, and several surveys in Australia and the larger American and Canadian cities indicate growing numbers.9, Reference Watson, George and Walker10
As there are no aggregate point-in-time or period statistics for all homeless people in the United Kingdom, the temporal trend in the total number of older homeless people is unknown. One constituent group is monitored, those who are accepted each year by local authority housing departments as homeless and in ‘priority need’ of rehousing on the grounds of ‘old age’. From 1997 to 2003 in England, around 4000 households (single people, couples and other household formations) were so accepted each year, but in line with the recent fall in all priority housing acceptances, the ‘old age’ total fell to 2530 in 2005, 1140 in 2007, and 600 in 2009 (1.4% of all acceptances). The decrease is probably a consequence of policy and assessment alterations rather than social changes, for in Scotland the number of people of retirement age accepted by local authorities as homeless and in priority need of rehousing has steadily risen, from 805 in 2005–2006, to 933 by 2007–2008. In Wales in 2008, the number accepted was 132. Moreover, many older homeless people in the United Kingdom sleep on the streets or stay in hostels and do not apply to local authorities for priority rehousing. In London, for example, 700 homeless people aged 50 or more years were in hostels on one night in 2000 (21% of the hostel population).Reference Crane and Warnes11 Likewise, the number of older people (aged over 55 years) known to have slept on the streets in London increased from 347 in 2005/2006 to 463 in 2007/2008.12, 13 There was a similar increase among those aged 46–55 years, from 617 to 799.
In the United States, surveys in 2007 in Baltimore City, Dallas County (Texas), Greater Los Angeles, Hillsborough County (Florida), and two California counties (Santa Clara and Sonoma) found that among homeless people on the streets and in shelters, 19–33% were over the age of 50 years, although less than 10% were over 60 years.14–19 In several cities, moreover, successive counts suggest that older people are a rising percentage of single homeless people. In San Francisco, 11% of street homeless people were aged 50 years or more during the early 1990s, compared with 32% in 2003.Reference Hahn, Kushel, Bangsberg, Riley and Moss20 In Greater Los Angeles, in 2005 there were 745 homeless people aged 51 or more years, and by 2007 the number had grown to 927 and the share of the total had increased from 24 to 29%.17 In Dallas County, Texas, people aged 50 or more years comprised 25% of the enumerated homeless in 2004, and 33% in 2007.18
The increase of older homeless people in the United States is mainly of those aged 50–64 years. In San Francisco, the median age of homeless people increased from 37 years during the early 1990s to 46 years in 2003, and the median duration of homelessness increased from 12 to 39.5 months.Reference Hahn, Kushel, Bangsberg, Riley and Moss20 The Homelessness Research Institute of the US National Alliance to End Homelessness projects that the national total of homeless people aged 62 or more years will double over the next 40 years, from 43,450 in 2008 to 58,000 in 2020, and 92,000 by 2050, partly because of the anticipated increase in the general elderly population.Reference Sermons and Henry21 The projection assumes that the percentage of the older population in serious poverty will remain constant (as it has since 1975), and takes into account the ageing of the current chronically homeless population.
Australian and Canadian statistics show similar trends. The 2006 Australian Census enumerated 18,108 homeless people aged 55 or more years, compared with 13,878 in 2001. In 2006, 10% of the homeless were aged 55–64 years, and 7% aged 65 or more years – the equivalent values in 2001 were 8% and 6%.Reference Chamberlain and Mackenzie22, Reference Chamberlain and Mackenzie23 Turning to Canada, in Metro Vancouver, British Columbia, there were 212 homeless people aged 55 years or over in 2008 compared with 51 in 2002, and in Edmonton, Alberta, the equivalent numbers increased from 81 in 2000 to 306 in 2008.24, 25
Reasons for homelessness
The causes of homelessness among older people have to be understood at both societal and individual levels. The rising numbers in the most affluent English-speaking countries are probably explained in large part by increases in the population at risk, life-course changes and structural economic changes. The most important life-course changes have been more fluid partnership histories, with a decreasing percentage of those reaching 50 years and older in first marriages or with adult children that are close (in both senses) and able and willing to offer support. The key economic changes are more ‘flexible’ labour markets, rising income inequality and the rising ratio of housing costs to incomes. Drawing on large national surveys, American researchers have examined the relationships between structural conditions and rates of homelessness.Reference Burt26–Reference Lee, Price-Spratlen and Kanan28 The analyses have shown that higher rates of homelessness were associated with high housing prices (as indexed by the median rent), with local economies that had shifted away from manufacturing and were dominated by low-paid service and unskilled jobs, and with a higher representation of single-person households. More widely available low-cost rented housing was associated with lower rates of homelessness, but the poverty rate explained little of the variation.
Elliott & Krivo argued that labour markets with a high representation of unskilled jobs increased homelessness because many employees had unstable and low-paid jobs, and because such cities or regions had weaker economies and comparatively weak social and economic supports.Reference Elliott and Krivo27 Burt's interpretation was that high population and job growth put pressure on a city's housing market, and ‘squeezed out’ poor and unemployed households.Reference Burt26 She also argued that a high prevalence of one-person households strained housing resources, and might indicate a high proportion of people with mental illness and other disabilities, and a high prevalence of older people or young professionals who are relatively isolated and have weak support networks in times of trouble.
Turning to the reasons why individual older people are homeless, some have been homeless intermittently or continuously for years, while others become homeless for the first time in later life. Many older homeless men have experienced lifelong intermittent or chronic homelessness – older homeless women are less likely to have been homeless before 50 years of age.Reference Crane2, 29, Reference Hecht and Coyle30 Some older men became homeless as teenagers or in early adulthood following the break-up of childhood homes, the dissolution of a marital or cohabiting relationship, or discharge from statutory care, the armed services or prison. A second group became homeless in middle age. Some had always lived at home with their parents, acquired only limited social and domestic skills, and did not cope when their last parent died. They either abandoned their accommodation or were evicted for rent arrears. Among 472 homeless people aged 50–64 years interviewed in Chicago in 2006–2007, the majority first became homeless in middle age (median 47 years), and just 25% had been homeless for more than 2 years.31 Common reasons for their homelessness were loss of job and unemployment, discontinued or inadequate public assistance, health and alcohol problems, and disagreements with co-resident family or friends.
A third group first become homeless in later life. A study in New York City of 79 older homeless people found that 53% had lived ‘relatively conventional lives involving long periods of employment and residential stability before becoming homeless at an average age of 59’.Reference Shinn, Gottlieb, Wett, Bahl, Cohen and Baron32 Multiple risk factors and events contributed to their homelessness, including loss of job and housing, lack of family support, and substance misuse. In a Tri-Nation Study conducted in four English cities, Boston (Massachusetts) and Melbourne (Australia) of 284 men and 94 women whose current episode of homelessness began when they were aged 50 or more years, 68% had never been homeless before.Reference Crane, Byrne, Fu, Lipmann, Mirabelli, Rota-Bartelink, Ryan, Shea, Watt and Warnes33–Reference Warnes and Crane35 Several events and states triggered becoming homeless, including having to leave their accommodation because it was sold, converted or condemned (19%), difficulties with paying rent or mortgage (27%), death of a spouse, relative or close friend (11%), the breakdown of the marital or cohabiting relationship (20%), and disputes with relatives, neighbours and co-tenants (23%). Other contributory factors included physical and mental health problems, the loss of a job, financial hardship, and alcohol problems. Recent changes in housing markets and housing management practices were implicated in all three countries. The diminished stock of affordable public and social (or subsidised) housing had produced long waiting lists, while many of the Boston and Melbourne respondents had lived in private rented housing and were displaced by ‘up-market’ housing redevelopments.
The men in the Tri-Nation Study were more likely than the women to associate becoming homeless with the loss of a job and alcohol problems, while a higher proportion of women reported relationship breakdown. Those aged in their fifties were more likely to report marital breakdown, mental health problems, heavy drinking and the loss of a job as contributory factors, while problems with the accommodation itself or with gambling had higher prevalence among those aged in their sixties and above. There were national variations. A higher percentage of the Boston respondents identified drug problems as a contributory factor. Gambling problems were mostly reported by the Melbourne respondents, and were probably related to the legalisation of electronic gaming machines in the State in 1992: the social pathologies and increased homelessness resulting from the recent rapid growth of gambling in Australia have been recognized.Reference Antonetti and Horn36, 37
Older homeless people's characteristics and problems
A large majority of older homeless people are men, with various estimates of the percentage in England, the United States and Australia ranging between 63 and 92%.9, Reference Crane, Byrne, Fu, Lipmann, Mirabelli, Rota-Bartelink, Ryan, Shea, Watt and Warnes33, Reference Garibaldi, Conde-Martel and O'Toole38, Reference Gorton39 In the Tri-Nation Study, one-third of the men were single and had never married, one-tenth were widowed and most of the others were divorced or separated.Reference Crane, Byrne, Fu, Lipmann, Mirabelli, Rota-Bartelink, Ryan, Shea, Watt and Warnes33 Fewer of the women (18%) were single and higher proportions were widowed, divorced or separated. Many older homeless people are isolated, estranged from relatives, and have no friends. Some have no living relatives or have had no family contact for years. For some, family arguments and estrangement were the triggers for homelessness. Some men were so distressed after becoming widowed that they abandoned their accommodation, slept on the streets, and did not keep in touch with their children. Compared with other age groups, homeless older people are exceptionally isolated. In the FOR-HOME study in England of resettlement outcomes for 400 single homeless people, the percentage in contact with family and relatives just before being rehoused declined steeply with age (93% of those aged 17–24 years, 82% of 25- to 49-year-olds, 58% of 50- to 59-year-olds, and 44% of 60+-year-olds). The respective age group percentages for being in contact with friends were 93, 76, 61 and 56%.Reference Warnes, Crane and Coward40
Health and substance misuse problems
Physical health problems are widespread among older homeless people, and they tend to be in poorer health than their domiciled age peers and younger homeless people.Reference Garibaldi, Conde-Martel and O'Toole38, Reference Gelberg, Linn and Mayer-Oakes41 Common problems include arthritis, hypertension, diabetes, chronic respiratory illnesses, gastrointestinal ailments, circulatory disorders, and dental problems.Reference Shinn, Gottlieb, Wett, Bahl, Cohen and Baron32, Reference Stergiopoulos and Herrmann42–Reference Wright44 The problems are exacerbated by their lifestyle, living conditions, age and lack of treatment. Those who sleep on the streets are exposed to dampness, extreme temperatures and infections. They are susceptible to leg ulcers, cellulitis, scabies and tuberculosis, and to injuries from accidents and assaults. Poor nutrition contributes to chronic health problems: studies in London and several American cities have found that the food intake of most homeless people does not meet normal dietary requirements.Reference Burt and Cohen45, Reference Evans and Dowler46 Among 136 older homeless people (aged 60+) surveyed in San Diego, 51% reported not having enough money to buy food regularly and relied on charitable handouts.Reference Richards and Elliott47
Mental health problems are prevalent among older homeless people, particularly women. According to several British and American studies, between one- and two-thirds of older homeless people report being depressed, while many of the women and one-third of the men have a psychotic illness or severe memory problems.Reference Cohen and Sokolovsky1, Reference Crane2, Reference Cohen, Teresi and Holmes48–Reference Kutza50 A study in London in 2000 found that three-quarters of homeless women aged 60 or more years in hostels and on the streets had mental health problems.Reference Crane and Warnes11 In a survey of 74 older homeless people (86% of them men) in Pittsburgh and Philadelphia, 74% reported psychiatric conditions, and the most common were depression, anxiety disorder and post-traumatic stress disorder.Reference Garibaldi, Conde-Martel and O'Toole38
About two-fifths of older homeless men and one-fifth of women have alcohol problems.Reference Hecht and Coyle30, Reference Cohen, Ramirez, Tersi, Gallagher and Sokolovsky49, Reference Ladner, Robertson and Greenblatt51 For some, heavy drinking preceded homelessness and is associated with traumatic experiences, while others use alcohol as a means to cope with the physical conditions and stresses of being homeless, and some socialize with other drinkers to alleviate boredom and loneliness. Many have serious physical illnesses, cognitive impairments and nutritional deficiencies related to years of heavy drinking. Some neglect their self-care, repeatedly fall, and are incontinent when drunk. They are more likely than non-drinkers to report depression, sleep disturbances, poor appetite and pessimism.Reference Crane and Warnes52 Up to one-quarter of older homeless men and one-tenth of women have both mental health and alcohol problems.Reference Crane2, Reference Crane and Warnes11
Until the mid-1990s, the use of illegal drugs among older homeless people was rare (affecting less than 5%),Reference Fischer and Breakey53–Reference Wright55 although one survey of 89 older homeless people in St Louis, Missouri reported 16% as having drug problems.Reference DeMallie, North and Smith56 The prevalence of illegal drug use among the age group is still lower than among young adults but is increasing, which reflects the substantial rise in drug abuse and dependence in both the general and homeless populations. Among 74 older homeless people surveyed in Pittsburgh and Philadelphia in 1997, 23% reported using heroin.Reference Garibaldi, Conde-Martel and O'Toole38 A 2004 survey in London of 365 homeless people aged 50 or more years found that 10% had a drug problem.Reference St Mungo's57 Among the older respondents in the FOR-HOME study (described earlier), 29% had used illegal drugs during the 5 years before being resettled, including 9% who had taken heroin and 13% crack-cocaine.Reference Warnes, Crane and Coward40 Among the Tri-Nation Study respondents, 9% said that they used illegal drugs before they became homeless. For some, the behaviour began in early adulthood, but for others onset was during their forties or older.
Older homeless people's use of services
Many older homeless people stay in temporary accommodation such as hostels and shelters managed by voluntary sector organizations and local charities. Others have little or no contact with services and sleep on the streets or in secluded places such as derelict buildings. Some are reluctant to use services for homeless people of all ages through fear of intimidation and violence from young homeless people.Reference Crane and Warnes58 Some stay in a hostel or shelter only briefly and are quickly rehoused, but others have persistent, multiple and deep-seated problems and remain on the streets or in temporary accommodation for years. Many older people who live on the streets, particularly women, have serious mental health problems, are alienated, suspicious and hostile, and very resistant to help.Reference Crane2, Reference O'Connell, Roncarati, Reilly, Kane, Morrison, Swain, Allen and Jones59 Many with alcohol problems find it impossible to break the cycle of heavy drinking, deteriorating health and low morale. They have lost their family, job and home, and have no motivation to stop drinking. Some are admitted to hospital or to a detoxification unit for a few weeks during which time they abstain, but when discharged many soon start drinking again.Reference Crane and Warnes52
Data for New York City in 1988–1995 and for Philadelphia in 1991–1995 indicate that 10% of shelter users were chronically homeless, and that this group tended to be older and non-White, and to have a high prevalence of physical health, mental health and substance misuse problems.Reference Culhane and Kuhn60 Likewise a review of shelter users in Toronto found that those aged 65 or more years tended to stay in the system longer than younger clients, and had a lower rate of moving into stable housing.Reference Stergiopoulos and Herrmann42 This was because many of the men had memory problems, were verbally aggressive and abused alcohol, while the women tended to suffer from paranoia, depression or have memory impairment. A survey of London's hostel residents in 2000 also found that the median stay in a hostel increased with age, from 984 days among those aged 30–39 years, to 1669 days for those aged 50–59 years, and 2952 days for those who were older. Altogether, 14% of those aged in their fifties and 39% of those 60 years and over had been so housed for more than 5 years.Reference Crane and Warnes11 More recently, a survey of 389 older homeless people in the London Borough of Westminster and in four English towns and cities found that 28% had been in their current hostel for more than 5 years.Reference Gorton39
Resettling older homeless people
Resettling older homeless people successfully into stable and permanent housing is not straightforward. Some are able to live independently and benefit from such a move. Small-sample studies in England, Germany and Melbourne have found that those who are resettled become more active and their confidence and self-care improves, and that some renew family contact and some reduce their alcohol consumption.Reference Busch-Geertsema61–Reference Hallebone, Huth and Wright63 Many older homeless people, however, lack the skills, confidence or motivation to manage independent living. Some have never previously lived alone, and some have impairments arising from ill-health or substance misuse. In the German sample, a few experienced crises linked to substance abuse problems or mounting rent arrears, and required intensive interventions by social workers and support at home for more than 1 year.Reference Busch-Geertsema61 Among 64 older homeless people resettled in England, 31% abandoned their tenancies or were evicted within 2 years. Tenancy failure and continuing unsettledness was associated with prolonged histories of homelessness (>5 years), no family contacts, continuing contacts with homeless people, having moved to congregate housing, and no support during the early months.Reference Crane and Warnes64 A Canadian survey in Calgary and Toronto of 237 homeless older people who had been rehoused in supported housing or independent housing with community support found that many felt ‘disconnected and isolated’ and relied heavily on service providers for support.Reference McDonald, Donahue, Janes and Cleghorn5
Service responses
Since the 1980s in many western countries, particularly the United Kingdom, the United States and Australia, the rise in the number of homeless people and the associated problems have been prominent issues in domestic politics. This has led to the creation of national agencies for ‘tackling homelessness’, to national plans for alleviation and prevention, and to substantial increases in capital investment and revenue funding for service development.Reference Warnes, Crane, Whitehead and Fu65 These efforts have created more systematic and effective pathways of advice, support and help, from outreach teams that make contact with those sleeping on the streets and in public places, through subsidised accommodation and specialist services that tackle substance abuse and other personal problems, to resettlement preparation and rehousing. Much of the focus, however, has been on young homeless people and on those with particular problems such as mental illness or substance misuse, and there has been little attention paid to the particular needs of older homeless people.
A few voluntary sector and faith-based organizations have developed services exclusively for older homeless people, including day centres, hostels and supported housing.Reference Crane and Warnes58 In Seattle, Washington State, for example, the Catholic Community Services of Western Washington and the Archdiocesan Housing Authority opened the St Martin de Porres Shelter for older homeless men in 1984 and the Lazarus Day Center for older homeless people in 1990. The Senior Community Centers of San Diego, California, provide services for low-income older people, and transitional accommodation for 35 homeless older people until more permanent housing can be obtained. In New York City, the West Side Federation for Senior and Supportive Housing provides permanent housing and support at Euclid Hall to 292 low-income older adults, many of whom have histories of homelessness and chronic mental illness.
In the United Kingdom, St Mungo's in London has established two registered care homes for 55 older homeless men, with the places funded by the local authority ‘community care’ budget. A few other British service provider organizations, including Framework and Thames Reach, have also established supported housing or registered care homes for older people with long histories of homelessness, heavy drinking and mental health problems. The Mayor of London has committed to end rough sleeping by 2012 and has established the London Delivery Board – a strategic partnership of representatives from central government, the local authorities, homelessness service providers and other stakeholders to achieve the goal. Intensive work has been underway since early 2009 to tackle rough sleeping among those who are most entrenched and hard to engage, many of whom are older and have mental health problems. Among 236 in this group who refused to enter hostels, 38% were aged 45 or more years.Reference Cebulla, Rice, Tomaszewski and Hough66 In collaboration with the City of London Corporation, St Mungo's is piloting a new way of working with long-term older rough sleepers at ‘The Lodge’. Opened in March 2010, this provides temporary accommodation but operates as a hotel rather than a traditional hostel, thus enabling the users to retain independence while at the same time receiving advice and support from staff. As Charles Fraser, the Chief Executive, has explained, ‘we know that older rough sleepers are some of the most resistant to the usual routes away from the streets – [many are] very independent, self-sufficient people used to their own patterns of daily life. There is a tendency for them to be unwilling to use the current services on offer. Our challenge then is to provide a better alternative to sleeping on the streets that appeals to them directly’.Reference St Mungo's67
Services exclusively for older homeless people are still not widespread. Arguably, an important benchmark is when an organization is established for this specific purpose. One such is Wintringham, in Melbourne, Australia, which was founded in the late 1980s. It provides more than 100 units of supported housing for older homeless people, a nursing home with 60 beds, 140 units of permanent housing, and has recently developed a long-term supported housing project for those with severe alcohol-related brain damage.Reference Rota-Bartelink and Lipmann68 It has successfully garnered ‘age care’ funds to build and manage its supported living units and nursing home. Its accommodation has relatively high staffing levels and, importantly, both the physical design and the management model encourage individual responsibility and mutual support among the residents. A second dedicated organization is Hearth in Boston, Massachusetts (formed in 1991 as the Committee to End Elder Homelessness). By 2008, it had 136 units of permanent supported housing in seven projects for older homeless people, an outreach service for those in shelters, and integrated health and welfare programmes. Since its inception, Hearth has helped an estimated 1400 vulnerable older people to secure affordable housing in and around the City of Boston.Reference Gonyea and Bachman69
A few voluntary sector organizations have lobbied for increased attention to the needs of older homeless people. In the United Kingdom, the national charity Help the Aged together with Crisis and the Housing Associations Charitable Trust formed the Older Homelessness Partnership Programme in 1998. It ran for 5 years and funded services nationwide for older homeless people, including specialist workers at day centres and resettlement and tenancy support workers. Regrettably, several of these posts ceased when the programme's charitable funding ended. The UK Coalition on Older Homelessness was set up in 2000 to raise the profile of older homeless people and to advocate for services on their behalf. Similarly in the United States, in Los Angeles County Shelter Partnership is campaigning for the development of permanent supported housing for older homeless people, and in 2008 published a Homeless Older Adults Strategic Plan.9 There had been no permanent housing projects for homeless older people in the County, but during the campaign's first 18 months, the Union Rescue Mission opened a project for older homeless women and three other projects for homeless older people and those at-risk were being planned in collaboration with statutory agencies.9
Conclusions
Homelessness among older people is by no means rare, yet those affected are a neglected, excluded and severely disadvantaged group. Given the ageing of the population, rising income and housing inequalities, and the increased fluidity of marriage and partnership histories, a plausible case can be made that the numbers of older homeless people will continue to grow. In the United Kingdom, services for people who become homeless have greatly improved over the last two decades and have become more effective at both amelioration and prevention. Few, however, have been dedicated to the particular problems of older homeless people. Most voluntary and statutory agencies working with older people have given little attention to the unmet needs of those who are homeless, and only a few homelessness-sector organizations have been convinced of the need for dedicated services for their older clients.
Services need to be developed that take into account the particular needs of older homeless people. More effective prevention requires early identification of cases of extreme housing and personal stress. New ways of engaging with older people who have been on the streets for years and of encouraging them to access services need to be piloted. Various types of permanent, supported housing options are also required that promote self-sufficiency and stability so that older people do not live in hostels and shelters for decades. To provide more appropriate services for older homeless people, there needs to be flexible implementation of the current framework of ‘age care’ and ‘housing with care/support’ measures, not least with reference to the customary ages of eligibility for ‘old age’ programmes and funding. A few organizations have demonstrated that this is possible – they have made imaginative use of existing funding structures to devise accommodation and care models that meet older homeless people's needs.
Conflicts of interest
Maureen Crane is a member of the UK Coalition on Older Homeless. The authors have no other conflicts of interest.
The authors are grateful to the UK Economic and Social Research Council for funding the FOR-HOME longitudinal study and the English component of the Tri-Nation Study (grants R000239675 and RES-062–23-0255), and indebted to their collaborators and respondents in England, Boston (Massachusetts) and Melbourne.
