As our population ages, the homeless are getting older too. In the early 1990s, only 11 percent of the adult homeless population in the United States was aged 50 and over. It increased to 37 percent by 2003, and today half of America's homeless are over 50. The number of aged homeless is expected to continue to increase, and increased health care costs and shelter needs are inevitable.
Given these worrying statistics, it is heartening that a new research institute was established in July this year at UC San Francisco: the Benioff Homelessness and Housing Initiative. It was funded by a $30 million donation from tech billionaire Marc Benioff, the biggest private donation ever given in the United States for research on homelessness.
Its mandate is to study homelessness and come up with ways to be more effective in creating housing and services for homeless people. It also aims to compile a digital library of local and national research, so that policy leaders and the public can better understand the issue.
Margot Kushel, a Professor of Medicine at the University of California in San Francisco, will head up the research team. Professor Kushel's previous research has found that, surprisingly, a large proportion of the homeless population in Oakland, California first became homeless late in life. Their stories follow a similar pattern of men and women who have worked throughout their lives in low-skill, low-wage jobs, with one study participant describing the shock of losing his job after 27 years. Job loss, illness, a new disability, the death of a loved one or an interaction with the criminal justice system are all possible causes. The other half of the older homeless have generally been homeless on and off for many years, cycling through jails, prisons and hospitals.
An ageing homeless population is not just a problem for the United States. For instance, in September 2017 a Ministry of Health, Labor and Welfare survey found that 42.8 percent of Japan's homeless population was over 65. The average age of a homeless person had reached 61.5 years old, older than ever before, and it has likely continued to rise since that survey.
Health is obviously a much larger issue for the ageing homeless. Research shows that homeless people in their 50s and 60s commonly develop health problems normally seen in people in their 70s and 80s, and don't have the means to obtain adequate medical care. Health care providers dealing with the homeless must now manage chronic diseases such as diabetes and heart and lung disease, as well as general ageing issues such as the ability to manage daily tasks and deteriorating vision and hearing. However, establishing and maintaining effective health regimes is made difficult when someone is homeless.
Research highlights that current systems are not designed to serve an ageing population. For example, people at high risk of falls are put at risk by bunk beds or by bathrooms in shared facilities that do not have grab bars and slip-resistant floors. Many require personal care assistants to enable them to bath and dress. Older homeless adults die at a rate four to five times what would be expected in the general population. They die from the same causes as do other people – heart disease and cancer – but they do so 20 to 30 years earlier.
Permanent supportive housing and rapid re-housing could be one solution, according to a recent report released by researchers at the University of Pennsylvania, University of California Los Angeles, New York University, and Boston University. Researcher, Professor Dennis Culhane, argues:
"We can either just maintain people who are in poor health and in a state of homelessness, with crowded emergency rooms, hospitals and nursing homes, or we could use the money wisely to actually solve their homelessness problem and reduce the total costs."
Effectively caring for the aged is something societies the world over are grappling with, and the homeless present an especially difficult case.