As our population ages, the homeless are getting older too.  This will present societal challenges in the years ahead. 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. 

Margot Kushel, a Professor of Medicine at the University of California in San Francisco, is part of a research team funded by the National Institute of Aging that is looking into how people aged 50 and over become homeless, and what happens to them and their health as a result.  Their (California centric) research finds that as a society we must find ways to adapt existing programs for homeless adults to meet the needs of an aging population, as well as trying to stop older people from losing their homes in the first place.

Surprisingly, the study results show that a large proportion of the homeless population in Oakland, California first became homeless late in life.  This is unexpected because a common perception of homelessness is that it it afflicts only those with mental health and substance use problems. 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 telling of the shock of losing his job after 27 years.  Another described losing his housing after being evicted when his wife had had a stroke.   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 surveyed had been homeless on and off for many years, cycling through jails, prisons and hospitals.

The major issue is a health one.  Research shows that homeless people in their 50’s and 60’s commonly develop health problems normally seen in people in their 70’s and 80’s, and often 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 aging issues such as the ability to manage daily tasks and deteriorating vision and hearing.  However, effective health regimes are made difficult when someone is homeless. 

Thus, the research highlights that current systems set up in the 1980s are not designed to serve an aging 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. The study suggests that many older homeless adults will require nursing home placement, some of which could have been avoided with earlier housing and home-based services. 

Kushel also comments that “to put it bluntly, as a society, we face the specter of older adults dying on the streets.”  Not a nice thought. 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.   Effectively caring for the aged is something societies the world over are grappling with, and the homeless present an especially difficult case.