With this post, we take a look at a pervasive problem facing us here in the United States…homelessnes. We all have likely read or heard news reports about the general problem, but often these numerical accounts do not dig beneath the surface to present analyses of specific population segments dealing with the very real aspects of “living on the street.” AMAC Researcher Eileen Cook, in recognition of the AMAC Foundation’s mission of protecting and ensuring the financial security, health, and social well being of current and future older Americans, conducted research recently that sheds a more specific light on the problem. Here is her report on “Senior Homelessness.”
Everyone deserves a roof over their heads without the fear becoming homeless.
As 10,000 people turn 65 every day in the United States and the population ages in general, the homeless population will age as well. It is predicted that homelessness among people age 65 and older will more than double by 2050 (1), from over 44,000 in 2010 to nearly 93,000 in 2050.The contemporary homelessness among single adults is concentrated among persons born in the latter half of the post-war baby boom (1955-1965) and in the years immediately adjacent to that period (2) Referred to by demographers as “cohort effect” are more likely to be economically disadvantaged relate to their predecessors due to an excess supply of workers at the time of their labor entry, among other factors. (3) While the people who experience homelessness are not the same from day to day-or even year to year- the emergence of a generational dislocation that would sustain a heightened risk of homelessness among this birth cohort.
Why this is happening?
According to the Stanford Center of Longevity, almost one-third of seniors in the U.S. have nothing saved for retirement, while two-thirds of baby boomers are carrying an average of about $110,000 in credit card, student loan or mortgage debt. During the recession, many people age 50-65 lost equity in their homes or lost their homes entirely and found themselves at the mercy of the country’s rental affordability crisis. Among homeless adults age 50 and older, 44 percent were never homeless before 50. (4)
Challenges of the aging homeless population
Older homeless adults have medical ages that far exceed their biological ages. Research has shown that they experience geriatric medical conditions such as cognitive decline and decreased mobility at rates that are on par with those among their housed counterparts who are 20 years older. (5)
Common conditions of aging, frequent falls, loss of strength and mobility are more difficult to manage on the street and in homeless shelters. Features of the shelter environment, such as bunk beds and shared bathing facilities, may increase the risk of falls and injury.
As aged homelessness grows, so too will the services and cost of healthcare services which include hospital and nursing home stays. It costs Denver Health $2,700 a night to keep someone in the hospital. Patients who are prime candidates for the transitional units stay on average 73 days, for a total cost to the hospital of nearly $200,000. (6) The hospital estimates it would cost a fraction of that, about $10,000, to house a patient for a year instead. (7)
In general, costs increase with age. Because many homeless older adults do have great health care needs and need support in activities of daily living, sometimes the only permanent shelter available to them is a nursing home; or worse, a jail or a psychiatric hospital. Sometimes called “institutionalization circuit”, individuals experiencing chronic homelessness are often caught between living on the street or in a shelter and living in an institution. (8) Since Medicaid funding pays for nursing homes, they are often the only placement options for very low-income older adults and people with disabilities.
Since homelessness is primarily a poverty problem, obviously increasing income support for low-income older adults and people with disabilities is an important step. Supplemental Security Income (SSI) is a safety net program administrated by the Social Security Administration that provides a very basic income to older adults and people with disabilities with no or only limited other income and resources. Currently, the federal monthly benefit for an individual is $771 and $1,157 for couple. (9) Although only four states do not provide additional small monthly supplemental to SSI, the federal monthly benefit amount requires a single individual recipients to live at 76 percent of the federal poverty line ($12,140 individual for 2019) and 84 percent for couples ($16,910 for 2019.) Clearly, SSI is no longer fulfilling its promise of keeping seniors and people with disabilities from living in poverty.
According to the Homelessness Research Institute, ten older adults await affordable housing for every unit of supportive housing that becomes available through the Section 202 Supportive Housing for Elderly program. (10) Besides more funding for Section 202 program; another way to improve the lives of low-income older adults who struggle with homelessness is to develop more affordable housing that includes or can be linked to supportive services.
Solutions that are working
Currently, to address the problem, hospitals from Baltimore to St. Louis to Sacramento, Calif., are exploring ways to help patients find a home. With recent federal policy changes that encourage hospitals to allocate charity dollars for housing, many hospitals realize it’s cheaper to provide a month of housing than to keep patients for a single night. (11)
Under a program funded by the Catholic Health Initiatives, Mercy Regional Medical Center, hired a social worker and a case manager to review records of frequent emergency room patients. With the combination of intensive case management and patient engagement helped to halve ER visits for the first 146 patients in the program, saving nearly $495,000 in Medicaid spending in less than three years. (12)
The solution cited above shows when all the sectors, public, private and government work together, we can address the problem because everyone deserves a roof over their heads without the fear becoming homeless.