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Healthy aging through an equity lens: Older adults experiencing homelessness
By Sarah Dyer from BC Healthy Communities (Cross-Posted with permission)
The development of Age-friendly Communities involves a policy approach to creating conditions that allow older adults to stay connected and age healthily in place, whether in their home or in their community. However, what does this look like when older adults don’t have a home? With the population aging in Canada and around the world, the number of older adults experiencing homelessness is also rising nationally and provincially. In 2018, 20% of people who identified as experiencing homelessness in B.C. were 55 years and older.
The uneven distribution of the social determinants of health––systemic and structural inequities––means that not everyone has access to the opportunities, power or resources that allow for healthy aging. To achieve inclusive Age-friendly Communities, we need to consider healthy aging through an equity lens. Historically, older adults have not been a part of the dialogue on homelessness, with this group having been under researched, and homelessness interventions and strategies within Canada generally focused on younger populations.
When the challenges of aging intersect with existing vulnerabilities, such as experiencing homelessness, the challenges of both are amplified and result in distinct needs for older adults. Those aged 50 and older experiencing homelessness encounter age-related health conditions 1 to 2 decades earlier than older adults who are housed. In the context of homelessness, age 50 and over is considered “older,” while the minimum age for seniors’ services is age 65.
Pathways to Older Adults Experiencing Homelessness
The Canadian Observatory on Homelessness shares that homelessness can be the result of a multiplicity of factors, including societal or systemic barriers; a lack of affordable and appropriate housing (including rental); personal or household financial, mental, cognitive, behavioural or physical challenges; as well as racism and discrimination.
Those who first experience homelessness at age 50 and older more often have gone through a financial or health crisis in later life, lost a loved one or experienced a relationship breakdown (particularly for women), come up against barriers to continued ability to work (such as ageism or health issues), or experience no or low pension or low fixed income. On the other hand, those who experience homelessness for the first time before age 50 tend to have had adverse experiences in early and/or younger life, mental health conditions, underemployment, incarceration, or substance use disorder. These different pathways point to a need for different approaches to preventing and addressing homelessness and providing support within older adults.
Areas of action
Healthy Housing is an important determinant of health and is affordable, appropriate, accessible, of good quality, and is more than simply shelter. For example, it affects the ability to access health care and gain employment, and positively contributes to health.
Housing First is a proven approach to addressing homelessness, which imposes no restrictions or eligibility criteria to access permanent independent housing and is combined with wrap-around support. This approach has been applied to other groups in Canada, and it is important to determine how it can be appropriately tailored to older adults.
Research in this area has been underway in B.C. and has identified Promising Practices for Supporting Older People Experiencing Homelessness, along with gaps in supports and services, and shelter and housing needs. The City of Abbotsford has developed the Abbotsford Coordinated Intake and Referral System, providing access to housing, income assistance, support connections, and services that address complex physical and mental health needs in those of all ages experiencing homelessness.
Taking a preventative approach, it is also imperative to provide affordable, accessible, and supportive housing for all older adults regardless of income level, since only those with higher incomes and investments are able to afford existing supportive housing, such as retirement and continued care homes and communities.
An example of a shelter/housing continuum for older adults. In the past, continuums like these have been called simply “housing continuums” but this renaming recognizes that shelter spaces are not housing and may not constitute part of a pathway toward housing. Image credit: Hanson Lee, Communications Research Assistant via SFU’s Aging in the Right Place (AIRP) Research Unit.
Expand Seniors’ Services
Since premature aging is associated with homelessness, chronological age is not the best indicator of need for seniors’ services. It would be beneficial to expand services normally available only for seniors (age 65 and older) to people 50 and older in relation to those experiencing, or at risk of experiencing, homelessness.
Engage with older adults with lived experience for solutions
In planning for addressing and preventing the experience of homelessness in older adults, bringing older adults with lived experience of homelessness (past and/or current) to the planning and decision-making tables yields responsive and sustainable results, as they know best what they need.
Apply equity lens to policy and program decision-making processes
At all levels of development, including policy, it is vital to engage the community––especially those with lived experience of homelessness. In terms of policy, it’s important to think about Health in All Policies, since many of the opportunities and impacts around health are outside of the health sector, such as housing, for example.
A complex issue: A multi-pronged approach
Since the pathways to older adults experiencing homelessness are a result of systemic and structural barriers, approaches to prevention have to take place at that same upstream level, alongside shorter-term solutions that address current homelessness. Also, similar to the process of building Age-friendly Communities, these and other possible solutions to older adult experiences of homelessness require partnerships and collaboration across sectors and levels of government.