Increasing Number of Homeless Seniors Demand Enhanced Support Systems

Shelters in Canada are not equipped to address the physical or mental health needs of the increasing number of older adults experiencing homelessness, according to a report released Tuesday.

Dr. Jillian Alston, lead author of the paper published in the Canadian Medical Association Journal, explained in an interview that homeless individuals age faster than those who are housed due to factors such as stress and the inability to properly manage chronic medical conditions.

“Many homeless individuals are considered seniors as early as age 50 because of documented physical and mental decline,” added Alston, a geriatrician at St. Michael’s Hospital in Toronto.

The report examined senior homelessness through the authors’ clinical observations and a review of multiple studies.

Alston noted that the need for support among seniors is increasing with the aging population. This includes both those who were already homeless and those who become homeless for the first time in their later years.

“I’ve seen numerous individuals in shelters who are in their 80s, and a few who have reached their 90s,” Alston said.

“Homeless shelters are not equipped to provide adequate care for seniors,” she said.

She highlighted several shortfalls, including insufficient space to safely store medications and a higher risk of falls due to shelters not being designed with accessibility in mind.

As a result, many seniors cannot receive the level of care they would otherwise get in a home-care setting.

“For instance, if somebody requires help or assistance with bathing or with wound care, but there’s not an adequate space for them to even receive that, then it’s difficult,” Alston said.

“We’re seeing an increase both in newly homeless older people as well as growing numbers of people aging while homeless,” said Dr. Lara Nixon, a family physician in Calgary who does outreach care.

“The affordable housing crisis puts many seniors at high risk of homelessness if just one thing goes wrong, such as losing a spouse, falling ill, or developing a disability,” she said.

Nixon concurred that existing systems, including shelters, fail to meet the needs of the homeless senior population.

“It’s a model that emphasizes autonomy and a return to independence, often with time-limited supports,” said Nixon, who was not involved in the report.

The expectation that individuals will return to work after receiving temporary shelter is not appropriate for older people, who are typically on an accelerated aging trajectory, appearing 10 to 20 years older than their stably-housed counterparts, she explained.

Alston and Nixon also agreed that many long-term care homes are not adequately equipped to care for seniors who have experienced homelessness.

“Anybody who has experienced homelessness is at high, high risk of being traumatized — just by that experience of homelessness, let alone what else has happened in their lives that led them to become homeless,” said Nixon.

The rushed pace many personal support workers must adhere to can exacerbate that trauma, as residents need time to build trust with their caregivers,” she said.

Alston noted that elderly people sometimes become homeless and are placed in “completely inappropriate” shelters, despite being on waiting lists for long-term care beds.

Moreover, most long-term care homes aren’t equipped to handle the mental health conditions and substance use issues common among the homeless population. These facilities often turn away seniors with addictions to alcohol or other drugs, Alston added.

Alston and Nixon advocate for a model that provides supportive housing, where seniors who have experienced homelessness can receive the medical, mental health, and addiction care they need.

One such program is run by WoodGreen Community Services in Toronto, where Alston regularly provides care. The 58-unit building is dedicated to seniors aged 55 and older who have been homeless. They live in bachelor apartments intended to be permanent residences, and residents aren’t required to meet specific conditions, such as being substance-free.

“Residents are primarily referred from Toronto’s shelter system,” she said. “Case managers then work with them to determine their available income, which may include social assistance, pensions, or supports they become eligible for after filing taxes.”

Alston and Nixon emphasized that programs like WoodGreen’s are successful because they integrate social services with healthcare, breaking down traditional silos.