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This article is the second in a three-part series, offering a fresh perspective on a topic that aging services providers often overlook older adults experiencing homelessness. For this series, we are interviewing Brother Damien Joseph of the Society of St. Francis. Damien works with people experiencing homelessness in California and offers some incredible insights.  

You can read the first article here.

There will be one more post in this series, so make sure to stop back next week as we complete the interview.

Many people think of the homeless as younger, or even middle-aged. From your experience, how many people experiencing homelessness are age 55+? What struggles might they face that the younger homeless population doesn’t?

Your point is well made. In most reports I’ve looked at, “young” is defined as under 25 or thereabouts. HUD reports to congress seem to use this division. The category of homeless seniors is often left out, but the older homeless population is growing alarmingly fast.

In my personal contact with individuals living directly on the streets, I am alarmed both by how many very young homeless there are and by how many older homeless there are. Increasing income disparity, cultural changes, individual social and moral attitudes and a deeply flawed social safety net are among many factors contributing to the fact that no age group is safe from homelessness.

The unique struggles for older homeless individuals are many. Many do use an age well below 55 or 65 to define “older” among individuals who experience homelessness, because the toll it takes on a person physically and emotionally is devastating and certainly reduces life expectancy. I’m often surprised when a person who has been unhoused for an extended period tells me his or her age. That “little old homeless man” you see wandering around your town may turn out to be 50, not 70!

I know that, even in middle age, I find that a night away with a lousy mattress is taxing. Imagine, as a senior, how uncomfortable it is, sleeping on hard surfaces like the ground, concrete, cots or metal shelter bunks! Plus, many are sleeping exposed to the elements. Even in shelters, temperature controls can be unpredictable, and leaks and dampness abound.

The “street” population explodes in numbers every day around 7 or 8 a.m. That’s the time that many, if not most shelters require most of their residents to leave for the day, returning again in the evening. During those daylight hours, folks will have to deal with whatever temperature, weather and air quality issues there are. Escape from the sun, heat, rain and so on may be possible, or individuals may be continually “moved along” by business owners and police who don’t want to see them hanging around. Many cities have been actively removing public seating areas, or at least designing them to make lying down impossible. In some cities, including in San Francisco, it is illegal to sit down or set down your property on a public sidewalk. In order to comply with this law, an individual would literally have to remain on the move, carrying all of his or her possessions all day long. Businesses increasingly install what activists call “violent architecture” or “anti-homeless measures,” placing raised or jagged structures on flat surfaces to prevent them from being used to rest.

Finally, we must address the lack of access to appropriate health care and medical treatment. While this affects all people experiencing homelessness, the older population is clearly hit hardest. Most are uninsured or underinsured. State/federal program coverage generally gives them access to care, but certainly not the best available care. Elderly individuals without stable housing may find great difficulty in receiving any medical care requiring privacy, storing medications in need of refrigeration or other special conditions, keeping track of times for dosages and so on. Add to this continual exposure to infection, trash, body fluids, vehicle exhaust, smog and so on, and it’s remarkable that older people in this context can ever be healthy.

Clinics that specially serve this population exist, of course, but the one where I volunteered in San Francisco was continually swamped with demand, had few providers (with high turnover) and lacked access to easy referrals, specialty equipment and procedures that would be readily accessible in a private practice. I performed routine record reviews for patients due for follow-up but often found that they had no phone or address at which to be contacted, or that, in the frequent instability of temporary housing, they had moved, and their Medicare now required them to start over with a new clinic. Consistent care is rare. Many, even the very ill, never seek medical treatment until they end up in an ER. I met an elderly unsheltered man last year who asked for help filling his prescription for an infection on his leg. He pulled up his pant leg to reveal his entire lower leg blackened and necrotic. Had he been a properly insured, or able to pay consumer rate, he would have been instantly hospitalized for so serious an infection. But somewhere, some provider gave him a prescription for some cream and told him to figure out how to pay to fill it. This really drove home the issues with health care for me.

Health care is such an important example of what aging services providers offer. It’s hard to imagine how anyone could survive for long without appropriate care from trained professionals. Assuredly, this is a problem for our whole society one without an easy solution.

We hope you’ll join us next week when we conclude our interview with Damien Joseph and wrap up our discussion on the challenges faced by older adults experiencing homelessness.

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