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Addressing Soaring Homelessness in America Among Senior Citizens. What Can Reverse the Trend?

By Senior Writer Stan Crock, with video by Senior Producer Colby Gottert and graphics by Senior Digital Designer Puneet Kaur

Homelessness in America is increasing dramatically among senior citizens—a trend 61-year-old Wesley Thomas knows all too well. After 29 years living on the streets of Washington, D.C., Thomas understands the challenges—and the promise—of tackling the rapid aging of the population experiencing homelessness.

In 1988, he found himself sleeping in Lafayette Square across the street from the White House, a far cry from the middle-class home from where he was born. “I was frightened, homeless, penniless, with only the clothing on my back and not a clue where I would sleep or eat,” he recalls. Others on the street who knew the ropes offered him blankets and showed him a safe place to rest his head for the night. The next day, they introduced him to Miriam’s Kitchen, which offered restrooms, a hot breakfast—and, importantly, emotional support. “It was like a safe haven,” he says.

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Twenty-eight years after his introduction to Miriam’s Kitchen, Thomas was talking to a friend who had just received a disability check, and then the friend slept in a park near the World Bank. The next morning, he was found dead on a bench. It shook Thomas to his core. “I didn’t want to die on a bench,” he says. He decided to take his life back.

Miriam’s Kitchen helped him get permanent supportive housing, which provides financial assistance for housing as well as services ranging from outpatient and mental health services to food and job training. He can see doctors, get therapy, eat healthy meals, and participate in substance use programs. He’s been clean for seven years. And he has helped 37 people find housing and stability. “I dedicate significant time, effort, and energy to seeing that others do not fall into chronic homelessness,” Thomas says.

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Homelessness in America: Examining the Crisis

Gathering homelessness statistics in America is critical to understanding the crisis. So, one night every January for nearly two decades, communities across the nation have gathered data on people sleeping outside or in shelters. Abt Global, whose staff volunteers at Miriam's Kitchen, has helped track homelessness in the U.S. by collecting and analyzing the data and estimating the number of people who, like Thomas, experienced homelessness. The figure in January 2022, the most recent data available, was 582,500. Abt’s work, in collaboration with communities, results in important data presented in the Department of Housing and Urban Development’s (HUD) Annual Homeless Assessment Report (AHAR) to Congress to inform decisions about policies, funding, and what services to provide.

Abt’s analysis of homelessness over the course of the entire year 2021 found that an estimated 1,214,000 people experienced sheltered homelessness at some point during the year. Sixty-two percent of them were doing so for the first time, while 28.2 percent of them had chronic patterns of homelessness—a 32.7 percent rise from 2019. The number of unsheltered people experiencing homelessness adds to that total. Because of COVID-19, HUD waived the requirement to count the unsheltered in 2021, but the results from the 36 percent of communities that did count those without shelter showed that they accounted for 18 percent of people experiencing homelessness.

More recently, from 2022 to 2023, the area Miriam’s Kitchen serves saw an 18 percent jump in homelessness, and the rise is unabating. That’s because some people who are just one paycheck away from losing housing actually lose it—and those who lose their homes have a hard time bouncing back from homelessness. “The trends are alarming, it feels really overwhelming, and there’s no magic wand to fix it all,” says Katie Kitchin, Abt’s director for state and local housing and asset building.


Homeless Senior Citizens

Homeless older adults account for a fast growing percentage of those without housing. Washington Metropolitan Area Council of Governments data show that people 55 and older are the largest age group of single people experiencing homelessness. The 2021 AHAR found the number of people aged 65 and older with chronic patterns of homelessness increased by an alarming 73 percent from 2019 to 2021.

Age Distribution of Single Adults Experiencing Homelessness


Source: Washington Metropolitan Area Council of Governments

And a 2016 study by researchers at the University of California San Francisco noted that half of single people experiencing homelessness were aged 50 and older, compared with 11 percent in 1990—a 354 percent increase. The pace intensified for the older cohort in this group: from just 2009 to 2017, the percentage of people 62 or older who experience homelessness nearly doubled, and the average age of unhoused adults soared from 30 in 1990 to 62 today. From 2017 to 2030, the number of senior citizens experiencing homelessness is projected to triple.

The aged homelessness population is growing rapidly and will continue to grow for the next decade.


Source: Emerging-crisis-of-aged-homelessness.pdf (upenn.edu)


Causes of Homelessness

The causes of homelessness among senior citizens are many and varied. One is demographics. A new report by Harvard’s Joint Center For Housing Studies notes that the U.S. population 65 and over jumped by 34 percent from 2012 to 2022 and now accounts for 17 percent of the population. Within the coming decade, growth in the over 80 cohort will accelerate. That will require accessible housing and lots of support.

Baby boomers who have experienced chronic homelessness in the past, particularly those born from 1955 to 1965, are simply aging into senior status. Other senior citizens are experiencing homelessness for the first time. “Health problems are often the thing that pushes someone into homelessness, and that's showing up more and more,” says Adam Rocap, deputy director of Miriam’s Kitchen. Other economic shocks also can play a role: losing a job, a divorce, or the death of a spouse or partner, which becomes more common as people age. Though the government has housing programs to help, “demand dramatically outstrips supply,” the Harvard report says. The U.S. simply isn't prepared to house or care for this surge.

The Housing Market

Housing costs are another factor. Kitchin notes that in the top 50 markets, housing prices rose by as much as 40 percent following the pandemic. Nationally, the median rent jumped $268 from 2015 to 2021. And the Government Accountability Office found that every $100 rise in median rent was associated with a nine percent growth in homelessness in the areas studied.

In addition, in 2021, 5.9 million older households rented their housing unit and had very low incomes (less than 50 percent of the area median income). Forty percent of those households “are close to homelessness or on the brink of homelessness,” says Abt’s Brooke Abrams, an equity manager with extensive housing experience. Adds Kitchin: “We can expect to see a rising homeless population as short-term pandemic-era eviction moratoriums and rental assistance programs all wind down—at the same time rents are escalating.”

An acute housing shortage makes matters worse. The St. Louis Federal Reserve’s data on active housing listings show a 49 percent drop from August 2016 to October 2023. Kitchin compares the situation to a game of musical chairs—with far more dire consequences. “You need 10 chairs, and you’ve only got eight,” she explains. “Someone with a medical condition or mental health disorder or substance use disorder isn’t going to be able to grab the chair. But the problem isn't necessarily that there are physical or behavioral health conditions, it's that there aren't enough chairs. These trends are very clear.”

The Effects of Racism

Many communities resist building low-income housing because of the new neighbors who would move in. “A lot of people are biased to homeless individuals,” Thomas says. “It's a stereotype. They're going to rob you. They're going to kill you.”

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An element of racism often lies behind the opposition. A disproportionate percentage of Black people experience homelessness. In 2022, people who identify as Black made up just 12 percent of the U.S. population but 37 percent of people experiencing homelessness and 50 percent of people experiencing homelessness as members of families with children.

This is a consequence of systemic racism. Racial bias can be present in every stage of the employment process, from job ads and hiring to pay, promotions, and discipline. And when Black workers get a decent job, they face discrimination when applying for a mortgage, getting charged higher interest rates than equivalent white mortgage applicants. Structural racism also has long been a part of U.S. health care and the criminal justice system. All of this conspires to increase the odds that Black individuals and families will experience homelessness. “Dismantling systemic racism across systems” is critical, Abrams says.

Housing Policy

A shift in federal housing policy aggravated matters. The government used to spend significantly on creating rental housing and affordable homes. Now the bulk of housing investments take the form of mortgage deductions for homeowners. Both spending and tax policies impact the budget, but in different ways. “We’ve flipped,” Kitchin says.

Resistance to public spending means the homeless system relies mostly on short-term rental assistance investments. “So, you'll get three to six months of help with your rent, and then you're on your own,” Kitchin says. That might work for younger people experiencing homelessness who can bounce back with a little rental help. They can get a new job or recover from an illness. But for senior citizens, “the thought that they can just bounce back in three to six months is not necessarily realistic,” she says. “What they need is long term affordability.”

Climate Change and Homelessness

Climate change and homelessness can be a deadly combination. Excessive heat events—abnormally high temperatures or humidity for an area at that time of year—"increase the number of daily deaths and other nonfatal adverse health outcomes,” says the Environmental Protection Agency. The most vulnerable groups include those who experience homelessness, are older, poor, or have physical challenges or mental impairments. The EPA declared that these events “are and will continue to be a fact of life in the United States.” It noted that excessive heat was responsible for about 120 deaths in Philadelphia in July 1993, more than 700 in the Chicago area in July 1995, and more than 15,000 in France in August 2003.


Facts About Homelessness and Its Impact

The facts about homelessness and its impact are clear. Lack of shelter has debilitating health effects on those experiencing homelessness. A study of Oakland in The Gerontologist showed that adults older than 50 experiencing homelessness have far worse health than housed adults decades older. On the streets “50 is the new 75,” says Abt partner Dr. Margot Kushel, a professor of medicine at the University of California San Francisco and director of the Benioff Homelessness and Housing Initiative.

Younger adults experiencing homelessness have worse health than much older housed adults


Source: The Gerontologist; *from a separate study of senior citizens with income of less than 200 percent of the federal poverty level

Thomas can attest to the huge physical and mental toll of chronic unsheltered homelessness. Knees hurting from sleeping on the cold ground. Rheumatism, high cholesterol, and diabetes. Bipolar disorder, depression, and anxiety. People who live on the street “age a lot harder and a lot different,” he says.

Those experiencing homelessness may be eligible for Medicaid and Medicare to help address their illnesses, but don’t know how to apply for benefits, don’t have access to healthcare providers, or don’t trust institutions. They also may not acknowledge their health issues. “Lots of clients do not want to address their mental health challenges or even admit to it,” says April Veney, senior case manager at Miriam’s Kitchen.

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Another Oakland study published in 2023 in JAMA Internal Medicine found older adults experiencing homelessness had a mortality rate 3.5 times higher than comparable housed senior citizens. The most common causes of death were heart disease (14.5 percent), cancer (14.5 percent), and drug overdose (12 percent). The study covered deaths through December 31, 2021, and COVID-19 played a minimal role after March 2020.

It doesn’t have to be this way. “We know, especially for older adults, when they’re in housing, their use of hospitals tends to go down the longer they're housed,” says Rocap. “Healthcare costs are less than if they were homeless. Wouldn't we rather spend that money on helping people be housed and preventing a lot of these costly health problems we’ll pay for later? Not to mention the human suffering that's involved. Spending the money on housing is actually just a wise choice.”


How To Solve Homelessness

Some experts have tackled the issue of how to solve homelessness with some success.

Take the Department of Veterans Affairs (VA). The VA’s Homeless Programs Office (HPO) has implemented Supportive Services for Veteran Families (SSVF), a best practice rapid rehousing and homelessness prevention program and has helped place hundreds of thousands of Veterans and their families in permanent housing. VA programs have helped cut the number of Veterans experiencing homelessness by 55 percent since 2010 and 11 percent since 2020.

Since the program’s inception, VA has contracted with the Technical Assistance Collaborative (TAC) and Abt to provide technical assistance (TA) to more than 250 private, non-profit organizations that receive grants to re-house low-income Veteran households. Abt’s work includes remote and group training, published guidance, and tools to support grantee operations and growth, community planning efforts, and implementation of promising practices.

The VA’s housing programs have had to evolve to serve an aging population. Almost half of Veterans in the U.S. are 65 or older. More than 60 percent of Veterans in the HUD-Veteran Affairs Supportive Housing Program (HUD-VASH) are older than 60. Abt's TA for HUD-VASH, among other things, included creating guidebooks for the field to support the development and operation of service models that can meet the needs of aging Veterans, including housing models with enhanced services.

Dempsey Spruell is a Veteran who benefits from VA programs. After four years in the Air Force, he found life outside the military routine daunting. He bounced around, ending up in Chicago, spiraling downward into mental illness and drug use and sleeping on the cold cement in the Loop during the Windy City’s unforgiving winters. Then the Thresholds Veterans Project stepped in. A community support specialist has been meeting with him regularly. He has access to therapy. And he’s living in a studio apartment. “I have a home,” Spruell told the VA. “I enjoy bein’ inside.”

 

The More Difficult Senior Citizens Solutions

As hard as the general homelessness issue is to solve, addressing issues for the aging population experiencing it might be even more complicated. Senior citizens need specialized housing due to geriatric conditions. Bunk beds won’t work because of the risk of falling. Wheelchair access and nearby medical care are critical. With the chances of a major federal program to tackle the issue slim, states and cities will have to devise remedies.

The solutions need to take into account that “there is significant diversity in needs among our aging population,” Abrams notes. “We're going to have to get innovative with our solutions, our interventions, and talk to different people so that we don't overgeneralize.” The focus can’t be solely on those without shelter. “The trauma and the impact of homelessness itself makes it harder and harder to get out,” says Rocap. “It's why we really need to be focused on not only helping everyone who's homeless right now get into housing and get the supports that they need, but that we're really looking big picture about how to prevent people from becoming homeless in the first place.”

Solutions for Homelessness: Programs and Strategies That Inspire Hope

Some solutions for homelessness for non-Veterans inspire hope. “There are examples of success that could be scalable with a shrewd deployment of resources,” Kitchin says. In fact, the United States Interagency Council on Homelessness (USICH) notes that the Biden administration has helped 105 communities end homelessness for more than 140,000 people. “Communities can make progress even under the most difficult circumstances,” USICH Executive Director Jeff Olivet said in a statement. “While we have a long way to go to end the life-and-death crisis of homelessness in this country, the work communities have done to house more than 100,000 people is a great start.”

Programs:

  • Permanent Supportive Housing (PSH). PSH provides an ongoing subsidy with intensive wraparound supports. This model has been effective at keeping people off the streets and out of emergency shelters and reducing encampment populations.
  • Housing Choice Vouchers. Ongoing rental subsidies, like the Housing Choice Voucher program, have been demonstrated to be the most effective way to prevent homelessness and returns to homelessness. Abt has studied local housing authorities’ efforts to use vouchers to promote exits from street homelessness, and the Family Options study highlighted the critical role of vouchers in reducing homelessness among families.
  • Sec. 202/811. These two HUD-funded initiatives provide rental assistance. They have helped develop small-scale multifamily housing projects that have housed senior citizens and people with disabilities, enabling them to avoid homelessness and institutional care.
  • Program of All-Inclusive Care for the Elderly (PACE). Some communities have combined the individualized care planning and residential supports offered through Medicaid and Medicare PACE programs with affordable housing financing tools to create an enriched service model promoting healthy aging in place. 
  • Home Repairs/Home Modifications. In many cases, a person may have access to services but needs home repairs or modifications to safely age in place. Various federal, state, and local home repair programs have existed for decades but often have limited funding or restrictions that limit their use.

Strategies:

  • Expanded use of Medicaid funds. Some states use Medicaid for supporting housing activities and tenancy supports, including finding housing, providing short-term rent assistance, and financing the wraparound services to connect senior citizens to medical and behavioral healthcare.
  • Homelessness Prevention/Emergency rental assistance. These strategies provide short-term help with rent and utilities to households that lost income. They reduce evictions and resulting homelessness as evidenced during the COVID-19 pandemic.
  • Shallow subsidies. These subsidies are shallow compared with traditional deep subsidies such as those provided by Housing Choice Vouchers and PSH. Shallow subsidies provide a lower level of assistance, often a set monthly amount, to those with fixed income so they can keep up with rental payments.

States and cities need information and data about pilots and models to make informed decisions about which initiatives to adopt. In addition to AHAR, Abt has been in the forefront of providing TA and evaluating programs that states and cities have undertaken. And we have developed tools for HUD, the Stella Performance tool and Stella Modeling, to help governments make evidence-based decisions about the best approaches to support their most vulnerable residents.

 


How Does Homelessness Affect the Community?

Homelessness affects the community in multiple ways. For one thing, pretty much all of these ideas have one thing in common: they cost money. But Miriam’s Kitchen asks a simple and important question: What is the cost of doing nothing? It has a simple and important answer: it’s enormously costly for the community. The annual per person cost of emergency responses for people experiencing chronic homelessness—emergency room visits, ambulances, police interactions, inpatient hospitalizations, and crisis services—comes to $40,843 in D.C., according to the report, Miriam’s Kitchen, 40 Years of Ending Chronic and Veteran Homelessness. The cost of permanent supportive housing, the report says, is less than half that: $15,889.


Source: Miriam’s Kitchen, 40 Years of Ending Chronic and Veteran Homelessness

The cost of supportive housing varies by locality and is likely higher in 2023. But for legislators of any political stripe who care about wasteful spending, this is an easy call. Doing the right thing is a wise investment: cheaper, effective, and humane. Such trifecta wins are rare. This is one.

Ultimately, though, programs aren’t the whole answer. People are. People on the streets “have lost their trust in the system,” Veney explains. “They do not trust the government. They do not trust some organizations out here because people show up, but they're not showing up with care and compassion. They're not showing up with a listening ear. They're not showing up with the love and support someone needs.” The people in the community who help need to have the right skills.

That's not the entire answer, either. Communities need a broader cultural change in attitudes toward people experiencing homelessness—far more empathy for their struggles—to foster public support for both organizations such as Miriam’s Kitchen and government programs. “Just because they don't look like you or they're not dressed like you or they don't have a home doesn't mean they're not human,” says Veney. She has a few words for those who have a roof over their heads, advice about what everyone can do, cost-free, to help bring those less fortunate out of the cold and back into the community: “Just be kind because kindness can go a long way.”


Wesley Thomas Saw the Challenge—and Now Sees the Promise

Wesley Thomas received that kindness and now is paying it back. He joined Miriam Kitchen’s Speakers Bureau and advocacy team. He has testified before the D.C. City Council and has been profiled in The Washington Post as he tries to change perceptions about people experiencing homelessness—and how they should be treated. That means, among other things, their inclusion when policymakers and organizations such as Miriam’s Kitchen make important decisions. Thomas knows that when they get input from people who have spent time on the streets, the outcomes are better. “I didn’t read it in a book,” he says. “I lived it.”

There’s Rural Homelessness, Too

Rural homelessness is different. The usual picture of homelessness is a tent encampment in a big city’s downtown district or under an overpass. But there is homelessness in non-urban areas, too. It doesn’t look the same, and the solutions may be tougher. “The wages were so low that you can’t build housing for people,” says Katie Kitchin, who has worked on housing in Kentucky.

In cities, the government subsidizes rent, with renters picking up the difference. In rural areas, the low wages require a 100 percent subsidy. But the low tax base from low wages and resistance to spending money on social welfare programs mean public funds aren’t available. That leaves what renters can pay. “What kind of housing can be created for $250 a month?” Kitchin asks. “That’s impossible.”

The result isn’t tents but substandard manufactured houses, often ramshackle mobile homes without plumbing, perhaps a half-step above tents, on land the residents don’t own. It’s unsuitable housing. “It looks different,” Kitchin says, “but the homelessness rates are going up in these rural areas in the same way that they’re going up everywhere.”

It may not be a tent city, but it’s no way to live. Either states will have to be more creative to find solutions—and Abt can help them do that--or Washington will have to step up.

Our gratitude to Wesley Thomas and Miriam’s Kitchen for sharing their stories and insights with us.

 
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