The Atlanta Journal-Constitution
Old and homeless: Seniors flooding shelters
Safety net abandons elderly who lack health care, homes.
Beatrice Herron, 73, clutched a flier offering low-cost cable TV, imagining herself settling into an apartment, somewhere out of the Arizona heat where, like others her age, she can settle into an armchair and tune into a television of her own. Instead, the grandmother and former autoworker can be found most mornings in a food line, or seeking shade under the awning of a mobile street clinic. At night, she sleeps on a floor mat at a homeless shelter.
She laments the odors of human waste outside and the thieves who have victimized her repeatedly.
“My wallet’s gone,” she said. “My purse was stolen.”
She hardly stands out from the dozens of seniors using wheelchairs and walkers at a complex of homeless shelters near downtown Phoenix, or from the whitehaired denizens of tents in the surrounding streets -- a testament to a demographic surge that is overwhelming America’s social safety net.
Nearly a quarter of a million people 55 or older are estimated by the government to have been homeless in the United States during at least part of 2019, the most recent reliable federal count available. They represent a particularly vulnerable segment of the 70 million Americans born after World War II known as the baby boom generation, the youngest of whom turn 59 this year.
Advocates for homeless people in many big cities say they have seen a spike in the number of elderly homeless, who have unique health and housing needs. Some communities, including Phoenix and Orange County in California, are racing to come up with novel solutions, including establishing senior shelters and hiring specially trained staff.
“It’s just a catastrophe. This is the fastest-growing group of people who are homeless,” said Margot Kushel, a professor of medicine and a vulnerable populations researcher at the University of California at San Francisco.
The largest shelter provider in Arizona, Central Arizona Shelter Services, is rushing to open an over-55 shelter in a former Phoenix hotel this summer with private rooms and medical and social services tailored for old people. The facility will open with 40 beds and eventually reach a capacity of 170, but that will barely begin to address the problem of keeping older people safe and healthy. CASS says it served 1,717 older adults in 2022, an increase in one year of 43 percent.
In Orange County, a Medicaid plan is creating a 119-bed, first-ofits-kind unit that essentially will serve as an assisted-living facility exclusively for homeless people, said Kelly Bruno-Nelson, executive director for the plan, CalOptima Health.
“The current shelter system cannot accommodate the physical needs of this population,” she said.
In San Francisco, Portland, Oregon, and Anchorage, seniors are staying months in respite centers meant to provide a shortterm stay for homeless people to recuperate. In Boise, shelter operators are hiring staff with backgrounds in long-term care to help homeless clients manage their daily needs while living for long stretches in hotels.
The homeless population is famously difficult to count. People 55 and older represented 16.5 percent of America’s homeless population of 1.45 million in 2019, according to the most recent reliable data. Dennis Culhane, a professor and social science researcher at the University of Pennsylvania, said the population of homeless seniors 65 and older will double or even triple 2017 levels in some places before peaking around 2030.
“It’s in crisis proportions. It’s in your face,” Culhane said. “Average citizens can see people in wheelchairs, people in walkers, people with incontinence and colostomy bags making their living out of a tent.”
A devastating combination of factors is to blame for the rising problem. People in the second half of the baby boom, who came of age during recessions in the 1970s and 1980s, face distinct economic disadvantages, Culhane said. Housing costs are soaring in many cities. The nation’s system of nursing homes and assisted-living facilities is not equipped to handle the needs of homeless people, who suffer from high rates of substance abuse and mental illness.
Before Phoenix officials began clearing some streets of people this month, there were about 900 people living in a few square blocks known as “The Zone” and another 900 or so living in emergency shelters on the gated Human Services Campus in the same neighborhood, shelter operators said.
In Maricopa County, which encompasses the Phoenix metro area, an annual count in January documented more than 2,000 homeless people 55 and above, nearly a third of those 65 or older.
Living on the street ravages the human body, street doctors and advocates say. Homeless people contract diseases and other geriatric problems much earlier than average. But long waits for housing and a lack of specialized care expose them to a continued onslaught on their health.
After treatment for an acute illness, hospitals often discharge homeless patients, who wind up back in shelters or even back into their sidewalk tents and makeshift lean-tos, in what health practitioners in Phoenix ruefully call “treat-and-street.”
The threat of relapses and rehospitalizations is large. Aid workers said seniors’ medicine is often stolen by younger homeless people. It is not unusual to assist clients with dementia.
Staff at CASS pass out adult diapers. Some unhoused seniors wait in the CASS shelter for a year or more while they wait placement in subsidized housing, assisted living or a nursing home. But CASS is not licensed to provide nursing-home-level care, and staff are not trained as nursing assistants. So patients cannot remain if they have advanced geriatric care needs and require help with activities of daily living such as dressing, eating and going to the bathroom.
“They need a higher level of care than the current shelter system can provide,” said Lisa Glow, chief executive of CASS. “There have been times here where we had to turn people away, where it’s really heartbreaking. They come in a wheelchair, late at night, and they can’t take care of themselves.”
In those instances, staff work to get an alternative space as quickly as possible, such as a hotel, she said.
In Phoenix, summer heat is on the way, which poses a particularly grave threat of dehydration, heat stroke and burns from bare feet -- arms and legs coming into contact with blisteringly hot concrete and asphalt.
“Quite a lot of our patients have mobility issues,” said Mark Bueno, a primary care doctor who treats patients living on the streets from a mobile clinic run by Circle the City, a local homeless aid group. “I have patients in their 80s out here.”
In years of researching homelessness, Kushel has catalogued countless paths to sudden homelessness for older adults. It often involves the death of a spouse or parent, which means income is lost and rent and mortgages can no longer be paid, she said.
Other long-term, chronically homeless people are simply aging on the street.
Medicaid, the health insurance program for the poor, will only pay for a long-term nursing home or assisted living bed if someone is unable to care for themselves. Many elderly homeless people are not debilitated enough.
“That’s where the gap in the system is,” said Regan Smith, longterm care ombudsman program director in Maricopa County.
A pinball effect takes hold, said health-care providers, shelter operators and advocates. Homeless people bounce from homeless shelter to hospital, then to a nursing home for a short-term recuperation stay. Once that shortterm stay ends, nursing homes must decide if the person is infirm enough to qualify for long-term care. If the answer is no, they must leave the nursing home, starting the cycle over again.
In New Mexico, 69-year-old Steven Block, suffering from memory problems, ended up homeless in the lobby of a Coyote South hotel in Santa Fe this year after being evicted from a nursing home in Taos, Block’s family members said.
Block, a former reporter for a community newspaper in southern Colorado, abused alcohol and suffered a fall near his home in Raton, New Mexico, said Terrie Gulden, his brother-in-law. He suffered hip and shoulder fractures and was treated in an Albuquerque hospital, where doctors discovered he had dementia, Gulden said. He transferred to the Taos facility in June 2022 but was discharged with no notification to the family on the last day of January, Gulden said. Block, who had some socks and a change of underwear in a garbage bag, was unable to tell his family how he ended up in Santa Fe.
“I had no idea that was happening until I got a call from a Santa Fe hotel that he was in their lobby. He had no money, no papers, no discharge papers. He was just out on the street,” Gulden said. “I can’t believe that this stuff happens across the country. I know it does, but when it happens to you, it just floors you. It’s unbelievable.”
After he spent two weeks in a homeless shelter in Santa Fe, the local fire department gave Block a ride to the Albuquerque airport, Gulden said, so Gulden could pick up him up and bring him back to Minnesota to be near family.
He was lucky to have relatives who could whisk him to a safer environment. Block now resides in a subsidized apartment. He has family and paid help assisting him with meals and housecleaning.