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Weekend Reads | The Data on Our Aging Homeless Population

Kevin Schofield

This weekend's reads are a pair of reports — one from 2013 and a follow-up study published two months ago — that try to understand a puzzling aspect of the demographics of the country's homeless population. 

Here's the puzzle in a nutshell: A disproportionate share of the homeless population consists of single adults born between 1955 and 1965, the youngest of the "baby boomer" generation. This was first noticed as a spike in the mid-1980s, just as these folks were "coming of age," but it has remained consistent for 40 years: As they have aged, the spike has persisted. 

This group is primarily men, which is generally true for the homeless population as a whole. As a point of comparison, the researchers looked at data for homeless "heads of household," who are primarily young mothers of small children, and found that there is a "period phenomenon" for them: About 17% of homeless heads-of-households are ages 21 to 23, and it falls off from there as the age increases.

In contrast, for adult male shelter users (a close proxy for all single adult homeless individuals), in every year that it is measured, there is a spike for those born between 1955 and 1965 — regardless of their current age. Researchers call that a "cohort phenomenon." Every 10 years, the spike moves 10 years to the right.

But wait, you say, it's called the "baby boomer" generation for a reason; there are more of them, so it's likely they would be over-represented. And that's true, except that when you look at the "relative risk" for becoming homeless — statistically how likely it is that someone of a certain age will be homeless given the number of people who are that age and the percentage of them who are homeless — we see a higher risk for this cohort that persists over time.

Ah, you say, so they must be "chronically homeless": people who become homeless as young adults and have remained so, or moved in and out of homelessness over their adult life. But the data suggests otherwise: The majority of the late-baby-boomer cohort who are homeless and measured in these studies have no prior history of homelessness. Rather than a fixed set of people stuck in the homeless system, it seems to be the case that new people from this age cohort keep falling into homelessness. 

Forty years into this cohort phenomenon, researchers still don't have a clear understanding as to why it's happening. Many of the hypotheses revolve around some of the big societal and economic changes that occurred in the U.S. in the 1980s and may have impacted this age group as they entered adulthood: deindustrialization, deinstitutionalization, residential segregation, the rise of crack cocaine, reduced social welfare programs, and an economic recession that led to depressed wages for low-skill workers and higher unemployment. Some suggest the coming-of-age of the boomer generation was itself a factor: a population boom that led to tighter housing and more competition for good-paying jobs.

But regardless of why, there are important implications. In the short term, this cohort is reaching advanced age. They are now between 60 and 70 years old, whereas the average life expectancy for a homeless man is 64 (compared with 78 for all U.S. men). Since they represent such a large fraction of the homeless population, we will need to adjust the services provisioned for the homeless community to provide them with age-appropriate services that meet their needs — though the good news there is that social security and Medicare benefits will become available to them as they are now reaching the qualifying ages. The researchers note that elderly homeless individuals have "significantly higher rates of a number of geriatric symptoms including difficulty performing activities of daily living (ADLs), mobility and cognitive impairment, frailty, and depression." In fact, the researchers who wrote the 2013 paper were remarkably prescient in predicting the state of homelessness today by projecting forward from what they were observing 12 years ago:

These health problems mean that the health care providers who serve homeless populations will increasingly be required to provide care for chronic conditions. New models of care may be needed to manage such chronic conditions so as to prevent homeless individuals from requiring expensive long-term care in nursing homes or other settings. Similarly, facilities providing long-term care may need to adapt practices to serve formerly homeless individuals who may have significant behavioral health needs. In short, the increased demand for new types and longer term health care among single homeless adults and the accompanying housing needs of this aging population will soon be a potentially unique and major issue for communities, as well as health care providers and payers.

The housing needs of this population undoubtedly merit close consideration as well. As the single adult homeless population ages, an increasing number of individuals will become eligible for mainstream federal, state, and local programs that provide subsidized housing, care in an assisted living facility, or other forms of housing assistance for low-income elderly adults. While a certain proportion of the single adult homeless population will have their housing needs met through such mainstream forms of support, the homeless assistance system will nonetheless also need to be prepared to address the housing needs of an aging homeless population. This may include the targeted provision of permanent supportive housing (PSH)—defined broadly as subsidized housing matched with ongoing supportive health and social services—towards particularly high need individuals who may be likely to stay in hospitals for extended periods or require expensive nursing home care in the absence of a PSH placement.

While much of the response to homelessness — national and local — seems lackluster, where there have been successes, they tend to involve focused attention on the specific needs of a cohort, such as families with children, veterans, and Native Americans. It appears this is one more cohort that deserves special attention.

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