Abt Conversations: A Growing Number of Older Adults Are Unhoused. How Can We Help?

With reasons ranging from a lack of affordable housing to rising medical costs, more and more people over the age of 55 are experiencing homelessness. While the national data show the beginning of an alarming trend—with a 73-percent year-over-year increase in chronic homelessness among the elderly—the effects are in full bloom in Washington, DC. Abt’s Brooke Abrams talks to Miriam’s Kitchen’s April Veney and Adam Rocap—who provide supportive services in the capital—about what they’re seeing on the ground and how we can support, as well as address root causes.

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Eric Tischler: Hi, I'm Eric Tischler from Abt Global. Data from 2019 to 2021 show the number of elderly people with chronic patterns of homelessness increased by an astonishing 73 percent. While that portion of the overall unhoused population is relatively small, the trend obviously is alarming. But here in Washington DC, Miriam's Kitchen—a nonprofit organization working to end chronic homelessness in DC through outreach and connections to services, housing and advocacy—finds 60 percent of their housing outreach support clients are over 55. Given the organization's robust experience with this growing population, we thought we'd sit down and talk about how we can best serve and support elderly people who are experiencing—or emerging from—homelessness.

From Abt, I'm joined by my colleague Brooke Abrams. Brooke is a trained political scientist and health equity expert whose research and technical assistance has, among other things, helped deliver culturally relevant housing services and improve housing stability outcomes for BIPOC communities nationwide.

From Miriam's Kitchen, we're joined by April Veney and Adam Rocap. April is a senior permanent supporting housing case manager with lived experiences of homelessness. Her passion is serving others by meeting them where they are in life and helping them to reach goals beyond their own expectations. Adam is the Deputy Director at Miriam's Kitchen. He also is active in DC's Inter-Agency Council on Homelessness, particularly in efforts to end veteran and chronic homelessness. Thank you all for your time today.

April Veney: Thank you.

Brooke Abrams: Thank you.

Adam Rocap: Thanks. So glad to be here.

Eric: Brooke, I just provided a single data point on the trends we're seeing nationally. Can you provide a little more context? And then, Adam, we'd love to hear more about what you're seeing at Miriam's Kitchen.

Brooke: Absolutely. So there's just been a lot of work from our Annual Homelessness Assessment Report. Based off of the report, we are seeing that nearly 10,000 more people aged 65 and older are experiencing sheltered homelessness. In addition to that, the number of people considered nearly elderly who had chronic patterns of homelessness has also increased. What this means is folks in our aged population are experiencing homelessness for the first time, and we're also seeing increases in folks that are aging into chronic homelessness.

I think another thing that's important to name is there's an estimated 2.5 million elderly people that are close to homelessness or on the brink of homelessness, and we're also seeing national trends of older adult renters, which means there's going to be decreases in wealth among this population. We're going to see more cost burdened households. So one of the questions that I try to keep top of mind is, where do folks cut back? What part of their livelihoods might this population be forced to negotiate? I think, nationally, there've been a few studies that are exploring the ways where we can anticipate the future of the aging homeless population and how it impacts health and shelter systems.

Eric: Well, thank you. So Adam, what are you seeing? Because this population makes up a much more significant portion of Miriam's Kitchen's clientele.

Adam: Yeah, absolutely. So I guess first just a little background about Miriam's Kitchen. Like you mentioned, we're a nonprofit that's based in Washington DC and our mission is to end chronic homelessness, and we do that through a mix of direct service programs as well as local advocacy work. So, just looking at our direct programs, we have three main programs where we're serving and working with people experiencing homelessness. So, we have a dining room and a case management team that sees people every day as they come for meals, and we help connect people to housing, healthcare, and other income supports. We have a similar street outreach team who's working with people who are currently homeless, and that group is going outside of our building, outside of our dining room to wherever people are staying on the street. And then we also work with about 300 people who are formerly homeless—were homeless for many years—but are now in housing, and we're offering the support services for them in housing.

So on some of the aging trends, we're seeing things a little bit differently in each of those program clusters. I'll start first, I think we are seeing the most of the trends in aging in our housing program. So of those, a little over 300 people that we serve in the PSH program, over 60 percent of our clients are 55 and older, and over almost 22 percent are 65 and older. From people who are currently homeless right now in our dining room in DC, the percentages are a little bit lower. So in our dining room we see over 60 percent, are at least 45 and older and 15 percent are 65 plus or, if you look DC wide, 35 percent of individuals are 55 and older, and about 10 percent are 65 and older. So we're really seeing both of those things that Brooke mentioned, both people that we've known for many years who have gotten older as they've been homeless for a long time, and we're seeing some of what we're seeing in the national trends data about seniors that are becoming homeless for the first time.

Eric: Great, thank you. And April, why don't we start with you for this next one. What are you seeing that's driving these trends? What factors are making seniors particularly vulnerable to homelessness and what are challenges to helping them maintain their homes once they're rehoused?

April: So I work as a senior case manager for Miriam's Kitchen in our permanent supportive housing department, and we serve quite a few clients. A lot of them are over the age of 65, and some of the challenges that we see is their health declining, some are dealing with untreated mental health challenges or substance use. And, once they're housed, those are the challenges. Getting them connected to healthcare services, home aids if they need it, medication that they need, helping them get their medication and managing their medication. I mean, it's a variety of things that we see with our clients, especially our senior clients. A lot of them are at the first stages of dementia, so we have to make sure they're connected with the proper services and have families that are involved and connected with them, and that they're giving them the support that they need, as well.

Eric: Thank you. So Adam, how about you? So what are you seeing? What might you add that's leading to the higher rates?

Adam: Yeah, I mean, when I think about why are we seeing more older adults who are either currently homeless or the older adults that we're serving who are now in housing, I mean, it's really these two different causes that are driving things. So, one, we know from a lot of research that there's something about the group that was in the latter half of the baby boom that was born from 1955 to 1965, that they're disproportionately at risk of experiencing homelessness.

So, I've been working at Miriam's Kitchen for about 17 years. So, when I first started and I was working in direct services here, that sort of group of people was in their 40s on average. But now that same cohort of people that was born in the late 1950s, early 1960s is now in their late 50s and their late 60s. So whether we're seeing that sort of same age group that's in our dining room that's been homeless for a long time, or a lot of the clients that April served, when we've been successful on a city level, helping people move into housing, that group is still the most numerous group that we've helped move into housing, and they're older now.

But then when I think about the things that drive seniors now to become homeless for the first time or homeless again, I mean, it's really the same causes when we think about why did anyone become homeless in the first place. So it's fundamentally, economic factors. When housing costs that are rising across the country in urban areas like DC are getting higher, then anyone who is very low income is at risk of losing their housing. And then when you layer on the vulnerabilities and risks that come with aging, whether that's less ability to work, you can't bring in as much income, so now those high housing costs are even farther out of the way, or the way that health problems, health challenges, those sorts of things are often the thing that pushes someone into homelessness and that's things that are showing up more and more as people are becoming older. So it's not surprising that as housing costs are really high and now there's an even larger group of people who are older that we're seeing a spike from that group.

Eric: Gotcha. And Brooke, how about you? What are we thinking about as we're looking at these trends?

Brooke: Just in addition to what Adam and April are lifting up, one of the other things that I'd like to emphasize is when we're thinking about the overlapping of other systems, I'm even thinking about our mass incarceration policies, the justice system. We know that within our justice system we have things, especially within probation, for example, probation and supervision fees, fines, testing, things like that, for many aging and senior folks that are just being released from prison, for example, they can be very cost burdened and the experiences that occur while being impacted by the justice system often significantly worsen mental and physical health conditions, too. So that can also lead to things like a lack of social safety nets, also the ability to afford housing, of course. We also see things like employment barriers to starting and sustaining a job for those most impacted.

And then maybe even things like, upon return to their community, there's feelings of a sense of community erasure within that urban revitalization sort of context. And this might have occurred while they may have been incarcerated, for example. So just that sense of place, belonging, and a home to return back to, that can all be eradicated because of an interlocking system with housing and homelessness as well.

And then I think the other thing that I'd like to add to this is, because we're talking a lot about what impacts maybe likelihood—or things that exacerbate the likelihood of becoming homeless, and I think I'm also thinking about that inverse relationship to how can homelessness exacerbate some of the existing things that our aging population are already continuing. So things like cognitive decline, mobility, access to social networks. As we age, we understand also that our costs increase as well, but homelessness adds an additional barrier and an additional issue that really makes this a lot more complex. It speeds up cognitive decline, it speeds up our physical immobility as folks are aging, and that's if we want to manage wellbeing as we're aging. We don't want to just manage wellbeing, rather the goal is sustaining a high quality of life where folks that are aging can actually thrive. So that's another thing I've been thinking about as well.

Eric: But that maybe leads into the next question, which is what are the implications and additional complications for this population? And, April, you want to start?

April: Yeah, like I said, it's definitely people are experiencing early stages of dementia, they may be dealing with mental health issues or challenges that're not treated. Also, their health conditions may be declining. But, I mean, we see a lot of clients who more so do not want to address their mental health challenges, even admit to it, that they have them, want to say that, "Hey, I have an issue and I need some help." We see that a lot and part of our work is to just work with them to try to connect them with people who are understanding that, hey, they have not acknowledged that there is some trouble there, but we know that there is, and try to help them to see a little help won't hurt. It can definitely help you, especially in maintaining your housing.

Another thing is when we don't have the families to support people, that just adds an extra layer of stress, feeling rejected or different types of feelings that they may have as far as not having that family support and love, and they rely on having a case manager around. Some of them, you could call them and they'll talk to you for hours just because they have somebody there to talk to them and it's not their family. A lot of people with the rising costs of things, people have struggled with getting food. So the food insecurity is a big issue with our clients, so we make sure that they do have some food as well as resources to get food.

Eric: Right, thank you. How about you, Adam? What you’re able to describe is pretty extensive in terms of another layer of services that needs to be provided, but what else are you seeing?

Adam: I think in our programs, especially the housing program, we're seeing firsthand what the medical research on people experiencing homelessness has been telling us for a while, which is that, especially for people who have been homeless for many years, that group is experiencing the types of health problems or health conditions of someone who's 15 to 20 years older than a housed counterpart of theirs. So, in our housing program, if over 60 percent of our group are 55 and older, and 25 percent are 65 and older, the bulk of our clients are often experiencing the same aging and health issues of people who are 75 to 85. So, on some level, as the whole U.S. is wrestling with the baby boomers getting older and these trends towards aging and the solutions that need to be in place to manage that and give people the support and the care that they need, we're seeing that much earlier in our work with housed individuals who used to be homeless.

And it's from everything. So I mean, there's parts of the what's needed, which is integrating and embedding aging services and healthcare directly in, like, homeless-specific housing. So, for instance, in programs like ours, even if people are renting through a voucher throughout the city, how are we partnering with medical services or other aging services to make sure that that's embedded in permanent supportive housing that's within the homeless services system? There's home health aides that Medicaid will pay for that are available to everyone, but all the structural and systemic barriers that are there, not enough home health aides, how arduous it is to get that set up? All the things that we need to do on a mainstream level to help people age in place, those barriers are there as much or more for a lot of the people that we serve who have experienced homelessness in the past.

Eric: Thanks, Adam. Brooke, how does that align with what we're seeing nationally?

Brooke: Nationally, adults 50 and older who are homeless have a mortality rate four times higher than the general population. So, in terms of implications, these folks are disproportionately less likely to be able to prepare for end-of-life planning. Also, it's much more difficult to seek preventative care. So when we talk about burden on our healthcare systems, burden on overlapping and interconnected systems, I think that that's something to continue to think about as an implication. The last thing I'll name is there is significant diversity in needs, in supports, in subgroup experiences among our aging population.

What that means in terms of implication is that we're going to have to get innovative with our solutions, our interventions, and talk to different people so that we don't overgeneralize. I know that sounds very costly when we start thinking about programs and how policies can talk to each other and how policy makers can talk to each other, but I think the implication is that that will lead to maybe more coordination, collaboration, building partnerships with those most impacted. And being able to speak to what Adam said, how can we begin to bridge together supports, funding, things like that to speak to the diverse experiences of our aging homelessness population?

Eric: Do we want to talk a little bit about what gets you to this position, which is employment? We've talked about dementia, we've talked about the justice system involvement, what does this mean in terms of what kind of jobs are available that aren't too taxing, that provide a living wage that enables you to afford housing that have health benefits?

Adam: I mean, in a lot of ways, I think it does speak to why older adults are at higher risk for becoming homeless for the first time or another time more so than they used to be. And again, at one point, Social Security plus some money that you were able to save up could help you pay for the relatively much cheaper housing costs of the past. But now, especially in urban areas and other places that are really high-rent areas, it's not surprising that now someone who's an older adult who's either not working anymore or working part-time, like you said, Eric, has less access to some of the healthcare and the preventative healthcare.

It's not surprising that unless we keep investing in the social safety net and do things around addressing the housing costs that group of people many times won't have the family to support them or won't be able to draw on the right resources to help get through a crisis. And what we know for anyone, whether you're an older adult or a younger adult or middle-aged, when you first become homeless, the longer you stay homeless, the more some of the trauma and the impact of homelessness itself makes it harder and harder to get out. So 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.

Eric: Thank you. Well, that's a great pivot to my next question, which is what can we do to help turn the tide for more people in these different scenarios that you just outlined, Adam, whether they're older and newly unhoused or they're chronically unhoused? Let's go back and talk about how do we prevent people from being in this position in the first place. Maybe, start with you, Adam: What are some approaches that we know work, approaches we should be trying out? What do you think?

Adam: I think of it in a couple buckets, and maybe we can work backwards. So, for older adults or anyone who's experiencing homelessness right now, on some level, the solution is quite simple: How do we connect people as quickly as we can to a type of housing that is the level of support that they need, both financially and any services that are connected to it? So, for many people—especially people that have been homeless for a while and who are older—they're really going to need something that looks like permanent supportive housing, which is one of the more expensive housing interventions because it involves helping people with a lot of rental help for a long time, and embeds support services that April and her team provide that are really important. We know how to do that, we know it works, it's just about both having the public and private will to say, “Yes, we want to solve this problem and we want to invest the money in figuring out how to scale that up.”

As you go more upstream, there's more programs that are emerging that we know how to work where it is like a prevention program. So, someone who either is at risk for an eviction or who we know has a previous history of homelessness, and there's often some not-that-large investments in helping people pay for groceries or helping people stay who are staying with friends and family, help them figure out a small amount of money or mediation that might help that work. All those sorts of things can help people from becoming homeless and getting stuck in homelessness for a long time.

In some ways, since we know, especially for older adults, that being in housing, people's use of hospitals tends to go down, the length of time that they're in hospitals go down, their healthcare costs over the years are less than if they were homeless, there's actually just a wise choice to be made for us as communities to say, "Hey, wouldn't we rather spend that money on helping people being in housing and preventing a lot of these health problems than this money that we're going to have to spend later in healthcare costs?" Not to mention, the human suffering that's involved in the additional health problems in being homeless.

Eric: Right, thank you. Brooke, that sounds like stuff that Abt looks into, but before I pivot to you, I want to ask, April, is there anything that you wanted to call out that you're seeing as being particularly effective that we need to lean into more?

April: I think the biggest issue that a lot of our clients are having, especially when we're trying to house them are the rise in prices, the rental prices is ... DC is very expensive, so that's one of the biggest challenges that we have in helping our clients is getting reasonable, let me put it that way, housing. And I think that it definitely needs to be a bigger discussion because it's not getting any cheaper for anybody. And then, if we want to look like we're even making a bigger difference than we are, then it has to be discussed as how can we do better economically? It is just too expensive. It causes too many issues. Once somebody is housed, how can they afford their rent, even if they have a voucher? The cost of living isn't going up, but the prices are continuing to rise.

Adam: So as we've talked about here, aging and homelessness is a housing issue. More and more in the country, people are understanding how deep of a crisis there is about rising housing costs and affordable housing, so people can see themselves in the solution there. If we could help address housing costs, that's a key part of addressing aging and homelessness. I can see where I'm connected.

Brooke: We can easily see that a lot of folks are much closer to being cost burdened than maybe they'd like to express. I think if we can understand what can prevent homelessness, what support services would be really helpful for those that are experiencing or on the brink of experiencing poverty or homelessness, I think that that's something that we could learn a lot more about.

Eric: Thank you. That makes me think of our guaranteed income work, Brooke, but what else do you think we should be looking at more closely?

Brooke: I’ve got to say, at Abt, I think we're beginning to make the connection within our technical assistance approaches to think more deeply about equity and how pervasive trends of both first-time homelessness and chronic homelessness among our aging population exacerbate comorbidities. We talked earlier about speeding up decline and also thinking about mortality, how that speeds that up quicker than normal, but also how we can apply an intersectional lens to further understand the disparities within that trend as well.

To answer your question about solutions, when you ask that, I'm like, "Oh, this is so big." I really appreciate April and Adam naming that because it really requires us addressing multiple interlocking systems. One of the things that I was thinking about, aside from paying folks a living wage, dismantling systemic racism across systems, and we can name a few, but also just thinking about affordable housing and inequities in homeownership, we can also, I think, hone in on three things that I want to lift up.

So the first one is one thing that we all talked about today, which is how can we braid together funding across these overlapping systems and sectors to provide a diverse portfolio of social and economic supports? This is something that I really, really appreciate about Miriam's Kitchen. They talk a lot about this extensively in their mission and how they serve folks. The other thing that I think will really help is to coordinate with and expand our policy and funding decision-making tables with those most impacted. This leads me to my third point about recognizing the power that we hold within our organizations and our roles, allowing that to not just be about power-sharing, but power redistribution. This sort of connects to my last point, which is continue to build relationships with those most impacted and build relationships with those authentically and meaningfully partnering with those most impacted.

I think viewed one way our stories can be seen as a data point, if you will, that can have the power to inform what is happening with respect to aging homelessness. But I think more importantly, stories around experiences with homelessness will continue to humanize and speak life into the trends that communities and government officials are seeing nationally. So I think really elevating the voices of those most impacted, that's the contextual stitching, if you will, that's critical to lifting up more sustainable, tailored human-centered programs and supports.

Eric: Thank you. And you mentioned listening to people and building that trust. That's something we talked about with April and Adam's colleague, Wesley. That's something, Brooke, our colleagues on the encampments team talk about maybe that practical need. And April, maybe you could speak to this, or Adam—or Brooke—that practical need to just earn that trust so people know to come to you for support.

April: I think that it is so important to build the rapport with someone experiencing chronic homelessness and being a little transparent with them to be able to develop that rapport. Not everybody can relate to someone being homeless, and so I think that one of the things that I see is that everybody can't relate. And so having somebody that you can relate to and be able to talk to and you can trust is a big part of what we do. I think that is one of the most important things that we do, is build that trust with our clients so that they won't be scared, scared to trust the processes.

Because a lot of people that are experiencing homelessness, seriously, they have lost their trust in the system. They do not trust the government. They do not trust some organizations out here because people have... They 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. And that aspect is one of the biggest things that we must have for people in any type of situation is compassion, empathy, love, care, and show them that you there and that you understand.

So that's what I see. Because I see when people... If they can't relate to you or they're not feeling you, they're definitely going to back up from you and it takes somebody else who has the compassion and the patience and the care and everything that they need to be able to help them get through this process. You just got to have those skills.

Eric: Well, and you've got to invest in that, right? But it's that connection that helps connect people to services, because otherwise, I think what our colleagues at Abt have seen is that you can have a program that might help somebody, but if you can't earn their trust to get them to engage with that program, then they can't benefit from it.

April: Absolutely. Absolutely. And not everybody is naturally equipped with it. So that's why I say, if you do this work, you have to come with compassion. Because if you come with, "Well, this is just another job, let me help this person." That's not going to work out too well.

Eric: Thank you.

Brooke: I love that you said that, April, it resonates so deeply. I think one of the things that we're constantly thinking about at Abt is the reach of our work, the impact that it's having. And I think you said it so eloquently, if folks are not trusting us, if we're unable to hear them, to really see their experiences, even though we're not all best equipped or well positioned to be able to connect with folks’ stories and their experiences, but I think as we are able to equip ourselves to do that, as we are able to elevate the voices of those most impacted, we're also going to be able to reach them quicker. We're going to be able to reach them in ways that are much more tailored and impactful. And I think when we're able to foster a sense of community or trust with those we're working alongside, we're then able to really hear the fullness of their experiences.

So I think ultimately, trust really helps us to get more tailored. It helps us to lean in a way that can extend our impact. And I think at Abt, we're really focused on that north star of really improving the lives and the wellbeing of the people that we serve.

Eric: Thank you. So on that note, let's pivot to my last question. We talked about some things that might work, some things that do work. In the short term, what are some supports that could help move the needle for you, Adam and April?

Adam: That's a great question. So, I mean, on some level, we've talked really macro about how what's needed is big societal change or addressing housing, aging, ways that healthcare systems are broken, and that's all really important so we need people to be involved in advocacy and that movement stuff in whatever way fits for you. And for people that live in the D.C. area, there's ways to get involved with Miriam's Kitchen and advocacy directly here locally. But wherever you are, wherever you're connected to, that's an important step.

There's also places like Miriam's Kitchen and others where, I wish it wasn't the case, but for right now, for the short term, we're helping fill a critical need to make sure that people experiencing homelessness have meals. People that are staying outside in the winter have the type of coats and blankets that they need if they're staying outside, or like we were talking about some of the other weather seasonal things, the extreme weather that we're seeing in the change in the world also has huge health impacts. So places like Miriam's Kitchen, making sure there's enough water and sunscreen and other hot weather items that you need.

And all of that, also the expertise that we build to try to help make sure that the healthcare needs and complex medical services are making it to the people who are homeless right now or seniors that are housed. And all of that takes time and expertise and money. So places like Miriam's Kitchen need financial support. We couldn't do this without that. We couldn't do it without the people who volunteer. We couldn't do it without the people that get together and advocate. And that's all the things that make the amazing work that I think April's been the most eloquent in describing. It's what makes that possible. And so we're always looking for that hope and always really thankful for everyone that is part of our community making it happen.

Eric: April, do you want to add to that?

April: I think Adam put it very well, but I would say on a personal level, not an organizational level, is just treat people like humans. The next person, just because they don't look like you or they're not dressed like you or they don't have a home it doesn't mean they're not human and they doesn't have feelings, just be kind. And we need a lot of kindness in the world, especially when we're talking about aging people that are experiencing homeless or even people who are reentering society. Just be kind because kindness can go a long way.

Eric: Well, thank you all. I mean, as you've all said so eloquently, this is a multifaceted challenge, but if it's a puzzle, I feel like at least you've all laid the pieces on the table so we can start putting them together, hopefully. Thank you for joining me.

April: Thank you for having me.

Adam: It was such a pleasure, thanks for hosting the conversation and really highlighting how important it is.

Brooke: I just want to thank Miriam's Kitchen and all the folks that took all the work to put all of this together. I love that we're able to come to the table and have conversations about this and to come into community with each other. So thank you for a great conversation.