By Lori Mars, JD
November 18, 2020
Through much of the past year, COVID-19 has unleashed unprecedented harms and exacerbated preexisting hardships for older adults worldwide. One particularly devastating effect of the contagion has been the descent of older adults at the economic margins into poverty and increased threat of homelessness. Prior to the pandemic, the aging homeless population in the United States was on the rise.[i] The coronavirus has placed them in an even more precarious position.
Older adults who experience homelessness are projected to more than double by 2050.[ii] While many in the older cohort have lived on the streets for a generation and aged into chronic homelessness,[iii] a majority are now experiencing homelessness for the first time. Rent burdened, food insecure, and laden with high health care expenses, thousands of elders have fallen below the poverty threshold and onto the streets. Over 30 percent of the total homeless population live in outdoor areas that are unsafe, crime prone, and neither intended nor suited for human habitation.[iv] Bereft of housing, economic reserves, and social supports, those who are homeless in older age are prey to opportunistic predators and targeted for mistreatment.
Unsheltered homeless elders may be the least recognized but largest concentration of individuals subjected to elder abuse. According to Brett Feldman, MSPAS, PA-C, Director of Street Medicine at the Keck School of Medicine of USC, and Vice Chair of the Street Medicine Institute, the vast majority of older adults on the street experience some, and frequently recurrent, forms of mistreatment. Elder abuse is both a precipitant and consequence of homelessness. Indeed, the causal factors which contribute to elder homelessness often serve as risk factors for mistreatment. Predisposing influences include age-related medical infirmities, mental health deficits, lack of communal supports, and substance misuse.[v] Systemic racism and ongoing oppressions also contribute to vulnerabilities which disproportionately expose African American elders, who comprise about 40% of those who are homeless, to harms.[vi] The lack of environmental protections and surfeit of contextual stressors on the streets further compound older adults’ susceptibilities to abuse.
For many older adults experiencing homelessness, each day begins and ends with a quest for sustenance and survival amid ambient threats. Unhoused older women, in particular, often feel impelled to stay awake all night, walking the pavement, riding the train, or otherwise remaining hypervigilant and in constant motion to avoid being assaulted. With mounting frailties and fewer reserves to protect against danger, the aging unsheltered are less able to defend against assailants and evade abuse. And because of the stigma attached to homelessness, the criminalization of conduct associated with street life, and prior incidents of racial bias, older people may be unlikely to report offenses to law enforcement.
Unsheltered elders experience excessively high rates of crime as compared with the general population.[vii] In addition to significantly heightened incidents of violent physical and sexual abuse,[viii] elders on the street are approximately 11 times more likely to be assaulted, have a 12 times greater risk of being robbed, and over 20 times increased chance of experiencing theft.[ix] This pervasive criminal threat, along with the paucity of health care, housing insecurity, and situational strife, contribute to accelerated aging and premature death among older adults. An unhoused 50-year-old typically exhibits the geriatric conditions common in adults who are 15 to 20 years older. Correspondingly, in Los Angeles, where Feldman practices medicine, the homeless die approximately 22 years earlier than the general population.[x]
As the pandemic enters a virulent second wave, the older community is facing impending harms and certain economic fallout. More than ever, it is essential that as a society, we address the underpinning structural and contextual risk factors which contribute to poverty and result in homelessness and abuse. Adequate resources are necessary to ensure the aging population has access to nutrition, health care, and affordable housing.
Feldman and his outstanding team of interdisciplinary health care specialists deliver primary medical care, social support, and hope to the unsheltered homeless in Los Angeles County. They also advocate for health equity and justice for this vastly underserved population in California and across the nation. Separately, government funded programs like the Home Safe Program in California can also help stanch homelessness through strategies, including short-term financial assistance, legal services, and eviction prevention, to support housing stability for abused older clients of Adult Protected Services.[xi] Further research on the unsheltered older population is equally critical to inform effective abuse prevention and harm mitigation efforts. As we conclude a tumultuous year, let us step back for a moment and reach out to provide assistance where we can, a donation to a foodbank, your time volunteering at a shelter, or simply building awareness of this growing social justice issue. With a COVID-19 vaccine on the horizon, perhaps we can soon ease the plight of older adults experiencing homelessness and lay to rest another societal epidemic.
[i] Rosenwohl-Mack, S., Kushel, M., Ramsey, C., Handley, M., & Knight, K. R. (2019). We really help, taking care of each other: Older homeless adults as caregivers. Gerontology and Geriatric Medicine. doi.org/10.1177/2333721419894765
[ii] Goldberg, J., Lang, K., & Barrington, V. (2016, April). How to prevent and end homelessness among older adults. Justice in Aging. http://www.justiceinaging.org/wp-content/uploads/2016/04/Homelessness-Older-Adults.pdf
[iii] Nagourney, A. (2016, May 31). Old and on the street: The graying of America’s homelessness. The New York Times. https://www.nytimes.com/2016/05/31/us/americas-aging-homeless-old-and-on-the-street.html
[iv] National Alliance to End Homelessness. (2020). Infographic: Key findings from the 2019 PiT Count [Infographic]. https://endhomelessness.org/resource/infographic-key-findings-from-the-2019-pit-count/
[v] Tong, M., Kaplan, L., Guzman, D., Ponath, C., & Kushel, M. (2019). Persistent homelessness and violent victimization among older adults in the HOPE HOME Study. Journal of Interpersonal Violence. doi: 10.1177/0886260519850532.
[vi] National Alliance to End Homelessness. (2020). Racial inequalities in homelessness, by the numbers [Data]. https://endhomelessness.org/resource/racial-inequalities-homelessness-numbers/
[vii] Tong, M., Kaplan, L., Guzman, D., Ponath, C., & Kushel, M. (2019). Persistent homelessness and violent victimization among older adults in the HOPE HOME Study. Journal of Interpersonal Violence. doi: 10.1177/0886260519850532.
[viii] Tong, M., Kaplan, L., Guzman, D., Ponath, C., & Kushel, M. (2019). Persistent homelessness and violent victimization among older adults in the HOPE HOME Study. Journal of Interpersonal Violence. doi: 10.1177/0886260519850532.
[ix] Ellsworth, J. T. (2019). Street crime victimization among homeless adults: A review of the literature. Victims & Offenders, 14(1), 96-118. doi.org/10.1080/15564886.2018.1547997
[x] Center for Health Impact Evaluation. (2019, October). Recent trends in mortality rates and causes of death among people experiencing homelessness in Los Angeles County. http://publichealth.lacounty.gov/chie/reports/HomelessMortality_CHIEBrief_Final.pdf
[xi] California Department of Social Services. (2020). Home Safe Program.