Shelters in Canada are not designed to meet the physical or mental health needs of the growing number of older adults who are homeless, a report released Tuesday says.
People who are experiencing homelessness age faster than those who are housed due to factors such as stress and the inability to properly manage chronic medical conditions, Dr. Jillian Alston, lead author of the paper published in the Canadian Medical Association Journal, said in an interview.
Many people who are homeless are considered seniors as early as age 50 because of documented physical and mental decline, said Alston, who is a geriatrician at St. Michael's Hospital in Toronto.
The report analyzed homelessness among seniors based on the authors' clinical observations and a review of several studies.
The number of seniors needing support is growing with an aging population, Alston said. That includes both people who were already homeless and seniors who are thrust into homelessness for the first time in their later years, she said.
"I've seen a number of individuals (in shelters) who have been in their 80s. I have seen — not many — but I have seen some who have been in their 90s," Alston said.
"I think as a society we can do better."
Homeless shelters are not designed to provide care for seniors, she said.
The shortfalls range from a lack of space to safely store medication to a higher risk of falls in shelters that weren't designed with accessibility in mind, she said.
Many seniors can't get the level of care they need that would otherwise be provided in a home-care setting.
"For instance, if somebody requires help or assistance with bathing or with wound care, but there's not an adequate space for them to even receive that, then it's difficult," Alston said.
Shelters often require clients to leave during the day, which is a big problem for people with mobility and cognitive issues, she said. Seniors with cognitive impairments are also at higher risk of being victimized within shelters, Alston added.
Caring for seniors experiencing homelessness is an issue across Canada, experts say.
"We're seeing an increase both in newly homeless older people as well as growing numbers of people aging while homeless," said Dr. Lara Nixon, a family physician in Calgary who does outreach care.
The affordable housing crisis puts many seniors at high risk of becoming homeless if just one thing goes wrong, she said, such as losing a spouse, falling ill or developing a disability.
Nixon agreed that systems to help people who are homeless, including shelters, don't meet the needs of that population.
"It's a model that really emphasizes ... autonomy and return to independence. And, you know, oftentimes time-limited supports," said Nixon, who was not involved in the report.
The expectation that people will return to work after receiving temporary shelter isn't appropriate "with older people who are typically on an accelerated aging trajectory such that they are older 10 to 20 years earlier than their stably-housed counterparts," she said.
Many long-term care homes are also not equipped to properly care for seniors who have been homeless, Alston and Nixon agreed.
"Anybody who has experienced homelessness is at high, high risk of being traumatized — just by that experience of homelessness, let alone what else has happened in their lives that led them to become homeless," said Nixon.
The rushed pace many personal support workers must adhere to can exacerbate that trauma, she said, because residents need time to develop trust with the people providing their care.
Sometimes, elderly people become homeless and are sent to "completely inappropriate" shelters even though they are on a waiting list for a long-term care bed, Alston said.
In addition, most long-term care homes aren't designed to deal with mental health conditions and substance use that many people who have been homeless experience. They will often turn away seniors who have addictions to alcohol or other drugs, Alston said.
A model that works includes providing supportive housing where seniors who have experienced homelessness can receive the medical, mental health and addictions care they need, Alston and Nixon said.
One such program is run by WoodGreen social services in Toronto where Alston regularly provides care, she said.
The 58-unit building is dedicated to seniors aged 55 and older who have been homeless. They live in bachelor apartments that are intended to be permanent. Residents aren't required to take specific actions such as being substance-free.
That's an important barrier to remove, WoodGreen's vice-president of community wellness Dorothy Quon said in an interview.
"It's really about giving people dignity, housing them so that they can sort of regain some of their independence in their own life, be contributing in whatever way that looks like for them," Quon said.
People are primarily referred from the city of Toronto's shelter system, she said, and case managers work with them to determine what income they have to contribute to their housing, such as social assistance, pensions or supports they become eligible for after filing taxes.
Programs like WoodGreen's work, Alston and Nixon said, because they break down the silos between social services and health care.
"We need to not look at health care as separate from housing and housing (as) separate from health care," Alston said.
"They are so intricately linked."
This report by The Canadian Press was first published May 21, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
Nicole Ireland, The Canadian Press
