Medical Care for the Homeless Elderly

By Horn, Ansell | Care Management Journals, April 1, 2008 | Go to article overview

Medical Care for the Homeless Elderly


Horn, Ansell, Care Management Journals


This is a case study of two elderly, frail women in New York City who were recently rendered homeless. One woman had a massive tumor on her occipital scalp; the other was in renal failure. The obstacles and complexities of providing care to those with double jeopardy-being elderly and homeless-are described. There are enormous difficulties for placement into safe, supportive housing once people become homeless. The process is expensive and labor intensive. This can be complicated by the existence of mental illness. A New York agency that works with mentally ill homeless people is described. There are systemic obstacles as well: One woman loses her Medicaid when she moves from one state to another to be closer to her family. Another, 82 years old, is told to get a job so that she could qualify for Medicare. There are numerous contradictions and unnecessary costs in a fragmented health care system to which the obvious solution is a national single-payer system of care.

Keywords: homeless; elderly; New York; mental illness; universal health care

There is a growing body of research on issues of homelessness and the formidable obstacles to housing people once they become homeless. The challenges are magnified for the elderly homeless, who have the same problems as other homeless people, compounded by increasing physical frailty, decreased mobility, hearing and vision, vulnerability to predators, debilitating medical conditions, and poverty, without the hope of future employment or relief.

There are many ways to describe or categorize the homeless elderly. One approach is to distinguish between the chronically homeless and those who are suddenly and recently rendered homeless. The former includes both the street homeless (a particularly hardy group, mainly men, often addicted to alcohol or drugs and averse to the rules and humiliations of shelter life) and those in emergency shelters or other precarious situations. The elderly, age 65 and older, who have recently been rendered homeless are the subject of this article. The nature of this population is as varied as the reasons for their becoming homeless-illness, the frailties of advancing age, the lack of affordable housing in a speculative market, or simply poverty. We can say unequivocally that the number of elderly homeless is growing and may be growing faster than the rate of homeless people in general (Bureau of Primary Health Care, 2003).

DOUBLE JEOPARDY

In a 1987 study, it was estimated that New York City shelters housed about 9,300 people a night. Today, in 2007, there are more than 35,000 people in New York City shelters on any given day, 2 years into the city's 5-year plan to end homelessness. This is part of a national problem. On one night in January 2005, more than 740,000 men, women, and children in the United States were without homes. Every year, more than 3.5 million Americans experience homelessness (Draft Statement by National Non Profits, 2007). In 20 years, the number of homeless people has increased dramatically. But from 1978 to the present, the budget for the U.S. Department of Housing and Urban Development, in real dollar value, fell 65% (National Council for the Health Care of the Homeless, 2007).

A series of studies conducted in Atlanta, San Francisco, Philadelphia, Boston, and New York showed that the age-adjusted mortality rate for homeless people was at least three times as high as for the housed population (O'Connell, 2005). Interestingly, a study in Toronto, Canada, where there is a national health care system, showed that mortality rates of homeless men were half those of such men in U.S. cities. Homeless people have more medical problems and appear older than those who are housed (Bureau of Primary Health Care, 2003). In a Boston study, 119 "rough sleepers"-street homeless, with a mean age of 47-were followed from 2000. Of these, 33 died within 5 years. Over a 4-year period, this cohort had a total of 18,384 emergency room visits. …

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