Abstract
AbstractWhile experiences of later-life homelessness are known to vary, classification of shelter, housing and service models that meet the diverse needs of older people with experiences of homelessness (OPEH) are limited. To address this gap, a scoping review was conducted of shelter/housing options, supports and interventions for OPEH. Fourteen databases were searched for English-language peer-reviewed and/or empirical literature published between 1999 and 2019, resulting in the inclusion of 22 sources. Through a collaborative, iterative process of reading, discussing and coding, data extracted from the studies were organised into six models: (1) long-term care, (2) permanent supportive housing (PSH), including PSH delivered through Housing First, (3) supported housing, (4) transitional housing, (5) emergency shelter settings with health and social supports, and (6) case management and outreach. Programme descriptions and OPEH outcomes are described and contribute to our understanding that multiple shelter/housing options are needed to support diverse OPEH. The categorised models are considered alongside existing ‘ageing in place’ research, which largely focuses on older adults who are housed. Through extending discussions of ageing in the ‘right’ place to diverse OPEH, additional considerations are offered. Future research should explore distinct sub-populations of OPEH and how individual-level supports for ageing in place must attend to mezzo- and macro-level systems and policies.
Highlights
Older people with experiences of homelessness (OPEH) remain largely invisible in research, policy and practice domains though rates of this population are increasing (Crane and Warnes, 2010; Gonyea et al, 2010; Culhane et al, 2019)
Six shelter/housing and service models were identified, reviewed and agreed upon by the research team. The findings of this scoping review were categorised according to the provision of a physical structure and the services and supports offered to clients, resulting in: (1) long-term care (LTC), (2) permanent supportive housing (PSH), including PSH delivered through Housing First (HF), (3) supported housing, (4) transitional housing, (5) emergency shelter settings with health and social supports, and (6) case management and outreach (Table 2)
(1) Long-term care (LTC) Research suggests that LTC designed to provide nursing care to general populations of older adults and others requiring complex care is often unprepared to manage the needs of OPEH, including alcohol use, smoking and other behaviours (Serge and Gnaedinger, 2003)
Summary
Older people with experiences of homelessness (OPEH) remain largely invisible in research, policy and practice domains though rates of this population are increasing (Crane and Warnes, 2010; Gonyea et al, 2010; Culhane et al, 2019). Compared to younger people experiencing homelessness, and older adults in general, OPEH have more complex health and social challenges and significant unmet needs regarding access to suitable shelter/housing and support services (McDonald et al, 2007, 2009; McGhie et al, 2013). Functional impairments and chronic health conditions, including difficulties with activities of daily living (e.g. eating, bathing) and instrumental activities of daily living (e.g. financial and medication management) (Brown et al, 2017), as well as depression, anxiety, post-traumatic stress disorder, psychosis and cognitive impairment of OPEH (Stergiopoulos and Herrmann, 2003; Garibaldi et al, 2005; Sudore et al, 2018), are challenging to support in traditional shelter/housing settings (Canham et al, 2020). Homelessness programming largely targets youth and people who have experienced chronic homelessness rather than OPEH (Canham et al, 2018), there is a research, policy and practice need to identify and describe shelter/housing models and outcomes for OPEH
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