Rethinking the Care Needs of Older Homeless People

by Rachel Barken and Amanda Grenier

The care needs of older adults experiencing physical and cognitive decline generate much attention in political, popular, and academic debates. Yet, particular subgroups of the older population are often overlooked. Such is the case for older homeless people, whose numbers are increasing across Canada and internationally. Older homelessness is also largely invisible in academic study, although interest is beginning to turn in this direction. Few gerontological works focus on homelessness, and studies on homelessness are often organized around earlier parts of the life course (Crane & Warnes, 2005; McDonald, Dergal, & Cleghorn, 2007). As a result, we know little about older homeless adults’ needs for care.

Our research project, “Homelessness in Late life: Growing Old on the Streets, in Shelters, and Long-term Care” explores the challenges older homelessness brings for aging societies as a whole and for service providers working in housing, shelter and long-term care. It involves a critical policy analysis; qualitative interviews with service providers and older homeless people; and participant observation in homeless shelters in Montreal, Quebec. This blog reports preliminary results from interviews with 15 service providers working with older homeless people. Interviews revealed three findings relevant to the challenges and contradictions of later life homelessness: (1) the need to adapt current approaches to homelessness to better accommodate older people, (2) the need to develop and sustain affordable housing across the life course, and (3) the inherent emotional conflicts and contradictions associated with homelessness in late life.

First, homelessness tends to be approached as a rupture in the life course requiring an emergency response. Support services are often provided in reaction to a fixed event, with the aim of reconnecting people with work or housing.  Interviews with service providers, though, reveal that older homelessness is often the result of marginal and precarious positions over time. The combined implications of social marginalization and older age means that traditional solutions based on work and housing are less able to ‘fix’ the problem of older homelessness. A deeper understanding of the interconnected individual and structural forces leading to later life homelessness is necessary.

Second, older people are caught between various housing and long-term care models. Housing options for older homeless adults in Canada include affordable housing units, alternative housing models, emergency shelters, and residential and long-term care facilities. Yet there is often a disjuncture between housing policies and practices on the one hand, and older homeless adults’ experiences, needs, and abilities on the other. Older people may need to compete against younger groups for subsidised housing. Pensions provide a certain level of income, but this does not address the shortage in supported housing options. Add to this that shelters or rooming houses are not intended as spaces to grow old. They are not adapted to changes in mobility and certainly do not qualify as ‘home’. Long-term care is also often inaccessible to older homeless people. They either cannot afford long-term care, or their needs cannot easily be accommodated in institutional environments.

Our third finding is perhaps most interesting to the debates circulating on this blog. Although workers do not necessarily name it as such, their interviews convey emotional, moral, and ethical conflicts around service priorities, personal associations, and expectations of aging. Their comments that one is ‘not expected to be homeless in later life’ poignantly articulate the conflicts that they experience with regards to aging and marginalisation and a profound helplessness given the lack of service options available for older homeless people.

In sum, homelessness rarely figures in to discussions of later life care. This leaves us with few directives when attempting to care for older homelessness people. We suggest that a life course perspective could be fruitfully applied to understand major pathways into homelessness, particularly risk factors and trigger events, and their prevalence across the life course. With this in place, it is necessary to design housing and care options that suit older homeless people’s diverse needs, abilities, and interests. Finally, it is urgent for discussions of later life care to address the realities of homelessness in particular, and social marginalization more generally. Our project, grounded in empirical data, seeks to generate knowledge that will enable policymakers and practitioners to account for homelessness in their responses to later life care.

References:

Crane, M., & Warnes, A. (2005). Responding to the needs of older homeless people.         Innovation: The European Journal of Social Science Research, 18(2), 137-152.

McDonald, L., Dergal, J., & Cleghorn, L. (2007). Living on the margins: Older homeless    adults in Toronto. Journal of Gerontological Social Work, 49(1-2), 19-46.

* The results discussed in this blog are part of an ongoing study being carried out at the Old Brewery Mission in Montreal, and funded by the Social Sciences and Humanities Research Council of Canada: Homelessness in Late Life: Growing Old on the Streets, in Shelters and Long-term Care: Amanda Grenier (PI), Tamara Sussman, David Rothwell and Jean-Pierre Lavoie.

Amanda Grenier, PhD, is Director of the Gilbrea Centre for the Studies of Aging, Gilbrea Chair in Aging and Mental Health, and Associate Professor in Health, Aging and Society at McMaster University, Canada.

Rachel Barken is a doctoral candidate in the Department of Sociology at McMaster University and Research Assistant on the Homelessness in Late Life research project.

Spaces of Care – the banning of soup kitchens

There is an extensive literature on “spaces of care” i.e. “socio-spatial field[s] disclosed through practices of care that take place between individuals” (Conradson, 2003; 508). Such spaces can be found in a range of settings: care homes for the elderly, day centres for the homeless, hospitals.

I have been grappling for some time without making much progress (those at the ReValuing Care conference in Adelaide will recognise these concerns from my paper there) with the treatment of a particular space of care – the soup kitchen. My reason for this interest was prompted by the attempts made by Westminster City Council in 2011 to outlaw soup kitchens in an area of London around Westminster Cathedral close to Victoria station.

One of the distinguishing features of the soup kitchen is that the space of care is an outdoor public space. This means that they are often viewed negatively by both local residents and local authorities. At the Adelaide conference I asked three questions which I would still welcome any help or suggestions in answering.

The first question relates to the nature of care offered by a soup kitchen. In an era where charitable and not for profit organisations are increasingly incorporated into the delivery of state care there is a view that “support agencies are increasingly accepting of the use of enforcement in some circumstances, in a desperate attempt to improve the quality of life of their clients and reduce any negative impact their activities might have on other people if/when all other approaches have failed” (Johnsen and Fitzpatrick, 2010; 1717).

By contrast providers of soup kitchens tend to fall outside the corporatist contracting mode of delivery of services. They are often provided by faith groups “attempting to articulate a theo-ethical sense of agape and caritas, a genuine openness to and an outpouring of unconditional love towards the other” (Cloke et al 2010; 99). In this “[s]oup runs tend to be noninterventionist, accepting of difference, and aim to bestow upon individuals the dignity to just ‘be’ without demanding anything in return” (Johnsen et al 2005; 329). This puts them very much at odds with government policy.

So my first question is whether we should distinguish between these two forms of care? What, if anything, is special about care which is delivered by non-professionals who are not demanding change from the recipient?

However, even if we see a positive in this rejection of a coercive form of care, can the soup kitchen do more than offer a compassionate but “ultimately degrading construal of the homeless as helpless victims” (Feldman, 2004; 92). Given its delivery of food in an outdoor setting does the soup kitchen do no more than simply help keep the homeless alive or does the “outpouring of unconditional love” referred to above provide something worthwhile in and of itself?

Finally, my last question relates to the long history of the soup kitchen which have been with us since the middle ages. Westminster’s attempts to outlaw soup kitchens were ultimately put on hold. But in an age of ever increasing control of public space why does the soup kitchen prove so resilient?

Professor Caroline Hunter, York Law School, University of York

caroline.hunter@york.ac.uk

References

Cloke P, May J. and Johnsen S. (2010) Swept up lives: Re-envisioning the homeless city Chichester: Wiley­Blackwell

Conradson D. (2004) Spaces of care in the city: the place of a community drop-in centre, Social & Cultural Geography, 4:4, 507-525

Feldman L.C. (2004) Citizens without shelter: homelessness, democracy and political exclusion Ithica: Cornell University Press

Johnsen S., Cloke P. and May J. (2005) “Transitory spaces of care: serving homeless people on the street” Health & Place 11, 323-336

Johnsen S. and Fitzpatrick S. (2010) “Revanchist Sanitisation or Coercive Care? The Use of Enforcement to Combat Begging, Street Drinking and Rough Sleeping in England” Urban Studies 47(8), 1703-1723

Care needs, gay men aged 60 and over

One of my research projects is to examine how a group of 25 gay men aged 60 and over have experienced or expect to experience old age. Interviewed as part of research I did for a book that Palgrave Macmillan published in 2013 (Gay Men’s Relationships Across the Life Course) the men were recruited in Auckland, London, Manchester, Melbourne, and New York. Six of them were in their 80s, nine were in their 70s and ten were in their 60s. This project builds on work that Brian Heaphy (2009), Ann Cronin and Andrew King (2012) among others, have already done in the area of queer ageing needs. It will also expand on my own findings from an all-Australian sample of gay men (n=80) that I used in The Changing World of Gay Men (Palgrave Macmillan, 2008) where I argued that I found little or no evidence to suggest that Australian gay men aged 60 and over were lonely in old age and that most seemed relatively optimistic about the prospect of growing old. What I did not examine, however, in The Changing World was the extent of their fears or concerns about life in care, which is the focus of the research I write about today.

Preliminary analysis of data from my international sample of 25 men suggests that they chiefly used two narratives when explaining what worried them about their care needs in old age. The first narrative related to that set of general fears and concerns that occupy the waking hours of many members of the general population as they age, namely fears about losing mobility or independence, having to live alone after the death of a partner, loss of sexual potency or interest, having to move into a nursing home, or the risk of dementia.

The second narrative the men drew on when explaining what worried them about old age were fears about heterosexism or homophobia. At the top of their list of worries was the heteronormativity they expected would exist in nursing homes or the homophobia of staff or other residents, either of which could have the effect of forcing some of the men back into the closet. One of the interviewees, a Sydney man aged 72 said the following about aged-care accommodation: ‘Nursing homes in Australia are often run by church organisations. Some church organisations, though not all, are not particularly welcoming to gay residents. They are not particularly understanding of the diversity of human relationships and of their needs’. A similar, related fear that men already living independently at home expressed was having to deal with care workers who were homophobic or uncooperative.

Cronin, Ann and Andrew King (2012) ‘Only Connect? Older lesbian, gay and Bisexual (LGB) social capital’ in Ageing and Society Available on CJO 2012  doi:10.1017/S0144686X12000955

Heaphy, Brian (2009) ‘The Storied, Complex Lives of Older GLBT Adults: Choice and its Limits in Older Lesbian and Gay Narratives of Relational Life’ in Journal of GLBT Family Studies, 5, 119–138.

Older People’s Day – Including Older LGBT people

It’s Older People’s Day in the UK on 1st October, and it seems timely to flag the particular issues affecting older LGBT people, who are an under-recognised and under-served group of individuals. Yet their numbers are growing. It is estimated that between 5-7½% of the population have a ‘non-heterosexual’ identity. This means there are between 61,000 and 122,000 ‘non-heterosexual people’ over 60 living in the UK today, and this figure is set to rise to between 881,000 and 1,763,000 by 2030. Older LGBT share many of the issues and concerns of all older people, but their ageing can be made more complicated by their sexualities, gender identities and histories (1).

According to a recent UK survey comparing over 1,000 older LGB people and 1,000 older heterosexual people (2), older LGB people are more likely to be single and to live alone, less likely to have children and are less likely to see biological family members on a regular basis.  Older LGB people are also more likely to suffer from the consequences of a lifetime of minority stress (stigma and marginalisation) and as a result are more likely to drink alcohol, take drugs and smoke than older heterosexual people. They are more likely to have a history of mental health problems, and to have current concerns about their mental health, particularly depression. This can be linked to bereavement following the deaths of partners and/or close friends, which often goes unrecognised (3).  Many trans people are also estranged from their families, and continue to be regarded as mentally ill under the psychiatric diagnosis of ‘gender dysphoria’ making them particularly wary of engaging with mental health services (4).

With less intergenerational support than their heterosexual peers, older LGBT are more likely to need formal social care, and at an earlier age, than older heterosexual people. Yet at the same time, the majority of older LGBT people are very worried that health and social care providers will not be able to recognise or meet their needs.  Many feel they would have to hide their identities from care staff and/or fellow service users (the older people are, the more they carried the prejudices of the past, (5)). Many are worried that they will be unwillingly exposed by their own or a loved one’s dementia (6). Many are fearful that they will spend the final years lonely and isolated, estranged from loved ones, in care homes where their lives and identities are either not recognised or not valued and validated (7).

We need to ensure that all older people are recognised and respected for who they are, and that includes older LGBT people. We also need to know much more about the lives, needs and wishes of older LGBT people, and this is where the ‘Minding the Knowledge Gaps’ project comes in. This project is funded by the Economic and Social Research Council (ESRC) and is co-organized by Andrew King (PI), University of Surrey, Kathryn Almack (University of Nottingham), Yiu-Tung Suen (University of Oxford/Chinese University of Hong Kong) and Sue Westwood (Keele University). The project involves a series of six themed seminars followed by a final conference, aimed at exploring gaps in knowledge and research about LGBT ageing, and identifying ways to address those gaps. For more information, go to the ‘Minding the Knowledge Gaps’ project. A further project of interest is ‘The Last Outing’ . Based at the Sue Ryder Centre, Nottingham University, the study is exploring end of life care experiences and concerns of older LGBT people.

Both projects can be followed on Twitter: @LGBTageing and @TheLastOuting.

References

(1)  Ward, R., et al (eds) (2013) Lesbian, Gay, Bisexual and Transgender Ageing: Biographical Approaches for Inclusive Care and Support, London and Philadelphia: Jessica Kingsley.

(2)  Stonewall (2011) Lesbian, Gay Bisexual People in Later Life, London: Stonewall

(3)  Almack, K., et al. (2010) ‘Exploring the impact of sexual orientation on experiences and concerns about end of life care and on bereavement for lesbian, gay and bisexual elders.’ Sociology. 44(5): 908-924.

(4) Fredriksen-Goldsen, K., et al. (2013) ‘Physical and Mental Health of Transgender Older Adults: An At-Risk and Underserved Population.’ The Gerontologist doi: 10.1093/geront/gnt021First published online: March 27, 2013

(5)  Valentine, G. & Macdonald, I. (2004) Understanding Prejudice London: Stonewall

(6)  Price, E. (2012) ‘Gay and lesbian carers: ageing in the shadow of dementia’, Ageing & Society, 32: 516-532.

(7)  Ward, R., et al (2011) Don’t look back? Improving health and social care service delivery for older LGB users, London: Equality and Human Rights Commission.

Mark Neary’s Tribunal: Unequal access to justice

Read Mark’s blog on trying to self-advocate in a housing battle on behalf of Mark and his disabled son, with no Legal Aid (since cuts), and so no legal representative, up against a powerful local authority’s barrister. Appalling. Shows vividly the power imbalance created by lack of funding for Legal Aid in social welfare disputes. The disempowered are further disempowered by a judicial process to which they do not have equal access.