Homelessness among older people: a comparative study in three countries of prevention and alleviation
Executive Summary
This report describes the genesis, design and preliminary findings of a study of the causes of homelessness among newly-homeless older people in England, Australia and the USA. The report concentrates on the Australian findings. Since the late 1980s, there has been an increased level of attention given to the problems of older homeless people and a few specialist services have been developed to meet their needs. It has been shown that many have recently become homeless for the first time, raising questions about the reasons why older people become homeless and whether their homelessness could have been prevented.
The aims of the three-nation study were: (i) to increase understanding of the causes of homelessness among older people, by examining the biographies of recently homeless people and the policy and service context in which they became homeless; and (ii) to inform the debate about prevention practice, by identifying the sequence of events that precede homelessness, and the risk factors and 'early warning' indicators of serious difficulties.
The tragedy of elderly homelessness is as much a blight on Australian society as it is in the other nation members of this study. The study highlighted and reinforced many of the experiences that Wintringham has gained over the past 15 years of working with aged homeless men and women, but also drew attention to causative factors which have not in the past been as widely acknowledged as perhaps they should be.
While the linkages between psychiatric disorders, ABI and depression with homelessness are well known, the study revealed new linkages with what has been described in the American literature as New Homeless: people who would normally have appeared to be unlikely candidates for homelessness, but whose changed circumstances have been sufficiently severe to culminate in the elderly person becoming homeless. Similarly, the linkages between gambling and aged homelessness is an area that needs further research if an effective preventative model is to be developed.
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The study demonstrated that it is clear that the longer a person had been homeless, the less likely that they retained a belief that there were supports and services in the community that could assist them. This conclusion is entirely consistent with the experience of Wintringham which has found that it is invariably the most recently homeless of our clients who retain a positive outlook and optimistic view of the future.
The results of this study provide clear guidelines to potential improvements in policy and service delivery.
The study demonstrates once again, that perhaps more so than with any other homeless group, the role of the outreach worker is absolutely critical. It appears to be within the nature of elderly homelessness, that the aged person withdraws, can at times be reclusive, and rarely if ever, goes searching for services. Compared to the relative assertiveness of many of the young homeless, aged people live and die often in the most appalling circumstances, unable or afraid to seek help.
An effective outreach worker can, through a variety of informants and established linkages with local services, find these aged people and begin to broker services for them. In Australia, the nationally funded program Assistance with Care and Housing for the Aged (ACHA) resources such services, and has made one of the most effective and productive impacts on the steady flow into the homeless world of elderly and financially vulnerable people. Unfortunately however, the program is tiny and severely under-resourced. A clear recommendation arising out of this study, is that the ACHA program be expanded and refocused towards the most vulnerable of the impoverished aged. ACHA remains one of the most cost-effective services in the country.
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The other clear outcome of this research is the need for specialised services to be developed or improved so that the aged homeless can gain access to them. There is in Australia, no clear Department or policy area that has responsibility for the aged homeless. Elderly homeless people have a variety of needs, the responsibility for which falls across Housing, Health and Aged Care as well as Social Security for income support and Veterans' Affairs for income and specialised support services.
The inevitable result is that the lack of services can be attributable to a variety of different jurisdictions and portfolio responsibilities. Wintringham has argued since its creation in 1989, that for the purposes of program responsibility, the elderly homeless should be considered to be aged and as such entitled to the same suite of services that mainstream elderly people are entitled to. By considering them as primarily homeless, departments are inevitably consigning the elderly homeless to a poorly resourced program area that has no experience or expertise in providing aged care services.
With regard to aged care services, it is clear that the elderly homeless need access to quality high and low care residential services. The responsibility of the Commonwealth Department of Ageing is to resource the capital construction of such services, for it is clear that the poverty of the homeless themselves prevents any organisation such as Wintringham from earning enough surplus income to finance the construction of additional services.
A further recommendation arising from this research is the clear and undeniable need for an increase in the provision of affordable housing for the aged homeless and for those at risk of becoming homeless. While it is apparent from the study that many of the respondents were unable to live independently and as a consequence, lost their housing, it is Wintringham's experience that the levels of support required is often quite low and able to be provided within the program parameters of the Community Aged Care Package Program. The lesson from our practical experience and from the results of this study is that the provision of affordable housing and the existence of low and medium levels of support can prevent vulnerable aged people from becoming homeless.
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