The Elderly Homeless Crisis: History and Origins

Madelena Eifert

May 2024

Historical, societal, and cultural factors have contributed to the unprecedented number of elderly homeless persons in the United States. Not only has the homeless population reached its peak within the past century, the growing number of elderly persons experiencing homelessness requires an extensive overhaul of the welfare systems originally designed to assist houseless individuals. Elderly persons are more likely to need medical assistance, supportive housing, and disability assistance, services that the U.S. government is straining to accommodate.  

History of Homelessness

Homelessness in the United States arose as a concept and in prevalence post-Civil War during Reconstruction and the Industrial Revolution. As a result of migrating populations within the United States during and after the Civil War and the changing demographics of the working class, individuals flocked to areas of economic growth for work. With the influx of “outsiders” into cities, tensions arose between the upper and lower socioeconomic classes, leading to the vilification of poverty as retribution by the “bourgeoisie” and, by extension, discrimination against homeless individuals. The Great Depression ignited the creation of welfare programs designed to assist individuals affected by the financial crisis; however, these initiatives collapsed after the post-World War II economic boom (Mitchell, 2011). 

Following the civil rights movement of the 1950s and 1960s, and particularly during the Reagan era, the United States saw an emergence of conservative politics, which resulted in social policies designed to provide only stopgap measures to alleviate homelessness at the individual level (Cronley, 2010). Infamously, Ronald Reagan was an opponent of advocates for homeless individuals, stating in an interview with David Hartman of ABC News, “the people who are sleeping on the grates, the homeless who are homeless, you might say, by choice” (Reagan, 1984). Throughout the Reagan administration, federal funding to social support programs was drastically reduced, justified using poorly-designed studies and skewed reports by the Department of the Health and Human Services (HHS) and Department of Housing and Urban Development (HUD) (Jones, 2015).  The Stewart B. McKinney Homeless Assistance Act, passed in 1987 during Ronald Reagan’s term, established emergency shelter programs and provided financial assistance to homeless support programs. However, the dissemination of funds occurred through a competitive grant process, were finite, and did not address societal, structural, or institutional causes of homelessness (Stewart B. McKinney Homeless Programs, 1995; Cronley, 2010).

Historically, the issue of homelessness has been approached with a dichotomous lens, characterizing individuals as “other” and blaming the individual for their life circumstances (Cronley, 2010).  Homelessness is viewed as a problem affecting only so-called “deviants” of society, such as persons with substance-use disorders, mental illness, and disabilities. Therefore, many solutions were focused on removing the visibility of homeless persons and not fixing the affordable housing issue in the United States.  Paternalism has dogged reforms intended to support homeless individuals, as it grants support conditionally, promulgating the notion that shelter is earned and not an intrinsic right. As with many other issues in the United States, homelessness is affected by the state of the economy and the persistence of the “bootstrap” mentality (Howard, 2019).

Why are older adults homeless?

The growing number of older homeless people is due to the aging cohort of baby boomers, currently the largest generation of persons. Financial recessions and meager Social Security benefits spread across a large population have contributed to the inability of older adults to afford housing (Najmabadi, 2023).  By 2040, adults 65 or older will comprise close to 21% of the overall United States population, emphasizing the need for elder support services. While many adults wish to remain in their own homes and age in place, high housing costs, mobility and accessibility challenges, and the need for transportation pose obstacles for many. The majority of adults over the age of 50 live in low-density areas with limited resources and limited access to essential services. Beyond inability to access medical facilities and grocery stores, older adults who cannot drive or utilize public transportation face the risk of social isolation (Office of Policy Development and Research, 2013). 

Homelessness can be caused by a variety of factors, such as lack of income, lack of affordable housing, inability to afford daily living costs, evictions, or foreclosures (National Law Center, 2015). Retirement-age adults can only receive Social Security benefits when they are 62 years old and were employed and paid Social Security taxes for over 10 years (Social Security Administration, n.d.). For those who do not meet these criteria, they must rely on personal savings, continued employment, or Supplemental Security Income (SSI). SSI is available for those who are disabled, are over the age of 65, or have insufficient income to pay for living expenses. According to the CDC, 28.6% of adults aged 45-64 have at least one disability, while that percentage increases to 41.7% for adults 65 and older. (Okoro, 2018).  With expenses for medical needs, food, transportation, and more, there is little to no money left over for rent. For example, the average monthly SSI payout for an individual adult was $914 in 2023, yet the average rent in the United States was $1,326 per month (Social Security Administration, 2024; World Population Review, 2024). Additionally, elderly persons may have difficulty accessing additional government benefits or applying for SSDI. More attention should be paid to renters’ rights and increasing eviction protections, as many renters are unaware of the rights granted to them by the law and are unable to advocate for better living conditions or contest an eviction (Kushel, 2020).

With this changing population, now more than ever there is a need for affordable, accessible, and supportive housing for older adults. In the past, the majority of older adults owned their own home; however, the proportion of older adults who rent has increased in recent years. Due to rising costs of living and dwindling incomes in retirement, many older adults are cost-burdened by housing and cannot afford to age in place (Office of Policy Development and Research, 2017). As of 2021, a third of senior households (or 11.2 million people) are cost-burdened. There are limited opportunities for older adults to receive financial aid among the rising rent costs, utility costs from climate change, and potential health complications (Ludden, 2023). As a result, in 2021, people aged 55 and older were 19.8% of the homeless population, according to the Department of Housing and Urban Development (HUD) (Najmabadi, 2023).

Structural racism and discrimination worsen the plight of Black and Latino homeless persons by further restricting housing opportunities through redlining, lack of oversight within Fair Housing Act policies, and predatory banking practices. Furthermore, the criminalization of Black communities has decreased housing, employment, and education opportunities for these individuals, leading to an increased chance of becoming homeless (Kushel, 2020). Wealth inequality is most pronounced among Black households and other minority groups, worsening this phenomenon within these populations (Ludden, 2023). Black and Latino populations are more likely to be highly cost-burdened and a higher proportion of renters are cost-burdened as they age. In 2018, 55% of Black renter households are cost-burdened and 31% are severely cost-burdened, with 58% of 62+ Black adults and 57% of Latino adults cost-burdened (Justice in Aging, 2021).

Due to privatization of the housing market, gentrification efforts, and restrictive zoning laws, the number of low-cost units has dramatically decreased. Even the cost of land rental for those who own mobile homes, traditionally a source of affordable housing, has soared in recent years (Bhattarai, 2022).  Lack of affordable housing has led many cost-burdened older adults to compromise their other necessities to remain housed. Others are forced into homelessness by illness, loss of employment, or other financial emergencies. This has led to an overwhelming number of persons aged 50 or older who become homeless for the first time (Justice in Aging, 2021). Current low-income housing options are in high demand and still unattainable for many low-income older adults. Section 8 housing, or “Housing Choice Vouchers,” is a federal program for low-income families, the elderly, and disabled persons that provides a voucher through public housing agencies to live in a subsidized rental unit (U.S. Department of Housing and Urban Development, n.d.). While Section 8 housing is available for low-income adults and requires only 30% of one’s income, the system has been inundated with requests for housing and is at capacity in many places. While federal subsidies can assist in providing housing, they do not guarantee affordable or quality housing opportunities and do not resolve the extensive waiting lists (Najmabadi, 2023). 

The Older American Act (OAA) of 1965, created under President Johnson, was designed to improve services and social support networks for older adults in the United States. OAA was responsible for enacting the Congregate Nutrition Program in 1972, area-specific Senior Centers, and Community Service Employment Programs in 1973, long-term care ombudsman services in 1978, and more recently, the National Family Caregiver Support Program in 2000. In 2006, OAA created home- and community-based long-term care development activities, established disease prevention and health promotion services, and formed Aging and Disability Resource Centers in all 50 U.S. states (Administration for Community Living, 2020). The plethora of services available through OAA are undoubtedly beneficial to older Americans; however, every so often Congress must reauthorize spending on services, thereby making available services contingent on bipartisan support for the act. With recent budget cuts to OAA services in the past decade and a growing elderly population, there are insufficient resources to assist senior citizens (National Association of Social Workers, 2016).  

Aging, in general, puts adults at greater risk of developing a myriad of mental and physical health conditions. It’s been found that homeless persons aged 50 or older, compared to the general “housed” population, have similar health conditions seen in 80-year-old persons. Geriatric health conditions experienced by homeless older adults at fairly young ages include impairment in activities of daily living, mobility impairment, falls, visual and hearing impairment, incontinence, and depression (Brown, 2016). Based on a systematic review by Mantell, et al., rates of physical frailty, prevalence of cognitive deficits, and emergence of psychological issues are more frequent and occur earlier in persons experiencing homelessness (Mantell, 2023). In a study of 450 older homeless individuals in Oakland, California, it was found that mortality among this population was associated with poor or fair overall health, homelessness, institutionalization, diabetes, and the first incidence of homelessness occurring after the age of 50. Of those who passed during the course of the study, the most common causes of death were heart disease, cancer, and drug overdose (Brown, 2022). Thus, homeless individuals have a greater risk of developing comorbidities that could ultimately contribute to premature death. Furthermore, older homeless adults (aged 35-78), compared to younger adults and adolescents, have been shown to experience a greater number of physical health symptoms and have less social support than their counterparts (Tompsett, 2009). 

Potential Solutions 

Current programs designed to address homelessness are woefully inadequate for the growing population of older adults without housing. Emergency homeless shelters are typically unequipped to assist with the medical needs of elderly adults, and can be traumatizing or dehumanizing for homeless persons. Furthermore, there is a current lack of integrated and supportive housing options for older adults that address their social and physical needs, and that maintain their autonomy (Humphries & Canham, 2021).  The newest solution to homelessness, propagated by the Bush and Obama administrations, is “Housing First” programs. These programs are designed to provide stable housing to the most vulnerable homeless populations, such as those who are severely mentally or physically ill, without strict requirements for sobriety or program adherence (National Alliance to End Homelessness, 2022). However, this solution is woefully underfunded and consistently undercut by efforts to reduce public housing, by subsidies from tax policies, and by the 2008 housing market crash (Mitchell, 2011).  In contrast, Chung, et al. (2017) found at a 24-month follow-up that improvement in mental health and quality of life was significant among older adults who participated in the Housing First program, indicating that supportive housing may be beneficial for homeless people over the age of 50. While “Housing First ” has its benefits, the problem of homelessness is not so simple as to be solved by providing a physical shelter, as it is a complex social health issue. Homelessness is inextricably connected to broader social concerns such as the welfare system, urban planning, and transportation (Howard, 2019).

The Supportive Services Demonstration for Elderly Households in HUD-Assisted Multifamily Housing is a grant program announced in 2016 that tests the Integrated Wellness in Supportive Housing (IWISH) model. This demonstration looks at federal support for aging in place, a less expensive and often more desirable option than costly nursing home care. IWISH is a supportive, place-based housing model that delivers enhanced service coordination to residents onsite through a full-time wellness director and a part-time wellness nurse. (Integrated Wellness, 2023) Supportive service models provide integrated care to elderly adults including but not limited to transitional care, housing stability, healthcare services, medication management, mental health treatment, fall prevention, and the creation of a comprehensive health plan. Congress extended the IWISH demonstration and evaluation for two additional years. A fourth and final comprehensive report, including an analysis of impacts over the entire study period, will be provided at the conclusion of the study (Supportive Service Demonstration, Overview). 

Another effort to help seniors live independently in their homes comes from the American Planning Association, which advocates for changes to zoning and building regulations to improve the “accessibility, visitability, connectivity, walkability, and universal design components” for older adults in a community (Office of Policy Development and Research, 2017).  In a study of elderly homeless adults in Los Angeles, California, it was found that permanent supportive housing was associated with a decrease in impairment of activities of daily living, thus supporting the creation and funding of senior-specific affordable housing programs (Henwood, 2019).  

The bleakness of the current homelessness crisis can be most adequately described by those most affected by it. As stated by Susi Pazurik, aged 70, from Yonkers, New York, “This is a horror story. And especially to treat 70-year-old people who worked all their life, never were on welfare, paid all their bills. Now, we went into a spiral. I don’t have a normal life anymore. All I do is worry, worry, worry…Every night, I go to bed, I wake up in the middle of the night and I pray for death” (Shain & Gardiner, 2023). 

Glossary

Activities of daily living (ADL) – the fundamental skills required to independently care for oneself, such as eating, bathing, and mobility.

Aging in place – the ability to live in one’s own home and community safely, independently, and comfortably, regardless of age, income, or ability level. (CDC Healthy Places Terminology)

Housing First – an approach to homelessness that provides permanent housing with supportive services without preconditions and barriers to entry, such as sobriety, treatment or service participation requirements.

Permanent supportive housing – Permanent Supportive Housing (PSH) is permanent housing in which housing assistance (e.g., long-term leasing or rental assistance) and supportive services are provided to assist households with at least one member (adult or child) with a disability in achieving housing stability.

Sheltered homelessness – residing in an emergency shelter (ES), transitional housing (TH), or safe haven (SH) program. 

Unsheltered homelessness – living in places not meant for human habitation. 

References: 

Administration for Community Living. Celebrating 51 Years of the Older Americans Act. (2020, May 6).
https://acl.gov/news-and-events/announcements/celebrating-51-years-older-americans-act

Bhattarai, A. (2022, June 6). ‘We’re all afraid’: Massive Rent Increases Hit Mobile Homes. The Washington Post. https://www.washingtonpost.com/business/2022/06/06/mobile-manufactured-home-rents-rising/

Brown, R. T., Evans, J. L., Valle, K., Guzman, D., Chen, Y. H., & Kushel, M. B. (2022). Factors Associated With Mortality Among Homeless Older Adults in California: The HOPE HOME Study. JAMA Internal Medicine, 182(10), 1052–1060. https://doi.org/10.1001/jamainternmed.2022.3697 

Brown, R. T., Hemati, K., Riley, E. D., Lee, C. T., Ponath, C., Tieu, L., Guzman, D., & Kushel, M. B. (2016). Geriatric Conditions in a Population-Based Sample of Older Homeless Adults. The Gerontologist, 57(4), gnw011. https://doi.org/10.1093/geront/gnw011 

Chung, T. E., Gozdzik, A., Palma Lazgare, L. I., To, M. J., Aubry, T., Frankish, J., Hwang, S. W., & Stergiopoulos, V. (2017). Housing First for older homeless adults with mental illness: a subgroup analysis of the At Home/Chez Soi randomized controlled trial. International Journal of Geriatric Psychiatry, 33(1), 85–95. https://doi.org/10.1002/gps.4682 

Cronley, C. (2010). Unraveling the Social Construction of Homelessness. Journal of Human Behavior in the Social Environment, 20(2), 319–333. https://doi.org/10.1080/10911350903269955 

Howard, E. (2019). The “Problem” of Homelessness. Journal of Urban History, 45(6), 1326–1331. https://doi.org/10.1177/0096144219861917 

Jones, M. M. (2015). Creating a Science of Homelessness During the Reagan Era. Milbank Quarterly, 93(1), 139–178. https://doi.org/10.1111/1468-0009.12108 

Justice in Aging. (2021, February). Issue Brief: Low-Income Older Adults Face Unaffordable Rents, Driving Housing Instability and Homelessness . https://justiceinaging.org/issue-brief-low-income-older-adults-face-unaffordable-rents-driving-housing-instability-and-homelessness/ 

Kushel, M. (2020). Homelessness, Older Adults, Poverty, Health. Generations Journal, Summer 2020. https://generations.asaging.org/homelessness-older-adults-poverty-health 

Ludden, J. (2023, November 30). Millions of seniors struggle to afford housing — and it’s about to get a lot worse. NPR. https://www.npr.org/2023/11/30/1215460460/housing-seniors-affordable-harvard-report-baby-boomers 

Mantell, R., Hwang, Y. I. J., Radford, K., Perkovic, S., Cullen, P., & Withall, A. (2023). Accelerated aging in people experiencing homelessness: A rapid review of frailty prevalence and determinants. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1086215 

Mitchell, D. (2011). Homelessness, American Style. Urban Geography, 32(7), 933–956. https://doi.org/10.2747/0272-3638.32.7.933 

National Alliance to End Homelessness. (2022, March 20). Housing First. https://endhomelessness.org/resource/housing-first/ 

National Association of Social Workers. (2016). Issue: Support Increased Funding for the Older Americans Act to Enhance Older Adults’ Dignity, Health, and Independence. https://www.socialworkers.org/LinkClick.aspx?fileticket=bsUr_5sDiCA%3D&portalid=0

National Law Center on Homelessness & Poverty. (2015). Homelessness in America: Overview of Data and Causes (pp. 1–4). https://homelesslaw.org/wp-content/uploads/2018/10/Homeless_Stats_Fact_Sheet.pdf 

Office of Policy Development and Research. (2017). Housing for Seniors: Challenges and Solutions. Evidence Matters, Summer 2017. U.S. Department of Housing and Urban Development. Office of Policy Development and Research. https://www.huduser.gov/portal/periodicals/em/summer17/highlight1.html 

Office of Policy Development and Research. (2023, August 22). The Integrated Wellness in Supportive Housing Model (IWISH) Shows Promise in Supporting Aging in Place. PD&R Edge. U. S. Department of Housing and Urban Development. Office of Policy Development and Research.  https://www.huduser.gov/portal/pdredge/pdr-edge-research-082223.html

Office of Policy Development and Research. (2013). Preparing for Change: Housing an Aging Population. PD&R Edge. U.S. Department of Housing and Urban Development. Office of Policy Development and Research. https://www.huduser.gov/portal/pdredge/pdr_edge_featd_article_102014.html 

Office of Policy Development and Research. (1995, December 12). Stewart B. McKinney Homeless Programs. U.S. Department of Housing and Urban Development. Office of Policy Development and Research.

Office of Policy Development and Research. Supportive Services Demonstration and Evaluation: Testing the Integrated Wellness in Supporting Housing (IWISH) Model. Overview. U. S. Department of Housing and Urban Development. https://www.huduser.gov/portal/IWISH_Evaluation.html 

Okoro, C. A., Hollis, N. D., Cyrus, A. C., & Griffin-Blake, S. (2018). Prevalence of Disabilities and Health Care Access by Disability Status and Type Among Adults — United States, 2016. MMWR. Morbidity and Mortality Weekly Report, 67(32), 882–887. https://doi.org/10.15585/mmwr.mm6732a3 

Reagan, R. (1984, January 30). Interview With David Hartman of ABC News on the 1984 Presidential Election [Interview]. Ronald Reagan Presidential Library and Museum. https://www.reaganlibrary.gov/archives/speech/interview-david-hartman-abc-news-1984-presidential-election

Shain, S., & Gardiner, A. (2023, February 10). What’s Homelessness Really Like? The New York Times. https://www.nytimes.com/interactive/2023/02/10/headway/homelessness-mental-health-us.html#/people/susi-pazurik/question-5/ 

Social Security Administration. (n.d.). Eligibility for Social Security in retirement. Retrieved January 27, 2024, from https://www.ssa.gov/retirement/eligibility 

Social Security Administration. (2024). SSI Federal Payment Amounts. https://www.ssa.gov/OACT/COLA/SSIamts.html 

Tompsett, C. J., Fowler, P. J., & Toro, P. A. (2009). Age differences among homeless individuals: adolescence through adulthood. Journal of Prevention & Intervention in the Community, 37(2), 86–99. https://doi.org/10.1080/10852350902735551 

U.S. Department of Housing and Urban Development. (n.d.). Housing Choice Vouchers Fact Sheet. Retrieved February 7, 2024, from https://www.hud.gov/topics/housing_choice_voucher_program_section_8#hcv01

https://www.huduser.gov/portal/publications/homeless/mckin/intro.html 

World Population Review. (2024). Average Rent by State 2024. https://worldpopulationreview.com/state-rankings/average-rent-by-state

For further reading: 

U.S. Department of Housing and Urban Development (HUD). Office of Community Planning and Development. (2023). The 2023 Annual Homelessness Assessment Report (AHAR) to Congress. Part 1: Point-in-time estimates of homelessness. https://www.huduser.gov/portal/sites/default/files/pdf/2023-AHAR-Part-1.pdf  Summary of key findings: https://www.hud.gov/sites/dfiles/PA/documents/HUD_No_23_278_4.pdf 

Joint Center for Housing Studies of Harvard University. (2023). Housing America’s Older Adults. https://www.jchs.harvard.edu/sites/default/files/reports/files/Harvard_JCHS_Housing_Americas_Older_Adults_2023.pdf 

Joint Center for Housing Studies of Harvard University. (2024). America’s Rental Housing. In Joint Center for Housing Studies (pp. 1–56). Harvard University. https://www.jchs.harvard.edu/sites/default/files/reports/files/Harvard_JCHS_Americas_Rental_Housing_2024.pdf 

Office of Behavioral Health, Disability, and Aging Policy. (2023). Addressing Homelessness Among Older Adults: Final Report. In Office of the Assistant Secretary for Planning and Evaluation (pp. 1–82). U.S. Department of Health & Human Services. https://aspe.hhs.gov/sites/default/files/documents/9ac2d2a7e8c360b4e75932b96f59a20b/addressing-older-adult-homelessness.pdf 

Culhane, Dennis & Doran, Kelly & Schretzman, Maryann & Johns, Eileen & Treglia, Daniela & Byrne, Thomas & Metraux, Stephen & Kuhn, Randall. (2019). The Emerging Crisis of Aged Homelessness in the US: Could Cost Avoidance in Health Care Fund Housing Solutions?. International Journal of Population Data Science. 4(3). DOI:10.23889/ijpds.v4i3.1185

Paul, C. A. (2018). Contemporary Housing Issues. Social Welfare History Project.

“Older Adults’ Pathways Into — and Out of — Housing Insecurity and Homelessness,” Friday, October 6, 2023  Joint Center for Housing Studies of Harvard University

Madelena Eifert is the recipient of a 2024 VCU Publishing Research Award.