The short answer is yes. The long answer is dark
On July 19, Real Change participated in a #SeaHomeless event, along with other local media outlets including The Evergrey, soliciting questions about homelessness. One in particular caught our attention, due to the magnitude of its implications:
“Do many people who are retired or aging end up homeless? Can people afford nursing homes?”
Strap in, folks. This is about to get dark.
The short answer is yes, many people who are retired or aging do end up homeless and no, many cannot afford senior housing.
The longer answer includes multiple complex systems and failures of systems. The size of the baby boomer generation, the cost of housing, lack of medical care and an insufficient social safety net all contribute to allowing older folks to slip into poverty. As a result, the number of older people experiencing homelessness is only predicted to grow.
The National Health Care for the Homeless Council reported in 2013 that the number of elderly people experiencing homelessness in the United States was expected to rise by a third — from 44,172 to 58,772 — between 2010 and 2020. By 2050, if trends continue, the number of older individuals experiencing homelessness will rise to more than 95,500.
Veterans are particularly vulnerable. A 2016 report to Congress showed that homeless veterans in shelters were 2.4 times more likely to be between the ages of 51 and 61 than the general population of veterans in the United States.
These numbers should be surprising, but they aren’t.
In a country where nearly half of households could not cover an unexpected $400 expense, few have savings to support themselves or their aging parents in retirement. And whereas career jobs used to offer pensions and benefits that could cover the cost of leaving the workforce, waning union membership and the increase of gig economy jobs have gutted those systemic supports. On their own, people approaching retirement age may not be able to afford the rising cost of housing and the incredibly high cost of health insurance. That is particularly true if they retire before aging into Medicare benefits, a socialized medical plan for adults over the age of 65.
Indeed, retirement in today’s economy forces older individuals to navigate a complicated web of services, many of which haven’t kept up with the swelling cost of living.
Those who qualify for their Social Security benefits — money they have accrued over their years participating in the labor market — may be eking it out on a fixed income that cannot compete with housing costs in areas that have the amenities that seniors need, such as ready access to medical care, proximity to family and community to prevent social isolation.
People who are 62 or 65, the ages that you can first qualify for Social Security and Medicare, may still not have enough money to remain housed, particularly if they’re struggling with any health issues.
If an individual has been sick for a long time, a category that includes all chronically homeless adults, they may be entitled to some relief under Supplemental Social Security (SSI), a program that offers money to people who are disabled. In 2018, SSI offered $750 per month at most to help cover costs. If a person receiving SSI also gets regular Social Security benefits, their SSI income drops. If they get almost any additional income, say from investments or part-time work, that number drops further, or the individual may be disqualified from the program entirely.
The average cost of a one-bedroom apartment in Seattle is about twice what SSI and Social Security can offer.
The average cost of a one-bedroom apartment in Seattle is about twice what SSI and Social Security can offer.
Locally, older adults who own their homes also struggle to keep up with property taxes. Cities in Washington rely primarily on property taxes and sales taxes to fund social services. Older adults on fixed incomes who bought when the price of homes and the annual bills from the government were lower struggle to come up with the thousands of dollars it takes to hold onto the homes they have already paid for.
People in this age group account for only 2 percent of the homeless population, compared to 15 percent of the housed population, according to a 2007 report from the Department of Housing and Urban Development.
That may seem like a good thing. But it isn’t; it means that there are thousands of older individuals who, while not technically “seniors,” can’t access the services they need. There is a hole in government services for homeless people between 50 and 64. The tragic truth is that most people experiencing homelessness die long before they reach the age where they qualify for otherwise life-saving programs.
The tragic truth is that most people experiencing homelessness die long before they reach the age where they qualify for otherwise life-saving programs.
According to research from the University of California at San Francisco, people living outside face different challengers and often die from conditions caused by trauma, infectious diseases and complications from substance abuse, while sheltered older folks die of ailments like cancer and heart disease.
Locally, the average life expectancy for a homeless person, according to a King County Public Health report from 2018, is roughly 50, or about the same average age of death of a person living a century ago.
This is due in part to a condition called “weathering.” According to the National Health Care for the Homeless Council, people in poverty are exposed to prolonged periods of stress that result in premature aging. People without stable housing can present as 10 to 20 years older than they actually are.
People without stable housing can present as 10 to 20 years older than they actually are.
This means that, while many of our older homeless individuals are not technically seniors, the brutality and stress of life outside or in shelters means that they are living in bodies that belong to someone far their senior — a reverse Dorian Gray. Their lives are literally being stolen from them.
Kathleen McGregor sees these kinds of patients firsthand.
McGregor is a nurse on the Housing Health Outreach Team at Neighborcare, a nonprofit healthcare organization that serves homeless and low-income people. She works at St. Martin’s on Westlake, a permanent supportive housing community reserved for people over the age of 55. Most of the people who live there came straight from homelessness.
McGregor’s clients often became homeless because of an accident or unexpected malady. Many worked manual labor and odd jobs. Even if they made enough money to live comfortably, they didn’t have access to employer health insurance, and didn’t see doctors or receive timely medical care. That means McGregor helps folks in their 50s who have lost limbs to unchecked diabetes or have dangerous lung diseases made worse by years without an inhaler or other treatments.
Such conditions get worse when people are out on the street, McGregor said.
“It is next to impossible when you’re homeless to get medical care,” McGregor said. Even now, when her patients do go to see other doctors, they can be treated poorly because of their formerly homeless status. Medical providers can carry prejudices against homeless people, assigning them the blame for their conditions, McGregor said.
Medical providers can carry prejudices against homeless people, assigning them the blame for their conditions.
Other times, practitioners who aren’t trained in trauma-informed care may send formerly homeless patients away confused, not understanding their conditions or the follow-up that’s needed to make them well.
Often, the key component to making them well is housing – but finding affordable housing for seniors in the Seattle area is difficult at best.
The city’s Office of Housing lists 18 buildings that, according to King County records, offer 978 units for lower-income seniors. This doesn’t include units in buildings run by the Senior Housing Assistance Group (SHAG), which, while touted as “affordable,” can still cost more than $1,000 a month, or permanent supportive housing units like St. Martin’s on Westlake where McGregor works.
Nursing homes are also an imperfect option.
According to a 2009 study, nursing homes cost between $50,000 and $60,000 per year, far out of the reach of people who are already on the verge of homelessness. Medicaid, the health care program for low-income people, can cover nursing care facilities and other kinds of supported housing for the elderly, but finding a spot could be tricky. The cost of care has increased along with the cost of other health services, while social service budgets have been slow to keep up.
In a 2017 lecture, Wharton Business School’s John Whitman cited a study that found that, in most states, Medicaid pays $23 less than the actual cost of services, per patient, per day, in nursing facilities. That shortage can lead to overcrowding, as facilities scramble to make up the losses, or prompts limits to the number of Medicaid patients that nursing facilities can afford to take.
“You don’t have to be a Wharton grad to realize the economic implications of that,” Whitman said in his remarks. In a capitalist market, potential residents – who are really clients – are simply not competitive.
People can become homeless after retirement, even if they’re homeowners and thought that their Social Security benefits would be enough to get by. They can become homeless as the result of a sudden medical emergency, a change in property tax laws or a spike in the local rental market.
Additionally, the number of older people experiencing homelessness is only expected to grow, trapping people in a system with few options. Once someone becomes homeless, they may suffer from physical ailments that kill them younger or force them to choose between needs like housing, food and medicine.
Asked what she would do to fix the system, McGregor just laughed. It would be a 12-hour discussion to scratch the surface, she said. But she did have one overarching recommendation:
“Universal health care and mental health care,” McGregor said. “If we’re going super macro, we have to have those two things.”
Ashley Archibald is a Staff Reporter covering local government, policy and equity. Have a story idea? She can be can reached at ashleya (at) realchangenews (dot) org. Follow Ashley on Twitter @AshleyA_RC
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