Housing, Care and Support: Coming of age: Meeting the challenge of older homelessness

Abstract

Older people who are homeless or at risk of homelessness have diverse and varied needs. Their needs are not the same as those of either younger homeless people or older people who already have secure and appropriate housing. This article explains the problems and proposes cost-effective solutions for commissioners and providers.

Introduction

Older people who are homeless or at risk of homelessness need special consideration in strategic planning and service delivery, by providing specialist services or by raising awareness and providing training so generic services take account of their needs.

Older homeless people tend to fall down the gaps between strategies and services because:

* mainstream services for older people take little or no account of people who are homeless

* older people tend to be marginalised in mainstream homelessness services

* services for people with problems such as mental ill-health or learning disability concentrate on people of working age and often ignore the needs of older people.

Local strategies (especially Supporting People, older people, homelessness and housing strategies) should mention the needs of older people vulnerable to homelessness and, by partnership working, ensure that their needs are met. This reflects the policy agenda of:

* older people's initiatives including Better Government for Older People, Quality and Choice for Older People's Housing and the work of HOPDEV (the Housing and Older People Development Group)

* homelessness initiatives, including the Homelessness Directorate, recent changes to homelessness legislation and the requirement for local homelessness strategies

* regional housing boards

* policies and procedures to protect vulnerable adults from abuse

* health initiatives such as the Department of Health Extra Care housing fund

* health inequalities programme for action, including reducing the gap between areas with the lowest life expectancy and the population as a whole.

Older homeless people are especially vulnerable because of their age, and their vulnerability may be made greater by other problems, such as physical disability and sensory impairment, mental ill-health, substance abuse, learning disability, domestic violence, poor housing and isolation.

Existing models of good practice, with housing from social housing providers and support funded by Supporting People and their partners, show what can be done. Older homeless people can be successfully resettled and such interventions can have cost benefits, meet Best Value principles and save public money.

However, there are barriers to developing provision. Some services for this group should be commissioned and funded jointly, or involve partnerships with other agencies to ensure that complementary services are provided to support older homeless people in maintaining their tenancies (eg meaningful activity, domiciliary care, health interventions). However, such arrangements are time-consuming and not easy to develop successfully.

Some services rely on bricks and mortar provision by RSLs or local housing authorities but, especially in areas of housing stress, suitable housing is not easy to obtain.

Many older homeless people have multiple needs. Their needs cross the boundaries of housing-related support and health and social care, so joint commissioning and partnership working across services are required.

Older homelessness: routes into and out of homelessness

Homelessness is especially damaging to the health and well-being of older people. Many die before their needs are met. Homelessness also has costs to the public purse across housing, health, social care and other budgets. The following scenarios are composite summaries of real cases. The alternative endings show what happens with minimal or with high-quality support, and that the latter can save money.

Older woman, gambling addiction, evicted from council house

Grace, aged 62, is a widow. Three years ago her only daughter and her grandchild died in a house fire. A month later her husband died of cancer. He had always managed the household finances because Grace has limited literacy and numeracy skills. After these traumas, Grace became depressed, but received no medical treatment or counselling. She was lonely and started going to bingo sessions where she spent more and more money, encouraged by new-found 'friends' who 'borrowed' money from her. She fell behind with rent payments and the council started possession proceedings. Grace could not cope, ignored all the letters from the council, and was evicted. She did not attend court and did not wait for the bailiffs to arrive. She was invited to stay with bingo 'friends', but after a few weeks they started asking for money. When she couldn't pay they threatened her and she left. She slept rough in woodland near her old home.

Variation 1

After a month, she found out about the night shelter in the nearest large town. The shelter had limited staff and was overwhelmed by the demands of younger people. Staff had received no training in the needs of older homeless people and there was no separate provision for women.

Grace stayed only two nights. It was full of young people and middle-aged men, the young people stole from her and talked of drug-taking, and the men drank and were violent. She went back to the woods. Later that Autumn, she was taken ill and was found by the roadside. She was admitted to hospital and diagnosed with pneumonia and mental health problems. After a stay in hospital, she was homeless, and so when the time came to discharge her she was admitted to a residential care home. She has lived in the care home for two years.

Variation 2

After a month, Grace went to a homeless day centre for a meal, where someone told her about a hostel for single women. She spent eight months in the hostel, rebuilding her confidence and attending a social club for older people. The hostel referred her to a specialist service for older people who are homeless or at risk of homelessness. They found her a housing association sheltered flat in the same area as her social club, to help her maintain her social contacts and not drift back to bingo. Her rent arrears from her council tenancy meant that she was considered intentionally homeless by the local authority, and she had to agree to repay the arrears before the housing association could offer her a tenancy. The support worker negotiated a low repayment and visited Grace every week to help with her budgeting for the first 18 months. The sheltered flat was well furnished and central heating is included in the rent and service charge, which helps with budgeting. There is a communal laundry and social activities.

Grace remains in sheltered housing with social support within the scheme and from her club. After the first 12 months, she no longer needed regular weekly visits from the support worker but could still contact the project when she needed to. The housing association monitors Grace's rent payments carefully. She started to fall behind a few months ago, and the association sent someone to talk to her sensitively and the problem was resolved.

Other scenarios

The full report, Coming of Age (UK Coalition on Older Homelessness, 2004; visit www.olderhomelessness.org.uk) includes two further scenarios.

Harold, a 63-year-old man with learning disabilities, moved in with his sister for a year after his parents died, but was asked to leave by her new partner because of overcrowding. After staying in a friend's caravan, he became street homeless.

Frank, a 55-year-old man, became homeless after his wife died and he was made redundant. He became depressed and started to drink more heavily. With no income to pay the mortgage, he abandoned his owner-occupied flat, stayed for a week with his son but was asked to leave, and then slept rough.

The costs of homelessness

Homelessness costs money. There can be substantial cost savings to the public purse if older homeless people receive appropriate interventions. Detailed figures, sources and assumptions for the scenarios (Frank, Grace and Harold) can be found in the full report. In each scenario at least £5,000 per year could be saved.

For Grace, there are costs of £2,300 for her failed tenancy, which apply whatever the subsequent outcome. For Variation 1, in the first year the cost to the NHS is over £10,000 and the former tenant arrears of £2,000 would not be recovered. Residential care costs more than sheltered housing. We estimate the cost savings of Variation 2 to be over £5,000 per year for the first two years and £7,500 per year thereafter.

The problems that cause older homelessness

Like Frank and Grace, most older people who become homeless had jobs, families and settled housing until some trauma caused homelessness. Like Harold, many single people lived with family into adulthood, but could not manage alone. Others became homeless when a private landlord sold up or died.

Reasons for homelessness in later life are complex, but a common trigger is bereavement or relationship breakdown, often linked to other risk factors including:

* limited or no support networks

* physical health problems and disability, which can lead to isolation and loneliness

* mental health problems or dementia

* substance abuse or other addiction, including gambling

* limited literacy and numeracy skills and lack (or loss) of confidence in coping with bills

* relationship changes (especially later in life)

* a history of unresolved loss and trauma.

These warning signs can be used to prevent homelessness in later life if staff are trained and monitoring systems are in place.

Even among older rough sleepers or long-term hostel residents, more than half had homes, jobs and families before becoming homeless in later life. Others became homeless earlier:

* after a difficult childhood (abuse, being in care, etc)

* after an itinerant working life (for example in the construction industry)

* after losing tied accommodation (hotels, the Forces and so on).

Studies show that about half of all long-term homeless older people have had at least one failed attempt at resettlement in previous years (often in unsuitable accommodation with little or no support). Each failed attempt meant that they lost confidence for next time, often accruing tenant arrears (like Frank and Grace) and being deemed intentionally homeless. High-quality resettlement and tenancy sustainment services are essential to avoid this 'revolving door' problem.

Limitations of homelessness legislation

To anyone unfamiliar with the detail of UK homeless legislation, it may seem surprising that older people can become and remain homeless in the twenty-first century. The legal definition of 'statutory homelessness' is quite broad:

* there is no accommodation they are entitled to occupy, including:

* rooflessness or eviction, like Frank, Grace and Harold

* staying somewhere where they have no legal right to stay, for example with family or friends who ask them to leave, like Frank, Grace and Harold

* they have accommodation but it is unreasonable to continue to occupy it, for example:

* because the housing is in such poor condition, like Harold's caravan

* because of violence or abuse, as from Grace's 'friends'.

However there are many limitations, including the following.

* Older people have to 'present' to their local authority as homeless before their case is considered. Many do not do so.

* Many older people are 'hidden homeless' (for example long-stay residents in direct access hostels, or people staying with friends and relatives).

* Old age' is not defined in law. People aged 50-60 are unlikely to qualify on grounds of age, and even people over pension age may not be accepted as 'vulnerable' and therefore in 'priority need' for housing.

* The duty is to find housing, but without adequate support tenancies may fail.

* Older people can be found to be 'intentionally homeless'.

* Older people are less likely to know their rights or seek advice.

How many older homeless people are there?

The full report estimates the number of older homeless people (aged 50+) nationally as 42,000. We have used the age of 50+ for two reasons: older people who have experienced long-term homelessness (especially rough sleepers) tend to die at a much younger age than usual and have the health problems of much older people, and people aged 50+ are more vulnerable to the known triggers of homelessness, especially bereavement, redundancy and chronic health problems.

To prepare for local strategies, it is essential to know how many older people are vulnerable to homelessness, and their housing and other circumstances. The report gives advice on data sources such as:

* local authority homelessness and housing advice statistics

* data from local advice agencies (such as Shelter and CABx)

* data from specialist local services (domestic violence agencies, for example).

What can be done?

Know the provision in your area

Supply-mapping for Supporting People will have identified local provision, but the following questions need answers in order to plan housing and support services for older people vulnerable to homelessness.

* How much specialist homelessness provision is available that is appropriate for older people?

* Are all-age services monitored for age data on their service users?

* Is there a gap in services for older homeless people with multiple and complex needs?

* Is there a gap in suitable provision for older homeless people with specific needs (eg older women, older people from minority ethnic communities, older people with alcohol problems)? All-age services are unlikely to cater for and may exclude these groups.

Housing and support providers can improve their services by monitoring for age and offering staff training. Supporting People teams can also enhance services for older homeless people by asking how their needs are met during service reviews and the contract management process. Older residents in homeless provision are often less assertive than younger residents. Supporting People funding for direct access and second-stage hostels can allow for better staffing levels or dedicated staff to work with older people. In sheltered housing, wardens and scheme managers should receive training, and providers should make links with homelessness agencies and floating support providers.

Supported housing: direct access and short-stay provision

Direct access hostels enable staff to work with older homeless people and move towards more appropriate, longer-term housing and support. Following concern about 'silting up' of direct access hostels by long-stay older residents, schemes have been developed to move older residents on into more appropriate longer-term housing with Supporting People funding, freeing direct access beds for homeless single people of all ages.

Specialist supported housing

Older homeless people with higher support needs cannot cope immediately in their own tenancies and need specialist provision. Some may progress to their own tenancies with floating support, but many will need to stay longer, perhaps permanently, in supported housing.

Resettlement services

Resettlement services are an essential part of the jigsaw for moving older people on from hostels into permanent housing. They sometimes have a few older people as part of their caseload. How well they cater for the needs of older people will depend on a number of factors.

* Does the organisation have a clearly defined and implemented diversity policy and procedures which take account of the needs of older service users?

* Have the staff received any specific training?

* Do the Supporting People contract and other funding arrangements recognise that older people need longer to build up relationships and more practical help and emotional support than younger service users, or is there pressure to maintain high levels of throughput?

* Do staff have good links with local older people's housing providers, especially sheltered housing?

A few specialist resettlement services for older people have developed expertise in the needs of older people and links with local housing providers.

Tenancy sustainment

Tenancy sustainment services help older people who have been homeless to maintain their tenancy and avoid the revolving door problem. They can help those vulnerable to homelessness remain in their existing housing, by tackling the causes (especially benefits delays, rent arrears and neighbour problems) before they lead to eviction or abandonment.

Sheltered housing for older homeless people

Sheltered housing can be a very effective solution, but there is a need for careful choice of scheme, additional support where needed (for example through resettlement and floating support services, as for Grace) and training for both homelessness and sheltered housing staff to understand the role that sheltered housing can play.

Home improvement agencies (HIAs), also known as Care and Repair or Staying Put schemes

HIAs have a role in preventing homelessness. They provide advice, information and support to older people on low incomes (owner occupiers and private tenants), including those living in housing in poor condition and disrepair. They will also help with income maximisation (benefits advice) and often have links with minority community groups and are aware of the needs of BME elders.

More information

The UK Coalition website, www.olderhomelessness.org.uk, has the full report, bibliography, detailed papers on estimates of the number of older homeless people, cost estimates and links to other information, including good practice examples.

This article and the full report were researched and written by Jenny Pannell. The appendices on numbers and costs were researched and written by Guy Palmer of the New Policy Institute.

JENNY PANNELL

Independent Consultant

GUY PALMER

Director, New Policy Institute