With a growing number of older adults experiencing homelessness across the US, we interviewed housing, aging, and homelessness service providers in Boston to examine factors unique to older adults. In our report, Pathways into and out of Housing Insecurity and Homelessness, Jennifer Molinsky, Chris Herbert, and I explain that often, people who became unhoused for the first time at age 50 or older had struggled for many years to maintain their housing. Age-related experiences such as retirement, new chronic health conditions, or changes in ability then strained tenuous housing arrangements until they broke. While researchers have documented numerous factors that increase risk of homelessness, this research illuminates the ways age-related changes in income, health and ability, and networks exacerbate these risks.

Economic

Older residents living on a fixed income struggle with rising housing costs, particularly when cost increases outpace rise in income. Multiple interviewees observed that recipients reliant on Social Security programs were unable to afford Boston housing prices. Additional challenges arise for long-term residents whose rent has lagged behind market rates. A sudden adjustment to current rental prices, such as when an aging landlord sells the property, can decimate the budget of a renter whose retirement planning did not account for massive rent inflation. Interviewees recounted older Boston residents living with a pension who became displaced when actual retirement costs outpaced their total income plus savings. Compounding housing affordability problems, many older adults lose income when their spouse dies. Interviewees further noted the lack of single-room occupancy units, leaving few options to downsize. Yet housing subsidies to close these gaps are hard to come by. Since housing assistance is not an entitlement, only about a third of households with very low income actually receive support. Without more affordable options or better access to subsidies, a rent increase or the death of a partner can become a triggering event that leads to housing loss.

Health and Ability

Mobility limitations increase fall and hospitalization risk, healthcare costs, and can also threaten housing stability. At least a third of people aged 70 and older have limitations that make it difficult for them to walk or climb stairs. Some use assistive devices such as a walker or wheelchair which need space to maneuver. Since less than four percent of the national housing stock is accessible to people with mobility challenges, many need to modify their homes or move. With such a small stock of accessible housing, older residents with mobility challenges must find a unit that is both accessible and affordable to them, vastly complicating their search. Those who try to remain in poor-fit homes amplify risk of falls that further threaten health and independence. Unable to use an assistive device, a resident might lean on furniture or household items. They might use stairs or stepstools, or other features are out of line with their physical ability. Poor housing fit can also increase isolation and reliance on others. For instance, one interviewee described a resident who, unable to climb the stairs to their apartment, needed to find help every time they wanted to leave the home. Mobility limitations can threaten housing stability when the home no longer works and there are few options to modify or move.

Other conditions that become more common with age can also increase an older resident’s reliance on support from others. Cognitive changes, chronic health conditions, and other functional limitations (such as low hearing or vision) can make it difficult to perform instrumental activities of daily living (IADLs) such as shopping, housekeeping, and paying bills, as well as activities of daily living (ADLs) such as bathing and dressing. However, professional assistance is expensive and public services to meet these needs remain in short supply, particularly in states that maintain long waiting lists for Medicaid-funded services, and places with a limited caregiving workforce. Even in Massachusetts, a state with relatively robust resources for low-income residents to receive personal care, interviewees found it difficult to manage transitions as needs evolved over time, especially when coordinating across healthcare, personal care, aging, housing, and homelessness services systems.

Social and Network

Ultimately, many people rely on family and friends to help them with ADLs and IADLs, so the loss of a caregiving spouse or adult child can be devastating. For instance, one interviewee described a man with dementia who was brought to a shelter after his spouse died. Shelters are in no position to fill in these care gaps, as residents must be able to feed themselves, shower and use the bathroom on their own, and get into and out of bed without help. Yet even older adults who are too independent for nursing homes may need assistance with some tasks. For instance, an interview participant described difficulties meeting the needs of older wheelchair-bound guests who are otherwise able to care for themselves.

Advanced age can also make it harder to connect older adults to programs. Combined with mobility and technological limitations, the loss of friends and family can lead to isolation. Unfamiliar with social service systems, isolated older adults may struggle to access the help they need. Still others may refuse services, misperceiving that programs are designed to assist people who are worse off. Finally, those long connected to service systems may have lost trust during past periods of hardship. Interviewees emphasized the importance of sustained relationships with older adults to build trust and proactively address needs before crises emerge.

Ultimately, there are not enough affordable housing options to meet the needs of older adults with limited budgets and accessibility needs, and personal care services are not always comprehensive or adequate. Fully scaled rental subsidies, home modification programs, personal care assistance, and service coordination are all key to ensuring the housing stability of older Boston residents.