Socioeconomic Pressures on the Elderlyand Newly Homeless in Toronto
The upcoming 2012 City of Toronto budget seeks to drop spending levels ten percent across the board (Dale, 2011), regardless of the need for services, increasing demand or consideration on the effects to the most marginalised within our city. One such cut will see the closure of homeless shelters gears to the elderly poor – a group that is considered one of the most at risk for abuse, neglect and health issues on the street or at other generalised shelters. This decision comes on the heels of the largest ever cohort of people entering old-age – the baby boom generation (MacDonald, Dergal & Cleghorn, 2007), – and on the cusp of the financial downturn that eradicated a large part of peoples’ retirement savings. Even those with proper housing are facing dramatic increases in property value and, in turn, property taxes based on new assessments that may be well outside any structured retirement plan they have in place (Gillespie, 2007). Persistently high unemployment along with near stagnant economic growth, leaves the elderly, along with the young, as the first groups to be rejected as potential candidates for hiring due to their age and perceived long-term value to a company which denies them the ability to supplement their retirement income (Cohen, 1999). This perfect storm of socioeconomic conditions sets the stage for what might be the largest influx of elderly homeless on our streets at a time when we callously rollback services.
The pathway to homelessness in the elderly is not unlike that of street youth in that it consists of multidimensional factors including the lack of affordable housing, employment or institutional services (Stegiopoulos & Herrmann, 2003) – but the risk factors are different, including the of loss of stable income, death of a spouse or significant other, lack of a proper caregiver or eviction (Crane, 1999). Others that have been institutionalised for a long period for physical or mental health issues and have lost their housing within that time (Hecht & Coyle, 2003) and are often released to shelters as a last resort. Further still, some have become homeless in their middle-age as they were living with elderly parents – due to economic or health concerns – who since passed away leaving their offspring little-to-no social safety net (Crane & Warnes, 2000). All of these factors are pressured by past economic ability – with many surviving in poor or near-poor conditions most of their lives – and never having the benefits that full- and long-time employment provides, such as personal saving or pensions (Cohen, 1999). While the relative population of this subgroup is falling when compared to all homeless people, in absolute numbers it is in fact increasing and expected to climb in North America by an estimated half million people (Cohen, 1999) in the next fifteen years as our general population ages.
Many studies argue that the defining age for elderly homeless be decrease by 10 to 20 years than in the average population since the physical and mental health effects of living on the street causes the appearance and behaviour of being older (Crane & Warnes, 2000). It is expected that a homeless man over the age of 45 were twice as likely to die prematurely than the average male and that “the cost of being homeless in North America is losing about 20 years of your life expectancy” (Wright, Rubin & Devine, 1998, 167). Unlike the rest of the homeless population, women outnumber men – possibly due to life expectancy (Cohen 1999) but also because men spend 50% more time on the street in comparison (Crane & Warnes, 2000) and women tend to enter street life in their later years (Crane, 1999). The lack of adequate and safe hospice for the elderly in shelters tends to bring the on-set of street sickness – a combination of a number of issues including respiratory problems, skin afflictions and malnutrition from exposure to the elements and poor hygiene (Higgitt, et al, 2003) – that further accelerates physical and mental health issues already progressing in the elderly population. This can lead to an increase of degenerative diseases and chronic conditions such as hypertension, anaemia, cardio- and cerebro-vascular diseases (MacDonald, Dergal & Cleghorn, 2007). Unlike other homeless groups whose mortality is more often caused by AIDS, suicide or homicide, the elderly tend to die early from cancer and heart diseases and mostly alone in a hospital or residential setting (Hwang, 2000).
Mental health issues are often sited as a driving factor to homelessness in the elderly population, such as the on-set of early dementia or Parkinson’s disease (Stegiopoulos & Herrmann, 2003), but often the conditions from living on the street and isolation from family and friends are the catalyst for these issues. One third of older homeless men were found to be clinically depressed (Cohen, 1999) which stresses am already weakened immune systems and physical health. Elderly women tend to be even further debilitated depending on age: with 57-75% reporting depression over the age of fifty in comparison to only 10 % under the age of twenty (Crane & Warnes, 2000). The lost of a long-time partner, isolation from a community or the inability to adapt to a life of poverty leads to an entrenched feeling of isolation and loss of pride that leads to depression, hostility, poor self-esteem and psychosomatic illnesses (Rokach, 2003). Males are four times more likely than women to engage in long-term alcohol abuse which follows them to the street and increases with age (Cohen, 1999) and is often neglected upon medical review, being incorrectly attributed to physiological changes due to aging or dementia (MacDonald, Dergal & Cleghorn, 2007).
The lack of services and support is sited as the causation and continuance of both mental and physical health issues and reliance on the street. Often, without encouragement, physical ailments go undiagnosed because of the lack of a family physician, inability to recognise the severity of the issue or fear, either of being shunned by or directly suspicious of, the medical community and potential institutionalisation (Crane & Warnes, 2000). Others were barred from seeking medical help because of the lack of a health card or insurance and from the reluctance of health providers to register homeless people because of their multiple inflictions and transient nature (Hwang, 2000). The Daily Bread Food bank also notes that 40% of their older recipients of their service often had difficulty paying for their prescription medications every month with as many as 27% declining outright to purchase them simply because of affordability (2001). The newly elderly homeless also tend also to stay with services familiar and close to them, such as onsite clinics where they take shelter, but are seemingly oblivious to community outreach programs and drop-in centres (MacDonald, Dergal & Cleghorn, 2007). They are also subject to more victimization within these shelters from other residents due to their frail condition, including physical assault, thief and rape (Cohen, 1999).
Traditional services to aid the homeless rely on as methodology of crisis intervention and attempt to focus on building independence and self-sufficiency (MacDonald, Dergal & Cleghorn, 2007) a program better geared to youth and young adults. Elderly homeless require greater access to mobility and care during the day, often unavailable in shelter as they only operate during the evening hours (Stegiopoulos & Herrmann, 2003). Mental health issues – including depression, requires constant and static care to stymie isolation – and chronic and multiple physical health conditions need support and aid for medication (Cohen, 1999). While income among older homeless people is reportedly two times higher than their younger counterparts due to social assistance, old age security and past pensions (Cohen, 1999; Crane & Warnes, 2000) their ability to find alternative sources of income from temporary employment or street services is limited by their physical abilities and public perception (Crane, 1999). The MacDonald, Dergal & Cleghorn study in Toronto also showed that 50% of the recently elderly homeless also are immigrants to Canada and have suffered from family breakdowns and little communications with ex-spouses and community. Those who are moved immediately out of standard social programs to dedicated, specialised shelters where they can obtain services and a proper network suffer less from chronic health issues and are more likely to survive longer and find permanent homes (2007). Regardless of who, where, when and how they arrive, the elderly homeless population struggle with differing needs that require much more substantive and long-term care and need for these programs, particularly when socioeconomic conditions are pushing more into old age and near poverty, has never been more prevalent. The audacity to close services rather than opening more seems ludicrous, untimely and wholly unpalatable.
Cohen, C. I. (1999) Aging and homelessness. The Gerontologist, 39(1). 5-14.
Crane, M. (1999) Understanding Older Homeless People. Housing Studies, 15(2). 325-327.
Crane, M & Warnes, A. M. (2000) Lessons from Lancefield Street: Tackling the needs of older homeless people. National Homeless Alliance. London.
Daily Bread Food Bank (2001) Aging with Dignity? How governments create insecurity for low-income seniors. Toronto.
Dale, D. (2011, Dec. 7) Environmentalists, child-care advocates speak out: Follow it Live. The Toronto Star. Retrieved from: http://www.thestar.com/news/cityhallpolitics/article/1098229–environmentalists-child-care-advocates-speak-out-follow-it-live
Gillespie, K. (2007, Sept. 27) Who can rescue seniors from property tax trap? The Toronto Star. Retrieved from: http://www.thestar.com/article/261080
Hecht, L. & Coyle, B. (2001). Elderly Homeless: A Comparison of Older and Younger Adult Emergency Shelter Seekers in Bakersfield, California. American Behavioral Scientist, 45(1). 66-79.
Hwang, S. (2000) Homelessness and Health. Canadian Medical Journal, 164(2). 229-233.
MacDonald, L., Dergal, J. & Cleghorn, L. (2007) Living on the Margins. Jornal of Gerontological Social Work, 49(1-2). 19-46.
Rokach, A. (2003) The Lonely and Homeless: Causes and Consequences. The Institute for the Study and Treatment of Psychosocial Stress, Toronto.
Stergiopoulos, V. & Herrmann, N. (2003, July) Old and Homeless: A Review and Survey of Older Adults Who Use Shelters in an Urban Setting. The Canadian Journal of Psychiatry, 48. Canadian Psychiatric Association. 374-380.
Wright, J. D., Rubin, B. A. & Devine J. A. (1998). Beside the golden door: Policy, politics and the homeless. Aldine de Gruyter, New York.