Homeless Older Adults Research Project Final Report

Transcription

1 Institute for Human Development, Life Course and Aging U N I V E R S I T Y O F T O R O N T O Homeless Older Adults Research Project Final Report November 2004 Principal Investigator: Lynn McDonald, Ph.D. Research Associate: Julie Dergal MSc, Ph.D. Student Research Coordinator: Laura Cleghorn, M.A. Funded by: Supporting Communities Partnership Initiative (SCPI) City of Toronto

2 TABLE OF CONTENTS 1. INTRODUCTION DATA SOURCE #1: Quantitative (Short) Interviews A Comparison of Chronic and New Homeless Older Adults A Gender Comparison of Older Homeless Adults Homeless Older Adults at Risk for Homelessness DATA SOURCE #2: Qualitative (Long) Interviews DATA SOURCE #3: Focus Groups with Homeless and Gerontology Services Sectors DATA SOURCE #4: Secondary Data Analysis, Hostel Data DATA SOURCE #5: Homelessness Among Older Adults: A Review of the Literature CONCLUSION RECOMMENDATIONS REFERENCES i

3 Homeless Older Adults Research Project: Final Report 1. Introduction Despite the increased focus on the homeless population in Canada, there is little empirical knowledge about the characteristics, circumstances, and service needs of older homeless adults. The purpose of this study is therefore to gain a better understanding of older adults who are homeless or at risk for homelessness in the City of Toronto. As the number of homeless older adults is expected to increase with the aging of the baby boomers, improving service delivery to reach this population is important. While the experience of homelessness impacts on the physical and mental well being of individuals, the aging component adds a new dimension, which creates unique challenges for service providers. Description of Research Team The Research Team consisted of Dr. Lynn McDonald, Principal Investigator; Julie Dergal, Research Associate, and Laura Cleghorn, Research Coordinator. Six interviewers with previous experience in social work and/or working with the homeless were hired to conduct the quantitative and qualitative interviews. Lynn McDonald Ph.D., the principal investigator for the project. Currently, she is the Interim Director of the Institute of Human Development, Life Course and Aging, and Professor in the Faculty of Social Work, University of Toronto. She is the leading Canadian investigator on the economic, social, and health sequelae of retirement and their effects on the aging process. She has also worked successfully on several projects on homelessness, including the East Village Study of homelessness in Calgary, and has hosted an international conference on enumerating the homeless in Canada. Dr. McDonald has conducted studies on elder abuse, the social and health status of minority ethnic and racial groups of older persons living in the community, and has completed a study of drug use among older adults. Julie Dergal M.Sc., the research associate for this project, is currently a doctoral student with a specialization in aging, at the Faculty of Social Work, and part of the collaborative program on aging, University of Toronto. Her research interests include the social determinants of health, elder abuse, 1

4 and caregiving for older people. She has had extensive experience in project coordination as a research assistant at the Baycrest Centre for Geriatric Care. Laura Cleghorn M.A., the research coordinator for the project, specializes in research on social service delivery and program development. Methodology The sample consisted of older adults defined as those aged 50 and over, from three subgroups: the chronic homeless, the newly homeless and those at risk for homelessness, which were recruited using purposive sampling from three sectors; the hostel sector, congregate areas (sleeping rough, parks, etc.) and the service sector other than hostels (drop-ins, hospitals, services for older adults). For the purposes of this study, participants were recruited and classified based on the following definitions: 1. Chronically homeless - defined as being homeless for 365 days or more 2. Newly homeless - defined as being homeless for less than 365 days 3. Persons at risk for homelessness - defined as people who were currently housed either in temporary housing or staying with friends or relatives, and who were accessing services for low-income or homeless people Ethics approval for this study was obtained from the Institutional Review Board at the University of Toronto and informed consent was obtained from all study participants. This study employed a multi-method approach using the following five sources of data: quantitative (short) face-to-face interviews with homeless older adults, qualitative (long) face-to-face interviews with homeless older adults, 3. Three separate focus groups with a total of 27 service providers in the homeless and gerontology service sectors, 4. Secondary data analysis of the hostel data file and the 1996 Census tract for Toronto, and 5. A review of the existing national and international research on older homeless persons. For a complete description of the research methodology, data collection procedures, data analysis and study limitations, please refer to Appendix A. 2

5 2. Data Source #1: Quantitative (Short) Interviews Following are the data reported from the sixty-one interviews conducted with homeless older adults that took place in shelters, drop-ins, and coffee shops across the City of Toronto between September 15, 2003 and March 10, Participants were interviewed on their socio-demographic characteristics, experience of homelessness, housing history, use of health and community services, health status, substance use, nutrition, and social support. Below are the findings for the short survey in three separate sections. Section one presents a summary of findings that compare the newly homeless to the chronically homeless. Section two presents findings from the survey cross tabulated by gender. Section three is a summary of findings for those at risk for homelessness. The corresponding data is presented in tables and can be found in three Appendices: Appendix D contains the tables comparing the new and chronic homeless older adults; Appendix E contains the tables comparing the male and female homeless older adults, and Appendix F contains summary tables for older adults at risk of homelessness. 3

6 2.1 A Comparison of Chronic and New Homeless Older Adults As noted in the literature review (see section 6 of this report), the homeless can be defined in a number of ways. In this section, based on the survey of 61 adults, the chronic homeless are defined as people who have been homeless for more then 365 days in their lifetime. The new homeless are those that have been homeless for less then 365 days. 1 Because a truly representative sample of the homeless is rarely possible, the results do not apply to all older homeless people. Rather, the data are exploratory and present an approximate picture of older adults in the City of Toronto. Both Charts and Tables are included to describe these two sub-populations of older homeless adults. Additional tables are contained in Appendix D. The starred numbers in the cells suggest an important difference between the new and chronic homeless. Key Findings Both of the new and chronic homeless people believed that "old age" starts at about age 50. The chronic homeless have more difficulties than the new homeless in meeting their basic needs such as finding a shelter bed, finding food, clothing, and a place to wash. About half of the entire sample did not have enough money or enough food to eat over the last six months, with the proportion being larger among the new compared to the chronic homeless. Based on the housing history (e.g. their current and last three residences), the rate of emergency shelter use increased over time for both the chronic and new homeless from 13.2 percent to 48.3 percent, whereas the proportion of people living in self contained housing dropped from 45.3 percent to 5.2 percent. About two-thirds of the chronic homeless were currently staying in emergency shelters compared to slightly more than forty percent of the new homeless. Almost 60 percent of the chronic homeless rated their health as poor or fair, whereas almost 50 percent of the new homeless rated their health as good, very good or excellent as compared to the general older population, of which 80 percent rate their health as excellent. Almost all of the new and chronic homeless people reported trouble with vision and slightly more than half reported having arthritis. Other frequently reported illnesses were dental problems, back problems, anxiety and depression. 1 The definition of 5 or more times homeless in a life time is not used because there are too few cases for analyses of subgroups given the small sample size. Caution in interpretation is advised when there is less then five cases in a cell. 4

7 According to the SF-12, a standardized measure of health status, both groups of chronic and new homeless older adults are physically older than their chronological age, and are in worse physical health than the general older population. In addition, the new homeless scored lower on the SF-12 mental health scale than the chronic homeless and the general older population. About one-half of both the chronic and newly homeless older adults have possible or probable depression. Most of both the new and the chronic homeless reported that they are supposed to be taking medication, yet more than half reported that they could not afford their medication. One-half of both new and the chronic homeless older adults showed evidence of problem drinking, as indicated by the CAGE, a screening tool for problem drinking. The chronic homeless are more likely to have taken painkillers and analgesics than the new homeless, whereas the new homeless are more likely to have used crack, cocaine or hallucinogens. In terms of health services, the chronic homeless accessed health care at emergency rooms, shelters, and community health centres, and the new homeless used private doctors, emergency room, and overnight stays at the hospital. One-third of both groups, however, reported difficulty accessing health services, primarily because services are not available when needed and the associated costs are too great. More than half of the new homeless are unemployed because of a disability compared to less than ten percent of the chronic homeless. The chronic homeless have significantly less income per month than the new homeless, and the main sources of income for chronic homeless was Personal Needs Allowance (PNA) and the Ontario Disability Support Program (ODSP) for the newly homeless. In most instances, a larger proportion of the new homeless used community services compared to the chronic homeless. Both groups used drop-ins to socialize, drop-ins to get a meal, and housing help centres. The chronic homeless frequented libraries and churches, while the newly homeless went to counseling services and recreation centres. The chronic homeless reported more contact with siblings, children, ex-spouses and grandchildren than the new homeless. Despite some contact with family members, very few of the new and chronic homeless consider their family as part of their social support network. The chronic homeless rely heavily on service providers for social support, and the new homeless tend to rely more on friends. 5

8 Sociodemographic Profile In the study sample, there were more male older homeless persons than females, but the proportions are similar in each of the two subgroups and probably accurately reflect the older population of homeless persons. As Table shows, the average age for the newly homeless is similar the chronically homeless (about 58 for the new and 57 for the chronic homeless), although the distribution across age groups differs significantly. The chronically homeless tend to be concentrated in the youngest (50-54) age group, while the newly homeless fall more evenly across the age groups. Table 2.1.1: Sociodemographic Characteristics New Chronic* Total Gender Men 67.4% (31) 58.3% (7) 65.5% (38) Women 32.6% (15) 41.7% (5) 34.5% (20) Age Mean Standard Deviation Age Groups % (16) 50.0% (6) 37.9% (22) % (12) 25.0% (3) 25.9% (15) % (13) 16.7% (2) 25.9% (15) % (1) % (1) % (3) % (3) % (1) 8.3% (1) 3.4% (2) * It should be noted that 7 additional interviews were conducted with chronic homeless people, but since they were found to be housed at the time of the interview (i.e., living in a nursing home, rooming house), they have not been included in this analysis. Country of Origin In keeping with the high immigration rates in Toronto, it is no surprise that a large proportion of both the chronic and new homeless were born outside of Canada. In 1996, 26 percent of the population aged were immigrants compared to 34 percent of the new and 42 percent of the chronic homeless suggesting that immigrants are over represented amongst the homeless population (82). Education Both groups also have approximately the same level of education although there are differences in the types of education. For example, the new homeless are more likely to have either some high 6

9 school or completed high school, and gone to a business/trade college, while the chronic homeless are more likely to hold a higher-level university degree. Family About 60 percent of both the new and chronic homeless appear to be separated or divorced, and about 25 percent are single. More of the new homeless appear to be in a common-law relationship. When the type of family relationships are considered, both the chronic and new homeless are very likely to have brothers and sisters but the chronic homeless have more contact with their siblings. More chronic homeless have children and grandchildren and they have more contact with them than do the new homeless. A smaller proportion of the chronic homeless appear to have ex-spouses, but a larger proportion have contact with the ex-spouses compared to the new homeless. Employment As would be expected, employment in the last six months of both groups of homeless adults is minimal. The main cause of this problem is that 46 percent of the sample is unemployed due to a disability. A larger proportion of the new compared to the chronic homeless report being disabled as seen in Table It appears that the new homeless have a closer relationship to the paid labour force than the chronic homeless. Although the numbers are small, the new homeless are more likely to be engaged in casual or full-time work, and are less likely to be retired or self-employed. There has to be a place for the older people to work because they re not finished a lot of them, at retirement age. I m just gonna turn fiftynine so I ve got another six years. I m not stupid, I have tons of experience, I can make decisions on my own, but basically you need someplace where you can market these people. Chronically homeless man 7

10 Employment During the Last Six Months Full-time job (more than 24 hours per week) Table 2.1.2: Employment Status New Chronic Total 2.2% (1) % (1) Part-time job 2.2% (1) 8.3% (1) 3.5% (2) Casual work 4.4% (2) % (2) Self-employed 2.2% (1) 16.7% (2) 5.3% (3) Unemployed and looking for work 15.6% (7) 25.0% (3) 17.5% (10) Unemployed and not looking for 6.7% (3) 25.0% (3) 10.5% (6) work Unemployed because of disability 55.6% (25) 8.3% (1) 45.6% (26) Retired 11.1% (5) 16.7% (2) 12.3% (7) Income As Table shows, the chronic homeless make significantly less income per month then the new homeless $ versus $ About 25 percent of both the new and the chronic homeless are likely to share what they have with friends and/or family. Slightly more chronic homeless, however, receive financial support from family. Because both groups are not old enough, on average, they do not qualify for many of the pension benefits that are usually available to older adults. The major source of income for the chronic older homeless is the Personal Needs I don t want to take no money from my son at all. I don t want that because he just got married two years ago. I don t want to be in the way. Chronically homeless man Allowance (67 percent). Other sources of income include Ontario Disability Support Program (17 percent) and panhandling (17 percent). The new homeless receive their income form the Ontario Disability Support Program (38 percent), Personal Needs Allowance (28 percent), and Ontario Works (20 percent). It is important to note that people residing in shelters are not eligible for Ontario Works benefits. 8

11 Table 2.1.3: Income New Chronic Total Monthly Income Mean (44) (11) (55) Standard Deviation Receive Some Income Family and/or Friends. Yes 13.0% (6) 16.7% (2) 13.8% (8) No 87.0% (40) 83.3% (10) 86.2% (50) Give Some Income to Family and or Friends. Yes 23.9% (11) 25.0% (3) 24.1% (14) No 76.1% (35) 75.0% (9) 75.9% (44) Experiencing Homelessness All members of the sample had been homeless at some time in their lives, highlighting the episodic nature of homelessness. Nevertheless, there were differences between the two groups, as Table illustrates. For example, almost one-third of the newly homeless would not describe themselves as homeless, even though they met the criteria for inclusion in the study and were homeless for less than 365 days at the time of the interview. There are different perceptions of homelessness, and it is possible that these newly homeless individuals believe that being homeless means living on the street, and they resisted defining themselves as such. As for other differences in experiences of homelessness, the chronic homeless were first homeless at slightly higher ages, in contrast to for the new homeless. As well, the chronic older homeless reported being homeless fewer times in their life (about 2 times versus 4 times for the newly homeless). The chronic homeless spent about 10 times more days in the state of homelessness and they were more likely to spend time in a shelter for the homeless than the new homeless. Both groups of older homeless adults were inclined to think that old age started at about 50. In addition, the two groups both reported that they had been homeless once in the last year, although their experiences had been clearly different. 9

12 Table 2.1.4: Experience of Homelessness New Chronic Total Age First Homeless Mean (46) (12) (58) Standard Deviation Times Homeless in Life (not counting shelters) Mean 3.87 (46) 2.18* (11) 3.54 (57) Standard Deviation Times Homeless (last year) Mean 1.35 (46) 1.27 (11) 1.33 (57) Standard Deviation Longest Number Days Homeless Mean (46) (12) (58) Standard Deviation Ever Stayed in Shelter Yes 78.3% (36) 100% (12) 82.8% (48) No 21.7% (10) % (10) Currently Describe Self as Homeless* Yes 71.1% (32) 91.7% (11) 75.4% (43) No 28.9% (13) 8.3% (1) 24.6% (14) Definition of Old Mean (44) (11) (55) Standard deviation History of Homelessness The chronic homeless appeared to have more difficulties in meeting their basic needs then the new homeless. The chronic homeless were more likely to have difficulty in the last six months finding a shelter bed, finding food, clothing, and a place to wash, and they were more likely to sleep in an abandoned building, on the street or in a park. On the other hand, from Table 2.1.5, it is clear that in the last six months, more than one-half of the new homeless said they often did not have enough money to pay for food and they worried that there would not be enough to eat. 10

13 Table 2.1.5: Nutrition New Chronic Total Not enough food to eat due to lack of money (last 6 months) Yes 55.6% (25) 33.3% (4) 50.9% (29) No 44.4% (20) 66.7% (8) 49.1% (28) Worried that there would not be enough to eat because of a lack of money (last 6 months) Yes 50.0% (23)* 33.3% (4)* 46.6% (27) No 50.0% (23) 66.7% (8) 53.4% (31) Housing History The participants were asked about the type of housing they lived in, who they lived with, for how long, and how difficult it was to afford. These questions were asked for the current living arrangement and the last three places where they lived. The chronic homeless used emergency shelters more than newly homeless (67 percent and 44 percent respectively) but the new homeless used shelters on a long-term basis slightly more than chronic homeless (20 percent and 17 percent respectively). 2 The newly homeless share of selfcontained housing drops from 47.7 percent to 6.5 percent in four housing moves, illustrated in Chart The housing pattern of the new homeless appears to be on a downward slide from being at risk to the use of shelters. Chart shows the chronic homeless use of emergency shelters has risen significantly from the 3 rd last to their current type of housing. What is remarkable is the overall drop in the proportion of people in self-contained housing from 45.3 percent to 5.2 percent overall, and the increase in the use of emergency shelters from 13.2 percent to 48.3 percent. It is important to note that with each successive move, the new homeless were less likely to live with a partner. Generally, people s living arrangements appeared to be somewhat unstable since both groups were housed for successively shorter time periods from their 3 rd last place to their current place. The new homeless reported that their current housing was very difficult to afford. Their perceptions of affordability drops fairly steadily from their first housing experience to their current experience. 2 For the purposes of this study, emergency shelter use was defined as 3 months or less continuous residence, and long-term shelter use was defined as over 3 months continuous residence. 11

14 Chart 2.1.1: Housing History, New Homeless Percentage Rooming House Apt/House Friends/Family Long Term Shelter Type of Housing Emergency Shelter Current Last 2nd Last 3rd Last Chart 2.1.2: Housing History, Chronic Homeless Percentage Rooming House Apt/House Friends/Family Long Term Shelter Type of Housing Emergency Shelter Current Last 2nd Last 3rd Last 12

15 Health Health was measured using a number of different standardized scales. First, the SF-12 provides a summary score of people s physical and mental health status. This scale is a short version of the SF- 36 health survey and has been used to measure the health of the homeless in earlier studies. The SF-12 is a multipurpose short-form (SF) measure of health status. The SF-12 measures eight health concepts found in most surveys: physical functioning, role limitations due to physical health problems, pain, vitality, social functioning, limitations due to emotional problems and mental health. Each measure included in the scale is also considered separately for a more detailed examination of health since the sample size is small and cases are lost in the scoring of the SF-12. Health Status The two summary scores on the SF-12 are consistent with the qualitative interviews and related questions in the survey. As Table indicates, the Summary Physical Score is very low for both the chronic and new homeless with the chronic homeless having a slightly lower score of compared to for the new homeless. The average score of the two groups, 35.56, is much lower than the score of for the general U.S. population of the same age. 3 Indeed, the general score for the older homeless is lower than the norm of for people over age 75 in the U.S general population. Although the number of cases is small, the scaled norms suggest that according to physical health indicators, the homeless are physically older than their chronological age. The score for mental health is consistent with the identified problems the homeless have with their mental health, especially the new homeless. The score of for the new homeless is lower than the score for the chronic homeless, and both are lower for the norms for the general U.S. population for the age groups 55 to 64, (50.57) and for those 75 plus (50.06). A closer look at each item in the scales gives a better idea of the problems suffered by the homeless. 3 SF-12 scores for the general Canadian population are not available. 13

16 Table 2.1.6: Health Status Score New Chronic Total SF-12 Physical Score Mean Standard Deviation SF-12 Mental Score Mean Standard Deviation An examination of each of the individual items on the SF-12 indicates that the chronic homeless are fairing quite poorly when it comes to both physical and mental health. A self-evaluation of health reported by the homeless indicates that they rate their health very poorly compared to the rest of the Canadian population 65 years of age and over, 80 percent of whom rate their health as good to excellent. Forty-eight percent of the new homeless rate their health as good to excellent, which was similar to the chronic homeless (47 percent). The chronic homeless tended to rate their health as worse, with 58 percent rating their health as poor or fair. Overall, 70 percent of the sample did not have difficulty performing moderate activities on a typical day. However, 40 percent of the sample reported being severely limited in climbing stairs, with a larger proportion experienced by the chronic homeless. Almost 60 percent of the chronic homeless versus 49 percent of the new homeless accomplished less then they wanted to as a result of physical health problems in the last four weeks. As illustrated in Chart 2.1.3, the proportion of the chronic and the new homeless who either have possible or probable depression are similar. Chart Level of Depression Percentage Chronic New 0 Not Depressed Possible Depression Probable Depression Level of Depression 14

17 Types of Chronic Diseases The ten most reported chronic diseases overall include vision problems, arthritis, dental problems, back problems, anxiety, depression, high blood pressure, bronchitis, trouble hearing and skin problems. Diabetes is the 14 th most noted disease. In the Canadian population 65 and over in 1996, the most reported chronic illnesses were arthritis, high blood pressure, heart disease and diabetes (82). 4 Overall, a larger proportion of the homeless suffer from each of these diseases. Arthritis suffered by 32.2 percent of the Canadian elderly is over-represented amongst the homeless at 55 percent. While 15.4 percent of the Canadian population report back problems, 47 percent of the homeless note this problem. More homeless people report high blood pressure, 33 percent compared to 28 percent for the whole population 65 and over. Dental problems, anxiety and depression are diseases the general population is less likely to note (82). There are few differences between the new and chronic homeless although a larger proportion of the chronic homeless report hearing, feet, heart problems, and diabetes. A larger proportion of the new homeless report mood swings, arthritis, skin problems bronchitis, high blood pressure and breathing problems. Forty-one percent of the new homeless report depression compared to 50 percent for the chronic homeless. Although not reported here because of small numbers, a doctor or a nurse did not diagnose most of the illnesses reported by both groups, with the exception for arthritis, high blood pressure and depression. In these instances, the new homeless were more likely to have received a doctor s diagnosis. Interestingly enough, the general Canadian population 65 and over also list arthritis and high blood pressure as diagnosed by a health professional as the two most prevalent illnesses. Memory and Activities of Daily Living (ADL) In the Orientation-Memory-Concentration Test that assesses memory and ranges from a score of 0 to 28, more of the new homeless tested as having some memory problems, 78 percent compared to 63 percent for the chronic homeless. Activities of daily living (ADL) were assessed to determine whether the person requires help with walking, bathing, grooming, dressing, eating, transferring and going to the bathroom. Ninety-five percent of both the new and chronic homeless experienced no problems with their activities of daily living. Scores for both scales are presented in Table

18 Table 2.1.7: Memory and Activities of Daily Living New Chronic Total Memory Normal 22.2% (6) 37.5% (3) 25.7% (9) Memory problems 77.8% (21) 62.5% (5) 74.3% (26) ADL Score Mean.0652 (46).0000 (12).0517 (58) Standard Deviation Medications The majority of both groups report that they are supposed to take medication. As compared to 84 percent of the older population in Canada, 67 percent of the chronic homeless and 72 percent of the new homeless take some type of medication. Both groups report that they take their medications as directed (91 percent), although if they run out, they do not bother to refill their prescriptions (38 percent of the chronic homeless compared to 35 percent of the new homeless). The newly homeless are more likely to forget to take their medications (32 percent compared to 25 percent of the chronic homeless). The new homeless sometimes cannot afford their prescriptions, 44 percent compared to 13 percent of the chronic homeless. Well over 80 percent of the homeless administer their own drugs and most refill their own prescriptions, although the chronic homeless appear to be a little more diligent in this matter. All told, 11 percent of professional health care workers give the medications of the new homeless while 13 percent give medication to the chronic homeless. Shelters do not seem to play a large role in giving medications and refilling prescriptions. Drugs As indicated in Table 2.1.8, about half of both the chronic and the new homeless reported drinking either occasionally or daily. Half of the chronic homeless and 64 percent of the newly homeless have attempted to cut down on their drinking. Others criticizing their drinking behaviours have angered 20 percent of the chronic homeless compared to 39 percent of the new homeless. About 40 percent of the chronic homeless have felt guilty about their drinking compared to 46 percent of the new homeless. The scores on the CAGE, which assesses the presence of a drinking problem, indicate that 50 percent of both the chronic and the new homeless have a drinking problem. More than half of 4 More recent data has not yet been released by Statistics Canada. 16

19 the group smokes daily, and more of the new homeless (62 percent compared to 42 percent) report a daily use of cigarettes. 17

20 Table 2.1.8: Alcohol and Tobacco Use New Chronic Total Drinks at present time: Not at all 43.5% (20) 58.3% (7) 46.6% (27) Occasionally 45.7% (21) 41.7% (5) 44.8% (26) Daily 10.9% (5) % (5) Number of drinks each day % (10) 100.0% (5) 55.6% (15) % (10) % (10) % (2) % (2) Tried to cut down on drinking Yes 64.3% (18) 50.0% (2) 62.5% (20) No 35.7% (10) 50.0% (2) 37.5% (12) Have been annoyed or angered by others criticizing drinking Yes 39.3% (11) 20.0% (1) 36.4% (12) No 60.7% (17) 80.0% (4) 63.6% (21) Have felt guilty about your drinking Yes 46.4% (13) 40.0% (2) 45.5% (15) No 53.6% (15) 60.0% (3) 54.5% (18) Used alcohol to steady nerves or to reduce the effects of a hangover Yes 50.0% (14) 40.0% (2) 48.5% (16) No 50.0% (14) 60.0% (3) 51.5% (17) CAGE Problem Drinking Index No evidence of problem drinking 50.0% (14) 50.0% (2) 50.0% (16) Problem Drinking Indicated (Score of 2 or more) 50.0% (14) 50.0% (2) 50.0% (16) Number of cigarettes smoked Not at all 28.9% (13) 50.0% (6) 33.3% (19) Occasionally 8.9% (4) 8.3% (1) 8.8% (5) Daily 62.2% (28) 41.7% (5) 57.9% (33) An examination of drug use in Table indicates that the new homeless are more likely to use crack (22 percent compared to 9 percent) but 16 percent of both groups use cocaine. The chronic homeless are slightly more inclined to use heroin (9 percent compared to 7 percent), but 47 percent of the new homeless use sleeping pills compared to 36 percent of the chronic homeless. The chronic homeless are more likely to have taken painkillers and analgesics (67 percent compared to 47 percent) 18

21 than the new homeless. The chronic homeless indicate that they are more likely to have taken amphetamines but the numbers are small. As mentioned in the literature review, there is reportedly minimal use of street drugs among older homeless people, yet there is some evidence that adults who are closer to age 50 may use street drugs more than those who are older. While it appears that a number of the chronic and new homeless in this study use drugs, it is important to note that this sample is not random and is not representative of the larger population; therefore, conclusions are limited. Table 2.1.9: Drug Use New Chronic Total Ever used crack Yes 22.2% (10) 9.1% (1) 19.6% (11) No 77.8% (35) 90.9% (10) 80.4% (45) Ever used cocaine Yes 18.2% (8) 9.1% (1) 16.4% (9) No 81.8% (36) 90.9% (10) 83.6% (46) Ever used hallucinogens Yes 17.4% (8) 8.3% (1) 15.5% (9) No 82.6% (38) 91.7% (11) 84.5% (49) Ever used heroin Yes 6.7% (3) 9.1% (1) 7.1% (4) No 93.3% (42) 90.9% (10) 92.9% (52) Ever used sleeping pills Yes 46.7% (21) 36.4% (4) 44.6% (25) No 53.3% (24) 63.6% (7) 55.4% (31) Ever used nerve pills Yes 26.7% (12) 36.4% (4) 28.6% (16) No 73.3% (33) 63.6% (7) 71.4% (40) Ever taken amphetamines Yes 15.9% (7) 25.0% (3) 17.9% (10) No 84.1% (37) 75.0% (9) 82.1% (46) Don t know/refused Ever taken painkillers Yes 46.7% (21) 66.7% (8) 50.9% (29) No 53.3% (24) 33.3% (4) 49.1% (28) 19

22 Social Supports The homeless in this study did not have large social support networks. The new homeless appear to fair poorer than the chronic homeless when it comes to a circle of people they can depend upon. If the new homeless are asked if they have someone they can borrow money from, they overestimate their contacts. Their score of whom they might borrow from is much higher than who actually loans them money. Of the people the new homeless would like to talk with, friends are most important followed by service providers. A larger proportion of the chronic homeless would prefer to have intimate conversations with service providers (60 percent versus 38 percent). The chronic homeless are true to their word and tend to talk to service providers (43 percent versus 38 percent of the new homeless). Forty-three percent of the new homeless do actually talk to their friends but this is a smaller number then what they originally indicate (52 percent). In terms of satisfaction with the times they talked to people in the last month, overall, a larger number of the sample were satisfied percent for the new homeless versus 62 percent for the chronic. Both groups reported being satisfied with what had been loaned. Overall, the chronic and the new homeless were satisfied with the advice they received (mainly from service providers). It is important to note that a larger proportion of the new homeless felt that they needed people to help them in the past month, and they were satisfied with the help that they did receive. When differences are identified between the new and chronic homeless, it is clear that the new homeless are not as entrenched in the homeless service system, they rely more on friends than service providers for social support although they over-estimate the extent of their social supports and they are not that satisfied with their interactions with service providers. In contrast, the chronic homeless heavily depend on service providers [I want to] be able to as their social support network and they value their advice although help myself and be independent. they appear to have more difficult relations with them from time-totime. It is clear from the data that neither group considers family part Newly homeless older woman of their social support networks. Like the general population of older Canadians, homeless older adults do not want to be a burden to their family. 20

23 Use of Health Services More new homeless persons than the chronic homeless use I was happy, I was medical services available to them as evidenced in Table What married, and then my wife passed away. So is somewhat serious is that less of the chronic homeless have a health then I went into a real card about two-thirds compared to over 80 percent of the new deep depression. It just seems I never well, homeless. The chronic homeless tend to use the emergency room, I ve recovered from that, but I ve never ever really shelters, community health centers, to access medical services whereas fully recovered from that most of the newly homeless use private doctor s offices, hospital cause I sort of live in the past a lot. And I have emergency rooms and overnight stays at the hospital. had some good opportunities and I always get to a point, In terms of professional service, more chronic homeless tend to you know, where the roof falls in on me. A see professionals but the proportions are not nearly large enough to little bit of that - where I match the degree of reported health problems. For example, a sabotage myself. You know what I mean by consideration of Table shows that about 33 percent of the that? chronic homeless and 24 percent of the new homeless see an eye Newly Homeless Older specialist when over 90 percent of both groups report vision problems. Man Similarly, while arthritis is a serious problem for both groups, only a small proportion of each group see these professionals. While 63 percent of the new homeless and 25 percent of the chronic homeless report having arthritis only 6.5 percent of the new homeless and 18.3 percent of the chronic homeless have seen a physiotherapist in the last six months. If 42 percent of the new homeless and 50 percent of the chronic homeless suffer from depression, and only 13 percent of the new homeless and none of the chronic homeless see a psychiatrist, there are clearly gaps in treatment. Psychology certainly does not fill the gap since these professionals are rarely seen and social work, while one of the most visited professionals (next to pharmacy) cannot prescribe drugs. While 89 percent of Canadian adults age 65 and over saw their general practitioner at least once a year (82), in this study, 44 percent of new homeless and 17 percent of chronic homeless older adults visited a private doctor s office in the last six months, and about 16 percent from both groups went to a walk-in clinic. 21

24 Table : Use of Medical Services New Chronic Total Has a Health Card Yes 82.6% (38) 66.7% (8) 79.3% (46) No 17.4% (8) 33.3% (4) 20.7% (12) Received Medical Care in Past 6 Months From: Hospital (at least 1 night) Yes 39.1% (18) 16.7% (2) 34.5% (20) No 60.9% (28) 83.3% (10) 65.5% (38) Hospital emergency room Yes 41.3% (19) 50.0% (6) 43.1% (25) No 58.7% (27) 50.0% (6) 56.9% (33) Hospital outpatient clinic Yes 23.9% (11) 16.7% (2) 22.4% (13) No 76.1% (35) 83.3% (10) 77.6% (45) Nursing home or long-term care Yes 6.7% (3) % (3) No 93.3% (42) 100% (12) 94.7% (54) Shelter Yes 21.7% (10) 33.3% (4) 24.1% (14) No 78.3% (36) 66.7% (8) 75.9% (44) Drop-in Yes 17.4% (8) 8.3% (1) 15.5% (9) No 82.6% (38) 91.7% (11) 84.5% (49) Street outreach program Yes 13.0% (6) 8.3% (1) 12.1% (7) No 87.0% (40) 91.7% (11) 87.9% (51) Community health centre Yes 11.1% (5) 33.3% (4) 15.8% (9) No 88.9% (40) 66.7% (8) 84.2% (48) Walk-in clinic Yes 15.9% (7) 16.7% (2) 16.1% (9) No 84.1% (37) 83.3% (10) 83.9% (47) Private doctor s office Yes 44.4% (20) 16.7% (2) 38.6% (22) No 55.6% (25) 83.3% (10) 61.4% (35) Addiction treatment unit/centre Yes 17.8% (8) % (8) No 82.2% (37) 100.0% (12) 86.0% (49) 22

25 Table : Use of Medical Professionals New Chronic Total In the past six months received medical care from... A psychiatrist Yes 13.0% (6) % (6) No 87.0% (40) 100.0% (12) 89.7% (52) A psychologist Yes 2.2% (1) % (1) No 97.8% (45) 100% (12) 98.3% (57) A mental health nurse Yes 6.5% (3) % (3) No 93.5% (43) 100% (12) 94.8% (55) A social worker Yes 32.6% (15) 25.0% (3) 31.0% (18) No 67.4% (31) 75.0% (9) 69.0% (40) A physiotherapist Yes 6.5% (3) 8.3% (1) 6.9% (4) No 93.5% (43) 91.7% (11) 93.1% (54) A police officer Yes 22.2% (10) % (10) No 77.8% (35) 100.0% (12) 82.5% (47) A firefighter Yes 4.8% (2) % (2) No 95.2% (40) 100% (12) 96.3% (52) An ambulance attendant Yes 22.7% (10) 8.3% (1) 19.6% (11) No 77.3% (34) 91.7% (11) 80.4% (45) An occupational therapist Yes 2.2% (1) 8.3% (1) 3.4% (2) No 97.8% (45) 91.7% (11) 96.6% (56) A dentist or orthodontist Yes 21.7% (10) 16.7% (2) 20.7% (12) No 78.3% (36) 83.3% (10) 79.3% (46) An eye specialist Yes 23.9% (11) 33.3% (4) 25.9% (15) No 76.1% (35) 66.7% (8) 74.1% (43) A foot doctor/podiatrist Yes 17.8% (8) 41.7% (5) 22.8% (13) No 82.2% (37) 58.3% (7) 77.2% (44) A gynecologist Yes 2.2% (1) % (1) No 97.8% (45) 100% (12) 98.3% (57) A pharmacist Yes 32.6% (15) 41.7% (5) 34.5% (20) No 67.4% (31) 58.3% (7) 65.5% (38) A Dietician/Nutritionist Yes 8.7% (4) % (4) No 91.3% (42) 100% (12) 93.1% (54) 23

26 Barriers to health service provision are similar between the two groups. About one-third of the new and chronic homeless reported being unable to get health care over the last six months when it was required. The big issue seems to be that the service is not available when needed 75 percent of the chronic homeless make this observation as do 62 percent of the new homeless. Both groups felt that they had to wait too long for service, which simply confirms the first observation. About half of those having trouble accessing medical services said that it costs too much. More of the new homeless (39 percent) do not have a health card, versus 25 percent of the chronic homeless, which would explain why cost is an issue for some. In other cases, costs such as transportation to appointments, prescription medicine and processing fees and de-listed services, such as podiatry, make health services difficult to afford. Use of Community Services The use of community services is presented in Table An overall conclusion is that a larger proportion of the new homeless use community services than do the chronic homeless. The only exception would be that two-thirds of each group access drop-ins for the purposes of socializing. Fifty-eight percent of the chronic homeless also use drop-ins to have a meal compared to 64 percent of the new homeless. The chronic homeless use community centres (25 percent), churches (50 percent) or the library (58 percent). Furthermore, 8 percent of the chronic homeless go to food banks compared with 16 percent of the new homeless. Even though the new homeless are more likely to be looking for employment, a smaller proportion use employment programs than do the chronic homeless (7 percent versus 17 percent). The new homeless use mental health services (12 percent compared to none) and housing services (51 percent compared to 33 percent). Use of Services for Older Adults In open-ended questions not reported here, about 29 percent of the new homeless indicate that there are services for older adults they would like to use but they have not taken advantage of them mainly because they did not know they existed until recently. They also note that they have been denied services and feel that they have been made to wait unreasonably long for help. Similar responses came from the qualitative interviews, where many participants felt that service providers were too busy to assist them. The message here is that a mechanism needs to be found to educate the new older homeless about what is available to them and that the services be offered in a timely fashion. 24

27 Table : Use of Community Services New Chronic Total Used the Following Services in the Past Six Months... Drop-in to socialize Yes 66.7% (30) 58.3% (7) 64.9% (37) No 33.3% (15) 41.7% (5) 35.1% (20) Drop-in to get a meal Yes 64.4% (29) 58.3% (7) 63.2% (36) No 35.6% (16) 41.7% (5) 36.8% (21) Meal program/food bank Yes 15.6% (7) 8.3% (1) 14.0% (8) No 84.4% (38) 91.7% (11) 86.0% (49) Community centre Yes 27.3% (12) 25.0% (3) 26.8% (15) No 72.7% (32) 75.0% (9) 73.2% (41) Counseling service Yes 26.7% (12) 16.7% (2) 24.6% (14) No 73.3% (33) 83.3% (10) 75.4% (43) Mental health service Yes 11.1% (5) % (5) No 88.9% (40) 100% (12) 91.2% (52) Church, mosque or temple Yes 37.8% (17) 50.0% (6) 40.4% (23) No 62.2% (28) 50.0% (6) 59.6% (34) Legal service Yes 20.0% (9) 16.7% (2) 19.3% (11) No 80.0% (36) 83.3% (10) 80.7% (46) Advocacy service Yes 11.1% (5) 8.3% (1) 10.5% (6) No 88.9% (40) 91.7% (11) 89.5% (51) Housing help service Yes 51.1% (23) 33.3% (4) 47.4% (27) No 48.9% (22) 66.7% (8) 52.6% (30) Special services for older people Yes 13.3% (6) 16.7% (2) 14.0% (8) No 86.7% (39) 83.3% (10) 86.0% (49) Ethno-specific organization Yes 2.2% (1) 25.0% (3) 7.0% (4) No 97.8% (44) 75.0% (9) 93.0% (53) 25

28 Table : Use of Community Services (cont d) New Chronic Total Used the Following Services in the Past Six Months... Mediation services Yes 9.1% (4) % (4) No 90.9% (40) 100.0% (12) 92.9% (52) Recreation centre Yes 15.6% (7) 8.3% (1) 14.0% (8) No 84.4% (38) 91.7% (11) 86.0% (49) Employment service or program Yes 6.8% (3) 16.7% (2) 8.9% (5) No 93.2% (41) 83.3% (10) 91.1% (51) Library Yes 42.2% (19) 58.3% (7) 45.6% (26) No 57.8% (26) 41.7% (5) 54.4% (31) Educational program Yes 4.3% (2) 8.3% (1) 5.2% (3) No 95.7% (44) 91.7% (11) 94.8% (55) 26

29 2.2 A Gender Comparison of Older Homeless Adults In this section, the information gathered from the community survey of 61 adults from all three homeless categories (new, chronic, and at risk) is presented to give an overview of the similarities and differences between homeless older men and women. The findings are descriptive and do not apply to all homeless older persons since the survey sample was not randomly chosen. Summary data are presented in tables with more tables available in Appendix E. Key Findings Almost 70 percent of both men and women reported first becoming homeless between the ages of 41 and 60. Homeless older women reported fewer episodes of homelessness per year and longer durations of homelessness compared to homeless older men. This finding suggests that homeless older women may have different patterns of homelessness compared to older men, and therefore need improved access to shelters and services that target their unique needs. More older women reported difficulty finding enough to eat and finding clothing, while more older men reported difficulty finding shelter for the night, finding a place to wash and using the bathroom. With regard to housing history, a larger percentage of older women than men found their current housing very difficult to afford. In addition, in their previous residences, most of the women lived in a self-contained apartment or with friends and family, while most of them men lived in a shelter or rooming/boarding house. According to the SF-12, a standardized measure of health status, the homeless older men scored lower than the homeless older women, and both groups scored lower than the general older population. The scores indicate that the homeless older adults are physically older than their chronological age, and are in worse physical health than the general older population. Forty percent of the older women did not have a health card compared to 10 percent of men. However, slightly more men than women reported difficulty accessing health care. There were few differences between men and women in the most common chronic diseases, such as trouble with vision, teeth problems and back problems. However, older women were more likely to report difficulties with arthritis and bladder control than the older men, while men were more likely than women to report back problems and skin ailments. More women than men demonstrated memory problems, at more than twice the average for the 27

30 general population. The community services used by most homeless older men and women were: a drop-in to get a meal, a drop-in to socialize and a housing help service. More of the older women used places of worship and a counseling service, while more of the older men visited the library. The men were more familiar with services or programs for older adults than the women. Both indicated they would attend services and programs for older adults if more were available, or if they knew about them. More older women received income from the Ontario Disability Support Program (ODSP), while more men reported income from Ontario Works (OW). With regard to family contact, women had more contact with their children, and men had more contact with their siblings. Socio-Demographic Profile Forty-one participants in the study were male (67 percent) and twenty were female (33 percent). The average age of the respondents was (std. dev. = 7.1), well over age 50, which is generally considered to be old in the homeless population. Sixty-three percent of the men and 55 percent of the women were born in Canada. Most of the men who were not born in Canada emigrated from the Caribbean as young adults, while most of the women who were born outside of Canada came from Europe, and immigrated when they were over 20 years old. The countries of origin were mainly English speaking countries so that most of the respondents were familiar with the English language. The majority of the homeless older men were separated or divorced (73 percent) at the time of the interview. Fewer of the homeless older women were divorced or separated (30 percent) and a slightly higher proportion was single (40 percent). About a third of the homeless older men had completed some high school education or some trade, technical or business college program, while 20 percent of the women compared to 7 percent of the men had completed high school. Family Of all family members, the homeless older adults were most frequently in contact with their brothers and sisters (52 percent), and they saw them an average of two times per month. The older homeless males had more contact with their siblings compared to the women. Typically, the homeless older women had more children and grandchildren than the homeless older men, and they had more frequent contact with them as well. The older women who had children (75 percent) had more contact with them than the older men who 28