Analysis

Homelessness among older people is ‘ticking time bomb’

There are insufficent dedicated services to care for the rising number of older people with nowhere to live.

There are insufficient dedicated services to care for the rising number of older people with nowhere to live.

Homeless_senior
Living in poor-quality temporary housing has adverse effects on health. Picture: Alamy

Homelessness is usually associated with younger age groups, but councils are warning it is now a ‘ticking time bomb’ among older people.

Figures from the Local Government Association (LGA) show the number of over-sixties accepted as homeless by councils over the past year has hit nearly 2,500, more than double the number seven years ago.

If the pattern continues, the LGA predicts the total will double again by 2025.

111%

rise in over 60 statutory homeless applicants in past seven years

Source: Local Government Association

And while older people account for only a minority of the overall homeless population – just under 5% – the LGA says the issue is particularly troubling given older homeless people’s poor health.

Community wellbeing board chair councillor Izzi Seccombe says: ‘Homelessness and ill-health are intrinsically linked – and this is especially evident in older people.

‘For example, older people experiencing homelessness are more likely to suffer from depression or dementia, which has wider implications for social care and health services.’

Distressing situations

She calls older homelessness a ‘ticking time bomb’ and predicts it will spiral in the coming years, highlighting Age UK data showing that one in seven pensioners are living in poverty.

Shelter chief executive Polly Neate agrees. She says her staff are hearing of some ‘terrible’ and ‘distressing’ situations involving older people.

Ms Neate says various factors account for the trend, including welfare cuts, the cost of housing and relationship breakdown.

She is also concerned about the toll on the health of older people, pointing out that not only those who sleep rough are affected.

Living in poor-quality temporary housing that is damp and cold can be dangerous for those with conditions such as bronchitis and arthritis. ‘For older people, the health impacts are considerable,’ she says.

‘The system is not geared to increasing numbers of older people becoming homeless. This is really becoming quite a serious problem.’

Specialist services

What can the health and care sector do? Specialist services are in place in some areas. These take the form of hospital-based teams, which work closely with doctors and nurses to identify and support homeless people when they are being discharged.

Other areas have specialist community nursing services that identify and work with homeless groups or voluntary-sector led arrangements that provide a similar function.

But Queen’s Nursing Institute (QNI) homeless health programme manager David Parker-Radford says a ‘greater onus’ is being placed on general health teams because there are not enough dedicated services.

41%

of homeless people have long-term conditions

Source: Local Government Association

‘Ideally, there would be more. We have seen the numbers of homeless people rise, but not the number of services. This means there are serious gaps in provision, particularly in seaside towns.’

Mr Parker-Radford says that even more will be expected of health staff when the Homelessness Reduction Act 2017 comes into force, from April 2018. Under this act councils will have a new duty to identify people at risk of homelessness as well as those who are already homeless.

‘Professionals need to be aware of what to do and what the local arrangements are, as well as what help is available to address their health and social needs,’ Mr Parker-Radford adds.

Complexity of care

To help, the QNI has developed a homeless health assessment tool in addition to providing a forum for training and learning through its homeless health network.

Jane Morton, who used to work as a community matron for the homeless in Stoke-on-Trent, Staffordshire and is now employed by homeless charity Brighter Futures, says it is vital that the NHS, councils and housing staff work together, even if there is no dedicated service.

She also highlights the complexity of caring for homeless people, including those just entering older age.

45%

of homeless people have a mental health problem

Source: Local Government Association

‘You see people in their fifties with the sort of conditions – arthritis and chest conditions, for example – you would normally associate with much older people. They need support.’

But Ms Morton says that it is not always easy to provide support because some GP surgeries ‘refuse registration’ even though guidelines suggest they should provide a ‘welcoming and sensitive service’ to homeless people.

She also has concerns about what is happening to dedicated services, pointing out that a number have been ‘decommissioned’ in recent years despite an increase in the number of people who need help.

‘The thinking is that mainstream services can provide support. But the problem is that staff don’t have the time to engage with these groups.

‘When I was running a service I had to visit one man six times before I could convince him to get help. District nurses and community nurses just don’t have time to do that.’

Cornwall: homeless hospital discharge

The council, local NHS and charities in Cornwall have set up a service to support homeless people when they are ready to be discharged from hospital.

The service involves employing a patient liaison adviser from charity Shelter to work alongside doctors and nurses in acute and mental health hospitals, and arrange onward care and accommodation.

This is done Monday to Friday and, since it began in 2014, has already started to have an effect.

Originally it was envisaged that the adviser would help about 100 people a year, but this number has now increased to 200.

More than 90% of patients helped have had accommodation arranged and speedy discharge is estimated to have saved more than 500 bed days in the past two years.

Anthony Ball, from Cornwall Council’s public health team, says: ‘It has worked well. The key is bridging the gap between health and housing – these are two different worlds.

‘Having someone in the hospitals creates a smoother, quicker pathway and ensures homeless people get the help they need, while allowing hospital staff to concentrate on the care they need to provide.’

South London: community support

Guy’s and St Thomas’ NHS Foundation Trust has set up a nurse-led health inclusion team to provide outreach support to vulnerable groups, including homeless people.

Its aim is to reduce demand on hospitals by providing in-hostel care. The staff, including a clinical nurse specialist, substance misuse worker and social worker, hold regular drop-ins at centres across Lambeth, Southwark and Lewisham.

They offer full health assessments, screening for blood-borne viruses, routine blood tests, sexual health screening, treatment for minor illnesses and injuries, and care for long-term conditions.

The support service began as a pilot but, having reduced hospital admissions by 75% and ambulance call outs by 50% among the cohort who have been helped, has now become permanent.

Staff have also escorted clients to referral appointments where necessary, reducing non-attendances by 11%.

Find out more


Nick Evans is a freelance writer

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