Older Homeless People

1
Older Homeless People meeting their continuing
health care and support needs

• Sarah Gorton
• UK Coalition on Older Homelessness

2
Homeless Link manages

• Homeless Link National membership agency for
  organisations working with homeless people
• UK Coalition on Older Homelessness - a project
  aimed at raising awareness of the needs of older
  homeless people and improving services

3
Case study -Tom

• Became homeless in forties when marriage ended.
• Slept rough and in hostels frequently evicted,
  aggressive behaviour linked to heavy drinking.
• Liver failure, severe anaemia, needs prompting
  with personal hygiene, eating and medication.
• Assessed and placed in residential care, could
  not settle and left.
• Highly vulnerable-multiple interacting physical
  and mental health and alcohol problems.

4
Numbers and definitions

• In relation to homeless people, due to premature
  ageing issues, we tend to define older people as
  those over 50 years of age.
• People who have been long term homeless have
  often sustained lasting damage to their health
  through their life style and/or alcohol
  dependence
• In the 1990s the average age of death for a
  rough sleeper was 42 years

5
Numbers

• There are an estimated 42, 000 older homeless
  people in the UK. This figure covers
• People over the age of 50 who are sleeping rough
  - an estimated 300 (in England.)
• Hostel dwellers- an estimated 5, 000
• People living in Bed and Breakfasts, an estimated
  12,000
• An official number of 4,420 people accepted as
  statutorily homeless and vulnerable due to old
  age
• People about to be discharged from
• prison or hospital with nowhere to go.
•  

6
Health problems

• November 2004 St Mungos survey of rough sleepers
• and those in hostels over 50 years of age
• 56 are alcohol dependent
• 48 have mental health problems
• 47 have physical health problems
• 27 have challenging behaviour

7
Social exclusion

• The majority of older homeless people have a
  combination of those issues, with 43 having 4 or
  more problems.
• 74 had no next kin of details
• Of 36 who are known to be parents 52 have no
  contact with their children .
• 23 have no social network

8
Access to health issues issues

• Tudor Hart first described the inverse care law
  in
• 1971. It states that the availability of good
• medical care tends to vary inversely with the
• need for it in the population served.
  Unfortunately
• despite the current emphasis on addressing
• inequalities in health this still holds true for
  the
• homeless population.
• Tudor hart J (1971) The Lancet 405-12

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Access to health issues

• There are a number of interlinked factors
• lack of understanding and awareness on the part
  of GP practices,
• discrimination and prejudice,
• a mistaken belief that people need a permanent
  address in order to register with a GP
• A lack of resources and training to address the
  complex problems presented by homeless people
  with complex needs
• Homeless peoples difficulty in using mainstream
  services, due to low self-esteem, expectation of
  rejection and difficulty in keeping to
  appointments.

10
Hospital discharge

• Research with homeless people over the age of 50
  years in Manchester showed a hospital admission
  rate three times greater than the national
  average for people between the ages of 65 79
  years, despite the fact that the average age of
  the homeless group was 16 years lower.
• Research in Bristol found a highly increased rate
  of re-admission in patients living in hostels
  (35) to those being admitted from their own home
  (10)

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What are the solutions?
12
Policy level

• For the first time ever health inequalities were
  made a
• Key priority for the NHS in the priorities and
  planning
• framework for 2003 06. This emphasis puts Public
• Health and partnership working with local
  authorities and
• local communities at the centre of PCT concerns.
• Homeless people were identified in the Cross
  Cutting
• review on tackling Health Inequalities as one of
  the
• vulnerable groups for whom specific actions must
  be
• identified if life expectancy targets are
• to be reached.

13
Social Exclusion Unit report

• A Sure Start to Later Life has recognised that
• Older homeless people face severe challenges in
  accessing accommodation in which they feel safe
  and supported.
• There is a need for specialist accommodation for
  the older homeless population
• There is a need for improved practice on the
  discharge of homeless people from hospital and
  for access to appropriate intermediate care.

14
Auditing the Older Homeless population

• The COHP are developing a methodology for use by
  local authorities to audit the numbers and needs
  of older homeless people in their area.
• This is first step to getting improved
  recognition of their specific needs from
  Supporting People, PCTs and Social Services

15
Sheltered housing and Extra care housing

• Access to sheltered housing with appropriate
  support
• Remodelled specialist sheltered housing schemes
  specifically for this client group
• Extra care housing for those with the most
  complex needs

16
Extra care and older homeless

• Extra care is a solution we would like to see
  applied to older homeless people with more
  complex needs.
• Independent accommodation
• Company and support
• Care needs met in flexible manner
• Developed by RSLs working with homeless or
  specialist units within a scheme

17
Intermediate care and homeless people

• High rate of hospital admission, self discharge
  and re-admission
• Hostels not suitable environment to return to
• Mainstream intermediate care does not work for
  client group
• Need for specialist service to provide ongoing
  health care and rehab support

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Joint commissioning

• The needs of older homeless people cross health
  and
• social care and housing support boundaries.
  Service
• criteria, lack of access to community care
  funding and local authority local connection
  rules tend to
• put barriers in the way of effectively delivering
  services to
• people with multiple needs who are also mobile.
  Joint
• commissioning and cross authority commissioning
  are
• under-developed but they do offer the possibility
  to
• develop integrated and holistic services for this
  client
• group.

19
Homeless people are not the problem, but
must be part of the solution!

• Homeless people have much to say
• about the way they experience services
• and it is important to find ways to listen
• and to respond to those experiences.

20
Contact details

• UK Coalition on Older Homelessness
• www.olderhomelessness.org.uk
• sarah.gorton_at_homelesslink.org.uk
• Tel [phone]