Recent Research Has Provided New Data to Illustrate the Public Service Impacts Of
Causes of Homelessness among Older People in Melbourne, Australia.
Rota-Bartelink, A.M. & Lipmann, B.
Australian and New Zealand Journal of Public Health, Volume 31 Issue 3 Page 252-258, June 2007
Abstract
Objective A comparative study of the causes of new episodes of homelessness among people aged 50 years and over has been undertaken in the Australia, United States and England. Semi-structured questionnaires were used to collect information on the circumstances and problems that contributed to homelessness.
Methods. This paper presents the findings from Australia, where information was obtained from 125 older homeless people (aged 50+ years) and their key-workers in Melbourne. All three participating nations followed identical research methodologies.
Results The factors most frequently reported by respondents as contributing to their homelessness were problems with people with whom they lived, followed by physical and mental ill-health and problems associated with the housing itself. The most frequently reported factors by case workers were problems with alcohol, followed by physical and mental health factors.
Conclusions This study demonstrates a significant under-utilization of housing and support services among recently homeless older people and provides evidence that people who had previously been homeless appear to be more resigned to their homelessness than do those who had not experienced homelessness before. Significant issues relating to depression and gambling were also noted. The findings support the need for more targeted, specialised services to be developed or improved such that older homeless people can readily gain access to them and for improved collaboration or information exchange among housing providers and welfare agencies.
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Background to the Study
Despite the richness of services available to older Australians there are still people in the community who are not accessing or are underutilising these services. For those who are at risk of homelessness and fortunate enough to successfully engage with an appropriate housing provider, a critical shortage of suitable, affordable housing places further obstacles in the path to securing a home. The 2001 Census and other sources identified 99,000 homeless people, of whom 24,227 (24%) were aged 45 years or more1. It has been estimated that there may be in excess of 250,000 older people at risk of homelessness due to increases in the number of older people on fixed incomes and those relying on insecure housing2. A recent Government funded review of aged care services observed that the elderly homeless population, albeit small, are one of the most difficult groups to place in residential care3. This can be attributed to a number of factors.
Homeless people often have poor interpersonal skills and are suspicious of people they don’t know, including service providers, and it takes a great deal of time to build up a relationship of trust4. It has been demonstrated that homeless populations have a higher rate of serious morbidity and premature mortality compared to the general population, with westernised countries reporting an average age of death between 42 and 52 years5,6. There is increasing acknowledgment that the minimum age of eligibility for homeless people to access to aged care services should be 50 years of age as opposed to 65 5,7. The strict eligibility criteria employed by many health and welfare agencies deny prematurely aged older homeless people access to their services.
Historically in Australia, support for the elderly homeless has been managed, with varying degrees of success, in an uncoordinated, ad hoc manner by a range of service systems. Complex funding processes mean that resources to support elderly homeless are spread over multiple Commonwealth and State and Territory government portfolios, non-government organisations and service providers, creating practical obstacles to agencies comprehensively addressing an individual’s complex needs8. Australia wide trends include declining levels of homeownership due to such factors as the gentrification of low cost housing stock and the growing number of people renting rather than buying. These have created obstacles for low income people to access the private market through lack of supply, higher income households occupying low cost housing, lack of affordability, discrimination, lack of legislative protection against unfair rent increases, lack of legislation to ensure minimum housing standards and the operation of unregulated tenancy databases9.
Since the late 1980s, increased attention has been given to the problems of older homeless people,10,11,12,13, many of whom were homeless for the first time, raising questions about the reasons why older people become homeless and whether their homelessness can be prevented. Two major reports have examined the plight of older homeless Australians. Judd et al (2004) presented evidence that unexpected life events such as the death of a spouse, relationship crises, decline in health, or rental increases commonly led to accommodation crises. A shortage of public and community housing options was attributed to a severe restriction in the availability of affordable and adequate housing14. Based on data obtained from the Supported Accommodation Assistance Program (SAAP), Lai (2003) found that the principal reason for older men to seek assistance were financial reasons, substance abuse, and/or having recently arrived in the area without supports. Older women cited such issues as; domestic violence, financial difficulties, having recently moved into the area with minimal support; and psychiatric illness as their reason for seeking assistance. Older clients were more likely than younger clients to have lived in their own homes before seeking SAAP assistance15.
Study Objectives
With the aim of increasing the understanding of the reasons for homelessness among people aged 50 years and over, and contributing to the development of prevention practice, a collaborative and comparative study between three nations; England, Australia and Boston
(Massachusetts) was undertaken. Led by the Sheffield Institute for Studies on Ageing (SISA), Melbourne-based Wintringham, funded by the Commonwealth Department of Family and Community Services was the Australian partner in the study. Wintringham is a non-profit welfare company that provides safe, secure, affordable, long term accommodation and high quality services to 750 frail elderly men and women who are homeless or living in marginalised accommodation. The conceptual model underpinning this study conceives homelessness as a function of structural factors and policy gaps, personal problems and incapacities, and welfare-service delivery problems16.
Methods
A full account of the genesis, aims, design and execution of the 3-nation study has previously been published16. Identical methodologies including selection criteria, questionnaires and data recording processes were employed in all three participating nations and were subject to regular quality and consistency audits throughout the study. The study population included people who had become homeless during the two years prior to participation and were aged 50 years or over when they became homeless. People who had previously been homeless were included if they had been housed for at least 12 months prior to their current episode of homelessness. The focus on people who had recently become homeless was intended to enhance the reliability of the information about the circumstances that lead to homelessness and to overcome problems of memory. In Melbourne, one hundred and twenty-five people were interviewed. The sample principally drew on Wintringham’s clients, but other organisations were approached to increase participant numbers particularly of women. Outreach service staff played a crucial role in establishing initial contact with potential participants for the study.
Homelessness was defined as: (i) those without conventional accommodation; (ii) people living in accommodation which was intended as only temporary; (iii) those who were ‘doubled up’ with relatives, friends or other households; (iv) those without housing after eviction, discharged from prison or hospital, etc; and (v) people who had housing but were unable or refused to stay in the accommodation. A semi-structured questionnaire was used to collect information on respondents’ circumstances and problems prior to homelessness. The interviews (completed in 2003) were conducted face-to-face by experienced researchers and focused on: (i) background details; (ii) services received; (iii) service responses; and (iv) perceived reasons for becoming homeless. As a measure of reliability on the self-reported information, interviews were also conducted with each individual respondent’s key-worker (or case-worker) to assess their understanding of the events and states that led to the person becoming homeless.
Non parametric analyses (Pearson’s r correlations) and F distributions were principally used to analyse the data with the level of significance (alpha) set at 0.05. Cross-national findings of this study, been previously been published16,17,18,19. We will now present the results from an Australian perspective.
Results
Of the 125 people interviewed, the gender split was 93 male (74%) and 32 female (26%). Almost half of the respondents were aged in their fifties, with 36% in their sixties and 16% in their seventies. Some 37% of the respondents were born outside Australia with approximately one quarter being born in a non-English speaking country. Twenty-six percent of the respondents had served in the armed forces (more than twice the expected proportion based on Wintringham’s experience and previous research20). A significant proportion of men lived on their own immediately prior to becoming homeless compared with women (F=10.12, df= 1, 123, P=0.002). Twelve respondents first became homeless before 30 years of age and a further nine people before the age of 50. Almost three-quarters (70%) of those aged 60 and over had never experienced a prior episode of homelessness. More than half of the respondents reported that they had lived in their former home for three years or more prior to becoming homeless. The study population demographics, compared with the UK are displayed in Table 1.
Insert Table 1 Approximately Here
Figure 1 displays the frequency with which various factors were reported by respondents as having contributed significantly to their current state of homelessness and the influence of gender. The factors most frequently reported were problems with other people with whom they lived, followed by physical health and problems with the housing itself. The most frequently reported factors by case workers were problems with alcohol, followed by physical and then mental health factors. The majority (86%) of respondents were in contact with relatives or friends before becoming homeless, but only 49% received help from these contacts. However, by far the most commonly cited contact or friendship was with fellow homeless persons. Women were more likely than men to seek informal help from friends and relatives. Just over half of respondents received no formal assistance from professional services prior to becoming homeless.
Insert Figure 1 Approximately Here
The analysis draws attention to the comparison of responses from those respondents who became homeless for the first time in later life (60%) with those who had experienced homelessness on one or more previous occasions (40% of the sample). Comparison of these two sub-groups confirms two distinct later life pathways. Men were more likely than women to have previously experienced an episode of homelessness and significantly more likely to have been homeless for periods totalling longer than three years (F=4.1, df=1,123, P=0.045). Those who had previous experience of homelessness were twice as likely than those who first became homeless to have never been married (42% compared to 23%) and the men were less likely to have worked regularly throughout their adult lives (50% compared to 74%). Those with previous experience of homelessness were also more likely to have moved several times in the three years prior to becoming homeless. Almost all (92%) of the first-time homeless had only one or two homes during this period, compared to 68% of those with prior experience of homelessness.
Those who had previously experienced homelessness were also twice as likely as those who had never been homeless to report problems with alcohol (60% compared to 32%) and more likely to report having both mental health and alcohol problems (44% compared to 24%) and occasionally using illegal drugs (24% compared to 5%). The previously homeless were less likely to receive assistance from friends or relatives prior to the last episode of homelessness (40% compared to 55%), more likely to attend a day centre for meals and less likely to access a housing support worker or social worker to assist them
The experience of primary homelessness is frequently associated with premature aging leading to premature admission into residential care, extended stays in hospital, and the requirement of a higher level of support21. It was found that almost half the Australian respondents (45 percent, or 56 respondents) reported that their main source of medical assistance was received from the local public hospital. Seventy-eight percent of all respondents reported having health problems prior to becoming homeless, of which one third (30%) stated that their physical health problems contributed significantly to their homelessness. Musculo-skeletal and cardiovascular problems were the most commonly reported medial complaints (Table 2).
Insert Table 2 Approximately Here
Sixty-one percent of the respondents in this study reported having felt depressed or low prior to becoming homeless and a further 28 percent reported having other mental health problems either in conjunction with their depression or in isolation. The presence of mental health problems was statistically significant (P<0.001). Men were significantly more likely than women to suffer depression immediately prior to becoming homeless (Pearson=50.2, df=1, P<0.001). To compound this issue, only 56% of men who reported that they had mental health problems had received treatment for it as compared with 78% of women. People aged 50-59 years were more likely than those aged 60+ to report depression, while those who had previously been homeless were more likely than those who had never been homeless to report being depressed (69% compared to 57%). One quarter of the entire population reported that their depression or mental health problems had contributed to their homelessness. Caseworker reports demonstrated that there was a significant underreporting of depression (84% caseworker reported versus 61% self reported), particularly among men (84% versus 55%).
Seventy-seven percent of men and forty-four percent of women were identified as having alcohol problems. Two-thirds (67%) of the respondents who reported having issues with excessive alcohol consumption had received assistance for their alcohol problems from self-help groups such as AA or professional counselling. Contrary to the culture surrounding youth homelessness, the aged homeless respondents in this study reported only a small incidence (13%) of problems with illicit drugs, however this may increase as survivors of heavy drug use are themselves ageing and presenting with a number of drug related ailments. All respondents who reported drug issues were aged between 50-59 years, most of whom had not sought profession assistance for their addiction.
Men were significantly more likely to report having problems with alcohol and gambling. Further analysis showed that men (46%) were more likely than women (16%) to self-report their gambling. A Victorian Casino and Gaming Authority report (1997) showed that older men were also more likely to spend more of their income on gambling each week ($25 compared with $14 for women)22. However, a significant relationship was found between those living alone and gambling (46%) compared to those who lived with others (28%). It was striking to note that despite the public anti-gambling campaigns and the numerous support agencies available to assist problem gamblers, 85% of those who reported gambling issues did not seek assistance for their problem.
Discussion
It is well known that many people in need of support find it difficult to access appropriate services due in part to the complexity arising from the division of powers in health and welfare systems23. The study provides new data to illustrate inadequacies of the public service system in meeting the needs of older people who are at risk of becoming homeless. The value of a comparative perspective between nations lies in the leverage it gives to identifying features of the welfare system that work to lessen or increase the risk of homelessness among this group. The same goes for broad cultural differences.
The United Kingdom partners summarised their findings by concluding that “For most respondents, a combination of vulnerabilities and negative events accumulated over time and led to a progressive increase of housing instability”. They identified five ‘packages of reasons’ that created distinctive ‘pathways’ into homelessness. These were: (1) mobility or functioning difficulties that derived from physical and mental health problems; (2) financial problems and rent arrears; (3) the death of a relative or close friend; (4) the breakdown of a marital or cohabiting relationship; and (5) disputes with co-tenants and neighbours17. These pathways do not differ significantly from the Australian findings, however an additional factor related to ‘problems with housing’, could be added to this list based on our results (Figure 1). Many of our respondents reported that issues such as; large increases in rental payments, unacceptable or unsafe states of disrepair, and the closure of rooming houses and hotels, had contributed significantly to their homelessness.