Social Justice, Respect, and Meaning-Making: Keys to Working with the Homeless Elderly Population

I don't look you in the eye, I'm ashamed, but I see you. Do you know that I am more than I appear? For God's sake, see the real me. Fuhr, 1996, p. 2 In U.S. culture, people do not like to believe that their grandparents, great uncles and aunts, and aging parents might suffer from severe mental illness, much less that they may be substance abusers or alcoholics. Consequently, we often deny that elderly people with mental illness and addictions exist, or if they do, we consider them to be anomalies. Substance abuse programs designed for the special needs of older adults are rare in the United States, and traditional mental health providers are often reluctant to work with the population, thus making it difficult for the homeless older adults to receive mental health services (Ladner, cited in Rosenheck, Bassuk, & Saloman, 1998). As a society, we have been slow to accept the growing need for age-specific treatment services for elderly people, especially homeless elderly individuals. It is easy to distance ourselves from the problem of homelessness, telling ourselves "it could never happen to any seniors I know," but in fact, "it" is increasingly happening to elderly people. LITERATURE REVIEW In recent years, the number of homeless individuals who are older than 50 has grown, and the numbers are expected to increase as the homeless problem and elderly population escalates. At the same time that the aging population is growing, the amount of affordable housing is decreasing, thus making the marginally housed individuals even more vulnerable (Rosenheck et al., 1998). Estimates of the aging homeless population vary considerably, ranging from 6 percent to 27 percent of the total homeless population (Kutza & Keigher, 1991), but the numbers alone do not tell the story of this population. Elderly homeless people need special attention as their age makes them especially defenseless; their options for reintegrating into society are few; and their physical ability to withstand the hardships of being homeless or living in shelters is limited. They often lack a network of relatives and friends, and their impaired judgment may lead to financial mismanagement and exploitation. Complications of aging can also affect the treatment process: The decline in hearing and vision may create a lack of trust and hypervigilance among elderly homeless people; they may reluctantly choose to remain on the streets because they are often targets in shelters; and they often fear that their independence will be limited, or worse, that they will be institutionalized (Cohen & Sullivan, 1990; Keigher, Ahrens, & Lumpkin, 1987; Kutza & Keigher, 1991; Rosenheck et al., 1998). There is general agreement that approximately one-third of the single adult homeless population suffers from a severe mental illness, and the percentage of mental illness among homeless people is significantly higher than that of the domiciled population (Wells, Williams, & Dennis, 2003). In addition, approximately 50 percent of homeless people with a serious mental illness have a co-occurring substance abuse disorder (Fischer & Breakey, 1991). The symptoms of mental illness or substance abuse disorders may render individuals more vulnerable to homelessness or marginal housing, and given this susceptibility, it has been estimated that as many as two-thirds of the people with a serious mental illness have been homeless or at risk of becoming homeless (Tessler & Dennis, cited in Wells et al., 2003). With regard to treating this population, the Federal Task Force on Homelessness and Severe Mental Illness (1992) noted that "homeless persons with severe mental illness will partake of services, if the service system can break out of the mold of traditional service provision and becomes responsive to their needs" (p. 360). The task force recommended "safe-haven" programs, namely, small and supportive environments with linkages to more specialized services to serve the hardest-to-reach portion of the homeless mentally ill population. …