Research Matters Blog

Canadian Observatory on Homelessness/Homeless Hub: York University
February 05, 2016
Tags: seniors
Categories: Ask the Hub

This question came from Tammy M. via our latest website survey: How many homeless or at risk older adults are there in Canada? In Ontario? What are the most preferred housing options chosen by older adults/seniors?

Last July, Statistics Canada reported that 5,780,900 (or, 1 in 6) Canadians are now over the age of 65. Our aging population is growing and currently outnumbers Canadian youth. The Atlantic provinces are seeing a much higher percentage of older adults, while the prairies and territories are seeing the least.

Working from 2011 census data, the Ontario Ministry of Finance estimates that in 2013, Ontario’s senior population was somewhere around 2.1 million, and that it will more than double by 2041. This is already having an enormous impact on our economic and social service systems, forcing everyone within to re-examine how we secure housing and services for older adults and seniors.

Older adults, poverty and homelessness

In the housing sector, an “older adult” is anyone over the age of 50 – much younger than the government definition of “senior” because marginalization, poverty and homelessness contribute to premature aging. This definition is not used by Statistics Canada or most other ways of accounting for older adults who may be at risk, which contributes to a lack of knowledge about this population.

What we do know is that seniors and older adults are vulnerable to homelessness because they often face deteriorating social support systems, increased mental and physical health needs, and financial constraints all at once. These complex needs often mean that our standard emergency responses to homelessness – shelters and transitional housing –are rarely appropriate for older adults and seniors.

According to the Canadian definition of homelessness, being at risk of homelessness refers to those “who are not homeless, but whose current economic and/or housing situation is precarious or does not meet public health and safety standards.” While it is impossible to accurately determine just how many older adults are at risk of homelessness – due to gaps in data and inconsistent counting - we can look to some existing studies to give us an idea.

While we don’t have a definitive number on seniors and older adults who are at risk of or experiencing homelessness, we have some general estimates. A 2014 Statistics Canada report concluded that 600,000 Canadian seniors are living in poverty – huge risk factor for becoming homelessness. In the 2014 State of Homelessness in Canada report, 0.9% of senior participants said in a survey that they had at some point, experienced homelessness or housing insecurity in their lifetime. (A total of about over 1.3 million Canadians said the same.)

The report also draws attention to people who are precariously housed – due primarily to affordability issues – noting that 19% of renter households fall into the “extreme” category: paying more than 50% of their income on housing. With such a small remaining budget to work from, all it often takes is a relationship breakdown, a lost source of income, and/or a health issue to put someone at risk of homelessness. Many older adults are precariously housed, or in extreme core housing need.

Preferred housing for seniors and older adults

Older adults and seniors become homeless for a variety of reasons and they all have unique needs, so there is no one type of preferred housing – though many want to remain as independent as they possibly can. This is why “aging in place” is so important.

A recent report from the Office of the Seniors’ Advocate in British Columbia found that seniors were most concerned with housing being affordable, appropriate, and available.

If living in their own house or apartment with home care is no longer possible, the next logical step would be to move into assisted living. This offers continued independence but with some support and socialization. What I found however, was that, as a result of out-dated regulations, many seniors were being denied the ability to stay in assisted living and were being pushed into residential care before it was clinically necessary. When residential care is required, seniors deserve as much as possible to be where they want to be and to enjoy the privacy of their own bedroom and bathroom. While there is some very good residential care in this province, there is more that needs to be done to fulfill our commitment to allow seniors to live where they want as independently as possible.

The report categorizes main housing options as being independent, assisted, and residential care styles of living; and makes a number of recommendations specific to British Columbia in making each type of housing more affordable, appropriate, and accessible – because it isn’t about finding a “perfect” housing option for all seniors and older adults, it’s about finding what is best for each individual person. Below is a breakdown of all the current types of housing that older adults and seniors are living in the province. (Note that those experiencing homelessness, transitional or otherwise, are captured under "or other" and amount to less than 1% of the measure population).

Seniors accommodation type in BC

According to a 2002 Health Canada study, 75% of seniors considered their housing “ affordable, adequately sized and in good condition.” Whether they live with spouses, family, alone or in institutions varies greatly – with more people living in institutions as they age. And many housing options (such as living with family or a spouse) heavily depend on individual circumstances (economic situation, physical and/or mental ability, family support, etc.).

There are also big differences between older adults who are chronically homeless and those who are newly homeless or at-risk of homelessness. The researchers of a 2004 Toronto study further underscored this in their report:

The chronic older homeless appear to be ‘aging in place’ like most Canadians. For the chronic homeless this is evident, where the condition of homelessness becomes normalized over time, and they spend many years in the shelter system in their lifetime. On the other hand, for newly homeless older adults, factors such as a lack of affordable housing, and a lack of appropriate supports to ensure their successful transition into housing, may affect their ability to age in place.

While there is a small supply of non-profit and subsidized housing stock available in most major cities – which can be excellent options in Housing First frameworks - these are not appropriate options for older adults with extremely little money and/or with different physical or mental abilities. There is a greater need for prevention, more appropriate emergency housing, and more supportive, long-term housing. The same researchers recommended the following for older adults at risk of or experiencing homelessness:

  • Age-segregated programming and housing
  • Intensive case management to help older adults be connected to the services they need
  • Small-scale emergency shelters that are age- and gender-segregated; especially for older women
  • Additional supportive and long-term housing with integrated health and social services (harm reduction, palliative care, long-term care, onsite nursing).

Many studies have recommended similar approaches to housing for older adults, indicating that flexibility and choice in housing is paramount. Jones, in her 2007 report on the role of supportive housing for seniors in Ontario and British Columbia, advocated for cross-sectoral partnership for supportive housing education, awareness, operations and planning. She also cautions against substituting one type of housing for another, as all play essential roles in the housing continuum for older adults and seniors.

We must also consider the different needs of Aboriginal older adults, who tend to be more impacted by marginalization and poverty and have distinct cultural needs. As I wrote in my post about homelessness and senior women:

In their report on Aboriginal seniors experiencing homelessness, Beatty and Berdahl recommend establishing long-term care facilities in major prairie cities and on reserves; as well as funding initiatives for Aboriginal caregivers. Indeed, more publicly funded long-term care for all Canadian seniors—like those created in Sweden, Denmark, and Iceland—would be beneficial for all, and would help relieve some of the financial stress on our seniors.

It is also important that we begin to move away from a system that focuses on emergency response and one that looks toward preventing homelessness. This will require coordinated efforts between social service, health and housing agencies and ongoing outreach to older adults who are at risk.

For more information about seniors and homelessness, read our past posts:

This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at thehub@edu.yorku.ca and we will provide a research-based answer.

York University; Canadian Observatory on Homelessness/Homeless Hub
February 03, 2016

This week’s infographic comes to us from Community Solutions and looks at ending veteran homelessness. Community Solutions is an organization located in the United States that is working towards a future without homelessness. The organization takes a community-based approach for identifying the best tools that can solve the challenge of homelessness facing communities. The infographic itself is closely related to Zero: 2016, a “national change effort designed to help a committed group of US communities end chronic and veteran homelessness outright by December 2016.” The project has seen tremendous buy-in from communities across the United States.

There is significantly more research available on the experience of homeless veterans in the States than in Canada. This can be misleading, and the absence of conducted research does not mean that homelessness is not a problem faced by Canadian veterans. In March 2015, Employment and Social Development Canada released a report of the first study to look at veteran homelessness nationally. The study was conducted using data collected at 60 emergency shelters from January to December 2014. The report estimates that 2,250 veterans use services offered by homeless shelters every year, and that there are higher rates of episodic homelessness for veterans compared to homeless non-veterans. The data is conclusive: homelessness is a problem faced by Canadian veterans.

Functional zero, used in this context, is reached when the number of veterans who are homeless, whether sheltered or unsheltered, is no greater than the monthly housing placement rate for veterans. This approach and terminology is not without its critics.

Number of veterans experiencing homelessness is less than or equal to average monthly veteran housing placement rate = functional zero

The project advocates for the immediate provision of supportive housing and wrap-around supports to homeless veterans. This is in contrast to the traditional approach to tackling homelessness, which largely consists of emergency responses to homelessness, such as emergency shelters. Homelessness in Canada and the United States is usually addressed in a treatment first approach, where individuals living in homelessness wait until housing is available, or are “treated” before being deemed fit for living in housing. It doesn’t have to be this way.

The project advocates for Housing First, which can be defined as the provision of permanent supportive housing immediately to those in need.  Time and time again, research has shown that Housing First is affordable, sustainable and cost-effective. While emergency shelters provide individuals with immediate relief in the short-term, Housing First is a solution that focuses on long-term outcomes and on helping individuals become independent again. 

There are numerous examples of successful applications of Housing First across Canada. These applications are tailored to the needs of local communities and populations. In Alberta, Nikhik Housing First/Homeward Trust highlights what agencies can do to integrate Aboriginal culture into a program. In British Columbia, the Streets to Homes project in Victoria demonstrates how large-city programs can be adapted to meet the needs of smaller communities. In Ontario, the Transitions to Home project in Hamilton provides a great example of how partnerships with police services can help identify individuals with high needs. These are just a few of the many ongoing Housing First projects that have had measured success in the Canadian context.

If you have any question about the Housing First model, I invite you to participate in our very first Ask Me Anything (AMA). Wally Czech, Housing First Specialist with the City of Lethbridge, will be answering questions live on the online Community Workspace on Homelessness today at 1PM (ET). Post your questions now!

Canadian Observatory on Homelessness/Homeless Hub: York University
January 29, 2016
Tags: youth
Categories: Ask the Hub

This question came from Gaynor H. via our latest website survey: “How do choices made by social workers affect youth aging out of care and their risk of experiencing homelessness; and what influences support for programs like support and financial agreements (SFAs)?”

Given the unfortunate relationship between foster care and youth homelessness, these are important questions.

One Raising the Roof study from 2009 found that 43% of participants experiencing homelessness had been in foster care; while a recent Vancouver study found that involvement in the child welfare system “independently predicted incomplete high school, duration of homelessness, discontinuous work history, less severe types of mental illness, multiple mental disorders, early initiation of drug and/or alcohol use, and daily drug use.”

Foster care, however, doesn’t always automatically lead to homelessness. Another Canadian study discovered that youth with more positive experiences and who moved around less (stayed with families longer) were less likely to become homeless, and that having at least one significant relationship was key to their wellbeing.

Sometimes, a very important relationship for youth is with their social worker, who provides counselling and connections to other services. Social workers are responsible for supporting youth while they transition to adulthood and prepare for independence, so their work with youth is incredibly important. Being in such a powerful position means that social workers can have enormous impacts on youth. While I couldn't find any precise studies measuring social worker choices and youth outcomes, existing literature gives us an idea of just how influential social workers can be in two primary ways:

When Youth Age OutOverall quality of the relationship


I mentioned above that youth often just need one important positive relationship with a person to feel loved and supported. In a study led by the School of Social Work at the University of Victoria with youth who had previously been in care:

25% of participants named their former foster parent(s) or their former social worker as someone to whom they could turn for either emotional or practical support; this was essentially equivalent to the percentage of youth who named their parent(s) as a source of support.

Furthermore, 36% of the participants said that their former social worker was still an active part of their life, calling up to “check up on them and provide emotional support when needed.” Other youth reported feeling glad and relieved to leave care so that they would no longer feel like they’re under surveillance or being judged. But for youth who don’t have strong social bonds elsewhere, a positive relationship with their social worker can be a very meaningful and important one.

Similarly, social workers’ biases and judgments can work against the development of a positive relationship. Writing about the experiences of young mothers, the study authors note: “Rutman et al (2002) have examined how social workers’ values and biases stigmatize young mothers and help to perpetuate the belief that 'the cycle' of youth in care who have children who end up in care is inevitable.” Some participants felt judged in this way and did not feel like they were given proper supports from their social workers. A critically reflexive practice - questioning how we know what we know - is crucial for social workers to recognize and, if necessary, change how they interact with and think of the youth they work with.

Social worker knowledge


In addition to having a good relationship with youth, how much social workers know about existing services is paramount in ensuring that youth access the services most appropriate for them. In the child welfare system, social workers have flexibility in the living arrangements they offer to youth who are in transition and can include independent living, room and board with former foster parents, reunification, transitional housing, or group homes. They must work closely with youth to determine what would work best for them and what other supports may be needed – like employment or skills training, financial support with rent, etc.

Sometimes, social workers are not aware of all the resources available to youth who are in transition. These services are generally provided by each province and territory and can vary greatly. In Ontario, for example, there is a variety of financial and educational supports for youth, but most are only available if youth are pursuing post-secondary education or job training. (The situation is similar in British Columbia.)

The University of Victoria study asked participants if they knew about the YEAF, a series of bursaries available to youth formerly in care, and 50% did not. The study authors also noted: “Participants’ and other key informants’ comments indicated that not all social workers or youth-serving service providers knew about this potential financial resource for youth in/from care.” Anywhere, a lack of service and program knowledge can result in inappropriate referrals or youth missing out on what is available to them.

Support and financial agreements (SFAs)


Gaynor’s question about what influences support for SFAs is also good, because it asks us to think about why our system is structured the way it is. My short answer would be funding - our governments tend to support projects that in the short term, seem to cost less.

As it stands in most provinces and territories, once someone reaches 18 or 19, they are considered independent and will no longer receive support from the government. This also often means moving out of their foster family’s home, sometimes before they’re ready, and having limited contact. (The Vancouver Sun published a fantastic six-part series on what happens to youth as they “age out,” and I highly recommend reading it.) In many cases, this transition feels abrupt and can be very traumatic – leading to many researchers to advocate for extending foster care services to age 25.

Many government agencies offer SFAs, which provide supports (emotional and financial) to youth up to ages of 21 or 22. The rationale for them is that they are flexible enough that youth who don’t need continued support don’t get it, but those who do can apply and continue on. Social workers tend to support these agreements because they are better than youth having no support at all, but I think many acknowledge that offering services in such a fragmented way isn’t always helpful.

In Coming of Age, Stephen Gaetz recommends that Canada take a more strategic approach to youth homelessness, which would also benefit the child welfare system. He also gave a number of recommendations in this story about youth aging out of care from The Tyee:

“• Raise the exiting age of 18 or 19 in most provinces and territories when foster care ends, to at least age 24 or graduation from their first post-secondary program;

• Plan an exit strategy and start planning early;

• Give kids a say in the design of services and the types of services provided to them;

• Encourage high school graduation and fund the first post-secondary program;

• Fund community-based youth supports instead of province-wide services run by bureaucrats;

• Ensure youth have at least one adult in their life, family or not, whom they can rely on;

• If they leave care early, let them come back whenever they need to.”

Some decision-makers and lobbyists would likely see extending care as a costly investment, but many researchers have estimated that cost of extending care to an older age is actually less than what we spend on SFAs and other piecemeal supports.

Related posts:

What are the rates of homelessness amongst youth previously in care?

This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at thehub@edu.yorku.ca and we will provide a research-based answer.

York University; Canadian Observatory on Homelessness/Homeless Hub
January 27, 2016

This week’s infographic, produced by the Canada Centre for Policy Alternatives (CCPA), takes a look at Ontario’s Child Poverty Reduction Strategy. Founded in 1980, the CCPA is one of Canada’s largest independent policy research organizations. Reports published by the CCPA fall into two main categories, those with a Canada-wide focus and those with a provincial focus. The CCPA’s provincial offices focus on province-specific issues such as Ontario’s Poverty Reduction Strategy.

Ontario’s poverty reduction strategy infographic

Eight years ago, the Ontario government made a commitment to reduce child poverty rates by a quarter between 2008 and 2013. The infographic states that by 2010 there was an 8.7% drop in child poverty after investments were made into the poverty reduction strategy. Unfortunately, after 2010, investments into the poverty reduction strategies stalled and child poverty rates began to increase. This is partially due to a lack of funding from the federal government. The province ended “its five-year strategy with the same level of child poverty as when it began in 2008.” In 2014, the government recommitted to reducing child poverty rates by 25% by 2018.

In order to be effective, child poverty reduction strategies require extensive planning and funding. Examples of investments that can make a difference include raising the minimum wage and increasing financial support for low to moderate income families through programs like the Ontario Child Benefit.

There are many barriers and care gaps that children living in poverty face compared to children from a financially secure household. Children living in poverty are more likely to face barriers to education, have difficulty obtaining safe and healthy nutritious foods, and live in poor housing conditions. Barriers in accessing nutritious food can lead to poor mental health outcomes. Poor mental health outcomes in turn can hinder a child’s ability to be successful over the course of their academic career. Few of the factors associated with child poverty can be targeted in isolation without considering other gaps in our social safety net.

Access to educational supports are a critical component of any strategy that looks to address child poverty. Education is one of the primary means through which upward social mobility can be achieved, breaking the cycle of poverty that may exist in many families.  By providing, and investing in children today, we lay the groundwork for their success in adulthood.

The importance of spreading awareness about the importance of continued funding in long-term strategies extends beyond child poverty, to issues including housing, healthcare and food insecurity. In the event that present funding strategies are inadequate and fail to meet the needs of society’s most vulnerable, it is important to remember that government budgets are not set in stone. Public support and advocacy for child poverty reduction programs can provide the necessary political will to change the status quo.

Canadian Observatory on Homelessness/Homeless Hub: York University
January 22, 2016
Tags: seniors
Categories: Ask the Hub

This question came from Glenda L. via our latest website survey: “How will the needs of seniors with dementia who are at risk of becoming homeless be effectively met? These are vulnerable individuals who may need a high level of support to obtain and retain housing.”

Many existing services for people experiencing homelessness do not meet the unique needs of seniors, especially those with dementia or other cognitive impairments. With the number of seniors experiencing homelessness growing over the past few years – doubling in Toronto between 2009 and 2013 - this is a really important question. Like anyone else, the causes of homelessness for seniors are varied and can include:

...lack of finances to pay for housing (low government assistance, insufficient pensions etc), lack of affordable and secure housing (including conversion of apartments into unaffordable condominiums), declining physical health, mental health issues, relationship breakdown, violence and abuse. The risk of homelessness can also be compounded by the death of a spouse, social isolation, discrimination, or lack of knowledge of benefits and services.

dementia infographicIn the category of personal factors, however, dementia is important to highlight amongst the risk factors for homelessness. According to the Alzheimer’s Association, dementia describes a series of symptoms of decline in memory or other thinking skills that affect someone’s everyday life. Alzheimer’s disease is 60-80% of cases, while vascular dementia (after a stroke) is the second most common type. Symptoms include memory loss, faulty reasoning, and impaired judgment. Diagnosing dementia among seniors who are isolated and/or experiencing homelessness can be challenging as it requires a series of tests and documented patterns of behaviour. Another area of concern is the premature aging caused by stressful living conditions in poverty and/or homelessness - for example, people who may be biologically 50 years old may be need to be screened as if they were 65.

While the rate of diagnosed dementia amongst seniors experiencing homelessness compared to those who are housed varies by study - a Toronto study placed both at 6%; while a study based in Sydney estimated that 67% of the older homeless population showed evidence of cognitive impairment), declining mental abilities can compound other existing issues (such as limited income, sparse social supports) and put someone at a high risk of homelessness. 

Research on the specific relationship between dementia and homelessness is scarce. A 2015 literature review of Australian research found that most studies are, on average, over ten years old. There is a need for more, but existing studies have provided some useful frameworks for how we can approach service provision for seniors with dementia. As the author of the literature review concluded:

…providing access to services including aged care, health and housing for older homeless people with multiple complex problems including mental illness who are hard to reach and do not seek services, is challenging. Therefore a combination of outreach using multidisciplinary teams to initially build trust with older homeless people, make assessments and evaluate the type of care needed, as well as an effective pathway through the aged care system to permanent housing either in the community or in residential aged care, is recommended. [O’Connell, 2004; Yang et al 2006; Crane et al, 2008; Rogoz et al, 2008) Ultimately, the best model for care of older homeless people is a one stop service that provides prevention, outreach, assessment and evaluation, all types of housing including crisis, transitional, community and residential, supportive services such as mental health, addiction etc; assistance with all aspects of daily living and continuity of care. (Green 2005)

Many Canadian studies also recommend moving towards a coordinated system of care that seamlessly provides services. In one Ontario case study, 129 older adults experiencing homelessness “…confirmed the value of a continuous caring relationship with an identified provider and the delivery of a seamless service through coordination, integration and information sharing between different providers.” Similarly, another Canadian study from 2009 examined a community shelter program that gave residents access to primary care physicians, nurses, personal support workers, and housing workers. The writers concluded that such an integrated system helped workers identify mental health and cognitive issues that may not have been otherwise discovered.

Fortunately, the Canadian government has already identified seniors as a priority population and has made progress in helping them age in place. In the Action for Seniors Report (2014), the following initiatives (among others) are highlighted:

While progress is definitely being made, we must continue working towards changing how we help seniors experiencing or at risk of experiencing homelessness. We will also need to:

Plan for the long-term

Hostels and shelters are not appropriate housing for seniors who, in addition to declining cognitive ability, may also have physical mobility issues that make these environments difficult to access. These seniors may also not be able to retain their existing housing and may need to look into long-term care.

Despite there being some funding for coordinated care teams, these teams only address a few of the issues faced by seniors. As such, we will need to look beyond emergency and transitional housing and invest in more long-term housing options. This will involve putting pressure on municipal, provincial and federal governments to go beyond Housing First and affordable housing plans to include more long-term/permanent supportive housing for seniors in our communities.

Start outreach early

Many seniors become socially isolated. Furthermore, some may worry about losing their independence and avoid making contact with healthcare providers until they absolutely have to. As Barrett et al. pointed out (from the Australian literature review):

Unfortunately due to the lack of engagement with services until an acute episode where urgent hospitalisation is required, preventative care delivered within the community poses enormous challenges (Barrett et al, 2011). A number of studies have found that effective models of care include outreach on an ongoing basis. In this way the many acute and chronic conditions that older homeless people suffer can be managed to minimise disability. Acute conditions can be detected in an earlier stage and chronic conditions can be better managed to prevent exacerbation (O’Connell et al, 2004; Green, 2005; Yang et al 2006; Crane et al, 2008; Rogoz et al, 2008).

Even though it requires more financial support and the use of multidisciplinary teams (doctors, housing workers, support workers, etc.), ongoing outreach to seniors at risk of homelessness will be crucial in making early screening for dementia and appropriate care a reality.

Invest in senior-specific programming

We will also need to support dementia-focused, senior-specific programs, as:

There is a strong need for more health care providers who are specialized in the care of seniors with mental health disorders, including those who reside in institutional settings. Current service delivery models do not meet the complex and ever changing mental health needs of seniors. There is a pressing need for best practice guidelines in managing multiple mental illnesses and physical problems in aging Canadians. Family caregivers also need a coordinated range of supports in order to help senior family members with mental disorders and to meet their own needs as the caregiver. The economic value of those support services is enormous.

This last point about caregivers is really important, especially for seniors who cannot afford to live in high-end institutions or who want to stay in their homes. While the Canadian government does offer 6 weeks of Compassionate Care Coverage and the Family Caregiver Tax Credit, this is not enough to support long-term, full-time care of seniors who need it.

Finally, these services will also have to be culturally appropriate. For Indigenous seniors experiencing homelessness, funding for housing both on and off-reserve is important; as well as for Indigenous caregivers.

For more information on dementia and homelessness, I recommend watching this video from Alzheimer's Australia.

Related posts:

This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at thehub@edu.yorku.ca and we will provide a research-based answer.

Photo credit: Affinity Training (UK)

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