Reaching Out and Caring for Our Elders: The Hearth Model

A growing number of older adults are facing homelessness in the US. Homelessness is a wearing and traumatic experience at any age. For the elderly, homelessness magnifies the effects of aging, including physical frailty, chronic disease, mental health issues, and social isolation. Hearth, a Boston-based agency dedicated to ending elder homelessness, has developed a model of outreach, case management, and service-enriched housing tailored to the needs of highly vulnerable elders. The agency has been named a 2009 Social Innovator for its unique approach to serving elders who are homeless or at risk of homelessness.

“Homeless elders are highly vulnerable. It is very difficult for an older person suffering from physical or mental frailties to live in a homeless shelter or on the streets.” shares Gale Druga of Hearth, an award-winning Boston-based agency providing outreach and service-enriched housing tailored to the special needs of elders who are homeless.

The numbers of elderly people experiencing homelessness is growing as the US population ages. A recent report by the National Alliance to End Homelessness, “The Rising Elderly Population,” projects an increase of 33% in elderly homelessness in the next decade – from 44,172 people in 2010 to 58,772 in 2020. The report projects that the number of elderly homeless persons will more than double between 2010 and 2050.

The struggle to survive in homelessness takes an enormous physical and mental toll on a person. For older adults, the conditions of homelessness can magnify the effects of aging, including physical frailty, chronic disease, mental health issues, and social isolation. Researchers suggest that a person who experiences chronic homelessness is in the same physical condition as a housed peer who is 15 years older. At age 50, a person who is homeless may have the body of a 65 year old.

“As people who are experiencing homelessness age, they face losing their independence and have growing physical and mental health needs,” says Adrienne Beloin, Hearth’s Director of Outreach. Others may be facing homelessness for the first time in their lives at an advanced age. “Elders have very directed needs quite different from other homeless populations. Many homeless service programs are focused on self-sufficiency, with jobs and employment training. But our elders are often post employment and cannot work due to age or disability,” adds Anne Garmey, Hearth’s Director of Institutional Advancement.

To meet these complex needs, Hearth has created an integrated approach that combines outreach, case management, and service-enriched housing. “Our outreach workers canvas 10 of Boston’s emergency shelters regularly. They start with engagement, find out who is interested in housing, and help them through the process,” explains Adrienne. The outreach team builds relationships and collaborates closely with staff at other agencies to help connect people over 50 with the services they need and to shepherd them through the housing application process.

“Our case managers go to appointments, interviews, accompany the elder to doctor’s appointments, or help with legal mediation or appeals. The elders often don’t know where to begin, and are overwhelmed. Elders have so many different needs, and those who have been on the streets for years are not likely to seek out help on their own,” shares Adrienne.

Service-enriched housing is the heart of Hearth’s approach to ending elder homelessness. It provides a unique blend of housing and supportive services tailored to the specific needs of elders. The agency operates 137 units of service-enriched housing, spread across seven residences in Boston. Hearth residences have a site director, social worker, and nurse on staff, and staff members rotate through smaller sites on a regular basis. Personal care assistants are available to help residents who need help making beds, doing laundry, or dressing. Site directors make sure that each Hearth resident receives the level of supportive services he or she needs.

“Our team is here, so we notice if someone has stopped opening the mail. We notice right away if someone is having trouble swallowing, or if an elder’s apartment is not being cared for as well as it was before. We can see if someone needs a little extra help, and we provide it. We are like a family,” explains Anne Garmey.

The support staff helps to connect residents with outside health and mental health care, including visiting nurses or hospice care. The resident nurse is available to accompany residents to doctor’s appointments residents. “Our nurse is a second set of ears for our residents. She advocates for residents and interprets conversations with providers, the way you would for an elderly family member. She helps people make informed choices about their medical care and models how to appropriately interact with care providers.”

At one of Hearth’s largest sites, Anna Bissonnette House in Boston’s South End, plush green carpeting, vases of silk flowers, and framed prints add homey touches. Light streams through large windows overlooking a community garden across the street. Each apartment is specially designed for an elderly resident. Bathtubs have grip rails and emergency pull cords. Every apartment has a kitchen, and hot lunches are available three times a week and served in the communal dining room, in addition to special meals that are cooked by volunteers throughout the year. Common areas on each floor offer clusters of comfortable armchairs, sofas, and TVs. To promote wellness, the site’s social worker offers health education programs, including a support group for smoking cessation.

The service-enriched housing model shows promising cost savings. The Hearth team tells the story of a woman who had 34 emergency room visits and 15 hospitalizations in the year before she moved into Hearth’s Ruggles residence. During her first year housed, she only had 5 emergency room visits and 4 hospitalizations. The Hearth team credits the reduction to her housing stability combined with the support and teamwork of the nurse and social worker who managed her care.

Through a survey of its residents, Hearth learned that residents express strong satisfaction with service-enriched housing and report improved health status. Their findings were published in the report, “Ending Elder Homelessness: The Importance of Service-Enriched Housing.”

Hearth’s strategic vision includes providing leadership at the local, state, and national level to raise awareness and offer solutions to the challenges of homelessness among elders. The team offers technical assistance to agencies and communities grappling with how to meet the needs of elders in their communities. To learn more about the Hearth approach to serving elders who are experiencing homelessness, visit Hearth’s website.

To learn more about addressing the needs of elderly adults experiencing homelessness, visit HRC’s Topic Page on Homeless Populations: Elderly.

Publication Date: 
Rockville, MD, USA