A Place to Call Home: A Community Response to Older Adults Who are Aging Without a Place to Age

1. A Place to Call Home: A Community Response to Older Adults Who are Aging Without a Place to Age Traci Perry, MSSW, MBA, PhD Texas A&M University-Commerce Keilah Jacques, MSSW CitySquare

2. Learning Objectives At the end of this presentation participants will be able to: Gain an understanding about the problem of homelessness among older adults. Develop ideas about how to address the needs of the population of older adults who are marginally housed and homeless in a client centered manner. Learn how to develop a community/macro practice response to the problem of homelessness among older adults.

3. Older adults in America Number of Americans aged 45-64 is expected to increase during the decade by 39% (Administration on Aging, 2005). Population of adults age 65 and older is projected to increase from 35 million in 2000 to 40 million in 2010 and then to 55 million in 2020 (Administration on Aging, 2005).

4. Older Adult Homelessness It is currently estimated that 2% of the sheltered homeless population represents older adults age 62 and older (Department of Housing and Urban Development, 2007). It is believed that older homeless adults constitute approximately 10% to 15% of the total population of homeless adults (Gibeau, 2001; Kutza & Keigher, 1991).

5. Causes of homelessness in older adults Deinstitutionalization Death of a spouse Gentrification Rising rents Evictions Shortages of Affordable housing Family domestic violence

6. Homeless Older Adults Have little or no prior service usage Have poor health and nutrition Have a history of long-term renting or boarding Have little knowledge or understanding of community resources Have a strong sense of independence

7. Older Adults Who AreMarginally Housed and Homeless Have a steady source of income from entitlement programs (social security, Medicare, Medicaid, VA health resources) Largely comprise women Have chronic medical conditions Have access to health insurance More likely to use shelter-based clinics, emergency rooms and street outreach teams for care Physically frail and socially isolated Have psychiatric illnesses and less likely to use alcohol and drugs

8. Frameworks of Macro Practice Strengths-based perspective Empowerment perspective Resiliency perspective Social Capital perspective

9. Strengths-Based Perspective Focusing on strengths, client system resources, capabilities, knowledge, abilities, motivations, experience, intelligence, and other positive qualities that can be put to use to solve problems and pursue positive changes (Krist-Ashman and Hull, 2012)

10. Empowerment Perspective Empowerment-process of increasing person, interpersonal or political power so individuals can take action to improve their life situations (Krist-Ashman and Hull, 2012) emphasizing, developing and nurturing strengths Enhancing individuals’, families’ and communities’ power and control over their own destinies

11. Resiliency Perspective Resiliency has two dimensions (Kirst-Ashman and Hull, 2012): Risk- stressful life events or adverse environmental conditions that increase vulnerability Protection-buffers that moderate and protect against vulnerability (an individual has strengths that protect against adversity)

12. Social Capital Perspective Social capital definitions: “the process by which social actors create and mobilize their network connections within and between organizations to gain access to other social actors' resources” (Knoke, 1999) “the ability of actors to secure benefits by virtue of membership in social networks or other social structures” (Portes, 1998) “the ability of people to work together for common purposes in groups and organizations” (Fukuyama, 1995)

13. Community Asset Map

14. Evidenced-Based Macro Practice Strategies used with older adults Caregiving networks produce better outcomes for older adults as compared to individual caregiving (Brewer, 2002; Stewart, 2008) Individual and social resources predict well-being and functioning in later years (Martin, 2002) Socioeconomic resources exert a stronger effect on mental and functional health than individual resources (Martin, 2002)

15. Evidenced-Based Strategies to Ending Homelessness Strengthening new and existing collaborative networks Growth and enhancement of continuums of care Development of policy academies to prioritize and coordinate state efforts Engagement of community resources to expand the services provided by homeless service providers Broad-based community coalitions

16. Evidenced-Based Strategies to Ending Homelessness Research shows that an experimental group that received critical time interventions had the best housing retention outcome: Make home visits Accompany patients to appointments Substitute for caregivers when necessary Give support and advice to patient and caregivers Mediate conflicts between patient and caregivers Help negotiate ground rules for relationships More effective in maintaining transition to the community than usual services (i.e. referrals and assistance upon request) provided to homeless individuals during a critical time period-1st 6 months after discharge (Susser, Conover, Felix, Tsai and Wyatt, 1997)

17. Community-based participatoryresearch (CBPR) Action research, participatory research seeks equitable partnerships between researchers and members of communities in which research is carried out (Lewin, 1946; Freire, 1972). Empowering process to increase participants’ control over their lives, seeks a balance between research and action (Minkler & Wallerstein, 2003; Bridgman, 2006).

18. Community-based participatory research (CBPR) CBPR consists of: participatory process cooperative engagement of community members and researchers co-learning and system development community capacity building

19. CitySquare 100,000 Homes-Dallas Project Community Social Action Participatory Research Project During the week of March 25-30, 2012, between 3:30am-6:30am 85 community volunteers canvassed the streets of targeted areas in downtown Dallas Used Community Solutions’ Vulnerability Index (36-item quest to survey to survey and create a by-name list of individual experiencing homelessness and at-risk for premature death

20. CitySquare 100,000 Homes Project Systematically gathered names, pictures, DOB of homeless individuals on the streets Captured data on health status, institutional history (jail, prison, hospital and military) Length of homelessness Patterns of shelter use Previous housing situation

21. At-risk Indicators Tri-morbidity (psychiatric, substance abuse, chronic medical condition) More than 3 ER visits in the past year More than 3 ER visits in the past month Age 60 and older HIV/AIDS Liver Disease, Cirrhosis, or ESLD Kidney Disease, ESRD, or Dialysis Frostbite, Cold/Wet Weather Injury

22. 100k Survey Results Older adults 268 individuals were surveyed 107 were found to have health conditions associated with a high mortality risk 29 (11%) were over 60 years old The older respondent was 70 years old The longest reported length of homelessness was 42 years

23. Research Collaboration Collaboration between CitySquare and Texas A&M University-Commerce, School of Social Work, Mesquite Campus Community Social Action Participatory Research Process Qualitative research study to survey the 29 individuals identified in 100K Project Purpose to gain an understanding of the values, needs and preferences of older homeless adults

24. Research Collaboration (continued) Rationale: To understand the needs, values and preferences for housing and community services as defined by the consumer and to empower clients affected by the problem by giving them a voice in designing and creating programs and services that meet their needs. Triangulation method- one-on-one interviews with older homeless individuals living on the street, focus group with homeless street out reach workers and other staff who work with this population and focus group with community residents and businesses

25. SAMHSA Consumer Advisory Board Guidelines for Health and Homeless Projects Fit local project needs Autonomous governance structures and procedures Clear organizational guidelines Membership represents all program constituents Conduct ongoing recruitment Support for meetings sites, facilitators, and transportation Strong relationships with governance boards and senior management

26. Strategies for Consumer Involvement Consumer advisory boards Consumer advocacy groups Planning boards that hire consumer consultants, trainers, advisers or employees Consumer perspectives have priority in the development of the policy agenda Training of consumer leaders

27. Promoting Consumer Voice within Agencies That Serve the Homeless Tenants serve on an advisory committee to express tenant concerns and provide programmatic input; An open door policy to all tenants by executives in the agency; Consumers hired as service providers, managers and elected members of board of directors; Moderator of meetings ensures full participation of consumers Social/recreational events for staff and consumers to meet informally and to expand dialogue about community issues.

28. PREPARE community practice model

29. IMAGINECommunity Practice Model

30. References Brewer, L. (2002). A qualitative study of families engaged in the provision of elder care. Journal of Gerontological Social Work, 39(3): 41-56. Center for Substance Abuse Treatment. (2004). Building bridges: Co-occurring mental illness and addiction: Consumers and service providers, policymakers, and researchers in dialogue. Washington, DC: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. Center for Substance Abuse Treatment. (2005). Substance abuse treatment for persons with co-occurring disorders(Treatment Improvement Protocol (TIP) Series 42. DHHS Publication No. SMA 05-3922). Rockville, MD: Author. Friere, P. (1972). Pedagogy of the oppressed. Harmondsworth, UK: Penguin Fukuyama, F. 1995. Trust: The social virtues and the creation of prosperity. New York: Free Press. Knoke, D. 1999. Organizational networks and corporate social capital. In R. Th. A. J. Leenders & S. M. Gabbay(Eds.), Corporate social capital and liability: 17-42. Boston: Kluwer.

31. References Lewin, K. (1946). Action research and minority problems. Journal of Social Issues, 2, 34–46. Martin, P. (2002). Individual and social resources predicting well-being and functioning in the later years. Conceptual models, research and practice. Ageing International, 27(2): 3-29. Minkler M., & Wallerstein N. (Eds.). (2003). Community-based participatory research for health. San Francisco: Jossey-Bass Portes, A. 1998. Social capital: Its origins and applications in modern sociology. Annual Review of Sociology, 24: 1-24. Steward, P. (2008). Care for provision of African American elders. Journal of Intergenerational Relationships, (6)1: 61-81. Susser, E., Valencia, E., Conover, S., Felix, A., Tsai, W. & Wyatt, R. (1997). Preventing homelessness among mentally ill men: a “critical time” intervention after discharge from a shelter. American Journal of Public Health, 87(2): 256-262.