End Homelessness

  • M. Lori Thomas
  • Laneshia Conner
  • Othelia Lee
  • Cheryl Waites SpellmanEmail author


Each year, nearly 1.5 million people in the United States experience homelessness, at least a third of whom are over the age of 50 (Henry et al., The 2017 Annual Homeless Assessment Report (AHAR) to Congress. Part 2: Estimates of homelessness in the United States. U.S. Department of Housing and Urban Development, Washington, DC, 2017). By 2030, the number of adults ages 65 and over experiencing homelessness is expected to triple (Culhane et al., The emerging crisis in aging homelessness: Could housing solutions be funded by avoidance of excess shelter, hospital, and nursing homes? Retrieved from, 2019). Evidence suggests that older adults experiencing homelessness have the physical and mental indicators of aging 10–20 years earlier than the general population (Cohen, Gerontologist 39(1):5–14, 1999) and experience premature mortality due to age-related chronic conditions (Baggett et al., JAMA Intern Med 173(3):189–195, 2013). This chapter will focus on the Grand Challenge to End Homelessness which seeks to address the persistent problem of homelessness and build on the evidence supporting housing-based interventions by expanding available housing resources, ensuring evidence-based psychosocial support to accompany housing, and developing and evaluating new housing-based interventions for specific populations, including older adults and elders.


Homeless Housing Aging Older adult homelessness Elder homelessness Mental health Aging services Aging network 


  1. Baggett, T. P., Hwang, S. W., O’Connell, J. J., Porneala, B. C., Stringfellow, E. J., Orav, E. J., & Rigotti, N. A. (2013). Mortality among homeless adults in Boston: Shifts in causes of death over a 15-year period. JAMA Internal Medicine, 173(3), 189–195. Scholar
  2. Ben-Shlomo, Y., & Kuh, D. (2002). A life course approach to chronic disease epidemiology: Conceptual models, empirical challenges and interdisciplinary perspectives. International Journal of Epidemiology., 31, 285–293. Scholar
  3. Biegel, D., & Roberts, A. (2015). Impoverished and homeless adults. In D. Kaplan & B. Berkman (Eds.), The Oxford handbook of social work in health and aging. New York, NY: Oxford University Press.Google Scholar
  4. Brown, M., Cummings, C., Lyons, J., Carrión, A., & Watson, D. P. (2018). Reliability and validity of the Vulnerability Index-Service Prioritization Decision Assistance Tool (VI-SPDAT) in real-world implementation. Journal of Social Distress and the Homeless, 27, 110. Scholar
  5. Brown, R., Thomas, M. L., Cutler, D. F., & Hinderlie, M. (2013). Meeting the housing and health care needs of older homeless adults: A supportive housing program targeting homeless seniors. Seniors Housing & Care Journal, 21(1), 126–135.Google Scholar
  6. Brown, R. T., Goodman, L., Guzman, D., Tieu, L., Ponath, C., & Kushel, M. B. (2016). Pathways to homelessness among older homeless adults: Results from the HOPE HOME Study. PLoS One, 11(5), e0155065. Scholar
  7. Brown, R. T., Hemati, K., Riley, E. D., Lee, C. T., Ponath, C., Tieu, L., … Kushel, M. B. (2016). Geriatric conditions in a population-based sample of older homeless adults. The Gerontologist, 57(4), 757–766.PubMedCentralGoogle Scholar
  8. Brown, R. T., Kiely, D. K., Bharel, M., & Mitchell, S. L. (2012). Geriatric syndromes in older homeless adults. Journal of General Internal Medicine, 27(1), 16–22.CrossRefGoogle Scholar
  9. Brown, R. T., Miao, Y., Mitchell, S. L., Bharel, M., Patel, M., Ard, K. L., … Steinman, M. A. (2015). Health outcomes of obtaining housing among older homeless adults. American Journal of Public Health, 105(7), 1482–1488.CrossRefGoogle Scholar
  10. Brown, R. T., & Steinman, M. A. (2013). Characteristics of emergency department visits by older versus younger homeless adults in the United States. American Journal of Public Health, 103(6), 1046–1051.CrossRefGoogle Scholar
  11. Brown, R. T., et al. (2013). Use of acute care services among older homeless adults. JAMA Internal Medicine, 173(19), 1831–1834.CrossRefGoogle Scholar
  12. Burt, M., Aron, L. Y., & Lee, E.. (with Valente, J.).(2001). Helping America’s homeless: Emergency shelter or affordable housing? Washington, D.C.: The Urban Institute.Google Scholar
  13. Chekuri, L., Turturro, C. L., Nekkalapudi, M., & Mittal, D. (2016). Racial differences in older homeless adults: Findings in a homeless sample from Little Rock. The American Journal of Geriatric Psychiatry, 24(3), S67–S68. Scholar
  14. Cheung, A. M., & Hwang, S. W. (2004). Risk of death among homeless women: A cohort study and review of the literature. Canadian Medical Association Journal, 170(8), 1243–1247.CrossRefGoogle Scholar
  15. Chinman, M., Rosenheck, R., & Lam, J. (2000). The case management relationship and outcomes of homeless persons with serious mental illness. Psychiatric Services, 51(9), 1142–1147. Retrieved from Scholar
  16. Christensen, R. C., Hodgkins, C. C., Garces, L. K., Estlund, K. L., Miller, M. D., & Touchton, R. (2005). Homeless, mentally ill, and addicted: The need for abuse and trauma services. Journal of Healthcare for the Poor and Underserved, 16(4), 615–622.CrossRefGoogle Scholar
  17. Cohen, C. I. (1999). Aging and homelessness. The Gerontologist, 39(1), 5–14.CrossRefGoogle Scholar
  18. Conroy, S. J., & Heer, D. M. (2003). Hidden Hispanic homelessness in Los Angeles: The “Latino Paradox” revisited. Hispanic Journal of Behavioral Sciences, 25(4), 530–538. Scholar
  19. CSH and Hearth. (2011, December). Ending homelessness among older adults and elders through permanent supportive housing. Retrieved from
  20. Culhane, D. P., Metraux, S., Byrne, T., Stino, M., & Bainbridge, J. (2013). The age structure of contemporary homelessness: Evidence and implications for public policy. Annals os Social Issues Public Policy, 13(1), 228–244. Scholar
  21. Culhane, D.P., Treglia, D., Byrne, T., Metraux, S., Kuhn, R., Doran, K., Johns, E., & Schretzman, M. (2019). The emerging crisis in aging homelessness: Could housing solutions be funded by avoidance of excess shelter, hospital, and nursing homes? Retrieved from
  22. Dietz, T. L. (2009). Drug and alcohol use among homeless older adults: Predictors of reported current and lifetime substance misuse problems in a national sample. Journal of Applied Gerontology, 28(2), 235–255.CrossRefGoogle Scholar
  23. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 114, 245–258. Scholar
  24. Folstein, M. F., Folstein, S. E., & Fanjiang, G. (2001). Mini-mental state examination: Clinical guide. Lutz, FL: Psychological Assessment Resources.Google Scholar
  25. Gelberg, L., Linn, L. S., & Mayer-Oakes, A. (1990). Differences in health status between older and younger homeless adults. Journal of the American Geriatrics Society, 38, 1220–1229.CrossRefGoogle Scholar
  26. Goodman, L., Saxe, L., & Harvey, M. (1991). Homelessness as psychological trauma. American Psychologist, 46, 1219–1225.CrossRefGoogle Scholar
  27. Gray, M. J., Litz, B. T., Hsu, J. L., & Lombardo, T. W. (2004). Psychometric properties of the life events checklist. Assessment, 11(4), 330–341. Scholar
  28. Gultekin, L., & Brush, B. (2017). In their own words: Exploring family pathways to housing instability. Journal of Family Nursing, 23(1), 90–115. Retrieved from Scholar
  29. Henry, M., Bishop, K., de Sousa, T., Shivji, A., & Watt, R. (2017). The 2017 Annual Homeless Assessment Report (AHAR) to Congress. Part 2: Estimates of homelessness in the United States. Washington, D.C.: U.S. Department of Housing and Urban Development.Google Scholar
  30. Henry, M., Mahathey, A., Morrill, T., Robinson, A., Shivji, A., & Watt, R. (2018). The 2018 Annual Homeless Assessment Report (AHAR) to Congress. Part 1: Point-in-time estimates of homelessness. Washington, D.C.: U.S. Department of Housing and Urban Development.Google Scholar
  31. Henwood, B. F., Katz, M. L., & Gilmer, T. P. (2014). Aging in place within permanent supportive housing. International Journal of Geriatric Psychiatry, 30, 80–87. Scholar
  32. Hurstak, E., Johnson, J. K., Tieu, L., Guzman, D., Ponath, C., Lee, C. T., … Kushel, M. (2017). Factors associated with cognitive impairment in a cohort of older homeless adults: Results from the HOPE HOME study. Drug and Alcohol Dependence, 178, 562–570.CrossRefGoogle Scholar
  33. Joint Center for Housing Studies (JCHS). (2017). America’s rental housing 2017. Cambridge, MA: Harvard University.Google Scholar
  34. Koegel, P., Melamid, E., & Burnam, M. A. (1995). Childhood risk factors for homelessness among homeless adults. American Journal of Public Health, 85(12), 1642–1649.CrossRefGoogle Scholar
  35. Kuno, E., Rothbard, A. B., Avery, J., & Culhane, D. (2000). Homelessness among persons with serious mental illness in an enhanced community-based mental health system. Psychiatric Services, 51, 1012–1016.CrossRefGoogle Scholar
  36. Lee, C. M., Mangurian, C., Tieu, L., Ponath, C., Guzman, D., & Kushel, M. (2017). Childhood adversities associated with poor adult mental health outcomes in older homeless adults: results from the HOPE HOME Study. The American Journal of Geriatric Psychiatry, 25(2), 107–117.CrossRefGoogle Scholar
  37. Lee, C. T., Guzman, D., Ponath, C., Tieu, L., Riley, E., & Kushel, M. (2016). Residential patterns in older homeless adults: Results of a cluster analysis. Social Science & Medicine, 153, 131–140.CrossRefGoogle Scholar
  38. Levin, S., & Miya, K. (2008). Assertive community treatment for older adults. Psychiatric Services, 59(1), 112–113.CrossRefGoogle Scholar
  39. Lim, S. C., Doshi, V., Castasus, B., Lim, J. K. H. & Lim et al., (2006). Factors causing delay in discharge of elderly patients in an acute care hospital. Annals Academy of Medicine, 35(1), 27–32.Google Scholar
  40. O’Connell, J. J. (2005). Premature mortality in homeless populations: A review of the literature. Nashville, TN: National Healthcare for the Homeless Council, Inc..Google Scholar
  41. Oh, H. Y., & Devylder, J. E. (2014). Mental health correlates of past homelessness in Latinos and Asians. Community Mental Health Journal, 50(8), 953–959. Scholar
  42. OrgCode and Community Solutions. (n.d.). The SPDAT and VI-SPDAT: Tools Grounded in Evidence. Retrieved from
  43. Padgett, D. K., Gulcur, L., & Tsemberis, S. (2006). Housing first services for people who are homeless with co-occurring serious mental illness and substance abuse. Research on Social Work Practice, 16(1), 74–83.CrossRefGoogle Scholar
  44. Padgett, D. K., & Struening, E. (1992). Victimization and traumatic injuries among the homeless: Associations with alcohol, drug, and mental problems. American Journal of Orthopsychiatry, 62, 525–534. Scholar
  45. Poulin, S. R., Maguire, M., Metraux, M., & Culhane, D. P. (2010). Service use and costs for persons experiencing chronic homelessness in Philadelphia: A population-based study. Psychiatric Services, 61(11), 1093–1098.CrossRefGoogle Scholar
  46. Raven, M. C., Tieu, L., Lee, C. T., Ponath, C., Guzman, D., & Kushel, M. (2017). Emergency department use in a cohort of older homeless adults: Results From the HOPE HOME Study. Academic Emergency Medicine, 24(1), 63–74. Scholar
  47. Rog, D. J., Marshall, T., Dougherty, R. H., George, P., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Permanent supportive housing: assessing the evidence. Psychiatric Services, 65(3), 287–294.CrossRefGoogle Scholar
  48. Ross, L., Jennings, P., & Williams, B. (2018). Improving health care student attitudes toward older adults through educational interventions: A systematic review. Gerontology & Geriatrics Education, 39(2), 193–213. Scholar
  49. Rothstein, R. (2017). The color of law: A forgotten history of how our government segregated America. New York, NY: Liveright Publishing.Google Scholar
  50. Ruggiero, K. J., Ben, K. D., Scotti, J. R., et al. (2003). Psychometric properties of the PTSD check list. Journal of Trauma Stress, 16, 495. Scholar
  51. Saad, B., de Medeiros, R., & Mosini, A. (2017). Are we ready for a true biopsychosocial-spiritual model? The many meanings of spiritual. Medicine, 4(4), 79. Retrieved from Scholar
  52. Shinn, M. (2007). International homelessness: Policy, socio-cultural, and individual perspectives. Journal of Social Issues, 63(3), 657–677.CrossRefGoogle Scholar
  53. Shinn, M., Gottlieb, J., Wett, J. L., Bahl, A., Cohen, A., & Baron, E. D. (2007). Predictors of homelessness among older adults in New York City: Disability, economic, human and social capital and stressful events. Journal of Health Psychology, 12, 696–708.CrossRefGoogle Scholar
  54. Spinelli, M. A., Ponath, C., Tieu, L., Hurstak, E. E., Guzman, D., & Kushel, M. (2017). Factors associated with substance use in older homeless adults: Results from the HOPE HOME study. Substance Abuse, 38(1), 88–94. Scholar
  55. Stefancic, A., Tsemberis, S., Messeri, P., Drake, R., & Goering, P. (2013). The Pathways Housing First fidelity scale for individuals with psychiatric disabilities. American Journal of Psychiatric Rehabilitation, 16(4), 240–261.CrossRefGoogle Scholar
  56. Substance Abuse and Mental Health Services Administration (SAMHSA). (2010). Permanent Supportive Housing: The evidence. HHS Pub. No. SMA-10-4509. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.Google Scholar
  57. Szanton, S. L., Thorpe, R. J., Boyd, C., Tanner, E. K., Leff, B., Agree, E., … Guralnik, J. M. (2011). Community aging in place, advancing better living for elders: A bio-behavioral-environmental intervention to improve function and health-related quality of life in disabled older adults. Journal of the American Geriatrics Society, 59(12), 2314–2320.CrossRefGoogle Scholar
  58. U.S. Department of Housing and Urban Development. (n.d.). Continuum of care (CoC) Program. Retrieved from
  59. Washington, O. G., Moxley, D. P., Garriott, L., & Weinberger, J. P. (2009). Five dimensions of faith and spiritually of older African American women transitioning out of homelessness. Journal of Religion and Health, 48(4), 431.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • M. Lori Thomas
    • 1
  • Laneshia Conner
    • 2
  • Othelia Lee
    • 3
  • Cheryl Waites Spellman
    • 3
    Email author
  1. 1.Urban Institute and School of Social Work, University of North CarolinaCharlotteUSA
  2. 2.School of Social Work, Spalding UniversityLouisvilleUSA
  3. 3.School of Social Work, University of North CarolinaCharlotteUSA

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