Homeless Older Adults: Health, Affordable Housing and Long-Term Care Accessibility

 

Homeless Older Adults: Health, Affordable Housing and Long-Term Care Accessibility

 

Introduction

Living on the streets is an inhumane and unsafe lifestyle that causes health disparities among the youth, adults and senior citizens. The elderly homeless population is one of the most vulnerable groups, being victimized and facing many challenges with accessing healthcare and affordable housing. The aging homeless population is designated as being 50 years of age and older. Within the United States, approximately 31% of the homeless population is older, in poor health, and trying to survive horrific conditions (Burns & Sussman, 2018). Not having stable shelter will eventually take a toll on aging individuals who are homeless due to major concerns with safety, lack of nutrition, unhealthy living conditions, and exposure to inclement weather. Homeless individuals are forced to reside on park benches, in crowded shelters, under bridges, in cars and tents. These living conditions are unsanitary and contribute to the deterioration of their health.

Over time, such living conditions will increase the rate at which one ages and will lead to premature death. Prevalent health conditions include depression, mental illness, HIV infections, tuberculosis, hypertension, diabetes, asthma, loss of hearing, and loss of eyesight (Brown, Thomas, Cutler, & Hinderlie, 2013). The aging homeless population often lives from pillow to post, which results in not getting adequate sleep, nutritious meals, proper hygiene, or access to preventive medical care.

         The reasons for becoming homeless later in life are multi-faceted.  Among the contributing factors are job loss, divorce, ineligibility of benefits due to age, drug and alcohol abuse, and limited affordable housing. Others may have earned minimum wages during their working years and, as a result, were not able to save for life’s challenges and retirement (Burns & Sussman, 2018). It is difficult for this population to maintain good health while living in unstable circumstances. These homeless older adults are in urgent need of affordable housing, health care services, transportation, and nutritious food. These necessities should be accessible and have no eligibility restrictions.

            The benefits of health care services for aging individuals will improve overall health status, decrease hospital visits, and stabilize their mental state (Van, 2005). Health care and housing work hand-in-hand as poor health can be both the cause and result of homelessness (Henwood, Cabassa, Craig, & Padgett, 2013). It has been reported that people experiencing homelessness are three to six times more likely to become ill than housed people (Stafford & Wood, 2017). Affordable housing and senior homes are scarce in the United States, which causes housing complexes to have long waiting lists.

          An alternative to housing is a long-term care (LTC) facility, which offers both housing and health care. LTC facilities may encompass assisted living as well as nursing homes that offer assistance with bathing, dressing, continence, eating, rehabilitation, counseling, medication management, post-hospital care, three meals a day, and 24-7 geriatric trained staff (Moore, 2019). LTC services are necessary for the older homeless population to help alleviate pain, decrease health deterioration and provide a sense of safety. However, there are numerous barriers encountered by older adults that prevent them from obtaining health care and affordable housing in a timely manner.  

 

 

 

 

Conclusion

It is widely acknowledged that chronic homelessness exists in the United States because un-housed individuals are seen residing in unsanitary and unsafe environments daily. Such conditions, in turn, are key contributors to adverse health outcomes. The aging homeless population is a particularly vulnerable group with health concerns and needs that are not addressed, voluntarily or involuntarily. The U.S. homeless population is composed of 31% of aging individuals who lack information pertaining to assistance in obtaining health care services and housing. Research indicates that homelessness will age anyone prematurely and lead to life expectancy years shorter than that of the general population due to lack of the basic essentials, such as health care and housing (Culhane, Kane, & Johnston, 2013).

 It is critical that older homeless individuals have equal access to health care and housing as they are more susceptible to chronic illnesses and diseases that require ongoing medical attention. This lack of support and resources puts this population at greater risk of aging in poverty and becoming homeless (Garibaldi, Conde-Martel, & O’Toole, 2005). Many older, homeless individuals end up falling through the cracks as a result of eligibility restrictions that deny them access to needed assistance.  As reported in research findings, the majority of these individuals have paid taxes throughout their younger working years only to be rejected when they are most in need of assistance and support. In the opinion of this author, such treatment seems cruel and without compassion. 

The health status and safety of the aging homeless population must be a top priority at all levels of government:  local, state, and federal. The urgency of removing older adults from living in inhumane conditions should be executed immediately in the United States. From an economic standpoint, most aging homeless individuals rely heavily on inpatient care and emergency health services, which are costly for providers (Goldberg, 2016).

 

About the Author

With over 17 years of health care experience, Nikiya Ward has a background in Medical Laboratory Technology & Radiologic Science. In addition, she has recently completed her M.H.A. degree from Saint Joseph’s College of Maine. This blog post was adapted from her graduate “Capstone” research.

  

 

References

Brown, R.T., Thomas, L., Cutler, F.D., & Hinderlie. (2013). Meeting the Housing and Care Needs of Older Homeless Adults. A Permanent Supportive Housing Program Targeting Homeless Seniors. Seniors Housing & Care Journal, 126-135, vol 21 (1).

Burns, V.F., & Sussman, T. (2019). Homeless for the First Time in Later: Uncovering More Than One Pathway. The Gerontologist, 59(2), 251-259. Retrieved from https://doi.org/10.1093/geront/gnx212

Culhane, D.P., Kane, V., & Johnston, M. (2013). Homelessness Research: Shaping Policy and Practice, Now and Into the Future. American Journal of Public Health, 103 (S2), S181-S 183. Retrieved from https://ezprozy.Sjcme.edu:2102/10.2105/AJPH.2013.301728

Garibaldi, B., Conde-Martel, A., & O’Toole, T, P. (2005). Self-reported comorbidities perceived needs and sources for usual care for older and younger homeless adults. Journal of General Internal Medicine, 20(8),726-730, Retrieved from https://doi.org/10.1111/j.1525-1497.2005.0142.x

Goldberg., J. (2016). How to Prevent and End Homelessness Among Older Adults. Justice in Aging. Retrieved by https://www.justiceinaging.org

Henwood, B.F. Cabassa, L.J., Craig, C.M., & Padgett, D.K. (2013). Permanent Supportive Housing: Addressing Homelessness and Health Disparities? American Journal of Public Health, 103 (S2), S 188-92. Retrieved from https://ezproxy.Sjcme.edu:2102/10.2105/AJPH.2013.301490

Moore., R.L. (2019). The Basics of Assisted Living. National Caregivers Library. Retrieved from https://www.caregiverslibrary.org

Stafford, A., & Wood, L. (2017). Tackling Health Disparities for People Who are Homeless? Start with Social Determinants. International journal of environmental research and public health, 14(12), 1535. Retrieved from https://doi.org/10.3390/ijerph14121535

Van, W.R. Homelessness Among Older Adults with Severe Mental Illness: A biological based developmental Perspective (2005). Journal of Human Behavior in the Social Environment. 10(4):39-49 (11p).

 

 

 

 

 

 

Medicaid Budgeting in Long-Term Care

 

Author:

 Aaron Szydlo.  M.H.A. Student.  Saint Joseph’s College

 

Medicaid Budgeting in Long-Term Care

Since its inception in 1965, Medicaid has been at the forefront of healthcare discussions. Stemming from coverage of the aggregate groups who qualify, to financing the vast expanding services, Medicaid has been reformed over ten times (CHCS, P.1)¹  While it is currently the largest insurance provider in the country, if the coverage and expansion continue at its current rate, it is my contention that it will not be sustainable. With the extension of coverage, it seems to be moving in the direction of universal medical care.  Working in a Skilled Nursing Facility, I see the firsthand impact of Medicaid budgeting and its ramifications on long term residents.

Medicaid’s original intent was to cover only those who required cash assistance.  However, since its inception, Medicaid has pivoted to cover children, pregnant women, the disabled, as well as long-term care2. Since 1965, Medicaid spending has jumped from under half a billion to $257 billion3. Specifically, in the long-term care sector, Medicaid is unable to meet the demand of those it covers. In addition, with an increasing elderly population, larger than any time in history, Medicaid is always playing catchup. Thus, we witness the evolution of MCO’s, Affordable Care Act, Home Care Based Services, and DRSIP programs.

While these and other programs are noble in virtue, few of them have had success. MCOs and the ACA have increased expenditures by adding administrative costs while simultaneously disincentivizing the necessary quality of care by focusing on cost cutting4. In addition, the ACA was introduced as friendly to those who did not want to lose their providers or current insurance, while millions found out that was not the case. Moreover, programs such as Delivery System Reform Incentive Payment (DSRIP), which aims to increase provider relations and reduce Medicaid expenses by 25% in 5 years, have been unsuccessful to date.  Little evidence exists that DSRIP waivers have significantly improved quality and health outcomes or reduced spending on health care services5.

I believe that if Medicaid were focused on guaranteed cost-saving approaches instead of pouring money into bold ideas that are questionable, we would see true reform. In addition, I think Medicaid should redact the number of people it covers as that was never its intent. Lastly, in efforts to reduce the costs of Medicaid for long-term care, I think Medicare should cover more than 100 days in a SNF.

About the Author:

With a background in Business Management & Public Health, Aaron Szydlo administers several Medical Model Adult Day Care Centers throughout New York.  In addition, he is completing his M.H.A. degree with Saint Joseph’s College / Maine.  This blog post was adapted from his graduate “Gerontology” research.

References

1.     Weil, A. (2003). There’s Something About Medicaid. Health Affairs, 22(1), 13-30. doi: 10.1377/hlthaff.22.1.13

 

2.     History | CMS. (2020). Retrieved 17 May 2020, from https://www.cms.gov/About-CMS/Agency-Information/History

 

 

3.     Weil, A. (2003). There’s Something About Medicaid. Health Affairs, 22(1), 13-30. doi: 10.1377/hlthaff.22.1.13

 

4.     Manchikanti L, e., Helm, S., Benyamin, R., & Hirsch, J. (2017). A Critical Analysis of Obamacare: Affordable Care or Insurance for Many and Coverage for Few? - PubMed - NCBI. Retrieved 17 May 2020, from https://www.ncbi.nlm.nih.gov/pubmed/28339427

 

 

5.     Gusmano, M., & Thompson, F. (2018). Medicaid Delivery System Reform Incentive Payments: Where Do We Stand? | Health Affairs. Retrieved 17 May 2020, from https://www.healthaffairs.org/do/10.1377/hblog20180920.103967/full/