On any given night, more than 35,000 individuals are experiencing homelessness in Canada. Each year, it is more than 235,000 individuals who will experience homelessness in the country.(1) Historically, homeless people in Canada were older, single males. That being said, the current crisis seems to reveal a much more diverse picture. Indeed, there are more women, families and youth today who are homeless than in the past. The number of people aged 50 and over who are homeless, however, continues to increase. They represent 24.4% of users in homeless shelters.(1)
These statistics resonate with other reports indicating that older adults are at increasing risk of homelessness due to a lack of support, precarious health, economic and housing situations, and a lack of age-appropriate programs and services.(2; 3; 4) The risk of homelessness can also be aggravated by many factors, including the death of a spouse, the lack of social housing, social isolation, or a past filled with abuse and violence. But what can be done to reduce homelessness?
What research tells us
A recent high-quality systematic review examined 43 studies, including 37 from the United States.(5) These studies examined the effectiveness of interventions to reduce homelessness and increase residential stability for those who are homeless or at risk of homelessness.
Overall, several housing programs combined with case-management interventions appear promising compared to usual services (for example, day centers, hospital emergencies, outpatient clinics). The authors of the systematic review indicated that there is still some uncertainty in these findings since most of the studies may have overestimated or underestimated the true intervention effects due to some limitations in how the studies were conducted. And given the very diverse homeless population, there is still some gaps regarding some age-specific groups, including disadvantaged youth and older adults. Having said that, here are some specific observations regarding the interventions examined in the review:
Case managers are individuals guiding homeless people (or those at risk) into the health and social system, and facilitating their access to resources and services. Support provided by case managers reduces the number of people with mental health and addiction problems who report being homeless by almost one-third. Individuals who received more intensive case management were less likely to be homeless and more likely to be in stable housing, compared to individuals who are offered the usual services.
The ‘Housing First’ approach
This program considers housing to be a fundamental right. Two core elements of the program include psychiatric rehabilitation and consumer choice. Users are thus encouraged to define their own needs and goals. Housing is provided to them and there are no restrictions related to sobriety. However, treatment is offered, as well as access to a nurse practitioner. This program improves the residential stability of people with mental health or chronic conditions and reduces homelessness compared to usual services.
The "treatment first" approach: housing program conditional on abstinence
Other programs emphasize the need for a transitional period of sobriety and adherence to treatment before allowing homeless people to live independently in their own apartments. Housing is available to these people, but they must stop using alcohol or drugs. This program reduces the number of days spent homeless compared to usual services. However, its effects are uncertain due to the demands of users to abstain from alcohol and drugs.
A combination of housing and case management programs
For adults with mental health and addiction problems, a combination of housing and case management appears more effective in reducing the number of days spent homeless. It also appears to be more effective to promote residential stability in the short and medium term.
Housing vouchers or rent supplement programs
Some governments provide financial support for individuals to be able to find housing. These allowances can help homeless families move out of temporary shelters faster and stay out of shelters for extended periods of time. Combined with case management, this financial support is probably more effective than usual services or case management alone for adults with mental health problems and chronic conditions.
Homelessness is a tragic and complex phenomenon, which may affect youth, families, older adults, and many others. The current body of synthesized research evidence offers a glimmer of hope. It reveals that we can collectively take action and leverage the assets of our health and social systems to address homelessness.