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Older rough sleepers
18% of rough sleepers are over the age of 50. Engaging with this age group can be a challenge and requires longer term interventions and support. This page details older rough sleepers issues and challenges, and recommends ways of working to engage this group.
Information for this page is taken from Our Forgotten Elders: Older People on the Street and in Hostels by Maureen Crane (2001)
Issues and challenges
Previous access to services
Older rough sleepers are generally more wary of services and less likely to engage immediately. Where homelessness services and hostels have a greater number of young people accessing them, there is often apprehension from older rough sleepers about fitting in and being able to access the service fairly.
Health
Rough sleeping has severe health impacts for people of all ages but has a particular propensity to affect those who are older. In addition, many older rough sleepers have limited or no contact with GPs resulting in longer term health decline in those needing treatment.
The following is a list of common physical conditions associated with older rough sleeping:
- respiratory disorders: asthma, bronchitis, pneumonia
- tuberculosis: In the early 1990s, high rates of active TB were reported amongst homeless people in London. The most vulnerable to TB are middle aged and elderly men who are heavy drinkers and slept rough or stayed in hostels
- stomach ulcers
- gastritis
- circulatory conditions: oedema, leg ulcers, cellulitis (caused through prolonged standing and walking)
- scabies
- lice.
Older homeless people are more likely to experience mental health problems. The prevalence of this rises with age – in particular for females. Rough sleeping is associated with demoralisation, loss of self-esteem and feelings of despair which often lead to depression and even suicidal thoughts. For many older rough sleepers, mental illness distorts their perceptions of reality and affects their day-to-day decision making. Most notably, this impacts on ways they seek, engage and accept services – in many cases this decision-making can result in sustaining their rough sleeping. When working with older rough sleepers, it is important for workers to be aware that severe memory problems leading to confusion and disorientation may not be immediately apparent and may only be noticeable once they leave the streets and enter a service/hostel.
Alcohol dependency
Heavy drinking is a visible activity often perceived to be associated with rough sleeping. Many visible street drinkers are not rough sleepers while a significant number of rough sleepers do not drink. Long term alcohol abuse leads to poor functioning, cognitive impairment, nutritional deficiencies and serious physical and mental problems (e.g. Korsakoff’s syndrome, neurological disorders and cirrhosis of the liver).
Ways of working
Outreach is intensive and time consuming; it can be highly varied and work depends on the needs and level of entrenchment of individuals. It is important that outreach workers are persistent; those who have been on the streets a significant period of time are likely to be wary of those trying to approach them. Females and those with mental illness, in general, are particularly suspicious of help. In these cases, it is necessary to work tenaciously and persistently. Longer term engagement may take months and require the worker to develop a rapport and understanding on a step by step basis. Understanding what the individual feels they require is essential to this process; buying food and hot drinks may be a useful tactic to get them off the streets (e.g. into a café environment) to engage.
Recent experience in the City of London has shown that a privately run B&B is more acceptable to entrenched rough sleepers than anything run by the homelessness sector. This illustrates the reluctance to engage with the process of assessment or key working and the desire to remain independent. It is an indication that ‘services provided by stealth’ may be more acceptable for some of this client group.
Some of the most entrenched rough sleepers are skilled at finding places out of sight and away from public attention. This is particularly common for older female rough sleepers who are vulnerable to attack.
Common places to avoid attention for rough sleepers include:
- car Parks
- deserted parks
- night buses
- 24 hour cafés
- hospital waiting areas
- derelict buildings
Issues with declining health are likely to encourage people into mainstream services. A health crisis, and subsequent hospital admission, can prove to be a watershed for someone who has been reluctant to accept services as it may encourage them to come off the streets. It is important that they can be linked into acceptable accommodation at this stage or the incentive might be lost. It is key to develop partnerships with local health services including alcohol and drug support that can provide throughcare for multiple needs. Aiding rough sleepers with accessing a GP and supporting visits to healthcare professionals is an example of good throughcare support and is likely to increase engagement with other services. It is valuable to have a record of the local walk-in clinics that offer quick access for those needing medial attention.
Good practice working with older rough sleepers
Good communications with partnership agencies and key workers within health, social services and the local authority housing department. This allows quicker referral when required.
Engagement may be a long process so ensure enough time is built into work plans to allow the relationship to develop. Working flexibly is key to this.
Be aware of stress factors such as cold/wet weather which make rough sleepers more likely to engage with services. (See our pages on Severe Weather Emergency Provision for information on cold weather protocols)
Ensure that information is available and proactively advertised; asking for help can sometimes be perceived as a weakness by rough sleepers.
Try to house or resettle into an environment with those of a similar age group. Own space and single rooms are important. Resettling in their area can also be beneficial as they have an established support network to aid their transition.
Case study of good practice
Information for this case study is from Lessons from Lancefield Street: Tackling the needs of older homeless people by Maurine Crane and Tony Warnes (2000).
Lancefield Street
Lancefield Street centre was set up as a pilot project, managed by St. Mungo’s, which ran for two years (January 1997 – December 1998) in West London. The project aimed to help older rough sleepers who were isolated and not accessing services. It provided outreach, a 24 hour drop-in centre, a residential first-stage hostel and preparation for resettlement in permanent accommodation.
The project provided a complete pathway from initial contact through to permanent accommodation. Outreach was a critical function to encouraging rough sleepers to use the centre. The drop-in centre was a crucial stepping-stone for those who were wary and anxious. The centre contained drop-in rooms, two sitting rooms, a kitchen, bathroom and toilet; these were separated from the hostel by a single corridor. Some users only used the centre at night while others accessed it during the day. At night, most clients slept on chairs covered with blankets. This was particularly successful with very short term users whom were keen to move on to better accommodation straight away and for the long term entrenched who had severe anxieties about living in a hostel. There was no limit on staying or a cost. For these reasons, it was necessary to incentivise transfer to hostel accommodation. The hostel element of the pathway was very popular; it was repeatedly stated that no younger residents and no problems with violence and drugs meant it had a relatively peaceful atmosphere. The hostel successfully accommodated some people who had been homeless for over 20 years and who had rarely accessed hostels and services. For some of the residents, this was the first time for many years that had accessed provisions such as medical care. The hostel also encouraged development of personal skills including hygiene, laundry and budgeting.
Lancefield Street found that effective resettlement services are necessary in temporary or first-stage hostels to reduce long term dependency. Designated workers are required to support this.
In conclusion, the experience of Lancefield reflects that an effective pathway with supported throughcare can engage the most heavily entrenched older rough sleepers. Lancefield highlights that when wary, isolated rough sleepers can see the next steps of the process to resettlement they are more likely to maintain engagement. The intermediatory of the day centre, which exposed rough sleepers to the staff, residents and workings of the hostel, supported the transition from the street required for those who have become entrenched. Continuity of access to members of staff supported the process; longer-term maintenance of relationships in this way encouraged older rough sleepers to have greater confidence in accessing more services.
Further information on good practice for hostel and resettlement services can be found in our good practice handbooks.
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