Preventing & Ending Homelessness for Older LGBTQ+ Adults

By Shireen McSpadden–

San Franciscans hold many opinions and stereotypes about people living on our streets. People I speak to are often surprised to learn that many of these individuals are older. Nationally, older adults are the fastest growing segment of homeless adults. In our city, 35% of people experiencing homelessness are 51 years and older. Aging on the streets is particularly challenging—74% of older homeless survey respondents reported living with one or more health conditions, including chronic physical illness, physical disabilities, chronic substance use, and severe mental health conditions, all exacerbated by life on the street. We also know that LGBTQ+ individuals, especially those of color, are overrepresented in the homelessness populations and that this trend continues in older age groups.

Data from the National Research on Homelessness and Older Adults shows that when individuals lose their housing at older ages or have more comorbidities, they are more likely to become chronically homeless. Unhoused older adults face some serious challenges to their well-being relative to younger adults. For example, people experiencing homelessness ages 50 to 62 often have similar health issues as people 10–20 years older who are housed. We also know that older LGBTQ+ people’s needs are often overlooked and they’re often not heard or recognized as the individuals they are. Their needs are therefore not met.

As a city, we are working toward a much more targeted and coordinated systems approach to ensure that we are matching older adults, and LGTBTQ+ people generally, with the right resources. Here are some examples of work that is underway:

• Centering equity. This means asking the people we are serving to inform our work. We have to understand the perspectives of older LGBTQ+ people in our system to really understand how to design systems that will respond to their needs.
• Working with our expert partners. San Francisco has a myriad of expert organizations serving LGBTQ+ people, people of color, and older adults. They have to help shape our response system.
• Prioritizing unsheltered older adults for shelter/housing.
• Working with our city and nonprofit partners to address the specific needs of LGBTQ+ people experiencing homelessness with particular attention to the transgender and gender non-conforming community.  We are doing this through our Ending Transgender Homelessness Initiative, operating the first transgender-focused navigation center, and operating the country’s first LGBTQ+ adult shelter.  
• Ensuring that people in permanent supportive housing and shelter have access to home care and accessible services.
• Bringing an enhanced medical care permanent supportive housing model that is funded through Medi-Cal to serve those with acute and complex medical needs.
• Implementing the recommendations of the cross-departmental needs assessment on affordable housing needs among older adults and people with disabilities, particularly focused on better assessment and homelessness prevention.
• Adjusting processes to rapidly house older adults from the street and decrease long stays in shelter.

We also need to make sure that older adults do not become homeless in the first place. One significant difference between older adults who become homeless for the first time and their younger counterparts is their reason for and pathway to homelessness.  Older adults typically fall into homelessness due to a significant financial change, death of a family member, or significant change in family makeup. These causes give us clear direction on how to prevent first-time or recurrence of homelessness among older adults.

Homelessness prevention is a set of strategies to prevent households at highest risk of homelessness from entering homelessness. This can include one-time financial assistance, rental subsidies, back rent, future rent, or move-in assistance. By focusing on prevention for this community, we can stabilize lives and continue to support older adults in our community to age in place and thrive. Between FY 2020–2023, the City of San Francisco invested approximately $194 million in homelessness prevention. This investment is expected to serve approximately 7,500 households.

• Approximately $6 million of this investment has been used to reduce the rent burden of people living in permanent supportive housing to help ensure that they remain stably housed.
• The San Francisco Department of Homelessness and Supportive Housing is partnering with the San Francisco Department of Disability and Aging Services and service providers with expertise in working with older adults and people with disabilities to ensure that they have access to these prevention resources.

Homelessness prevention is a critical intervention for people who have never been homeless before and those who have been homeless in the past and are at-risk of housing instability. To improve the targeting of these resources, the homeless service system must collaborate with the aging services both upstream and at the moment of crisis.

San Francisco has a lot of work to do to ensure that older people generally, and older LGBTQ+ people more specifically, receive the services they need to avoid homelessness, to make it brief, or to receive robust services within the homelessness response system. Fortunately, we have the experts—people with lived experience, savvy nonprofit organizations, strong departmental partnerships, and a clear set of priorities in the city’s new strategic plan on homelessness—to ensure that older adults will be well served.

Shireen McSpadden is the Executive Director of the San Francisco Department of Homelessness & Supportive Housing. She previously served as the Executive Director of the San Francisco Department of Disability & Aging Services.

Special Section Aging in Community by Dr. Marcy Adelman
Published on May 4, 2023