Shelter/Housing Options, Supports, and Interventions for Older Persons Experiencing Homelessness: A Scoping Review

Background and Purpose: Despite few supportive options across the shelter/housing continuum that address the diverse needs of OPEH or enable aging in place, a growing body of literature is identifying the innovations required to support aging in the right place for marginalized older adults. While there is a need for appropriately designed supportive shelter/housing options that can support the health and psychosocial needs of newly and chronically homeless OPEH and enable aging in the right place, knowledge of the range of shelter/housing options that exist on an international scale is limited. The purpose of this study is to identify shelter/housing models that have been developed to support OPEH and examine what impact these models have had on health and housing outcomes for OPEH, and ultimately their ability to age in the right place.

Methods: Using Arksey and O’Malley’s scoping review methodology, we conducted a review of the literature to capture the nature and breadth of existing research on shelter/housing models for OPEH. Fourteen databases (Academic Search Premier; Ageline; CINAHL Complete; ERIC; Geobase; Global Health; Google Scholar; JSTOR; Medline w/Full Text; ProQuest Sociology Collection; Project Muse; PsycINFO; Social Sciences w/Full Test; Social Work Abstracts; and Web of Science) were searched for English-language peer-reviewed and/or empirical literature published 1999 – 2019.

Results: After screening, 24 articles remained for inclusion in the review. Supportive shelter/housing models for OPEH, categorized into across a continuum that considered whether a physical structure was provided, the length of time OPEH were able to access the physical structures, and the services and supports offered to OPEH clients include: 1) Permanent supportive housing (PSH), including PSH delivered through Housing First, 2) Transitional housing, 3) Shelter settings with medical supports, 4) Drop-in centers, and 5) Case management and outreach.

Conclusions and Implications: Aging in the right place for OPEH requires inclusion of health and social supports in shelter/housing that contribute to positive aging, a sense of home, and community reintegration. This review revealed additional considerations for promoting aging in the right place for diverse OPEH across the shelter/housing continuum, including social connection and trusting relationships, including from peer supports; individualized services and supports, including 24-hour onsite physical and mental health care; and affordable supportive housing options that are co-located with opportunities for socialization and transportation to offsite services. Findings from this review have enabled us to outline the continuum of existing shelter/housing models that support aging in the right place for OPEH. This continuum of models can be used as a template for designing and implementing future shelter/housing solutions, while providing a foundation for exploring new avenues of evaluation research and determining which shelter/housing models hold the opportunity to support which sub-groups of OPEH to age in the right place. Building such an evidence base has significant potential to advance policy, practice, and housing design to better meet the unique shelter/housing needs of diverse OPEH.