Discovering, Dreaming, Designing, and Delivering the 'right' Place for Older People Experiencing Homelessness: Needs, Challenges, and Solutions

Background and Purpose: Over the last two decades, ‘aging in place,’ which idealizes remaining in one’s home and community through later life, has risen in prominence in age-related policy and practice. However, aging in place research largely focuses on individuals who have sustained, long-term tenancies in a particular house or neighborhood or life histories of stable housing, while overlooking marginalization and intersections of disadvantage that exclude older adults who do not have access to stable and supportive housing settings in which to develop place attachment. Without stable shelter/housing that meets their needs, OPEH often experience worsening health and further marginalization. Moreover, there are significant gaps in supporting the shelter/housing needs of OPEH. To explore the design and delivery of existing shelter/housing options, we investigated the specific needs, challenges, and solutions for promoting aging in the right place for OPEH in three Canadian cities.

Methods: We conducted three World Café dialogue workshops – one in each of Montreal, Calgary, and Vancouver – between June and November 2019. A total of 89 health, shelter/housing, and homelessness service providers (n=51) and OPEH (n=38) participated in one of three workshops (Montreal, n=23; Calgary, n=30; Vancouver, n=36). Each World Café included four to five concurrent round table discussions asking participants to identify key shelter/housing needs and gaps and identify priorities for further evaluation. Two facilitators led each round table discussion using a semi-structured interview guide. Deliberations were audio-recorded, transcribed and thematically analyzed.

Results: Findings revealed four overarching themes: 1) Challenges to sheltering/housing OPEH; 2) A continuum of shelter/housing options is needed to support OPEH; 3) Design considerations for sheltering/housing OPEH; and 4) Social supports promote place attachment. Challenges to sheltering/housing OPEH include systemic barriers, such as lack of available and affordable shelter/housing and strict eligibility requirements, as well as victimization and discrimination. Common across all discussions was the idea that a continuum of shelter/housing options is needed to meet the diverse needs of OPEH, including low-barrier and abstinence-based options, intergenerational and senior-specific options, and culturally sensitive options. Moreover, participants emphasized that shelter/housing solutions should have universal design, coordinated and centralized support, and involve relevant stakeholders. Finally, participants discussed integrating opportunities for social connection and community building and supporting OPEHs’ independence and choice to create homelike environments that promote place attachment.

Conclusions and Implications: Findings from the World Cafés suggested a series of service gaps and solutions that if addressed hold promise in supporting ‘aging in the right place' for older homeless adults with a diversity of needs. Our team has selected housing models in each city that consider these factors in service provision and are working towards developing an evaluation structure using outcomes deemed important by World Café participants.