Health Insurance and Independent Living Among Older Homeless Adults

Background and Purpose: Adults aged 50 or older represent nearly half of homeless populations and prevalence rates continue to rise. While existing programs for the homeless aim to help improve independent living skills and achieve non-subsidized housing, there is still limited evidence on predictors of independent living outside of subsidized programs. The literature supports having health insurance is associated with greater health outcomes however, homeless individuals are found to be less likely than the general population to have health insurance. The Behavioral Model for Vulnerable Populations (Gelberg et al., 2000) depicts that predisposing factors (e.g., demographic characteristics), enabling resources (e.g., community resources), need factors (e.g., health conditions), and health behaviors that are unique to vulnerable populations, can explain utilization of health services and further health outcomes of individuals. Using the behavioral model for vulnerable populations, we sought to answer the following questions: (1) What are the demographic and clinical factors associated with the likelihood of having health insurance among older homeless adults? (2) What are the demographic and clinical factors associated with the likelihood of independent living without subsidized housing assistance among older homeless adults? (3) What is the relationship between having health insurance and independent living without subsidized housing assistance, after controlling for demographic and clinical characteristics, among older homeless adults?

Methods: Using data from 2019 Tampa Hillsborough Homeless Initiative, we identified 1,204 older homeless adults aged 55 and over. The data shared contained demographic information (e.g., age, sex, race/ethnicity, health insurance) of clients receiving housing service (e.g., transitional housing, supportive housing, permanent housing, etc.) in Tampa, FL (Hillsborough County) between October 2018 and September 2019. We conducted multivariable-adjusted logistic regression analyses. Our study included two dependent variables, “Health Insurance” and “Independent Living.”. “Health Insurance” analyzed the type of health insurance participants had and information was aggregated and coded to be a dichotomous variable. The second dependent variable was whether an individual became independent from subsidized housing.

Results: The mean age of the respondents was 62 years. Age, gender, a physical disability, and a mental health condition were significant factors associated with having health insurance. After controlling for demographic characteristics and clinical factors, those who were covered by health insurance were more likely to live independently (p=.011). In addition, those who reported alcohol use were less likely to be independent (p=.001).

Conclusions and Implications: This study’s findings support the importance of older homeless adults having health insurance to ensure their transition from homelessness to independent living within the community. The young-old are not eligible for either traditional medical insurance or federal or state healthcare programs, such as Medicare or Medicaid. Females tend to be under-insured across the nation. Policy changes are required to ensure access to healthcare despite age. As older adults with alcohol abuse were less likely to become independent, community practitioners should help them connect to and maintain with substance use treatment programs. Health insurance may play an important role to provide a long-term opportunity to utilize health care services as they age.