This week, Oregon’s governor followed Washington and California in declaring a state of emergency, allowing the Oregon Health Authority to deploy additional staff and resources to respond to the Coronavirus Disease 2019 (COVID-19) crisis. A highly contagious upper respiratory infection that is transmitted through coughing and sneezing, it is poised to threaten the lives of many vulnerable older adults in our community who are already battling more than their share of health risks.
While Gov. Kate Brown’s promise of more health services is welcome, it does little to reassure housing advocates who work with the rapidly growing population of older adults experiencing homelessness and housing instability. When we read the Centers for Disease Control and Prevention’s advice for older adults to stock up on supplies, avoid crowds and limit close contact with others, it can feel almost absurd to imagine how this fits within the reality of senior poverty.
In a sense, COVID-19 adds fuel to a fire that is already burning out of control. Since the early 2010s, researchers have identified that the population of people over age 55 experiencing homelessness is growing rapidly, and that the overall number will triple by the end of this decade. Though the roots of homelessness include more than just economic instability — the powerful legacy of systemic racism in the U.S. converging with many other forms of social inequality play an unmistakable role — it’s also the case that more and more older adults are retiring into extreme poverty, living on incomes that are insufficient to meet their basic needs and struggling to get by.
Protecting our older adult community members during a public health crisis of this magnitude is going to require more than a list of recommended action steps by the CDC, including the advice to stock up. When I worked as a housing case manager, my older adult clients often found it difficult to afford a pack of cough drops and canned soup when they had a common cold. Many of them, especially those living on Supplemental Security Income who receive a meager $783 per month, had their entire monthly checks spent by the tenth day of each month on rent and utilities, groceries, bus fare and medication co-payments. And they knew better than anybody that one unexpected health crisis could send them over the edge financially.
What’s missing from the conversation is a better understanding of senior poverty, especially these three key points:
1. Older adults experiencing homelessness have urgent and specific needs.
The 2019 Multnomah County Point in Time count showed that older adults made up 23% (more than 1 out of 5) of those counted as “living unsheltered, in emergency shelter, or in transitional housing.” This was up from 2017’s count, which showed older adults were 19.6% of those counted. Given what we know about the limitations to Point in Time methodology, and how narrowly HUD defines homelessness, the true number of seniors experiencing homelessness on that January night is likely much higher.
Senior homelessness is a growing phenomenon, and there are a number of reasons. According to Harvard researchers, older adults are “entering retirement in worse financial shape than same-age households in 2001,” in part because of rising housing costs and largely because this cohort of older adults has dealt with significant economic disadvantages throughout their lives. Many older adults lost jobs or had to retire early during the Great Recession, losing their homes and savings in the process. Despite working hard their whole lives, years of declining wages and scarcity of jobs that offer pension plans have left many older adults relying solely on Social Security or SSI to make ends meet. Meanwhile, rents have far outpaced the average Social Security recipient’s income, leaving most vulnerable seniors with literally no place that they can afford to live.
While roughly half had periods of homelessness in earlier parts of their lives, and others had their first experience of homelessness after age 50, older adults experiencing homelessness have a lot in common: Health researchers have coined the phrase “50 is the new 75” to describe how devastating homelessness can be to an individual’s physical and mental health, resulting in a health profile that resembles someone much, much older. Signs of premature aging like chronic conditions, falls and memory problems are all too common and quickly worsen the longer an older adult remains without housing.
Given what we know about the spread of COVID-19, it’s unrealistic to think that an older adult living outside, or even in a congregate setting like a shelter, is going to be adequately protected from this dangerous infection, no matter how many handwashing stations or face masks are offered. This population of seniors has already survived incredible hardship, but a public health crisis of this scale will require a higher level of intervention, ideally options that allow individuals to be placed temporarily in a setting where they are not exposed to the elements nor to anyone carrying the virus.
2. The health needs of low-income older adults cannot be separated from their economic needs.
Though luckier than their unhoused counterparts, many low-income older adults know that they are one unexpected bill or financial setback away from losing their homes. Too many of them are relying on incomes that are far lower than their monthly bills, and under such tight financial constraints, their health does not get the attention it needs. In fact, given that half of all older adult renters are paying more than 30% of their income on rent, health costs are often pitted directly against housing costs.
For many low-income older adults, health issues play a significant role in their economic back story. Those who rely on SSI are often individuals who worked very low-wage, physically demanding jobs that weren’t enough to qualify them for a higher Social Security benefit amount. Many had to leave the workforce early, as a consequence of health issues, sometimes due to a chronic disabling condition or other physical problem that worsened during their years of hard work. Heart conditions, diabetes, lung problems and compromised immune systems — all listed under the CDC’s guidelines for populations at high risk — are commonplace.
But because of the inaccessibility of affordable health care in the U.S., low-income older adults do not have an easy time caring for their health. Many have significant out-of-pocket health care costs, especially those on Medicare without vision, dental or mental health coverage. Those who need in-home assistance with activities of daily living face steep barriers to qualifying for publicly funded services, so many make do with minimal help or go without. And once these bills are paid, affording healthy and nutritious food is a complex puzzle to be solved each week.
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In an outbreak, low-income older adults are not in a financial position to stock up on extra food or household supplies, and taking an occasional taxi to the grocery store to avoid exposure to sick people is out of the question. Without economic flexibility, there is no realistic way to adjust their routines to better protect their health if it costs more money. And the situation is exponentially more difficult for those who live in affordable units that are not designed for the specific needs of seniors: those who live in single-room occupancy, or SRO, units are at great risk, due to having to share bathrooms and kitchens with other residents who may be carrying the virus.
3. Quality and quantity of services for older adults are essential to ensuring their safety.
To be clear, we’ve needed more and better services for vulnerable seniors for a long time. Navigating affordable housing options, making sense of Medicare insurance plans, and ensuring adequate support in the home are not easily managed by an individual facing health challenges and economic stress. And in the face of a tremendous housing crisis, more and more seniors need rent assistance and ongoing support services to ensure they remain housed — and healthy — over the long term.
But accessing services is not just a matter of having someone walk you through the process. Instead, we need to look at how inadequately funded these services are to begin with, and ensure that there are more resources available for all who need them. Only 1 out of 3 older adults in the U.S. who qualify for housing assistance receives any, and harsh budget cuts targeting safety net programs that many seniors rely on are expected in the 2021 federal budget. These are the services that keep individuals from slipping through the cracks, and given what we know about how economic stability and health are tied together, this can play a significant role in preventing further harm from an outbreak like COVID-19.
And those who provide these services are of critical importance, which has become more obvious in recent weeks: in-home providers and caregivers, social service workers and transportation drivers need good health benefits and paid sick leave, so that they can stay home if infected and not put their clients or patients at risk of exposure. In order for frontline workers to hold it all together, their work cannot be treated as an afterthought.
Looking back at how quickly COVID-19 has made its way into our communities and our daily concerns, it’s challenging to imagine a simple and effective response that keeps everyone safe. We know that many related systemic challenges our community has faced, and continues to face, still go unsolved and continue to perpetuate immense suffering among our neighbors. But these same neighbors also show up with an incredible amount of resilience and determination, as well as a vision for what we want our community to look like in the future. As a housing advocate, it’s my hope that we can pull together a coordinated and effective response to COVID-19 that can quickly assist the most vulnerable and move us all closer to being a community that ensures long-term safety and health for everyone.
Marisa Espinoza is the public policy coordinator with Northwest Pilot Project.