Family-assisted Housing for Older Homeless Adults

Investigator: Margot Kushel, MD
Sponsor: NIH National Institute on Aging

Location(s): United States


The proposed study will examine the possibility of housing older homeless adults (aged 50 and older) with their family members, as a strategy to help end homelessness in older adults. Using qualitative methods including in-depth interviews with older homeless adults, members of their family, and people who work with homeless individuals (including case managers, lawyers and low-income housing directors), and ethnographic home visits, the investigators will explore the factors that both prevent and help older homeless adults live with their housed family members. Based on their findings, the investigators will develop a toolkit to be used by homeless service providers and low income housing officials to assist their efforts in rehousing older homeless individuals with family members.

The proposed study will use qualitative methods to understand barriers to and facilitators of re-housing older homeless adults (aged 50 and older) with members of their family. The proportion of homeless adults age 50 and older has grown at a rate exceeding the general population for the past two decades. Despite extensive evidence demonstrating the severe deleterious effects of homelessness on health, gaps exist in identifying housing strategies for older homeless adults. The NIA funded R01, "Aging among the homeless: geriatric conditions, health and healthcare outcomes," (AG041860, PI Kushel) a longitudinal study of 350 older homeless adults, will serve as the parent study to the proposed project. In the Aging Homeless Study, a large proportion of older homeless adults have frequent and on-going contact with family members; approximately one-third were temporarily housed with family for a week or longer in the prior six months, most homeless participants expressed a willingness to live with family and a belief that their family members would allow them. This combination of temporary housing with family and willingness to continue has raised questions as to whether steps could be taken to make these temporary housing situations permanent. Existing interventions to promote older individuals' ability to thrive in the community bolster social ties, as loneliness and social isolation are associated with higher rates of chronic medical conditions, cognitive decline, and mortality. The proposed project will examine whether re-housing with family members is an effective means to promote re-housing and support older homeless adults' existing social ties. We propose to adapt the social-ecological model to address the following specific aims: Aim 1: To understand the factors influencing older homeless adults' ability to live with housed family members from the perspective of both older homeless adults and their family members. Aim 2: To understand the factors influencing older homeless adults' ability to live with housed family members from the perspective of key programmatic and policy stakeholders. Aim 3: To develop a toolkit addressing the barriers and facilitators to housing older homeless adults with family members for clinicians, homeless services providers, low-income housing program leaders and policy makers. To address Aims 1 and 2, we will conduct one-to-one qualitative interviews with a purposive sample of older homeless adults enrolled in the parent study, their family members, and service providers and policy stakeholders. We will conduct ethnographic participant observation in family members' home environments. Qualitative data will be transcribed, coded and analyzed using grounded theory methodologies by the multidisciplinary research team, consisting of an internationally recognized researcher of health for homeless populations (Principal Investigator), a medical anthropologist (Principal Investigator), and an epidemiologist with expertise in transitional science (Co-investigator). For Aim 3, we will synthesize study data and develop the toolkit to provide guidance about re-housing older homeless adults with family members.