Communities across the globe face unprecedented environmental challenges attributed to climate change, increasing population and devastating pollution. These challenges threaten individual health and quality-of-life and are likely connected to the frequency and severity of natural disasters, which are on the rise.
One population that is especially vulnerable to extreme weather and disaster events from climate change are older adults experiencing homelessness.
Globally an estimated 100 million people are homeless and as many as 1.6 billion people lack adequate housing. Further, people ages 50 and older make up more than 30% of the nation's homeless population. Many of these individuals experiencing homelessness lack financial resources and physical resources such as shelter and transportation, which limit them from adequately preparing for, responding to, and recovering from disasters.
Unhoused people also often lack intangible resources such as health literacy and healthcare education, and may have language barriers or unstable immigration status, all of which can have a significant impact on one’s health. Additional barriers can include an inability to make follow-up appointments due to transportation challenges, or health conditions that impair time management abilities.
Further, the stigma associated with homelessness can directly affect the willingness of communities and other residents to support efforts to care for this population. Stigma, particularly in situations where a person is uninsured, a high utilizer of emergency services, or when patients engage in high-risk, undesirable behaviors are common contributors that can elicit provider bias.
Geographical location also factors into health outcomes (e.g., health opportunity, health equity), and additional barriers to care include the costs of care or medication; particularly for those who are uninsured. Environmental inequities are social inequities, resulting in health and economic disparities.
Access to Housing
According to the Internal Displacement Monitoring Centre (IDMC), globally 14 million people are left homeless every year after experiencing a natural disaster. The dearth of affordable housing in the United States is a notable barrier for reducing and preventing homelessness, before and following a disaster. Disasters often lead to loss of public and private property, economic discord, increased government involvement and unfavorable social attitudes, which, when combined, affect access to housing in the recovery phase of an event.
The stigma associated with homelessness can affect a community’s willingness to support efforts to care for this population.
According to the American Planning Association (APA), “community members with lower incomes are not only vulnerable to displacement but are least able to access safe and affordable housing after a disaster,” despite having greater needs post-disaster. Finding new housing is difficult when much of the local housing stock may have been decimated and affordable options are limited. This can further marginalize older adults experiencing homelessness, making it more difficult to access available housing, particularly housing that serves their needs as older adults. All factors that can hinder unhoused individuals on their path to recovery, access to healthcare and healthy living, and permanent housing.
Displacement and Relocation
Immediately following a catastrophic disaster that causes major population movements, displaced elders are in greater need of emergency assistance and/or medical treatment, and yet their locations may be unknown. Furthermore, people displaced by a disaster are likely to remain highly transient for many months following the event. While some social service providers will go out and look for their clients after an event, often healthcare and service providers do not know what happens to these individuals, especially if those experiencing homelessness leave that community.
Sometimes people reappear months or years later as they seek emergency medical or other services, but many times they disappear into new communities and seek out new support or opportunities. Relocation results in stress even when the move or transition is planned. The experience of relocation among the general population can prompt a range of psychological changes, such as posttraumatic stress disorder, depression, social withdrawal and changes in satisfaction with life. Relocation also can lead to physical change such as increased pain, decreased mental and physical functioning, and downgraded perception of one’s health status.
While unhoused people are already displaced in their community due to their disenfranchised status and use of regulated public space, disasters frequently relocate these individuals to entirely new and unfamiliar communities. Such changes often exacerbate older adults’ inadequate access to healthcare and connection to existing healthcare providers.
Organizations Serving Homeless Populations
Organizations serving the homeless also face unique challenges in meeting the needs of their older clients when affected by disaster. Increased demands impact homeless shelters, as well as tangible resources such as food, resulting in an increased reliance on nonprofit and community-based organizations, which often already were struggling to serve the growing numbers of individuals in need of services prior to a disaster event. This may be evident in the community that experienced the disaster, as well as in nearby communities that receive an influx of those displaced. Furthermore, mental health issues and physical limitations also may be exacerbated, which can further strain organizations serving the community.
Planning for Change
One way communities can begin to address this cascade of needs is through their local Age-Friendly initiative. The World Health Organization’s (WHO) Age-Friendly Cities and Communities program has provided international guidelines to help communities prepare for rapid population aging and the parallel trend of urbanization (see also www.who.int/publications/i/item/WHO-FWC-ALC-18.4). In the United States, there are more than 650 communities with a commitment to developing age-friendly environments.
‘Age-Friendly communities could prepare for the multifaceted needs of older homeless adults affected by disaster.’
Tasking Age-Friendly initiatives with focusing on enhancing communities to reduce the negative impacts of disasters, particularly for the consideration of unhoused older adults, greatly supports their well-being in our communities. AgeFriendlyLexington (Lexington, KY) is working to tackle housing affordability for its older adults by considering alternative housing models, improving access for shared housing, and engaging with the Affordable Housing Trust. There also have been efforts in Lexington to rezone parts of the community to allow more accessory dwelling units for use by older adults.
In other Age-Friendly cities and communities, initiatives may focus on disaster planning or preparedness and helping to communicate to those experiencing homelessness about what to do during a disaster and what resources will be available to them post-disaster. Communication is key for reaching this population in times of a crisis. Often a lack of housing is not the only need of unhoused older adults, and physical health, mental health or substance use/abuse may compound the issue.
Age-Friendly communities could prepare for the multifaceted needs of older homeless adults affected by disaster by considering the role of gerontological disaster planning within Age-Friendly Cities and Communities’ strategic plans to counter issues such as relocation and displacement, affordable housing needs and support for bolstering organizations already serving homeless populations.
We must address the needs of older adult community members to ensure that communities are prepared to support marginalized populations’ health and well-being when it is affected by disasters and guarantee older adults do not fall through the cracks during disaster response and recovery.
Allison Gibson, PhD, MSW, is an associate professor, at the University of Kentucky College of Social Work in Lexington.
Photo: Half a house in Union Beach, NJ, after Superstorm Sandy.
Photo credit: Sky Cinema, Shutterstock
