San Francisco’s Answer to Housing Unhoused Elders

Editor’s Note: ASA focused on homelessness, housing and hunger in its May–June Generations Today issue.

By now, it is well-documented that older adults are one of the fastest growing segments of the population experiencing homelessness. People ages 50 and older make up more than 30% of the country’s homeless population. We know that older people experiencing homelessness have higher rates of mortality, age prematurely, and experience more emergency room visits than their younger counterparts. For many professionals in the aging services field, it has been a challenge to understand how we can integrate ourselves and our expertise into the homelessness conversation.

I have spent 30 years of my career serving older people in San Francisco, most recently as the executive director of the San Francisco Department of Disability and Aging Services. One year ago, I was appointed by Mayor London Breed to serve as the executive director of the San Francisco Department of Homelessness and Supportive Housing. I have learned so much in this first year and would like to share my thoughts about how local aging and homelessness organizations can work more closely together.

Housing Models Born of Necessity

I, like many other professionals in the aging network, watched with alarm as I heard countless stories about the growing population of older adults experiencing homelessness. I had little understanding of the workings of the homelessness response system and, while there was some collaboration on this issue, there certainly wasn’t enough. The past year has taught me that the aging network and homelessness response system need each other and have much to learn from one another.

While the COVID-19 pandemic has certainly brought challenges and dangers for older people, there have also been some amazing new models born out of necessity that forced new partnerships. Most notable was the Shelter In Place (SIP) hotel model. Many jurisdictions across the country adopted this model to help ensure that those most at risk of COVID-19 would be protected from infection. People in congregate shelters and those living on the street moved into unused hotels where they had their own rooms and could avoid contact with others who might be carrying the virus.

The aging network and homelessness response system need each other and have much to learn from one another.

In its SIP Hotel program, San Francisco was able, at the program’s peak, to shelter more than 2,700 people in 25 hotels. Because the focus was on people most at risk of COVID, many of those housed were older people. City leaders from health, aging, human services and homelessness came together to discuss how best to ensure that their clientele could remain stably housed. And a much stronger partnership was born.

More recently, San Francisco made a commitment that those housed in SIP hotels would have access to permanent housing, and the city has since been making good on that promise by offering hotel guests permanent supportive housing. (Permanent supportive housing is a model that provides access to housing, healthcare and support services that help individuals remain stably housed).

The SIP showed us how we could rapidly work together to house people, while providing much needed services. We provided robust In-Home Supportive Services (IHSS) and nursing for those who needed it. And we began to have more earnest conversations about other potential partnerships.

Fast forward to the present. The Department of Homelessness and Supportive Housing, Department of Public Health and Department of Disability and Aging Services, along with nonprofit partners, are regularly engaged in dialogue about how to improve our collective response to serving older people at risk of or experiencing homelessness. We have a new partnership with Homebridge, a homecare organization, to provide IHSS to people in permanent supportive housing units and are aggressively seeking new clients who could benefit from that extra support.

An Equitable Approach to More Shelter and Prevention

We have new ideas in the pipeline that we plan to pursue. In the next fiscal year, we plan to identify and design a shelter for older people and people with disabilities that provides accessible accommodations, case management and homecare services. We have pulled together a workgroup that is focused on braiding funding sources to serve older permanent supportive housing clients most in need of services, to ensure that people can remain stably housed with supports in place. And we are preparing to identify specific buildings in our permanent supportive housing portfolio that can be designed especially for people with disabilities and older adults.

'One of the keys to addressing homelessness is to prevent it in the first place.’

We are also engaged with the Department of Disability and Aging Services to identify appropriate individuals for Home Safe, a program designed to support housing stability for Adult Protective Services clients. We know that one of the keys to addressing homelessness is to prevent it in the first place, and the city has several subsidy programs for older adults at risk of homelessness.

The Department of Homelessness and Supportive Housing is in the process of developing a new strategic plan with a focus on equity. This equity approach must include a focus on older adults, especially older adults of color, as people of color are overrepresented in the homelessness population.

Older adults are a new priority population for our department, and we will rely heavily upon the expertise of our local aging services network to help flesh out that piece of our plan. And our department is including aging services experts in the development of our problem-solving and homelessness prevention strategies.

Partnerships between the homelessness response system and aging network are critical if we are to achieve innovative and effective solutions to older adult homelessness. At the local level, Area Agencies on Aging and Homelessness Continuum of Care organizations can lead the way for strong local partnerships. There are many wonderful examples of this work across the country, but much more is needed. We are much stronger when we pool our collective expertise to improve outcomes for the older people who most need our services.

Shireen McSpadden is the executive director of the Department of Homelessness and Supportive Housing for the City and County of San Francisco.