Report: SF needs to adapt services for an aging homeless population

San Francisco’s existing system of care for homeless residents was never designed to address an older population, leaving it ill-equipped to meet the needs of today’s growing number of seniors living on the streets, says a new city report.

More than half of San Francisco’s homeless shelter residents are age 50 or older, which has created many challenges for The City. Older homeless residents are often confused as to how to access shelter and unable to receive proper medical care.

They are vulnerable to violence on the streets, and lack targeted outreach to connect to housing. In some cases, they end up on the streets when terminally ill, according to the “Assessment of the Needs of San Francisco Seniors and Adults with Disabilities” report.

The report was released last month by the Department of Aging and Adult Services, which is part of the Human Services Agency.

The findings are the results of a seniors’ needs assessment required every four years by the state’s Older Californians Act.

In the report, the department supports Mayor Ed Lee’s planned creation of a homeless department as part of his budget proposal, calling it an opportunity to discuss “the unique needs of this group and a potential remodeling of the service system to reduce the presence of frail and chronically ill seniors on San Francisco’s streets.”

San Francisco’s aging homeless population is growing, much like elsewhere in the U.S. In 2009, the median age for persons using homeless shelters in San Francisco was 45. That increased to 49 this year. Twenty percent, or 377, of the average 1,878 shelter occupants last year were age 60 or older.

“There is a group of late stage baby boomers that has always been over-represented in the homeless population and they are now aging into the senior bracket,” Sam Dodge, The City’s homeless czar, wrote in an email to the San Francisco Examiner.

But systems in place are unable to adequately care for the growing population because younger homeless residents were the initial targets for outreach.

“San Francisco’s homeless system was designed for a younger homeless population needing short term treatment, but increasingly the people living on The City’s streets are struggling with chronic health conditions and physical disabilities that require continuing care,” the report said.

Drawing from focus groups and “informant interviews” (service providers or city staff), the report makes such statements like “violence stalks homeless seniors.” Those interviewed were not identified by name in the report.

It also provides sobering statistics, like how older homeless persons die 20 to 30 years earlier and at an up to five times higher rate than the general population of older persons, often from conventional ailments like heart disease and cancer.

For those who are terminally ill, the options may be limited other than returning to the street. The report said that “many of the hospice facilities that serve homeless persons were created at the outset of the AIDS epidemic, and their services tend to be limited to men. Women with terminal illnesses may be more likely to be discharged from hospitals to the street.”

When seniors are housed in supportive housing, the services are not tailored to their demographic but rather are more generic, the report said, citing an “informant.”

“Seniors in supportive housing often find their way to health treatment by way of behavioral health interventions, being [held] for psychiatric events only to end up in a skilled nursing facility,” the report said.

Violence is also a reality for those living on the street.

“Focus group participants agreed that the level of violence varied by neighborhood,” the report said. “The Tenderloin was seen as too risky, and some even avoided housing opportunities there, and ‘the Haight is not safe anymore,’ a development the seniors tied to a rough crowd of younger homeless adults.”

Some seniors may choose to live on the streets and not use a portion of their social security benefits for housing costs. In the case of a public housing unit, for example, a person receiving the SSI maximum benefit could pay about $300 a month in rent leaving them with $600, “which may seem less tolerable than being unhoused for some.”

Some seniors, however, may not even be aware of their housing options. “It may be that they do not ask for housing assistance while in shelter and require targeted outreach,” the report said.

For seniors wishing to find shelter, the process can be daunting. “Homeless seniors expressed confusion at the complicated system for gaining access to shelter,” the report said.

Maurice Pittman, 70, the longtime friend of a homeless woman named Pattie who died at 16th and Valencia streets April 3, told the San Francisco Examiner on a recent Wednesday that his friend had suffered from medical issues since he met her 15 years ago at the Seneca Hotel. He said she was unable to find the help from city services she needed.

“It’s lonely,” Pittman said from inside his tent next to her memorial, which includes flowers and candles. He described her as “very charming” and said she enjoyed singing country western songs with a voice he likened to Dolly Parton. “She got many a compliment.”

While the Examiner could not independently confirm whether Pattie received services from The City, Pittman noted that Pattie — believed to be in her 60s when she died — was consistently let down by efforts meant to help homeless residents.

“They would build her up, then let her down,” Pittman said.

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