Living from day to day: Aspects of social services that hinder and exacerbate thinking about the future for older adults who have experiences of homelessness
By Diandra Serrano, Montreal Regional Coordinator, McGill, & Émilie Cormier, Doctoral Research Assitant, UQAM
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Attitudes about the future significantly influence the communication of preferences for future and end-of-life care and facilitate planning. These factors are known to promote adaptation, adjustment, and quality of life in later life and/or as a person's health becomes more fragile (Brinkman-Stoppelenburg, 2014; Detering et al., 2010). Due to the potentially increased health needs associated with both aging and homelessness, as well as the need for coordination of services and resources to ensure access, forward thinking becomes even more important for older persons with experiences of homelessness (OPEH). Despite the obvious benefits of care planning, a variety of factors seem to make future thinking out of reach for many OPEH.
Our reflections on the possibilities and capacities of OPEHs to envision the future, emerge from our work as research assistants on two studies. The first the being Aging in the Right Place study which explores the housing needs and preferences of older adults who have experienced homelessness in three cities across Canada, and the other being a branch of the project Government Actions in Quebec: Impacts on Seniors Experiencing Marginalization or Social Exclusion, which focuses on service needs, accessibility issues, and gaps and innovations in the coordination of services for older adults experiencing homelessness in Quebec. Gathering the accounts of OPEHs in these studies allowed us to reflect on how current experiences of precarity and homelessness, and their intersection with other important variables, influence a person's attitude toward the future and the extent to which they have the opportunity to consider themselves and their future psychosocial and physical health needs.
Our thinking revolves around how elements of the current social service system inhibit thinking about the future for OPEH by reinforcing a survival lifestyle (Bourgeois- Guérin et al., 2020) on a daily basis, exacerbating a sense of ongoing threat, and contributing to internalized stigma and blame through a mirage of service opportunities.
Reinforcing a lifestyle of daily survival
Consistent with some studies (Bourgeois-Guérin et al., 2020), regardless of the life context of the OPEHs encountered, there appeared to be a visible intersection between the need to adopt a survival lifestyle and a reduced ability to think about tomorrow. The daily lives of participants living on the street were largely organized around the services they accessed, while those living in longer-term housing organized their routines around the schedules and expectations of the organization. Cooper (2014) showed that the institutionalization of time by organizations that support communities with experience of homelessness exacerbates the need for a survival lifestyle.
Living on the street means constantly considering agencies that provide services to meet basic needs, including showering, feeding, and having a place to sleep. Difficulty in accessing services seems to make meeting basic needs a daily burden of: walking, waiting, and sometimes not getting the service you need. While residents of longer-term housing have their basic needs, such as shelter and food, met, all OPEHs, regardless of their access to housing, seem to have difficulty surviving from an identity perspective, finding space to be themselves and express themselves, within the context of the social service system. Under the circumstances, given the amount of emotional, psychological and physical energy required to literally or more metaphorically survive from day to day, there seems to be little or no energy left to think about tomorrow, let alone a longer term future.
Exacerbating the feeling of constant threat
The relentless threat to one's well-being and safety can contribute to a sense of being "stuck" due to the ongoing activation of one's defensive responses (Kozlowska et al., 2015). For many participants, the threat imposed by resource scarcity and experiences of abuse and discrimination within the social service system is explicit and ongoing. Some OPEH living without housing have responded to this perceived threat by withdrawing from services, putting themselves at risk of having a variety of their psychosocial and physical health needs unmet and thus worsening their situation. Due to the lack of choice, other OPEH living in a variety of situations along the homelessness continuum have made the decision to continue to access resources, even if it means increasing the risk of being subjected to permanent harm. These experiences of relational and social threat appear to have two major influences on their attitudes toward, and ability to think, about the future. While for some, the lack of choice leaves them stuck in their current context, for others, the ongoing threat intensifies avoidance or withdrawal strategies, which are expressed as difficulty imagining a "better" or "different" future.
Contributing to internalized stigma and blame
Years of waiting lists, endless paperwork to access services, and promises of social service strategies to support the homeless community are all hidden behind the mirage of social service opportunities. Participants who took planning steps, whether living without housing or with longer-term housing, were often discouraged by long delays, the stress of finding their way through the system, the lack of choices, and being shuffled between resources and stakeholders. The sense of hopelessness about the possibility of change is also compounded by external symbolic messages - the development of condo towers and the construction of luxury buildings nearby for another segment of the population, but which are being built in close proximity to the spaces they occupy - that contribute to the feeling of being less important or forgotten by government and society. However, while acknowledging the lack of follow-through from government and society, participants often internalized the stigma associated with their experience of homelessness and blamed themselves for not being able to access services and improve their situations. It appears to us that the critical internal schemas that are fostered by the mirage of service opportunities have the potential to decrease self-efficacy (Jahn et al., 2020) while contributing to the maintenance of structural problems and barriers in the social service system.
For more information on government actions in Quebec: Impacts on Marginalized and Socially Excluded Seniors, please access the following link: Les actions gouvernementales au Québec :
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References:
Bourgeois-Guérin, V., Grenier, A., Bourgeois-Guérin, É., Sussman, T., & Rothwell, D. (2020). «Vieillir dans la rue » : Interprétations du temps par les aînés en situation d’itinérance. Revue québécoise de psychologie, 41(2), 83-104. https://doi.org/10.7202/1072288ar
Brinkman-Stoppelenburg, A., Rietjens, J. A. C., & van der Heide, A. (2014). The effects of advance care planning on end-of-life care: A systematic review. Palliative Medicine , 28(8). https://doi.org/10.1177/0269216314526272
Cooper, A. (2014). Time seizures and the self: Institutional temporalities and self-preservation among homeless women. Culture, Medicine, and Psychiatry, 39(1), 162–185. https://doi.org/10.1007/s11013-014-9405-8
Detering, K. M., Hancock, A. D., Reade, M. C., & Silvester, W. (2010). The impact of advance care planning on end of life care in elderly patients: Randomised controlled trial. BMJ, 340(mar23 1), c1345–c1345. https://doi.org/10.1136/bmj.c1345
Jahn, D. R., Leith, J., Muralidharan, A., Brown, C. H., Drapalski, A. L., Hack, S., & Lucksted, A. (2020). The influence of experiences of stigma on recovery: Mediating roles of internalized stigma, self-esteem, and self-efficacy. Psychiatric Rehabilitation Journal, 43(2), 97–105. https://doi.org/10.1037/prj0000377
Kozlowska, K., Walker, P., McLean, L., & Carrive, P. (2015). Fear and the Defense Cascade:Clinical Implications and Management. Harvard Review of Psychiatry, 23(4), 263–287. https://doi.org/10.1097/hrp.0000000000000065
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