When Sheltering in Place is Easier Said than Done

By Joe Humphries, Atiya Mahmood, and Sarah Canham

This piece is an excerpt from the COVID-19 edition of the GRC News.

COVID-19 has impacted people from all walks of life, yet it has had a particularly profound effect on disadvantaged and frail members of our society. Evidence from around the world indicates that adults aged 65 and older are at increased risk for contracting COVID-19 and have a much higher mortality rate compared to younger persons.For older people experiencing homelessness, including those living in substandard shelter or housing, COVID-19 presents significant disruptions. For instance, disadvantaged individuals who rely on cafeterias, soup kitchens, and affordable meal delivery programs for meals find their food security is threatened, as many of these programs have shut down. Their social networks are disrupted without access to a reliable phone, computer, or internet access, and with limited opportunities to connect with outreach and social workers. Their sources of income have become uncertain and often unsafe, as people working lower-wage positions risk unsafe employment conditions just to pay the bills and those who rely on panhandling or sex work are finding their income streams drying up. Individuals with limited education, literacy, and coping skills may be unable to access or understand complex, stress-inducing, and ever-changing information and advisories about ongoing developments and lifestyle restrictions. Misinformation and mistrust add to this burden of what to believe, where to go for help, and how to cope. Each of these factors, known as ‘social determinants of health,’ have a profound influence on the risk of exposure to COVID-19 and bring to the forefront the individual health, social, and economic consequences of this global pandemic for people in the margins of our society.

 Even before the COVID outbreak, older people experiencing homelessness have higher rates of chronic illness and mortality compared to stably housed individuals of the same age. In addition, people experiencing homelessness often prioritize immediate needs, such as shelter, food, and safety, over health promotion and public health advisories. These are among the list of reasons why people experiencing homelessness experience ‘accelerated aging,’ whereby they often present with physical and cognitive health more akin to a stably housed person in the general population who is 10 to 15 years older. Therefore, researchers and service providers working in the homelessness sector often refer to people who are age 50 and older as ‘older adults.’

Despite this understanding in both research and practice, policy restricts people aged 50 to 65 from accessing programs, services, and financial benefits designed to support the social determinants of health for stably housed people age 65 and older. This includes access to seniors’ affordable housing and assisted living, social and recreational programs that aim to promote healthy lifestyles, and pension and old age security. Without a social safety net, older people experiencing homelessness are consigned to negotiate precarious housing, health, and finances largely on their own and in the face of stigma and discrimination from people who blame them for their own circumstances. During this time of a global health crisis, these vulnerabilities are exacerbated. 

Vancouver’s Downtown Eastside is one of Canada’s homelessness hotspots, which makes it particularly important to examine with respect to COVID-19 risks, responses and resilience. Located on Alexander Street, a few blocks north of East Hastings, is the Veterans’ Manor. The Veteran’s Manor provides 134 one-person units of affordable housing to men age 55 and older with experiences of homelessness, precarious housing, and marginalization. Many of these men live with chronic health conditions that can be traced back to long hours of hard labour. Other tenants live with cognitive impairment resulting from long-term substance use or brain injury. Most have only tenuous connections to distant families who have grown apart or were never together to begin with. 

However, operating out of a small office on the ground floor of the Veterans’ Manor is a social service organization called Whole Way House. Serving as a formal social network to tenants, Whole Way House normally provides social programming and support services that seek to promote social connection and independence among tenants, including exercise activities, financial assistance, and social outings; however, these are not normal times. In response to the COVID-19 pandemic, Whole Way House has teamed up with other organizations in the Downtown Eastside, including the Evelyne Saller Centre next door, to deliver cooked meals to tenants twice a day, every day. Volunteers assist the Whole Way House staff in delivering meals door-to-door, offering hand sanitizer, and providing encouragement and social connection. Recently, Whole Way House has teamed up with two other local food providers, The Dirty Apron and The Kitchen Table, to expand meal deliveries to neighbouring buildings, including the Union Gospel Mission’s emergency shelter at 601 East Hastings Street. By adapting their services in a time of crisis, Whole Way House has broadened its scope to support as many people experiencing precarious housing and homelessness as possible.

In research, Whole Way House is described as a ‘promising practice.’ Although it is a model of service delivery that has not yet been subject to rigorous evaluation, it is worthy of attention, especially how it functions under the current set of challenges faced by community organizations. A research partnership of 20 academics, 47 service providers and partner organizations, and nine older people experiencing homelessness spanning across Canada and internationally have come together to examine homelessness and housing insecurity in later life. Our team has been conducting research over the last year to explore the shelter and housing landscape in Montréal, Calgary, and Vancouver and classify promising practices for older people experiencing homelessness. We have arranged these promising practices along a continuum of shelter and housing, from emergency shelter accommodation and transitional housing, to independent housing, supported housing, long-term care, and palliative care/hospice. Common across promising practices for sheltering and housing older people experiencing homelessness is the recognition that the ‘right’ set of health, housing, and social supports is needed to support aging in the right place, regardless of life circumstance.

COVID-19 has highlighted that promising practices are severely needed to support the health and psychosocial needs of the most vulnerable people in our society. Our research partnership aims to conduct a series of evaluations of promising practices to determine how they promote aging in the right place and the groups of older people for which the promising practices work best. With this information, there is potential to improve the shelter and housing options to meet the unique and complex health and social needs of older people experiencing homelessness across Canada. Key to this research is the understanding that housing is health and housing is a right. The COVID-19 pandemic has placed this issue into sharp focus. As we negotiate this immediate threat to our individual health together, let’s move forward with a holistic view of our collective health by recognizing the importance of the social determinants that impact the health, wellbeing, and safety of all people from diverse backgrounds, ages and abilities.

To donate to Whole Way House, visit their website at https://wholewayhouse.ca/