"Shelter is Stressing Me Out": Challenges Meeting Health Care Needs of Older Adults in Congregate Shelters

Older adults experiencing homelessness are a growing population with high rates of medical, psychiatric, and substance use-related health conditions. This mixed-methods study sampled older adults experiencing homelessness admitted to an academic safety-net hospital. We analyzed chart review data on the cohorts' medical and psychiatric conditions and their health care utilization. Qualitative interviews examined the impact of the congregate shelter environment on health. The sixteen participants with experiences living in a shelter had high rates of depression (56%), alcohol use disorder (52%) and hypertension (39%). Annually, participants averaged 2.8 hospitalizations and 8.5 emergency department visits. Forty-four percent (44%) of participants were discharged from hospital to shelter. Qualitative interviews linked living in congregate shelters to challenges meeting daily physical and psychological needs and barriers to medical system engagement. Our study highlights the complex health and psychological needs of this population, and challenges meeting those needs across congregate shelters and acute hospital settings.