Late-Life Homelessness: Experiences of Disadvantage and Unequal Aging 9780228009535

Citation preview

l at e - l i f e h o melessn ess

Late-Life Homelessness Experiences of Disadvantage and Unequal Aging

Amanda Grenier

McGill-Queen’s University Press Montreal & Kingston • London • Chicago

© McGill-Queen’s University Press 2021 ISB N ISB N ISB N ISB N

978-0-2280-0835-4 978-0-2280-0836-1 978-0-2280-0953-5 978-0-2280-0954-2

(cloth) (paper) (eP df) (eP UB)

Legal deposit first quarter 2022 Bibliothèque nationale du Québec Printed in Canada on acid-free paper that is 100% ancient forest free (100% post-consumer recycled), processed chlorine free This book has been published with the help of a grant from the Federation for the Humanities and Social Sciences, through the Awards to Scholarly Publications Program, using funds provided by the Social Sciences and Humanities Research Council of Canada.

We acknowledge the support of the Canada Council for the Arts. Nous remercions le Conseil des arts du Canada de son soutien.

Library and Archives Canada Cataloguing in Publication

Title: Late-life homelessness : experiences of disadvantage and unequal aging / Amanda Grenier. Names: Grenier, Amanda, author. Description: Includes bibliographical references and index. Identifiers: Canadiana (print) 20210294795 | Canadiana (ebook) 20210294949 | i s bn 9780228008354 (cloth) | isbn 9780228008361 (paper) | isbn 9780228009535 (eP DF) | isbn 9780228009542 (ePUB) Subjects: l csh: Older homeless persons. | lcsh: Older homeless persons— Québec (Province)—Montréal—Case studies. | lcsh: Homelessness. | lcs h: Aging. Classification: lcc hv4493.g74 2021 | ddc 362.6/96942—dc23 This book was typeset in 10.5/13 Sabon.

Contents

Tables and Figures

vii

Acknowledgments ix section i: context, frame, and methodology 1 Setting the Context 3 2 The State of Knowledge on Late-Life Homelessness

23

3 A Critical Perspective and Ethnographic Approach to Late-Life Homelessness

44

section ii: project insights from four thematic angles 4 Age and Late-Life Homelessness

69

5 The Places of Late-Life Homelessness: Aging in “Undesirable” Locations 99 6 Late-Life Homelessness as a Reflection of Disadvantage over Time

127

7 Late-Life Homelessness as Social Exclusion and Abandonment 157

vi

Contents

section iii: directions for change 8 The Need to Prevent Homelessness across the Life Course and into Late Life

187

9 The Moral Imperative: Political and Just Responses to Late-Life Homelessness

215

appendix i: Canadian Definition of Homelessness (2017) 243 appendix ii: Comparative Table of Older People with Lived Experience 245 Notes

247

References Index

265

329

Tables and Figures

ta b l es 1.1

Four Sub-Groups of People Experiencing Homelessness

2.1

Proportional Representation of Homelessness among Older People in Three Canadian Cities 32

3.1

Demographic Profiles of Older People with Lived Experiences of Homelessness

8.1

Project Insights: Features to Address Late-Life Homelessness

8.2

60

201

Project Insights: Steps for Enacting Policy Change

209

f ig u r es 2.1

Three Main Understandings of Homelessness among Older People 35

11

Acknowledgments

This book represents just over ten years of work on late-life homelessness. It began as a response to trends in Montreal, followed by a sshrc-funded Insight Grant (2012–16). It was then developed into a book starting in 2016, and more intensively during my sabbatical in 2017 at the University of Manchester. As such, the interviews take place against population aging, the transition to Housing First (and other such models), and changes in the field of homelessness more generally. The arguments for the book were developed prior to the outbreak of covid -19, and final revisions carried out during the pandemic. For many older people, the pandemic exacerbated existing challenges with regard to housing and care, and in the case of the public, made known the issues of need, risk/safety, and abandonment discussed throughout the text. Thank you to everyone who participated in this research. Thank you to the older people who shared their stories, experiences, and insights with me and the team. In many cases, this was the first time many of you had been asked to speak in such details about your lives, and your experiences of aging. We appreciate your willingness to share your views, and hope that we have done justice in understanding your accounts, and advocating for the changes you would like to see. Like you, we hope that this brings about better solutions with regard to aging, income, housing, and care. Thank you to the community partner, the obm , and to the various stakeholders in Montreal who spoke with us about their work. Thank you to the research team in Montreal who helped me to understand homelessness in late life, and for your support as I developed the book. Thank you to Jean Pierre Lavoie, Tamara Sussman,

x

Acknowledgments

David Rothwell, Valerie Bourgeois-Guérin, and the teams at the Old Brewery Mission and the creges for sharing your time, ideas, and contributions throughout the project. Our collaboration helped me to establish a blueprint for projects whereby members of the team could work together across disciplines and methodologies, and with a close partner organization. Thank you to the Social Sciences and Humanities Research Council (sshrc ) for funding our work (2012–16), and the continued support of conceptually and theoretically sound social science research focused on pressing social issues. We hope our research achieves both academic merit and the social and economic benefit of improving the lives of older people with experiences of homelessness. This book has been published with the help of a grant from the Federation for the Humanities and Social Sciences, through the Awards to Scholarly Publications Program, using funds provided by the Social Sciences and Humanities Research Council of Canada. Projects like this are never the work of one person alone – they take large teams to assist with data collection, the organization of material, and the various academic and editorial components. Over the years, the team and I have had the privilege of working with a fantastic team of students and researchers who helped to conduct literature reviews, set up interviews, collect data, format papers, and prepare materials for websites and policy-makers. Thank you to Rachel Barken, Sonia Ben Soltane, Brian Budd, Equity Burke, Victoria Burns, Anne Marie CarleMarsan, Maya Cerda, Fatima Chohan, Cristi Flood, Saira Haque Ali, Daphne Imahori, Stephanie Hatzifilalithis, Rebecca Hessels, Grace Martin, Laura McGhie, Colleen McGrath, Sebastien Mott, Mylene Ouellette, Celeste Pang, Sarah Pettersen, and Veronique Pilon. There are also a number of scholars and advocates working across the country who are committed to issues related to homelessness in late life. I am thankful to have shared the floor with you at conferences and events, and to have heard your ideas and feedback. Here, a shout-out to Hilary Chapple, Naheed Dosani, Nick Falvo, Judith Gonyea, Lauro Monteiro, Christine Walsh, and others. Throughout the research, I had the opportunity to engage with academics, students, and community stakeholders across Canada and in the United Kingdom. Project results were presented at the British Society on Gerontology (bsg ), the Canadian Association on Gerontology (cag ), the Canadian Alliance to End Homelessness (caeh ), the Gerontological Society of America (gsa ), and the

Acknowledgments

xi

International Association of Gerontology and Geriatrics (iagg ). The ideas for the book, and in some cases the arguments from specific chapters, were also presented as invited lectures. A sincere thank you for these invitations, which helped me to clarify ideas, identify the angles of analysis, and present the voices of older people and community stakeholders. Thank you to the Institute on Aging and Lifelong Health at the University of Victoria (2016); the Department of Sociology and the Manchester Institute for Collaborative Research on Ageing (micra ) (2017–18); the Centre for Dementia at the University of Nottingham (2017); the act program at Concordia University (2017); the Irish Centre for Social Gerontology at the National University of Ireland, Galway (2018); the Katz Distinguished Lecture Series at Trent University (2018); Economic and Social Development Canada (esdc ) (2018); the International Federation on Aging (ifa ) (2018); haven Drop-In Centre for Older Homeless Men (2018); and the Status of Women’s Committee, Government of Canada (2019). A number of academic colleagues and graduate students also provided valuable feedback along the way, as I grappled with how to complete the interdisciplinary and critical gerontological analysis at the intersections of a field that was not always aware of issues of aging, and where qualitative research is the exception rather than the norm. A number of people provided me with feedback through discussion and/or on written materials. The errors and omissions made throughout the book are, of course, mine. A sincere thank you to: Gavin Andrews, Bill Bytheway, Toni Calasanti, Stephen Katz, Karen Kobayashi, Lynn McDonald, Nancy Guberman, Chris Phillipson, Tom Scharf, and Janine Wiles. I also wish to thank McGill-Queen’s University Press (mqup ) for their interest in the book and their support in moving the book through the various stages of publication, and to press and Alexandra Peace for the Index. My research and scholarship have also received additional support over the years from the Gilbrea Chair in Aging and Mental Health at McMaster University (2011–19), the Hallsworth Visiting Fellowship program at the University of Manchester (2017–18), and the Norman and Honey Schipper Chair in Gerontological Social Work at the University of Toronto and Baycrest Hospital (2019+). I am grateful for how these positions have created opportunities to conduct conceptual work, make social science–led explorations, and be ‘invited to the table’ to suggest change with regards to aging and inequality.

xii

Acknowledgments

This project has spanned ten years, and I could not have finished the book when I did without the support of friends and colleagues. To my dear friends – Sara Collings, Jen do Forno, Alex Campbell, Michele Gnanamuttu, Jill Hanley, Miljana Horvat, Karen Kobayashi, Becky McClellan, Suzanne Mills, Raza Mirza, Sandra Lapointe, Mary Margaret Lessard, Dana Scruton, Emily Stidwell, Laura TamblynWatts, Mark Wolfe – thank you. Thank you to the Canadian and international gerontological community for supporting my ideas and giving constructive feedback. I am also grateful to my neighbourhood for the meals, calls, and outdoor babysitting, and to my parents and in-laws for their support. Having such a network while writing about ‘what happens when things fall apart’ is not lost on me. Last but not least, I wish to thank my late partner James Robinson and my son Oliver. Luckily, Peppa Pig’s mother also writes books, so that gave me some credibility in a child’s world. I remember I was pregnant when I started the observational component of research in the shelter, and how the men who were dining in the halls would offer me a chair. There is something about these everyday ethnographic moments, and the lessons such metaphors can later provide. It is this awareness, and the acts of care that take place amidst social and cultural responses of exclusion and abandonment, that underscores the importance of hope and insistence on justice rooted in a shared humanity.

s e c t io n i

Context, Frame, and Methodology

1 Setting the Context

An older man sits waiting on a bench in downtown Montreal, only a block away from the largest shelter in the city, in a local square not far from the provincial courts. Just up the street an older woman makes her way to the cafeteria service of the women’s shelter; she pushes a cart full of items, and is weighed down by a heavy coat and blanket. She arrives at the shelter, keeping to herself, and slowly makes her way through the door, which is being held open by the staff. Shelter workers wonder: “How did this happen? How does one end up homeless in late life?” They express puzzlement, stating, “this simply shouldn’t happen to older people” – but they know from their everyday work that it does. Their questions are not unlike those older people ask themselves: “just how did I end up old and on the street?” “I don’t understand how I ended up here.” And yet, while older people are increasingly visible on the streets and in the shelter system, official strategies say little about their needs. Older people are both visible and overlooked – their stories do not fit with the ideas we tell ourselves about aging, nor do they make sense where understandings and practices related to homelessness are concerned, namely the idea that homelessness should be solved by the time one gets to late life. And while the presence of older people on the streets may be met with a sense of incomprehension, there is also a niggling feeling that they are somehow at fault or to be blamed for the choices they are considered to have made – but just how does one arrive at being homeless in late life and who holds the responsibility for change? This account of late-life homelessness begins in the Canadian city of Montreal, prompted by the concerns of shelter workers, and of a team of researchers interested in aging and exclusion. In the early

4

Late-Life Homelessness

2000s, shelter workers witnessed more older people needing shelter beds, using their cafeteria services, and existing on the streets of the city. Yet this trend was generally unacknowledged in the Canadian context of homelessness. Although international examples of work on late-life homelessness existed in the 1980s and 1990s, it seemed to stall in the 2000s. Classic studies conducted in New York during the 1980s documented aging men living on the streets of large American cities (Cohen and Sokolovsky 1989). In the United Kingdom, a series of reports highlighted the service challenges related to aging and homelessness, and a coalition on older homelessness was formed in the 1990s by Help the Aged (Pannell 2002; Pannell and Palmer 2004).1 In Canada, there was a surge of attention to homelessness between 2008 and 2013, corresponding with the nationwide Housing First demonstration project. However, there was very little focus on older people, and Canada has yet to produce a position paper on late-life homelessness.2 The aging of the homeless population mirrors population aging and the phenomenon commonly referred to as the “greying” of society.3 In this global context, homelessness, both in general and among older people, has gone from being exceptional as a social issue to being an ongoing reality across a range of settings. Homelessness reflects rising costs of housing, and changes to social programs since the 1980s, worsened in many cases by the 2008–09 financial crisis. As such, homelessness at any age reveals (and reflects) disadvantage and inequality across a range of international contexts. Homelessness is disproportionately experienced by racialized groups, immigrants, and, in Canada, Indigenous peoples (inclusive of First Nations, Métis, and Inuit peoples). In more recent years, older people are also increasingly visible in and across a range of settings. Without focused response, this phenomenon may continue to increase, especially among groups who are currently over-represented in homelessness. Perhaps unsurprisingly, the last ten to fifteen years have witnessed an upsurge in attention to homelessness as a major social issue and political challenge.4 Articles on homelessness have appeared across local, national, and international newspapers such as The Economist, The Globe and Mail, The Guardian, and The New York Times, making homelessness, and in some cases late-life homelessness, more visible. For example, in the United Kingdom, The Guardian, backed by the support of the Bill and Melinda Gates Foundation, ran a series on homelessness between 2017 and 2018.

Setting the Context

5

The global pandemic of 2020–21 further exposed the major fault lines with regard to housing and care, laying bare how older people with experiences of homelessness and in long-term care were living at some of the most vulnerable locations in Canadian society, and elsewhere. The increased journalistic attention to homelessness among older people revealed the international phenomenon witnessed on the everyday frontlines of local practices in cities such as Montreal. It also, however, exposed a paradox – while older people were increasingly visible “on the streets” and in shelters, only a handful of scholars and activists were focused on this issue (Cohen and Sokolovsky 1989; Crane 1999; McDonald, Dergal, and Cleghorn 2007). Older people were unnamed and unrecognized in Canadian public policy, programs, and homelessness strategies. As was made visible through our ethnography, and will be developed through the book, older people who are homeless occupy a paradoxical position of being hyper-visible and at the same time invisible. That is, they are “hidden in plain sight” (see York Region Alliance to End Homelessness 2009). This tendency to overlook older people and their needs may be considered reflective of ageist interpretations or stereotypes about marginalized people, including stigmatized views of the old “vagrant” as a lifestyle choice (O’Flaherty 1996; Stern 1984). Situated from a perspective of critical analysis, however, late-life homelessness is also a reflection of political and economic choices that have led to the abandonment of disadvantaged groups of older people in need. Since the 1980s, attempts have been made to document late-life homelessness. International researchers in countries such as the United States, Canada, the UK, and Australia outlined how late-life homelessness was on the rise and more present across settings such as city streets, shelters or food banks, community services, and the sofas of friends and family across urban, suburban, and rural contexts (Cohen and Sokolovsky 1989; Crane et al. 2005; Culhane et al. 2013a). The health and social needs of older people with experiences of homelessness have also been clearly documented, as have the significant gaps in policies and services (Crane 1999; Gonyea, Mills-Dick, and Bachman 2010; McDonald, Dergal, and Cleghorn 2004). However, no recent attempts have been made to document and explain the phenomenon from a critical perspective on aging through an ethnography focused on older people’s experiences.

6

Late-Life Homelessness

A number of changes prompt the need for a detailed exploration of homelessness among older people, resulting from the intersection of individual and structural factors that contribute to disadvantage across the life course. This includes a careful consideration of the shifting age profile of the population, older people’s proportional share of homelessness, and the heightened visibility of older people. Where rises in homelessness among older people are regularly attributed to population aging, and the assumption that more older people in a given society would automatically result in larger numbers who are homeless, explanations based solely on shifting demographics fall short. In particular, they overlook how homelessness has extended beyond traditional groups known to be at risk, such as persons with mental health issues, long-term unemployment, abuse, or incarceration (Daly 2013; McNaughton 2008); how the proportional share of older people within point in time (PiT) counts seems to be rising in a number of Canadian cities (Grenier et al. 2016a); and, as will be developed in this book, how late-life homelessness unfolds over time, as a result of a lack of support. This book engages with the paradoxical position of older people as hyper-visible and yet invisible as a result of ageist understandings and stigmatized views of homelessness as an individual fault. The book serves to connect and expose how these views shape political responses to homelessness and the experiences of older people who are homeless.

a critical perspective on late-life homelessness as witnessed through ethnography This book takes a critical perspective on aging to reflect on findings from a four-year ethnographic study of late-life homelessness in Montreal, Canada from 2012 to 2016, funded by the Social Sciences and Humanities Research Council of Canada (sshrc ). I led the late-life homelessness study (Grenier – PI), along with four coinvestigators (Sussman, Rothwell, Bourgeois-Guérin, Lavoie), in partnership with the Centre de recherche et d’expertise en gérontologie sociale (creges ; a research centre on aging), and the largest shelter system in the City of Montreal (The Old Brewery Mission). Organized as an ethnography, the project consisted of a range of complementary methodologies, including forty interviews with older people with experiences of homelessness, fifteen interviews

Setting the Context

7

with community stakeholders with direct experience working in housing and homelessness, ten interviews in and around long-term care, a review of forty-two Canadian strategies on homelessness, ethnographic observations of shelters throughout the study period, and a review of administrative data (quantitative analysis; n=1,214 files). The empirical results of each component of the study were published in co-authored academic articles, with the single-authored book extending into social and critical gerontology in order to better include diverse and marginalized experiences of aging, and to theorize with regard to aging and inequality. The book expands results, and links findings with the state of knowledge in the field of social and critical gerontology. This book uses a critical gerontological perspective to argue that late-life homelessness is an experience of unequal aging. It considers the phenomenon of late-life homelessness through the overarching questions: how do we understand and define late-life homelessness; what happens at the intersections of aging and homelessness; and what needs to be done? The critical gerontological perspective developed through the book reveals how late-life homelessness is constructed, shaped, and experienced. It assembles project insights across macro, mezzo, and micro levels to reveal the intricate processes, relationships, and responses that create and sustain homelessness. With insights gathered from policy texts and stakeholder practices, as well as observations of and interviews with older people, it serves to draw attention to the needs and experiences of older people who are homeless, and to expose the challenges related to population aging, rising inequality, and declining social commitments. Although the study on which the book is based was carried out at the local level in the Canadian city of Montreal, the themes and discussions have global resonance with regard to homelessness among older people. The critical perspective on aging anchors the book through a range of interdisciplinary perspectives concerned with questioning taken-for-granted assumptions about aging, the social norms and cultural frames that shape responses to older people, and the relationship between structures and experiences (see Grenier 2012). The frame used throughout is a critical, interdisciplinary, and multi-level approach to the study of aging (see chapter 3). While the use of the phrase “critical perspectives on aging” can signal different theoretical and historical trends in the study of aging, and

8

Late-Life Homelessness

cause some confusion, I employ it as an umbrella term inclusive of a range of perspectives and theoretical insights, and in particular, conceptual notions of language, power, diversity, and change (Grenier 2012). There are, however, important historical markers and distinctions. Gerontological scholars situate the development of critical perspectives on aging (or critical gerontology) in multidisciplinary work beginning in the 1980s, and often categorize it into two strands of political economy and the humanities (see Moody 1992; Katz 1996; Twigg and Martin 2015a; 2015b). While such disciplinary and theoretical divisions were perhaps more pronounced in the United States than they were in the United Kingdom or Canada, these distinctions provide a helpful marker of the theoretical tensions between structural, cultural, and interpretive readings of aging. And when viewed through a contemporary lens, these strands suggest that there is a historical rationale behind the shifting landscape and contemporary renaming of sub-fields of critical or cultural gerontology (see chapter 3). This book employs a critical perspective on aging as a lens through which to consider the intersections of aging and homelessness in a larger social, cultural, political, and economic context. As such, the approach taken is not strictly macro, derived from the strand of political economy (sometimes known as critical gerontology), nor is it only cultural, as derived from humanistic or cultural gerontology. Instead, it draws together insights from a range of affiliated critical and interdisciplinary perspectives including critical gerontology, cultural gerontology, and age studies, under the umbrella term of “critical perspectives” (see Bernard and Scharf 2007). In their text Social Theory, Social Policy, and Ageing, Estes, Biggs, and Phillipson (2003) outline critical perspectives as challenging the biomedical dominance of studies of aging, drawing attention to the cultural tendencies to depict aging as a period of dependence and/or decline, and detailing the powerful social structures and responses that organize older people’s lives. More recently, Twigg and Martin (2015a) have added how cultural gerontology (and the cultural turn) brought the analysis of identities and subjectivities, the body and embodiment, the visual, and time and space into the field (also see Katz 2005; Tornstam 1992; Twigg and Martin 2015b). It is the combination of these features that are used to explore and understand late-life homelessness through linking the experiences of older people with the theoretical knowledge in the field.

Setting the Context

9

The book attempts to address the oversight with regard to homelessness among older people, both in general and from a critical perspective. Despite the relevance that critical perspectives hold for assessing the relationship between contemporary structures and the interpretive experiences of housing insecurity and homelessness among older people, few attempts at this have been made (see Means 2007 for an exception). This book focuses on the phenomenon of late-life homelessness as it is witnessed through an ethnography of the lives and experiences of older people, and of community stakeholders with direct practice working with older people who have experienced homelessness. This includes how and why late-life homelessness has emerged at this point in time, the contradictions that exist for people who are both older and homeless, what this phenomenon reveals about existing responses to disadvantage and need, and why it is problematic to leave the needs of older people unaddressed. Ethnography was chosen because it has a shared aim of rendering visible the contradictions of practice, the complexity of relationships, encounters with systems and structures, and the everyday lives of older people (see chapter 3). Throughout, the book examines ethnographic insights from a critical perspective to understand and illustrate how structures, organizational practices, and relationships related to homelessness come to affect older people. It focuses, for example, on features such as age, place, and disadvantage, as well as how late-life homelessness is constructed in ways that open or close eligibility and social responses, what it means to be homeless in late life, and how this is experienced in relation to “normative” expectations of aging. Time and again, our research revealed a sense of disillusionment with regards to the society within which we live. Shelter and community workers expressed how this should not happen in a country considered to have a public social safety net, and older people were baffled by the life course trajectories that had led them to the streets and the shelter. Such reflections reveal the power of a cultural or interpretive lens to the study of aging, with late-life homelessness at odds with personal expectations of aging, social/cultural scripts of social protection in welfare states, and frameworks of healthy aging and/or “aging in place.” This lens also raises a series of questions about social support networks and programs that create or sustain the conditions for late-life homelessness.

10

Late-Life Homelessness

what is m e a n t b y l at e - l i fe homelessnes s? A number of challenges existed with regard to articulating the phenomenon of late-life homelessness and establishing the boundaries for the study. At the outset of the project we needed to determine the definition and phenomenon we were concerned with documenting – that of homelessness among older people. Where definitions and understandings existed with regard to homelessness, the idea of “older” was considered to be more fluid in gerontology, and the criteria for what counts as “late-life homelessness” were not established. We began with a conceptual search in the literature and the literal definition. On the literal or phenomenological level, the term “homelessness” signifies the “state or condition of being homeless” (Oxford English Dictionary 2018).5 It is defined through the “absence of a home,” with the suffix “-less” marking the experience of being without a home.6 The term “homelessness” thus marks a practical (or policy) situation of not having housing or a home, while at the same time conjuring the symbolic or ideological and practical implications of what being without a home entails (Grenier, Barken, and McGrath 2016; also see Somerville 1992). Such definitions are important on policy and practical levels because they are used to classify groups in need, and to target, allocate, and deliver services accordingly (see chapter 4). They are also important on symbolic and cultural levels because they establish the location of late-life homelessness outside the normative conventions of having a home, and mark older people as lacking the foundations upon which to “age well” or receive care (i.e. at home or in the community – see further chapters 4 and 5). We then turned to existing policy-relevant Canadian definitions of homelessness. At the time of our research, the most frequently employed and comprehensive definition of homelessness in Canada was that articulated by the Canadian Homelessness Research Network (chrn ). The chrn (2012, 1) defined “homelessness” as “the situation of an individual or family without stable, permanent, appropriate housing, or the immediate prospect, means and ability of acquiring it.” The umbrella definition of the chrn (2012) outlined four sub-groups of homeless people: 1) the unsheltered, 2) the emergency sheltered, 3) the provisionally sheltered, and 4) those at risk of homelessness (see Table 1.1: Four Sub-Groups of People Experiencing Homelessness).7 This definition was designed to be comprehensive in taking account a continuum of housing experiences, risks, and spatial locations where

Setting the Context

11

Table 1.1 | Four Sub-Groups of People Experiencing Homelessness Unsheltered, or absolutely homeless and living on the streets or in places not intended for human habitation.

Emergency sheltered, including those staying in overnight shelters for people who are homeless, as well as shelters for those impacted by family violence.

Provisionally accommodated, referring to those whose accommodation is temporary or insecure.

At risk of homelessness, referring to people who are not homeless, but whose current economic and/or housing situation is precarious or does not meet public health and safety standards.

Adapted from the Canadian Homelessness Research Network (2012) *Our sample included older people from across the four sub-groups of People Experiencing Homelessness. Most of our interview participants were from the emergency shelter as a result of the ethnographic methods and partner organization. However, older people who were unsheltered, provisionally accommodated, or at risk of homelessness would also have been witnessed in and around the shelter through observational methods (see Appendix II: Comparative Table of Older People with Lived Experience).

homeless people reside and experience instability.8 Although the 2012 definition of and approach to homelessness did not include older people or any sub-populations until 2017 (see chapter 2), it was, at a basic level, flexible enough to include a range of within-group populations such as older people (see Appendix i: Canadian Definition of Homelessness).9 We broadly aligned our research with the 2012 definition in the hope of linking with an existing policy agenda. Where our research differed, however, is that it was organized specifically around age (late-life homelessness) and situated in a critical perspective that included attention to diverse social locations, historical policy changes, and processes of exclusion that became officially recognized in the 2017 definition. Given the lack of operational definitions of late-life homelessness, the team was faced with the challenge of determining the age-based boundaries for the phenomenon, experience, and study sample. The notion of age, and/or being an older person, is socially constructed, meaning that there is no specific age or social boundary at

12

Late-Life Homelessness

which someone moves into the sub-population or category of “older people” (Bytheway 2011; Bytheway and Johnson 1990). While age 65 – the previous age of retirement in many countries – is the most widely accepted definition of old age, this number is shifting along with changes to retirement programs.10 A strict classification of age 65 also fails to address the subjective components of age that are rendered visible through statements such as “I am not old.” Further, the standard age of 65 is thus deficient with regard to health disparities and disadvantage. Older people who were homeless exhibited mental and physical health characteristics more consistent with (non-homeless) people approximately ten years older than them (Brown et al. 2012; Gonyea, Mills-Dick, and Bachman 2010; Salem et al. 2013).11 Older people with experiences of homelessness are also known to have higher rates of early mortality than the general population (Cohen 1999; Hwang et al. 1998; Morrison 2009), with a 2009 report citing the average life expectancy of a homeless person in Canada as 39 years. This, compared to the general average life expectancy of 79 years for men and 83 years for women in Canada (Statistics Canada 2015a), suggests a possible forty-year difference between older people who are homeless and the general Canadian population (also see Hwang 2000; Hwang et al. 2009),12 and draws attention to discrepancies between older people’s needs and the typical age of eligibility for services designed for older people. Yet, policies and practices often work on age-based limits, as do research samples. The findings of our literature review revealed that given these trends, age fify was the most inclusive age-threshold for research and programming for older people who are homeless, based on objective indicators such as health status, and on the insights and subjective considerations of older people with lived experiences (Grenier et al. 2016b; McDonald, Dergal, and Cleghorn 2004).13 Further distinctions also existed in the literature on the sub-group of older people with experiences of homelessness. Authors noted two within-groups of older people: a group with ongoing experiences of homelessness, and a group who were new to homelessness in later life. The first category comprised a group of people “growing old in situations of homelessness” or who had “aged on the streets.” This group was described as having previous, ongoing, or episodic experiences with homelessness, also categorized as “chronic” or “long-term” homelessness. Defining features of this group included reference to mental health issues, substance use, “rough sleeping,”

Setting the Context

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the use of shelters as housing, and/or movement between locations over extended periods of time. Where some researchers writing about homelessness at any age defined the chronic category as anything above three months of homelessness (Trypuc and Robinson 2009), others used more than one year to denote chronic homelessness (McDonald, Dergal, and Cleghorn 2004). Distinctions were also made between transitional or temporary, episodic or cyclical, and chronic homelessness (Aubry et al. 2013; Culhane and Metraux 2008; Mott, Moore, and Rothwell 2012).14 The second category, reported to be on the rise, described people who become homeless for the first time in later life (Burns, Sussman, and Bourgeois-Guérin 2018; Hahn et al. 2006; McLeod and Walsh 2014). This group tended to have never experienced homelessness, and came into homelessness by means of trajectories that included changing family situations (divorce or bereavement) and/or economic circumstances, often in combination with other health, employment, or family issues (Cohen 1999; Crane et al. 2005; Padgett, Henwood, and Tsemberis 2016). It also seemed to increasingly include older people who were displaced or evicted, and it is possible that such circumstances were connected to the financial crisis of 2008–09 (Crane et al. 2005; McDonald, Dergal, and Cleghorn 2007). Our research sample included older people who “aged in situations of homelessness” and those who were “new to homelessness.” Accounts revealed different trajectories into homelessness, how particular issues compounded health and social care needs, and the challenges of exiting homelessness (see further chapters 4–7). The intent, however, was not to compare or contrast these groups, but to understand the phenomenon of late-life homelessness from a perspective that was inclusive of the wide-ranging transitions, pathways, and social locations that could impact needs and experiences in different ways. It is important to note that while this book is organized around the concept of late-life homelessness, this notion did not exist as an accepted frame at the outset of our work, nor throughout our project. Rather, it is one that was defined through our engagement with older people, stakeholders, the literature, and policy responses, and more specifically, through the process of making connections between the field of social gerontology and the ethnographic data from our study over time. Viewed from a critical perspective, the language used to refer to a particular phenomenon or sub-population is both socially constructed, and also operates as an exercise of power.

14

Late-Life Homelessness

As such, attention to how terms are used to classify and construct social responses is central to a critical gerontological analysis, and thus fundamental to our exploration of homelessness in late life. The challenge of defining late-life homelessness and responding to the research questions was part of our study process, and of the book. Throughout our research (and especially at the beginning), we struggled with the lack of linguistic and conceptual reference points from which to discuss the issues that prompted the study – the emergence of more older people on the streets and in shelters. In early stages of the project we considered the range of terms used such as “older homelessness,” “homelessness among older people,” and “homelessness in late life.” The language used in this book is that of “homelessness among older people” / “people with experiences of homelessness” and “late-life homelessness” as preferred terms. The first situates homelessness from an experiential and first-person perspective that is crucial to recognizing older people’s needs and advocating for change. This is similar to the rationale and usage of the term “people with disabilities.” The second situates homelessness as structural and social, thereby shifting the interpretation away from homelessness as an individual or personal fault, or simply something that happens to older people in a particular period of later life, as “older homelessness” or “homelessness in late life” would suggest. In this view, late-life homelessness is both a phenomenon resulting from inadequate support, and a location where assumptions and social and cultural ideas come together to shape practices and responses. The use of “late-life homelessness” repositions the notion (and experience) of homelessness among older people as one that has structural causes related to disadvantage and inequality. In particular, I employ the concept of “late-life homelessness” throughout the book as a means to draw attention to how homelessness is structured, lived, and experienced on an everyday level, through systems, and by older people. It is this conceptualization of “late-life homelessness” that provides the structure for the argument of the book – that late-life homelessness is an experience of “unequal aging.”

k e y a im s f o r t he book The book is concerned with understanding the phenomenon and experience of being both older and homeless – features that are structured through policies, are constructed through social

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responses, and become visible by means of ethnographic analysis. The argument is that late-life homelessness results from an assemblage of forces, histories, and unanticipated events that accumulate through disadvantage and culminate in unequal aging, and which require multiple sectors of society to address. Given that the concept of late-life homelessness emerged through the research process, the book reflects and shares the journey of understanding as it was recounted by older people with lived experience, in comparison with what is respectively known about aging and homelessness. As a point of clarification, the study was not about exploring the precise moment an individual became homeless (although in some cases it may have done so), but about the constructs, ideas, and practices that configure homelessness in late life, and it had the goal of defining the boundaries and experience(s) in a way that can be used to suggest meaningful change on a policy and practice level. As such, the analysis that unfolds across the chapters differs from approaches that look back to early years to trace or explain the common or individual pathways of homelessness, and/or document the unique needs of older people – both of which exist in the literature on homelessness among older people (see chapter 2). Instead, it begins with late-life homelessness as a troublesome contemporary issue that requires detailed consideration, and situates this issue in the social context of declining social commitments and responses, and as an experience of disadvantage and inequality. The approach taken to study late-life homelessness from a critical and ethnographic perspective is interdisciplinary, multifaceted, and reaches across a range of contexts and sites of practice. The material developed throughout the book crosses the boundaries of a number of social studies and approaches, including social gerontology, sociology, social work, labour or policy studies, and geography. Although few of these disciplinary contributions to the study of homelessness focus on older people (with the exception of social work), those connected with studies of aging offer lessons with regards to place, exclusion, and disadvantage. The book brings these debates together, to reconsider contemporary challenges exposed in the ethnography, and to further consider the lessons that late-life homelessness offers for thinking about, and responding to, disadvantage across the life course and into late-life. This includes, for example, how responses to homelessness are intertwined with cost-cutting priorities and austerity politics that pair demographic transitions with ideas of burden

16

Late-Life Homelessness

of cost, and which can have serious implications for marginalized groups of older people, including those who have experienced or are at risk of homelessness. The book is written with multiple audiences of academic scholars, decision-makers, students, and advocates in mind. The critical gerontological angle of analysis that is developed throughout is intended to reach across a range of policy and practice domains, in part because the systems and locational contexts that could seamlessly respond to the intersections of aging and homelessness do not yet exist. Late-life homelessness, as will be revealed, exists in a liminal space between various ministries such as health and housing, and is further interwined with income distribution and care. As such, the book is directed to those interested in homelessness, aging and/or the life course, and/or scholars or community practitioners, and especially those who recognize the need to think more carefully about the connections between aging and inequality. While the same systems that render late-life homelessness difficult to name and address mean there are no particular decision-makers charged with making change, it is likely that those who find themselves faced with the practical challenges of late-life homelessness will recognize the dilemmas they experience in their work with older people and be validated by the analysis. Finally, the book serves as an example of qualitative ethnographic research methods rooted in critical practice. This study of late-life homelessness illustrates ethnography in action and provides guidance on how to link theoretical perspectives such as critical gerontology with methodological approaches such as ethnography. In this sense, the book offers a guide to researchers and students, and in doing so, serves to further the methodological, conceptual, and substantive contributions in social gerontology. It also reveals how accounts and stories – whether told by the older person, by the stakeholder, or through the discourse of policy frameworks and responses – can be understood and linked with larger social and cultural issues, and political and economic responses to homelessness and aging. Considering late-life homelessness from a critical perspective connects the analysis with wider social responses related to aging, care, and disadvantage over time. Given this, the book has a threefold aim: First, it extends scholarship on late-life homelessness by linking the broader context of social and cultural framing of contemporary

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aging, the responses to homelessness, and the experiences of older people who are homeless. Insights from stakeholders and older people with experiences of homelessness reveal how structures and practices shape homelessness, and create challenges that are experienced at the intersections of aging and homelessness, on the street and in emergency shelters. Second, it exposes late-life homelessness as a result of disadvantage, exclusion, and inequality. The argument is that late-life homelessness is a clear example of unequal aging resulting from disadvantage and unmet need across the life course. Most notably, it shows how gaps in social programming and inadequate responses to need create and shape both homelessness and “unequal aging.” Third, it contributes a new theoretical and practical angle of analysis to the understanding of homelessness in late life. The theoretical lens of critical gerontology (framed broadly as a critical perspective to the study of aging and carried out through ethnographic methods) seeks to understand the intersection of individual, social, and cultural factors that shape and sustain homelessness in late life, and offers critical insights from older people’s experiences as to how policies, programs, and practices can be transformed to mitigate homelessness.

b o o k s t ru c t u r e a n d chapter outli ne The book details the phenomenon of late-life homelessness as it exists at the intersections of aging and homelessness. It is guided by the overarching questions of how is late-life homelessness understood and defined and what happens at the intersections of aging and homelessness? It provides a detailed account of the intersections of aging and homelessness from the views of older people with lived experience, from community stakeholders working in the shelter system and long-term care, and as it is constructed in policy documents and through service responses. Whereas many of the approaches to homelessness document health disparities or unique service needs, this book draws on stories and accounts to better understand how people become (and/or stay) homeless in late life. It reveals the contradictions that emerge, raises critical questions about the social issues and responses, highlights existing flaws with regard to understanding and addressing late-life homelessness, and outlines findings that can inform the development of meaningful policies and

18

Late-Life Homelessness

practices. Each chapter focuses on a unique angle consistent with a critical perspective on the study of aging. Developed from ethnographic insights in the Canadian city of Montreal, and rooted in the interdisciplinary gerontological literature, it reveals how late-life homelessness is, put simply, “unequal aging.” The book comprises nine interconnected chapters organized into three sections. The first section of the book, chapters 1, 2, and 3, sets the context for the study, and the analytic frame and methodology taken throughout the research and across the book. The second section, chapters 4 through 7, presents project insights from thematic angles in social gerontology including age, place, disadvantage over time, and social exclusion. The third section, chapters 8 and 9, represents an attempt to link study findings and suggest thoughtful directions for change. Chapter 8 offers slightly more practical suggestions related to the life course; chapter 9 situates these as part of a larger call for just responses to homelessness in late-life. Chapter 1 establishes the context and aims for the book, and positions the view of late-life homelessness from one Canadian city in a global context. Chapter 2 sets the context, prevalence, and state of knowledge within which to situate the study of late-life homelessness. It engages with the question: what is the state of knowledge on late-life homelessness? It begins by sketching an outline of the global features against which the people we interviewed experienced homelessness in late life. Next, it raises the issue of prevalence and the challenges of representation. This is followed by detailing three trends identified in the literature at the beginning of our study, which informed the observation and interview components of the study as well as the theoretical perspective of the book. It then clarifies the gaps that prompted the critical analysis of late-life homelessness. Chapter 3 provides the frame for developing a critical gerontological and ethnographic approach to late-life homelessness. It engages with the question: what can a critical gerontological and ethnographic analysis offer existing understandings and approaches? It outlines the critical perspective on aging as the theoretical framework for the analysis for following chapters and insights about age, disadvantage, place, and exclusion. After this, it outlines the ethnographic method used to understand late-life homelessness, both as a means to situate the research project and as an expression of the critical perspective as it is applied to homelessness among older people. Taken together, the

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components of this frame develop the position that a critical gerontological perspective carried out through ethnographic methods can render visible the oversights, challenges, and dilemmas that occur between structures, policy or program responses, and the everyday lives of older people with experiences of homelessness. Chapter 4 shines a light on the central question of age and late-life homelessness. The chapter engages with the questions: what happens at the intersection of aging and homelessness; how do understandings of age structure and shape social responses; and how do these configurations affect older people with experiences of homelessness? The chapter is a direct engagement with “chronological age” as understood, enacted, and experienced with regard to late-life homelessness. Drawing on ethnographic observations and analysis, it highlights the contradictory aspects of service responses to homelessness in late life – in particular how age operates as invisible in debates on homelessness, how it is ever-present through systems that configure access through “chronological age,” and, in turn, how this results in discrepancies between established service norms and older people’s needs. It demonstrates, for example, how ideas of age can complicate access to supports, causing older people to fall between the cracks of services, either because they are “too young” (age fifty) for seniors’ services (often offered to ages sixty-five plus), or “too old” for services that target youth or family homelessness. Chapter 5 focuses on how late-life homelessness is structured, shaped, and experienced in relation to place. It documents experiences of “growing old” at three locations observed in the ethnographic work: the street, the shelter, and long-term care. It engages with the question: how are aging and homelessness shaped and experienced in relation to place? Delving into ethnographic examples, it reveals how particular locations differently affect aging and homelessness, what it is like to “grow old” in these places, and the contradictions that exist between dominant expectations and frameworks organized around “housing,” “home,” and “place.” In particular, it exposes how everyday realities of late-life homelessness may aptly be described as experiences of aging in “undesirable” locations. Chapter 6 builds on the analysis of age and place to focus on late-life homelessness as an experience of disadvantage over time. The chapter engages with the questions: what does late life tell us about disadvantage over time and what is it like to live at the intersections of aging, disadvantage, and homelessness? Data and quotes

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Late-Life Homelessness

from older people with experiences of homelessness reveal how disadvantage pools at the level of lived experience, and point to the unpredictability of life, the intersectional and accumulated forms of disadvantage across the life course, and how needs are worsened in a context where supports are difficult to access or do not exist. Here, illustrations from older people demonstrate the importance of shifting the analysis from homelessness in late life, to late-life homelessness as an experience of accumulated disadvantage over time (rather than age), as a means to understand the intersections of aging and homelessness, and improve responses for older people. Chapter 7 focuses on the process and experience of social exclusion and abandonment. The chapter engages with the study questions: what is it like to experience late-life homelessness and how can contemporary responses to homelessness be understood? This chapter was derived from one of the strongest themes within the interviews – that of late-life homelessness as social exclusion. Insights and examples from older people with experiences of homelessness are used to develop a threefold argument: of late-life homelessness as social exclusion; that older people who are homeless experience their everyday lives as social exclusion; and that policies and responses to homelessness create conditions of unnecessary and sustained vulnerability that extend beyond social exclusion into neglect, expulsion, and abandonment. Moving into the third section of the book, which links the analysis to suggestions for change, chapter 8 suggests the need for welltimed preventative interventions delivered across the life course and into late life. The chapter engages with the question: what responses and interventions can be used to address disadvantage and late-life homelessness? Building on study results of late-life homelessness as a result of structured inequalities, age and spatial relations, and disadvantage over time, which in turn produce exclusion and abandonment, it suggests that responses could be conceptualized, designed, and delivered differently. In this chapter, quotes from older people highlight the importance of accounting for disadvantage, change over time, and timing as a means to develop meaningful responses. The chapter explores the conceptual idea of a life course approach to policy and the importance of linking these initiatives to a larger philosophical commitment to social justice. It also suggests a range of immediate, mid-term, and long-term interventions to prevent disadvantage and eliminate homelessness, across the life course and into late life.

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Chapter 9 emphasizes the moral imperative to develop political and just responses to late-life homelessness. Consistent with a critical perspective, chapter 9 returns to the contradictions and lessons that have emerged throughout the book, and the insights from stakeholders and older people as a means to consider change. It engages with the questions of how do older people endure unnecessary vulnerability and extended suffering and what suggestions can (and must) be made? The chapter points to the relationship between political and economic priorities in the response to homelessness, places the problem of abandonment in the context of individual responsibility and declining support, draws attention to hope, and argues for social commitment and public responses rooted in social justice as a means to address rather than reproduce vulnerability. In doing so, the chapter moves the discussion from the practical suggestions offered, to connect with intertwined notions of hope, care, and the need for a shared public commitment to respond to suffering. Over the course of the chapters, the book uses a critical perspective on the study of aging, carried out through ethnographic methods to reveal the human element of late-life homelessness. It documents how late-life homelessness is shaped through age, place, and disadvantage over time, and is experienced as social exclusion. It draws attention to how late-life homelessness results from the failure to respond to need across the life course and into late life and signals a growing problem of the neglect and abandonment of older people from disadvantaged groups. Building on this, it highlights the necessity of developing responsive and meaningful models organized around prevention and social justice. Taken together, the book outlines what is meant by late-life homelessness, revealing how this phenomenon (and experience) is one of unequal aging. While concepts such as age, place, and disadvantage over time are at the heart of gerontological analysis, policies and programs, and social/cultural configurations of “what it means to grow old,” these have not been brought into an analysis of late-life homelessness. Discussions of neglect, abandonment, and justice are less developed in social gerontology, and with regards to late-life homelessness. Situated between the local and the global, the book provides ethnographic insight into the challenges that exist between structures, services, and the lives of older people with experiences of homelessness. In doing so, the analysis pushes existing interpretations beyond individual- or group-level explanations of homelessness among older

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Late-Life Homelessness

people, to the everyday discrepancies and impacts of systemic and structural factors, social programs and policies, and organizational practices. The book concludes with the recognition that contemporary contexts have altered the needs of marginalized groups, and that new long-term solutions must be developed at the intersection of aging, housing, income support, and care. This is especially the case where population aging intersects with disadvantage, a lack of affordable housing, and/or declining – or broken – social commitments, such as those witnessed in the case of precarious labour or migration, shifting age-based eligibility for support, shortages of housing and social care, and/or the breakdown of private pension schemes. Rooted in the language and accounts of older people and shelter workers, and the documents that frame responses and structure services, the book articulates what happens at the intersections of aging and homelessness, raises critical questions, draws attention to (and engages with) contradictory ideas and practices, and highlights directions for change. It sums up the experience of late-life homelessness as an experience of “unequal aging” that calls for devoted attention to prevention and social justice.

2 The State of Knowledge on Late-Life Homelessness

This chapter outlines the backdrop against which older people experience homelessness, attempts to establish the parameters of the social issue, and documents knowledge gaps. It engages with the question: what is the state of knowledge on late-life homelessness? It begins by outlining a set of global features against which the people we interviewed experienced homelessness in late-life. Next, it raises the issue of prevalence and the challenges of representation. It then details three trends that were identified in the literature at the beginning of our study (with some notable additions since), and which informed the observation and interview components of the study, as well as the theoretical perspective of the book. These include how understandings of homelessness among older people were organized around understandings of individual pathways, health needs, and responses that failed to include them. Although these features formed early results of our study (and in a strict reporting sense of the project would have appeared after a description of the methods), they are presented here as a rationale and jumping-off point for the critical approach adopted in this book.

l at e - l if e h o m e l e s s n e ss i n the global a n d l o c a l context This section details five global features that contribute to late-life homelessness, and establishes the backdrop against which older people experience homelessness. That is, it articulates components of the current context and environment that may influence or constrain contemporary policy responses to late-life homelessness.

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Late-Life Homelessness

The features relevant to the analysis of late-life homelessness are: 1) population aging, 2) inequality alongside longevity, 3) changes to families and households, 4) rising costs of housing, and 5) declining public supports. While these issues will be familiar to social and critical gerontologists, they are rarely made explicit in the majority of research and scholarship on homelessness among older people. Yet, global features reveal how population aging, poverty, labour market instabilities, health and social inequities, transitions, and unmet needs contribute to, and shape, homelessness in late-life. The literature that appears in this review is drawn from a variety of international sources, especially where Canadian data or scholarship is unavailable. While the case explored in the book comes from the Canadian city of Montreal, results will resonate with readers across Canada, the United Kingdom, Australia, Belgium, New Zealand, and the United States, as well as Sweden, Norway, and Denmark, linked with the varying mechanisms of support and patterns of homelessness that play out differently within and between countries. Population Aging Population aging, or what is sometimes referred to as the “greying of societies,” is a recognized feature of many international contexts (see Edmonston and Fong 2011).1 In Canada, the projection is that 23–25 per cent of the population will be aged sixty-five or older by the year 2036 (Statistics Canada 2015a). When compared with other countries in the oecd in 2010, “the proportion of seniors in Canada (14.1%) was below the proportions in Japan (23.1%), Germany (20.4%), France (16.7%), the United Kingdom (16.5%) and Australia (14.3%), but slightly above that in the United States (13.0%)” (Statistics Canada 2015a). In this context, the rise of homelessness among older people as a features that coincides with a broader ‘greying of the population’ can be somewhat expected. However, a rise in homelessness among older people draws attention to problems associated with a mismatch between need and response. Beyond population aging, a closer look at emerging trends points to a disproportionate representation of older people, a rising incidence of first-time homelessness in late life, and the challenges of longterm income and housing insecurity, especially where care is needed (Anderson and Christian 2003; Crane et al. 2005). In the United States, Culhane and colleagues (2013b) identified a shifting age structure

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whereby some people “grow old in situations of homelessness” (also see Culhane and Kuhn 1998; Culhane et al. 2013a). Yet, Hahn et al. (2006) documented that 40 per cent of the sample in the American city of San Francisco were new to homelessness in late life. This suggests that more older people who are homeless reflects larger numbers of older people in society, but also a new phenomenon whereby older people become homeless for the first time in late life. While our sample included older people with chronic and new experiences of homelessness, we also identified a large number of homeless men near our selected “age threshold” for late-life homelessness (aged forty to forty-five) who were at risk for sustained homelessness (Rothwell et al. 2017). Given that older people spend longer in shelters than younger groups (Culhane and Kuhn 1998; Rothwell et al. 2017), and that few exit options are available due to problems accessing work in mid-late life (Acosta and Toro 2000; Caton et al. 2005), late-life homelessness may worsen with population aging, not only as a result of a shifting age profile, but because older people who are already marginalized or at risk are moving into late life with unmet needs, and may more easily become homeless under these conditions.2 Longevity and Rising Inequality Longevity and population aging also shape homelessness in late life. While longevity has been heralded as a modern success story, it is increasingly obvious that contemporary gains in longevity have also resulted in rising inequality (often measured by means of comorbidity or mortality rates), and are beginning to stall in particular regions (Coburn 2000; Dorling 2015; Pickett and Wilkinson 2015).3 Research on homelessness has documented social and health disparities of disadvantaged groups, including higher health needs at earlier ages and premature death, when compared to the general population (Gaetz et al. 2016; Patrick 2014; Walker 2017).4 Homelessness is also racialized, including higher numbers of people from Black and visible ethnic minority groups, the foreign-born, and Indigenous peoples (First Nations, Inuit, and Métis). These trends vary between international contexts as well as across Canadian cities. For example, in the United States, African Americans are highly over-represented in homelessness (Brown et al. 2016; Paul et al. 2019). Although comparisons about the over-representation of racialized groups is difficult to know because the data is less available, in Canada, Indig-

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Late-Life Homelessness

enous peoples (First Nations, Inuit, and Métis) are over-represented, with the composition of Indigenous homelessness varying between 11 and 90 per cent across Canadian cities (Belanger, Awosoga, and Head 2013; see chapter 3). Disadvantaged groups carry the results of socially determined health and inequality via injury, illness, and impairment into late life. When medical intervention is added to the equation, disadvantaged sub-populations may live longer than in previous years as a result of health and technology, bringing complex care needs into late life. However, early mortality patterns such as those among Indigenous peoples with experiences of homelessness also suggest that this group may die before reaching old age (see further chapter 6). Yet, such socially determined realities that result from inequality are rarely considered in the discussions of “economic burdens” that are attributed to older people or during discussions of vulnerable populations who are currently characterized as having high health needs (see Gee and Gutman 2000). These inequalities raise social questions and practical challenges. On a social level, they draw attention to political and social priorities, policy-induced problems, and the failure to address disadvantage. Rising inequality and disparities (both health and social) raise practical policy and practice issues. Although people who experience homelessness may become “frail” at an earlier age, they may not qualify for services because they have not yet reached age sixty-five – a contradiction that will be further explored in chapter 4. Public rhetoric tends to focus on healthy and active older people, and in doing so, often overlooks how marginalized groups carry disadvantage into late life. For example, one striking finding of our ethnography that will be discussed in chapter 6 is the extent of serious medical illnesses and interventions that older people with experiences of homelessness have endured. Although many of the ailments were preventable, they were often left untreated until considered urgent, pointing to the implications of a system that prioritizes the medical model. And while universal health care in Canada offers access to medical procedures and treatments (that indirectly serve to extend longevity), older people return from surgery to unsuitable living conditions and an absence of social care. In this context, the failure to address inequality creates needs that are both expensive and sustain the conditions of exclusion and “unequal aging.”5 Yet, time and disadvantage are rarely connected with the analysis of homelessness or late life, even in critical scholarship.

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Structural Factors of Households and Families Changes to households and families contribute to homelessness among older people. Features such as changing household structures (e.g., a rise in single households; multi-generational households), a rise in divorce rates amongst people in mid-life, and the provision of care are considered to impact homelessness across the life course and into late life (Gould and Williams 2010). Research on lifecourse pathways into homelessness cite divorce, bereavement, and the loss of a person or family member for whom one provided care as factors leading to homelessness (Crane et al. 2005; Fitzpatrick, Bramley, and Johnsen 2013; Waldbrook 2013; also see Gonyea and Melekis 2017; Padgett et al. 2012). Here, issues such as abuse, eviction, migration, citizenship, and leaving work to provide care contribute to homelessness in late life (see Crane et al. 2005; Grenier et al. 2016b; McDonald, Dergal, and Cleghorn 2007). Changes to households and families are also known to differently affect men and women due to labour and care trajectories, life expectancy, and poverty as a result of divorce or widowhood (Angel, Jimenez, and Angel 2007; Sharma 2015).6 This is related to the differential life expectancies of men and women, and the ways in which structures such as public pensions are tied to labour force participation. The literature on pathways to homelessness often refers to such moments as “shocks” or “crises,” reflecting a disruption of the individual biographical pathway (Padgett 2007; Padgett et al. 2006). However, placing these in the structural context helps to better understand rising rates of homelessness, and differences for particular groups. Life course transitions, reflective of structural factors and changes to households and families, are intricately connected with homelessness, especially in late life where fewer supports may exist, and where retirement makes maintaining a stable income more difficult (see Curtis et al. 2013; McNaughton 2008). The research on known pathways to homelessness, however, seldom ventures into understanding why homelessness among older people is on the rise, or how it is experienced in later life. Rising Costs of Housing and the Shortage of Safe, Affordable Housing Clear links have been established between homelessness and the lack of affordable housing in Canada (Frankish, Hwang, and Quantz 2005; Gaetz 2010; Moore and Skaburskis 2004) and

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Late-Life Homelessness

elsewhere. Cities such as Vancouver and Toronto have the highest housing costs, and consequently, higher rates of homelessness in comparison to other cities (although Vancouver’s population is large, it is younger than that of Toronto or Montreal). Housing instability is unsurprisingly intertwined with low income and employment opportunities, and thus plays out differently across Canada, and among marginalized and over-represented groups (e.g., those with mental health issues, those experiencing intimate partner violence, Indigenous peoples [First Nations, Inuit, and Métis], or the lgbtq community) (Abramovich 2016; Daoud et al. 2016; Kidd et al. 2019).7 Though the province of Quebec has a history of social housing that may play a role in mitigating homelessness, this is changing (Eberle 2001). It is also worth note that while media attention tends to focus on large urban centres, late-life homelessness in Canada is also increasingly experienced in smaller cities, as well as rural and remote communities (Bruce 2006; Cloke, Milbourne, and Widowfield 2000; Forchuk 2011). The rising costs and the shortage of safe, affordable, and suitable housing, particularly compounded by social cuts in the 1980s, contribute to homelessness (see Gaetz 2010). Over time, these features have started to affect previously unaffected population groups, including older people who find themselves with insufficient funds to afford housing, food, medication, and transportation. As will be further explored in chapter 6 on disadvantage, effects may accumulate over time. For example, life course research has shown how fixed income in later life is reflective of life-long labour patterns and access to pension income, and can result in limited purchasing power in relation to the market (Padgett et al. 2012; Shibusawa and Padgett 2009). Where late-life homelessness is concerned, older people (often with low incomes and dependent on retirement benefits) participate in a housing market characterized by a lack of affordable housing, limited access to social housing, and risk of displacement (Casey and Yamada 2002; McDonald, Dergal, and Cleghorn 2007; Skaburskis 2006). Eviction and displacement, which are on the rise across a number of Canadian cities, are also key contributors to homelessness, especially in late-life (Crane and Warnes 2000a; McDonald 2011; Weitzman, Knickman, and Shinn 1990).

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Declining Public Supports – Austerity and Marketization Cuts to social programs since the 1980s, often described as “neoliberalization” or more recently “austerity,” have altered public commitments and supports, contributing to gaps in affordable housing and services (see Gaetz 2010; McBride and Evans 2017). Since the 1980s, the closure of psychiatric hospitals, the reduction of long-term care beds, and the overall shortage of funding to community-based organizations and social housing have contributed to the rise in homelessness in general (Greene 2014; Hulchanski et al. 2009; Layton 2008). The impacts of such trends can also be seen as population aging and disadvantage intersect to create and sustain homelessness among older people (Bennett and Möhring 2015; O’Rand 1996; Piat et al. 2015). Factors such as poverty, unemployment, and displacement have resulted in at-risk groups falling into homelessness (often for the first time) due to the shortage of public supports and limited exit options (traditionally configured through work) (Tsemberis 2010). The rising concern, then, is both for older people who are currently homeless and require immediate support, and for disadvantaged or marginalized groups who are at risk of homelessness as they move into late life (Gonyea, Mills-Dick, and Backman 2010; Grenier and Phillipson 2018). A number of researchers have attributed the rise in homelessness to the dismantling of public housing (Forrest and Murie 2014; Gaetz 2010; Jacobs et al. 2010).8 Although this trend is seldom discussed with regard to late-life homelessness, it has long been noted with regard to older people. The marketization of care, increased privatization of services, movement to residual support, reliance on family and kin care, and retrenchment of public support programs have resulted in unmet needs among older people (Armstrong and Armstrong 2003; Aronson and Neysmith 1997; Duncan and Reutter 2006). This problem of reduced public spending on housing and care means that older people with limited financial resources have few housing options, and even fewer options for care. Yet debates about the impacts of neo-liberal priorities and austerity often remain disconnected from poverty and homelessness in late life. Together, the above features provide a context for a detailed exploration at the intersections of aging and homelessness. With this context in mind, we turn to the question

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Late-Life Homelessness

of prevalence and the extent to which older people are overlooked in policies and practice as a means of setting the context for the critical analysis.

t h e e x t e n t o f t h e p ro b l e m a n d t h e r e c o g n i t i o n o f l at e - l i f e h o m e l e s s n e s s The prevalence of late-life homelessness in Canada is difficult to establish, and is not officially known, as it may be in other countries. Although there is a growing awareness that people aged fifty plus experience homelessness in countries such as the United States (Culhane et al. 2013a; 2013b; Sermons and Henry 2010; Brown et al. 2016), Canada (McDonald, Dergal, and Cleghorn 2007; Grenier et al. 2016b; 2016c; Hightower, Hightower, and Smith 2003), and the United Kingdom (Crane 1999; Crane and Warnes 2010), older people remain a minority in the homeless population in Canada and elsewhere.9 Numbers are, however, considered to be on the rise as a result of population aging, poverty, and the rising cost of housing described earlier (Crane and Warnes 2010; Culhane et al. 2013b). The National Shelter Study carried out in Canada between 2005 and 2009 indicated that over 8.3 per cent of shelter users were fifty-five and over, and tended to have longer shelter stays compared to younger adults (Canadian Observatory on Homelessness 2017a). Nearly ten years later, the “State of Homelessness in Canada” report (2016) indicated that the number of older people between the ages of fifty and sixty-four and seniors aged sixty-five plus who experience homelessness is growing, and that they make up a combined 24.4 per cent of shelter users10 (see also Canadian Observatory on Homelessness 2017b; Gaetz et al. 2016). Given the lack of reliable data to establish prevalence, the tendency in the field is to use PiT counts as an estimate of homelessness in a given city.11 As part of our study, we carried out a review of published PiT counts for older people, which for the most part revealed rising rates of homelessness among older people, especially in the cities of Toronto and Montreal. The proportion of people aged fifty-one plus in Toronto in the 2013 PiT count was 29 per cent, and in Montreal in 2015, 41 per cent of those counted indicated they were over age fifty (Grenier et al. 2016a).12 (See Table 2.1: Proportional Representation of Homelessness among Older People in Three Canadian Cities.) Although the lack of standardized age groups makes it difficult to compare and assess change, using the conservative age bracket of

The State of Knowledge

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age 60, data from the Street Needs assessments in Toronto revealed that the share of respondents who indicated that they were aged sixty-one and older increased from 5 to 10 per cent between 2009 and 2013 (City of Toronto 2013a, 19).13 The challenge, however, is that while shelter workers and PiT counts make clear the existence of a social issue on the rise, older people seemed to be overlooked in debates and official agendas. Our experience in carrying out the ethnography, as will be outlined in chapter 4, revealed resistance to the attempt to include the needs of older people in strategies and programs. Efforts to understand, analyze, or respond to older people’s needs were hindered by a lack of reliable data about their prevalence and were compounded by the lack of formal recognition for this within-group population. Until recently, age was not collected as a specific part of the PiT count efforts, making it difficult to gauge the extent of late-life homelessness, and further, to argue for the recognition of a within population group. Yet, PiT counts are regularly considered as conservative because they miss people who stay with friends or family – a phenomenon that is often called “couch-surfing” (Statistics Canada 2016). They also do not account for high levels of comorbidity, whereby people who are homeless die prematurely, and thus do not make it into a sample of people over the age of fifty. From the outset of the research project, the team was concerned with how to gain recognition for older people, and with drawing attention to the trends of rising homelessness that shelter workers were seeing in their everyday work, but which remained relatively unrecognized in the formal agenda on housing and homelessness. At the beginning of our study, there were few Canadian studies of homelessness among older people, and older people were rarely mentioned in larger strategies (see chapter 4). The initial problem with having a body of research that fails to consider aging or late life, and more so diversity amongst this sub-population, is that research is often used to document a “problem” and to provide the evidence base for the purpose of social response. Without this knowledge base, those developing responses either continue to overlook a particular group such as older people, or base decisions on findings that do not consider their needs. The failure to count older people created initial challenges to identifying and naming late-life homelessness as an issue, further revealing the relationship between the construction of the problem and the social response, as will be developed in

Table 2.1 | Proportional Representation of Homelessness among Older People in Three Canadian Cities City

Year

Age Group

Percentage

Montreal*

2018

50–64 65+

31.5% 6.2%

2015

31–49 50+

39% 41%

2018

55–59 60+

8% 10%

2013

51–60 61–65 65+

19% 5% 5%

2009

51–60 61–65 65+

15% 2% 3%

2019

55–64 65–74 75+

17% 6% 1%

2018

55–64 65+

15% 5%

2014

55–64 65+

13% 3%

Toronto**

Vancouver***

* In Montreal in 2018, 3,149 people were homeless on the night of April 24. 4.3% were less than 18 years old; 19.4% were aged 18–29, and 38.6% were aged 30–49. In 2015, there were an estimated 3,016 people experiencing homelessness on the night of March 24. 19% were below 30 years of age (Latimer et al. 2015; Latimer and Bordeleau 2019). ** In Toronto in 2018, 8,715 people were homeless on the night of April 26. 10% were 16–24 years old and 70% were aged 25–54. In 2013 on the night of April 17 5,253 people were homeless. 7% were under 21 and 64% were aged 21–50. The

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percentage of people who indicated they were aged 61+ increased from 5% to 10% between 2009 and 2013. An unexplained drop seemed to occur in 2018 (City of Toronto 2009; 2013; 2018). The PiT count did reveal, however, a greater number of homeless people than in 2013. ***In Vancouver in 2019, 2,223 individuals were identified as experiencing homelessness. 1% were under 19 years old, 7% were aged 19–24, and 69% were aged 24–54 (Homeless Services Association of BC, BC Non-Profit Housing Association, and Urban Matters 2019). In 2014, 1,803 individuals were experiencing homelessness. 8% were under 19 years of age, 13% were between the ages of 19 and 24, and 62% were 24–54 years of age (Homeless Services Association of BC, BC Non-Profit Housing Association, and Urban Matters 2019).

chapter 4. However, as will be outlined throughout the book, this was not only a data problem. The argument I am developing is that late-life homelessness is also a political problem about the lack of recognition and response that is interconnected with the devaluation of subjects and sustained through policies of neglect (see chapter 8). The inability to identify older people within the data, and thus define parameters for a population group, could be considered a reason that older people were absent and unrecognized in the definition of homelessness. At the time of our research, between 2012 and 2016, the formal definition and the majority of strategies to end homelessness overlooked diverse locations such as aging, Indigeneity,14 sexual orientation, and/or gender (see Grenier et al. 2016a). In 2017, the definition of homelessness was revised to include notable updates: the recognition of over-representation of Indigenous peoples resulting from colonization and cultural genocide; an acknowledgment that responses must take the diversity of the homeless population into account, including seniors and veterans; and an awareness that homelessness and housing exclusion are the outcome of a broken social contract and a societal failure to ensure all people have access to housing and the supports they need.15 (See Appendix I: Canadian Definition of Homelessness.16) Further to this change, a rights-based perspective was suggested as an overall guiding principle in Canada (see Gaetz et al. 2016).17 While the 2017 definition addressed the recognition of diverse groups and the impacts of colonialism, it did not stretch into understanding the neglect of older people as a form of ageism, nor the

34

Late-Life Homelessness

relationship between the social contract, disadvantage, and change over time that is crucial to the analysis of older people’s experiences and needs. The next section outlines the state of knowledge on homelessness among older people as it existed at the outset of our study. It is presented here as a springboard for the analysis of late-life homelessness as unequal aging.

t he s tat e o f k n ow l e d g e on homelessnes s a m o n g o l d e r p e o p l e : three trends Early in the project, we conducted a literature review to identify and set the parameters for our research into late-life homelessness. The literature on older people with experiences of homelessness pointed to complex structural and individual pathways into homelessness, high levels of comorbidity, and discrepancies between age and need.18 The literature review reflected different disciplinary perspectives, a range of methodologies, and practical tools. For example, there was a tendency to use statistical methods to document the prevalence of particular health issues and medical needs, or to predict late-life outcomes. Three thematic trends were identified: life course approaches with findings on individual pathways or trajectories into homelessness (Brown et al. 2016; Padgett et al. 2012);19 epidemiological and allied health professional studies documenting the health issues or comorbidities of older people with experiences of homelessness (Patanwala et al. 2018; Schinka et al. 2017);20 and policy-and-practice-related works that outlined service responses to homelessness in the Canadian context (City of Toronto 2013a; Gaetz, Gulliver, and Richter 2014).21 (See Figure 2.1: Three Main Understandings of Homelessness among Older People.) Taken together, these three propensities helped to identify gaps, and set the foundation for our ethnographic research and critical analysis. The following section sketches key contributions in each thematic area. Individual Pathways and Trajectories The first theme in the literature was an attempt to document and explain pathways into homelessness. A range of individual and structural factors were considered to lead to homelessness across the life course and in late life (Chamberlain and Johnson 2013;

The State of Knowledge

Individual Pathways and Trajectories into Homelessness

Focus on Health, Co-Morbidities, and Unique Needs

35

Descriptions of Policy and Practice Interventions

Critical Gerontological Ethnographic Analysis on Late-Life Homelessness

Figure 2.1 | Three Main Understandings of Homelessness among Older People

Fitzpatrick, Bramley, and Johnsen 2013; Piat et al. 2015). Regularly cited trajectories into homelessness included family breakdown, unstable employment, abuse, or trauma (Abramovich 2012; Daoud et al. 2016; Hamilton, Poza, and Washington 2011).22 Although the majority of literature was based on general pathways and trends to homelessness (Thurston et al. 2013; Tyler and Schmitz 2013), there was a smaller body of research focused on establishing patterns for older people (McDonald, Dergal, and Cleghorn 2004; 2007; Padgett, Henwood, and Tsemberis 2016; Padgett et al.2012).23 The literature relevant to homelessness among older people situated homelessness as: risk factors, trigger events, simultaneous or cumulative events, structural factors / shifting conditions, and the accumulation of these issues over time (Grenier et al. 2016b). Risk factors and events (trigger or cumulative) tended to be approached on the individual level of analysis, while the structural analysis of conditions and the accumulation of disadvantage were much less developed with regards to homelessness in later life. General risk factors for homelessness (at any age) included previous incarceration (Metraux and Culhane 2006); early experiences of victimization and/or poverty (Stein, Leslie, and Nyamathi 2002); precarious work histories, especially injuries or disability (Washington et al. 2010); meagre social and family networks (Mallett, Rosenthal, and Keys 2005); and substance use (North, Smith, and Spitznagel 1994).24 In this explanation, individuals were considered at risk for homelessness through trajectories such

36

Late-Life Homelessness

as insecure employment, poor mental or physical health, decreasing social connections, psychiatric conditions, and/or substance use (Statistics Canada 2016).25 The negative effect of homelessness on education was also identified as problematic for homeless children and youth (Masten et al. 1997; Solomon 2013). A substantial portion of the literature focused on trigger events interconnected with general risk factors for homelessness (at any age). A number of trigger events, defined as events that occur simultaneously or are considered to accumulate over time, were identified as pathways to homelessness. These included: psychological disorders (often connected with childhood traumatic events); loss of accommodation or eviction; death of a spouse, relative, or close friend (who may have provided care); domestic violence; and/ or family breakdown (see Gonyea, Mills-Dick, and Bachman 2010; Martijn and Sharpe 2006; Padgett et al. 2012).26 The combination of high unemployment, poverty, and limited access to health care, disability benefits, and pensions were also deemed to contribute to homelessness at any age (Gaetz et al. 2016),27 and these pathways were prominent in our later discussions with older people. Cumulative circumstances or simultaneous events such as unemployment, family breakdown, and physical/mental health were also considered to lead to homelessness (at any age), as well as to have a particular effect on older people already at risk due to low income, smaller social networks, or high health needs (Piat et al. 2015). Research in this area revealed trajectories that differentially affected particular groups, such as women’s experiences of violence in intimate relationships (Daoud et al. 2016)28 and/or experiences of family conflict or breakdown leading to youth homelessness (Abramovich 2016; Kidd, Gaetz, and O’Grady 2017; Stewart and Townley 2019).29 It is important to note that findings outlining cumulative or simultaneous events tended to frame homelessness as resulting from individual trajectories and pathways rather than from larger structural changes to family structures, households, or social programs that may affect networks of support across the life course and into late life, as would be emphasized in a critical perspective on aging and late life (see Phillipson 2002). Structural factors and/or shifting social conditions were however noted in some of the literature. For example, the rising costs of housing since the 1990s, combined with cuts to social programs, made it difficult to access affordable housing, and resulted in more people

The State of Knowledge

37

living below the low-income cut-off in both urban and rural areas (Crane et al. 2005; Fitchen 1992; Moore and Skaburskis 2004).30 Similarly, precarious work and unemployment were documented as structural causes of homelessness (Persaud, McIntyre, and Milaney 2010), as was workplace injury (Woodhall-Melnick et al. 2018). Yet the analysis of structured factors, shifting social conditions, and rights was much less developed where older people were concerned. The literature on older people’s trajectories into homelessness was tipped toward individual risk or trigger event–based explanations, with few studies drawing attention to homelessness as an outcome of disadvantage over time (see Hodgetts et al. 2007; Lyon-Callo 2000).31 The literature on older people was also heavily focused on health and comorbidity, as will be outlined in further detail in the next section. Life course approaches were used to document trajectories into homelessness, most notably in the United States (Brown et al. 2016; Kennedy et al. 2010; Paat et al. 2019). There were, however, gaps with regard to older people. These include: the recognition of older people as a sub-population, and consideration of how their pathways differ from those in other periods of the life course; how trajectories can change over time, causing people to move into, out of, or back into homelessness as they age; how social locations of disadvantage and systemic processes related to disability/ableism, gender-based discrimination, racism, or homophobia, for example, alter trajectories across the life course and into late life; how risks and insecurities take place in a larger social structure and across time; and how needs are particularly complex when they intersect with larger social systems, such as a shortage of seniors’ social housing or public care, as well as with experiences such as mental illness, trauma, substance use, or family breakdown (see Caton et al. 2005; Crane et al. 2005; McDonald, Dergal, and Cleghorn 2007). One example is how insecure employment brought on by discrimination across a variety of forms such as workplace injury, racism, or ableism all lead to reduced pension and/or poverty that make it difficult to access and sustain affordable housing and care. The gap in the first theme can be summarized as a gap related to the recognition and inclusion of older people. We turn now to the unique health needs and comorbidities of older people with experiences of homelessness.

38

Late-Life Homelessness

Focus on Older People’s Health, Comorbidities, and Unique Needs The second theme in the existing knowledge base on homelessness amongst older people was a heavy focus on health conditions, comorbidities, and unique needs (Serge and Gnaedinger 2003; Stergiopoulos and Herrmann 2003). Unlike the first tendency’s focus on general pathways and trends, findings on health-related issues were specifically geared to older people. This strand of research was primarily conducted from an epidemiological or population health perspective, and by medical and allied health professionals. It outlined the variety of health conditions experienced by older people, and drew comparisons between the health of older people who were homeless and the general population. In particular, findings from across this subset of the literature outlined how comorbidities for people with experiences of homelessness occurred at earlier ages than in the general population. The research in this theme documented a range of general issues experienced by older people who were homeless. These included tuberculosis, hiv , arthritis, diabetes, fungal infections, parasites, hypertension, cardiac disease, lung disease, vision loss, dental problems, and back problems (see Hwang 2001; Waldbrook 2013). It also outlined how older people who were homeless were more likely to suffer from geriatric syndromes such as functional impairment, frailty, depression, visual impairment, and urinary incontinence than the general population (Crane and Warnes 2005; McDonald, Dergal, and Cleghorn 2007). Further, it detailed how poor health intersected with safety and risks of violence. Older people who were homeless were considered to be at a higher risk of victimization because they were more likely to be in poor health and were seen as easy targets (Crane and Warnes 2005; McDonald et al. 2006).32 In this theme, a body of research written by allied professionals, such as social workers and nurses, highlighted unique needs and unavailable or unsuitable programs (Crane et al. 2005; Crane and Warnes 2010; Garibaldi, Conde-Martel, and O’Toole 2005). Researchers noted problems such as issues of access as a result of not having a valid insurance card and/or stable home address (especially for older people), long wait times in hospitals and clinics, the challenge of navigating services, the costs of prescription medications and transportation, and discriminatory treatment in health-care settings (Lipmann 2009; Martins 2008; Quine et al. 2004). Problems with institutional structures and care

The State of Knowledge

39

systems were also noted, whereby older people without housing and care were discharged directly to shelters after an extended hospital stay – a phenomenon referred to as “reckless discharge” or “discharge to the streets” (Davis et al. 2012; Forchuk et al. 2008; Kertesz et al. 2009).33 Citing American studies, Hwang (2001) outlines that homeless people were admitted to hospital up to five times more often than the general population, and stayed in hospital longer than other low-income patients (230). This was also present in our research interviews, with shelter workers giving examples of hospitals, psychiatric facilities, and prisons dropping older people without anywhere to go at their shelters. Research has noted the importance of access to care and support, including how access to medical care reduced emergency room visits (McGuire et al. 2009), and how the shortage of long-term care beds meant shelters were acting as long-term residences for older people, rather than a transition to stable housing (Culhane and Metraux 2008; Serge and Gnaedinger 2003). Together, the focus on health issues, comorbidities, and unique needs documented the medical, health, and service needs of older people with experiences of homelessness, and drew attention to disparities between older people in the general population and those with experiences of homelessness. This emphasis represented an important first step in documenting health disparities and unmet needs, and was likely a result of the newness of late-life homelessness as an emerging field of study. However, the dominance of a health and medical focus also served to sustain the tendency to individualize responses or biomedicalize late-life homelessness by portraying and responding to only health and medical needs. This seemed to create a prioritization of the biomedical over social issues such as housing, downplaying structural causes of homelessness and the broader relationship to inequality over the life course and into late life. A gap thus existed with regard to understanding the social experiences of homelessness, how disadvantage and unmet need accumulate, and how systems or structures may create and sustain homelessness. Next, we consider responses to late-life homelessness. Policy and Practice Backgrounds and Points of Reference The third theme in the knowledge base on homelessness as relevant to older people was a descriptive focus on the types of policy and service response in Canada. This set of literature outlined the policy

40

Late-Life Homelessness

and practice responses for addressing homelessness in Canada, established the context and points of reference, and drew attention to key debates that informed the development of our critical and ethnographic research. This interdisciplinary literature documented policy frameworks and responses to homelessness (either historically or as they varied across the country), and, as such, provided the backdrop for understanding late-life homelessness. Given the changes in policy and practice during our study, the literature in this domain referenced the emergency shelter/transitional model (i.e., shelter to support and housing), the Housing First model (i.e., the idea of immediate housing), and the rights-based approach (i.e., advocacy). The literature documented that until 2014, Canada’s response was premised on an emergency shelter and transitional model, with roots in charity services and community-based approaches (see Hughes 2018; Hulchanski et al. 2009). It then outlined the shift that occurred in 2014, when Canada’s response to homelessness was reorganized according to a Housing First approach (Gaetz, Scott, and Gulliver 2013; Nelson et al. 2016).34 The idea behind Housing First began with New York City’s Pathways to Housing program in the 1990s, reporting high levels of success in providing stable accommodations for “hard-to-house” chronically homeless populations (see Tsemberis and Eisenberg 2000; Tsemberis 2010). This model, when piloted in a Canadian context, also achieved success across five cities. Housing was considered a starting point and prerequisite for overcoming social and physical challenges. Housing First targeted people who were chronically and/or episodically homeless, to relieve pressures on emergency systems,35 and was intended to alter the approach from crisis/emergency shelter response (see Tainio and Fredriksson 2009; McDonald et al. 2006; Tsemberis, Gulcur, and Nakae 2004)36 to the provision of housing followed by support (Tsemberis, Gulcur, and Nakae 2004).37 There was also an emerging literature on a rights-based approach to complement the Housing First model (see Kothari 2007; Salinas 2019; Ontario Human Rights Commission 2018; Right to Housing Coalition 2019).38 One of the major shortcomings within this theme of literature, however, was the failure to include older people, or to outline how strategies, policies, and practices would need to be adapted. When older people were mentioned, there was a tendency to focus on their health, hospitalization, or mobility issues. There was also a

The State of Knowledge

41

proclivity to discuss housing in terms of youth or family needs. In principle, Housing First, and the interconnected debate on the “right to housing,” had no age limit and would technically include older people. However, there was no mention of how the program would be implemented with regard to older people. Despite the shortages of affordable housing or long-term care beds, the impacts of hospital closures, and the need for supportive housing, older people’s needs were seldom mentioned, and for the most part, late-life homelessness was absent from the larger debates in housing, homelessness, and social gerontology.39 Another shortcoming in this theme was the tendency to present a decontextualized view of homelessness that overlooked social conditions such as those presented earlier in this chapter, including change over time. A number of contemporary issues speak to the relevance of these connections. The last two to three decades have witnessed a reduction of federal and provincial investments in social housing amidst rising costs of housing across Canada (Gaetz 2010; Raphael 2002; Rolnik 2013); a labour market increasingly characterized by precarious and contract employment (Kalleberg 2009; Lewchuk and Clarke 2011; Standing 2014); pension reform (Beland and Myles 2005; Raphael 2011); and reductions in public and social care (e.g., home care, reduction of long-term care beds) (Chow and Priebe 2013; Raphael, Bryant, and Rioux 2010).40 Such changes have impacted particular groups more than others, including women (Kisor and Kendal-Wilson 2002; Kutza and Keigher 1991; Sullivan 1991), veterans (Bruckner 2001), and those with mental illness (Parsell 2010).41 Yet discussions of these issues in the field of homelessness were often separate from the takenfor-granted concerns about older people, and as such, seemed to reinforce the invisibility of aging and disadvantage in the homeless agenda, as will be outlined in chapter 4. Given the nature of disadvantage, however, such changes are likely to accumulate and impact people as they age, with differential effects depending on social location. It is for this reason that the increases in homelessness among children, families, and older people – although often approached separately in the literature and in policy – are part of the same social challenge. They are simply expressed and enacted at different historical points in time – the present and the future. We now summarize the gaps that emphasize the need for a critical perspective on late-life homelessness.

42

Late-Life Homelessness

g ap s in k n ow l e d g e : t h e need for a cri ti cal e t h n o g r a p h y o n l at e - l i fe homelessnes s A number of knowledge gaps existed where late-life homelessness and the intersection of aging and homelessness were concerned. Some of these related to recognition, inclusion, or a tendency to focus on health needs, where others related to understanding diverse experiences of homelessness in the context of population aging, declining social commitments, and the retrenchment of the welfare state. The following limitations were identified in the first years of our research project and formed the basis for observations and interviews, and later for the critical analysis of late-life homelessness presented throughout the book:

· · · · ·

Confusion existed with regards to defining late-life homelessness, and few works drew on the accounts and experiences of older people. Older people and their needs were not recognized or included in larger understandings, approaches, and strategies to late-life homelessness. Homelessness was depicted as a series of individual pathways or personal choices rather than a phenomenon that resulted from social issues, systems, or structures. A biomedical and professional focus on medical issues and unique health needs overshadowed discussions of systemic issues, social relations, and service gaps. Existing frameworks and models overlooked shifting social conditions, historical trajectories, disadvantage, and how policy creates and worsens situations for particular groups of older people.

The gaps in the literature pointed to the need for a critical approach focused on understanding the relationship between responses to homelessness and everyday encounters with systems amid social change. The existing literature pointed to the need for a clear articulation of late-life homelessness; for stronger and more meaningful inclusion of older people; for the analysis of the linkage between demographic change, shifting social conditions, and impacts of disadvantage over time; and for the inclusion of everyday insights from older people. The adoption of a critical perspective, enacted through ethnographic research, provided the theoretical and methodological

The State of Knowledge

43

foundation from which to understand the intersections of aging and homelessness, and to identify the contradictions experienced within and between the systemic and relational levels. Drawing attention to the needs of older people who are homeless is often met with resistance, if not outright dismissal, because the numbers of people affected are not deemed large enough to merit response. Even after years of conducting this research amidst a growing public awareness, it remains difficult to have older people added to the policy and practice agenda on homelessness. The emphasis remains on targeting resources to younger people in order to prevent long-term homelessness. While such interventions (if effective) may impact the numbers of people who move across the life course in situations of homelessness, they overlook the ageist assumptions that may underlie the lack of response to older people who are currently homeless, or at risk of becoming so. Existing perspectives miss how poverty and housing instability intersect with age, age relations, and disadvantage to create and sustain homelessness. This is especially the case where disadvantage brushes up against shifting priorities on housing and income support, longevity and demographic change, private care markets, and a reliance on family care. An approach that considers late-life homelessness from a critical perspective with insights from older people is crucial. We now turn to the critical and ethnographic analysis that underpins the book.

3 A Critical Perspective and Ethnographic Approach to Late-life Homelessness

Late-life homelessness is overdue for a critical analysis that is inclusive of insights from older people, and which reveals how age and power relations, social structures, and responses come together to shape late-life homelessness, and the experiences of older people who are homeless. This chapter introduces the critical gerontological perspective, and details the ethnographic methods used to understand the phenomenon of late-life homelessness in the Canadian city of Montreal. It outlines how a critical perspective can be used to pinpoint disjuncture(s) between policy frameworks, organizational practices, and older people’s experiences. It then details the four methods that were used to better understand the phenomenon and the human element of aging on the streets, in shelters, and in longterm care. The book offers a new lens to the study of homelessness that is based on qualitative work with older people and stakeholders. As such, it extends the knowledge base of social gerontology and studies of housing/homelessness to draw attention to late-life homelessness as unequal aging. This chapter engages with the question: what can a critical gerontological and ethnographic analysis offer existing understandings and approaches? It outlines the theoretical and methodological foundations that informed our research, and establishes the basis for exploring the intersections of aging and homelessness as structured and experienced. It sketches the iterative techniques and methodologies, where each stage built on findings from other methodological sources from the ethnographic project. The argument of this chapter is that a critical gerontological perspective, carried out through a

A Critical Perspective and Ethnographic Approach

45

range of complementary qualitative ethnographic methods, can render visible the challenges, contradictions, and dilemmas that exist with regard to homelessness in late life.

m y in t ro du c t io n to the study of h o m e l e s s n e s s a m o ng older people In 2009, my colleagues and I working at the creges , a province-level team with expertise in social gerontology, were contacted about an emerging trend in the city of Montreal. The creges has expertise in aging, social exclusion, and solidarity. It is primarily composed of researchers from universities in Montreal (Concordia, McGill, Université de Montréal, uqam ), and is located in a community health and social care centre that specializes in services for older people. The shelter services of the Old Brewery Mission (obm ), who would later become our research partner, were witnessing growing numbers of older people using their cafeteria and seeking emergency accommodation in the men’s and women’s shelters affiliated with their organization. The obm is an organization that provides essential services to homeless men and women in Montreal. Some of the services offered by the obm are emergency shelter, psychosocial support, urban health services to treat mental and physical health, affordable housing options, community outreach, and knowledge-building through various collaborations (Old Brewery Mission 2019; 2020). The staff and allied community-based organizations were perplexed by this surge in demand, were worried about the suitability of the shelter and its services, and were unsure how to best address the needs of older people. The concern was that the shelter was not equipped to meet older people’s needs in terms of physical accessibility, severity of health issues, and end-of-life care. Early discussions with representatives of the shelter outlined that workers and managers alike were concerned about how to meet older people’s needs in a context where few suitable rehousing options existed. Managers noted the shifting scope of the work carried out in their organizations and were unsure about what this meant for their mandate and/or service delivery. Shelter workers felt ill-prepared to take on complex cases, such as those involving memory loss, complex medical issues, or rehabilitation or palliative care. They were also disturbed to see older people “aging on the streets,”

46

Late-Life Homelessness

and coming to the shelter for the first time in late life. This echoed a similar conversation with a community worker in a woman’s shelter in Toronto, who was witnessing the same phenomenon, including situations where older women who were homeless for the first time found themselves involved in drug trafficking and/or sex work. Later, through our research, we would come to understand how greater numbers of older people on the streets and in emergency shelters brought about professional and personal challenges in the context of public services and the lives of shelter workers. For workers, witnessing older people in the shelter, and in particular those who came to the shelter to die, was fraught with ambivalence. On the one hand, it evoked a sense of relief among workers, that at minimum the shelter provided a better place for older people to die than on the street. But for many, it also symbolized a systemic failure with regards to rehousing and the goal of helping people achieve long-term stability. In Canada, there is a strong connection to public and community services, and for many professionals such as social workers and nurses, an ethics of practice that outlines this level of unmet need and suffering as unacceptable (Canadian Association of Social Workers 2005; Canadian Nurses Association 2017).1 It is this sense of injustice that informed the work from the outset of the ethnographic project, and which continued to resonate throughout. As the project progressed, shelter workers and older people exposed stories of disadvantage carried into late life, encounters with systems that revealed failed social supports, and practices that seemed to signify a cultural abandonment of vulnerable older people in need. At the time, homelessness was a new area of research for us, and my approach was (and remains) that of a critical gerontologist rather than a housing scholar, epidemiologist working with longitudinal life course data, or community-based social worker or nurse. Although we had published results as a team, the collective insights that emerged from this project deserved much greater reflection, both in terms of defining the phenomenon of late-life homelessness, and in rethinking the taken-for-granted knowledge and practices in order to suggest directions for change. Once the research project was complete, I took on this book as an attempt to extend the state of knowledge in the field of gerontology, and in particular the study of aging, disadvantage, and inequality. I approach late-life homelessness as a social gerontologist specializing in transitions, and in particular, the experiences of marginalized or vulnerable groups of older

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people. Trained in social work, social policy, women’s studies, and social gerontology, my research is interdisciplinary; located at the intersection of policy, organizational practice, and older people’s lives; and aims to bridge insights from older people with policy frames and conceptual perspectives. I am particularly interested in how concepts, frameworks, and practices used to guide social responses may or may not fit with the experiences of older people who are considered marginal, excluded, or at-risk. Late-life homelessness is one such location of disadvantage. Since the late 1990s I have conducted funded research on the social and cultural construct of frailty, managerialism in homecare (in Quebec), late-life transitions, social exclusion, and homelessness. I employ qualitative ethnographic and interpretive methods and have carried out interviews with older people across a range of social locations and situations. My research projects comprise multiple qualitative methodologies, including: discourse analysis of policy frameworks; on-site observations of institutional or community settings such as public clinics, long-term care facilities, shelters, and/or the home; professional or stakeholder interviews across private and public settings; and narratives of experience from diverse groups of older people. My work on late-life homelessness is thus informed by the collective insights of these projects and the visible connections between larger discourses, systems, and practices as they relate to diverse older people’s needs across a range of situations. My current research, which evolved directly from the findings of the late-life homelessness project, explores precarity in the context of longevity and declining social commitments (Grenier, Phillipson, and Settersten 2020). That is, it makes an attempt to trace some of the trajectories of insecurity and risk through the concept of precarity. In this sense, the project on precarity is a direct extension of my work on homelessness. The next section details the critical perspective that underpins the analysis of late-life homelessness.

a c r it ic a l g e ro n to l o gi cal pers pecti ve: a l e n s f o r a n a ly z in g l at e-li fe homeles snes s The frame of a “critical gerontological perspective on aging,” often shortened throughout the book to a “critical perspective,” is used as an umbrella approach to describe and integrate the insights of interdisciplinary research conducted from perspectives most often

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Late-Life Homelessness

referred to as critical gerontology, and more recently, cultural gerontology. Critical gerontology is a field of study concerned with aging and late-life, and comprises scholarship from disciplines in the social sciences and humanities (Estes, Biggs, and Phillipson 2003; Minkler and Estes 1999; Moody 1992). Critical gerontology draws attention to taken-for-granted assumptions, power imbalances, and social relations that create and sustain disadvantage (Estes 1979; Phillipson 1982; Walker 1981; 1982).2 Critical gerontology emerged in the 1980s and 1990s to challenge normative understandings of aging as a biomedical issue characterized by decline, and has evolved over time to include a wide range of research initiatives and contributions. According to Estes, Biggs, and Phillipson (2003), five major concerns led to the formation of critical gerontology: the need for a clearer understanding of the “social construction of dependency” in old age, made necessary by the development of welfare state services; the financial impoverishment of a large section of older people; ageism, or the systematic stereotyping of older people; the dominance of a biomedical model that conflates age with decline and illness; and the individual focus on gerontology that pays insufficient attention to social stratification and socioeconomic structures (2). As will be demonstrated throughout the chapters, these initial concerns remain ever-present, with the ethnography revealing how such features continue to affect older people at the intersections of aging and homelessness. Since its initial development in the 1980s, critical gerontology and, as positioned here, critical perspectives on aging have become increasingly interdisciplinary and expanded in scope. Differences are sometimes noted through reference to sub-fields of aging studies, humanistic gerontology, critical gerontology, or cultural gerontology (Katz 2005; Twigg and Martin 2015b).3 Geographical differences also exist,4 but the development of critical gerontology is broadly considered to have roots in two strands: one emanating from the social sciences, and in particular structural approaches in political economy, and the other situated in the humanities and what is known as “age studies” (Bengtson, Burgess, and Parrott 1997; Grenier 2012; Moody 1988; 1993). As the approach developed, the social sciences offered a critique of structured relations and economic disadvantage (see Estes 1979; Phillipson 1982; 1998; Townsend 1981),5 with cultural and humanistic approaches contributing interpretive and cultural aspects of aging and experience (Andersson 2002; Katz 1996; 2005; Twigg and Martin 2015b).

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Critical gerontology, and specifically the branch of studies rooted in political economy, contributed detailed analysis of the relationship between the state, social constructions of aging, and responses to older people. Political economists aimed to shift understandings of aging from “private troubles” (for which individuals are typically blamed) to troubles that are produced and located in the relationship between the state and a capitalist economy. For example, political economists drew attention to the political and economic conditions of older people, power arrangements, and how inequalities are created and sustained through social relations and practices (Estes, Biggs, and Phillipson 2003). Estes (1979) argues that the structure of society itself has created the problem of old age, and the construction of older people as dependant and powerless to alter their social status and condition. This includes how social policies may open up or close down opportunities, resulting in poverty, social exclusion, and inequality (Walker 2005; 2006). Arguments about the relationship between the state, institutions, and responses are certainly one feature of the analysis of late-life homelessness, as it will be pursued throughout the book. The other is to understand how the experiences that result are also cultural and meaningful, shaped through language and practice, and experienced through bodies and relationships. Humanistic approaches, viewed under the broad umbrella of critical perspectives on aging, have highlighted meanings, interpretations, and experiences of aging and late life. There are a number of terms used with regards to this second strand, including interpretive gerontology, humanistic gerontology, and cultural gerontology. When grouped, this set of perspectives is best described as having made contributions through questions such as the now-classic “what does it mean to grow old?” raised by Cole and Gadow in 1986. Perhaps unsurprisingly, this strand of work is also often referred to as interpretive, and is increasingly interdisciplinary in nature. For example, humanistic and cultural perspectives have drawn attention to how aging is constructed through organizational practices (Holstein and Gubrium 2000; Gubrium and Holstein 2008) and framed as a period of either activity or “decline” (Gullette 1997; 2004; Katz 1996; 2005). Other contributions include a focus on cultural representations of aging through media representations, depictions of lifestyles such as retirement, and the interpretations or performances of age and aging (Featherstone and Wernick 1995; Gilleard and Higgs 2000; Woodward 1999; 2003).

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Late-Life Homelessness

More recently, the thinking in this perspective has come to fall under the label of “cultural gerontology,” to highlight dominant expectations and the frameworks through which aging is understood and experienced (Katz 1996; Twigg and Martin 2015b).6 For example, Twigg and Martin (2015a) highlight four features that have resulted from the cultural turn in gerontology, including the analysis of identities and subjectivities, the body and embodiment, the visual, and time and space into the field (also see Katz 2005; Tornstam 1992; Twigg and Martin 2015b). This strand of thinking within the broad umbrella of critical perspectives facilitates the exploration of the human dimensions of late-life homelessness, including how older people experience late-life homelessness, how it takes on meaning in practices and particular spaces, and how older people have become abandoned, thereby providing interpretations that foreground a moral imperative and the argument for justice that will be developed in the third section of this book. Both the structural forms of critical gerontology (rooted in political economy) and the cultural or interpretive approach of cultural gerontology (linked with the humanities and age studies) have to date been silent on the issue of late-life homelessness, and are brought together in this analysis. A critical perspective on aging links a structural, cultural, and interpretive analysis to understand knowledge gaps; situate late-life homelessness as unequal aging; and suggest directions for change. It considers the relationships between macro-level frameworks and structural relations, organizational and service-level responses, and how these come to affect older people’s personal, social, and cultural lives (Bernard and Scharf 2007; also see Biggs and Lowenstein 2013; Calasanti 2003; McMullin 1995). In this case, a critical perspective on aging offers four analytic contributions to the understanding of late-life homelessness: first, to draw attention to social structures and responses that create and sustain late-life homelessness, and the power relations that cause late-life homelessness to be overlooked; second, to shed light on social constructs, cultural meanings, and representations of homelessness in late life; third, to highlight how structures, representations, and practices impact older people; and fourth, to expose disadvantage and inequality amidst altered conditions, and to advocate for change (Grenier 2012). As Phillipson and Walker (1987) outlined in their early work, critical gerontology holds “[a] commitment not to just understand the social construction

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of aging, but to change it” (12). We turn now to the details of the ethnography to situate the research and insights developed through the book.

a n e t h n o g r a p h i c study of l at e - l if e h o m e l e s snes s: enacti ng t h e c r it ic a l p e rs pecti ve This section outlines the ethnographic study used to understand late-life homelessness in the Canadian city of Montreal from a critical gerontological perspective. An ethnographic study was selected for its attention to the experiences and contradictions of everyday lives, its ability to render visible how systems and practices produced relations that created and sustained homelessness, and its capacity to identify areas and mechanisms for change. Critical gerontology shares with ethnography a critical focus on social relations, a cross-contextual and interdisciplinary focus, a commitment to examining how social systems shape differently situated people’s life worlds, and, most notably, an analysis of the reproduction of inequalities. Both fields are concerned with the taken-for-granted truths in language and practice, experience and encounters contextualized within a larger context, and change (see Carspecken and Carspecken 1996; Madison 2011; Thomas 1993). As Cathrine Degnen (2015) describes in the co-edited handbook on aging, “ethnography is itself a method and a perspective on the move” (109), and well-suited to the aims of critical gerontology. Ethnographies have been used across a range of subjects relating to aging and late life. For example, ethnographies have examined questions of power in institutional and non-institutional care settings (e.g. Buch 2013; 2018; Kaufman 2005; 2015), as well as the intersections of aging with gender, class, migration trajectories, and more (e.g. Dossa 1999; Lamb 2000; 2010; Livingston 2005). Given the existing emphasis on predictive models and health disparities, employing a critical ethnography was particularly innovative in its dedication to the inclusion of older people’s voices, understanding the phenomenon of late-life homelessness through the relationship between systems, structures, and everyday encounters, and rendering visible the contradictions and challenges. As such, the ethnographic study is also an enactment of the critical gerontological perspective in practice.

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Late-Life Homelessness

Ethnographies have critically examined homelessness among marginalized populations (e.g. Bourgois and Schonberg 2009; Gowan 2010; Padgett and Priyam 2017; 2019). Although few focused on the intersections of aging and homelessness, and none in Canada to the author’s knowledge, existing international works and reports on older people’s unique needs formed the jumping-off point for our ethnographic research. In the field of homelessness, the groundbreaking work of Cohen and Sokolovsky (1989) documented the survival strategies of chronically homeless older men living in the Bowery, New York City, and Padgett’s research on life course trajectories, trauma, and resilience (Padgett et al. 2006; Padgett et al. 2012), also written in the context of the United States, provided detailed examples of homelessness among older people. In gerontology, classic qualitative studies such as those carried out by Gubrium (1975) in long-term care and Rowles (1978) on older people’s social connections provide the best examples of observing, and theorizing about in the field, older people in care and in their home/community respectively. Finally, professional reports such as those of Crane and Warnes (2001) in the UK and McDonald and colleagues in Canada (2006) were also useful points of reference with regards to the unique needs of older people (also see Ploeg et al. 2008; Stergiopoulos and Herrmann 2003). The ethnographic approach taken in our study builds on these works by linking the analysis of discourses, frameworks, and responses that structure homelessness in late-life with the everyday experiences of older people. As mentioned, the project evolved from a service provider request at the obm . Montreal was selected as the study site due to our geographic location, the expressed interest from the local shelter, and in particular, the sense that there was a rising prevalence of homelessness among older people – a fact that was later confirmed through our review of the PiT count in 2015. With 1,704,694 inhabitants, Montreal is the second-largest city in Canada, comprising approximately 4.8 per cent of the total Canadian population (Statistics Canada 2017a). The 2016 Statistics Canada Census reported 16 per cent of the Montreal population as 65 years and older (Statistics Canada 2017b), and the 2018 PiT count found 3,149 people experiencing homelessness (Latimer and Bordeleau 2019). Although very limited data is available on cross-country or international comparisons for older people, the oecd report on homelessness outlines that “[i]n Canada, seniors (aged 65 and over) make up a small share

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of users of homeless shelters but the number of seniors using emergency shelters increased approximately 50% from 2005 to 2016 … England recorded a ten-year high of homeless people over the age of 60 in 2018, with the share of homeless seniors more than doubling in eight years … In New York City, homelessness among seniors has more than tripled over the past decade, with the waiting list for affordable senior housing reaching up to seven years” (oecd 2020, 6–7). Our ethnographic research focused on understanding (and describing) the phenomenon and experience of late-life homelessness, and does not attempt to establish prevalence or generalizable comparisons. The ethnography of late-life homelessness in Montreal is to be considered as a local illustration of an international phenomenon. However, differences between Canadian cities and international contexts exist. These relate to policy differences, the composition of particular cities, historical trends, job prospects, migration, and so forth. Some of the more pronounced differences can be seen between the United States and Canada, most notably related to policy structures such as the Universal Health Care system, historical trajectories of slavery, and restrictions related to housing that resulted in racialized homelessness.7 In the United States, African Americans comprise a larger percentage of the homeless population. “In 2019, African Americans accounted for 40% of all people experiencing homelessness and 52% of people experiencing homelessness as members of families with children, despite being 13% of the U.S. population. In contrast, 48% of all people experiencing homelessness were white compared with 77% of the U.S. population” (Henry et al. 2020, 1). In Canada, Indigenous peoples (First Nations, Inuit, and Métis) are over-represented in the homeless population, and this varies across the country (see further chapter 6). Indigenous peoples make up only 4.3 per cent of the general population but account for between 28 and 34 per cent of the homeless population (Gaetz, Dej, Richter, and Redman 2016, 50), and Indigenous peoples in major urban centres are eight times more likely to experience homelessness (Belanger, Awosoga, and Head 2013). Research shows that Indigenous homelessness in major urban areas  can have a range as wide as 11–96 per cent (Belanger, Awosoga, and Head 2013). In Canadian cities such as Yellowknife or Whitehorse, Indigenous peoples make up 90 per cent of the homeless population (Canadian Observatory on Homelessness n.d.), with places such as Thunder Bay and Winnipeg reporting an average of 50 per

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Late-Life Homelessness

cent of those experiencing homelessness as Indigenous (Patrick 2014). Indigenous peoples (First Nations, Inuit, and Métis) in Montreal are considered to constitute around  20 per cent of those experiencing homelessness in the city, even though they make up only around 0.5 per cent of the total population (Belanger, Awosoga, and Head 2013). As will be further discussed, however, one of the challenges in estimating the prevalence of over-represented and disadvantaged groups is that early mortality patterns seem to drastically affect the numbers of people who remain homeless into late life. The study was conducted in the francophone context of Montreal and included study participants from both official languages in Canada (French and English). While nuances may exist with regards to the way people speak about their backgrounds, lives, and experiences, the differences that emerge with regards to late-life homelessness were more likely to occur in relation to policy features such as social housing or employment trends, than to language spoken. The province of Quebec has some rent control, a history of social housing, and historically lower costs of housing, all of which may make results in this context somewhat different from cities such as Vancouver or Toronto (Eberle 2001). However, global issues of gentrification and eviction have been noted, and the features that may have protected people from homelessness in the province of Quebec have eroded over time (Burns, Lavoie, and Rose 2012; Germain and Rose 2000). Comparisons between policy features, changes to social housing in Montreal over time, or language differences are beyond the goals of our study. Given that data and knowledge about homelessness in Canada often overlook the French-speaking context of Montreal, this study also contributes insights from older people in this context, and from the second-largest city in Canada. Our study involved five academics (Grenier, Lavoie, Sussman, Rothwell, Bourgeois-Guérin), the largest shelter system in the city – the Old Brewery Mission (obm ), and the creges . In terms of our years of expertise, the research team included a social and critical gerontologist interested in aging and inequality (Grenier), a research specialist in caregiving family relationships and place and aging (Lavoie), a gerontological social worker, with specific expertise in end-of-life and long-term care (Sussman), a specialist in social work and poverty with a focus on the mechanisms that drive social and economic inequalities (Rothwell), and a researcher interested in psychology related to dying, bereavement, and end of life

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(Bourgeois-Guérin). The partner organization, the obm , founded in 1889, provides services for homeless men and women in Montreal, including a men’s and women’s pavilion, and transitional and permanent social housing. At 286 beds in the men’s pavilion and 55 beds in the women’s unit, the obm is the largest homeless shelter for men in the province of Quebec, and the largest homeless shelter for women in Canada (obm 2019; 2020). The creges conducts research on social gerontological issues, including social environments, care, and public policies, and has a recognized expertise in social exclusion and solidarity among older people. Partnering with the obm and the creges meant that the research and scholarship were situated in a provincial centre of excellence, and that there was a connection to front-line services at both the shelters, and more generally across Montreal, because the centre has an extensive network of health and social care service providers throughout the city. The study aimed to understand the intersection of aging and homelessness with regards to the cultural and political framing of late-life homelessness; social programming for older people; and insights from older people and community stakeholders. It consisted of interconnected methods carried out by various members of the research team, including: a literature review on the state of knowledge (see chapter 2); a content analysis of documents and strategies on homelessness and on aging; ethnographic observations in and around shelters in the city of Montreal; in-depth qualitative interviews with older people and stakeholders; an analysis of administrative data (available for the men’s shelter only); and interviews with workers in long-term care and referring organizations. In terms of timeline, the study began with a literature review on aging intended to establish the known patterns and approaches in the field, and to define the age limit for our study, which was set at fifty plus (Grenier et al. 2016b). I then conducted fifteen key informant interviews with management and staff across a range of provider services as a means to understand late-life homelessness on the ground level. From there, we moved to an analysis of policy documents (led by Grenier) and trends in administrative data (Rothwell). This was followed by interviews of forty men and women over the age of fifty who were homeless, in particular those using the shelter services such as sleeping quarters and cafeteria services (Grenier). We concluded our study with interviews with workers in long-term care (conducted by Sussman), and analysis across all forms of data collection. This

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section provides details and an overview of the contributions gained from each method for the purpose of providing the reader with the background research results that inform the forthcoming chapters. Stakeholder interviews allowed us to become familiar with the obm, existing programs in the city of Montreal, and a broad overview of the issue of late-life homelessness. As project lead, I conducted the interviews in English and French with stakeholders at a range of locations including emergency shelters, social work services, community soup kitchens or foodbank programs, and related services for home care and homelessness. In this book I have translated the quotes which were originally spoken in French into English. We did not interview workers whose mandate was youth or limited to people under age fifty. Levels of experience and roles within the organizations were also taken into account (see Grenier et al. 2016c). We followed a technique of “active interviewing” that is conversational in nature, and draws attention to the collaborative interview process (Holstein and Gubrium 1995). Probes focused on challenges and issues, typical practices, particular needs, and suggestions for adjustment or change. In this style, key informants were also asked to walk us through cases that illustrated the complexities and gaps within the systems. Led by Sussman, we also conducted eight interviews with stakeholders in long-term care and referring organizations to complete the project (see Sussman, Barken, and Grenier 2020). In general, stakeholder findings outlined the complexities in defining an older person in this context, the systemic challenges that resulted from older people being unrecognized, and the gaps in services for this group (see Grenier et al. 2016c). Stakeholder findings were particularly helpful in understanding the importance of age that is developed in chapter 4, and are also peppered across the chapters. In order to disguise the participants in what is in many ways a relatively small community of practice, stakeholders have been identified as working in the broad areas of either housing and homelessness, or long-term care or referring organizations. Building on the stakeholder interviews, and in particular the finding that older people were considered ‘invisible’ or excluded from strategies and services, we then simultaneously carried out ethnographic observations and document analysis. In this stage, we sought to understand how older people’s needs were framed in policy and practice; to explore what late-life homelessness looked like in everyday environments; to identify visible patterns or encounters; and

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to learn how the challenges outlined by stakeholders were enacted in everyday lives. The textual focus was on Canadian policy and policy statements at the provincial or municipal level. Our interest was to determine whether older people were recognized or included, and if there were visible patterns with regard to chronological age or older people. We also wanted to place stakeholder insights into perspective, analyzing whether identified challenges were a case of policy gaps or other systemic problems whereby services fell short of stated intentions, and how these came to affect older people. In other words, we wanted to establish whether there was a relationship between what was stated in policy and what was enacted in practice. In terms of visual data, the observations were conducted on the street, in shelters, and nearby parks by me and a research assistant primarily in the first two years of the project. Given that there was no formal agenda on late-life homelessness in Canada, the document analysis was conducted in the separate domains of aging and homelessness. The document review began with a scan of international frameworks on aging to get a sense of leading guidelines and frameworks for older people, reconfirming the notions of “success,” “activity,” and “aging in place” that are widely known and acknowledged in social gerontology, and which shape the majority of national and provincial strategies on aging (e.g., Ministère de la Santé et des Services Sociaux 1991; 2003; United Nations 2002; Human Resources and Skills Development Canada 2012). We then turned to explore the overarching statements and frameworks used to target the response to homelessness to understand if and how these portrayed aging in Canada and in Quebec (e.g. Gouvernement du Québec 2009; 2014a; 2014b; Government of Canada, esdc 2014; 2015a; 2018a; 2018b). Given the shortage of documents that mentioned both homelessness and aging, discussion with the obm and the Homeless Partnering Strategy (Canada) led to the idea of a content analysis on the municipal strategies that emerged as part of the Housing First Initiative. Our review of these documents led to the finding that of the forty-two strategies, only four had a meaningful focus on late-life homelessness, and a further twenty-two had a minimal mention, listing older people as a population group (Grenier 2016a). Further, we found that three of these were in Quebec, and as such, were likely a reflection of the discussions we had at the provincial level as well as the advocacy of the groups we had spoken to or been in contact with. We then conducted

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a content analysis to understand the discourses and frameworks around age and homelessness (Hsieh and Shannon 2005; Ritchie, Lewis, and Elam 2003). The insights from this process are discussed in chapter 4. The observations in and around the shelter were conducted throughout the first and second years of the project by me and a research assistant (see Kemmis and McTaggart 2005). As per our agreement with the obm , indoor tours of and on-site presence in the shelter spaces were conducted during the day when most of the occupants were outside, except those who had enrolled in the transitional day programs (a few older women, and a fairly substantial number of older men). In these observations I walked around with staff and then on my own, sitting to take notes in various places and speaking with residents (only when approached). This provided a sense of the physical structures of the buildings, such as stairs and shower units, and how routines were structured in and around the shelter. As suggested by the obm , outdoor observations were conducted in and around the shelter prior to scheduled mealtimes and the line-up for sleeping. Observations were also conducted in the cafeteria at both the men’s and women’s shelters during mealtimes. Having a sense of the building, structures, and routines proved important to the interpretation of the interview data, particularly where issues of access and movement were concerned (see further chapter 5). The analysis of the observations revealed the importance of place in action, including how older people used spaces such as the line-up for meals, the cafeteria, and nearby bus shelters; the challenges related to mobility and inaccessible spaces; and practices of accommodation. The results of the observations, combined with insights about service gaps, exposed the everyday experiences, notable trends, and discrepancies between policy ideals and structured experiences of exclusion (see chapters 4, 5, and 7). Building on stakeholder insights and observations of our partner organization and surrounding areas, which suggested that the numbers of people aged 50 and above were on the rise in the shelter system in Montreal, we then turned to the administrative data to understand the age profile of people using the shelter system, as well as their length of stay. Literature from the United States suggested that older people stayed longer in the shelter system than younger people, but limited estimates existed in Canada (see Culhane and Kuhn 1998; Hwang 2000; Hwang et al. 2009). In this component

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of the project, led by Rothwell, we were interested in understanding statistical trends in service utilization among our population group (Rothwell et al. 2017). Unfortunately, the records were insufficient where the data from the women’s shelter was concerned, but the men’s shelter had sufficient administrative data via the Homeless Individuals and Families Information System database (hifis ). Our analysis focused on length of stay, and reasons for departure. Using this data, and sas software, we found that older men stayed longer than younger men in the shelter by an average of about two weeks. Further, we learned that the risk of departure was related to legal issues and concerns with mobility (see Rothwell et al. 2017). In the process, we also identified a group of men nearing age 50 who, without intervention, would likely move into a position of aging within the shelter system. This finding informed our thinking on disadvantage, and became the point for a further study on precarious aging. We then conducted interviews with forty older men and women aged fifty plus with experiences of homelessness in Montreal. Interviews were carried out in English and French, in the language the older person was most comfortable speaking.8 After consultation with the partner organizations, the decision made was to have people who had worked in the field conduct the interviews in order to help with recruitment. Although this decision had strengths and weaknesses in terms of the distance between me and the interview participants (and sometimes wanting to have followed up with particular questions), it resulted in extremely high levels of participation and a sense of ongoing involvement from the partner organization. Given the nature of our sshrc funding, which requires student trainees, the team located two bilingual student research assistants who had experience working with the shelter (one with men and the other with women). Recruitment was facilitated by our agency partner by allowing access to the cafeteria and the property during programming hours. Interview questions focused on understanding experiences of the intersections of aging and homelessness, and in particular, the challenges of aging while homeless. This included discussions of everyday lives; trajectories into homelessness; past, present, and future expectations with regards to homelessness and aging; and the challenges these men and women experience as they age, including their use of shelter services. The names of older people have been replaced throughout. Older people were asked to pick a pseudonym to be used in the report. Researchers then reviewed

Table 3.1 | Demographic Profiles of Older People with Lived Experiences of Homelessness Male Participant Demographics Archival Number

Pseudonym

Age

Education

Employment Status (and Length if Unemployed)

Living Situation

Receiving Benefits

oh-m1-t-f

Robert

56

Bachelor’s

Unemployed (1 month)

Transitional program

No

oh-m2-t-f

Jean

57

Some secondary

Unemployed (Unanswered)

Transitional program

No

oh-m3-h-f

François

55

Some secondary

Unemployed (Unanswered)

Stable housing (1 year)

Unanswered

oh-m4-s-f

Simon

56

Some college

Unemployed (Unanswered)

Shelter

Disability

oh-m5-s-f

Étienne

57

Some college

Seasonally employed

Shelter

Unanswered

oh-m6-o-f

Axtérix

60

Some graduate school

Unemployed (Unanswered)

Subsidized housing

Government pension

oh-m7-t-f

Normand

50

Some college

Unemployed (Unanswered)

Transitional program

Disability

oh-m8-t-e

Marc

46

Some secondary

Unanswered

Transitional program

Unanswered

oh-m9-s-f

Ben

56

Bachelor’s

Unemployed (3.5 years)

Shelter

No

oh-m10-t-f

Fernando

76

Secondary

Unemployed (12 years)

Transitional program

No

oh-m11-o-f

Harmonibros

55

Grade school

Unemployed (10 years)

Subsidized housing

No

oh-m12-s-f

Mattieu

51

Secondary

Unemployed (17 years)

Shelter

No

oh-m13-s-f

James Bond

70

Secondary

Unemployed (5 years)

Shelter

Government pension

oh-m14-s-f

Frédéric

69

Some college

Unemployed (23 years)

Shelter

Government & private pension

oh-m15-s-f

Spider-Man

61

Bachelor’s

Unemployed (3–4 years)

Shelter

Government pension

oh-m16-s-f

Gabriel

51

Grade school

Unemployed (8 years)

Shelter

Disability

Archival Number

Pseudonym

Age

Education

Employment Status (and Length if Unemployed)

Living Situation

Receiving Benefits

oh-m17-s-f

Bakuet

60

Grade school

Unemployed (4 years)

Shelter

Government pension

oh-m18-o-f

JP

55

Secondary

Unemployed (6 months)

Subsidized housing

Unanswered

oh-m19-t-f

Denis

52

Some secondary

Unemployed (5 months)

Transitional program

Unanswered

oh-m20-s-f

Pierre

59

Bachelor’s

Unemployed (1 year)

Shelter

Private pension

oh-m27-s-f

Lucas

64

Cégep

Seasonally employed

Shelter

Government pension + work

oh-m28-s-f

André

58

Bachelor’s

Unemployed (1 year)

Shelter

Private pension

oh-m33-t-f

Yves

53

Some secondary

Unemployed (1.5 years)

Transitional program

Unanswered

oh-m34-t-f

Jacques

50

Some secondary

Unemployed (33 years)

Transitional program

Unanswered

oh-m35-t-f

René

55

Some college

Employed

Transitional program

Unanswered

oh-m36-t-f

Max

54

Secondary

Unemployed (3 years)

Transitional program

Unanswered

oh-m37-t-f

Mitsuboy

57

Bachelor’s

Unemployed (3 years)

Transitional program

Unanswered

oh-m38-t-f

Paul

58

Some secondary

Unemployed (10 years)

Transitional program

Disability

oh-m39-s-f

Claude

75

Some graduate school

Unemployed (20–25 years)

Shelter

Government pension

oh-m40-s-f

Grizzly

59

Bachelor’s

Unemployed (25 years)

Shelter

Unanswered

Code for Archival Numbers (Male and Female Participants) oh – Older person with experience of homelessness m or w – Recruited from men’s or women’s shelter # – Number

t – Transitional program at the shelter; h – Housed; s – Shelter; o – Other (all three subsidized-shelter program) f – Interviewed in French; e – Interviewed in English

Table 3.1 | Demographic Profiles of Older People with Lived Experiences of Homelessness Female Participant Demographics Archival Number

Pseudonym

Age

Education

Employment Status (and Length if Unemployed)

Living Situation

Receiving Benefits

oh-w21-t-e

Wanda

59

Master’s

Unemployed (~ 2 years)

Transitional program

No

oh-w22-t-f

Marie

65

Elementary school

Unemployed (20 years)

Transitional program

Disability

oh-w23-t-e

Rita

55

Bachelor’s

Unemployed (15 years)

Transitional program

Disability

oh-w24-t-f

Claudine

63

Some secondary

Unemployed (Long, long time)

Shelter

Unanswered

oh-w24-t-f

Manon

59

Some secondary

Unemployed (15 years)

Shelter

Disability

oh-w26-t-f

Marcia

55

Secondary

Unemployed (10 years)

Transitional program

Disability

oh-w29-t-f

Joanne

60

Some college

Unanswered

Transitional program

Disability

oh-w30-t-f

Betty

53

Some secondary

Employed

Transitional program

No

oh-w31-t-f

Sylvie

50

Grade school

Unemployed (Whole life)

Transitional program

Disability

oh-w32-t-f

Sarah

61

Unanswered

Unemployed (19 years)

Shelter

Unanswered

Code for Archival Numbers (Male and Female Participants)

oh – Older person with experience of homelessness m or w – Recruited from men’s or women’s shelter Interview Number

t – Transitional program at the shelter; h – Housed; s – Shelter; o – Other (all three subsidized-shelter program) f – Interviewed in French; e – Interviewed in English

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Other information and summary details from the above tables: * Place of birth: thirty-six of forty participants reported their place of birth as Quebec. Two were foreign-born (Ben and Fernando). One person was from the East Coast (Claudine) and one response was unanswered. * Language: All were French speakers or bilingual, leading to this being interpreted as a sample of people who were relatively local (as opposed to migrating across the country throughout the year). Immigration policies require some proficiency in French, meaning that the two foreign-born people would have been subject to a language exam. * Indigeneity: three people reported being Indigenous (First Nations, Métis, or Inuit) (Spider-Man; Betty; Mitsuboy) and five were unanswered. * Civil status: None of the people we interviewed were partnered. All were separated/divorced, single, or widowed; five unanswered. * Children & in contact with children: There was an almost even mix with regard to having children: twenty-three participants reported having children, and seventeen indicated that they did not have children. Having children did not necessarily mean they were in contact with them. * Chronic or new to homelessness: The demographic information collected did not permit classification into ‘chronic’ or ‘new to homelessness’ categories. Stories and the years unemployed, however, do provide insight into the duration of homelessness, although some had cycled in and out of homelessness at different periods of their lives.

names, and altered those that were more nicknames and might have been used to identify the person. I have translated older people’s quotes that were spoken in French into English throughout. Our sample provides a range of insights from varying social locations of homelessness in late life. Table 3.1 provides the individual-level details of the forty older people with experiences of homelessness. Of the forty people interviewed, twenty-nine were men and eleven were women, with twenty-five people falling in the middle age range of fifty-five to sixty-four, ten in the age range of fifty to fifty-four, and five over sixty-five. The youngest person was forty-six,9 and there were two people who were aged seventy-six at the time of the interview. Most of the participants were from Quebec (thirty-six of the forty), with one from another province (East Coast), two foreign-born (Africa and Latin America), and one unanswered. Three older people self-identified as Indigenous (First Nations, Inuit, or Métis). All of the people we interviewed were single, by means of not having partnered, separation or

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divorce (fifteen), or widowhood (three), and the sample was nearly split between those with children (twenty-three) and those without (seventeen). Education also ranged, with the most populated categories being high school or less (fifteen people) and some university (eleven; we did not ask whether they had completed, only if they had taken courses). In terms of income, most were unemployed (thirty-four), with two employed and homeless, two seasonally employed, and two unanswered. In terms of benefits, most either did not answer (twelve) or claimed no benefits (ten), with ten people on disability, six on a government pension, and two with an additional source of income. (Also see Appendix II, Comparative Table of Older People with Lived Experience.) Analysis was carried out at each stage and checked by the team. Further analysis was carried out at each stage of writing the journal articles, and new understandings emerged through writing about late-life homelessness from a critical perspective. Consistent with the critical gerontological perspective of my research practice, the analysis of interview data was informed by constructivist grounded theory (Charmaz 2005; Holstein and Gubrium 2000; 2007; Patton 2002) and narrative analysis (Chamberlayne et al. 2000; Frank 2001; Roberts 2002), which helped us to understand the stories, experiences, and insights in relation to social/cultural constructs and contexts. Special attention focused on the elements of the storied account (e.g., turning points, metaphors, key events) (Chamberlayne et al. 2000; Frank 1995; Roberts 2002), and the insights gleaned within each story and across all accounts (Charmaz 2005). The idea was to establish a better understanding of the phenomenon of latelife homelessness, how late-life homelessness was structured through responses, and how ideas and practices affected older people’s experiences of homelessness in late life. Qualitative research aims to understand experiences and relationships rather than making comparisons or generalizing outcomes. As in other projects, analysis focused on how stories were linked to macro-level structures, policy frames, and organizational practices (Grenier 2012; Grenier, Phillipson, and Settersten 2020).10 It is precisely these detailed accounts, as will be outlined across the book, that led to witnessing how systems, structures, and practices impacted the lives of older people with experiences of living on the streets, in shelters, and in long-term care. Throughout the project, we published results that generally corresponded with the stages of

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data collection. This book builds on these publications to advance the understanding of late-life homelessness as structured and experienced, and in particular, how late-life homelessness results from a range of forces that cannot necessarily be predicted, that accumulate over time, and that create and sustain disadvantage. It does so through a unique critical perspective that is enacted through qualitative research and the stories of older people, revealing late-life homelessness as unequal aging.

c o n c l u s i on This chapter established the theoretical and methodological foundations for a critical analysis inclusive of insights from older people, revealing how age and power relations, social structures, and responses came together to create and shape homelessness among older people. It introduced the critical gerontological perspective, and detailed the ethnographic methods used to understand late-life homelessness in the Canadian city of Montreal. It outlined the role that a critical gerontological perspective could play with regards to understanding the intersections of aging and homelessness; the possibility of understanding late-life homelessness as a reflection of shifting social, political, and economic conditions; the relationship between institutional policy structures, practices, and experiences; and an analysis of the dynamic patterns that can unfold across life, settings, or places, and deepen where supports are either difficult to access or unavailable. This chapter has positioned the critical gerontological perspective as a strong basis from which to understand late-life homelessness, address knowledge gaps, and initiate change. In doing so, it highlights how critical perspectives that claim to study disadvantage can be extended to better understand how age and spatial relations create and sustain late-life homelessness. It brings awareness to latelife homelessness as an experience of structured yet unpredictable moments, disadvantage over time, and unequal aging. As such, it repositions late-life homelessness from something that happens to individuals in later life, to something that happens as a result of social, cultural, and political priorities, and a failure of social support. The outcome, as will be demonstrated throughout the book, is a novel awareness of late-life homelessness resulting from disadvantages and unmet needs that are sustained and carried into late

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life. With the foundations for the critical gerontological and ethnographic perspective firmly established, we now move to the next section of the book that explains the intersections of aging and homelessness through detailed qualitative insights from the vantage points of age, place, disadvantage, and exclusion.

s e c t io n i i

Project Insights from Four Thematic Angles

4 Age and Late-Life Homelessness

This chapter focuses on age and late-life homelessness. It begins the second section of the book, where ethnographic findings are used to reveal a new understanding of late-life homelessness. The chapter is organized around age as it is known in gerontology, and as it came to be observed in the lives of older people with experiences of homelessness, and by stakeholders who work with this group. It reveals how late-life homelessness is structured through chronological age and enacted through age-based responses, exposing the gaps that result from these arrangements. While growing attention has turned to latelife homelessness as a new social challenge, the implications of relationships and responses that are mediated through age are not well understood. This chapter demonstrates how chronological age, expectations about age, and the real and perceived needs attributed to age factor into understandings and approaches to late-life homelessness. The chapter draws together findings from policy documents, stakeholder interviews, non-participant observation, and interviews with older people into an enactment of a critical gerontological perspective. The chapter engages with the questions: what happens at the intersection of aging and homelessness; how do social constructions of aging and homelessness structure and shape understandings and responses; and how do these configurations affect the experiences of older people who are homeless? It begins with an overview of how age is understood in social gerontology. It then sketches multiple views from policy frameworks and the frontlines, including: homelessness among older people as invisible or overlooked; older people with experiences of homelessness as a vulnerable population in need of protection; and age as a means to provide or limit access

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to services. The section includes quotations from policy documents and stakeholders to render visible the effects of age and age-based structures. This is followed by a section that illustrates the impacts of age-based arrangements from the perspective of older people. Together, the results show how responses organized around age can complicate access to essential supports, and in so doing, overlook the realities of “being old” and “on the street.” It then explores ageism and stereotypical assumptions as an explanation for these responses, and reflects on issues of income security, health, housing, and care.

u n d e rs ta n d in gs of age: s o c ia l g e ro n to l o g ical pers pecti ves Age is a key factor of analysis in social gerontology, and central to the analysis of late-life homelessness. This section is written as a foundation for those new to the study of aging and late life, but gerontologists and students may find it a useful refresher. Age can be understood and viewed in overlapping ways, including: as a social process and/or cultural construct; as an institution or social structure; as a distinct period or life course process; and as a subjective experience. The following sections primarily address the first three as a means to understand the social relations of age that are relevant to homelessness, with some commentary about subjective interpretations of age woven into each discussion. This section does not focus on the subjective debates about age in any detail here, because doing so would distract from laying the foundation with regard to social constructions, structures, social relations, and cultural imperatives as they relate to late-life homelessness. The discrepancy between age and need, and further between perceived and actual age, will be picked up as a study finding, and discussed later in the chapter. Studies of aging in the social sciences and humanities have documented that aging is not only biological, or a standard measure of time based on date of birth, but a socially and culturally constructed process that takes place across the life course. Age is configured through date of birth, stage-based markers, and visible signs of change in the body over time (Baars 2012; Bytheway 1995; 2005). “Western” interpretations of age focus on the importance of youthfulness, and are intertwined with ideas of independence and longevity (Achenbaum 1995; Small 2007). Age is also mediated through social relations, and through cultural notions such as “decline” or “healthy

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aging.” In the contemporary “Western” context, there is a tension between depictions of aging as impairment/decline and opportunity/ health/vitality (Gullette 2004; Lamb 2014). Whereas policy frameworks tend to emphasize the imperatives of “health and success” (Featherstone and Wernick 1995; Gergen and Gergen 2001; Katz 2001), policies and practices are often configured to prevent frailty and decline (Grenier 2007; Gilleard and Higgs 2000; Higgs and Gilleard 2015). Thus, whether by means of chronological age (i.e. birthdate) or the social and cultural markers through which someone is considered “old” (e.g. grandparenthood, grey hair, wrinkles, the use of rehabilitation devices), age is an important social distinction. Age also figures into ideas of what counts as “young” or “old” in processes of meaning-making (e.g., “I feel old” or “I do not feel old – I am 70 but feel 55”), and in distributions of care or support (e.g., retirement benefits based on age) (Hurd 1999; 2000). For the most part, however, older people tend to claim to “look” or “feel” younger than their age, thereby reflecting a youth-based imperative. As will be revealed, late-life homelessness flips this narrative because older people with experiences of homelessness report looking and feeling “older” – not younger – than their chronological age. Age is also deeply embedded in social structure, and used to mark roles, norms, and expectations of a life course (see below). Age is at the heart of the standard life course structure, which is punctuated by typical markers of childhood, adulthood, and later life (Hockey and James 2003; 2017). Within each stage are associated sets of activities and their related timing such as school, family, work, and retirement (Hareven and Adams 1982), although debates have been raised about the problems of normative framing (Fabbre and Siverskog 2019), the distinction between objective and subjective age (Rudolph, Kunze, and Zacher 2019), and the “blurring of life course stages” (Levin 2013). Age demarcates “normative” expectations, determines the timing of events or roles, and marks points of change or transition across the life course (Cain 1964; 1967; see Grenier 2012). It is for this reason that age is considered as an institution that shapes relationships between structures and actors in society (see Kohli and Meyer 1986; Mayer and Schoepflin 1989; Meyer 1986).1 For example, Riley (1971) referred to American society as being “age stratified” or segregated by age (Riley 1971; Riley, Johnson, and Foner 1972; Riley et al. 1994),2 with chronological age forming the pivot for social relationships between young and

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old people.3 In this sense, age is a social structure against which lives take shape and can be measured for objective and subjective appraisal. The idea and assessment of age, whether chronological or age-based, thus become the means to assess maturation or development, capital and status in social relations, and the cultural achievement of “success.” Yet, late-life homelessness presents challenges to age-based structures and configured markers of success. Understandings of age are about segmenting life and people into groups for the purposes of social response. Responses to aging and late-life contain an inherent tension between configurations of age as a distinct period determined by chronological age, and a process that takes place over time and throughout a life (and lives). On the one hand, aging, or late life, is considered as a distinct point or period defined by date of birth (chronological age). It is also often characterized by biological, psychological, and social issues of impairment, illness, and/or the need for care. For example, the needs of people who are older are often viewed as “age-related,” and there is a common notion (and, for many, reality) that age brings about changes to the body and health that prompt a need for additional care. On the other hand, aging is considered a process that evolves over time – it is a “structure through which a life unfolds” (Holstein and Gubrium 2007). This unfolding implies notions of continuity or rupture, and the possibility of development and change over time. The underlying conceptualizations of aging as a particular period or life-long process become particularly important when used, either implicitly or explicitly, with regards to ideals, cultural imperatives, and policy or practice. The difference between responses based on views of aging as a distinct period and of life as a whole become acutely visible in the context of public services. Policies and programs geared toward particular age groups or periods in the life course look different from those based on understandings of aging as part of a life-long process. For example, income support programs target particular groups such as people with disabilities (e.g., disability benefit) or older people (e.g., retirement), and programs such as universal health care reflect understandings of health as a life-long process. Late-life homelessness, however, does not fit easily into the configurations and responses to age: it is outside expected models and normative frames, it is more unstable than predictable, and it presents health disparities that are incongruent with chronological age.

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ag in g a n d h o m e l e s s n ess: fi ndi ngs from p o l icy d o c u m e n t s a n d the front li nes This section presents early project results of the analysis of age and late-life homelessness in policy documents at federal, provincial, and municipal levels, combined with insights from stakeholders working in the housing/homelessness sector. The aim of this part of the analysis was to understand the formal configurations and textual responses to aging and homelessness. This includes the extent to which older people were included, how their needs were depicted, and how age was used (or not) in the service responses. Findings are intended to demonstrate system- and structural-level challenges, and to set the context for understanding older people’s experiences. Material on age is presented according to three intersecting themes relevant to late-life homelessness and the challenges experienced by older people. First, older people were an invisible and/or overlooked population. Second, when older people were discussed, it was as a vulnerable sub-population in need of protection. Third, responses based on chronological age were deemed to hinder access to services and leave needs unmet. An Invisible and/or Overlooked Group The analysis of policy frameworks and guiding documents on homelessness revealed that older people were, for the most part, absent, invisible, or overlooked in Canadian strategies, provincial documents, and municipal initiatives to end homelessness. As outlined in chapters 1 and 2, despite a growing awareness of homelessness among older people, policy, social programming, and services tended to focus on younger adults and young families (Cohen 1999; Crane and Warnes 2007; Gonyea et al. 2010).4 The document review drew attention to older people with experiences of homelessness as an invisible group. There were no existing federal strategies or statements on late-life homelessness in Canada, few Canadian strategies had a dedicated section on older people, and most were unlikely to mention older people among ‘at-risk’ groups (Grenier et al. 2016a). As outlined in chapter 1, older people were also relatively absent from the federal pilot projects for Housing First (Gaetz, Scott, and Gulliver 2013; Goering et al. 2014). As such, a gap in the implementation of Housing First with regard to

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older people was unsurprising as programs rolled out across the country. The gap in knowledge about how proposed models work with regards to late life served to compound challenges emerging from the context of a lack of affordable housing in the context of population aging (see Gaetz, Scott, and Gulliver 2013; Goering et al. 2014; Serge and Gnaedinger 2003). Two provincial-level documents, both in the province of Quebec, were found to include older people. In Quebec, the Inter-ministerial Action Plan on Homelessness (2009) and the National Policy on Homelessness (2014) (Gouvernement du Québec 2009; 2014a; 2014b) recognized older people who were homeless. These two provincial-level documents were the exception to the finding that older people were invisible in policy documents. These documents attested to the specific challenges, vulnerabilities, and needs of homeless people over age fifty. In each, older people were depicted as a vulnerable group in need of protection (see next section). The following quote from Quebec’s National Policy on Homelessness recognizes older people and their needs: Older people who are homeless have extremely poor health (physical, psychological, cognitive); experience premature aging; and have a mortality rate that is three to four times greater than the general population. As such, this group is particularly vulnerable, both financially and socially (victimization, abuse, isolation). (Gouvernment du Québec 2014a, 14–15, translation by author) The observable trend of invisibility continued across municipal-level documents and strategies. Our team located only two municipal-level strategies with a significant discussion of older people’s needs (see Grenier et al. 2016a).5 These were the City of Drummondville’s Community Plan on Homelessness (L’Agence de la santé et des services sociaux de la Mauricie et du Centre du Québec 2011), and the hrsdc Homelessness Partnering Strategy Plan for Metro Vancouver (City of Vancouver 2011).6 A further rapid review of the fifty-three existing community plans written as part of the federal-level Homeless Partnership Strategy (Canada) for 2014–2019 (the strategy guiding and responsible for the cross-country initiative to test Housing First in Canada) found that only nine of the submitted municipal and community-level plans named older people as a target

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population, and even fewer focused on defining the particular needs of this group (Government of Canada 2015a; see Gaetz, Gulliver, and Richter 2014; Grenier et al. 2016a). The failure to recognize older people in the municipal strategies and community plans suggested that organizations serving homeless people were not aware of older people’s needs, or that the groups who serve older people were not adequately consulted, which make the insights from stakeholders and older people especially informative in the Canadian context. The lack of recognition of older people across federal policy, and in provincial and municipal strategies on homelessness, has implications for support, and may become especially problematic in the context of population aging, and as homelessness among older people continues to rise. Similar to the illustrations in the documents written by the provincial government of Quebec, stakeholders and front-line workers presented a complex perspective on late-life homelessness, including the needs of this population and major service gaps, and the challenges they witnessed in their everyday caseloads in Montreal. When set against the dominant tendency to overlook older people, the examples from Quebec (where three of the four examples were located), combined with stakeholder interviews, revealed an emerging phenomenon and pattern whereby discussions of vulnerability were used to gain access to services. A Vulnerable Group in Need of Protection The view of older people as a vulnerable group in need of protection was prevalent in the specialized literature, stakeholder interviews, observations of older people, and the two above-mentioned provincial-level documents (i.e., Quebec’s Inter-ministerial Action Plan on Homelessness and the National Policy on Homelessness). There were, however, notable differences by source of data. The general literature on homelessness among older people discussed specific diseases, impairments, and comorbidities from a primarily biomedical perspective (see chapter 2). The four strategies that included a meaningful discussion of older people (two provincial and two municipal) and the stakeholder insights expanded this focus to include vulnerability across a range of medical, social, and geographic contexts. Yet there was overlap between the literature and stakeholder discussions, with both employing health issues to signal the need for intervention and access to treatment. Here, stakeholder

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discussions of income support, housing, psychological support, and care matched the interpretations within Quebec’s national policy on homelessness. Stakeholders regularly used discussions of age, health disparities, and the language of “frailties” to convey the vulnerability of older people with experiences of homelessness. Such disparities were referred to as the “geriatric profile” or as “premature aging.” For example, stakeholders outlined how older homeless people had multiple health issues and “looked” older at younger ages. Stakeholders revealed how homelessness in late life differed from expected patterns of aging because it involved greater levels of vulnerability; presented service challenges because programs did not exist or people were “too young”; and included needs related to disadvantage and trauma across the life course. Stakeholders discussed how people with experiences of homelessness “prematurely” became old by means of disparities, and gave subjective appraisals of encountering people who looked seventy but were only fifty. The stakeholder interviews also emphasized the need for high levels of support that were not available in the shelter system (see further below). Stakeholder comments reflected the widespread recognition of health disparities, and that being homeless exacerbated health issues (see Hwang 2001; Waldbrook 2013). Although stakeholder views were generally consistent with provincial and municipal strategies, stakeholders also addressed a wider range of social issues, such as access to services, housing, and care, stressing how older people with experiences of homelessness fell between the gaps of services. The following quotes reveal typical stakeholder interpretations: Q: When you use the word older person in the context of homelessness, what age do you have in mind? R: Well, it really depends, because sometimes you see the person, she just seems so, so tired, you say she must be very old, but she is only fifty years old. So, when I think of an older person I tend to go with the age of sixty-five. But in this case [homelessness] you’d be surprised, they seem like they are … but they are only fifty, even forty-eight or forty-nine, but they look sixty or seventy. It is very subjective. – Stakeholder, Housing and Homeless Sector Well, some of our members speak of aging at age fifty or thereabouts. We are working with the health agency to define what is

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meant by the geriatric profile. So, the idea would be that it is not only age, but the profile of the person – that is what we want to communicate. – Stakeholder, Housing and Homeless Sector Results from stakeholder interviews revealed vulnerabilities related to (or which became apparent through) the discrepancies between chronological age, health needs, and available services. Analysis across data sources revealed how late-life homelessness, and the accompanying health and social disparities, also altered the typical socio-cultural markers of “age.” That is, as acutely noted by stakeholders, there was a discrepancy between chronological age based on the date of birth, perceived age, and health needs. For older people who are homeless, needs typically deemed to be “age-related” (i.e., the “geriatric profile”) and the visible markers of age or impairment (e.g. grey hair and/or rehabilitative devices) both objectively and subjectively appear at earlier ages. In defining late-life homelessness, stakeholders underlined the differences between the perceived and actual ages of their service users. This finding was also observed in recruitment and data collection. In our research, for example, we encountered one participant aged forty-six who insisted on sharing his insights, because he subjectively felt – and would have been classified by many as – “old.” In this case, even the researcher judged this person to be approximately seventy years old, drawing attention to how seemingly objective and normative classifications of chronological age based on visual judgments are skewed by the impacts of inequality. Whereas the body of literature in gerontology has tended to discuss how older people use subjective statements to express their youthfulness and defy age, late-life homelessness counters this practice because people seem, and are judged to be, much older than they are. Observations of interactions in and around the shelter revealed everyday encounters related to the ideas of vulnerability and protection that are often intricately interwoven with assessments of and responses to age, especially within welfare state models of care. It was not possible to know the precise age of people observed in shelters or cafeterias. Assessments were thus based on subjective and cultural markers or signifiers of age, such as grey hair, physical stature, or the use of rehabilitative equipment. Results suggested that the people who “appeared to be older” were subject to particular types of interactions that were different from younger people in these settings. For

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example, people who “seemed older” were always the first in the line at the men’s shelter. The first round of the cafeteria service could also be described as a “sea of grey” and included countless people with rehabilitative devices. This finding, while rendered visible through subjective assessments of the cultural markers of age, had more to do with the impacts of disadvantage and age, through reduced mobility and safety, as will be further developed in chapter 6. While we may have included more people who “appeared older” in the observations (such as the forty-six-year-old man), witnessing interactions with people who had the cultural markers of age provided insight into the interpersonal relations and institutional practices related to age, simply because the people being observed were likely to have also been judged by others as “old.” Of note, the population of older people were less diverse in terms of Indigeneity and visible ethnic minority status than would be expected in younger cohorts, and especially in other cities, although there was some change in this regard as the evening progressed – with younger people from visible ethnic minority backgrounds showing up in the second and third rounds of service. Although the reasons for this timing are unknown, this may relate to the distance between the locations people tended to frequent during the day and the shelter. Observations, paired with on-site engagement and interviews with stakeholders across a range of sites, revealed informal responses and practices of accommodation organized around age, and which were interconnected with vulnerability and the need for protection. Such practices were present in both the men and women’s shelters. On several occasions, I witnessed a routine where the men farther down the line would allow older men and women to move to the front of the line (the cafeteria for the men’s shelter was not limited to men; however, fewer women tended to use this service). It was difficult to assess how this initially came about, and the extent to which this practice was about recognition of vulnerability, respect, or marking people as targets for violence (as the literature might suggest). This response seemed to be enacted as a caring and friendly act, possibly connected to institutional practices at that site, but also potentially a sign of respect for wisdom, or an inside recognition of how difficult a life on the streets as an older person can be (see chapters 7 and 9). It was, however, a very meaningful moment of recognition of ethnographic work, which led to understandings of how older people used spaces and configured their routines differently as a result of

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limited mobility, and for the purposes of protection. What became clear from both stakeholder interviews and observations was the idea that age – or the appearance of being older and homeless – was interconnected with ideas of vulnerability, weakness, and protection, whether enacted by self or other. Stakeholders also adopted practices to accommodate age and vulnerability. For example, they discussed how older people could be permitted to stay inside on days they were not feeling well (despite programming that suggested people needed to leave the shelter during the day). There were also attempts to adapt internal programming to better address the needs of older people. At the women’s shelter this took the form of assigning older women to a smaller room. Although our study did not afford the time for a detailed assessment of this practice, it raised questions about whether segregation would increase or decrease safety, and the interpretations of being given “special” protection and a smaller space. For example, on one site visit inside the shelter with a worker, there was evidence that drugs had been used in the small room (drug use was not permitted on site – so this act would have been concealed and against shelter rules). Were the older women using drugs (which would defy typical expectations)? Or did this smaller room also serve as a place people would hide out to use drugs, and if so, what risks did this inadvertently pose to older women? At the men’s shelter, examples included allowing older men more time to shower (especially those who needed rehabilitative equipment) and encouraging older men to enrol in a program that provided access to the apartment units in the shelter (also available at the women’s shelter). Together, the informal processes and everyday interactions were organized in relation to (and visible through) age and presumed vulnerability, thereby shaping experiences of homelessness in late life. Chronological Age as a Means of Access or a Barrier to Service We now turn to how age was configured through standard stagebased models of response and eligibility for service. Chronological age as a barrier to service was most apparent in stakeholder discussions, the academic literature, public statements, and programming. Given that our research was about older people, age was central to our discussions. Stakeholders outlined how they or their organization used (or did not use) age (or the proxy of the geriatric profile)

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to assess vulnerability and respond to need. These illustrations were set against knowledge about programming in Canada whereby age provides access to programs such as pensions (Government of Canada 2018b). However, our findings revealed that in the case of late-life homelessness, age tended to act as a barrier to accessing service, rather than a feature that opened or facilitated access to additional supports. In particular, age operated invisibly through service eligibility, and the emphasis on programming for youth and families. Although age formally provides access to services in policy and programming, older people with experiences of homelessness encountered age as a barrier because their life course trajectories and needs did not match the standard normative models and/or typical service configurations. The relationship between age and public programming was, however, varied. Stakeholders pointed to some cases where people became eligible for additional benefits upon reaching retirement age, the limited services for older people, and the problems encountered by people aged forty-five or fifty plus with highlevel needs (i.e. the geriatric profile of frailty), but who were not yet eligible for services. Questions about age and need produced unexpected reflections on the part of shelter workers and service providers in long-term care – with some commenting that they had never been asked about age in relation to their services. In some cases, stakeholders outlined how age provided access to supports that could lift some older people out of poverty or provide a minimal income security (see Kemp et al. 2004; Rossi 1990). For example, reaching pension age could provide access to income support that was previously unavailable. This messaging was consistent with the discourse of the federal government at the outset of the project, whereby the former Minister of Seniors emphasized the need to connect older people with experiences of homelessness to existing benefits and supports (Grenier et al. 2016c; also see Ploeg et al. 2008). Yet, the impact of access to existing pension benefits (available for the general population) was generally considered to have limited reach. It would not address the needs of older people who do not reach the minimum age threshold for a service, or the meagre benefits of those without stable employment across the life course.7 Here, the invisibility of age acutely conveyed the disjuncture between existing services and older people’s needs. Consider the following quote, highlighting the challenges that result from overlooking the operation of age and age relations:

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Well, that is difficult because we are not a service that is designed to offer services to older people. So, there is no real specific criteria that we use to identify age. There are projects that take people who are fifty-five or older … And there are others that use sixty, and others that use sixty-five. So, it is difficult to say. An older person, I guess is about the age of public pension at sixty-five. The “golden age” clubs as they call then. But in community organizations, the criteria for service can vary between shelters and services. Not having age criteria here means that someone who is sixty-five won’t get any more services than someone who is twenty-two. – Stakeholder, Housing and Homelessness Sector The age-based structuring of programs is a crucial component of understanding challenges, service gaps, and unmet need. Stakeholders discussed how Montreal organizations geared to homelessness were either “ageless” or designed with particular ages or stages in mind. Stakeholders highlighted how needs were difficult to meet in the shelter system. A number of stakeholders (and older people as well) made reference to the shortage of programs for older people, and the problems of relying on work as the typical exit trajectory from homelessness. Here, the structures of services must be contextualized within larger cultural expectations about aging, including how aging brings about a need for income support as a result of moving out of the labour force, accompanied by a greater likelihood of needing care. The ideas that people transition from stable work to retirement, and may experience health-related changes in late life, are deeply embedded in social responses.8 Yet the realities of late-life homelessness, including having no physical home within which to receive care, high levels of complex needs, and a decreased likelihood of returning to work, remain unrecognized in existing service models, thereby sustaining unmet need. A quote from one of the older men in the shelter sums this up nicely: They really should start with the older people. I mean … the fifty-five to seventy year olds, help them more. The younger people, they might still have their health, whereas we don’t have it anymore … you don’t have thirty years to live, once you reach sixty. You don’t have much left … even if you have ten, fifteen years, that’s nice. It’s us they should help. I don’t feel comfortable

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in places like this [the shelter]. Me, I leave, I wake up at 4:30–5 in the morning, and I get out of there. I have to get out of there … it’s not good, it’s difficult. I can’t do it anymore. – Bakuet, sixty-year-old man, shelter, Participant 17 A number of stakeholders discussed the mismatch between service structures and older people’s needs. Similar to the literature, stakeholder interviews revealed that older people’s needs occurred at the intersections of housing, income support, health, and care (see Crane et al. 2005; McDonald, Dergal, and Cleghorn 2007). These needs were experienced in a context where services reflect traditional age-based understandings, and where programs are delivered via discrete sectors. In Canada and Quebec, programs are organized according to ministries of children and families, housing, transportation, and health, each with distinct budgets and service boundaries. Even when age is not explicitly used to define access to services, many policies and programs are linked to stages of “dependence” such as children in need (e.g., daycare and education), people with disabilities (e.g., income support), or “frailty” (e.g., home or institutional nursing care).9 Similarly, services for women are often organized around needs related to intimate partner violence, aging, or homelessness, with little recognition of the intersections of these experiences. According to stakeholders, this misalignment can create problems for older people who are unable to return to the workforce, such as those with workplace injuries or health issues. It also raises serious questions about long-term housing affordability and stability, especially where the practicalities of ministries and agencies sharing budgets may inadvertently restrict services and access.

ag e an d h o m e l e s s n e s s : ins i ghts from older p e o p l e w it h l iv e d experi ence This section turns to older people’s insights on age and late-life homelessness to reveal the everyday accounts of older people with experiences of homelessness. Older people’s interviews showed the challenges of being homeless, how aging changed their experiences of homelessness (for those who had experience), and how homelessness impacted their experiences of aging. They revealed that late-life homelessness was: difficult and unthinkable; changed by illness and

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as a result of aging bodies; a situation of narrowing opportunities as they aged; and characterized by inaccessible services and unmet need. Distinct and Unthinkable Older people with experiences of homelessness differentiated the intersection of aging and homelessness as distinct from their experiences of homelessness and aging (or how they envisioned their aging). All of the participants outlined the everyday difficulties of being homeless in later life, leaving no question about the toll of this experience. Of the forty people we interviewed, nineteen were in transitional units, seventeen in the emergency shelter, three in subsidized housing affiliated with the shelter, and one person was precariously housed. Where some had life-long or episodic experiences of homelessness, others were new to homelessness in late life (defined as having been homeless for one year or less).10 Older people with prior experiences of homelessness were well-positioned to comment on the differences between homelessness in earlier periods and in later life, while those new to homelessness outlined how it had altered their experiences and expectations for late life. It is important to keep in mind that all of our research participants were homeless, so they could only speculate about how aging might be different if they were not homeless. Further, given the age range between forty-six and seventy-six, some of the people we spoke with were older than others, meaning that their experiences of aging were differently positioned where health and mobility were concerned. The following quotes reveal how homelessness is difficult at any age, the additional challenges of being homeless in late life, and the emotional anxieties that made late-life homelessness a distinct experience that older people preferred not to think about: Well, I think it is the same thing. Whether you are twenty, or thirty, or fifty – living on the street? It’s not fun for anyone. – Betty, fifty-three-year-old Indigenous woman, transitional housing program, Participant 30 Well, I don’t know [that there are differences?]. Everyone ages, first of all, whether it is in long-term care settings for people who need assistance or living independently in an apartment, we all age … But I do think that when it comes to aging on the streets,

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it is not the same. – Sylvie, fifty-year-old woman, transitional program, Participant 31 Growing old on the streets, ugh! Well, I don’t want to think about it. But I’ve thought about it because I’m scared … I’m scared, because I’ve seen people in the streets, eh. Sleeping on the sidewalks and … destitute, in the cold … oh no, I don’t want that to be me! I’m scared! – Paul, fifty-eight-year-old man, transitional program, Participant 38 Difficult Everyday Locations to Occupy as Their Bodies Age In describing the intersection of aging and homelessness, older people pointed to how changes in body function, mobility, and overall health impacted their experience. Older men and women highlighted how their bodies were not the same, and stressed health problems and the impacts of disadvantage. Such findings coincide with the issues pointed out in the medical literature and the comorbidities related to being older and homeless (Patanwala et al. 2018; Schinka et al. 2017). While such changes to health and mobility are often attributed to age, older people’s stories drew attention to the impacts of disadvantage and life on the streets. Stakeholders mentioned instances where forgetting to pay bills led to eviction, where older people forgot appointments, and where it was much more difficult to secure housing for someone with memory loss (see Cohen, Onserud, and Monaco 1992; Horn 2008; Proehl 2007). The following quotes reveal how older people depicted life at the intersections of aging and homelessness, providing the detailed human dimensions of comorbidities and health disparities: I have problems with my leg; it is difficult for me to walk sometimes. I am going to have to get a cane, I’ll get one next month. I had an injury! I had an operation … I was cut open from here up to my hip. They took it out, but my bones aren’t strong like they used to be. So I am going to have to get a cane to walk, because when I walk I get tired, and it is painful. – Paul, fiftyeight-year-old man, transitional program, Participant 38 [W]hen you get older, whether you like it or not, it’s harder and harder. First, you know, just in terms of mobility … if you start

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to have problems, walking, or … health problems, and that, it’s that you have to get around. So what happens is that you have a more difficult time to ‘move it’ as we say in Quebec French, so you stay much closer to the place where you will eat and sleep, right. – André, fifty-eight-year-old man, shelter, Participant 28 Opportunities that Narrowed with Age Older people outlined how opportunities that narrowed with age affected their experiences of aging and homelessness. In particular, they discussed how late-life homelessness was created and/or maintained by an age-segregated job market and reduced opportunities for income. Older people’s stories revealed how the labour market produced near-immediate effects whereby an older person attempting to find work may be blocked from access to income that would help them to exit homelessness. A number of older people outlined how the labour market pushed them into homelessness, and others discussed how it left them with few exit options. Many accounts drew attention to the effects of precarious work over time, and/ or their age at the time of job loss. Although it is typically men’s homelessness that is explained through insecure labour trajectories (MacKenzie and Chamberlain 2003; Rossi 1990), our study also included women who discussed insecure employment. Problems related to unemployment and securing work among older people are often attributed to ageism (Duncan and Loretto 2004; Palmore 2001), and homelessness in later life compounds challenges, especially where there are fewer supports to fall back on. Stories also highlighted how insecure employment and a lack of access to full-time work as people aged resulted in insufficient retirement income, leading some to first-time homelessness in late life. Such examples can be understood on a structural level whereby a history of unstable work results in long-term low income because the person falls short of the calculated formula for pension earnings (based on roughly forty years of full-time work). For others who met the eligibility for programs such as Old Age Security, the Canada Pension Plan, or the Guaranteed Income Supplement, the benefits were often insufficient to remain housed, given rising costs and a lack of affordable housing (see Government of Canada 2018a). The impacts of insecure attachment to the labour force, lack of access to full-time work across the life course, and practices that

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overlook the need for sustainable seniors’ housing contributed to homelessness. In addition, older people mentioned particular trajectories that heightened their challenges, including disability or workplace injury, and periods of leaving the labour force for care, all of which impacted income security in later life. The following quote illustrates how the connections between employment, risk, and aging prompted homelessness in some cases, and in others created barriers to exiting homelessness. These differences highlight the within-group difference that may exist between people “aging” in situations of homelessness and people who fall into homelessness for the first time in later life: I should start working again, but age is always there. Age in the job market, we all know it, the older you are, the harder it is, there are less choices, heh! Because age is an issue. And then there’s also the issue of holes in the resume. What were you doing during these six months? And these three months here? Well! – Robert, fifty-six-year-old man, transitional program, Participant 1 Those who are younger have more chance of working, finding something, it’s easier for them to get out ... but when you’re older, well then, work isn’t so easy, because people don’t hire you, you’re getting old, and you can’t just take anything either. I can’t go work collecting trash, running after the truck, I can’t do it. – Lucas, sixty-four-year-old man, shelter, Participant 27

Unmet Needs across Services that Do Not Exist or Are Difficult to Access The accounts of older people with experiences of homelessness revealed high levels of need that fell between existing services, and stories of the everyday struggles at the intersections of aging and homelessness. Here, older people provided detailed first-person insights to the complex trajectories and unmet needs that had been mentioned by the stakeholders. Those needs and uncertainty about how to have their needs met were particularly pronounced amongst those who were newer to homelessness. This finding reflected the existence of systemic gaps and the knowledge required to negotiate

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homelessness as an older person – features those with experiences of homelessness had learned to navigate. The following quotes reveal different pathways into homelessness, namely how low income, intimate partner violence, and medical issues, combined with the increased costs of housing, a shortage of affordable housing, and a lack of protection from eviction, intersected to create and sustain late-life homelessness: There’s no way, I mean, minimum wage … a single person living alone has to make at least fifteen to twenty bucks an hour to actually have a reasonably proper way of living … Nowadays … it’s more than fifty per cent going on rent. Then you have your transportation which is extremely expensive now … I look at back fifteen, twenty years ago and I made about the same amount of money … it’s not that much cash but back in the way how life was, you could survive. – Marc, forty-six-year-old man, transitional program, Participant 8 And then, at a certain point, I dumped him because when we came back to Quebec, he became too violent, I was scared! ... I was scared he would kill me. – Claudine, sixty-three-year-old woman, shelter, Participant 24 The homelessness began, it’s been three months. I went to the hospital … I had surgery … They took out part of my colon and a part of my intestine. And then when I left the hospital, I went home. Someone had stolen all of my furniture, and they had made some noise, the guys who robbed us. They partied, and the landlord cancelled my lease … I found myself on the street the next day, there we are, three months. And I have nothing! Not one cent! It’s a woman who told me about this place, I didn’t know about it. – Paul, fifty-eight-year-old man, transitional program, Participant 38

p o s s ib l e e x p l a n at io ns for res ponses to ag in g a n d h omelessnes s The findings from our qualitative studies on age and late-life homelessness point to an overall neglect of aging that takes place through relations that structure services according to age- and stage-based

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expectations. This section contemplates the reasons for not including older people in strategies and services. It considers how the need for income, health, and stability have been overlooked or configured only through vulnerability, thereby creating barriers to service. That is, it focuses on how age-based structures and relations created and sustained late-life homelessness. Possible explanations for age-invisible responses to late-life homelessness include: ageism and discrimination; the idea that older people’s needs are met elsewhere; and the belief that it is too late to address the complex needs of older people who are homeless. Age, Ageism, and Age-Based Discrimination Invisibility and non-response to the needs of older people with experiences of homelessness may reflect larger cultural and social assumptions of devaluation and/or discrimination based on age. “Western” societies have long been considered to be ageist and to have practices of ageism. According to Bytheway (1995), “Ageism is a set of beliefs originating in the biological variation between people and relating to the ageing process … Ageism generates and reinforces a fear and denigration of the ageing process, and stereotyping presumptions regarding competence and protection. In particular, ageism legitimates the use of chronological age to mark out classes of people who are systematically denied resources and opportunities that others enjoy, and who suffer the consequences of such denigration, ranging from well-meaning patronage to unambiguous vilification” (14). Studies of aging reveal that age is used to configure access to services through institutional structures, plays out through social relations and encounters, and is a commonplace cultural marker. Age is also intricately intertwined in configurations of the welfare state, and the ideas of a standard institutionalized life course, which involves “dependence” as structured through retirement (Walker 1980; Townsend 1981). It could thus be expected that responses to older people who are homeless would replicate existing socio-cultural and institutional divisions and age-based patterns, as well as the associated negative cultural storylines of devaluation and/or decline (Gullette 2004). In fact, it would be difficult for any group to exist outside such deeply engrained cultural notions and practices. Overlooking late-life homelessness may thus represent a layering of assumptions that exist at the intersection of aging and homelessness.

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That said, our research identified a number of examples of ageism, exclusion of older people, and age-based discrimination. There was a shortage of programs and services for older people, despite older people being “hyper-visible” on the streets and in emergency shelter systems, and a lack of knowledge of complex health needs. One could argue that the failure to provide housing and care is not unique to homelessness, but represents a larger phenomenon of failing to recognize the need for care in late life (see Gee and Gutman 2000). The service gap can be understood through mechanisms of exclusion, as well as attributed to a devaluation of older lives (see further chapter 8). However, the layering of aging and homelessness reveals differences between the group we interviewed and the general population. The lack of preventative care means that health and social disparities continue to accumulate as their needs remain unmet. While some of these disparities result from age relations in the workplace, where people lose jobs in mid-to-late life and are unable to secure employment, others are related to trajectories of violence, colonization, and/or abuse (Browne and Bassuk 1997; Patrick 2014; Thurston et al. 2013). Additionally, older people with experiences of homelessness do not have the home or family support networks that form the bedrock of policy frameworks for success and/or care (see Daly and Armstrong 2016; Daly, Armstrong, and Lowndes 2015). On top of this, once homeless, older people become further vulnerable and unsafe in shelters and on the streets. Insights from the ethnography suggest that the failure to respond is in part related to ageism and age relations that operate in social encounters. The Assumption that Older People’s Needs Will Be Met Elsewhere Our engagement with late-life homelessness through research and workshops since 2010 has revealed the prominence of assumptions that older people’s needs will be taken care of by existing services, and thus do not require attention within the domains of housing or homelessness.11 The idea that older people’s needs are met elsewhere is historically situated in welfare state structures, public institutions, and organizational practices, which have tended to split service boundaries according to early or late periods of life, and according to responses through discrete ministries of health, housing, or transport (Means and Smith 1998; Wister and McPherson 2014). For example, historical ideas of income support in retirement (i.e.

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a pension) as a reward for a lifetime of labour force contributions, universal health care, and the existence of safety nets contribute to the idea of older people as a protected and/or cared-for group (Biggs and Powell 2001; Phillipson 1982; Walker 1996). However, the assumption that older people’s needs are met by other services is inaccurate in the contemporary context, given changes to work (particularly short-term or part-time positions), the shift in income supports such as company pensions (defined benefit to defined contribution), and the rising costs of housing. The assumption of needs being met elsewhere fails to consider changes to social safety nets resulting from neo-liberalization and the dismantling of the welfare state, the cumulative impacts of colonization and/or deinstitutionalization, or how policies structure disadvantage among particular groups (e.g., migrants, women, and people with disabilities). Changing structures have also created conditions whereby older people who are most in need may be less well-served by traditional public supports. For example, trajectories of insecure employment, incarceration, mental health issues, or late-life migration may mean that existing forms of social protection have limited reach for those who have not built up sufficient contributions to attain benefits (George and George 2013; Habibov and Fan 2008; Statistics Canada 2019b). The idea that older people’s needs are met by existing programs does not universally hold true, and certainly not for people with experiences of homelessness. The idea that older people’s needs are met elsewhere also fails to acknowledge how late-life homelessness is both structured by policy and service gaps, and crosses a range of issues that fall outside existing service structures. A major gap for older people, but especially those with experiences of homelessness, is care. In Canada, the notion of care as a private matter fulfilled by kin is deeply embedded in policy (Armstrong 2010; Armstrong and Braedley 2013). Canadian responses rely heavily on unpaid models of family and kin care, configured around care that is provided “at home” and “in the community,” and by family or kin (see further chapter 5). Yet, this configuration has differential effects on older people with experiences of homelessness because they are less likely to have such supports (Crane 1999; Crane and Warnes 2005). Older people with experiences of homelessness often have smaller care networks, meagre financial resources, and a lack of stable and secure housing (see Means 2007). The unmet needs of older people with experiences

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of homelessness reveal the impacts of having no defined policy on care, the shortcomings of a model that assumes needs will be met by unpaid family and kin care, and the failure to respond when such conditions are not in place. In doing so, late-life homelessness points to the pervasiveness of the individual (and family) model of responsibility that operates as a backdrop for care in late life. The assumption that needs are being met elsewhere is incorrect, especially where social needs and care for members of marginalized groups are concerned. Too Difficult and Too Late A final explanation for overlooking late-life homelessness is the perception that it is “too late” to respond because needs are too complex or too far gone. This idea operated implicitly across a range of discussions, and was interconnected with normative age- and stagebased assumptions and expectations about late-life. Accounts from stakeholders and older people alike revealed the complex health and social challenges of addressing late-life homelessness. For example, the quotes presented earlier in this chapter highlight the extent to which impairments and health disparities cause everyday challenges in the lives of older people. They also demonstrate how such issues are difficult to address as a result of comorbidities, untreated issues, and service structures. A critical examination of responses to aging and homelessness reveals how invisibility and non-response may result from a process of ageism, through a dismissal of older people who are perceived to be closer to the end of life, or because they are deemed to have ‘less potential’ for work or societal contribution. At the same time, the coupling of two stigmatized locations is pertinent to the analysis, where aging is known to be devalued, and homelessness, historically deemed “deviant.” In both cases, aging and homelessness are positioned, albeit differently, outside normative expectations and trajectories of the standard life course (see Fischer 1992; Rossi 1991). As such, the idea that homelessness results from poor individual choices – a notion that operates during earlier periods of the life course – becomes less convincing in later life, because we can see how this location conflicts with expectations around care, by family or society. Ideas about work, and in particular, the centrality of work across the life course are interconnected with non-response. Work and

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employment across the life course are intricately connected to valued social contributions. In this sense, older people with experiences of homelessness are often considered to fall short where employment, individual self-sufficiency (or kin-care), and success in late life are concerned. Part of this is connected to how work can alter one’s life course trajectory in either direction, with positive work experiences leading to stability in later life (or the presumption of stability, as will later be discussed), and negative leading to exclusion and inequality. As such, it is not only that existing service structures and systems make it is difficult to respond to because needs fall outside of expected life course patterns and institutional structures, but also that non-response is tied up with cultural notions of blame and failure. Homelessness in later life is “out of synch” with expected life course transitions; it is both “atypical” and unexpected with regards to the standard life course (see Grenier 2012). It is constructed as rare and incomprehensible – no one plans or sets out to be homeless. Further, late-life homelessness does not “fit” with the anticipated stage of retirement nor the “gold standards” for health. It stands in direct contrast to ideas of lifestyles of opportunity, and the resolution of psychological “developmental hurdles” suggested by models of coping and maturation (see Baltes and Baltes 1990; Brandtstädter and Greve 1994). As such, it stands in symbolic contrast to expectations of “success,” in later life, presenting instead material and lived realities that are about a life of difficulty, hardship, and perceived failure. Homelessness, at any age, but especially in late life, is to be avoided. This lack of synchronicity, and socio-cultural positioning, can explain responses that take for granted the idea that it is “too late” and “nothing can be done.” A critical analysis renders visible how the idea that it is “too late” to respond is rooted in age-based assumptions, processes of ageism, and the devaluation of marginalized groups. Homelessness in late life is an example of extreme disadvantage and marginalization. Not only is it viewed as a “failure,” but it disrupts the rhetorical idea of security in late life, and shatters the illusion of a “shared social project” that underpins the welfare state, and policy rhetoric on healthy and successful aging (see Rozanova 2010; also Government of Ontario 2017; Government of Canada, esdc 2016). Late-life homelessness exposes the implications of years of overlooking complex needs and shrinking community-based supports, which have widened the gap between those with the potential to “achieve” the

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positive models of aging and those for whom the barriers are often insurmountable (see chapter 7). It also reveals the impacts of social relations and cultural assumptions about the aging of disadvantaged groups, and explains the responses of stakeholders and front-line staff who in stating that “late-life homelessness should not happen” pointed out the injustice of current configurations (see chapter 8). Herein lies the contradiction exposed by the idea that it is “too late” – late-life homelessness is neither individual, nor a matter of choice or circumstance. It results from the systemic failure to intervene, which allows needs to become unmanageable over time (see chapter 6). The analysis of age draws attention to a system that is stuck because the situation of late-life homelessness is incomprehensible within standard expectations for aging, because the system is poorly equipped to address complex needs (which resulted from service gaps), and because older people with experiences of homelessness are stigmatized, devalued, and excluded (see chapter 7).

d is c u s s io n : t h e im p l i cati ons of agea n d s tag e - bas e d structures The argument of this chapter is that late-life homelessness is structured and experienced in relation to age and age-based assumptions that produce and sustain unmet need. Late-life homelessness draws attention to the inconsistencies between policy frameworks organized around age or stage and the everyday lives of older people with experiences of homelessness. Responses to homelessness replicate the domains of the institutional life course, which are organized primarily around attempts to reconnect people with education (in the case of children) and income through labour (particularly in mid-life). Yet, late-life homelessness occurs at a point in time where the opportunities afforded by reconnecting with the standard institutions of the life course are limited by a shortage of appropriate options, age-based discrimination, or heavier health and care needs. Late-life homelessness, by means of chronological age/health needs and the challenges of achieving the associated life course expectations, thus configures an impossibility of “getting back on track” via the existing mechanisms of the institutional life course. This then becomes coupled with the devaluation of age, the shortage of supports (either public or family/kin), and the intersection of the two stigmatized locations of aging and homelessness – ideas that become

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particularly problematic in the context of rationed services, and which draw attention to age relations, public responsibility, and the human capacity to care (see chapter 9). A critical gerontological approach reveals how constructs such as chronological age become naturalized through normative expectations, and in turn feature in social responses to older people from disadvantaged groups. It permits a focus on the contradictions between ideal frameworks, and the places people frequent and live. For example, it exposes how pathways configured through age leave older people with experiences of homelessness with few options for housing and care. In doing so, it corrects the reliance on individual explanations of homelessness, revealing instead how experiences intersect with (or are produced by) systemic and social relations (including policy), and are enacted through relations of power. It situates late-life homelessness in the context of cultural expectations about aging, frameworks and responses, and relational encounters that may reinforce exclusion and marginalization. In doing so, drawing on the accounts of community workers and older people reveals how the discrepancy between perceived and actual age is so severe that it can no longer be simply attributed to chronological age, but must be viewed as disadvantage, as articulated in chapter 6.12 Older people are not “young enough” to fit into existing services, but they are “too young” to be considered for services for older people, and have needs that fall outside of what is offered in either domain. As such, responses reinforce late-life homelessness as a location that defies the usual configurations of the life course, and as a result, one where needs continue to be unrecognized and are increasingly pushed outside the peripheries of service, as will be discussed further in chapter 8. The question of age as a social category and means of configuring services has been debated in the social sciences and critical gerontology. In his work on ageism, for example, Bytheway (1995; 2005) grappled with the conceptual dilemma of eliminating age as a social category and/or retaining it as a social location or classification for the purposes of service eligibility. On one hand, the elimination of age as a category could be posed as a solution to ageism. If age were eliminated as an eligibility criterion within social programs and services, there would be no basis for ageism in a service context. On a practical basis, however, this solution would fall short because, as demonstrated in our analysis, age operates as invisible, and ageism

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would still exist within an “age-segregated society” and service structure, even if it were to operate by stage or expectations alone (see Riley 1971; Riley, Johnson, and Foner 1972). Our analysis of latelife homelessness reveals that the associations that accompany age are so pervasive that the elimination (or oversight) of age as a category would likely sustain ageism, disadvantage, and unmet need. In fact, responses to homelessness currently operate without reference to age, and in doing so, overlook how these very relations structure inequality and produce late-life homelessness. In the context of an ageist or “age-segregated” society, the elimination of age as a category of analysis masks and reinforces the youth-based dominance of social structures, practices of discrimination, and inequalities related to age. The conclusion, it would seem, is to draw attention to age and ageism, to render age visible in everyday acts of power, and to consider the implications of “age relations” (see Calasanti 2003). At minimum, the intricacies of late-life homelessness suggest the need to adopt an “age-lens” that is attuned to the power inherent in the construct of chronological age. Adopting an age-lens means that researchers, policy-makers, and practitioners would consider responses to homelessness in relation to age and age relations. An age-lens is a way to translate research findings into policy and practice, to form an inclusive means of speaking about age in contexts where attention to age or to older people as a population group have been absent, and to argue for equitable access to services. The suggestion being made here is that an age-lens can initiate the process of inclusion, to ensure the needs of older people are included among the range of diverse social locations that are increasingly part of the discussion. This would mean that age would appear alongside considerations for locations such as (dis)ability, gender, Indigeneity, sexual orientation, and racialization where the assessment and response to homelessness in late life are concerned. This idea of the age-lens, however, is more practical for the purposes of policy, and more strategic than conceptual. A stronger suggestion is that age relations be adopted as part of an ongoing critical analysis of and response to late-life homelessness.13 Age relations can form one part of a critical analysis to draw attention to age- and stage-based norms, power relations that are enacted through institutional structures and social relationships, and the production/reproduction of inequalities in late life. A critical perspective that includes age relations acknowledges age as a social and

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cultural construct that takes on meaning and implications through interaction and relationships over time. It highlights age as relational process, product of encounters with individuals and settings, as enacted with particular groups and/or at particular periods or stages (Calasanti and Slevin 2006; Nikander 2000; 2008; Twigg 1999). It draws attention to how age is configured and enacted through power relations, language, and constructs that form the basis for access to (or barriers to / exclusion from) rights and privileges (Calasanti 2003; McMullin and Curtis 2016; also see Vincent 1999). This includes, for example, how disadvantage and inequality intersect with class, ethnicity, Indigeneity, gender, race/racialization, and sexual orientation to produce and sustain ageism (Calasanti 2003; McMullin 2000; Krekula 2010). As such, age relations get behind the invisibility of late-life homelessness to expose the problems of overlooking age. They become part of a critical perspective that renders visible the fundamental flaws of approaches that passively wait for late-life homelessness to happen, rather than actively preventing the disadvantage that can lead to homelessness in late life. Age relations were apparent in stories of older people being told they were “too old” for a particular job; changes to bodies and needs over time; and the age-ordering of eligibility for services. Age relations were also evident in the more subtle forms of language and practice that resulted in disadvantage and unmet need; in the failure to include older people in strategies on homelessness; and in the overlooking of older people as a sub-group with a unique set of needs. Further, age relations were present in how trajectories in and out of homelessness are intricately connected to employment, income support, and housing. This includes how the absence of a relevant safety net and targeted interventions can worsen risk, complicate needs as one ages, and create or sustain late-life homelessness. Age relations reveal how categorization and responses (whether explicit or implicit) are not neutral, but are enacted through social and institutional relations and impact older people. As such, this perspective reveals the relationship between institutional structures, organizational practices, and the everyday lives of older people with experiences of homelessness. Developments since the completion of our research suggest that a shift in thinking may be taking place with regard to the recognition of diversity and inclusion of sub-populations of people experiencing homelessness. For example, the 2017 definition of homelessness

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expanded to include veterans and there is specific mention of seniors facing abuse14 (see Gaetz et al. 2012, revised in 2017).15 Dedicated efforts to include older people in the PiT count processes have also resulted in a more consistent ability to document the rising prevalence of late-life homelessness across Canada. However, there is a lack of consistency with regard to age, which makes comparison difficult. Seniors and veterans also now appear in the National Housing Strategy (2018), entitled A Place to Call Home16 (Government of Canada 2018a), and the National Poverty Reduction Strategy (2018) entitled Opportunity for All mentions seniors (Government of Canada, esdc 2018). However, at the moment, older people are included in limited ways. For example, although this inclusion reflects eligibility criteria where some additional supports may be available in Canada, most older people with experience of homelessness are not veterans. This reflects a limited view of the complex trajectories into late-life homelessness, and overlooks the intersections and needs of a wide range of older people. Further, Opportunity for All only discusses the cancellation of the proposed change to the age of retirement, and an increase to the Guaranteed Income Supplement (a means-tested payment for older people in poverty), measures that were not specific to older people with experiences of homelessness, and given general patterns in labour trajectories, may have limited impact on this group.17

c o n c l u s i on This chapter explored age and late-life homelessness. It highlighted how late-life homelessness was shaped through policy frameworks, institutional structures, and cultural ideas about aging and late life. It drew on a review of provincial strategies and municipal planning documents on homelessness, stakeholder interviews, observations in and around the shelter, and interviews with older people to engage with the questions: what happens at the intersection of aging and homelessness; how do understandings of age structure and shape response; and how do these configurations affect older people’s experiences of homelessness? The chapter highlighted everyday experiences of homelessness in aging and late life, and exposed the problems of age-based eligibility and distinct policy spheres. It revealed how late-life homelessness was invisible and overlooked in policy documents; how it was constructed through notions of

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vulnerability; and how it was enacted in a context where age often poses barriers to service. To this, it added the perspectives of older people, revealing how late-life homelessness was experienced as unthinkable, through changes to their body, as a result of labour market challenges, and as compound unmet needs over time. It then explored the potential reasons for these relations, suggesting ageism, the idea that older people’s needs are met elsewhere, and the idea that those needs are too complex and it is “too late.” Though few scholars have explored the link between late-life homelessness, population aging, and shifting social structures, rethinking late-life homelessness with regard to age provides a novel understanding of how lives are shaped and experienced accordingly. The ethnographic results of our research reveal how the consideration of age is a question not only of inclusion, but of how age relations produce particular social relations, cultural values, and systemic responses. Late-life homelessness is a location whereby socio-cultural configurations of age and need play out against structures of recognition and valued (or devalued) lives, and as such, demonstrate the need for a better match between responses and older people’s needs. In sum, the collective insights from the assessment of policy frameworks, service guidelines, front-line work, and lived experience underscore the need to include older people as a target population in the agenda to end homelessness; to listen and account for the unmet needs voiced by older people; and to develop concerted policies regarding resource allocation, access to services, and the provision of appropriate housing. This includes the need for adapted housing (e.g. physical access), sites for care (in shelters and sustainable long-term solutions), and long-term housing. Building on the insights on age and late-life homelessness, we now turn to an analysis of place and spatial relations as a means to extend the argument.

5 The Places of Late-Life Homelessness: Aging in “Undesirable” Locations

This chapter focuses on how late-life homelessness is structured, shaped, and experienced in relation to place, and through encounters in particular spatial locations. Place now features prominently as a means to understand experiences of aging in social gerontology. However, debates about aging in place have been less well developed with regard to late-life homelessness. In particular, a gap exists between the places where people are expected to “grow old” and the realities for older people with experiences of homelessness. Earlier chapters noted how being without a home in later life creates an immediate dissonance from taken-for-granted expectations of stability and protection, and raises practical challenges for the provision of care within the home and community.1 This chapter carries out an in-depth exploration of three spatial locations where people with experiences of homelessness age: on the street, in shelters, and in long-term care. The material draws on the analysis of public documents on aging, stakeholder interviews, observations in and around the shelter(s), and interviews with older people with experiences of homelessness. This chapter engages with the question: how is late-life homelessness shaped and experienced in relation to place? It begins with a discussion of the ideal dominant frames of “aging in place” and “at home and in the community.” Consistent with a critical perspective, it outlines the inherent challenges of each location as recounted by older people and/or stakeholders working primarily in the shelter system. Although the term “shelter” implies one physical space, our research site was composed of a network of shelters and related programs that operate across a range of locations, including one

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large men’s shelter, one large women’s shelter, and a series of transitional housing units. Building on chapter 4, this chapter reveals how places are ordered, accessed, or used (or not) by particular groups of people; inequities in the types of places people with experiences of homelessness grow old; and what it is like to inhabit or experience these places in later life. In particular, it draws attention to how older people who were homeless aged in public locations that were unsuitable, expensive, and considered “undesirable,” laying the foundation for forthcoming chapters on exclusion, disadvantage, and justice. In doing so, it adds knowledge from the everyday lives of older people with experiences of homelessness; insight into how place structures and shapes experiences; and awareness of how challenges are mediated through place. Together, these lead to understanding how older people with experiences of homelessness live out their private lives in public places, and have lives that differ greatly from those of the general population (see Willcocks, Peace, and Kellaher 1987).

th e id e a l f r a m e s : “agi ng i n place”; “at h o m e a n d in t h e communi ty” The notions of “aging in place” and “at home and in the community” are two dominant frameworks that guide policy, practice, and experiences of aging and late life, and which structure and shape older people’s lives. In a critical perspective on the study of aging, policy discourses and frameworks represent social relations that structure and shape understandings of late life and social responses (Biggs 2001; Hendricks 2004). In this approach, leading policy concepts (and social care practices) can be read as stories or frames that reflect socio-cultural expectations and shape lives in particular directions, sometimes to influence social or public health outcomes (see Neysmith, Bezanson, and O’Connell 2005; Wiggan 2012; Willcocks, Peace, and Kellaher 1987). Examples of such interventions include the provision of social benefits to particular sub-populations or groups, targeted access to services to correct disadvantage, and/ or positive reframing intended to counter stigmatizing views. This section begins by outlining the concept of “aging in place” that serves as a broad umbrella for policy and practice for older people. It then turns to discuss the notions of “home and community care” that establish the ideological preference for home both as a structure for care systems and a practical site for care. Together, these

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ideal frameworks form the backdrop for the analysis of the spatial relations of late-life homelessness, and draw attention to the places within which disadvantage occurs among older people. “Aging in Place”: A Philosophy and Script for Success in Later Life Aging in place is a philosophy and idea that guides cultural and policy frameworks for aging and late life. The concept of “aging in place” surfaced in the late 1990s and has gained momentum ever since, alongside positive conceptions of aging such as successful, healthy, and optimal aging. Beginning as a philosophy or idea, “aging in place” encapsulates the sentiments of home and place as expressed and experienced on a social, cultural, and personal level. Cutchin (2003), for example, refers to aging in place as a concept to denote a “complex geographical process mediated by institutions and other social forces” (1077). “Aging in place” situates the individual in relation to their environment, thus aligning with the interests and desires of many older people. It extends beyond individual health, personal responsibility for well-being, or network capacity, to consider the social and spatial relations that underpin the places within which one ages. The notion came to focus on aging in locations that one is familiar with, and resonates with fostering lifestyle, community involvement, and continuity. As such, the idea of “aging in place” became a solid conceptual means to an end for social policy. It encapsulated the various ways an individual or group could achieve the positive expressions of aging through remaining at home and in their neighbourhood, harnessing personal resources, and ensuring that family and kin networks were available to be mobilized. “Aging in place” became the discursive policy-level script for making communities “better places to age.” The philosophy of “aging in place” also appears as a leading framework and discourse across international and local contexts in gerontology, urban planning, and social care. “Aging in place” appears in tandem with Age-Friendly City initiatives, and was adopted into the who (World Health Organization) “World Report on Ageing” (2015), and the framework of active aging (also see Buffel, Phillipson, and Scharf 2012; Menec et al. 2011; Plouffe and Kalache 2010). The public health discourse of the Centre for Disease Control (2010) – the most cited definition of the concept – defines “aging in place” as “the ability to live in one’s own home

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and community safely, independently, and comfortably, regardless of age, income, or ability level.”2 Similarly, Economic and Social Development Canada (esdc ), a government department linked with the ministry of Children and Families, defines aging in place as “having the health and social supports and services you need to live safely and independently in your home or your community for as long as you wish and are able” (Government of Canada, esdc 2016, 2). In Canada, ideas about aging in place as a policy priority can be seen in the responsibilities of the inter-ministerial group of federal/provincial/territorial ministers (hrsdc 2012). The government of Canada even has a landing page devoted to “aging in place” on its website, a checklist of domains to assess readiness (Government of Canada, esdc 2015b).3 In this sense, “aging in place” is deeply embedded in policy, research, and the scripts used to assess success and well-being in late life. Yet, while philosophies and practices that subscribe to this set of ideas are often considered universal truths, a number of questions remain with regard to marginalized groups of older people. Late-life homelessness is one location of immediate disjuncture with regard to aging in place because, as will be seen in this chapter, older people with experiences of homelessness do not have the same access to aging in place, and instead age in places deemed undesirable. We turn now to the “home and community” as the second discursive foundation for the analysis of place with regards to late-life homelessness. Care for Older People “at Home” and in “the Community” The notion of “home and community care” represents an ideology, a structure of care systems, and a practical site for care. At the broadest level, “home and community care” is a concept used in Canada and elsewhere to establish and situate the home and community as the ideal locations for care. This terminology came about in the 1990s as part of a formal set of discourses used to shift priorities and care resources from institutional contexts (i.e., nursing home or residential care) to the home and community (i.e., homecare) (Armstrong 2010; Means, Richards, and Smith 2008; Wiles, Leibing, and Guberman 2012). Although the majority of care was already taking place in the home, provided by family and kin, the idea of “home and community care” marked a historical and rhetorical position in the care landscape. It also served to set professional roles and standard

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assessment practices, delineate the types of care provided (predominantly medical rather than social), and establish home as the location within which the majority of the care was to be delivered. “Home” thus became both the official site within which to deliver and receive homecare services, and the discourse for neo-liberal priorities focused on standardization, management, and cost reduction (see Armstrong and Armstrong 2003; Aronson and Neysmith 1997; Dyck et al. 2005). Viewed together, and from a critical perspective, the intersecting concepts of “home” and “community” are discursive frames that structure service delivery and care practice.4 Home is also an idea and site that is both practical and imbued with meaning in late life. “Home” is a multidimensional, value-laden, and often taken-for-granted concept considered to hold symbolic meaning and significance for older people (Chapman and Hockey 2002; Mallett 2004; Rowles and Chaudhury 2005).5 It is often deemed to be the most central fixture in a person’s life, an “extension of the self through place” (Fuhrer, Kaiser, and Hartig 1993), and a site where people have acquired meaningful experiences (Hillcoat-Nallétamby and Ogg 2014; Iwarsson, Horstmann, and Slaug 2007; Oswald and Wahl 2005). As such, home is a practical physical location that centres experience, and carries an emotional appeal linked to meaningful events across life. Thus, it is unsurprising that, over time, policy discourse began to reflect the sentiments of home and the ideological and practical positioning of home as the only place for care (also see Kontos 1998; Pavolini and Ranci 2008; Wiles et al. 2012). In this frame, settings such as hospitals and long-term care facilities began to be considered “last resorts” where care for older people was concerned. However, late-life homelessness challenges the taken-forgranted status of home and its universal appeal as a positive feature. Older people with experiences of homelessness are often excluded from the practical location within which to receive homecare, and the associated symbolic meanings that home is presumed to hold in later life. Whether by means of “being without a home,” or care models that rely on a stable physical environment and available kin (also see Means 2007), late-life homelessness is inadvertently structured outside the ideological, symbolic, and practical positions of “home and community” that guide frameworks and responses for aging and late life. It is for this reason that late-life homelessness emerges as a site of interest where aging and inequality are concerned. We now turn to everyday experiences of aging and homelessness.

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ag in g in “ u n d e s ir a b l e locati ons ”: a n e x p l o r at io n o f three s i tes Our research on homelessness revealed that older people who were homeless were aging in public locations that were far from the ideal frames of “aging in place” or “at home and in the community.” This section provides detailed insights from three spatial locations of “homeless aging”: the streets, emergency shelters, and long-term care. These sites were included in the original research proposal as angles of analysis, and as embedded cases from which to understand late-life homelessness. As the research progressed, they became meaningful ways to contrast expectations and realities, and to expose the challenges that occurred as older people attempted to move between services to have their needs met. Discussions of each site are composed of quotes from shelter workers, older people (over age 50), and workers in long-term care facilities, with insights from ethnographic observations included as appropriate. Set together, the three spatial locations provide a partial answer to the overarching question: what is it like to live at the intersection of aging and homelessness? The everyday challenges at each site highlight its inappropriateness as a site of support or care, and the contrast between policy frameworks and the realities of older people’s lives. Organized in this way, this section reaches beyond simply exposing the problematic places where older people with experiences of homelessness age, to demonstrate how current arrangements create and sustain unmet need. Aging on the Streets The first and most obvious spatial location of late-life homelessness was “the street.” Although the phrase “aging on the streets” conjures the image of “rough sleepers” who do not use emergency shelters, the idea of “aging on the streets” is intended to provoke a spatial analysis of place, and how place alters experiences of homelessness among older people across a range of situations. These situations include people aging while homeless, people with episodic or recurrent experiences of homelessness, and people using shelter systems for the first time in later life, as well as those who sleep rough, use shelters, and/or stay with friends or relatives (see chapter 2). Older people with experiences of homelessness were seen in parks,

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on street corners, in soup kitchens, and in bus shelters. Observations conducted as part of our ethnographic work revealed patterns related to age (or what appeared to be a result of age markers; see chapter 4). Men were often on their own, more publicly visible than women, and older people were first in line for the shelter and cafeteria. It is worth noting that some of the people observed would have been sleeping rough, others would have been using an emergency shelter, and some would have been precariously housed with no kitchen for meal preparation, or not enough income to purchase food. Observations on the streets of Montreal revealed the extent to which older people were publicly visible, thereby coinciding with the rise in homelessness documented by shelter workers and in the PiT count (see chapter 2). Interviews with stakeholders and older people revealed detailed descriptions of everyday lives at the intersections of aging and homelessness. Throughout our study, older people discussed how their lives were characterized by staying outside for long periods of the day, walking for hours, and being in the right place at the right time in order to receive meal and shelter services. Their experiences of homelessness were intricately linked with their physical mobility and how their bodies had changed over time, with reduced mobility making it more difficult to get around than in earlier periods of their life. Ethnographic insights outlined that aging on the street was about fear, vulnerability, and insecurity. Older people compared their experiences to earlier parts of their life course, with some alluding to their homelessness in late life as a fate worse than death. Quotes from older people highlighted how their fears were related to victimization, pain, and suffering – both physical and emotional. The following quotes highlight what it is like to age on the streets, from the perspective of older people: During the day, there is no place for you to rest, you’re on the street, so you’re outside, so it seems to me, you know, the stress is even worse. So, you know, they say all the time that stress makes you older. I think that in those cases, if it was me, I think I would age faster. – Betty, fifty-three-year-old Indigenous woman, transitional program, Participant 30 No, I don’t want to grow old on the streets, no. There’s no question. Living on the streets, I’d rather die than live on the

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streets in my old age. – Frédéric, sixty-nine-year-old man, shelter, Participant 14 I’m very insecure now; I feel very vulnerable and I’m … I’m scared and I wasn’t scared before. You know, because when you’re physically not as strong, you’re … you’re more scared … I can’t take as much anymore. I can’t, you know, I’m weaker. I’m old ... I’m older, you know, like, I ... I ... and I ... and you’re aware of it because you feel your body deteriorating; it doesn’t have the same energy that it ... that it had. I … I can’t ... I have no desire ... I couldn’t stay up all night anymore doing ... doing drugs. – Rita, fifity-five-year-old woman, transitional program, born out of province, Participant 23 Older people’s fears of aging on the street were intricately connected with the fear of violence and victimization. Both older men and women discussed feeling increasingly vulnerable, and feared for their safety on the streets. They discussed the everyday realities of violence, how fears for their safety affected their ability to sleep, and how aging worsened their sense of vulnerability because they did not have as much energy or did not feel as strong. Whereas many older people with experiences of homelessness repeatedly noted how things had changed for them over time and were markedly different in later life from in earlier periods of the life course, those who were new to homelessness outlined their fears of living on the street and staying in shelters, which they outlined as dangerous places, namely for robbery and physical violence. Such insights correspond with the state of knowledge in the field, where older people who are homeless are considered to be at higher risk of violence than their younger counterparts because they are seen as easy targets (Cohen, Onserud, and Monaco 1992; Dietz and Wright 2005; Lee and Schreck 2005).6 The following quotes highlight violence from the perspective of older men: Before, when I was living around Berri-uqam [metro station], that was where I had an apartment, I used to hang out in that area, but I don’t do drugs and I don’t drink, and I had to leave that area, there was a lot of violence. – Ben, fifty-six-year-old man, shelter, foreign-born, Participant 9

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It’s because in the alleys when you sleep, you don’t sleep heavily, you never know what will happen. It isn’t the cats or dogs that bother me, not even the rats, but those on two feet you know. If they have bad intentions, maybe while you sleep, they knock you out with a brick to see if you have money in your pockets or to steal your backpack. – François, fifty-five-year-old man, in stable housing for one year, Participant 3 The findings related to the fear of violence and victimization were also gendered. Overall, women tended to speak less in the interviews (see chapter 6), but when they did, their discussions were often organized around violence. This finding speaks to gender differences in the trajectories into homelessness, whereby many of the women had come to homelessness via intimate partner violence and/or family conflict. Their fears of violence were discussed as the threat of being raped (although often alluding to it rather than saying it directly; the exception is below) (also see Lewinson, Thomas, and Shaneureka 2014). Such fears contextualize why women were generally much less visible than men. Women also engaged in practices of concealing their homelessness. For example, I observed women (of all ages) leaving the women’s shelter. Although some could be identified as homeless as a result of the sorts of activities and appearances associated with mental health issues, it would have been difficult to identify some of the women as homeless because they had styled their hair and seemed to blend in, or hide in plain sight (this was more the case for younger women than older women). The interview discussions of the fear of being raped, combined with these observations, suggest that women’s efforts to not appear homeless may be a strategy to protect themselves against violence and rape. The following quote illustrates those fears: For a woman, it’s more complicated, it’s harder to find a place. A man can sleep anywhere, a woman, she can’t sleep anywhere. She can’t go there, she could be raped. I always have to watch out, to watch out, to be able to sleep in peace, be calm, to have one good night’s sleep. – Marie,7 sixty-five-year-old woman, transitional program, Participant 22 A number of older people discussed how they modified their routines and activities to increase their personal safety. Discussions explicitly outlined how their fear of victimization limited what they

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could do, or where they could (or should) go (see Grenier et al. 2016c). Modifications made by older people included staying closer to the shelter, staying visible (men) or invisible (women), keeping their distance from particular people or groups they felt were dangerous, and carrying less baggage with them throughout the day. Whereas men’s modifications to avoid violence were about staying visible, women did their best to remain unseen – striking differences where power, voice, and exclusion are concerned (see chapter 7). According to older men, staying closer to the shelter meant they had less distance to travel if they needed help. It also meant that they would have enough time to reach cafeteria services on time, have their meal, and get in line for the shelter bed. While some related these tactics to safety, others such as Fernando outlined how this was related to being in physical pain: “You don’t go far because of your health? Yes, because my legs hurt … I can’t walk” (Fernando, seventy-six-yearold man, transitional program, foreign-born, Participant 10). Older people (and especially older men) were observed in close proximity to the shelter throughout the day in parks, bus shelters, and public places – venturing less far afield into the city. Evening observations of the meal services at the downtown (men’s) shelter confirmed the pattern of staying close. Together, observations and interviews revealed the relationship between proximity, mobility, and the need for protection that was inherent to late-life homelessness. Given that the men’s shelter had the main cafeteria service, comparison between the men’s and women’s sites was not possible. Aging in the Emergency Shelter(s) The second spatial location of late-life homelessness was the emergency shelter. This section explores how emergency shelters structured and shaped life at the intersections of aging and homelessness. Discussions with older people and shelter workers alike revealed the unsuitability of existing programs or services, the barriers imposed by physical structures, and the gaps where older people were concerned. In doing so, the interview results pointed to the practical and emotional challenges this raised for older people, particularly where access and further marginalization within the shelter space were concerned. Insights from older people and shelter workers demonstrate how the potential for a positive experience

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of “aging in place” is limited within existing service mechanisms. The problem, simply stated, is that older people with experiences of homelessness may indeed ‘grow old’ in their existing situations (i.e. in place), but these are undesirable in terms of access, and the specific needs of older people. The places within which older people with experiences of homelessness ‘grow old’ sustain exclusion and offer few options for support and care. The following quotes illustrate some of the challenges: I have said to them: “My legs hurt, I can’t get up to the third floor.” Someone said to me, well, you could climb up on your bum. Those are the stupid things that people have said. And I started to cry after all of that. – Manon, fifty-nine-year-old woman, shelter, Participant 25 Ah! It’s very negative, very negative, because you have to repeat yourself all of the time, that you need an elevator every day, for everyday activities, and to be a person you could say, social activities, it’s exclusion. – Grizzly, fifty-nine-year-old man, shelter, Participant 40 Interviews with older people and shelter workers repeatedly mentioned the lack of services, the unsuitability of programs, and the inaccessibility of building structures that are poorly suited for older people or people with reduced mobility. There was a resounding sense across the stakeholder interviews that the shelter was not an acceptable place to “grow old,” but that few other options existed for older people. Some of the specific problems were stairs between the entrance, cafeteria, and sleeping quarters; high bunks; and inaccessible or cramped shower spaces. Shelter workers regularly encountered older people who were unable to access the sleeping quarters as a result of limited mobility, or who experienced difficulty in staying outside all day. Although the transitional housing units featured in our Montreal study were more in line with contemporary expectations of accessibility (e.g., ramps, elevators, etc.), the two main sites of the emergency shelters (one for men and one for women) where the food and majority of beds were located were in older, much less accessible buildings. The following quotes highlight the unsuitability of the shelter, and problems with access:

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[Shelters are] not here to provide long-term solutions ... They need a place to go for the rest of their lives in a way you know that’s kind of … whether it’s back with their family, whether it’s into an adaptive facility. – Stakeholder, Housing and Homelessness Sector Well first of all here, you can’t really [get around] because they’re not prepared, there’s only stairs. Right from the get go, you exclude people with walkers and people with very limited mobility. – André, fifty-eight-year-old man, shelter, Participant 28 Stakeholders and older people alike revealed how encounters with physical structures formed barriers to care and served to marginalize older people. Older people discussed the problems associated with having to use the stairs to reach their sleeping quarters or the bunks, the challenges associated with moving through the shelter amid large numbers of people (from rooms to meals, etc.), the lack of time and suitable supports in the shower areas, and the general fear of staying in the shelter. In more than one case, older people discussed how they felt hurt and excluded by being left out, in terms of both physical access to the space and broader levels of meaningful inclusion in society. The impacts of inaccessible and unsuitable spaces were also recounted by stakeholders, who described their practices as further excluding older people. For example, two workers at the women’s shelter gave an example of how they had placed a sleeping mat in the downstairs cafeteria for a woman who could not climb up and down the stairs. The following quote highlights the impact of poor access to the various spaces of the shelter: The more people age, the more difficulty they have getting up onto the top bunks. But sometimes, there simply isn’t any other option … We also have to think about when people age, and the problems that might come about with mental health and/or physical decline. We can’t accept women who are in a wheelchair because the building isn’t accommodated. If someone comes with a cane, we have to think about them being able to get out of the shelter in the case of an emergency, fire for example. So there are many things that need to change about the physical space. Q: So what would happen then if someone came in a wheelchair. R: Well, I can’t really accept them. So what would I do? In an

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emergency, I would never let the person stay outside. I would say, well I guess this is a situation where I need to bring a mattress downstairs into the cafeteria space. But really, all this really does is add to their insecurity and instability. She wouldn’t even be able to stay in a bed in the dorms, but would have to stay downstairs in the cafeteria – it is unreasonable to accept a situation like this! – Stakeholder, Housing and Homelessness Sector Observations and interviews with older people revealed how shelter workers modified their practices where possible, but in many cases, these were considered inadequate at best. Shelter workers and older people outlined the challenges and the unsuitability of the physical spaces, with older people also expressing how grateful they were for the meals and services provided, and in many cases, not wanting to complain. Across observations, the presence of older people at the front of the lines were consistent with the above-mentioned practices of staying close to the shelter, as well as practices whereby volunteers and other shelter users helped older people (and particularly those with rehabilitative devices such as canes and walkers) to the front of the line. Although it was difficult to get a sense of how such practices were initiated, their frequency over the observations suggested that this was an informal mechanism of support. Shelter workers also mentioned modifications such as the attempt to assign the lower bunks to older people. A bunk, for example, could be reserved provided the person made it back to the shelter by the specific time. If they did not, their bed would be allocated to the next in line. Additionally, older people were given passes to remain indoors when feeling unwell (the usual practice is that people who are not enrolled in the day programs need to leave the shelter during the day) or when the weather was too severe. The following quotes highlight how shelter workers spoke about the modifications they made: Well, sometimes people need a bar so that they can bathe, or the distance they have to walk, things like that, that simply become more difficult for this group. Here, you know, we have common shared showers. The person can use a plastic chair to take their shower, but it is not properly adapted for someone who needs more … that is our limit. In terms of the third and fourth levels [of the transitional programs], I think there are some showers

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with bath bars, but even then it is not … the set-up does not always work for someone with vision loss, sleeping in a dorm room with beds everywhere, and where people leave their shoes on the ground. Whether we like it or not, loss of independence and decline are becoming more of an issue. – Stakeholder, Housing and Homelessness Sector One of the things we do sometimes [in cases where the person has high-level needs] is suggest that they could stay at the shelter during the day. We do give out passes in these cases, for people who are not feeling well, who are convalescing, who need more sleep. But they never accept. So what can we do? They don’t want it. They refuse to stay here to rest up during the day. They want to get out, go through their routine and come back. – Stakeholder, Housing and Homelessness Sector At the time of the observations, a number of more substantial modifications were being considered to respond to older people’s needs. The main shelter (men’s sleeping quarters and all-gender meal service) was in the process of developing a daytime drop-in café (which had opened by the time we were conducting interviews), an on-site medical clinic (which opened shortly after our study), and streamlining services so that men new to homelessness, and in particular older men, would enter a transitional housing program rather than the large dormitory-style shelters. These changes were intended to help people get back on their feet quickly, shorten rehousing time, and avoid “patterns of shelter life.” These initiatives corresponded with Housing First, but were not specifically a part of the program due to existing federal-provincial agreements (see chapter 2). The women’s shelter was also experimenting with housing very old women together in one of the smaller bedrooms of eight or fewer people as a means of giving them a slightly more quiet space and additional protection from the dorm spaces. Similar to men, older women were being encouraged to join the transitional program so that they could stay indoors throughout the day. While some older people accepted these adjustments as a welcome relief, others refused the modifications made for them. All modifications, however, were discussed as temporary solutions that did not address the need for safe, affordable housing, and thus further contributed to shaping late-life homelessness as marginalization.

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Interviews with stakeholders and older people revealed a tension between the shelter as a dangerous and difficult place to age, and a refuge or safe space of stability and protection. Without question, the shelter is not a safe and comfortable environment for older people. It is one where older people are afraid and may encounter further violence and marginalization. Yet, ethnographic insights highlighted how although the conditions were less than ‘ideal,’ the emergency shelters also played an important role where safety, security, and care for older people were concerned. The earlier-mentioned examples of fear and routines of staying close to the shelter suggested that the shelter provided some sense of security, although it could not ease the anxieties associated with being homeless in later life. Discussions with shelter workers also provided glimpses into cases where the shelter was the only safe and meaningful place at a difficult point in a person’s life. This was confirmed by the number of older people who highlighted that without the shelter they would have nowhere to go, and who expressed their desire to stay in the safe transitional units linked with the shelter. The following quotes outline the tension between the shelter as a difficult place and one of refuge and support, a complex tension that can be understood within the context of limited options for care and support: That’s it, plus in terms of safety, when you are sleeping in a dorm room with thirty-five people, there are problems with substance use, mental health, people who have just been released from prison. They don’t always play nice. And as you know, with the level of vulnerability and anguish, this is a group that leads a very stressful life. And it affects their health and their mental health. – Stakeholder, Housing and Homelessness Sector I want to stay here … Have some freedom; be able to breathe a bit … Not have an obligation to the system. I want a space where I can be well. – Marie, sixty-five-year-old woman, transitional program, Participant 22 The most poignant examples that highlight the limited choices of older people, and the meaningful connections with shelter staff, were those where older people returned to the shelter after surgery, in long-term illness, and at the end of their lives. Throughout the study, at least three different cases of providing palliation and support were

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mentioned.8 These examples exposed the extent of the gaps in the system and the moral distress of providing palliative care in a shelter system without the proper supports (de Veer et al. 2018; Stajduhar et al. 2019; Sumalinog et al. 2017).9 Though stakeholders felt relieved that older people would return to the shelter for end-of-life care rather than die alone on the streets, they were also distressed at the lack of options and lack of justice that continued into older people’s deaths. Shelter workers repeatedly stressed that their services were not designed for the end of life, and were not suitable to meet such needs, but they were the only option for people with experiences of homelessness. The findings of our study point to the shortage of options for rehabilitative and end-of-life care, corresponding with emerging research on vulnerable groups in Canada (de Veer et al. 2018; Stajduhar et al. 2019). Our findings also echoed a high-profile event that took place in June 2018, where an older homeless man died in public in a corner of a Vancouver Tim Hortons coffee shop,10 drawing attention to the realities of having no other place to go, and the extent of abandonment (see chapter 7). The importance of fostering trust and security with older people with experiences of homelessness thus cannot be overlooked. Older people’s needs were about not only housing, but also a stable and safe place at the end of their lives. Aging in Long-Term Care Facilities The third spatial location of late-life homelessness is public longterm care. Given that homecare is unavailable to older people who are homeless, long-term care can, in some cases, become one of the few locations (other than the streets or shelters) where older people with experiences of homelessness may age. Long-term care is generally considered a limited option due to the shortage of long-term care beds, waiting lists that make it difficult for people with meagre resources to access residential care, and the institutional nature of the setting itself (Aronson and Neysmith 1997; Cloutier-Fisher and Joseph 2000; Harrington et al. 2012),11 and it serves only a small minority of older people with experiences of homelessness. However, it is one of the available options for aging and care, and thus shapes the intersection of aging and homelessness. Our ethnographic research focused on the provider side, and included interviews with stakeholders and workers in long-term care facilities and referring

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organizations (Sussman, Barken, and Grenier 2020). Interviews revealed the premature placement of older people with experiences of homelessness, difficult transitions to care, and sustained exclusion and marginalization. The following quote details some of the challenges workers experience in long-term care: [Speaking of service gaps and connecting people to housing]. For most of them, it is difficult to get access – for the most part, the health and social services system works by address. All of the requests between agencies work by address of postal code. So from the moment there is no address, which is most of the time, there is no access to services that they really need. Sometimes I see something and think “this is too good to be true” / would be really great. In truth, I try my best to look, but it is crazy, how difficult it is. This is really not the best time for this group in terms of how the system is structured. – Stakeholder, Long-Term Care and Referring Organizations Interviews with stakeholders working in long-term care and referring organizations in Montreal revealed that older people with experiences of homelessness were often “prematurely placed” compared to the general population because few other options for their care existed. Stakeholders tended to focus their discussions on individual care needs, and questions about suitability and “fit” with long-term care. They employed the language of “premature placement” as a means to differentiate the thresholds of age and/or required level of care – a concept echoing the discussion of premature aging of homeless people documented by health and medical specialists. Despite notable disparities in health between people with experiences of homelessness and the general population, stakeholders explained that people with experiences of homelessness ended up in long-term care before they needed to be there. They noted that people with experiences of homelessness were younger than those generally living in long-term care homes, and were below the level of support that was usual for these facilities. As a point of reference, the level of support for public facilities tends to be configured around the need for twenty-four-hour support, dementia, or high levels of physical impairment. Stakeholders outlined how “premature placement” among older people with experiences of homelessness was the result of not having

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a physical home within which to receive homecare, the shortage of other suitable affordable housing options, and the lack of family and kin networks. As a result, older people with experiences of homelessness were being funnelled into the most expensive locations of care – long-term care and hospital emergency rooms. Interviews revealed that they were also being repeatedly subject to loss and ruptures in relation to the stability that care should provide, findings that also provide nuance to the layering of exclusion and displacement that occurs among older people with experiences of homelessness (see chapter 7). The following quotes illustrate the structural gaps and problems experienced at the site of long-term care: When the person leaves the hospital they can go to [a] transitional rehabilitation unit and then transitional care before they are permanently discharged. So what will she do? She will leave the hospital and care. Because she has to go to three places before she has access to permanent long-term care. The longterm care system is backed up, especially for intermediate care. There are less and less intermediate care resources, the hours of care have been reduced, which is irritating. And often, they go to a long-term care facility before the rehabilitation unit. So, those are the key problems as I see them. The person must get used to having to move many times in a short period of time. Whether we like it or not, people create networks. And as you know, people with experiences of homelessness, have had many losses where connections are concerned, they have been hurt many times. So, the fact of having to transition, transition, and transition, and then they lose all of it. Everything they create, they lose. – Stakeholder, Long-Term Care and Referring Organizations Long-term care workers discussed how once placed, older people with experiences of homelessness were known to experience difficult transitions to this care setting or challenges with regards to the “fit” with long-term care. This was often discussed as a “breakdown in the placement,” meaning that the person may not be adjusting well, may express anger or depression, or may leave the facility. Workers pointed to problems with adjustment, and how older people with experiences of homelessness often “broke the rules” of the institution by eating food from the fridge or using banned substances. Stakeholders highlighted how mental health, experiences of trauma or abuse, or

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substance use could negatively impact whether the person was able to adjust to life in a residential setting. Interviews suggested a perceived clash between a structured and unstructured existence. Stakeholders also discussed how the rigidity of long-term care facilities, which were common critiques with regard to adjustment to this setting, was exacerbated where homelessness was concerned. For example, structured mealtimes and the freedom of coming and going were contrasted with the behaviours and lifestyles of the older people with experiences of homelessness to demonstrate problems of “suitability or fit.” Yet, what these illustrations overlook is how life on the streets also has a very regimented schedule whereby older people’s lives are organized by hours of access, timed meals, and deadlines (and limits) for holding a bed. In some cases, workers acknowledged the pain and loss that people had experienced, and in others, they expressed that the older people’s lifestyles were unsuitable for shared residential living, highlighting the structural drivers of exclusion, which will be further developed in chapter 7. Consider the following: There are always concerns in the health network to accept people with experiences of homelessness in the long-term care facilities. They say things like well, they are not very good with rules, what is it going to be like? Is it going to work? So, there are a number of prejudices that we need to address to get access for people. It is difficult for our population because there are many people who need a place and there are simply not enough. And for someone who is homeless, who doesn’t have the means to pay for a private residence, well this is a serious barrier. From our point of view, the health system really needs to do something to ensure access for people who need it, and to guarantee that they have a home where they are not discriminated against … and an unconditional place to call home. – Stakeholder, Housing and Homelessness Sector Sometimes there is a bit of aggression in their way of being, in the way of speaking, they may speak loudly, intimidate other residents, other clients, staff. There can also be substance use, they come in a bit all over the place, but not really bad enough that you need to call the police and a bit like everyone else … when people drink and are using substances sometimes they get a bit unruly. And in

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this state they might act out. And there is also the cafeteria. For example, there is a fridge on the fourth floor. They might go and get a loaf of bread and eat the entire thing without thinking that the bread was for everyone to share, and that we are limited in what we can order. I mean, you can’t really take an entire loaf of bread. And sometimes there is theft. They might smoke inside. There are all sorts of behaviours that are challenging. They might drink in their rooms, or elsewhere in the building. There are all sorts of situations where we have to step in. You know, not respecting the rules of the place. There are places that are restricted for certain clientele [altered for anonymity] and they can’t just go there – it is some people’s living quarters. So there are a number of rules and times where you have to pull people aside and go over the rules, and in taking this sort of approach you can see that they start to understand the rules of the place. – Stakeholder, LongTerm Care and Referring Organizations The analysis of interviews in long-term care revealed how older people with histories of homelessness were marginalized in long-term care settings, both through examples of rule-breaking and not fitting in, and expressions that they should go elsewhere. Throughout the interviews, workers outlined how the histories of older people with experiences of homelessness also sometimes resulted in exclusion by other residents within the setting, particularly where they related to mental illness and/or the associated actions of being loud or aggressive. Illustrations revealed the layering of exclusion with regard to older people, and included a range of judgments that signalled differential treatment and problems where inclusion and ‘good standards of care’ were concerned. Quotes from stakeholders also contained exclusionary and discriminatory comments. While complaints about food are fairly standard in care settings, the comments about “disruptive visitors” stand out because long-term care is a setting where family visits are typically encouraged (see below quotes). Although we did not have interviews from older people in care facilities, the following quotes provide a glimpse of what it might be like for an older person with experiences of homelessness to live in long-term care. Findings from stakeholders in long-term care stood in stark contrast to how shelter workers spoke of older people and their needs. Where shelter workers seemed to accept interactions as part of the everyday and spoke about the structural causes of homelessness,

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there was a tendency among long-term care workers to deem actions as disruptive, and to discuss these as an individual issue of adaption or fit (also see DeForge et al. 2011). These characterizations extend beyond notions of residents as difficult into exclusionary judgments, ideas of not belonging, or beliefs that they should be grateful: “Can you accommodate her?” And they said, “Yes, we can accommodate her but we would prefer if she went somewhere else because she’s very difficult because of her undiagnosed mental health issues.” – Stakeholder, Long-Term Care and Referring Organizations Sometimes you hear them complaining about the food or something and I think to myself, “I don’t think they realize they are better off here than in the streets.” – Stakeholder, Long-Term Care and Referring Organizations Sometimes we need to limit their visits [from other homeless adults] because the other residents are scared. – Stakeholder, Long-Term Care and Referring Organizations Together, the observations and the interviews with stakeholders and older people revealed how late-life homelessness was structured through place, and the discrepancies that existed between policy frames and older people’s experiences of aging on the streets, in shelters, and in long-term care. This further exposes how late-life homelessness is structured into, and experienced in, places that are considered “undesirable” either by means of socio-cultural standards of acceptability (i.e., the streets or shelters), or by means of non-existent, unsuitable, or exclusionary practices (i.e., shelters and long-term care). Rather than an experience of “aging in place” that takes place “at home and in the community,” older people with experiences of homelessness age in public places that engender fear and anxiety. At the same time, considerations of the suitability of long-term care point to contradictions where older people with experiences of homelessness may gain stability of housing and care within a place where they become feared. As such, the accounts told within three prominent spaces reveal how life at the intersection of aging and homelessness is exhausting and painful; frightening and insecure; and subject to stigma and marginalization. In doing so, the

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stories point to how ideas and practicalities of home and place are features that structure and shape the lives of older people. In particular, the accounts highlight the lived effects of public policies (or the lack thereof), the impacts of inherent assumptions about home and stability in late life, and the disparities that exist between “aging in place” for the general population versus older people with experiences of homelessness.

t he dis j u n c t u r e b e t w e e n poli cy frames and e xp e r ie n c e s o f l at e - l ife homeles snes s This section builds on the findings from the ethnography to highlight the intricacies of how late-life homelessness is structured, mediated, and experienced through place. It picks up on an argument by Laws (1997) that more attention be devoted to the spatiality of age relations, and draws on key debates and insights from social gerontology. It thus addresses the gap with regard to place and latelife homelessness and challenges the preconceived positive status of home and stability in late life. To do so, it turns to a critical reflection on the importance of home and place as a means to further the analysis of late-life homelessness and to build the foundation for further chapters on disadvantage, exclusion, and justice. The Importance of Home The ethnographic insights on late-life homelessness can be understood as illustrative of the variations of meaning within a backdrop that includes the ideological imperative of home, the social and cultural significance of home, and home as the practical site of service delivery. In gerontology “home” is considered a powerful discursive frame for aging and late life, interconnected with meaning-making, a physical site of service delivery, an ideological discourse, and a political imperative (Grenier, Barken, and McGrath 2016). Meanings of aging and late life are often constructed in relation to social, cultural, ideological, and sentimental notions of home (Kontos 1998; Wiles et al. 2012). Home is also employed politically, in examples related to the systems and structures of care delivery, and through neo-liberal priorities of individual responsibility and reduced public services (see Rudman 2006). Yet, while home is considered to play an important role in older people’s lives, home is not universally

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experienced. Gubrium (1993) suggests, for example, that there are “horizons of meanings” that can vary among individuals in the same setting, and between contexts. Experiences at the intersections of age and homelessness reveal how meanings of home can vary between the general population and people with experiences of homelessness. Older people’s experiences of homelessness thus offer insights from a social location that is at odds with the social, cultural, ideological, and political interpretations of home. The older people in our research did not have homes (or homes constructed in the ideal ways), and, as such, were deprived of the stability that is presumed to be in place in late life, both as a foundation for making meaning of aging, and for the practical (and political) purpose of receiving care. In gerontology there is a long-standing critique that the shift to “home and community” care represented a neo-liberalization of care enacted through cutting services and shifting responsibility onto families (see Armstrong and Braedley 2013; Aronson and Neysmith 2001; Estes, Swan, and Associates 1993).12 That is, where symbolic associations of home were employed for the political and ideological purposes of cost containment. Estes, Swan, and Associates’ (1993) argument about “no care zones,” which emphasize private and market-based care are relevant. These processes leave marginalized groups without access, and best encapsulate how formalized care causes those without family to age without care. Nowhere is this more visibly observed than in the case of latelife homelessness, where older people do not have the traditional family resources, nor the home within which to receive available public options. In the case of late-life homelessness, it is precisely the contrast between the importance of home and not having a home (or suitable arrangements) that reveals the disparities that characterize being older and homeless. The ideological and political role of home in organizing care services for older people thus cannot be overlooked as a spatial dynamic that configures late-life homelessness. Policies on aging and care leave older people with experiences of homelessness outside the formal mechanisms of care, with no options but the street or the shelter. Yet, if and when they do receive care through the only option of public long-term care, available only to a small number of people (and in some cases refused by older people), they are deemed to not “fit in” and/or are excluded. The absence of a place to age and receive care leads to the consideration of how frameworks organized around homelessness address

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the needs of older people, particularly where home is concerned. Strategies to address homelessness tend to focus on the concrete and practical notion of housing rather than home. That is, they focus on the provision of basic needs of housing and shelter. The emphasis on physical housing can be seen in the “Housing First” agenda that has underpinned more recent Canadian approaches to homelessness (Government of Canada, esdc 2014). For example, Housing First emphasizes the importance of a physical place, thereby linking housing with health and social outcomes. In doing so, it evokes a hierarchy of needs whereby one’s mental health and/or psychological stability are reliant on the basic need for housing being met. Yet, older people, and the specific needs that occur at the intersection of aging and homelessness, are overlooked in this context. Although this idea of housing as the first priority and starting point for overcoming social and physical challenges related to homelessness is in line with the needs of homelessness in late life, older people were not included in the planning phases, and the model has moved ahead with little information (or adjustment) for older people (see Gaetz, Gulliver, and Richter 2014; Goering et al. 2014; Serge and Gnaedinger 2003). And although housing older people may indeed serve to relieve pressures on emergency systems, the failure to include older people has left this sub-population without “house” or “home,” highlighting yet again the importance of place, and the associated meaning of having “somewhere to go.” The Importance of Place The ethnographic insights revealed lessons for social gerontology with regard to understandings of how place structures and shapes social relations of disadvantage and late life. The importance of place and space as impacting health and well-being is widely established in social gerontology (Laws 1994; Mallett 2004; Rowles and Bernard 2013; Rowles and Chaudhury 2005; also see Farber and Shinkle 2011), and forms the basis for a range of public health and policy frameworks. Ideas about the positive (or negative) effects of “place” are central to local, national, and international policies and organizational practices. For example, Davey et al. (2004) situate their definition of “aging in place” in the service context, defining aging in place as “remaining living in the community, with some level of independence, rather than in residential care” (133). Thus,

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“place” becomes similarly positioned to “home” as significant on personal, experiential, and social levels, and to older people’s attributions of meaning to the spaces and places within which they live or work (Hillcoat-Nallétamby and Ogg 2014; Iwarsson, Horstman, and Slaug 2007; Oswald and Wahl 2005).13 Yet, there is often less nuance to or critique of the concept, and especially where disadvantage is concerned. Although ‘aging in place’ has largely escaped the critique raised about models of successful or healthy aging (see Rubinstein and de Medeiros 2014), late-life homelessness disrupts the universal positivity of ‘aging in place,’ and points to the symbolic and political processes of exclusion, which result from the emphasis on home, place, and community. Statements from older people reveal what it is like to occupy the intersections of aging and homelessness, and the spatial dynamics of exclusion. There are a number of insights that can be drawn from gerontology to understand these accounts. Older people’s practices of staying closer to the shelter, for example, are reminiscent of Rowles’s (1978) depiction of a diagram of concentric circles, whereby older people would frequent places that were in closer proximity to their homes, and venture less frequently (especially unaccompanied) into more geographically distant places. Where the findings differ from Rowles’s original work, however, is that in the case of latelife homelessness, the safety net from which they depart and return (the home) is absent. Instead, older people’s experiences of aging take place spatially in a public world, in places deemed “unsuitable,” and which instill anxiety and fear. This contrast can be extended further, to argue that the absence of this home root functions to heighten the anxiety of late-life homelessness because it leaves people without a stable environment, and access to security and shelter. While the emergency shelter system functions to temporarily fulfill this need, it is inadequate as a solution. Similarly, long-term care could function to provide stability to older people with experiences of homelessness; however, in order to do so, challenges of inclusion would need to be addressed. At present, the disparities experienced through place, and to secure spaces (both symbolically and practically), sustain disadvantage and exclusion among older people with experiences of homelessness. The absence of places to age, and the negative experiences that are structured and shaped through place, raise a series of questions where aging, disadvantage, and marginalization are concerned.

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Spatial Dynamics of Late-Life Homelessness The insights gleaned from exploring the spatial aspects of late-life homelessness reveal the extent to which existing responses create an experience of aging that is far from the expressed ideals of active, healthy, and successful aging experienced “at home and in the community” (see chapter 7). Older people with experiences of homelessness are not afforded access to the presumed benefits of “aging in place,” and are aging in locations that are unsafe, unsuitable, and considered to be the most expensive. Ethnographic insights draw attention to how the failure to address intersecting needs for income, long-term housing, health, and care will continue to produce care gaps and jeopardize well-being. Further, they reveal how current responses allow older people to live their everyday lives in risk, insecurity, anxiety, and violence. Such findings raise questions about older people’s rights as they are left to age in “undesirable locations,” and draw attention to the injustices of exclusion and marginalization. This gap between expected ideals and realities also renders visible how underlying assumptions about ‘place’ and ‘care at home and in the community’ rely on shaky foundations of a stable life course, the availability of a home, and the unpaid care of women, kin, and community. Overlooking the spatial relations of late-life homelessness, and the ways in which older people with experiences of homelessness are relegated to “less desirable” places, or “being the less desirable” in a particular place such as long-term care, raises important questions about the mechanisms and conditions to ensure support, meaningful participation, and well-being. What a detailed and critical exploration of late-life homelessness points to is that the experiences are not only about different “horizons of meaning” (Gubrium 1993) but processes of differentiation whereby frameworks, structures, and social relations actively exclude particular groups of older people. The three spatial locations of late-life homelessness reveal how aging is experienced in particular “undesirable places” that create and sustain disadvantage and unmet need, and produce anxiety and insecurity. That is, in the case of late-life homelessness, the idealized assumptions of “home” and “place” bind together to produce perverse outcomes and sustain the exclusion of marginalized groups of older people, rendering apparent questions such as: What is it like to live the effects of aging in place from a disadvantaged location? Who

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is left out, how, and why? And what unequal effects are produced when “aging in place” is considered as universal? Where aging is concerned, housing can no longer be assumed to be in place as people age; approaches can no longer consider that older people’s needs are met elsewhere; and ideas of stability in late life must be challenged. Further, programs cannot assume that the provision of a house will equate to needs being met, nor that the provision of a house is synonymous with the subjective expectations of “home.” Thinking through a critical lens exposes disjuncture and disparities, sparking reflection about the lived effects of public policies, the indifference or marginalization that older people experience, and how these differ from intended ambitions and sentimental frameworks of house, home, and place. Late-life homelessness raises questions about the extent to which those without homes, or who are precariously housed, can “age in place” “within their homes or communities.” As will be further explored in forthcoming chapters, older people’s expressed desires for safe, secure housing and a place to call “home” are completely aligned with the personal and subjective expectations of the philosophy of “aging in place” and the structures for service delivery within the home. Yet, older people with experiences of homelessness live in spaces and places where they must rely on emergency supports with little hope of permanent solutions.

c o n c l u s i on This chapter outlined how late-life homelessness was structured, shaped, and experienced in relation to place, and through encounters in three spatial locations where homeless people “grow old”: in the streets, in shelters, and in long-term care. It revealed how latelife homelessness was characterized by walking, waiting, and sleeping in fear (on the streets); being fearful, encountering unsuitable or unadapted spaces, and being stuck (in the shelter); and being judged, not “fitting in,” and/or “not belonging” (in long-term care). It drew attention to the fault lines that exist within the two leading frameworks of “aging in place” and “aging at home and in the community,” and between the experiences of older people in general and of those who were homeless. Using these concepts as an anchor, it drew attention to service gaps, the lived effects of policies on people’s lives, and the resulting unmet need that can occur when mechanisms

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are not in place. In particular, it contributed a detailed spatial analysis, adding how place structures and shapes late-life homelessness and how challenges are mediated through place. It revealed that life at the intersection of aging and homelessness is about aging in locations deemed unsuitable, expensive, and ‘undesirable’ such as hospitals, the streets, and emergency shelters – places that defy the positive ethos underlying “aging in place.” In doing so, the ethnographic data also exposed how life at the intersection of aging and homelessness is a location of suffering that is mediated by and experienced through place, and in ways that sustain disadvantage and unequal aging. The everyday lives of older people with experiences of homelessness were characterized by finding shelter, walking through the city all day, experiencing aches and pains without the security and safety of a home, having difficulty reaching a bed, being afraid, and being subject to stigma. The accounts of older people thus reveal how older people with experiences of homelessness do not have access to the same ideals of aging well and “in place,” and as such, experience aging in and across a range of “undesirable locations.” Accounts from older people highlight how late-life homelessness is about having to lead one’s existence in public contexts without the presumed supports of the physical and emotional shelter of the home and/or the family care. As such, they revealed the importance of recognizing the needs of older people who are homeless, and of advocating for safe and affordable housing as a means to stability, well-being, and care, and not simply as an endpoint in itself. Together, and building on previous chapters, the ethnographic insights about place provided a glimpse into the spatial discrepancies and disjuncture that exist, thereby laying the foundation for the forthcoming analysis of disadvantage, exclusion, and the need for justice. In the next chapter we turn to how homelessness is an experience of disadvantage over time.

6 Late-Life Homelessness as a Reflection of Disadvantage over Time

This chapter develops the perspective that late-life homelessness is structured and experienced as disadvantage over time. While detailed evidence on health disparities and the unique needs of older people with experiences of homelessness exists, there is little attention to late-life homelessness as produced through (and resulting from) disadvantage and unmet need over time. Existing understandings tend to focus on identifying and predicting how early pathways can alter those of late life, or how particular groups are over-represented among people experiencing homelessness. While these are important components, they tend to overlook how some events cannot be predicted, and how disadvantage is experienced across a range of intersecting social locations, sites, and settings. Chapter 6 adds to the analysis of late-life homelessness developed thus far by revealing how inequality pools at the level of lived experience, and becomes visible through everyday experiences of disadvantage over time. The stories of older people and the accounts of stakeholders reveal countless illustrations of unmet need where income, housing, health, and care are concerned. These stand in contrast to approaches that are organized according to a dichotomous focus on housing or health care, which are segmented according to stage-based responses, and/or miss the everyday impacts of inequalities. A critical perspective on late-life homelessness addresses the knowledge gap by suggesting disadvantage over time as pertinent to the analysis. This chapter engages with the research questions: what does latelife homelessness tell us about disadvantage over time and what is it like to live at the intersections of aging and homelessness? It begins by outlining a brief sketch of cumulative advantage and

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disadvantage (cad ) and intersectionality as they are known in social and critical gerontology. It then turns to the findings of the ethnographic study to reveal disadvantage in the everyday lives of older people with experiences of homelessness, and to extend the analysis of inequality in aging through awareness of how disadvantage plays out in lives over time. Material from stakeholders and older people is presented in four areas: first, how stories recounted in late life are mired with histories of disadvantage and unmet need from earlier periods in the life course; second, how intersecting and interlocked forms of oppression create and sustain disadvantage throughout people’s lives; third, how encounters with structures and services further disadvantage people through unmet needs or unsuitable supports; and fourth, how disadvantage deepens over time. Together, these illustrations further the understanding of late-life homelessness as an experience of disadvantage that can deepen over time as needs continue to go unmet. The chapter proposes the concept of disadvantage over time as a means to shift the conversation from predictable pathways and unique needs of older people to a more complex understanding of late-life homelessness as produced and experienced between structures and everyday lives.

ap p roac h e s to u n d e rs ta n di ng di sadvantage: c a d a n d in t e rs e c ti onali ty This chapter engages with two existing approaches to the study of inequality in social gerontology – cad and intersectionality – to further our understanding of late-life homelessness.1 Attention to poverty and inequality has long featured in the study of aging and late-life from a critical perspective. For example, in the United Kingdom, landmark studies such as those led by Rowntree (1941) and Townsend (1979) focused on poverty among families and older people. In France, Charcot’s medical studies, carried out at the Pitié-Salpêtrière hospital in Paris, were based on the classifications and diagnosis of women who were institutionalized, older, and poor (see Achenbaum 1995; Katz 1996). And in the United States, the development of the life course perspective was intricately connected to the study of transition, social change, and unequal outcomes between historical cohorts (Elder Jr. 1994; Hareven and Adams 1982; Quadagno 2008). However, while the study of disadvantage is an important thread in social and critical gerontology (Dannefer 2003; Hendricks and

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Hatch 2009; O’Rand 1996), the field has been relatively silent with regard to late-life homelessness. The contributions from two highly influential perspectives in aging, cad and intersectionality, can, however, be used to situate our ethnographic results and further understandings of late-life homelessness. Although cad and intersectionality differ theoretically, methodologically, and as they are deployed in international and disciplinary contexts, they share a common focus on inequality, the unequal distribution of resources, differential chances, and unfairness. Yet, while both hold relevant insights for the analysis, neither approach has been sufficiently developed with regard to late-life homelessness. The foundations of each are briefly outlined here as a basis for extending the argument that late-life homelessness is shaped by processes of disadvantage that become visible at the everyday experiential level, and as they intersect with various social locations and life events over time. The Cumulative Advantage and Disadvantage Model The cad model offers a solid base for furthering the study of late-life homelessness as inequality and disadvantage. This model focusses on the relationship between macro- and micro-level factors (see Crystal, Shea, and Reyes 2016; Dannefer 2003; O’Rand 1996; O’Rand and Henretta 1999).2 In the mid-1980s, researchers in social gerontology (many of whom were located in the usa ) proposed the cad model as a means to comprehend differentiation over time, to challenge the cohort-centric nature of cross-sectional studies, and to expand understandings of inequalities beyond measures of income and poverty (Crystal, Shea, and Reyes 2016; O’Rand 1996). The model focuses on “the process of production of disparate life outcomes through the interaction of initial advantages and societal institutions over the life course” (Crystal, Shea, and Reyes 2016, 911). In doing so, it establishes a potential relationship between institutional structures of the life course, interventions such as public policy, outcomes for older people, and a method of analysis. As Crystal, Shea, and Reyes (2016) outline, cad provides a means to explain “the ways in which early-life advantages and disadvantages persist into late life, despite the many intervening contingencies and random life events” (911). This includes, but is not limited to, how the economic effects of early advantage (and disadvantage) are magnified over time and/ or moderated by social institutions, producing income inequality

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in late life (Crystal and Shea 1990; 2003; Dannefer 1987; 2003; O’Rand 1996).3 As such, the cad model is designed to take account of the social inequalities that accumulate across the life course, and which persist in late life (Dannefer and Huang 2017). The cad model contributed explanations of the socially produced positive and negative effects on health and well-being, intra-cohort differences in micro-level income, and social disparities over the life course (see Dannefer 1987, 2003). For example, it demonstrated racial disparities and how particular groups were over-represented in poverty, as well as how income, health, and social disparities persisted and worsened in late life (Brown et al. 2012; Kelley-Moore and Ferraro 2004; Shuey and Willson 2008). In the context of the United States, for instance, research demonstrated that a lack of access to education in childhood has negative impacts into late life, and further that racial discrimination with regards to education and labour is associated with poverty, health disparities, and early mortality when compared to the white population (Hargrove and Brown 2015; Kahn and Fazio 2005; Shuey and Willson 2008).4 As such, the cad model renders visible how disadvantage becomes magnified over time, by means of the accumulation of advantage or disadvantage, to become a regular feature of cohort aging (also see Crystal, Shea, and Reyes 2016; Dannefer 2003, S328). In doing so, the model reveals how “aging is not only something that happens to individuals but to collectives,” “involv[ing] processes … between them” (Dannefer 1987, 213). This includes insight into factors such as the premature mortality of particular groups. Yet, the methods used to explain such differences often rely on trends and statistics, meaning that the impacts of disparities may be larger than evidence suggests. Here, Dannefer highlights the work of Rosenbaum, who likens the process of cumulative disadvantage to a “tournament mentality” that removes the group at the bottom of the socio-economic gradient; this means this group has been forever eliminated, and disparities cannot be recognized (Dannefer 2018). Such understandings seem extremely relevant to the disparities with regards to homelessness, resulting from historical practices of racism and colonization. Research on cad can provide a foundation to further the analysis of late-life homelessness. There are, however, some limitations to keep in mind and places where cad could benefit from linkage with intersectionality and qualitative research practices. Although widely used in social gerontology in the United States, the cad model has

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received less attention in Canada, where understandings of inequality tend to be dominated by the social determinants of health model (Wanless, Mitchell, and Wister 2010). Further, although cad has been credited with opening the door to studying intra-cohort differences based on gender, race, and ethnicity (Quadagno 2008; Thorpe and Kelley-Moore 2013), there is more work to be done with regards to systemic racism and institutional forms of discrimination and violence. Again, the literature rooted in cad depicts a detailed illustration of the existence of racial disparities, but focuses less on how these are produced and experienced through systems, institutional structures, and social relations. In the field of homelessness, efforts to apply cad have produced insights with regard to predictive outcomes of early life course experiences (Lippert and Lee 2015; Oppenheimer, Nurius, and Green 2016; True-Funk 2018).5 In fact, much of the research on homelessness in late life has roots in perspectives that demonstrate the impacts of trajectories related to education, work, trauma or violence, or incarceration.6 Yet, how inequality pools through intersecting and everyday forms of disadvantage on local and relational levels is less known. While cad provides a relevant model for understanding inequality across the life course, and late-life homelessness, it falls short where assumptions of coherence among cohort groups and undefined notions of agency are concerned (see Dannefer 1987; 2003; Hitlin and Elder 2007). Pairing the contributions of cad with qualitative approaches on the relationships between structures, institutions, systems, and experiences; the intersectional relations and effects of disadvantage; and events that cannot be predicted can help to better understand late-life homelessness as unequal aging and disadvantage over time. Intersectionality and Aging Intersectionality, a feminist approach to studying diversity and oppression, offers another foundation for furthering the analysis of inequality and late-life homelessness. Intersectionality links well with a focus on diverse social locations, qualitative research, and how policies and structures impact lives through domination and oppression. The concept of intersectionality focuses on multiple and interlocking systems of oppression that shape and structure people’s lives through the interplay of categories of difference within wider structures of domination (see Collins 2015; Collins and Bilge 2016; Crenshaw 1989; Dhamoon

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2011).7 Intersectionality was born from a statement written in 1977 by the Combahee River Collective, a Black feminist lesbian group concerned with the pervasive marginalization of Black women from the white feminist and anti-racist movements (Combahee River Collective 1983). According to Collins (2015), intersectionality outlines the critical insight that race, class, gender, sexuality, ethnicity, nation, ability, and age operate not as unitary, mutually exclusive entities, but rather as reciprocally constructing phenomena. Intersectionality draws attention to processes of differentiation, including how social relations are organized through historically constituted systems of domination such as racism, colonialism, patriarchy, and capitalism. This includes the organization of subjects and subjectivities, how subjects negotiate these modes of differentiation, and how systems of domination reflect and rely on these processes. Originally developed in women’s studies in the 1980s, intersectionality was introduced to gerontology in the 1990s to challenge its lack of diversity and homogeneous views of aging, and to draw attention to the intersecting forms of disadvantage and social relations of power that created and sustained the oppression of particular groups of older people (Calasanti 2003; 2009; McMullin and Curtis 2016). Intersectionality provides insight into the systemic forms of discrimination and oppression, impacts of particular social locations of aging, and disparities that exist between older people in the general population and those who have experienced disadvantage. Although age is often overlooked in wider discussions of intersectionality, there are a number of gerontological researchers who have established linkages between studies of oppression, domination, and age relations. Hulko (2009), for example, summarized intersectionality within social gerontology, as a path to operationalize and (re)centre voice, subjectivity, and privilege, and to connect subjective (micro) experiences with (macro) social structures as a means to reveal the privileged centre and the marginalized oppressed. In gerontology, intersectionality has been used alongside qualitative methods to highlight gendered experiences of poverty, unequal forms of participation (and compensation) in the labour market, caregiving, lgbt seniors, racism, and public policy (Calasanti 2009; Koehn et al. 2013; McMullin and Curtis 2016).8 More recently, it has been employed to examine the impacts of colonization and migration with regards to age and aging (Ferrer et al. 2017; Hulko 2016; Hulko et al. 2019).

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Despite the relevance of this approach for understanding late-life homelessness, very few scholars have considered this lens. While both Collins (2016) and Yuval-Davis (2016), authors who developed and advanced the intersectional approach, gave examples of homelessness in their defining work on intersectionality, most applications of intersectionality have focused on younger populations who are homeless (Zufferey 2016). One notable exception, however, is the research of Gonyea and Melekis (2017), who outline older women’s experiences of homelessness, negotiation, and resistance from an intersectional perspective. Their research outlines how older women’s narratives revealed multidimensional and complex relations, demonstrates how power dynamics between sexism, ageism, and homelessness are linked, and highlights older women’s expressions of agency and enactments of self.9 In our ethnographic research, older people similarly outlined several intersecting forms of disadvantage over the life course, moving in and out of homelessness (sometimes since childhood) as a result of poverty or abuse, unstable housing, experiences of precarious work, or gender-based violence, as well as trauma, colonization, and discrimination. Approaching the study of late-life homelessness from a critical and qualitative perspective that draws on cad and intersectionality has much to offer. In particular, it reveals how the impacts of inequality intersect through various forms of oppression, domination, and discrimination that are experienced across the life course and into late life, and exposes the intersecting processes that produce systemic and institutional forms of violence and suffering.

i l l u s t r at io n s o f d isa dvantage over ti me: v ie w s f ro m t he i ns i de Equipped with the knowledge of two relevant ways to approach the study of disadvantage and aging, this section turns to quotes from stakeholders and older people in Montreal. These insights reveal how inequality amasses at the level of lived experience and becomes visible through intersecting forms of disadvantage and discrimination over time. As ethnographers have long argued, the everyday is a site where social relations of power and suffering can be critically examined (Farmer 2003; Scott 1998). Our ethnographic research revealed that older people with experiences of homelessness had lived through and accumulated a range of disadvantages. The

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material in this chapter is organized according to disadvantage as it appears through four domains at the intersections of aging and homelessness: life-long stories of disadvantage and unmet need; intersecting and interlocked forms of oppression; the creation of disadvantage through structures and systems; and the deepening of disadvantage over time, as needs continued to go unmet. Together, these components reveal intricate relationships of inequality within and between structures, practices, and encounters. They also point to the everyday suffering that people with experiences of homelessness endure. Histories of Disadvantage Our interviews took place among people who were over the age of 50. However, older people recounted strikingly detailed histories of disadvantage and hardship in early life and over long periods of the life course. Older people spoke of disadvantage through encounters with institutions such as school, family, and the labour market. The most commonly discussed pathways to homelessness were job loss or work injury in mid-life, partner loss (separation, widowhood, etc.), eviction (sometimes due to prolonged hospital stays), and intimate partner violence (especially among women). These themes echo the literature on pathways to late-life homelessness (see Gonyea, MillsDick, and Bachman 2010; Gonyea and Melekis 2017) and the known disparities highlighted by cad and life course research into inequality. In many cases, stories from older people demonstrated how their experience of homelessness in later life was not their first experience of hardship. Some had experienced childhood trauma, strained family relationships, and/or mental health issues (also see Padgett 2007; Padgett et al. 2008). For the most part, disadvantage was recounted as part of the trajectory or pathway that led them into homelessness. Although interviews in gerontology are always in a sense present and retrospective, the stories at the intersection of aging and homelessness had collective levels of disadvantage we had not witnessed in other projects on frailty, homecare, and/or life course transitions. Rather than focus on the pathway itself, which is typical in the field, the intent in this chapter is to focus on disadvantage as a larger driving force that shapes and cuts across the various trajectories. The following quotes demonstrate the difficult histories people brought to (and which brought them to) homelessness in later life:

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My work was always physical. I didn’t have much education, and I couldn’t find work … So I ended up on unemployment, I used up my unemployment. I ended up on welfare – 600 bucks a month, I ended up on the street, and that[’s] what brought me here. – Yves, fifty-three-year-old man, transitional program, Participant 33 So ... we would have fights, he didn’t want me to push myself … he didn’t want me to … I had long hair … it was verbal violence and a bit physical … And so I couldn’t do it anymore. – Joanne, sixty-year-old woman, transitional program, Participant 29 And then ... following that, you know, there was our break-up … and when we were a couple, it was my partner who managed the bills … and then the separation itself, it really traumatizes me, in any case. – Lucas, sixty-four-year-old man, shelter, Participant 27 Other difficult histories detailed substance use or gambling as leading into homelessness, although these were infrequent in our sample. For example, Robert said: “So, until about forty, I had a completely normal life … what brought me to homelessness was the use of cocaine around age forty … in the summer of 2009, I found myself without a fixed address” (Robert, fifty-six-year-old man, transitional program, Participant 1). In some cases, people commented that although they had used substances in the past, they no longer did so in late life. For example, one older person said: “I stopped using drugs about a year ago, but I have a drink on occasion … [my] health (laugh) doesn’t really allow me to use anymore.” The data on substance use among older people in Canada is limited, and reflects uncertainty as to whether people continue, decrease, or stop their use, as interviews in our study suggested.10 Available data from the United States suggests that substance use affects roughly 49 per cent of those who are transitionally homeless, 66 per cent of those who are episodically homeless, and 83 per cent of those who are chronically homeless (Kuhn and Culhane 1998). Although patterns of drug and alcohol use among older people (and older people with experiences of homelessness) have yet to be clearly established, research suggests that people who have used substances across their lives may require services that allow for continued use, and substance use likely means there are

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also comorbidity issues related to prolonged use (see Kuhn and Culhane 1998; Blazer and Wu 2009; Dietz 2009).11 Yet, it is worth noting that even when substance use was discussed by stakeholders and older people, it often remained disconnected from discussions of earlier experiences of trauma and violence, and theories of substance use as self-medication.12 Stories of disadvantage were interwoven with instability and insecurity across periods of older people’s lives. Linked to difficult histories, older people’s accounts included various identifiable points at which intervention could have altered their paths. Older people used stories to explain “how they came to be homeless,” the turning points that led to their homelessness, and what it meant to be homeless in later life. Throughout, older people repeatedly used expressions such as “I don’t know how I got here” or “I am too old to be homeless” to explain their paths into homelessness. While these statements accurately depict the psychological struggle of being homeless in late life, they also somewhat obscure the various pathways into homelessness that can be understood through considerations of disadvantage and inequality. In qualitative interviews, the researcher often witnesses larger social patterns and shared themes that people in the thick of their own lives, and especially in crisis situations such as homelessness, may not see. For example, interviews reflected common patterns of disruptions caused by unemployment, illness, or family breakdown, often worsened by systemic failures such as hospital discharge, running out of unemployment benefits, or being evicted (Shibusawa and Padgett 2009). Yet, what the older person was attempting to communicate was that late-life homelessness was irreconcilable with individual and social expectations. Here, the lack of stability in people’s lives directly contrasts with the idea that the institutions of the life course, including family, school, community, and society, provide the foundations of stability and security. Stories of late-life homelessness reveal how the expected forms of stability were, in many cases, never really there. Even in cases where people had not been homeless until later life, difficult trajectories and unhealed wounds were clear in the accounts. In our sample this was particularly pronounced among older women, who tended to discuss longer periods of homelessness than the men we interviewed. The following quotes speak to strained relationships as an example of these wounds:

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I called my mother and asked her if I could live with her until I get back on my feet and find an apartment. But she didn’t want that. And I wasn’t in contact with anyone else, and they didn’t want me to go there, so I didn’t. – Marcia, fifty-five-year-old woman, transitional program, Participant 26 When I confronted him, he picked up one of the rifles and he put it to the side of my head and he said, “How does that feel? I could kill you.” … Q: How did you feel? R: Terrified. I said, “You have to leave right now. Please leave right now” … He was a crazy man; he was obsessed with guns. – Wanda, fifty-nine-year-old woman, transitional program, Participant 21 I am the oldest of two children. My sister is five years older than me. It is a long time that I haven’t seen her. And my children, it is a long time that I haven’t seen them either. – Sarah, sixty-oneyear-old woman, shelter, Participant 32 Intersecting Forms of Oppression The interviews revealed how interlocking forms of disadvantage and oppression differently affected older people at particular social locations. For example, experiences of homelessness were impacted by age, (dis)ability, gender, physical health, ethnicity, Indigeneity, mental health, racialization, and sexual orientation. Although the sample size restricts us from deep explorations of each social location (particularly with regard to racialization), gendered differences were the most noticeable across our sample. Our research comprised twenty-nine men and eleven women with experiences of homelessness; three identified as Indigenous (First Nations, Inuit, or Métis) and two were foreign-born. Gender differences existed in the process of collecting data and the results. Where men would speak about their experiences and histories (with some hesitation), older women primarily kept to themselves, and were reluctant to speak about their lives. The findings of women having smaller spaces and hiding in plain sight, discussed in chapter 5, are also pertinent to the analysis of power, voice, and violence. The most prominent everyday challenge and reason given for remaining homeless was “not being able

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to make ends meet” as a result of health, employment, and housing costs. However, where men tended to discuss the challenges in relation to employment or divorce, women (when they spoke) tended to discuss intimate partner violence and the fear of being further victimized in the shelter or on the street. An intersectional lens helps to contextualize these differences in the gendered power relations that exist with regard to age, labour, care, and violence. Homelessness among men in later life tended to be depicted, and occur, through labour-related discrimination. As expected, many of the older men we interviewed spoke about under- or unemployment across the life course (also see Brown et al. 2016; Caton et al. 2005; McDonald, Dergal, and Cleghorn 2004), and this was certainly the case among the two foreign-born men in our study. Men spoke about the physical violence that occurred on the streets and in shelter systems, an expression of toughness and strength as the expected form of masculinity between groups of men. They also spoke about how homelessness impacted their mental health. Time and again, older men spoke about how age compounded by homelessness made it extremely difficult to exit homelessness in later life. Both stakeholders and older men spoke about how struggles to find work had worsened as they aged, as a result of declining health or age-based discrimination. Men spoke about limited work opportunities, how poor health impeded their chances of re-entering the workforce, and their subsequent feelings of hopelessness, which placed them at risk for suicide. They also spoke about the importance of work, and their desire to be retrained and employed. The following quotes reveal the intersection between employment, self-worth, and mental health recounted by older men, one of whom was foreign-born. Together, all three quotes are from men in their fifties, highlighting the challenges of securing work, and the extent to which homelessness, if not addressed, could become long-term: When [I] was younger, my health was good so I could work, I could get around. Whereas today, I’m sick, I’ve had a heart attack, two pulmonary embolisms … I can’t bounce back like I used to. And I don’t have the will to bounce back. And that, I find dangerous. – Simon, fifty-six-year-old man, shelter, Participant 4

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[I became homeless] … In 2008–2009, I had an accident at work. I didn’t work for almost two and a half years. Last year, I started working again, but I had an accident … and since I didn’t have enough hours to get my unemployment. In April or May I will start working again. – Étienne, fifty-seven-year-old man, shelter, Participant 5 Coming up to fifty-five years old, you see, and I can’t just start over and be a plumber … I was the manager of a team, I supervised twenty-four or twenty-five people. Today, I find myself washing dishes. I can’t continue to do things like this. But if I can find something else [work], and the government allows me to claim unemployment again, a second chance, I could reinvent myself in technology, I could do it. Because I would … I have a high school diploma, but a diploma today doesn’t get me anywhere! You see. But if I had a diploma in technology, I could build something, adjust and get by. But I have a diploma in industrial relations. They’d [employers] be better off hiring a guy with a diploma and an undergraduate degree than someone who came from the university setting. – Ben, fifty-six-year-old man, shelter, foreign-born, Participant 9 Our sample did not allow for much comparison with regard to the intersection of visible ethnic minority status, racism, and age. Most of the sample were born in the province of Quebec, with two people who identified as foreign-born, and three as Indigenous (First Nations, Inuit, or Métis). The quote from Ben, however, a racialized and foreign-born man from Africa, provides some insight into the intersections of race, age, and homelessness. Although Ben did not specifically speak about racism, his challenges in securing stable full-time employment could be read through this lens. Trends in Montreal reveal that Black men are under-employed throughout the life course, suggesting that his employment history is related to experiences of migration and racism (High 2017; Torczyner et al. 2010). His profile and interview reveal that he had a bachelor’s degree, and lost employment in his early fifties. At the time of the interview he had no benefits, likely due partly to being too young. Yet, his history of being foreign-born and his shorter work history are likely to continue to structure him into poverty upon reaching the retirement age of sixty-five. Such features reveal the intersectional effects of

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disadvantage over time, as structured through policy and programs such as retirement/labour, migration, and housing. Older women’s homelessness tended to be discussed in relation to violence. As outlined in chapter 5, older women kept to themselves in the shelter and cafeteria spaces, and, despite their interest in being part of the research and sharing their stories, spoke in short sentences. The women’s pavilion of the shelter looked and felt different from the men’s. It was smaller, and had plants and personal items such as fabrics and art – a contrast to the large institutional character of the men’s shelter. Yet, there was a nervous energy when groups of women were around, in the cafeteria and the corridors. In the interviews, older women required more prompting and would provide short answers about prior experiences of violence, and fears for their safety and well-being. Women often defined their experience in contrast to men’s homelessness, outlining the extent to which they had to re-position themselves to be heard on a regular basis. For example, they would say things such as “For women it is different.” Women’s stories also often referenced experiences of violence in their lives, either in childhood or as a result of intimate partner violence, and were often extremely charged and descriptive, suggesting high levels of trauma. Both women and men discussed being scared of men, and similar to the men, some older women were afraid of younger women in the shelter. As such, findings revealed the gendered constructs of masculinity that revolve around physical defence, and how this impacts women with histories of violence. Women also spoke slightly more about their children and families, many of which were estranged. The following quotes highlight women’s views: [Speaking of aging and homelessness, and the gender differences] But women, sometimes, we are scared. – Claudine, sixty-threeyear-old woman, shelter, Participant 24 Well, the difference [for women] is that we are more afraid. When I leave Tim Hortons … because I come here at about 6:00, to be careful not to disturb the others in my unit – there are eight of us that sleep there. I always ask someone to come with me. This morning it was [worker] who came with me. – Joanne, sixty-year-old woman, transitional program, Participant 29

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At the same time as our interviews reflected known gender differences between men’s and women’s trajectories into homelessness, where men tend to come into homelessness through job loss and/or substance use, and women by means of intimate partner violence, our findings suggested shifting patterns with regards to women’s labour. Our research suggested that there may be more people becoming homeless in later life through the loss of work in mid-tolate life, and through eviction (see Gaetz et al. 2016). Some of the women we interviewed spoke about their involvement in precarious labour and the impacts of losing employment in mid-later life. In some cases, the loss of work and experiences of intimate partner violence existed within the same interview, and in others, women encountered violence in their work settings in restaurants or cleaning (although further analysis of the occupational component was not possible in our sample). We were, however, surprised at the extent to which women discussed precarious work as their pathway into homelessness, thereby signalling a change with regard to gendered labour trajectories, and a possible rising trend of first-time homelessness among older women. Likewise, older people and stakeholders discussed how eviction (although likely less prominent in Montreal than other cities as a result of social protections and features such as rent control) was also emerging as an issue for older women. Intersectionality illustrates the differential age, gendered, and racialized relations that structure and shape homelessness for men and women as they age, and that impact disadvantage in employment, partnered relationships, and housing. Encounters with Policies, Systems, and Structures Interviews with stakeholders and older people revealed how late-life homelessness was created and sustained through encounters with systems, policies, and structures. To do so, it draws on the systemic injustices and colonization of Indigenous peoples,13 and the deinstitutionalization of people with disabilities and/or mental health issues in the 1980s and 1990s – both of which have shaped the composition of the homeless population, and experiences of late-life homelessness.14 Although the two illustrations differ in scope and intent, with the former organized around a politics of assimilation and the latter reflecting a neo-liberal and political shift in the loca-

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tion of care, both produced disproportionate rates of homelessness among Indigenous peoples (First Nations, Inuit, and Métis) and among people with mental health issues and/or physical disabilities (Hanselman 2001; Patrick 2014; Piat et al. 2015). Here, the critical analysis outlines relationships with systems, institutional structures, and formal policies related to family, education, and care. Our ethnographic research provides grounds for reflection with regard to the effects of colonization on Indigenous peoples and relationships with the North. Particularly striking is how trends in the composition of the homeless population differ in earlier and later periods of the life course in Canada. Indigenous peoples (First Nations, Inuit and Métis) are considered to be over-represented among the homeless in Canada. According to Belanger et al. (2013), on any one night, 6.97 per cent of the urban Indigenous population in Canada is homeless, compared to a national average of 0.78 per cent. The tables presented in this report indicate that Indigenous peoples make up 20 per cent of the homeless population in Montreal, despite being 0.5 per cent of the city’s population at all ages. In other research, Indigenous peoples are considered to be over-represented by a factor of 10 among homeless people, and although the city of Montreal was not mentioned, a comparison of Canadian cities reveals that Indigenous peoples (First Nations, Inuit and Métis) accounted for 35 per cent of the homeless population in Edmonton, 18 per cent in Calgary, 11 per cent in Vancouver, and 5 per cent in Toronto, but only 3.8 per cent, 1.9 per cent, 1.7 per cent, and 0.4 per cent of the general population of these cities respectively (Hwang 2001).15 In both cases, the numbers for Indigenous peoples who are homeless after age fifty were not available. The impacts of colonization and relations with the North were visible on the streets, in shelters through ethnographic observations, in conversations about “complex cases,” and in interviews with older men. Our observations and interviews with stakeholders and older people, however, fell below the expected prevalence of 20 per cent homelessness among Indigenous peoples (First Nations, Inuit, and Métis) in the city of Montreal (at all ages). Our interviews included three people who self-identified as Indigenous (First Nations, Inuit, or Métis); people from Indigenous groups were, however, also witnessed in and around the shelter; and reference was made to Indigenous men and women (men in particular) across interviews and observations. Yet, we were not quite seeing the expected numbers of Indigenous peoples aged fifty plus in our study,

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and stakeholder discussions also focused on the needs of younger groups of Indigenous peoples. There was a tension between the facts of over-representation and what we witnessed in our research, which led us to think more carefully about the relationship between disadvantage, life expectancy, and avoidable mortality. Examination of the available data comparing the life expectancy for First Nations, Métis, and Inuit households to the non-Indigenous household population provides some insight into how discrepancies may affect life expectancy. One analysis found, for example, that “[l]ife expectancies for First Nations, Métis, and Inuit household populations are significantly lower than for the non-Indigenous household population” (Tjepkema, Bushnik, and Bougie 2019, 5). In 2011, the life expectancy for the First Nations household population at age one was 72.5 years for males and 77.7 years for females. This was 8.9 (95 per cent CI 8.1; 9.7) and 9.6 (95 per cent CI 8.7; 10.5) years shorter than for non-Indigenous males and females.16 For the 2011 Métis household population, life expectancy at age one was 76.9 years for males and 82.3 years for females – 4.5 (95 per cent CI 3.2; 5.8) and 5.0 (95 per cent CI 3.0; 7.0) years shorter, respectively, than for the non-Indigenous population.17 Life expectancy at age one for the Inuit household population was 70.0 years for Inuit males and 76.1 years for Inuit females, which is 11.4 (95 per cent CI 9.2; 13.6) and 11.2 (95 per cent CI 8.3; 14.2) years shorter than for the non-Indigenous population (Tjepkema, Bushnik, and Bougie 2019; also see Statistics Canada 2005).18 What such numbers suggest is that large disparities exist between Indigenous peoples (First Nations, Inuit, or Métis) and the general population, which would likely be more pronounced in the cases of homelessness, and thereby explain the lower number of Indigenous older people with experiences of homelessness. That is, if the life expectancy of someone with experiences of homelessness is lower than the general population, as is the life expectancy of Indigenous peoples compared to the Canadian population, it can be expected that the life expectancy of Indigenous peoples with experiences of homelessness is lower still. The contrast between the known over-representation of Indigenous, Inuit, and/or Métis people and their reduced presence in our ethnographic study of older people suggests a tragic relationship between policy and experience as people age in situations of homelessness. In Canadian history, the process of colonization refers to government policies and targeted acts of the assimilation of Indigenous

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peoples enacted through programs such as residential schools and displacement by means of residency rights (blood quotient), as well as the lack of health services in the North, and unsanitary conditions (contaminated water) that have created and sustained violence and trauma against Indigenous peoples (see Czyzewski 2011; Leach 2010; Reading and Wein 2009). Although Montreal was expected to have a lower rate of Indigenous homelessness than other Canadian cities such as Calgary, our recruitment efforts and discussions with our partner confirmed that the groups of men witnessed on the street did not meet the age criteria for inclusion in our work – that is, although they appeared to be over fifty, they were not. What we came to realize is that what we were “not seeing” – Indigenous older people on the streets, in shelters, and in long-term care – was a direct reflection of the extreme health disparities and differences in life expectancy between older people in the general population and in the Indigenous population.19 Although it is difficult to locate such statistics, research on avoidable mortality helps explain how older people from Indigenous (First Nations, Inuit, and Métis) groups were not making it into our sampling frame. According to an analysis of linked census and mortality data, during the 1991–2006 period, First Nations adults had more than twice the risk of dying from avoidable causes compared with non-Aboriginal [Indigenous] adults (Statistics Canada 2005; also see Tjepkema, Bushnik, and Bougie 2019; Statistics Canada 2015b).20 Although there was no official way to document this, what we believed we were seeing (or not in this case), based on data on health disparities and avoidable mortality, is that some of the people with experiences of homelessness from Indigenous, Inuit, and Métis backgrounds may have died before reaching age fifty and late life (see Government of Canada 2015a; Greenwood, Leeuw, and Lindsay 2018; Ring and Brown 2003). Such findings draw attention to the stark realities of cumulative disadvantage, and inequality in late life as both under-reported and unrecognized as a result of early mortality (see Dannefer 2003). The effects of colonization and violence were, however, witnessed in observations, in stakeholder discussions (although these were the younger men in the shelter system), and in the accounts of some of older people. For example, groups of Indigenous, (First Nations, Inuit or Métis) men (approximately age thirty to forty) would congregate in spaces around the shelter, including a green space nearby, outside of Chinatown in Montreal. Many times, the group would be sitting

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on the grass surrounded by bottles of alcohol and sleeping or engaging in loud discussions with members of the group and passers-by. Discussions with shelter workers and older people with experiences of homelessness were also peppered with caveats about Indigenous peoples, particularly in large urban centres, and their culturally relevant needs. For example, shelter workers discussed how some Indigenous, (often generally referred to as “Native” men or women, despite the different histories or backgrounds of the individuals or groups) became homeless as a result of coming to Montreal for medical services (Krausz et al. 2013; Reading and Wein 2009). They also mentioned how substance use complicated access to service and placement, because many shelters operate a “dry” and “clean” policy, and landlords did not want to accept people who used substances. With regard to Indigeneity, stakeholders expressed an awareness of the historical practices, with discussions tending to focus on the practical needs of this group, the fast routinized pace and mandate of shelters (to provide housing and support), and the challenges to securing long-term appropriate housing. Social issues such as substance use and violence are, however, a product of colonialism, and have been considered as self-medicating (Czyzewski 2011). A number of older men discussed experiences they had had with younger men whom they presumed to be Indigenous. In particular, they made reference to safety concerns when large groups of men congregated (such as the group witnessed near the shelter), and whom the older men avoided in order to stay safe. These accounts often evoked racialized and stigmatizing categorizations, particularly with regard to their reputation as violent substance users. While it was possible that older men speaking about their experiences were aware of the historical practices of assimilation or substance use as a by-product of colonialism, rarely did they comment on the impacts of colonization, including trauma, substance use, and violence. Instead their accounts were about their own survival, fears, and the practical strategies they used to avoid violent encounters. The accounts from older men suggest the complex needs that exist amongst men across the life course, and the need to develop safety and security for diverse groups of older men. In particular, the comments highlight the need to address the stigmatization and marginalization of Indigenous men who were often identified as dangerous and therefore excluded from shelters and social relations (remembering, of course, that this is a group that were younger than our set sample

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and thus did not participate in the interview component). The following quotes demonstrate the historical impacts of policies over time, and the various forms of exclusion and violence that operate between men on the street: When you are on the streets, you get ‘in the line’ [referring to the various routines and forms of waiting]. When you are there, there are always groups that arrive: two or three guys who stick together, and play tough. You know ahead of time that you can take it, that you have a decent relaxed way of being, not too bad. You know it will be ok. But the atmosphere has gotten pretty tough in the line. Because those guys really play it up. – Jacques, fifty-year-old man, transitional program, Participant 34 The day centre [name], it is not bad, but you have to be careful not to say anything, you can’t do anything. The guys that go there, they are all really fucked up, sick [high]. There is a lot of violence and aggression there, I don’t go often. The [names service] I don’t go there. It is the worst guys off the streets who go there. The real [slur redacted], forget it. Sorry for saying it like that. But it is the real [slur redacted] who go there. I don’t even want them to speak to me … it’s the worst of the gang … I go there on Friday because there is a film. – Étienne, fifty-sevenyear-old man, shelter, Participant 5 Disadvantage as a result of policy structures could also be seen in the example of the deinstitutionalization of people with physical disabilities and mental health issues. Ten of forty people in our sample indicated that they received disability benefits, although we did not differentiate between life-long and acquired disabilities, and were unable to distinguish between people with intellectual or physical disabilities, and those with workplace injuries. Although there is very little attention to the intersections of disability, mental health, homelessness, and aging, mental illness is a known factor for homelessness, and the likelihood of having mental health problems doubles for homeless people over the age of forty-two (Kim et al. 2010). In Canada, the deinstitutionalization of people with disabilities and mental health issues from institutional settings caused an overrepresentation of people on the streets and in shelters (see chapter 2).21 This was certainly the case in Montreal, where the closure of large

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mental institutions was combined with a shortage of suitable housing programs with support (see Piat et al. 2015). Attention to the intersections of aging and homelessness gave insight into the impacts of this policy over time, with the group who would have been affected in earlier parts of their life courses now entering late life. Our observations revealed men and women with disabilities (intellectual, physical, and mental health issues), around or over the age of fifty, using the cafeteria services.22 Although the prevalence of mental illness is difficult to determine (see Hwang 2001; 2002; Canadian Institute for Health Information 2007),23 people with disabilities and mental health issues were somewhat identifiable by means of observation in the shelter. This was particularly visible in the women’s shelter where one of the women observed appeared to have Down syndrome, and a number of others demonstrated actions typically associated with mental health issues. This was slightly different from the men’s shelter, where the men with disabilities and mental health issues (with some exceptions) seemed to blend in slightly more, perhaps a function of the sheer volume of people, and/or having less physical space. The long-term impact of closing institutions without appropriate supports was often discussed by stakeholders. Stakeholders working in the shelters commented on the stress and mental health issues associated with being homeless, as well as the challenges of housing older people with disabilities and/or mental health issues. This was coupled with the challenges of placement mentioned by stakeholders in long-term care. Stakeholders drew on the presence of mental health issues to highlight the inappropriate match between service and need, and the barriers to rehousing people because landlords were reluctant to accept people with mental health issues. The concern was that without targeted interventions, this group would become permanently homeless. Similarly, in long-term care, aggression related to mental health issues was often described as creating challenges for adapting to care settings, and causing the breakdown of a placement. The following quotes, one from a stakeholder and another from an older person, outline the impacts of the shortage of appropriate supports with regard to mental health: It goes without saying that people who find themselves homeless, we can’t deny, there is a lot of stress with that life, that is very important to acknowledge, and security and fear, and a general absence of everything … Plus illness, and often mental illness

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that can be added to that, and physical health issues that go unmet. – Stakeholder, Housing and Homelessness Sector When you get there [names service], it is full of people with issues … psychiatric cases. Everywhere, everywhere, everywhere! So, you have to learn how to deal with those kind of people. It is not always obvious. You get there and, Well! Sometimes, everything is really fucked up. But listen, you get it, you know they are sick, and what that does to people, and what it is like. If you raise your voice they will raise theirs louder. Yes, if you raise your voice, they will raise theirs even more. – Gabriel, fifty-one-yearold man, shelter, Participant 16 Older people also discussed the safety risks that people with serious mental health issues raised in the context of their everyday lives, echoing the discussions of violence in chapter 5. Older people spoke about general everyday encounters and specific instances, such as the below quote from Grizzly about being attacked. In Grizzly’s case, he discusses how he ended up hospitalized as a result of an unprovoked attack that occurred in the shelter, and Bakuet talks about the everyday fears of living in the shelter. Also, consider the earlier quote by Joanne, an older woman sleeping in the smaller room of the women’s shelter, who requests the protection of the shelter worker to leave her room before anyone wakes up. Such instances highlight the risks that accompany disadvantage and shelter use as an older person. The following quotes highlight the tension between understanding people’s trajectories, and the unpredictability this raises in older people’s lives: Well, here [at the shelter] in 2010, after the lights went off, a person with a mental health issue jumped on me – on my back – I was going to get my eye drops, I didn’t hear him coming, I couldn’t … he broke my, I had a double fracture of the shoulder, separated shoulder, and my two knees are finished. So there it is, I am waiting for the decision of the csst [injury board] … but what happened, whether you want it or not, it could happen to anyone, the guy jumped, he was afraid, I’m not sure of what. I had never seen him before that night, and I haven’t seen him since. – Grizzly, fifty-nine-year-old man, shelter, Participant 40

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You know, about 70 per cent of them are mental, they have mental health issues. They are really sick. There is not enough [help], you never know what will happen. Interviewer: How do you manage to get along? Response: It is difficult, very difficult. I can’t really live with this group. – Bakuet, sixty-year-old man, shelter, Participant 17 Deepening of Disadvantage over Time Accounts from stakeholders and older people reveal how lifelong disadvantage, if left unaddressed, can worsen over time, directly related to low income, insecure employment, trauma, and ill health. In some cases, stakeholders and older people discussed how worsened health altered late-life homelessness, and how homelessness affected physical and mental health. Stakeholders, and in particular those with years of experience in housing and/or social work, spoke of the service gaps, problems rehousing older people, and the reduction of supports they had witnessed over time in the areas of income, housing, and care (see chapter 2). Older people also outlined how disadvantage had intersecting and cumulative effects over time. Where some accounts demonstrate how crisis set off a chain of events (in particular when experienced against a lack of affordable housing), others recounted an existence that can be characterized by “hanging on at the edges of homelessness” for prolonged periods of time. Older people’s accounts revealed how unmet needs made things more difficult as they aged, with pronounced discrepancies apparent between the needs of older people in the general population and those with experiences of homelessness: There are people who we have seen for fourteen years, who come to the shelter at night, they are there every night, but we see how they have changed, it is incredible. It is not what we would think of as a regular aging, like you and me, we know are aging, but fourteen years later, we will not be as completely wrecked physically as they will be. And often, it is exactly this group that is the most hard to reach … to help them get off the streets because they are so accustomed to their routine. – Stakeholder, Housing and Homelessness Sector

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[Defining homelessness among older people.] Often they have a number of illnesses, physical ailments, cancer, tuberculosis, impairments. The worst is really those who have spent ten years on the street. They might only be forty-five, but when you see them they are so worn out that you think they are seventy. So, it is not really age that is the determinant for our work. And then, there are people who really are seventy, it’s even worse. You say my God, this does not make any sense. But we don’t refuse anyone. – Stakeholder, Housing and Homelessness Sector So the first thing I would say is that people with experiences of homelessness don’t age at the same rate as someone who is loved, who had a job, and who can get by in life without drugs and alcohol. When I tell other women about the work I do, who are fifty, fifty-five, or sixty and in good health, they are shocked! – Stakeholder, Housing and Homelessness Sector Insights from older people reveal how disadvantage, structured responses (or the lack thereof), and the resulting disparities can create and sustain homelessness in late life. Older people highlighted how gaps in services and a shortage of options meant they were left with no other choice but homelessness. This was particularly the case in first-time homelessness, where work could not be obtained, and where benefits were insufficient to meet their basic needs due to rising costs of food, transportation, and housing. And further, once homeless, how older people had fewer options to exit homelessness because it is difficult to find work, housing is unaffordable, and they may have long-standing health issues that necessitate care. Although age is often used to discuss disadvantage, the inequalities people experienced were not about chronological age, but how disparities worsen situations, and deepen disadvantage over time when needs remain unmet. As such, thinking about disadvantage rather than age reveals the impact of non-response, the retrenchment of public services, and the problems attributed to the divestment of social housing over time. Older people’s accounts reveal the toll homelessness takes on them over time, and how being older meant that they had a shortage of “time left” to recover from hardship, alter their financial circumstances (i.e., “get back on their feet”), find employment, and obtain long-term affordable housing. The following quotes outline how limited opportunities and a shortage of time left affect their lives

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and everyday needs. In many cases, the quotes reveal an accumulation of disadvantage that had changed and worsened with time: My history of homelessness started in 2012, it was when I first lost my job, and I wasn’t able to integrate in society. Well then, I really had to try hard [to] pay my rent, to have enough to eat and all that. I wasn’t able to get back into work, so I could really get out … And with the little bit of welfare they gave me I could make it to the end of the month. And after that, anyways, I fell into homelessness. And from this point, I’m trying left and right so I can really get out of this. – Ben, fifty-six-year-old man, shelter, foreign-born, Participant 9 Sure, it’s worrisome because you have less time left. There will come a time where my health is going to catch up with me. Up to now I have been lucky, I don’t have any major health problems, but at fifty-six, you never know, it could happen at any point! So, yes, I am worried. And sometimes it is so difficult that you have to just ‘put your head in the sand’ and say “I am going to think about that later, then next week, and then the next day, and the next.” But to be honest there will come a day when I must “face the music.” – Robert, fifty-six-year-old man, transitional program, Participant 1 In particular, stakeholders and older people highlighted how their proximity to retirement exacerbated challenges at the intersections of income security and housing stability. Older people discussed how they could no longer rely on the traditional exit options of “re-integration into the labour market” that are deeply embedded in responses to homelessness (see Woolley 2015). They outlined how the loss of employment in mid-life triggered their homelessness, and made it extremely difficult to exit homelessness. For example, a workplace injury in mid-life was considered to lessen opportunities for retraining and reduce the possibility of finding suitable work. Examples focused on discussions of “age” at the time of job loss or injury, and a labour market that was structured around youth. Many older people we interviewed expressed a desire to return to work; however, their age, combined with gaps in their work histories, the stigma of homelessness, and the routines and requirements imposed by the shelter system (see further chapter 7) made it difficult for them to gain employment. These experiences had immediate and

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long-term impacts, complicating access to income security, affordable housing, and care. Although late-life homelessness is often configured as an individual issue, our research reveals how it is more accurately depicted as disadvantage that accumulates over time. The following quotes demonstrate how encounters with social and institutional structures such as work, social benefits, and the shortage of safe, affordable housing sustain unmet need: It’s … the workforce, it is geared to young people. Whether we like it or not. So for those who lost their jobs at age fifty, are they going to be hired? Are the companies really going to want to employ them? People who earn more than the younger people they could hire. Will they be hired? And if so, for how long? Ten years? To do what? Give them a chance at a career? Their career is over. So this group, what are they going to do with their lives? Are they really going to … Can they get back into the labour market, into a mediocre job that pays them much less than they were making before. That is the reality. This is what is happening. And we are seeing more and more of this group. – Stakeholder, Housing and Homelessness Sector So that is it – being very old. There is even a problem with the fifty-five/seventy [year olds], where they are independent, but their income is limited, and they don’t have the rights to [a] pension. And they can’t really get back into work, so they end up on social assistance, which is $600 per month. – Stakeholder, Housing and Homelessness Sector

di s c u s s io n : t h e bac k d rop for late-li fe h o m e l e s s n e s s as di sadvantage The results of our ethnographic research into late-life homelessness reveal how late-life homelessness is best described as a structure and experience of disadvantage over time, against a backdrop where needs continue to go unmet. Late-life homelessness is more than a rupture in an individual storyline or a case of unique needs in later life: it is the direct result of particular trajectories of risk; of intersecting forms of inequality and oppression that may be structured or result from particular policies; and of unmet needs. Late-life homelessness is inequality that pools and becomes visible through every-

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day disadvantage, and results from deprivation that is permitted to endure across the life course, and into late life. Narratives from older people and stakeholder accounts offered crucial insight into the disadvantage that occurred at the intersection of macro-level structures, meso-level interactions, and micro-level experiences, insinuating that although difficult to predict, late-life homelessness was for many simply a matter of time. For some people, late-life homelessness was created or sustained by processes that unfolded over time through policies and failures of support, and/or prolonged exposure to poverty and disadvantage that continued as they aged. For others, it was a matter of “losing their grip” as they found it increasingly difficult to meet needs over time, were unable to find work or affordable housing, and in some cases experienced severe health needs. For others, late-life homelessness was an explosion where everything that had accumulated across the life course could no longer be held together, and finally came undone. Although the encounters or patterns that sparked homelessness differed among groups of older people, and varied according to social locations that reflected historical policy decisions such as colonization and deinstitutionalization, gender-based violence, racism and racialization, or job loss, late-life homelessness reflected inequality and disadvantage that was experienced (and made visible) over time. As will be further developed in chapter 7, this marginalization set the conditions whereby older people with experiences of homelessness were permitted (and perhaps expected) to endure the process of being worn down over time, and to live (and die) in situations of disadvantage. The insights from older people with experiences of homelessness suggest the need to shift the conversation from chronological age to disadvantage experienced over time, in a context where services are not available, and where needs remain unmet. This section proposes the notion of disadvantage over time as a frame to articulate and address older people’s needs. Rather than explaining homelessness in late life as a set of health disparities or unique needs among older people, the frame of disadvantage over time repositions homelessness as the result of intersecting processes of disadvantage and oppression that accumulate across the life course and into late life. This distinction represents an important shift from late-life homelessness as individual to a situation resulting from disadvantage produced through systems and social relations. Repositioned as such, the critical analysis pushes the analysis of late-life homelessness beyond

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boundaries focused on health outcomes in late life, to reveal systemic issues, and the impacts of organizational practices and everyday encounters. The qualitative and interpretive accounts of people with experiences of homelessness thus become valued insights from which to understand (and witness) how late-life homelessness is lived and experienced, and from which to instigate change. Drawing on existing models such as cad and intersectionality can further the analysis of late-life homelessness as disadvantage over time, and as a process of unequal aging. cad offers a conceptual anchor to resituate patterns of disadvantage; dynamic relationships between structures, dynamics, and experience; and time (Dannefer 2003; Dannefer and Settersten 2010; Marshall and Mueller 2003).24 Intersectionality draws on qualitative insights to highlight how disadvantage occurs at various social locations, and plays out through social and interpersonal relations, in the contexts of institutional structures, programs, and everyday encounters. The two existing models thus provide a strong conceptual frame for understanding late-life homelessness through relations of discrimination, oppression, and a qualitative tradition focused on voice, experience, and power (Calasanti and Giles 2018; Calasanti and Kiecolt 2012; Calasanti and King 2015). Both models as they currently exist, however, fall short on accounting for late-life homelessness as unequal aging. What is required moving forward is an analysis that is capable of understanding disadvantage over time, as it is created and deepens through structures, policies, and practices, and pools at the level of everyday experience. That is, there is a need for an analysis that reveals how systems and structures hold the potential to oppress and discriminate, and one that can alter these processes through interventions that meet needs when and as they are experienced, and which can stop homelessness from becoming long term. There is no denying that age plays a role in shaping late-life homelessness, and the responses to older people with experiences of homelessness. Indeed, as outlined in chapter 4, age is intricately woven into program eligibility, often complicating access to income security, housing supports, and services. Few services exist for older people who are homeless, and those that do are often not adapted for their needs. For example, in Toronto and Montreal, older people aged fifty to sixty-five reported feelings of frustration because neither the services offered nor the programs created for the general homeless population suited their needs (see also McDonald et al. 2006). This can mean that despite health disparities and resulting high levels of need,

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older people may not be able to access services. Yet, the conversation about age masks how the needs of older people who are homeless are more related to inequalities that become visible through experiences of disadvantage over time than to chronological age alone. Drawing attention to disadvantage and the cumulative impacts of unmet needs can change the conversation to reveal how existing service configurations and approaches (including non-response) can worsen everyday lives. In doing so, it also underscores the moral imperative that is expressed by older people and shelter workers alike – that older people subjectively feel “too old” to be living the difficult lives of homelessness, and that they should be able to expect some assistance and relief from the injustices of disadvantage and the hardships they have encountered throughout life (see further chapter 9). In sum, there are a number of benefits in shifting the analysis from chronological age to disadvantage over time. First, it promotes a more holistic understanding of intersecting forms of disadvantage that occur over time, rather than as a unique (and unexpected) experience in late life. Second, it links the understanding of pathways into homelessness with contexts and relationships that include encounters with macro-level structures, institutions (including the family), and society. It repositions homelessness from a discrete event discursively marked by a lack or loss of housing, to a longer process of disadvantage created and sustained through social relations and networks over (and in) time. Third, it provides new insight derived from everyday experiences over time, and in the context of older people’s lives. As such, it counters the idea of late-life homelessness as an unexpected phenomenon, and offers possibilities for human agency and social intervention at particular transitional moments of risk and insecurity. In doing so, it reveals that late-life homelessness is not only about a shifting age structure (see Culhane et al. 2013b; Culhane, Metraux, and Bainbridge 2010) but precarious forms of aging produced by insecurities in labour, family, and altered social programming (see Grenier et al. 2017) – ideas that will be further developed in chapters 7, 8, and 9.

c o n c l u s i on The argument developed in this chapter is that late-life homelessness is better understood through a lens of disadvantage over time rather than solely one of aging. The chapter highlighted how late-life homelessness is an experience of inequality that pools at the level of

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lived experience, and which becomes visible through disadvantage. It engaged with the research questions: what happens at the intersection of aging and homelessness; what is it like to experience latelife homelessness; and what does late-life homelessness tell us about disadvantage over time? Drawing on the insights from observations, stakeholders, and older people, it situated how stories recounted in late life are mired with histories of disadvantage and unmet need from earlier periods; how intersecting and interlocked forms of oppression create and sustain disadvantage and homelessness; how encounters with structures, systems, and supports can further disadvantage people through unmet needs or unsuitable supports; and how disadvantage can deepen over time. Homelessness in late life draws attention to the need to address disadvantage, and prevent homelessness from occurring, and becoming long term. Taken together, the insights from our research on homelessness signal that a larger problem may be on the horizon, where the effects of disadvantage over time may surface with greater frequency as a result of historical policy decisions (e.g., colonization, deinstitutionalization), systemic changes to welfare and public programming since the 1980s, and the contemporary context of population aging amidst rationed public services. The chapter offered new insight by positioning late-life homelessness as an experience of disadvantage over time. It revealed how late-life homelessness is an experience that is more aptly described as precarious or difficult than aligned with policy discourses of “healthy aging” or “aging in place,” at home and in the community. That is, it revealed how late-life homelessness is a location where disadvantage accumulates and crystalizes through unmet need, the permanence of not having income, housing, and care, and missed opportunities to address human suffering. It suggested that older people who are homeless have a range of needs that stem from earlier experiences, contemporary social relations such as work or violence, and encounters with structures and systems that create and sustain inequality. The chapter concluded by proposing the use of the language of disadvantage over time as a means to shift the conversation from consideration of late-life homelessness as characterized by complex individual needs and health disparities to a phenomenon and experience that results from intersecting and cumulative forms of inequality, discrimination, and oppression over time. We now turn to an exploration of late-life homelessness as a process and experience of social exclusion, vulnerability, and abandonment.

7 Late-Life Homelessness as Social Exclusion and Abandonment

This chapter focuses on late-life homelessness as social exclusion and abandonment.1 It engages directly with older people’s experiences to demonstrate processes of social exclusion, and outlines the structures that produce vulnerability. The idea for this chapter came directly from older people’s comments that late-life homelessness is the ultimate experience of exclusion. A threefold argument is developed in relation to late-life homelessness and social exclusion: first, that late-life homelessness corresponds with what we know about social exclusion; second, that late-life homelessness is structured, felt, and experienced by older people as social exclusion, stigma, and vulnerability; and third, that responses to homelessness extend exclusion into neglect, expulsion, and abandonment. The first part of the chapter engages with the broad and overarching question: what happens at the intersections of aging and homelessness? The chapter begins by situating the existing definitions and conceptual guidelines for the study of social exclusion among older people. It then maps out quotes from older people according to established dimensions, revealing the extent to which late-life homelessness corresponds with existing models. In doing so, it demonstrates that the intersections of aging and homelessness can be aptly described as a process of social exclusion. With this argument established, the chapter turns to answer the questions: what is it like to experience late-life homelessness and how can contemporary responses be understood? Drawing on quotes from our research, it develops the idea that late-life homelessness and the social exclusion experienced from this location produce unnecessary and sustained vulnerability. It extends the argument on exclusion

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by considering policies of neglect and practices of expulsion that worsen the everyday conditions of older people’s lives. In doing so, the chapter demonstrates how late-life homelessness is a process of exclusion that happens through relationships between structures, practices, and encounters to produce feelings of “being left out,” stigma, and vulnerability, and how these processes deepen through social responses of neglect and abandonment.

de f i nit io n s a n d c o n c e p t ual di mensi ons of s oc ia l e xc l u s io n a m o n g older people This chapter draws on leading definitions and concepts of social exclusion among older people to understand and situate late-life homelessness. Studies of aging from a critical perspective have advanced understanding of social exclusion among older people, and there are strong definitions and conceptual models to guide the analysis of exclusion and late-life homelessness. Attention to social exclusion as a core theme of social policy and a way of understanding inequality emerged in 1997 and continued throughout the 2000s in Europe (see Levitas 2006; Silver 1994).2 The consideration of social exclusion among older people followed from these developments and steadily developed to guide research and policy, most notably through work on disadvantaged neighbourhoods in the United Kingdom, and in the Canadian province of Quebec (Grenier and Guberman 2009; Scharf, Phillipson, and Smith 2005; Walsh et al. 2017).3 Although the notion is sometimes restrictively used to denote economic disadvantage, most research in social gerontology employs social exclusion as a multidimensional, relative, and dynamic concept (Scharf and Keating 2012). Research on social exclusion revealed the importance of place, impacts of systems and structures (including policy and practice), and the experiences of poor or marginalized groups of older people. The research on social exclusion among older people clarified the concept, drew attention to social and health disparities, and outlined the processes by which particular groups were blocked from meaningful participation in society (see Billette et al. 2012; Scharf, Phillipson, and Smith 2005; Walsh et al. 2017). Walker and Walker (1997) define exclusion as “the dynamic process of being shut out, fully or partially, from any of the social, economic, political, and cultural systems which determine the social integration of a person

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in society” (8). And in 2017, Walsh, Scharf, and Keating further proposed the following definition of social exclusion among older people: Old age exclusion involves interchanges between multi-level risk factors, processes and outcomes. Varying in form and degree across the older adult life course, its complexity, impact and prevalence are amplified by old-age vulnerabilities, accumulated disadvantage for some groups, and constrained opportunities to ameliorate exclusion. Old age exclusion leads to inequities in choice and control, resources and relationships, and power and rights in key domains of neighbourhood and community; services, amenities, and mobility; material and financial resources; social relations; socio-cultural aspects of society; and civic participation. Old-age exclusion implicates states, societies, communities and individuals. (93) A number of conceptual signposts exist to guide research and policy development with regards to social exclusion. Social exclusion is considered to be produced by multiple and varying trajectories, is relative to the society and time within which people live, can change over time, and may have effects that reach across generations (Scharf, Phillipson, and Smith 2005; Walsh et al. 2017).4 A number of dimensions have been used to study social exclusion among older people. For example, Scharf, Phillipson, and Smith (2005) articulated five domains of exclusion (material resources; social relations; civic activities; basic services; and neighbourhood exclusion); Walsh, Scharf, and Keating (2017) investigated six domains of exclusion (the neighbourhood and community; social relations; services, amenities, and mobility; material and financial resources; socio-cultural aspects; and civic participation); and Grenier and Guberman (2009) and the vies team in Montreal employed seven forms of analysis of social exclusion to understand the experiences of older people (symbolic; identity; socio-political; institutional; economic; meaningful relations; and territorial) (also see Billette et al. 2012; Van Regenmortel et al. 2016). Together, the body of research on social exclusion among older people provides a point of engagement for exploring the individual, organizational, environmental, and macro-level processes and dynamics that create and sustain social exclusion among older people with experiences of homelessness.5

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This chapter considers results from our ethnography through five of the conceptual distinctions proposed by Walsh, Scharf, and Keating (2017).6

s oc ia l e xc l u s io n : in s ig hts from older p e op l e w it h e x p e r ie n c e s of homeles snes s This section presents results of our ethnographic interviews with older people with experiences of homelessness, organized according to key dimensions of exclusion. Given our previous work, we had expected the content of the interviews to reflect exclusion, but had not anticipated that older people would use the term to refer to their lives or experiences. Led by older people’s expression of latelife homelessness as social exclusion, we turned to the conceptual models of exclusion, and found the material to be well-aligned with the established domains. Insights from older people with experiences of homelessness in our study are presented along five domains of social exclusion: material and financial resources; services, amenities, and mobility; neighbourhood and community; social relations and social/cultural exclusion (which have been combined for the purposes of our analysis); and civic participation (Grenier and Guberman 2009; Scharf, Phillipson, and Smith 2005; Walsh, Scharf, and Keating 2017). The quotes reveal how late-life homelessness is an example of social exclusion involving interchanges between multi-level risk factors, processes, and outcomes, inequities, and constrained opportunities. In each domain, the experiences of older people demonstrate how the everyday realities of late-life homelessness were enacted through processes of exclusion. Material and Financial Resources Older people’s experiences of homelessness highlighted exclusion from material and financial resources through experiences of poverty, deprivation, income insecurity, and a high level of unmet need. Poverty and low income across the life course were repeatedly mentioned, intersecting with disadvantage and social exclusion (see chapter 6). Given the distinction between older people who have “aged on the streets” and those “new to homelessness in late life,” not all patterns reflected life-long poverty. Some were prompted by events such as illness, job loss in mid-life, divorce, or bereavement,

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while others worsened in late life as a result of disadvantage. Others focused more prominently on the issue of high expenditure relative to income. This included rising costs of housing, and having few funds to spend on essential items, resulting in exclusion from material and financial resources: Social assistance gives me $600 per month, I am not able to find an apartment, even if I find myself a room it is $400. I also have to eat and pay bus fare. And now and again I have to give my kids a gift, I have to buy cigarettes. – Ben, fifty-six-year-old man, shelter, foreign-born, Participant 9 And then, there is also the issue of the amount that they give you in social assistance. What [kind of apartment] can you really get. If you pay your rent then you don’t have enough left to eat. And the biggest thing that people say, and that you can see is “even if you have an apartment, or a room, no matter what, you still need to get up in the morning, come to the food hall to eat, you may as well stay on the street.” Because they guys who have apartments, they don’t even have enough at the end of the day to buy cigarettes or a coffee. – Pierre, fifty-nine-year-old man, shelter, Participant 20 The domain of material and financial social exclusion was particularly pronounced in the interviews and occurred across time, in relation to structures, social relations, and interpersonal relationships. Older people highlighted the extent of unmet need, and the impossibility of accessing basic needs of income and food security, housing, and care. They also outlined how structural, environmental, and individual drivers could intersect to tip people from insecurity into late-life homelessness, where few other supports existed (see Grenier et al. 2016b). Services, Amenities, and Mobility Older people with experiences of homelessness outlined their exclusion from services, amenities, and mobility. They spoke about the limited services for older people experiencing homelessness (defined in our research as over age fifty), lack of access to mainstream services, waiting lists for social housing or affordable

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housing units, and the unsuitability of existing supports. As discussed in earlier chapters, older people were often unable to secure work due to a shortage of jobs/training, age-based discrimination, injury, or health issues. Such instances raise questions about the expected assumptions of securing work up to retirement age, and further problematize how people with low income may need to continue working longer than expected in order to meet their needs. In the interviews, older people also made reference to the problem of not having enough bridging capital to hold them over until they found new employment or housing upon loss, which can become more complicated upon entering the shelter as a result of the everyday routines of seeking shelter. Even those that managed to access services outlined the significant challenges of leaving homelessness due to a lack of “exit options”: Ah! It’s hell, I often think of that, I am not far from being turned away from places because there are no resources. To see myself sleeping on the streets, like I see all of the time. I remember when I was young, staying outside when it was minus 15 degrees. At my age, I can’t see it. – Yves, fifty-three-year-old man, transitional program, Participant 33 Well the shelters, [they] are an industry, and we are part of what keeps the shelters going. Hear me out. The [names service], you leave at 8:00 in the morning. It is too late to try to find yourself a job at 8:00. You have to carry your bag around with you all day. You can’t go see a potential employer with a backpack! Do you get it? They [shelter] don’t take messages for the residents. If you go to a job interview you better have a phone for them to call you back. They don’t really help you out. Then you have to get back [to the shelter] for 2:00 in the afternoon. Everything is set up in a way that you can’t get off the street. It has become a business. – Gabriel, fifty-one-year-old man, shelter, Participant 16 There are certain services, like [names employment program that allows people to stay inside during the day] where they require people to [be] actively looking for a job, but we know that when we have older people it is more difficult to find a job, and for some it is impossible. Yes, there are some, when they get past sixty it is impossible. Me, I am fifty-six years old and I have decent work

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experience and all, and even then it is difficult. – Robert, fifty-six-year-old man, transitional program, Participant 1 Interviews with older men and women revealed a dynamic pattern between the extended impacts of exclusion from material and financial resources, job loss, injury or mobility issues, housing insecurity, and the non-existence or inaccessibility of services. Older people with experiences of homelessness revealed high levels of needs, yet little or no access to supports, as a result of their chronological age and/or their homelessness. This occurs because their needs do not “fit” with existing service configurations, or because supports are unavailable or unsuitable (see chapter 4). Their exclusion also resulted from impossible choices, such as how shelter schedules can mean that they risk missing meals or a confirmed bed in order to search for a job that could help them “get off the street.” As mentioned in chapter 5, they were also limited by mobility, and stayed closer to the shelter for protection and to ensure they could make it back in time for a meal and a bed. Older people also mentioned how they may secure housing, but have insufficient income to afford food, or be offered substandard housing riddled with bedbugs. The domain of social exclusion pertaining to services drew attention to late-life homelessness as a process of exclusion worsened by inaccessible or unavailable supports. Neighbourhood and Community Older people with experiences of homelessness discussed perceived and actual exclusion from neighbourhood and community spaces, and deprivation where expectations of “home” were concerned. This exclusion from neighbourhood and community was perhaps unsurprising, given the earlier-mentioned linguistic distinction of the term “homelessness” through the absence of a “home,” and a location “outside” the usual classification of the community (see chapter 1). Chapter 5 exposed how older people with experiences of homelessness were aging in “less than desirable locations” including the streets, hospitals, shelters, and (where available) long-term care, and chapter 6 revealed the extent to which everyday encounters were rife with violence and insecurity. Linking these findings with the dimensions of exclusion further reveals how older people with experiences of homelessness were “being shut out of” the typical and expected

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sites of stability (i.e., home or place), the sense of belonging that is typically associated with home, and the expected models of neighbourhood and community involvement (see Rowles and Bernard 2013; Rowles and Watkins 2003; Walker and Walker 1997). They were also relegated to living and sleeping in dangerous places that created additional and unnecessary vulnerability: It is like I was saying earlier, there are certain places/ neighbourhoods that are more dangerous than others, and certain people, you have to be smart about things, know more. But you also have to have to keep your wits about you. You keep your eyes open and protect yourself more when you go through those places. – François, fifty-five-year-old man, in stable housing for one year, Participant 3 Yes, you know we say that the more you age, the more chances you have of being attacked on leaving. And I find that despicable. I don’t know how many times I have seen it, people waiting and attacking people who are over sixty-five when they leave the bank. It is terrible. Really disgusting. Me on the other hand, it’s funny, I don’t get attacked. I walk around, have my money out, they don’t attack me because they know I can defend myself. But that guy, who is seventy years old, I’ve seen it in broad daylight. Bing! Bing! Bing! They take your wallet. It is disgusting. That is what happens as you get older. – Étienne, fifty-seven-year-old man, shelter, Participant 5 Building on the spatial aspects of exclusion, older people’s quotes reveal the extent to which exclusion impacted their everyday strategies of negotiating the city, and their feelings of self-worth. Accounts were laden with loneliness and prolonged suffering. Older people discussed “being alone,” having few people to trust, limited social networks, feelings of loss, and the constant fear and avoidance of violence in the “less than ideal” spaces within which they lived. Many expressed the sentiment of being “on your own in the world,” with few reliable supports. This is not to suggest that older people with experiences of homelessness do not make attempts to build a sense of “place” (see Burns 2016; Leith 2006), but that there was a mutually reinforcing relationship between social exclusion, disadvantage, and homelessness that intersected to produce negative effects in neighbourhoods

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and communities. It was precisely these encounters that sustained vulnerability and suffering through unmet need and abandonment, as will be pursued in the second part of this chapter. Social Relations and Socio-Cultural Exclusion The interviews also contained examples of exclusion from social relations and cultural processes. Older people experienced and felt excluded from mainstream society; felt judged by other people; reported distance from social opportunities, social relationships, and family; and felt rejected because they were homeless (also see Davis-Berman 2011). They discussed experiences of isolation, segregation, discrimination, stigma, and shame as a result of being homeless. Although shelters are busy places and there are always people around, social interactions were described as insecure. Older people who formed new social networks in the context of emergency shelters described these as complicated, without trust, and always involving the potential for violence or victimization. A couple of participants noted that they were in contact with their families, but that their families did not know they were living in the shelter. Corresponding feelings of shame were commonplace across accounts, with some people indicating that they wanted to “disappear” and/or become “invisible” – phrases that are associated with extreme marginalization and suicidal ideation (Grenier et al. 2016c). For example, when one of the interviewers clarified a point being made by asking “Is it an option to stay here [in the shelter]?” the older person responded: “I want to make myself disappear” (James Bond, seventy-year-old man, shelter, Participant 13). The following quotes reveal how processes of social exclusion impact social relations, encounters, and the achievement of cultural expectations: As for me, I think that living this, you exclude yourself, and a lot of other people exclude you. I was on the other side before becoming homeless. So, you know, the perception that people have, it plays a big part … So that together makes it so that, if you don’t have family either, let’s say, you don’t have ... close friends or a strong social network. Well, you experience all that, you live with loneliness and isolation. – René, fifty-five–year-old man, transitional program, Participant 35

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Look, in reality, it’s not a choice that people make. You know, it’s not their fault, and so what happens to them ... in other words it’s a bit like ... I’m not talking about the people who work in the shelters, it’s more like “society” as it is, that rejects those people. Then those people feel rejected, and they decide it is better to live on the street, look after themselves. – Sylvie, fifty-year-old woman, transitional program, Participant 31 There are some people who never change. I keep away from other people. I stay away, I don’t want to cross those people. But it hurts me to see them like that, and going there. And I can see myself going back there at some point, into those situations, and it really hurts me. That is why I try to stay away from it all. – Paul, fiftyeight-year-old man, transitional program, Participant 38 Interviews shed light on exclusion from social relations, limited everyday and long-term connections, and the feeling of being excluded from meaningful social relations. Discussions revealed how processes of exclusion heightened their feelings of “not belonging” and vulnerability, as well as shame, anxiety, and worry. In this sense, older people were both objectively and subjectively isolated. They had few close contacts and spent a good deal of time on their own. At the same time, as outlined in the quotes, the processes of exclusion caused them to withdraw and reinforced their isolation and feelings of ostracization (see Burns, Sussman, and Bourgeois-Guérin 2018; Grenier et al. 2016c). For older people with experiences of homelessness, exclusion from social relations is a dynamic act and a relational process whereby people are excluded by society, and in turn exclude themselves. Civic Participation Social exclusion across a range of dimensions had knock-on effects with regards to civic participation. Older people with experiences of homelessness highlighted the frustration, anger, and resolve of their ongoing exclusion from society. Although few spoke directly about being excluded from civic participation in a traditional sense, the accounts highlighted how deprivation and unmet need supersede questions of regular civic engagement (see Torres et al. 2017). Older people’s accounts revealed how routines of seeking shelter

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and everyday suffering limited opportunities for engagement in voting, volunteering, and general civic activities. Many of the older men and women discussed how they had few occasions to influence the decisions that affected their lives (e.g. shelter routines and procedures, municipal priorities), thereby sustaining further distance from society. Yet, despite these limitations, there were countless examples of volunteering and assisting with shelter routines that are reflective of coping strategies that will be further discussed in chapter 9. However, gender differences existed where the general levels of participation – in the interviews, and civic participation – were concerned. As outlined in chapter 5, older women had a tendency not to speak, or to speak in very short answers, and Ben did not discuss the racism that had undoubtedly affected his trajectory. Such examples highlight the extreme effects of exclusion, where older people at particular social locations such as being a woman or a foreign-born racialized man may feel they have no voice (in the case of women), or cannot express their experiences (e.g., Ben’s account). Consider the following quotes from an older person and a stakeholder synthesizing the extent and effects of social exclusion with regards to late-life homelessness: You know when they say you just don’t care anymore, what goes on; you just don’t care about society, you just don’t care about yourself; because, it’s just to the point where you get tired of everything and that’s what happens to a lot of people and the suicides and stuff like that. We just give up … I mean, I went through all this stuff and I ... I’m one of the lucky ones, you know? I’m very lucky but it’s ... it’s a rough life. – Marc, forty-six-year-old man, transitional program, Participant 8 They don’t have an ID, no wallet, nothing, they live from one day to the other. We have to try to get them a health card. And the doctor who sees them knows that they likely won’t be here next month, they’ll be in another part of the city, that they won’t be able to do any follow-up. Imagine how it must be to accept a client knowing that you won’t be able to follow up, and won’t be able to help. Because they are homeless. Sometimes we need to take someone to the doctor, we call and they say “yes, we can take them, but it won’t be until next month.” They don’t give them any priority, there is not much awareness when it comes to

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their needs. Sometimes we have to take them to the emergency department because someone is very sick. We bring them to the emergency room, they leave. The person doesn’t want to be in the emergency room neither. The emergency room doesn’t want to see them because it is not only a health issue, there are other problems too. No one wants them. As a society, we are not prepared to deal with this group, in general – in general. – Stakeholder, Housing and Homelessness Sector Ethnographic accounts demonstrate how the expectation of civic participation is unfair given the realities of survival and unmet basic needs. Further, the extension of this idea into traditional forms of civic participation such as voting reveals the relational and cumulative impact of exclusion, and the differences that exist between older people in the general population and those with experiences of homelessness. Being outside the civic process furthers exclusion by not allowing voices to be heard, acknowledged, and recognized as a means to change circumstances. That is, exclusion abets exclusion. The act of bringing the insights together through a critical perspective, viewed through the lens of exclusion, demonstrates the compound processes involved in late-life homelessness. It contributes a fuller understanding that social exclusion is what happens at the intersections of aging and homelessness, and reveals the systemic challenges and impacts of disadvantage when older people with experiences of homelessness are not afforded security, or the means for participation and engagement. Having demonstrated how late-life homelessness corresponds with existing understandings of social exclusion among older people, we now turn to the emotional impacts of being segregated from society, the feelings of being left out, and experiences of extended vulnerability.

l at e - l if e h o m e l e s s n e s s : e x peri ences of s oci al e xc l u s io n a n d v u lnerabi li ty This section explores the subjective interpretations and feelings experienced by older people as a result of exclusion and late-life homelessness. To this point, our material has focused on the systems and processes by which older people with experiences of homelessness are excluded. As such, the chapter has built on previous discussions to demonstrate how age, spatial relations, and disadvantage inter-

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sect and manifest to produce and sustain exclusion. Yet, the impacts of processes of exclusion were also deeply felt. Shelter workers and older people discussed how they were impacted by the discrepancies between perceptions of ‘what counts as a good and decent life,’ and their experiences and work with regards to late-life homelessness. These include, for example, feeling “alone in the madness,” and witnessing other people aging in “undesirable places” and “dying on the streets.” The following quotes speak to the suffering that occurs among older people who are homeless: Ah! Walking all day, it is very hard on the body. Sleeping outside on a park bench in the cold, it is very hard on the body. Your bones, the humidity. Even just waking up in the morning and not having a job to go to. Figuring out where you are going to go. Even if you go inside a mall, you are always faced with the outside, faced with walking, walking. So yeah, with all of that, I find it very hard on the body. – Gabriel, fifty-one-year-old man, shelter, Participant 16 I am not sure how to say this. The resources that they put into helping us get off the street, I don’t believe it, it is a total fantasy. The people who say “ok, we are going to help you get an apartment.” Yes, sure. But it is full of fleas, they send us into these holes that are full of bugs, I am not going there, I don’t want anything to do with that. It’s all [expletive], there is no real solution. That is what I think. And I don’t want to say that I am right. – Étienne, fifty-seven-year-old man, shelter, Participant 5 People from marginalized and disadvantaged backgrounds are often deemed to be “vulnerable” for the purposes of service eligibility. For example, terms such as “structural vulnerabilities” and/ or “social frailties” are used to argue for access to services and/or justify the need for intervention with regards to health and homelessness (see Stajduhar et al. 2019; Stajduhar and Mollison 2018). In other fields, particularly feminist ethics, vulnerability is defined as part of the human condition, and considered central to care. On a philosophical level, vulnerability arises from embodiment, and the ever-present possibility of harm, injury, impairment, or limitation (Butler 2016; Fineman 2008; 2010; Kittay 2011; see also chapter 9). A tension thus exists between approaches to vulnerability as part

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of the human condition and circumstances whereby vulnerability is worsened by structured conditions. Insights presented through a lens of exclusion reveal how social, economic, or political situations render some older people more vulnerable than others, and how systems and structures can increase vulnerability. The following examples illustrate the impacts of homelessness and vulnerability: I am bored here, so bored here. Interviewer: Bored of what? Participant: I don’t even know what bores me. Interviewer: Do you find time goes by slowly? Participant: There is no life! There is no life! – Marie, sixty-fiveyear-old woman, transitional program, Participant 22 At my age, I don’t have much life ahead of me anymore. You see, I don’t know, I don’t see the end of the tunnel, because everywhere I go: “Ah! He’s homeless.” Everywhere you go: you’re homeless. It’s as if I wanted to erase myself, but when I think of my family, it is important that I stay alive, yes. I have children. And that would really haunt them to say: “he killed himself because he was homeless, and all of that.” – Ben, fifty-six-yearold man, shelter, foreign-born, Participant 9 Older people with experiences of homelessness live with a vulnerability that is sustained by systems that continue to overlook their needs. Quotes offered by older people provide powerful portrayals of what it is like to live at the intersections of aging and homelessness – in situations of exclusion and vulnerability. They outline how late-life homelessness is experienced as ‘being alone in the world,’ without anywhere to go or sleep on a regular basis, and being judged for occupying a marginal location: Q: If I asked you, what does it mean to grow older on the streets? A: Not much, there are no real options, 1. Work. 2. The social exclusion. It’s really an overload of social segregation. Because family life, you forget that. Your parents, well they watch down on you from above … – Grizzly, fifty-nine-year-old man, shelter, Participant 40

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Isolation … We live a lot of loneliness in homelessness. Even if we have the chance to speak to people and interact, you are all alone in the madness. Yeah, that’s it – you are all alone in the madness. – René, fifty-five-year-old man, transitional program, Participant 35 With all the problems of the street, they get tired of seeing your face, they think that you are a criminal. Sigh. Ah, whatever. You are poorly dressed, not wearing a tie. Here, this is downtown. Have a look – Old Montreal. You have the lawyers, the bankers, the good clients on the other side, the palace of justice, more like the palace of injustice. – François, fifty-five-year-old man, in stable housing for one year, Participant 3 The first quote speaks to grief and the weight of being responsible for one’s path amid the limited opportunities, thereby highlighting the loneliness carried into everyday encounters. The second speaks to the monotony of insecurity, the preoccupation with finding a place to sleep, and being emotionally worn down by exclusion from safe, stable housing. The third reveals the stark contrasts and inequalities that are experienced within the city. This quote powerfully demonstrates the duality between the high-income professionals and people with experiences of homelessness – groups who, as a result of the physical location of the shelter, pass each other on the street on a daily basis. In French, city hall is palais de justice, and as such, evokes both the physical presence and the symbolic power of the “palace” that stands above the shelter – a daily reminder of injustice: The accounts of older people stretch the interpretations of vulnerability that are currently evoked across applied disciplinary contexts of gerontology. Vulnerability is often defined in psychology as “the state of susceptibility to harm from exposure to stresses associated with environmental and social change and from the absence of capacity to adapt” (Adger 2006, 268). In the fields of health and aging, vulnerability is often used synonymously with individual health (Delor and Hubert 2000); psychological risks (Spini 2013); and exposure to stress, whether environmental or other (Adger 2006, 268). It is also linked with psychological strategies of coping, adaptation, and resilience as a means to lessen the effects of impairment and decline (Baltes and Baltes 1990). Yet, the results of our research reveal how vulnerability is not only about coping with

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health disparities or psychological risks. It is also about systemic processes, the resulting conditions of vulnerability and suffering, and an awareness of how existing understandings that are rooted in ideas of coping may sustain structures that replicate devaluation and non-response (also see Bolin and Kurtz 2018; Bolin and Stanford 2006). Insights from our research document that vulnerability, and especially extended forms of vulnerability, are by-products of exclusion and neglect. The illustrations from our ethnography reveal how experiences of exclusion and vulnerability take place through social relations in contexts such as the city, and against cultural discourses and expected conventions for aging and late life. The quotes from older people with experiences of homelessness demonstrate the systemic, environmental, and personal drivers of social exclusion in action, including how these play out through age and spatial relations, and processes of cumulative disadvantage over time. Older people reported problems accessing work, income, and health and social services; experienced age-based exclusion and problems of access; and had little access to safe, secure housing. They discussed being stigmatized in their communities, estranged from families and social networks, and having few close and meaningful relationships, revealing how late-life homelessness is also about frustration, insecurities, and fear. As such, the interviews reveal how late-life homelessness is a process of exclusion that renders people unnecessarily vulnerable by means of continued unmet need. The following quotes from older people and stakeholders outline the systemic failures and gaps that are known to exist: It goes without saying … there is a lot of stress with that life, that is very important to acknowledge, and security and fear, and a general absence of everything. Their basic needs are not met, and there is a premature aging, that is for sure. – Stakeholder, Housing and Homelessness Sector So it takes too long, the waiting list is too long, there are not enough buildings, and not enough places. – Claude, seventy-fiveyear-old man, shelter, Participant 39 Experiences of late-life homelessness reveal the distinction between vulnerabilities that are philosophically defined as part of the universal experience of being human (Butler 2016; Fineman 2008; 2010),

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and the unnecessary and extended forms of vulnerability created and sustained through systemic processes of exclusion. In this sense, the vulnerabilities that take place at the intersection of aging and homelessness are particularly profound. Late life is considered to bring about what Laceulle (2017) has labelled an existential vulnerability as a result of changes to health, possibilities of impairment, and mortality. In the case of late-life homelessness, there is a multi-layering effect of the universal vulnerabilities associated with shared humanity (namely needing care), the existential vulnerabilities that may come about in late life, and the systemic and politically induced suffering that is associated with and experienced through being homeless in late life. The experiences of older people who are homeless expose the compound effects of universal, existential, and socially produced forms of vulnerability, which can be labelled as conditions of “unnecessary vulnerability.” This distinction becomes an important element where consideration of the social response (or failure to respond) and care are concerned, which will be further developed throughout the remainder of the book. We now turn to further the analysis through the consideration of indifference, displacement, and abandonment of older people with experiences of homelessness.

l at e - l if e h o m e l e s s n e s s and expuls i on: i n di f f e r e n c e , d is p l ac e m ent, and abandonment Findings about social exclusion and vulnerability lead to considerations of social responses of indifference, neglect, and abandonment. Accounts from older people and stakeholders alike detail vulnerability and suffering that went unrecognized and needs that went unmet. Older people’s accounts revealed the weight of the social stigma brought into late-life homelessness from earlier periods of the life course, the accumulation of disadvantage, and processes of exclusion or discrimination through policies, practices, and encounters. They outlined how their physical and psychological vulnerability worsened as basic needs for food, shelter, security, safety, and support remained unmet. In many cases, social supports delivered at the appropriate time could have altered pathways before needs became long term. The argument developed in this section of the chapter is that contemporary responses to late life homelessness can be characterized along a continuum of responses that overlook, remove, displace, or ignore people with experiences of homelessness. Here,

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the idea is that late-life homelessness can be understood as resulting from: indifference, non-recognition, and the policies of neglect; the displacement and punishment of marginalized groups; and the abandonment of older people in need. Unmet Needs, Indifference, and the Politics of Neglect Our ethnographic research on late-life homelessness revealed countless illustrations where needs were permitted to go unmet through the shortage of affordable housing and the lack of access to essential services and supports. For example, older people with low income were up against the rising costs of rent, and they ended up spending most of their monthly income on housing, leaving them without essential and everyday items, or falling into homelessness (often visible through use of food services/cafeteria). Yet, despite the visible presence of older people “on the streets” and in point in time counts, few strategies on homelessness included older people. As outlined in chapter 4, the omission of older people’s needs resulted from age relations, a possible misunderstanding of systems and existing gaps, and cultural devaluations of age. The suffering of older people with experiences of homelessness was permitted to continue through waiting in long lines and walking despite poor health, through violence and victimization, and through exclusion and shame. The interpretation of study results from a critical perspective exposes how responses to late-life homelessness can be characterized as a “politics of neglect” exercised through inaction with regards to housing, income, and care. The idea of a “policy of neglect” refers to a non-response, or a decision not to act, and can be used to describe a range of situations where policies do not exist on a particular topic or for a particular population.7 This can include areas that have not yet become recognized as a matter of public concern, such as late-life homelessness, as well as domains where decision-makers may recognize a particular issue, but consciously decide not to act (see Hill 1996; Scharf 2010; 2015). Although it is difficult to ascertain the reasons for inaction on late-life homelessness, explanations include a lack of formal recognition, perceived cost, prevalence (i.e., the population group is viewed as too small), the difficulty of the problem, or a lack of public support. It is worth pointing out that even in cases where recognition of late-life homelessness exists and is documented through calls to action (UK or Australia), the systemic

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response remains one of inaction – or neglect – rather than action or response (see Means 2017). This would suggest that policies of inaction or neglect are about not only recognition, but also public support and/or cultural expressions of indifference toward older people from disadvantaged groups. Although surprisingly little is written on “policies of neglect” or inaction, the decision not to respond provides important insight into the social constructions of a problem, and shared social, political, economic, and cultural priorities in operation. Responses of inaction or non-response are often attributed to the “invisibility” of a particular marginalized group, their level of deservedness as a social group, or the degree of threat to social norms (see Hill 1996).8 Yet, in the case of late-life homelessness, the impact of inaction extends even further when the intersections of age, disadvantage, and inequality are taken into account. For example, older people with experiences of homelessness are at risk for early mortality as a result of social, health, and income disparities. They may also belong to over-represented groups affected by historical practices, such as Indigenous peoples or people with disabilities, as outlined in chapter 5. Schneider and Ingram (1993) suggest that social constructions, and the attribution of the social value of particular population groups, shape ideas about deservedness and have implications for response (also see Means, Richards, and Smith 2008; Townsend 1981; 2006; Walker 1980). The application of ideas of inaction and non-response sheds light on rethinking late-life homelessness. While older people hold relative advantage with regards to the “deservedness” historically attributed to them, cultural ideas of individual responsibility and the stigma of homelessness affect later configurations, constructions, and responses at the intersections of aging and homelessness. This connection between the social constructions of older people and the non-response to late-life homelessness points to a mounting indifference with regards to disadvantage and older people. Social constructions of marginality and deviance are known to affect social and policy response (see Levitas 2005). A critical analysis on late-life homelessness reveals if and how the position of older people as both “deserving” by means of chronological age, and “undeserving” as a result of homelessness (or not being old enough to qualify as “old”), can cause ambiguity in cultural understandings and organizational responses. As demonstrated in earlier chapters, older people who are

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homeless occupy a liminal and unrecognized place between being older and thus both devalued and in need of protection because of their age, and being “undeserving” due to the perception of having made “poor lifestyle choices” – ideas that reinforce indifference, as well as policies of neglect and inaction. That is, older people with experience of homelessness sit alongside both the cultural discourses of avoiding dependency, decline, or tragedy that are associated with aging and impairment, and the associations of occupying a stigmatized identity and location of exclusion and marginalization (see Gullette 2004; Lloyd 2004; Kafer 2013). Yet, situating homelessness across the life course reveals how it can result from both political decisions of action (deinstitutionalization; colonization) or inaction (shortage of housing with supports; reliance on kin-based care). Taken together, ethnographic insights and analysis of strategies on homelessness can be taken as evidence of policies of neglect and inaction that are indicative of a larger politics enacted at the intersections of aging and disadvantage. Displacement, Punishment, and Expulsion Older people’s experiences of homelessness were also affected by larger trends and responses. This section focuses on active responses of displacement, punitive practices of harm, forcible removal of city encampments, and/or expulsion from city spaces that were taking place at the same time as the observable trends of non-response to homelessness among older people. While it can be argued that older people are somewhat protected from the levels of punishment and force enacted on younger people deemed “deviant,” older people are disproportionately affected by particular types of displacement (although often invisible within the groups of those affected), by service gaps and gentrification, and as a result of limited mobility. Displacement generally refers to changing the place within which a person resides, including moving people out of particular places and spaces into others. Where policies of displacement related to rehousing can be considered by decision-makers to hold positive connotations of moving to suitable accommodation or shelters to gain stability (as in the case of long-term care, for example), the term “displacement” is more often used to refer to harmful practices such as fines for loitering, forcible relocation from city centres to other parts of the city, bussing people out of major cities, and preventing

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the use of public spaces through what is known as “defensive architecture” (see Andreou 2015; also Kennelly 2015). Older people with experiences of homelessness, and in particular those who never before experienced homelessness, are one group for whom the concept of displacement is particularly relevant. In our work, displacement was most notable in the trajectories that led to homelessness, particularly eviction, job loss, and rising rents. Our work revealed the displacement of older people as a result of insufficient income or gentrification eviction resulting from renovation (“renoviction”) or hospital stays, divorce, or bereavement. By the nature of their movement through city spaces, older people were also impacted by defensive architecture intended to deter people (e.g. shortage of benches), leaving them with few options to rest, or by being asked to “not loiter” and leave particular places within the city (see Burns 2016; Smith and Walters 2018; Watt 2018).9 Although we did not observe the high-profile examples of bussing people out of the city that were noted in American cities, or the destruction of tent cities in our site of Montreal, these actions were occurring in other contexts at the time of our study, particularly in advance of events such as the Olympics or tourist seasons (Lenskyj 2012). While it is difficult to assess the extent to which older people were involved in formal displacement efforts, the prevalence of older people among the general ranks of homelessness suggest they would have been subject to such practices, rendering this yet another location of exclusion where age operates as invisible.10 In recent years, researchers and advocates have drawn attention to shifting social and cultural global dynamics, and movement from social exclusion to expulsion. The results of our ethnographic study suggest older people with experiences of homelessness are also being moved, by means of non-response and inaction, from a more protected category of “deservedness” to neglect and abandonment. Authors such as Sassen (2011; 2014) argue that a shift has taken place from exclusion to active expulsion whereby changes in global society have altered forms of inclusion, with marginalized groups increasingly pushed outside of the social peripheries of membership. Her work identified processes of devaluation, and how groups deemed less valuable were not only denied entry, or kept out (which would be more akin to the concept of exclusion), but are now being removed from the social and cultural context by means of direct (or even indirect, as is suggested in this chapter) action. Considerations

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of expulsion are extremely relevant to the case of late-life homelessness, given how older people are being moved outside the system by means of housing for private investment (gentrification and renoviction), a lack of access to affordable housing and care, and the shortage of supports for older people with experiences of homelessness11 (also see Watt 2018; Gertten 2019). Whereas exclusion prevents people outside the system from entering, the processes of expulsion ejects those who are within to the other side, and over time, increases the ranks of the excluded and displaced (see Povinelli 2011). Once outside these systems, marginalized groups such as older people with experiences of homelessness are at risk for further violence and victimization – a trend observed in our findings. Older people discussed the violence they encountered on the street and in the shelter as a result of their homelessness (see chapter 5). Although most understood these acts to be interpersonal in nature, the scholarship on displacement, expulsion, and punishment revisits violence as systemically, politically, and institutionally induced. Research on homelessness has critiqued the defensive architecture intended to deter people from, or inflict harm in, the locations where homeless people may congregate or sleep. Here, the response flips from one of inaction to one of direct confrontation or punishment. Such illustrations reveal that violence has not only come to be increasingly tolerated among marginalized groups, but has been actively endorsed and enacted through the policies and practices of governments and institutions (Cooper and Whyte 2017). What is most striking from a policy perspective is how such practices have come to be envisaged and enacted. Although some practices are the product of private decisions of business owners, alluding to a widening cultural acceptance of inducing harm, others have involved lengthy government discussions about potential solutions, with active decisions made to deter people and/or erase a social problem. An additional distinction can be made: while some actions are visible and direct (even if by means of inaction), others are better characterized by “erasure” or a soft form of “letting die,” raising serious questions about moral responsibility (Povinelli 2011; also see Kelley, Dannefer, and Issa Al Masarweh 2018). Practices with regards to homelessness reveal a growing acceptance and endorsement of violence toward marginalized groups such as older people who are homeless. While older people may still remain somewhat protected, they are also increasingly being displaced and subjected to expulsion and

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violence through softer forms of prolonged suffering and “letting die.” Our research included ongoing and everyday threats of violence on the street and in the shelter, as well as attempts to protect older people from this violence. Letting people pass to the front of the line, described in chapter 6, is exemplary of support and protection. Yet, it may also reflect pity associated with decline, as well as a process to set someone apart and mark them for violence. Further, older people with experiences of homelessness may be deemed “harmless” – a direct contrast to ideas of young homeless people (but especially men) as violent and in need of control. As such, the idea that older people are a group in need of protection may spare them from the direct violent responses enacted on younger people – a finding consistent with our work on frailty, where older people were less likely to be targeted by the police in political protests (see Grenier and Hanley 2007). In these examples, the linkage between age and passivity (age relations) may serve as a protective mechanism from displacement and violence. Yet, they may also explain why responses to older people are characterized by indirect forms of neglect or indifference that prolong suffering rather than direct actions of punishment or violence.12 The punishment and violence enacted toward older people with experiences of homelessness take place through indifference, overlooking, and allowing to endure unnecessary and prolonged suffering. Late-life homelessness is a form of punishment that takes place over time, and through processes of neglect and abandonment. The accounts of older people and stakeholders working in community systems alongside notions of displacement, punishment, and expulsion render visible the subtle (and not so subtle) forms of violence enacted against older people who are homeless. In doing so, they signal a shifting tide where socially condoned forms of violence and abandonment are concerned. Older people are already being included in the forcible acts of displacement, and in moves from exclusion to expulsion, and it may only be a matter of time until they are also directly targeted with punitive actions of “control” over “care.”13 If the trends witnessed by Sassen (2014) continue, older people who are currently marginally located at the peripheries of the system may already be in the process of being ejected to the outside. The cases of eviction for unpaid bills, hospital discharge to the street, and the shortage of public care certainly suggest the relevance of this reading. And, while older people may to date have been subject to less punitive responses related to their identification as a “deserving

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group,” it is yet to be seen whether they will be increasingly subject to violence as they become more visible in numbers, or whether they continue, by means of their age and devaluation, to suffer as a result of passive forms of indifference, inaction, and “letting die.” Endured Suffering and the Cultural Abandonment of Subjects in Need Results from our ethnographic study of late-life homelessness in the city of Montreal reveal the extent to which older people with experiences of homelessness are being abandoned. As illustrated through this book, older people with experiences of homelessness endured lives of extended vulnerability and suffering as a result of unmet need. Stakeholders often defined older people who were homeless by means of their vulnerability, and used these definitions to advocate for services and response. For example, one worker said: “An older [homeless] person, whether you like it or not, they [are] frail, you know what I mean by frailty, they are vulnerable, fragile … it is different than someone who is simply getting old” (Stakeholder, Housing and Homelessness Sector). At the same time, they spoke about the difficulties they had in trying to meet the needs of older people in a context where few options existed. Older people also spoke about their tangible basic needs, the emotional distress of anxiety, and how their worries worsened the feeling of having “limited time left” to alter their circumstances – an experience they found particularly stressful (see Grenier et al. 2016c; also Burns, Sussman, and Bourgeois-Guérin 2018). For example, they said, “I just need a roof over my head, or a meal, or to buy a gift for my family now and then.” Unmet needs in the contemporary context lead to the importance of considering the widening acceptance of social suffering and the abandonment of older people from disadvantaged groups.14 The ideas articulated in Povinelli’s (2011) Economies of Abandonment are particularly helpful in exploring the link between devalued subjects and neo-liberal responses. Povinelli’s anthropological research across a number of sites explored how cultural discourses and practices created and sustained “spaces and zones of exposure and abandonment” (44). In her work, she articulates a “social spacing – a bracketing of the other in a no-man’s land of having been neither recognized nor denied recognition” that is relevant to understanding late-life homelessness (77). Further, she

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contextualizes these changes as neo-liberal practices, whereby the cultural idea of “potentiality” (or the lack thereof) exposes particular groups to risk, and makes forms of “making live, making die, and letting die” seem right, reasonable, and good (29). The examination of the relationship between devalued subjects and social and cultural responses are extremely relevant to understanding processes of non-recognition, exclusion, vulnerability, and non-response with regards to late-life homelessness (also see Lang 1989). In the case of late-life homelessness, older people may be overlooked because they are considered to have less potential “time left,” and therefore less value compared to younger or able-bodied people (see Gullette 2004; Kafer 2013).15 Whether by cumulative disadvantage, unmet need, or endured suffering, Povinelli’s (2011) argument highlights the relationship between shifting cultural constructs of value/ devalue, structural causes of homelessness, and ongoing institutional neglect. It exposes how liberal priorities have produced “economies of abandonment” that sustain the lives of older homeless people as devalued against a backdrop of individual responsibility and economic priorities. Further, older people are not only rendered devoid of potential (outside means of production and thus market value), but also associated with notions of burden associated with the increased economic costs of care (see Gee and Gutman 2000). Although social gerontology has been silent on late-life homelessness, there is a body of research critiquing the impacts of neo-liberal systems of care on older people and their families. Neo-liberal systems of care characterized by economic expediency and private market imperatives have been identified as producing major care gaps where public and affordable care is concerned (see Daly and Armstrong 2016; Daly, Armstrong, and Lowndes 2015), a phenomenon Estes, Swan, and Associates (1993) deemed as the creation of “no care zones,” places where older people are not afforded the commitment of care. In the case of late-life homelessness, abandonment is even more acute, against a weakened welfare state, and where older people from disadvantaged groups with higher-level needs cannot afford private model options. Yet, structures and institutional practices continue to move older people with experiences of homelessness farther out of the frame of reference and public response. Older people with experiences of homelessness come to occupy a “zone of abandonment” from social welfare systems, and by society more generally – they are left to age on the streets, without shelter,

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and without care (also see Biehl 2013a; 2013b; Markell 2009). This relationship between the economy and response renders visible the unnecessary vulnerability and practical, political, and cultural abandonment that occurs in a context that prioritises individual responsibility, profit, success, and a productive late life. Take for example large cities such as San Francisco, where one must step over people in the street – some of whom are old, many of whom are racialized and/or mentally ill. Homelessness that is permitted to endure, and is increasingly tolerated as part of life in a city,16 represents a widening tolerance of unmet need and a growing abandonment. It is in this vein that late-life homelessness can be understood in line with Povinelli’s (2011) notions of “causing to suffer” and “letting die” – a softer form of mortality whereby groups are allowed to persist until they exhaust themselves, living a life of indifference, expulsion, and abandonment. The tendency to neglect and abandon older people with experiences of homelessness is deeply embedded in current social, cultural, political, and economic responses. Policies and responses occur at particular moments in time, alongside political conditions and within the context of historical times (deVries 2010). According to deVries, policy decisions about recognition and response happen as a result of world views such as economic scarcity, and/or dominant views about expected roles and norms (see deVries 1999; Frieden and Kaplan 1975). Responses to need are deeply connected to perceptions of social value, the visibility of particular groups, social values or perceived “deservedness,” and the political context within which these needs occur. The argument is thus that approaches to homelessness – whether cultural or systemic – represent an abandonment of vulnerable older people in times of need, and are reflective of a larger social and cultural malaise. When critically interrogated, practices of indifference, expulsion, and abandonment raise important questions about policies of neglect, their role in creating and sustaining inequality, and the moral and public responsibility for justice. Framed as such, responses become exposed as reflective of shifting social and cultural values that overlook and neglect older people with experiences of homelessness.

c o n c l u s ion This chapter focused on the process and experience of late-life homelessness as social exclusion. It actively engaged with the questions what happens at the intersections of aging and homelessness? and

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what is it like to live at the intersections of aging and homelessness? through a lens of social exclusion. The first part of the chapter presented qualitative insights according to five domains of exclusion to highlight the extent to which older people with experiences of homelessness were excluded from or “shut out” of social, economic, political, and cultural systems (Walker and Walker 1997). In doing so, it revealed that late-life homelessness corresponds with what we know about social exclusion, and as such, can be considered as an example of social exclusion among older people. It deepened our understanding of late-life homelessness by repositioning homelessness as the result of processes of exclusion, adding this to the awareness of age relations, spatial encounters, and disadvantage developed thus far throughout the book. The chapter then exposed the everyday felt impacts that accompany the processes of social exclusion, and how responses create and sustain unnecessary forms of vulnerability. The quotes from older people revealed how late-life homelessness is experienced as social exclusion, stigma, and vulnerability, and is lived through feelings of loss, loneliness, disappointment, and anger. This chapter thus pushes our understanding of social exclusion and late life to engage directly with older people’s subjective interpretations of their experiences, and in particular, how systems and processes both worsen the conditions of late-life homelessness, and create situations of endured suffering. These descriptions draw attention to the weight of the vulnerabilities and difficult experiences that are brought into homelessness, and which are sustained through encounters with other people, professional practices, as well as systems and structures. In doing so, the chapter concludes that late-life homelessness is a process of exclusion that happens through structures, organizational practices, and encounters, to produce feelings of “being left out” and further vulnerability. The chapter then built on these findings to more carefully consider responses of neglect and abandonment in the contemporary context. Drawing on Sassen (2014) and Povinelli (2011), it outlined that responses to homelessness represented a larger shift from exclusion to expulsion, and to an abandonment of particular devalued lives, such as those of older people with experiences of homelessness. Set in this context, the research findings drew attention to tipping points from acts of indifference, such as walking over people on the street, to policies of neglect, and active attempts to relegate disadvantaged

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groups to the margins, and punish them based on their social status. Further, it highlighted how these processes are intricately linked with neo-liberal economic and political imperatives of risk, efficiency, and productivity, and are thus complicit in permitting suffering to endure, and for allowing a process whereby older people with experiences of homelessness are abandoned to be “let die.” Given these insights, the question becomes at what point, and under what conditions, does (and will) this suffering demand a response? In an attempt to respond, we now turn to the third part of the book, focused on the need for targeted and preventative responses, and a moral imperative to address the injustices of disadvantage, inequality, and suffering.

s e c t io n i i i

Directions for Change

8 The Need to Prevent Homelessness across the Life Course and into Late Life

This chapter focuses on the need to prevent homelessness across the life course and into late life. It begins the third section of the book, which draws together project insights to suggest areas for change. The study of late-life homelessness from a critical ethnographic perspective highlights how late-life homelessness results from structured inequalities, age and spatial relations, disadvantage over time, and processes of exclusion and abandonment. It reveals how late-life homelessness occurs and is sustained through inaction, and alongside social expectations and cultural scripts. In doing so, it exposes how older people with experiences of homelessness have been denied access to the lauded benefits of aging and late life, namely stability, home, and ideals of health and success. That is, how people who are currently homeless have been denied the future of aging. Findings from our ethnographic research reveal how preventative policies, well-timed interventions, and support may, if designed and implemented properly, alter homelessness across the life course and into late life. This chapter engages with the question: how can project insights be drawn together to change policy and practice responses to latelife homelessness? Thus far, the book has focused on detailing the contradictions and experiences at the intersection of aging and homelessness. This chapter collates these insights to articulate a preventative model of life course policy as a pathway to change. Although late-life homelessness and other forms of disadvantage experienced by older people have been studied from a life course perspective, few works have attempted to translate findings to policy

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and practice. This chapter tries to fill this gap. It begins by reiterating study results of late-life homelessness as a result of disadvantage over time. It then sketches out the boundaries of a preventative approach at the intersections of income, housing, health, and care. Essential features identified across the research include the adoption of an agelens, building mechanisms to ensure access and support, addressing intersecting locations and cumulative disadvantage over time, and establishing a larger commitment to social justice. Following this, the chapter provides immediate, mid-, and long-term suggestions for change and concludes with the need to bridge preventative life course policy with a stronger conceptual and philosophical foundation of justice.

t he i m pac t s o f d isa dva ntage and s hi fti ng con d it io n s ac ro s s l iv es and over ti me The accounts of older people with experiences of homelessness and shelter workers outlined how social and structural arrangements created and sustained late-life homelessness. On the social and structural level, older people were affected by a shortage of programs and responses and by shifting systems of support, as well as by responses that denied access to existing services. This included how the drop in income on reaching retirement impacted housing security; how features such as universal entitlements, labour force participation, and/or access to pension contributions influenced late life; how the shortage of affordable housing and the prevalence of eviction impacted housing security, especially at challenging life transitions or unanticipated life events; and how disadvantage and health disparities led to patterns of early and preventable mortality. Although the study did not focus on changes to policies over time, the stories from older people with experiences of homelessness revealed the implications of changing patterns of work and family structures, and the shortage of available options. The following stakeholder quote emphasizes the importance of establishing connection across a range of sectors: If we could have closer working relationship[s] with the people who referred them [older people with experiences of homelessness] to us. The police bring them to us. They dump them there … I guess they don’t know what to do, better here than in

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prison, I would imagine, but you know … That’s another thing, I mean, we are there for that. But still it would be nice … work something [out]: [develop a] common plan: “We’ll do this and you’ll do that.” Because we can’t do everything and we shouldn’t have to. – Stakeholder, Housing and Homelessness Sector Illustrations at the intersections of housing, work, and income exposed how institutional structures and systems created and sustained disadvantage and late-life homelessness. The rising cost of rent and the shortage of affordable housing for older people worsened the present day and the futures of older people with experiences of homelessness. Older people were affected by gentrification and displacement, including cases of eviction following prolonged hospitalization, stays in a rehabilitation unit, or imprisonment (see Crane et al. 2005; McDonald et al. 2006; Rothwell et al. 2017).1 A focus on change over time revealed how disadvantage accumulated and deepened across the life course as basic needs become unaffordable, as a result of increasing prices over time and the reduced income older people have in later life. Changes in affordability crystalized homelessness, particularly where lifelong poverty, job loss around mid-life, or illness or relationship breakdown were concerned (see Crane et al. 2005; Cohen 1999; Lee, Tyler, and Wright 2010), and acted in combination with agediscriminatory practices and a shortage of appropriate supports. This focus demonstrated how gaps in care structures impacted practical issues with regards to eligibility (e.g., home care), and because services do not exist. Further, it showed how illness and impairment exacerbated and accentuated difficulties of securing permanent housing, resulting in the abandonment of older people with complex needs. The following quotes illustrate how life at the intersection of aging and homelessness was difficult and painful (both physically and emotionally): Ah! It’s terrible. It’s so much harder at fifty-five, to find yourself homeless than it would be at twenty, twenty-five years old … Normally, at twenty, twenty-five years old, thirty, you have a good bit ahead, you know, time ... At fifty-five, it’s very different. Sometimes, I wake up in the morning, and I find it very difficult to be in this situation. I find it emotionally difficult ... when I wake up in the morning, at fifty-five years old, in a shelter bed,

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it troubles me, and it makes me scared. I’m scared to stay here. And it troubles my family, it is very painful … I find that being homeless at my age. I find it emotionally difficult. – René, fiftyfive-year-old man, transitional program, Participant 35 No, you know, I’m sixty-nine years old, I’ll be seventy soon, the most that I can live on the streets, maybe two years, but more than that, I won’t be able to do it, I won’t be able. I must find housing. I must. I can no longer live ... I’m not saying I don’t like the shelter, we’re very well treated, we’re very well fed, very well received, but I need a place. To be able to get up in the morning, look at the sun, say hello, lie down in the afternoon, take a nap. I need to rest, I’m tired, I’m not young. I have a broken hip, I have osteoporosis, I have kidney pain, I have slipped discs. – Frédéric, sixty-nine-year-old man, shelter, Participant 14 Our research demonstrated how current programs were insufficient, both in that they created and sustained homelessness, and that they excluded and denied older people access to the forms of aging experienced by the general population. Late-life homelessness is an example of unmet needs resulting from neo-liberal agendas where economic expediency has been prioritized over care and human needs (see Armstrong and Armstrong 2003; Evans and McBride 2017; Cooper and Whyte 2017). Although there was an assumption that older people would be protected by public pensions, this group was poorly served because they had not contributed the roughly forty required years of full-time work due to periods of unemployment, disability, or mental illness, and were therefore at high risk for structured poverty and early mortality. Further, the societal shifts to private pension schemes were also not usually available to people with experiences of homelessness because they were less likely to have worked in jobs with such programs. Few of our participants had access to additional benefits, and limited income in late life could be seen to have a direct impact on housing stability and care, placing older people at risk of homelessness. While Housing First was intended to provide housing as a means to address chronic or long-term homelessness, it did not include older people, nor account for long-term housing needs.

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bu i l d in g o n p ro j e c t in s i ghts to develop a l if e c o u rs e p o l i cy approach Viewed together, the insights from stakeholders and older people reveal the need to prevent disadvantage and inequality across the life course and into late life. The development of a life course approach to policy and service is a useful way to frame a comprehensive set of well-timed interventions that respond to the series of challenges identified throughout the book. This section sketches out the rationale and structural boundaries of such an approach. It suggests a model that builds on research-based insights as a basis for prevention. Statistical data, whether cohort or longitudinal, can provide insight into prevalence, patterns, and trends. Qualitative insights can expose and articulate the human dimensions, including experiences and contradictions, to target for system-level change. Accounts from people directly involved with late-life homelessness point to major challenges, and identify how unmet needs are experienced differently by sub-populations of older people, based on intersecting social locations or historical practices. Further, they provide ideas of what will (or will not) work in the everyday contexts of the streets, shelters, and long-term care. One of the fault lines within existing life course models is the attempt to predict outcomes and explain trajectories – features that would be difficult to achieve considering the unpredictability of the circumstances leading to homelessness. The innovation of the ethnographic model put forward in this book is in exposing how assumptions based on explanation and prediction, and whereby lives are presumed to correspond with standard models, have serious implications where disadvantage and the lives of marginalized older people are concerned. Bridging everyday experiences with ideas of a critical life course policy can bring the voices and experiences of older people who have been marginalized back into the discussion, and develop active responses that contrast non-recognition, inaction, and abandonment. A number of international authors have called for a closer link between research and policy development in the field of aging, and the life course perspective is often noted as “the missing element in the public policy debate” (Rother of aarp in 2009, as cited by Dannefer and Settersten 2010, 3). Life course perspectives have been used to study homelessness in later life, but few authors have articulated how knowledge about trajectories of disadvantage can

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be used to inform policy and practice (McDonald 2011; Gonyea et al. 2010; Padgett et al. 2012).2 Padgett et al. (2012), for example, relate late-life homelessness to cumulative loss and trauma over the life course, including such adverse events such as incarceration, suicide attempts, abuse, and loss of family and friends, as well as chronic stressors including poor health, poverty, social isolation, and stigma. The suggestion being made in this chapter is that qualitative research insights can be helpful to develop a more radical approach to thinking about the life course because they point to the relationships between structures and experiences, and offer meaningful directions for change. An emerging literature from which to develop and further a preventative life course policy approach does exist, although it has not yet been connected with homelessness as done in this chapter (see Marshall 2009; Marshall and Mueller 2003; Settersten 2003).3 According to Dannefer and Settersten (2010), “the life course perspective brings … the recognition that life experiences, which are inevitably organised by social relationships and societal contexts in which individuals are located, powerfully shape how people grow old” (4). This claim for the relevance of a life course approach is often positioned as a rationale for better statistical data to determine outcomes that result from early life course patterns, and to design preventative interventions that change the path of disadvantage. It is thus intertwined with standard models of the life course and predictive (and statistical) models aimed at earlier periods in the life course, as well as the establishment of new areas of expertise and funding. The suggestion being made in this case is that there is a need for a broader, more critical life course approach, inclusive of the structural and human elements of lived experiences, to inform policy development and instigate change. This would build on models such as that outlined by Settersten and Trauten (2010) as follows: A life course perspective emphasises the importance of updating or remaking social policies to better keep up with the times. It begs us to better anticipate the future: not only to pursue immediate answers to current problems by focusing on individuals who are already old, but also to ready ourselves for future needs by focusing [on] those who are not yet old … A key challenge is to figure out how to articulate a more coherent, coordinated, and comprehensive set of policies and programs for the entire life

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course. Movement in these directions is essential for ensuring the well-being of societies and their citizens now and in the future, at home and around the world. (156–7) The rationale for the development of life course policy and practice seems well aligned with the needs of older people with experiences of homelessness, as reported in our research. One of the main issues that comes up when using qualitative research, and which challenges a good deal of the research from a life course perspective, is that the disruptive moments and life events could not always be predicted – they were about illness, loss of job or relationship, eviction related to both, and/or other features that were outside of the control of the individual. That is, they were an assemblage of forces which intersected to produce and sustain disadvantage in a context where needs remained unmet. Second, they are not only personal and individual. Late-life homelessness was about the failure of a variety of systems, non-existent services, and an absence of structures of support, which left the individual on their own. As such, our research points out that interventions need to cross the boundaries of income, health, housing, and care, and require flexibility and thoughtfulness with regards to particular social locations, over-represented groups, timing, and pathways of risk. Interventions need to consider shifting and contemporary conditions, eligibility criteria, and change over time, as well as access to programs, and a series of legislative measures to prohibit practices that cause harm and lead to homelessness (e.g., eviction). They also must address the within-group categories of those who are already homeless in late life, and those at risk for firsttime homelessness as a result of contemporary conditions (see Brown et al. 2016). Leading examples of life course approaches to homelessness can be found in Padgett and colleagues’ (2012) research, whereby the life course provides the “temporal depth, multiplicity, and cumulative nature of exposure to adversity” (8).4 A critical perspective, however, takes the next step, extending the focus from the individual to the systemic and structural level, and accounting for the contradictions experienced in relation to institutional structures, organizational practices, and social, cultural, and relational configurations (and enactments) of age and inequality. At the moment, structural, institutional, and relational aspects of the life course approach are often missing from existing models. This is perhaps especially the case for models derived from

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the United States, which do not have the same historical connections to the welfare state as a backdrop institution that shapes the life course (see Dannefer and Settersten 2010 for the distinction).5 Our qualitative methods suggest that understanding late-life homelessness through observations, discussions, analysis of policy frameworks, and the experiences of stakeholders and older people exposes intricate details of how structures and institutions impact older people through life, over time, and in everyday encounters. As such, these observations hold fruitful lessons for the development of a systems-level critical life course policy approach. These include: attention to structures, contexts, and experiences; the impact of responses (and non-response) to individuals and populations across a range of contexts over time; and how each policy or practice intervention affects possibilities and outcomes among diverse groups of older people. In this way of thinking, Hendricks (2012) highlights how social policies are important for lives because they are normative in terms of expectations, and as such, “pose parameters within which actors spend their lives” (227). Extending this further, he suggests that a life course approach to policy can serve as an “action framework” to recognize the relationship between scripts and structures, as well as serve as a basis to alter experiences such as inequality. This includes how policies may have differential effects on men and women as a result of life course structures, as well as how differences may unfold through exclusion, isolation, systemic racism and discrimination, inequities, and related social status (Calasanti 2003; Hendricks 2012; McMullin and Curtis 2016).6 The material presented throughout this book reveals precisely the sorts of relationships and differences that could be addressed by a critical life course approach to policy and practice. A series of questions emerge when the insights from our research on homelessness are combined with the idea of life course policy designed to build well-timed interventions across the life course and into late-life. The following questions can be used to situate the intersections of aging and homelessness and to gain policy and practice relevant insights. The questions appear here as an attempt to explicate sets of ideas to build a strong conceptual and systemic preventative approach to life course policy. As such, they are an attempt to think through the types of interventions that would address latelife homelessness on a societal and institutional level:

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How have particular policies and historical practices across the life course and into late life contributed to and/or shaped late-life homelessness at this point in time? How are risks and insecurities (unequally) distributed among the population? What are the trends? Which groups are over- (or under-)represented or recognized? What is missing from the policy and practice landscape? Where are the major gaps in service or access? Who is most affected (e.g., early or avoidable mortality)? How do older people experience homelessness in their lives, relationships, and everyday social encounters? How are these mediated by age, spatial relations, disadvantage, and social location? What do the needs of older people with experiences of homelessness tell us about existing systems, structures, and services (barriers, spatial locations, etc.)? What do the insights from older people reveal about social and cultural priorities (e.g., exclusion and abandonment)? How might this change in the future? What solutions emerge from the insights of older people with experiences of homelessness? What suggestions can be developed and implemented? What are the broader lessons for theory, research, policy, and practice?

As carried out in our research, biographical accounts and ethnographic methods elucidate complex relationships between policy structures, interventions, experiences, and effects. They render visible the human element of late-life homelessness, painting a vivid portrait of the complexities in the lives of older people, the various pathways and challenges that led to homelessness, and how systemic barriers have left needs unaddressed. In gerontology, authors have turned to stories as a means to understand the relationship between policies and experience (see Biggs 2001; Bornat 2008; Hendricks 2012),7 and to situate experience over time and in relation to the contexts within which they operate. Holstein and Gubrium (2007) provide examples of this interpretive approach in social gerontology, noting how “stories and biographies highlight the relationship between private lives and public places” and how the “most personal of matters are now brought into light in decidedly public circumstances” (14).

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Kenyon and Randall (2001) extend the potentiality of stories by outlining four dimensions of life stories: the personal, the interpersonal, the socio-cultural, and the structural (also see Baars 2012; Bytheway 2009). Further, stories about policies can also help to identify and address systemic and institutional change.8 For example, in Telling Tales, Neysmith, Bezanson, and O’Connell (2005) used situated case studies of individuals and their families to demonstrate the relationship between a range of policies and experiences, and to question taken-for-granted distinctions between the household and family that are commonly used in research and policy. In doing so, their approach shifted the focus away from the distinct policy arenas of housing, income, care, and health, and practices such as relying on kin-care, to the lived effects as they were felt and experienced across a range of systems, domains, and family units, and over time (also see Mitchell and Charmaz 1996). This is a vantage point that is critical to understanding the multifaceted and intersecting impacts of a range of policies on housing instability and homelessness in later life.

st ru c t u r in g a c r it ical li fe course a p p roac h to poli cy The argument of this chapter is that a preventative and critical life course approach can be used to address disadvantage and the impacts of the shifting conditions experienced across lives and over time by older people with experiences of homelessness. The idea of life course policy began to emerge in the social sciences in the late 1990s and early 2000s (Marshall 2009; McDaniel and Bernard 2011), based on reactions to policy interventions that were considered uneven, inconsistent, and in some cases harmful (see McDonald 2011). Although the conceptual framework for a critical life course approach to policy does not yet exist, a number of organizations have already shifted to espouse a life course approach (see Komp and Marier 2015; Marshall 2009; Settersten 2003). For example, the who division is named “Ageing and the Life Course,” and the mandate of the Canadian Institute on Aging covers issues from “cradle to grave.” There are also several large international research team examples, such as the Policy Research Initiative in Canada, where researchers worked with government to explore life course policy (McDaniel and Bernard 2011), the New Dynamics of Ageing program in the UK, and the Swiss research focused on life course policy and vulnerability (Maeder

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2015; Marshall 2009; University of Sheffield 2018). While research teams are developing a promising evidence base, there is currently no solid conceptual model for the implementation of a critical life course approach to policy. What does emerge, however, is the idea that to be effective interventions should cover the same scope of time over which the disadvantage accumulated. As such, problems that have evolved over the course of a life require solutions that extend across lives, rather than simply applying to the moment at which the acute problem or issue such as homelessness becomes visible. Those advocating for life course approaches to policy argue that this approach provides an alternative means of understanding and addressing inequality, need, and disadvantage. Conventional approaches to policy are considered to lack a comprehensive framework for assessing the outcome (i.e., what are they meant to do); are often individual and reactive, rather than preventative; overlook the relationship between policy interventions and the production of inequality; and take inequality and disadvantage for granted. They are also, as mentioned, based on predictable, normative, and standard life course models that fail to recognize, or worse, exclude older people with experiences of homelessness. In response, life course policies are considered to be more flexible, dynamic, and preventative. The most comprehensive attempt thus far to map out a framework for life course policy can be found in the edited collection Invitation to the Life Course (Settersten 2003). In this book, Settersten sets out the rationale for how “life course concepts, principles, and methods might change the ways in which social policies are developed, implemented, evaluated and reformed” (191). The chapter “Rethinking Social Policy” proposes a framework structured around a series of questions to guide the development of life course policy. These include, for example, consideration of the level at which the policy is aimed, the intent, the temporal view (past, present, future), the models or assumptions embedded in the policy (life course or particular period of life), the extent to which the policy corresponds to or lags behind contemporary needs, the target population, the level of implementation, and the costs both financial and social.9 There are, however, a number of challenges where the development and implementation of life course policy is concerned, and perhaps more so, the critical model being suggested here. The largest hurdle is the lack of consensus with regards to this approach, and gaining the political impetus for implementation across levels of government

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and programs. Yet, it could be argued that the conceptual framework for life course policies already exists in some form, in original welfare state programming in countries such as Canada and the United Kingdom. In 1995, Brückner noted that social policy has essentially become life course policy because it is concerned with the management of risk over time. One suggestion in considering how to build life course policy is to return to the preventative language and rationale for the development of welfare state programs, which heralded coverage from “cradle to grave,” and to examine the extent to which such programs would comply with such ideas. For example, analysis could assess the extent to which the types of programs designed around universal access achieve a life course perspective, and identify those that do not achieve features of access, prevention, or support. This, of course, would also require attention to programs such as care that have never been included in universal programs, as well as awareness of former critiques of abuse, paternalism, or exclusion. This is especially important given the over-representation of particular groups in the homeless population and the marginal status that people with experiences of homelessness have historically been deemed to occupy. Komp and Marier (2015) suggest that stumbling blocks to the development of life course policy exist, including political features such as the short terms of elected officials, legislation issues, and the special status of groups such as “older people.” Front-line challenges have also been noted, where rigid service structures prohibit movement across domains such as housing, immigration, income, and care (Gonyea, Mills-Dick, and Bachman 2010; McDonald, Dergal, and Cleghorn 2007; Smith 2004). The idea that disadvantage is structured and shaped through policy structures and practice interventions is, however, central to a critical gerontological perspective on late-life homelessness (see Means, Richards, and Smith 2008; Phillipson et al. 1998; Townsend 1981).10 The results of this analysis lend themselves to a more detailed consideration of how a critical version of life course policy may provide a scaffold for change. Here, the results of the ethnography revealed two possibilities, one that policies created harm, through inaction or more directly in the case of deinstitutionalization without proper supports, and the other, that if organized properly, policy could have long-reaching positive effects over the life course. Although it was not possible to ascertain how particular interventions may have prevented homelessness in some cases, this is an important aspect of

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analysis to keep in mind. Ideas of prevention are embedded across a range of historical and social policy approaches. For example, the famous idea that the interventions of the British welfare state (which heavily influenced the Canadian model) would slay the five giants of want, disease, ignorance, squalor, and idleness reflects a life course approach.11 This includes how interventions are delivered through what is well-known in the policy domain as the three-box framework of education, work, and retirement. Yet, while the delivery of “cradle to grave” programs directed in typical life course domains may impact homelessness, they may also break down when they are delivered through segmented stage-based programs that do not match people’s experiences, or where complex issues cross existing policy boundaries of services, as with homelessness. Our study on late-life homelessness revealed how gaps, and being outside traditional categories, produced and sustained homelessness, and resulted in unequal aging whereby older people did not have access to the same benefits of health, place, and longevity as the general population. Further, it revealed the implications of shifting forms of protection over time, where the “social glue” binding a society for all has been altered from collective protection from risks and insecurities to models focused on individual responsibility and self-reliance (see Esping-Andersen et al. 2002; Priestley 2003). Life course approaches to policy and practice in the domain of homelessness need to respond to a variety of factors, events, and relations. This includes how government interventions have themselves been complicit in allowing needs to remain unmet and have permitted suffering to occur and endure. Although less developed where implementation is concerned, life course approaches that grapple with system-level changes can be found, particularly among researchers working in welfare state contexts such as Canada and Europe. Extending the reach into the systemic and institutional (rather than only personal) level is particularly needed in order to address the structural forms of disadvantage and inequality. Marshall (2009), for example, denoted that an academic approach to building life course policy must comprise four key components: 1) time and context; 2) the life course as social structure; 3) biography as transitions and trajectory; and 4) differentiation and the principle of cumulative advantage and disadvantage (579). As such, the suggestion is for a critical life course policy approach that is mindful of structural dimensions and relationships, and draws on both

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predictive and biographical data as a means to develop preventative programs, and offer the most meaningful and potentially effective interventions. A life course approach to policy would place emphasis on prevention rather than reaction, and emphasize the importance of a long reach to mitigate risk and inequality over time. It would also draw attention to two problematic assumptions – the insistence on individual responsibility and the aim of social integration into normative institutions of the life course – both features that have been exposed as problematic with regards to late-life homelessness.

e s s e n t ia l f e at u r e s f o r m ovi ng forward wi th p r e v e n tat iv e p o l icy approaches Building on our research results, there are a number of essential features to address, followed by practical suggestions to end late-life homelessness. Four components that emerged from our research could form the conceptual basis for developing a critical life course approach to late-life homelessness. Although there is not yet formal recognition of late-life homelessness in Canada, which would typically occur through a position paper, followed by adoption into government action at a range of levels, this section suggests a series of essential features that could underpin the development of a critical life course approach. This includes accounting for the needs of people “aging on the streets,” those who may “feel old” and experience high health needs but are “too young” to qualify for services, over-represented and highly stigmatized groups, and groups at risk of homelessness as a result of intersecting and cumulative disadvantage. The features to include in a preventative and critical life course approach are: age relations, access to services for those who are homeless (or at risk of becoming so), flexibility in addressing intersecting needs related to intersecting and cumulative forms of disadvantage, and justice. (See Table 8.1: Project Insights: Features to Address Late-Life Homelessness.) The Integration of an Age-Lens and an Analysis of Age Relations First, building a critical life course policy approach to homelessness requires recognizing older people, and how social institutions such as policy interventions (including inaction) may create inequalities or block access to support across the life course and into late life. A

Table 8.1 | Project Insights: Features to Address Late-Life Homelessness Feature

Illustration or example

Integrate an age-lens and an analysis of age relations

* Meaningfully include older people in strategies and frameworks * Consider over-represented groups and intersecting experiences * Adapt interventions to the needs of older people, and consider how needs may change over time for housing and care

Develop mechanisms to ensure access and support at crucial moments

* Consider transitional moments and life events, and how needs are experienced in the contemporary context * Provide adequate supports at times of need * Ensure access to support, even if this means altering eligibility or typical budget arrangements (i.e., fifty plus) * Aim for interventions that achieve the ideals espoused in policy frameworks (health, success, well-being, stability)

Prevent inequality and disadvantage

* Account for how social locations affect needs * Address at-risk trajectories of over-represented groups * Understand and alter policies and programs that create and sustain disadvantage over time * Provide preventative programs and supports (housing and care) * Foster “aging well” and “aging in safe/desirable places”

Connect interventions with principles of social justice

* Develop linkages between policy and philosophical or practical intentions (e.g., human rights or social justice) * Assess the extent to which each will achieve the desired outcome of preventing and eliminating late life homelessness * Employ justice as a means to regularly assess program outcomes

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lens of inclusion that is cognizant of age, of encounters with structures and programs, and of the impact of disadvantage over time represents an important component of a life course approach with regards to late-life homelessness. This would include an understanding of heterogeneity among older people with regards to geographic location, pathways through homelessness (i.e. chronic/episodic or new), and the impacts of income, health, and social inequalities related to gender, racism, im/migration status, Indigeneity, immigration, and sexual orientation. The following quotes illustrate the need for an approach that is mindful of age, intersecting needs, access to programs, prevention, and change over time: But if I was fifty-five, I would use the one for people fifty-five and over … I would feel more comfortable there. Because it’s people who have similar experiences. We’ve lived through the same times, you know … well often you chat about things you’ve done in your life. – Gabriel, fifty-one-year-old man, shelter, Participant 16 The things that you are asking me about why it is more difficult to be homeless in later life, well, there’s the depression, there there’s the fatigue and the depression. – Spider-Man, sixty-oneyear-old Indigenous man, shelter, Participant 15 Well, everything is going well, I am continuing to pay my rent [for the transitional housing]. I am going to try the impossible to find myself somewhere decent [apartment]. Because at my age, I am really coming up to the limit, you know. – Claudine, sixtythree-year-old woman, shelter, Participant 24 Integrating a critical policy approach inclusive of an age-lens highlights the pitfalls of existing interventions, and the need for programs that address low-income housing, social support, and care. These include for example, the dual components of the ideological, emotional, and interpretive aspects of having a physical place within which to “age” (a house) as well as a symbolic “place to grow old” (a home). A critical life course policy approach, combined with an analysis of age relations, highlights the impacts of historical trajectories, contemporary priorities, and the psycho-social needs that may exist for people with histories of homelessness (see Crane and Warnes 2010). As such, policy

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and practice responses must alter how older people are “aging in unsuitable, unsafe, and/or undesirable places” by focusing on the need for change, rather than features of stability that are often assumed within policy discourses related to place. Mechanisms to Ensure Access and Support Second, approaches to homelessness must consider policy as a frame for older people’s expectations and experience, and a structure that can have positive and negative effects on people’s lives. At present, particular interventions based in inaction have created and sustained disadvantage and inequality, as well as established barriers that render it difficult for older people with experiences of homelessness to meet their needs. Designing effective systems-level responses to late-life homelessness will require a fundamental shift to: include older people; recognize the effects of public policy on the lives of individuals, communities, and societies; consider needs over time and through lives; create programs that address people’s needs as they occur (regardless of which service budget they fall within); and ensure that services exist and can be accessed. The following quotes illustrate the need for access to housing and support: Well, I want a space where I can be well. I wasn’t well when I was young. I didn’t have an adolescence. I’ve never been well anywhere. What I really need is a place ... where I can have peace, be quiet … but not be all alone. – Marie, sixty-five-yearold woman, transitional program, Participant 22 Me, I find there should be a ... place just for people who ... not those who aren’t able ... but those who are starting to have little problems. You know to have a place for them. – Betty, fifty-threeyear-old Indigenous woman, transitional program, Participant 30 A life course approach would ensure that older people have access to the envisaged expectations and futures of aging, as well as real access to a place with the accompanying supports. At present, a number of sub-groups are at risk for prolonged unmet needs, including people with experiences of homelessness who are not yet sixty-five, older people with low income (who may be unable to

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afford housing, especially if/when displaced), and older people who are considered difficult to house or place in care due to health or psychological needs. The lack of government subsidies makes the demand for affordable housing in most Canadian cities much higher than the supply (see City of Toronto 2013b; Canada Mortgage and Housing Corporation 2020). For example, recent findings noted a fifteen-year rental vacancy low, most notably in the city of Montreal, which has the highest number of purpose-built units in the country (Canada Mortgage and Housing Corporation 2020).12 Access to housing with support enable people to “age in place” as their needs change, thereby granting access to a more “equal aging,” while at the same time potentially reducing the high financial costs associated with long-term care and emergency hospitalization. A critical life course policy could be imagined as a way to alleviate stress and suffering. Rehousing is about providing not only a physical structure, but a safe location that prevents further risk of victimization and provides the means for achieving desired frameworks for general well-being and/or physical care requirements. As such, a critical life course approach to policy would be both philosophically and practically sound (see chapter 9). A critical life course policy approach draws attention to the importance of balancing expectations and ideals (societal and personal), and providing supports through key transitions, and at particular moments in time. This includes the recognition of and planning for: a need or event experienced at a particular moment in one’s life within a historical context; interventions intended to prevent inequality, paired with programs and access to services for when problems do arise; awareness of diverse needs and the impact of social locations (e.g., sub-populations and over-represented groups); and a connection to larger philosophical frameworks or desired social goals. In speaking of life course concepts, Hendricks (2012) points to the importance of three alternate moments that could be used to organize policy interventions, including latency or sensitive periods (outcomes of early life conditions); cumulative exposure (adult health outcomes), and a social trajectory model (social relationships) – all of which have resonance with the analysis of late-life homelessness and the culmination of findings into a critical life course policy approach.

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Addressing Intersecting Social Locations and Cumulative Disadvantage over Time Third, building a critical life course approach can address intersecting locations of experience that create disadvantage before they become long-term. For example, groups who experience marginalization over the life course include older women who have lower pension incomes due to less time spent in the labour force (Denton and Boos 2007; McDonald and Robb 2004); people who have experienced racism or discrimination; those with a lifetime of precarious work trajectories (see Grenier et al. 2017); immigrants who come to Canada in mid-to-late life and have had less time to accumulate a pension (McDonald, Dergal, and Cleghorn 2007); and groups that have been negatively impacted by historical policies such as deinstitutionalization (e.g., people with disabilities or mental health issues), colonization, and relations with the North (e.g., Indigenous peoples from First Nations, Inuit, and/or Métis backgrounds) (see Patrick 2014; also Statistics Canada 2019b). Approaches that fail to recognize how policies differentially affect particular groups overlook their role in creating exclusion and inequality. The following quotes reveal the cumulative and intersecting effects of disadvantage: Yeah. Because I didn’t have the means to have a place, meant that I started my homelessness. I did lots of odd jobs, but it never went far. So that meant I always ended up on the streets, it meant that I was always looking for a place to sleep. – Marie, sixty-fiveyear-old woman, transitional program, Participant 22 If guys like me aren’t able to work, it’s trying to find an apartment on social assistance. Where are you going to find for 300 bucks a month. You can’t even think of getting a room. They should help people like that out. First of all, help them to get a room or an apartment that is acceptable. This is the difficult thing. If you ask me, if they want to help us get off the street, it takes places that are acceptable and decent. Not beside pushers who are dealing. – Étienne, fifty-seven-year-old man, shelter, Participant 5 A critical life course model of policy attuned to everyday lives and experiences can be used to cross traditional policy domains of income, health, housing, and care. It can also attempt to address

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the larger problems that have resulted from neo-liberal priorities and political decisions made about care, particularly with regards to inaction, non-response, and the dismantling of public forms of supports. Our research suggests that late-life homelessness is extending to effect groups who would not have previously been affected, and this is cause for concern. These patterns seem to be connected to precarious trajectories in labour, shifting forms of support, and an absence of a public commitment to care (see Grenier et al. 2017; also Crystal, Shea, and Reyes 2016). The implications of service gaps become most obvious in the case of social care, and have recently been exposed by the covid -19 pandemic, where older people, particularly in long-term care, were the hardest hit. Access to services is perhaps best (albeit far from being widespread) in the medical domain as a result of universal supports, evidenced in the numbers of older people who had undergone complicated medical procedures. However, better supports and services must be developed to meet the social needs of older people, and to allow for rehabilitation and palliation among those post–hospital care. Further, there is a need to bring the services to groups who may not access care as a result of historical practices, disadvantage, and systemic forms of discrimination, such as racism or colonization. Connecting the Critical Life Course Approach with Larger Principles of Social Justice Fourth, building a critical life course policy approach to late-life homelessness involves linking policy initiatives with a broader philosophy intended to guide the intent, purpose, and expected outcomes of any set of initiatives. At present, policies contain a number of assumptions, with little effort to distill what is expected, or how initiatives align with a broader framework and/or policy landscape in Canada. In particular, a number of advocates have suggested that housing and income security should be part of a just society or be granted as rights.13 In Canada and elsewhere, there have been efforts to link approaches to homelessness with a human rights agenda, as it is articulated in the universal declaration of human rights (UN General Assembly 1948). This emphasis on a rights-based approach was developed to complement the Housing First model (see Kothari 2007; Right to Housing Coalition 2019; Salinas 2019). Human rights are now at the foundation of Canada’s housing initiative, announced

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in the fall of 2017, and this and the amendment of the definition of homelessness to include the “right to housing” are cases in point (Gaetz, Scott, and Gulliver 2013; United Nations 2002; unfpa and HelpAge International 2012). The following quotes highlight the modest and basic needs that are being requested by older people, underscoring the need for access, support, and justice: Yeah [I’d like to have] a quiet place, where … if I could have my own room … unwind a bit … I always have someone in my room. It’s long. – Jacques, fifty-year-old man, transitional program, Participant 34 But you know do something for these people here who have … the first thing is to have a room or housing that’s acceptable, and that … it’s hard, that idea. – Étienne, fifty-seven-year-old man, shelter, Participant 5 I need more stability, yeah. To be in my own place, and to have a television that works like it’s supposed to. And to watch TV, and not have to go out when I don’t want to. In order to stay here [transitional program], I have to agree to see a therapist, and if I don’t then I have to go back on the street, or sleep in the shelter. Because I use substances about once a month. It’s not everyday, I don’t have the money for that. So, to stay here, not just a bed for a night, not to be homeless, stay outside until 4:30, I have to follow the rules, and what they ask of me. At fifty-three years old, I do what they tell me. – Marie, sixty-five-year-old woman, transitional program, Participant 22 The challenge with applying a human rights framework to late-life homelessness is that while intended as universal, the insistence on human rights is only useful in contexts whereby human rights are recognized, and where established responses exist for ensuring those rights, and ensuring that people can access them. While the adoption of a human rights perspective could help recognize discrepancies between the general population and those who are homeless, questions can be raised about whether this will have any effect. Ensuring housing as a human right will require extension beyond individual rights: a connection to larger collective responsibilities and to legislative frameworks. For example, although Housing First is the

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official response to homelessness in Canada, there is a lack of legal accountability to ensure that it is achieved as intended, and in ways that meet the needs of the groups it is intended to serve. The question of age, and the current neglect of older people as a recognized group, demonstrates the type of challenges that may come up in implementing a human rights approach to housing in Canada, and especially for older people, who remain on the peripheries of recognition. The need for further distinctions between housing and home will also need to be teased out. What quality and standard of housing do people have a right to? And should there also be access to the established societal ideals of home and care? Rights require safeguarding through formal mechanisms, political will, and socio-cultural and economic priorities, and our results on non-response and abandonment raise concerns in this regard. Instead, the ethnographic findings seem to suggest that a stronger conceptual platform may be to link a critical life course perspectives with the concept of social justice as a means to initiate change, which will be further developed in chapter 9. We turn now to a series of practical short-, mid-, and long-term strategies to address late-life homelessness.

s u g g e s t io n s f o r c h a nge: practi cal s t rat e g ie s to e n d l at e - li fe homelessnes s A number of practical directions for change emerged from our research, and could be initiated immediately to demonstrate that the suggestions of older people with everyday experiences of homelessness have been heard. Whereas some of these were identified directly in our research, others result from the combined analysis of one or more methods of investigation. These practical suggestions for change must be conceptualized as structural and systemic changes that are urgently needed to address poverty, disadvantage, and inequality.14 Preventing late-life homelessness and meeting the needs of older people who are homeless will require initiatives that cut across the different departments responsible for seniors’ programming at all levels of government, as well as the boundaries between social services, health care, income support, and housing (see Wister and McPherson 2014). While part of the resistance to responding to homelessness among older people is often attributed to the idea that the population group is too small, exclusion by means of being unable to gauge the scope of the issue is part of the problem. The

Table 8.2 | Project Insights: Practical Steps for Enacting Policy Change Feature

Illustration or example

Step One: Inclusion

* Recognize and include older people in the National Housing Strategy, Canada’s Homelessness Strategy, and Poverty Reduction Strategies. * Task federal, provincial, and inter-ministerial working groups to focus on seniors’ housing and homelessness. * Develop dedicated efforts to include older people in municipal PiT counts, with comparative age range reports (50–64; 65+). * Initiate and support the development of a country-wide position paper on Late-Life Homelessness in Canada.

Step Two: Provincial Policy

* Provincial governments must develop a seniors’ Housing First Policy to provide funding for people aged 50+ facing homelessness. * Ensure seniors are swiftly provided safe affordable housing with supports, as outlined in Housing First models (and in the province of Quebec). * Create transitional housing with support for seniors, and ensure access for disadvantaged groups (age 50+), specifically people with disabilities, mental health, and/or complex medical needs where major gaps exist.

Step Three: Funding Mechanisms

* Federal funding transfers for housing provided directly to municipalities to provide affordable housing for at-risk seniors. * Develop federal and provincial land grants to build affordable housing for low-income, homeless, and at-risk seniors. * Earmark budget envelopes that can (and should) be shared across ministries and/or programs to address complex needs (income, housing, health).

Step Four: Predictive and Preventative Efforts

* Create mechanisms for guaranteed income and support, including flexible programming for addressing reduced income, care, and changing needs. * Develop initiatives that respond to seniors who are most at risk for homelessness (Indigenous peoples; low-income; disability and mental illness; im/migrants over age 50) and moments of heightened risk (job loss; loss of partner; hospital/prison discharge; intimate partner violence; etc.).

Step Five: Additional Tailored Supports

* Develop tailored programming, including adjusting eligibility and budget models to permit access of seniors with complex needs. * Develop targeted drop-in centres, medical supports in shelters; trained workers to assist with benefit applications (where relevant); access to homecare and long-term and palliative care. * Ensure that older people are not discharged from hospitals, rehabilitation units, or prisons onto the streets.

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failure to collect data on older people, and to include them in strategies and efforts, is not only a data problem, but is intricately linked with recognition and a policy of non-response, neglect, and abandonment. The following series of changes call on governments at all levels to engage responsibly with older people and the range of organizations and service providers that work with them. Table 8.2 summarizes suggested directions to address late-life homelessness. Immediate Goals for Responding to Late-Life Homelessness First, older people must be recognized, and their needs included in current and future strategies to address housing and homelessness at the municipal, provincial, and federal levels. Steps to include older people in the point in time count efforts have been developed, and there is an emerging picture of homelessness among older people in Canada. In addition, older people should also be recognized alongside sub-populations that currently include youth, women, lgbtq people, and Indigenous peoples. This means extending the current mention of veterans and older people who have experienced abuse to include all older people, inclusive of the intersecting social locations and trajectories that may impact their experiences and needs. Inclusion, however, is only the first step. Once older people are recognized and included as a sub-population, attention must turn to how their needs may coincide with or differ from those of other sub-populations as a result of age relations, intersecting social locations (gender, migration, disability, racialization, Indigeneity, sexual orientation, etc.), in particular contexts or regions (rural and urban differences), and as a result of cumulative disadvantage over time. As outlined throughout the book, late life can bring on more permanent needs for income and care, which can affect housing stability. Older people’s needs must be included in housing initiatives such as Housing First, the National Housing Strategy, and the Reaching Home and Poverty Reduction strategies that are rolling out across the country (Government of Canada 2018a). Building on this, is the need to correct the age bias in approaches to homelessness across the life course and into late life. A broad-based position paper on homelessness among older people could call attention to the issue, as has been done for youth (see Gaetz, Gulliver, and Richter 2014), Indigenous peoples (First Nations, Inuit, and Métis) (see Patrick 2014; Thistle

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2017), and older people in the United Kingdom and Australia (see Pannell and Palmer 2004; Victorian Government Department of Human Services 2010).15 Such a position paper could provide the impetus for a Canada-wide commitment to recognize and address the needs of older people at a range of government levels. Although our research revealed that the province of Quebec and the City of Vancouver were leading with regards to the inclusion of older people, greater efforts need to be made on a country-wide basis. Mid-Term Suggestions and Responses A series of short- to mid-term efforts can be made to develop and implement well-timed solutions. Measures that link and ensure housing, income, and support are crucial steps to addressing late-life homelessness. The provision of housing and a guaranteed income (whether through retirement, disability benefits, or other) are also key. Best practices in the field stress the importance of the swift provision of housing accompanied by ongoing social and emotional support for older people (Grenier et al. 2016b; Gonyea et al. 2010; McDonald 2011; McDonald, Dergal, and Cleghorn 2007). Midterm suggestions also include a range of solutions targeted to specific groups. For those already experiencing homelessness, access to age-appropriate, safe, affordable, and decent housing is critical. Planning and services that are inclusive of older people and their needs must also recognize that older people with experiences of homelessness are poorly served by programs of care or support that rely on family/kin (see Means 2007).16 The idea that older people’s needs will be met by existing public programs, such as seniors’ housing or public pensions, must also be challenged to ensure older people do not fall through the cracks.17 One potential intervention is to preventatively target income and housing to groups with limited pension contributions (e.g., people with unstable employment due to mental illness, women, and immigrants who moved to Canada in mid- to later life). There should also be places for older people to receive care, or palliate, other than the emergency room, the shelter, or the streets. Few programs currently address these needs, and where they do, they are often funded on a short-term basis. The development of initiatives must also consider access, and develop new forms of protection. Specific measures to improve access include eliminating the age of eligibility and ensuring workers

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are knowledgeable about processes of applying for pension benefits so that they can assist people who seek their services (where relevant). A number of other measures should also be developed including: securing dedicated low-income housing for older people, the development of support services (in shelter or transitional settings), access to appropriate housing with care, and the development of affordable long-term housing with support (medical, physical, and emotional). Institutional practices that result in homelessness must also be eliminated through legal mechanisms. For example, older people should not be “discharged to the streets” (from hospitals or on release from prison) nor evicted from their apartments as a result of long hospital stays or private property development. A number of complementary solutions have also been identified with regards to health and social care. These include, but are not limited to, the provision of on-site medical and nursing care in shelter locations, an on-site social worker who is knowledgeable about benefits or services for older people, community workers trained in gerontology, and palliative care programs. Providing supports for people in midlife from a range of disadvantaged social locations is a key strategy to preventing homelessness in late life. Long-Term Sustainable Solutions and Supports The results of our research reveal the extent to which late-life homelessness results from a failure of all other systems and policy interventions. That is, how opportunities for change have been missed, and how needs have continued to go unmet across the life course and into late life. Late-life homelessness draws attention to the urgent need to rethink responses to homelessness and to care, and to expose cumulative disadvantage and unmet need. At present, there is little scope to address late-life homelessness in existing systems. Formal recognition of older people’s needs continues to be a challenge across policy contexts, within services, and more generally in the field of homelessness. Roadblocks are conceptual as well as practical. For example, present approaches are limited by an inability to think beyond the distinct discursive approaches to house and home – a contradictory location that late-life homelessness brings to light. Further, while both the entry into homelessness and the typical exit from homelessness are conceptualized around work and labour, such understandings break down when older people are not

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able to secure work for reasons ranging from age discrimination, to injury, to health or mobility issues. Policies and frameworks must thus extend understandings beyond work as the only “exit option” from homelessness, and begin to acknowledge that the intersecting need for housing and care is likely, at this point, long-term. Two long-term planning goals should be initiated. First, larger debates on affordable housing and care for older people and groups at risk for homelessness in late life must be developed. Our research indicates that it is precisely the joining of these two needs, and the unavailability of services and supports, that creates and sustains latelife homelessness. Put simply, the needs that occur at the locations of late-life homelessness and care reveal systemic shortcomings and the implications and injustices of aging at marginalized locations whereby older people are shut out, abandoned, and left out of care. Second, multi-sectorial programs that allow movement across ministries and structures must be implemented to address interconnected needs related to income, housing, health, and care. Addressing latelife homelessness requires a strategy that simultaneously focuses on the needs of persons who are currently homeless, and on prevention strategies for those who are at risk of falling into homelessness in late life. On a practical level, this means that responses will need to consider and address the needs of persons who have experienced homelessness throughout the life course (e.g., chronic or episodic homelessness, especially in over-represented groups); older people who fall into homelessness for the first time in late life (economic or care trajectories); and people at high risk for late-life homelessness. Long-term planning must address the impacts of disadvantage as well as the effects of reduced forms of social support. Without a commitment to address disadvantage and intersecting needs, we cannot expect the numbers of older people who are homeless to decrease. If unaddressed, older people’s needs may result in a breakdown of housing or rehousing efforts, lack of access to the benefits of longevity, and a surge in hospital and emergency service use – programs that are known to be the most expensive forms of programming and care (Lehnert et al. 2011; Martel et al. 1992). Addressing latelife homelessness will require attention to key transitions such as loss of employment or family breakdown in later life; intersecting social locations and structures of disadvantage such as illness, intimate partner violence, incarceration, and the impacts of racism or colonization; change over time; and the long-term need for housing

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and care. Although there is an implicit assumption of prediction in life course studies, pathways that led to homelessness in late life resulted from the accumulation and intersection of unmet needs, disadvantage, and unpredictable events. Starting with the above practical suggestions is the next logical step with regards to developing responses to late-life homelessness. The challenge is that the above suggestions do not engage with the larger philosophical need for justice which the ethnographic analysis also uncovered by drawing attention to experiences of homelessness as lives of extended vulnerability and everyday suffering.

c o n c l u s ion The insights of the book as relayed by older people and stakeholders reveal that changes must be made to address late-life homelessness, and to prevent homelessness in late life for those at most risk. This chapter has built on the findings developed throughout the book to reflect on the need for a preventative and critical life course approach to policy in the domain of late-life homelessness. It has argued that a preventative approach to policy is needed to address the disadvantage over time and unmet needs. It engaged with the question: How can project insights be drawn together to change policy and practice responses to late-life homelessness? It began by reiterating identified challenges and weaknesses in existing approaches. Based on research insights, it suggested that harmful practices, structural barriers, and moments for intervention be identified and addressed through a strong conceptual plan, as well as a series of immediate, mid-term, and long-term practical suggestions. It concluded with the need to develop a stronger conceptual foundation for preventative policy and practice interventions, and with the need to situate interventions in relation to social justice, as will be further pursued in the final chapter.

9 The Moral Imperative: Political and Just Responses to Late-Life Homelessness

This concluding chapter summarizes the argument developed throughout the book, and building on this, outlines the need for the development of responses that reflect the value of life and respond to suffering. It draws together project insights about how current political and economic priorities have led to unmet needs among older people. It weaves together the themes of the book, with philosophical and political questions about social responses to care and justice, and the insights from older people and stakeholders to provide nuanced discussions of homelessness, vulnerability, and suffering. It highlights the need for a moral imperative and a political response to late-life homelessness that is envisioned and expressed through care and justice. In doing so, it places the problem of abandonment in the contemporary neo-liberal context of individual responsibility and the lack of social commitment to public forms of support. This chapter draws together insights from the book in order to suggest directions for change. It engages with the questions: how do people endure unnecessary vulnerability and extended suffering and what suggestions and socially just changes can be made to reduce or end late-life homelessness? The chapter begins by reviewing the angles of analysis developed throughout the book, and the argument that late-life homelessness is the result of unmet need, disadvantage over time, and processes that create and sustain unequal aging. It then moves forward from the immediate and practical suggestions, which can fail to recognize the undercurrents of injustice with regards to late-life homelessness. The chapter explores how people endure suffering, through an examination of resilience and hope. Based on this, it exposes how responses to homelessness and care are

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political and, at present, characterized by injustice. It then outlines relevant insights to link responses with ideas of care and justice. It concludes with a summary of the contributions of each chapter and directions for future consideration.

l at e - l if e h o m e l e s s n e ss: di sadvantage, un e q ua l ag in g , a n d abandonment The book has provided a detailed sketch of late-life homelessness based on an ethnographic project in the Canadian city of Montreal. It drew on insights from older people and community shelter and long-term care workers to understand and articulate what happens at the intersections of aging and homelessness. It employed a critical ethnographic perspective in social gerontology to understand late-life homelessness as structured and experienced; to reveal how late-life homelessness is experienced in relation to age, place, disadvantage, and exclusion; and to make suggestions for change. Building on ethnographic results, it engaged in a reconsideration of taken-for-granted knowledge and practice, and suggested a number of new insights for the fields of social gerontology and from which to address late-life homelessness:

· · · · ·

Late-life homelessness is structured and experienced through age and age relations. Older people with experiences of homelessness age in “undesirable” locations. Late-life homelessness results from unmet need and disadvantage over time. Late-life homelessness is experienced as exclusion, vulnerability, and abandonment. Addressing the cumulative effects of disadvantage and unequal aging requires a preventative approach and the development of a moral imperative to care and justice.

The critical perspective applied to late-life homelessness revealed a new understanding of late-life homelessness, and identified pathways for change. The book drew attention to the oversight of aging in current strategies on homelessness, how age relations resulted in gaps and unmet need, and the processes of cumulative disadvantage over time, and exposed the level of exclusion, non-response,

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and abandonment of older people who are homeless. It combined ethnographic observations and insights from stakeholders and older people to demonstrate that homelessness was not an individual problem or choice, and that the needs associated with homelessness would not simply improve as a result of reaching late life. Instead, the analysis revealed how late-life homelessness resulted from a series of structures and social relations that produced disadvantage across the life course, and which worsened over time as people experienced reduced income, lack of affordable housing, and the need for care in a context where services were either unavailable or difficult to access. As outlined throughout the book, these included the life-long effects of poverty, precarious employment, and rising costs of housing; policy-induced forms of disadvantage, related to colonization and relations with the North in the case of Indigenous peoples (First Nations, Inuit, and Métis), and to changes to care systems such as the deinstitutionalization of people with disabilities or mental health issues without accompanying supports; as well as the intersections of social locations and risk trajectories such as bereavement, loss, abuse, trauma, and eviction. The critical perspective on aging, as applied to late-life homelessness, provided detailed insight into the relationship between macro-level structures and micro-level experiences. Our exploration also revealed more general policies of neglect, whereby governments failed to provide social supports or ensure access to safe, secure, and affordable housing and care. The analysis that emerged from our ethnographic study revealed that despite the various pathways of risk and complex needs, late-life homelessness is an expression of disadvantage and inequality that occurs as a result of the failure to respond. That is, late-life homelessness results from inaction over time, within a neo-liberal political context preoccupied with economic efficiency, enacted through individual and family responsibility, intertwined with cultural beliefs about aging and care, and where needs fall outside of public responsibility for care (see Armstrong and Armstrong 2003; Cooper and Whyte 2017; Evans and McBride 2017). Late-life homelessness – viewed through a critical gerontological perspective – demands attention to inequality, injustice, and the need to respond to suffering. Setting the lives of older people with experiences of homelessness in the context of aging, and in contrast to older people in the general population, reveals huge disparities and

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widening gaps. Older people with experiences of homelessness lead lives that do not meet the ideal positive frameworks of health, productivity, or success that are set out as policy objectives for aging. Nor do older people with experiences of homelessness have access to the kinds of supports that are taken for granted among the general population, including a house or location within which to “grow old,” “age in place,” or receive home care. Further, they are less likely to have family and kin supports in place to provide care – a feature that is presumed to exist across policy contexts in Canada. Consequently, older people with experiences of homelessness have fewer opportunities to achieve the positive expectations of good or long lives, because they continue to be distanced and excluded from the means of doing so.1 In the case of late life homelessness, structured and relational forms of disadvantage intersect to cause the promise of longevity and a good late life to go unfulfilled. However, our findings also reveal that it is not merely that the expectations of a good old age go unfulfilled, or that older people are excluded, but that older people with experiences of homelessness are relegated to lives of extended vulnerability and unnecessary suffering, and are denied a future. The insights and experiences gleaned through the ethnography signal a social and moral crisis with regards to the neglect and abandonment of disadvantaged groups of older people in need. Over time, the results of shifting priorities from shared forms of social protection and support have created unequal experiences of aging whereby people have unmet needs that accumulate as they age. These circumstances, namely insufficient income and a failure to protect older people from conditions such as housing loss, result in processes of aging in “undesirable locations.” Once homeless, or as they continue to be homeless as they age, older people are exposed on a daily basis to stigma and exclusion that continue to mount across the life course. They are also increasingly subjected to (or fearful of) violence in the locations they inhabit. In exposing these conditions, the ethnography challenges traditional interpretations of homelessness as individual failure, or the result of particular, relatively predictable trajectories of risk. This is more the case in later life, where the impacts of unmet need become glaringly obvious over time, and where the contradictions and gaps based on age, the shortage of suitable or existing programs, and the frequency of first-time homelessness in late life are concerned.

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Insights from older people with experiences of homelessness clearly demonstrate the impacts of a range of disadvantages (some of which are created and sustained through policy), how needs and experiences can worsen over time, and the real and experienced impacts of the relinquishment of shared responsibilities for protection and care. The chapter now turns to a discussion of how people survive within structured conditions of vulnerability and everyday suffering.

s u rv iv in g v u l n e r a b il i ty and extended s u f f e r in g : h o p e a nd resi li ence The awareness of disadvantage, vulnerability, and suffering in situations of homelessness brings about questions about how older people endure and survive such conditions (see Povinelli 2011). As demonstrated throughout the book, stakeholders and older people gave detailed descriptions of hardship and suffering. Many of the pathways into homelessness were incomprehensible, and particularly so where structures and responses created and/or sustained homelessness. The accounts evoked disillusionment about how societies such as Canada can continue to both cause and permit suffering to endure. Where workers tended to express this realization as dissonance between their professional ethics and the realities of their work, as a researcher, I was troubled by accounts of unaddressed trauma and injustice. Some older people identified the suffering as unfair, where others seemed to accept it as their daily state of affairs, thereby emphasizing the injustice of the conditions within which they lived. One of the greatest tensions in older people’s narratives was between the realities of their circumstances and the desire for something different. Some accounts employed denial, either because they did not have the time to think about it, or because they refused to. For example, when asked about homelessness in late-life, one of the older men we interviewed responded by saying “[I am] putting my head in the sand” (Robert, fifty-six-year-old man, transitional program, Participant 1). Others expressed misery, everyday difficulties, and injustices. A few of the interviews included mention of suicidal thoughts, such as “I’ve thought of it before but never acted on it.” Taken together, the accounts highlight the injustice and inequalities that exist at structural, social, cultural, and political levels. They reveal how the experiences and everyday realities of late-life

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homelessness are far from the promise of positive frameworks for aging, expectations of stability in late life, and the desired cultural discourses of a “good life,” and related to this, a “good death.” Yet also threaded through the accounts were profound illustrations of resilience and hope. This section considers two individual-level explanations about how older people with experiences of homelessness “endure” or “get through” their everyday lives. The question of how people survive is reminiscent of Cohen and Sokolovsky’s (1989) early work focused on survival among old men of the Bowery, and more recently, Povinelli’s (2011) studies of marginalized communities, which prompted her theorizing on abandonment (see chapter 7). Our research identified two interconnected suggestions for understanding how people manage to endure such conditions, including practices of coping and resilience (amidst suffering), and the idea of hope (and the importance that things could be otherwise). Although these are only minimally developed in the homeless literature (especially among older people), they were acutely present in everyday accounts. The first explanation is one of resilience as a process of “positive adaptation in the context of significant risk or adversity”2 (Masten, Powell, and Luthar 2003, 4; see also Kidd and Davidson 2007; Rew et al. 2001). The second explanation is the idea and expression of hope. The following section presents insights from older people, organized according to the explanations of resilience (amidst extended or prolonged suffering) and hope (and the expectation that things could be otherwise). Coping and Resilience amidst Extended and Prolonged Suffering The first explanation for how people survive and endure suffering is personal resilience, coping, and/or strength. Although most of the literature on resilience focuses on childhood adversity (rather than in late life), in this case, resilience is used to broadly refer to process of coping with stress, adversity, or trauma (see Gonyea and Melekis 2017; Moxley et al. 2012; Padgett et al. 1998).3 Trauma informed work in the field of late-life homelessness stresses the importance of identifying strength and resilience as the key to change (Burns, Sussman, and Bourgeois-Guérin 2018; Grenier et al. 2016b; 2016c). Without question, the older people who shared their experiences of homelessness demonstrated resilience, coping, and survival over

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long periods of time. The illustrations of waiting in long lines, poverty, and deprivation, and of difficulties securing meaningful work are cases in point. Their stories were also replete with stories that explain their resilience through having survived hardship, including traumatic experiences of loss, violence, and exclusion. The trajectories of older people with experiences of homelessness point to the history of disadvantage and suffering, the necessity of surviving difficult moments, and the development of strategies to do so. They also, however, speak to late-life homelessness as an experience of prolonged and extended suffering – something that could be summarized as “resilience within extended suffering.” From a research perspective, this point was most acute where older people emphasized “not knowing how they ended up homeless in late life.” Stories conjured narrative notions of “hanging on,” or “living on the edge for extended periods of time,” as a result of interactions with structures and unmet needs. They also revealed moments of “getting by,” “extended enduring,” and/or “prolonged suffering.” This pairing of the capacity to survive and the suffering that is endured while doing so represents an important tension in understanding late-life homelessness. The following quotes provide insight into what it is like to live at the intersections of aging and homelessness, highlighting the toll of homelessness over time: It’s harder on your mental health, because you always have worries on your mind, and you think about them all the time, and you don’t think about anything but that. – Lucas, sixty-fouryear-old man, shelter, Participant 27 It takes so long to get a place at a decent price. It takes, a year, maybe a year and a half, two years, there is so much need that you can’t get anything in less than two years. Listen, I might be dead in two years. See what I am trying to say? I really need to find somewhere to live. – Gabriel, fifty-one-year-old man, shelter, Participant 16 Coping and resilience were visible across older people’s accounts. These examples, often framed as life lessons and/or wisdom, included discussions about achieving a meaningful life, and the importance of helping others. Many older people responded to our open-ended questions by reflecting on their wisdom or experience. Such stories

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represented points of connection between the researcher and the older person, and seemed to provide older people with a validation of their strengths. Given that the interviewers were students with experiences of working in the shelter, there was also an intergenerational component witnessed in the interviews. These encounters between people the ages of grandparents and children, who are considered to hold less potential parent-child conflict, are known to offer the potential for rewarding encounters (see Grenier 2007; Knight 2004). As such, the wisdom and lessons offered resonate with the concept of generativity whereby older people express a concern for the future and the next generation, and enact this concern through shared social relations and encounters with younger people (see Erikson and Erikson 1981). The following examples portray their responses: It’s a learning experience; that’s all I can say the value of life is. It’s always ... it never stops ... you never stop learning. I … with the purpose of life, I can’t really say what the purpose of life is except that we keep on building life for the next generation. – Marc, forty-six-year-old man, transitional program, Participant 8 Interviewer: What can you tell us about growing older on the street? Participant: Experience, wisdom. Interviewer: That is how you see living on the street? Through the wisdom you have gained? Participant: Yes, that is where I got my wisdom from. Many people say that I am wise, that’s where it is from. There are many people who tell me that. – Jean, fifty-seven-year-old man, transitional program, Participant 2 Yes, that is what I want to say. You learn things from people living on the streets. There are positive things too, it isn’t just the negative things that come from living with homeless people, even those that have spent their entire lives on the streets. You learn from others. Yeah. There are things I have learned, like how to read how people will react. Also how resilient people can be – I mean these [homeless] people have some serious resilience. It is not easy to live on the streets, especially for the guys in line, the people who stay in shelters, on a regular basis, who line

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up for everything, who wait everywhere, outside in the cold. It takes serious patience to be part of the line, to wait in line for nothing. So yeah, you learn from others. Even if they might not have much education or you know a bit of a bumpkin, if they are unwell [mentally] in their way of being, there is something to learn from them. That’s what I have to say about it at the moment. – Robert, fifty-six-year-old man, transitional program, Participant 1 At the same time as demonstrating strength and resilience, the lessons also reveal profound sadness and injustice. This is especially the case when results are read alongside project insights about disadvantage over time, exclusion, and unmet need. In our research, telling their story for the first time offered some a therapeutic moment. A number of older people and shelter workers commented on how the interviews offered a safe space within which to share experiences, stories, and insights, something that many commented they had never done. A close examination of the depiction of life lessons reveals how these were often used to come to terms with their suffering, exclusion, or abandonment. Framing hardships as life lessons may thus represent an attempt to rationalize and manage the reality of “the way things are,” and to manage the circumstances over which they have little control. As such, they draw attention to the injustice of enduring prolonged suffering, and speak to the importance of the moral imperative for response (see later in this chapter). Such examples are also worth additional reflection where individual-level responses are concerned, as they reveal how people protect themselves from the emotional damage of their everyday lives. The suggestion made below is that resilience be paired with the caveat of ‘amidst suffering’ in order to accurately reflect everyday realities of late-life homelessness, while also avoiding the cultural imperative of resilience as an individual responsibility. In speaking about their stories, older people shared moments or routines that brought them pleasure or that they found enjoyable. In many cases, the moments of pleasure were connected to particular places in the city, or to small routines that punctuated their days. For some, these were integrated into daily routines; for others, they were special places or infrequent moments. Such stories offer a contrast to the “undesirable” places of aging on the streets, demonstrating how older people with experiences of homelessness also found pleasure

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and enjoyment. The places and meaningful moments provided insight into coping, resilience, and strength. They also reveal the injury that may be sustained when people attempting to experience moments of pleasure are treated with stigma, violence, or discriminatory practices because they are considered to be loitering in public places, “aging on the streets,” or simply just homeless. Identifying such contrasts amidst attempts to derive meaning and pleasure can foreground discussions of justice. The following quotes highlight the enjoyable places and moments of pleasure: [The mall] I love going there. It’s great. You see women with their babies, and there is an interior garden. It is nice to see people, just going about their lives, happy. People who are working, there are offices inside, shops, there is everything. There are beautiful clothes. You have Laura Secord, it’s fun going to Laura Secord for the chocolate. – Frédéric, sixty-nine-year-old man, shelter, Participant 14 Then I will go to the café at the mission, then to the mall to get a cup of coffee. And then at 10:00 the library opens, so I go there. There are many places that I like going, mainly the library, museums, of course it depends on the season, but I like to walk, go see a film if I can, if I have some money. – André, fifty-eight-year-old man, shelter, Participant 28 There is a place I like to go, just down by the water’s edge. I have a bench there, and I like to go there, I walk down [names street] to get to the water’s edge. The first bench there, that is my bench. I sit down, there is a boat docked there, it never moves. But I like to watch it, it is beautiful. – Paul, fifty-eight-year-old man, transitional program, Participant 38 The challenge of focusing on coping and resilience in the context of structural and systemic disadvantage is that the identification of strengths may be used to sustain an individual-level response, or worse, justify non-response. Resilience tends to be understood and employed at the individual level, identified by professionals, and aligned with personal responsibility for well-being (see Bottrell 2009; Fletcher and Sarkar 2013; MacKinnon and Driscoll-Derickson 2013)4 rather than public or social responsibility for change. As

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outlined by Katz (2020), there is a concern in the field of aging that coping mechanisms attributed as resilient will be read in line with individual models of self-reliance, and subsequently used to sustain responses which assume the individual can cope without additional supports. As such, the main problem with resilience is that it masks the structural causes and emotional needs of older people who are homeless, remains disconnected from policies that lead to homelessness, and lacks connections with the impact of social, cultural, political, and economic choices. Considering the problem of resistance as yet another individualized script for aging can help to expose the tensions and disparities that exist between the general population and people with experiences of homelessness. In this sense, the focus on resilience is perverse considering structural issues that sustain exclusion by distinguishing between those with, and those without, the capacity to exercise it. While resilience can hold therapeutic potential, it can also sustain injustice and violence in the context of austerity (see Cooper and Whyte 2017). The concern is that responses organized around resilience can sustain indifference and abandonment because the devalued subject is positioned as coping, or responsible for their own well-being. Given that late-life homelessness results from political decisions, economic priorities, and disadvantage over time, a focus on resilience alone seems short-sighted. This is especially the case when the experience of disadvantage and the injustices that have led to the development of resilience are factored into the equation. The disadvantage and suffering that have been created and/or permitted to endure through systems and institutional practices call for systematic, multi-level, and multi-sectoral response to injustice and inequality, in order to ensure the conditions for a “good life.” Hope and the Importance of the Idea that “Things Could Be Otherwise” A second explanation for how people manage and endure conditions of suffering is related to hope, and the importance of maintaining a belief that “things could be otherwise” (see Povinelli 2011). The Oxford English Dictionary refers to hope as “a feeling of expectation and desire for a particular thing to happen” (2018). The sense of hope was clear across our interviews, consistent with an emerging literature with regards to late-life homelessness (see Henwood et al.

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2013; Kirst et al. 2014; Tutty et al. 2013).5 The accounts of older people with experiences of homelessness in our research expressed a range of hopes, including exiting homelessness, securing housing, being well and secure, and simply having a regular life. Older people discussed the desire to find work and stable housing, build or rebuild family or partner relationships, secure a safe and affordable apartment, and/or live more stably in their later years. For many older people, hope was interconnected with dissatisfaction with their present situation, a consideration of their past trajectories, and a desire for a different future. Yet, at the same time, their hopes were quite simple, and revealed the inequalities that existed between their lives and those of the general population: they expressed needs centred on safety, stability, and autonomy. The following quotes highlight older people’s expressions of hope: I’m looking for, to try to find some security and a place and I ... and I do have to ... I want to have a job because I ... I want that feeling again, you know, of, you know, of working ... of having, like, somebody that works ... you know that normal thing. – Rita, fifty-five-year-old woman, transitional program, born out of province, Participant 23 In the next couple years, I hope to find myself an apartment for the few good years I have left, before the big pains of “aging” come. I really want a normal life, get up in the morning, go to work, think about vacation. Hang out with other people … I don’t have a girlfriend, but would like to start a life with someone else. – Pierre, fifty-nine-year-old man, shelter, Participant 20 Interviews drew attention to the importance of hope, and provided insight into how older people maintained hope amidst adversity and suffering. A number of people we interviewed discussed how they looked back to better times in their lives, and drew on these for support and guidance in the present, and their future. In a number of cases, participants attributed their hope to their age, and the lessons they had gained over time. Some expressed trust in knowing that things would work out because they had in the past. For example, a few highlighted their hope as a protective factor that prevented them from giving up, falling into despair, or attempting suicide – an idea that some mentioned, but did not entertain (see Grenier et al.

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2016c). Throughout the interviews, there was also a strong desire for general well-being and for the remainder of their lives to be wellspent. In other cases, the combination of age and a shortage of “time left” contributed to feelings of hopelessness. The prominence of hope across the interviews draws attention to the importance of maintaining the idea that “things could be otherwise.” Following on from Povinelli’s (2011) enquiry, this insistence was central to how marginalized groups endured suffering across a range of cultural contexts. The insistence that “things could be otherwise” seemed crucial in the lives of the older people we interviewed, and was key to persevering, maintaining self, and living with the devalued subjectivity of late-life homelessness. At the same time, the importance of hope suggests the need for a shared responsibility and just response to late-life homelessness. Unlike resilience, which is situated in individual responsibility, hope involves a belief or trust that is connected to interdependence. It involves a desire for change or different circumstances on a shared level of human experience and connection. That is, hope involves the belief that someone will help, and something will change, thus opening the possibility for systemic support. One of the major everyday problems, however, is the discrepancy between the insistence on hope and the conditions of suffering. While hope was acutely present in the accounts of older people, the reality of housing shortages, and the difficulties securing work, served to sustain unmet need, and painted a dismal picture suggesting that help was unavailable. Our analysis of the current context suggested that the lack of recognition of older people’s needs resulted from political and economic priorities, and contributed to social exclusion and abandonment. Yet, reaching and achieving (if only in part) a satisfactory life, and even better, a “good life,” requires that hope be recognized, and support provided in times of need. There is thus a fine balance to be struck in the insistence on hope as coping, or a tool of intervention in an institutional context where needs continue to go unmet. The accounts of older people revealed how unmet need and sustained disadvantage act as cumulative weights carried into each encounter, and over time lead to disappointment, exclusion, and sustained hopelessness. Based on this, the suggestion is that while resilience and hope are important coping strategies, they are only fair – or just – when they are combined with a commitment to care and support, and an ethics and politics committed to changing

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the fundamental circumstances that cause pain and suffering. We turn now to a discussion of the moral imperative for a just response to late-life homelessness.

t h e m o r a l im p e r at iv e: care as a just p o l it ic a l r e s p o n s e to vulnerabi li ty This section considers the idea of a moral imperative enacted through care and a political response to injustice. Earlier chapters outlined how older people with experiences of homelessness were living lives of exclusion, extended vulnerability, and unnecessary suffering. Our ethnographic research exposed problems of neglect, abandonment, and letting older people continue to suffer into and until death. It revealed how unmet needs produced vulnerability and suffering that intensified where population aging and cumulative disadvantage butted up against broken social commitments, precarious conditions, and the intersection of reduced income and rising costs of housing. Suffering, and the realization of injustice, were voiced directly by some and implied by others, particularly through illustrations of ‘discharge to the streets’ or ‘death in public settings.’ This section builds on these examples to highlight the need for responses based on a moral imperative rooted in care as a political response and act of social justice. A number of authors writing in the feminist traditions of care position the moral and ethical response in relation to the shared vulnerability as part of the human condition (see Butler 2016; Fineman 2008; 2010), and others extend the discussions into allied concepts of justice, citizenship, and/or rights (see Williams 2001; Sevenhuijsen 2003; Tronto 1993; 2010).6 The following sections explore and link the politics of care with the emphasis on justice as a path to end homelessness across the life course and into late life. The idea of a moral response is linked to Kant, and is a principle that compels one to act because it is “right” to do so (see Sullivan 1989). Stated simply, it refers to a need to do something about misery and suffering, to enact change in a particular situation, or to act for the betterment of a particular group. The moral imperative is grounded in a philosophical belief that a good and just society should (and would) not permit conditions of suffering to endure. In the case of late-life homelessness, and building on earlier arguments with regards to vulnerability and suffering, a moral imperative can form the basis for a just response.

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The political response to vulnerability involves two interrelated components: first, a politics of care, and second, an emphasis on social justice. The argument is that the moral imperative to care can be used as a political lever to address disadvantage and exclusion by connecting with the ideals of aging and the practical locations for care. In other words, the emphasis on change that comes out of the critical perspective to the study of late-life homelessness draws attention to the need to address the discrepancy between current realities of inequality and abandonment and what is expected, fair, and just. As such, the focus is not only on how the suffering has come to be, but on instigating change in existing acts, practices, and responses that have been rendered visible as unacceptable. The moral imperative provides a foundation from which to pursue a just response involving, for example, including and responding to the needs of older people who are excluded from secure housing, advocating for the right to decent locations to “age in place,” and providing care and services that meet the needs of older people with experiences of homelessness. We now explore two aspects of this imperative: care as a political choice, and an act of social justice. Care as a Political Choice across the Life Course and into Late Life Our research exposed the extent to which responses to late-life homelessness reflected social, cultural, and political priorities. These include decisions about which groups are recognized to have legitimate need, about eligibility for particular services, and about public spending. As developed throughout the book, homelessness has resulted from political choices about support and care, through policies such as deinstitutionalization and colonization, a shortage of social housing, and practices such as hospital discharge to the streets, or eviction. In some cases, political choices and decisions served to fix homelessness as a permanent feature; in others, it created (or permitted) first-time homelessness in late life. The impacts of political choices about care and support in late life were clearly conveyed by a number of stakeholders. For example, stakeholders outlined how gaps between income and costs of housing made it difficult for older people. The following examples highlight the challenges encountered in the shelter, the intersections of ageism, and the unsuitability of existing options for housing and care:

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Who wants to take on a seventy-seven year old woman … you can see she’s losing it a little bit, you know. She needs a home, she refuses to go into a [care] home, but also some of the care homes are $2,000 and up a month … So, the only option for them, most of the time, is a place that’s a waiting list for Chambre et pension [translation: room and board] … and there’s waiting lists for all of them too. – Stakeholder, Housing and Homeless Sector I have had other situations that went well. For example, I had one person, they arrived completely disoriented, and had a difficult time following the routine of the day. They would come to me and say, “I’ve lost my shirt,” “I can’t find my bed,” “where are the toilets?” We really had to show them around, take the time to explain where things were, and how things happened at particular points in the day. And we had to be consistent and firm to allow them to get their autonomy. And things eventually came together, they managed to get control of the situation. They are still here, but are able to manage their welfare assistance and get their medication and so forth. – Stakeholder, Housing and Homeless Sector There are no partnerships between the homeless world and old age care ... and I think they are literally scared of the issue of having to work with homelessness and old age care … There is [one organization] that works with this old age care, but it’s full, jam packed. There is a waiting list and the list to get on the waiting list. – Stakeholder, Housing and Homeless Sector Authors writing from a political economy perspective have long exposed care gaps, the shortage of care options, and how privatization has on one hand depleted public systems, and on the other allowed profitable sectors such as private high-end residential care to expand (Armstrong and Armstrong 2003; Estes 1979; Neysmith, Bezanson, and O’Connell 2005). However, intersections between late-life homelessness and the effects of political choices and care priorities over time have not been connected to these debates. Yet, as our exploration of late-life homelessness reveals, the impacts of care priorities have the clearest effects on marginalized and disadvantaged groups, who continue to be excluded from the physical spaces,

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mechanisms of supports, and forms of care that are assumed to be available. These include exclusion from home and community care, kin care, access to healthy aging, and the desired hope of a “good death.” Responding to older people’s needs will require addressing existing gaps, challenging the assumption that needs are met elsewhere, and altering services to better suit older people. This may mean focusing on older people’s safety in their communities and at home, and ensuring that rehousing is sustainable as the person moves into late life. It also means that the abandonment of older people and the permitting of endured suffering and violence must end. The intersection of aging and homelessness reveals the need for political will to recognize injustice, to prevent inequality, and to provide systems of care for older people who are homeless or at risk of becoming so. This suggestion of understanding problems in care as a result of political, social, and economic decisions is not new, although the linkage to late-life homelessness is. A number of authors have suggested a moral imperative as the basis for articulating an ethics of care. For example, authors writing on the ethics of care have outlined the need for discussions focused on interdependence rather than independence, and care as a social act (see Sevenhuijsen 2003; Tronto 1993; 2010). Such discussions expose the interconnections between political decisions and needs in late life, serving to relocate care from an individual private matter to a public commitment. Fine (2014) in particular has argued for care as a social and relational act, suggesting that an insistence on justice and citizenship can move responses to care away from individualistic and/or paternalistic models (also see Fine 2007a; Lloyd et al. 2014). Following this, the moral imperative to care provides a response to vulnerability as an expression of a human and social bond (see Fine 2007b; Tronto 1993; 2010). Moving forward, the application of this perspective to the case of late-life homelessness insists on care as a social act, and emphasizes the necessity of responding to disadvantage and inequality. As such, the provision of care can be used to shift responses from inaction, neglect, and abandonment, to responsible action to provide relief from suffering. That is, the provision of care and support, viewed through the lens of a moral imperative, can be employed to rethink priorities, change the social conditions which sustain homelessness, and attempt to deliver meaningful and fair responses to older people in need.

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The Need for Social Justice Our research revealed everyday experiences of injustice from institutional systems, professional responses, and cultural imperatives organized around individual responsibility. Throughout the book, the quotes from stakeholders and older people alike revealed the profound sense of injustice experienced through a lack of recognition, spatial exclusion, being discharged from hospitals or rehabilitation program units directly “onto the streets,” being evicted during their hospitalization, having nowhere else to go, and the issue of death in shelters or on the streets. Such examples highlight suffering and expose the significant problems in policies of care in Canada. Older people’s experiences of homelessness highlight problems where access to health care is universal, but where social support including income, housing, and care is not. In fact, the injustice of this health and social care configuration becomes acutely obvious in cases where older people who were homeless had undergone several complicated surgeries that were available through universal health care, but had no stable housing within which to recover and live out the rest of their lives. The following stakeholder quotes speak to the injustices within care systems: We try to follow up with people, to watch for problems, or to know where there is something that is just not right. But it is challenging to do on a case-by-case basis. We always say to ourselves, there are people there who are at risk of things like a heart attack, but we don’t really have the resources for them. We can give them a bed, they go to sleep, and we don’t know whether they are going to wake up in the morning or not. – Stakeholder, Housing and Homelessness Sector My intent is not to criticize the health system, I recognize that they themselves don’t necessarily have the means to accommodate the special needs of this population. Fine. And sometimes we have people who leave the hospital [implying before discharge], we wait for them, this is well-known. And they show up on our doorstep when what they really need is a convalescent bed or rehabilitation setting which is tolerant of their desire to use substances, and get back out there. – Stakeholder, Housing and Homelessness Sector

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Sometimes it is very difficult when the hospital is involved, it is really hard to get our population a decent ongoing follow-up, outside of the emergency room, even when they have been hospitalized, and after a period of time, when the person leaves, that is it, there is no follow-up. A social worker might be in place, but the moment they leave the file is closed. – Stakeholder, Housing and Homelessness Sector Stakeholder interviews provided detailed examples of injustices endured by older people who were homeless, linking these with an analysis of the contradictions between care priorities and professional responsibilities. Professional affiliations and expected standards for practice meant that stakeholders were in a unique position to comment on injustice because they were often being asked to carry out work that conflicted with professional and personal expectations. Many community and professional responses to homelessness are based on justice and the protection of dignity. For example, the mandates of shelters are rooted in principles of social justice, and shelter workers deem this to be a crucial part of the work they do. Social justice is also deeply embedded in professional ethics of nursing or social work associations. Yet, the possibility to achieve justice and good care is impossible in the context of dismantled social programs, the cultural ethos of economic expediency, and models of individual responsibility for care. It is precisely this foundation that leads workers to recognize and comment on the injustice of late-life homelessness, and to themselves experience disillusionment with the work they do, often as a result of witnessing extended suffering. Where our research revealed examples whereby workers modified practices in order to lessen suffering, such as allowing people to stay indoors if ill, or permitting them to stay on the lower bunks, shelter workers experience high level of “moral distress” (see Barlem and Ramos 2015; McCarthy and Monteverde 2018; Morley et al. 2019). The flexibility they carry out in their practices involves a personal toll that does not adequately recognize the demoralization involved in not being able to respond to unjust conditions and basic needs of older people who are homeless. The lack of fit with personal values, and the impossibility of achieving professional ethics, draws attention to the importance of social justice in rethinking responses to late-life homelessness. The principles of social justice can be employed as a framework from which to link understandings of vulnerability, hope, and public

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responses to care.7 Social justice can become part of a larger conceptual framework to recognize the impacts of disadvantage over time, and respond to late-life homelessness in a manner that is inclusive of the need for care. Discussions of justice in care are often framed with regards to recognition, citizenship, and ethics (see Fraser 2014; Sevenhuijsen 2003). Here, a relationship can be considered to exist between recognition as a social group, attention to the unequal distribution of power, unmet need, and the act of redistribution – a dialectic that is best articulated by Nancy Fraser (2014) in her book Justice Interruptus. Following this line of thought, a gap can be seen to exist between the needs of older people who are homeless and responses to the need, because the problem is not recognized to exist (see further chapter 4). Although some approaches to justice and care are linked to Fraser’s (2014) work, others are linked to ethical perspectives or models of citizenship as the foundation for a legitimate response (see Sevenhuijsen 2003). It is precisely for this reason that Fineman (2010) has highlighted the importance of enshrining justice in legislative and public frameworks. Fineman (2010), for example, articulates vulnerability as the foundation for an ethical response, and pairs this with the need for formal public systems such as laws, frameworks, and policies. This is also articulated by Fine (2020), who draws on precarity to link vulnerability and hope. He says: “The recognition and response to the vulnerability of others arises from our inherent interdependence as a basic condition for our existence. Acknowledging this underpins a sense of hope, just as it provides the basis for joint ethical action and the possibility of solidarity” (173). Together, the various suggestions linking the politics of care, the emotional experiences of vulnerability, and shared responsibility for well-being resonate with our research findings, and can be used to reposition responses to late-life homelessness that are ethical, just, and caring. A number of promising examples also exist with regards to homelessness and care, particularly at the end of life. An emerging literature applies principles of justice to the case of homelessness, and in particular, to the need for palliative care of vulnerable groups. For example, in Death Is a Social Justice Issue, Reimer-Kirkham et al. (2016) argue that palliative care for vulnerable people is an issue of social justice (see Lolich and Lynch 2017; Stajduhar et al. 2019). The argument is that the structural vulnerabilities of disadvantage require a public commitment, and equitable access to a

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“good death.” Although authors writing on this subject employ the term “structural vulnerabilities,” which is more aligned with a medical response, the argument is similar to the suggestion being made in this chapter because it positions the need for justice in relation to disadvantage and inequality. Further, examples in critical gerontology have suggested the need for a politics of care that insists on justice, social models of care, and the correction of systems of inequality, rather than responses rooted in the cultural imperative of cost-effectiveness and/or individual responsibility (Fine 2020; Holloway 2007). The suggestion developed in this book leans on developing a moral imperative to care, and creating social and political responses that address late-life homelessness, exclusion, and unnecessary vulnerability. In sum, the suggestion is that principles of social justice can be used to address the inequality and disadvantage that lead to homelessness, extended and unnecessary suffering, and unmet need. This includes how policies and responses have the potential for harm or to create positive change over time. Older people with experiences of homelessness should not be left alone to endure suffering and misery. There is a moral imperative to respond, to alleviate suffering, and to care. Doing so, however, requires countering understandings and responses that are rooted in notions of choice, individual responsibility, and blame. It also requires recognition that older people with experiences of homelessness have been overlooked and abandoned. While it is beyond the scope of this work to understand why older people with experiences of homelessness have been neglected, the illustrations discussed throughout the book point to misunderstandings about public welfare, the impacts of ageist practices, the misalignment of income and rising costs, processes of exclusion, and the effects of disadvantage over time. Older people with experiences of homelessness experience health and social disparities as well as disadvantages carried into later life, and which become most acute at the point of needing care, in a system where few supports are available. Yet, they are left without traditional exit strategies from homelessness and with few places to turn for care and support. As such, responses calling for resilience or hope alone, without a foundation for justice and care, sustain injustice because they fail to recognize how strengths and resources have been depleted over time. Structural and systemic causes of latelife homelessness must be recognized and addressed. This includes

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responding to older people’s humanity and complex histories where trauma, strained family relations, mental health, and economic conditions are concerned.

c o n c l u s ion This chapter has suggested the need to address late-life homelessness as a moral imperative. Drawing together the insights developed throughout the book, it offered suggestions for change, beginning with recognition and inclusion, and new understandings of the impacts of systemic change and long-term needs. The chapter outlined the strategies of resilience and hope, and contextualized these within the current political and economic system. Based on research insights, it argued that existing priorities and systems have created and sustained homelessness through programs that are ill-equipped to deal with needs that cross policy domains of income, housing, health, and care. Following this, it exposed the extent to which current interventions lack a cohesive and intentional dedication to addressing disadvantage and inequality among older people. It then stretched the discussion to consider the extended vulnerability and suffering that older people with experiences of homelessness endure, which are created and sustained by political priorities, and which produce injustice. In response, the chapter suggested the need for a response envisioned and expressed through care, a social commitment to public forms of support, justice, and the response to human suffering. It suggested a proactive policy approach that does not simply wait for homelessness to happen. At the same time, it stressed the urgency for a moral imperative that recognizes the social and cultural irresponsibility of giving people false hope, or expecting individuals to emerge unassisted from problems created and sustained through political, economic, and social systems of disadvantage and hardship. The chapter outlined how in order to be effective, strategies to ensure housing and income security must be expanded beyond issues of access to basic services, and individual responsibility for outcomes, into care and support. This book has explored late-life homelessness as an experience situated at the intersections of aging and homelessness, and drawn attention to homelessness as unequal aging. In early chapters, it outlined the state of knowledge on late-life homelessness, including definitions and distinctions in the literature, pathways into

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homelessness, and key challenges with regards to the absence of an age-based lens. It also outlined how older people have significant unmet needs that occur at and across the intersections of income, housing, health, and social care, and identified the problems with disadvantage, and problems accessing services and supports. Each chapter then turned to explore challenges from angles including age and spatial relations, disadvantage over time, exclusion, and abandonment, whereby older people with experiences of late-life homelessness experienced substantial risks in their everyday lives. This included a lack of physical access to sleeping quarters in shelters, everyday violence and social exclusion, threats to safety, sustained disadvantage, unmet need, vulnerability, and suffering. The insights of older people with experiences of homelessness highlighted how people with experiences of homelessness aged in “undesirable locations” such as the streets, shelters, and long-term care. The analysis also drew attention to a range of contradictions used to frame need, in particular the bifurcation between responses to housing in earlier periods of the life course, and care in late life. Building on this collective insight, it outlined how responses reflect policies of neglect and a process of cultural abandonment. On a conceptual level, the book provided a detailed investigation into the intersections of aging and homelessness. Rather than describing homelessness in late life as a unique experience that happens to older people, and is made prevalent by population aging, the book offered an alternate explanation for the rising prevalence of homelessness in late life. It argued that late-life homelessness is created and sustained through a failure of policies and programs, and results from disadvantage and inequalities, and from unaddressed needs that worsen over time and in the contemporary context. The suggestion made throughout was that the phenomenon of late-life homelessness resulted from political and economic choices, and the cumulative impacts of disadvantage over time, combined with larger shifts in work and care, and changes to social programs since the 1980s, which have worsened in the context of austerity. In doing so, the book established late-life homelessness as an illustration of unequal aging, whereby a particular group is not afforded access to the presumed benefits and opportunities of aging and longevity, and in essence, denied a decent future. The critical analysis of late-life homelessness rendered visible the high level of vulnerability and everyday suffering experienced by older people. It exposed the

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differences that exist between older people in the general population and people with experiences of homelessness, including health and social disparities where comorbidity and longevity are concerned. It also demonstrated the everyday social inequalities that occur through exclusion and being “shut out” of social and community experiences, and the suffering that results from these and other processes. It pointed to policies of neglect, abandonment, and vulnerability, and suggested that responses that continue to allow needs to go unmet will likely result in rising trends of late-life homelessness. In doing so, it drew attention to a range of solutions that could be developed immediately, in the short to medium term, and more long-term initiatives to address disadvantage and inequality. It then outlined the need for a moral imperative to address the injustice of late-life homelessness. Throughout, the book articulated the need for a conceptually rooted critical and qualitative approach to research and policy that draws attention to the relationship between cultural discourses, organizational practices, institutional structures, and experiences of late-life homelessness. In particular, it drew attention to the need to understand the relationship between structures of disadvantage over time, and older people’s experiences of precarity, risk, and homelessness across the life course and into late life. As such, the critical perspective on aging, along with the various aspects of age and spatial and comparative analysis that it affords, opens the possibility to address needs as they occur throughout the life course, rather than as a crisis response timed at the moment of homelessness. Examples from our ethnographic research outlined the shortcomings of existing approaches based on individual trajectories, predictive models, or predetermined categories. That is, the stories of older people with experiences of homelessness revealed how current models configured around housing or care, and delivered through age- or stage-based programs, poorly serve older people from disadvantaged groups, and may cause or sustain their homelessness. Approaches to homelessness that are understood to unfold through systems, structures, relations, and encounters over time hold the potential to improve response. For example, the provision of housing with care and support across the life course – rather than housing earlier in life and care during late life – provides a more suitable frame that is in line with older people’s experiences. Further, when framed in terms of social justice and the response to suffering,

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access to housing (with care) resituates housing to ensure suitability, access, and adaptability, and therefore sustainability. Similarly, an emphasis on social justice represents a much-needed philosophical and cultural shift to address disadvantage and inequality across the life course. Such alterations, however, require philosophical, political, and practical changes, including challenging neo-liberal priorities on cost, expediency, and individual responsibility. This would involve challenging the idea of homelessness as a choice, contesting the assumption that older people’s needs are met through existing systems (e.g. retirement or long-term care), accepting a short-term economic cost, and altering systems of support so that they no longer rely on the provision of informal care by families and friends. A number of specific suggestions have been made with regards to spurring policy change to improve the lives of older people who are homeless. These include recognizing and including older people in strategies and programming; gearing programs to address key points and transitions known to create and sustain homelessness (eviction, job loss, family breakdown); and consulting with diverse groups of older people so that their needs may be represented and met through relevant programs. It also includes linking discussions of housing with debates around what makes a place “home,” the accessibility of physical spaces, considerations of violence and safety, and eligibility for care. This could include for example, an exchange between services that traditionally serve seniors, as well as hospitals, shelters, and long-term care facilities, to help prevent homelessness. Here, the approach would also need to be specifically targeted to include sub-populations who are disproportionately represented in homelessness such as Indigenous peoples (First Nations, Inuit, and Métis), those with life-long experiences of insecure employment and poverty, including racialized groups, rural seniors, and persons who lose housing as a result of abuse, eviction, or illness. At the government level, greater preventative efforts must be made to prevent poverty and inequality across the life course, and to ensure access to income security, affordable housing, and care. The compound impacts of policies of immigration, retirement, and care (including health and mental health), for example, need to be more closely examined so that they do not produce disadvantages that result in homelessness in late life. Features such as the rising cost of housing across Canada and changes to social safety nets and social programs must also need to be carefully considered with regards to

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their role in causing people to fall into homelessness for the first time in late life. This is perhaps even more so in the context of covid -19, which has exposed and accentuated the existing health disparities, the impacts of disadvantage, and heightened the risks of employment and housing loss. Given the changing population, it is now urgent to address the significant pathway issues of precarity with regards to income, health, housing, and care. Governments must devote attention to responding to the needs of older people who have remained in (or cycled through) homelessness throughout their lives and are still on the street, as well as those who have either fallen into homelessness for the first time in late life, or are at risk of doing so. Here, prevalence statistics and profiles of risk, including attention to the group of people currently homeless and aged forty to forty-five, should be combined with understandings of key moments and ways of addressing homelessness for older people (see Brown et al. 2016). Within this, there is a need to understand the impact of intersecting social locations and over-representation of particular populations (e.g., age, ability, gender, income, racialization, sexual orientation, Indigeneity, ethnicity, etc.). Efforts must be made to address the needs that occur at the intersections of age, disadvantage, income, care, health, and housing. Further, and importantly, the most pressing questions that emerge from the analysis of late-life homelessness are ethical, moral, and political in nature. Insights and experiences from older people raise serious questions about the political and economic choices that are being made about social programming and care across a range of global contexts, including Canada. The rising evidence of late-life homelessness across the country, and elsewhere, points to the magnitude of late-life homelessness and the need for change. Responses to homelessness, such as those of walking over people in the streets, providing no other option than aging on the street, and allowing older people to die in public settings, highlight the extent to which societies are exercising indifference, abandonment, and neglect. Further, the results of the ethnographic research reveal a tolerance of disadvantage and inequality, and a failure to address human suffering that is ethically, morally, and humanly wrong. It reveals how late-life homelessness is a form of violence that sustains exclusion, trauma, and prolonged suffering of older people in need. What is required at this point is a reconsideration of our perceptions

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and responses to age and disadvantage at a social, cultural, political, and human level. Responses must thus begin by focusing on those in greatest need, particularly older people with experiences of homelessness, as witnessed and recounted from the locations of the streets, emergency shelters, and long-term care.

appen d ix i

Canadian Definition of Homelessness The following selections are part of the Canadian Definition of Homelessness:

Homelessness describes the situation of an individual, family or community without stable, safe, permanent, appropriate housing, or the immediate prospect, means and ability of acquiring it. It is the result of systemic or societal barriers, a lack of affordable and appropriate housing, the individual/household’s financial, mental, cognitive, behavioral or physical challenges, and/or racism and discrimination. Homelessness describes a range of housing and shelter circumstances, with people being without any shelter at one end, and being insecurely housed at the other. That is, homelessness encompasses a range of physical living situations, organized here in a typology that includes 1) Unsheltered, or absolutely homeless and living on the streets or in places not intended for human habitation; 2) Emergency Sheltered, including those staying in overnight shelters for people who are homeless, as well as shelters for those impacted by family violence; 3) Provisionally Accommodated, referring to those whose accommodation is temporary or lacks security of tenure, and finally, 4) At Risk of Homelessness, referring to people who are not homeless, but whose current economic and/or housing situation is precarious or does not meet public health and safety standards. It should be noted that for many people homelessness is not a static state but rather a fluid experience, where one’s shelter circumstances and options may shift and change quite dramatically and with frequency. The problem of homelessness and housing exclusion is the outcome of our broken social contract; the failure of society to ensure that adequate systems, funding and supports are in place

244

Late-Life Homelessness

so that all people, even in crisis situations, have access to housing and the supports they need. The goal of ending homelessness is to ensure housing stability, which means people have a fixed address and housing that is appropriate (affordable, safe, adequately maintained, accessible and suitable in size), and includes required income, services and supports to enhance their well-being and reduce the risk that they will ever become homeless. This means focusing both on prevention and on sustainable exits from homelessness. In 2012, the coh (formerly the Canadian Homelessness Research Network) established a working group with leaders from the areas of research, policy, and practice, to develop, refine, and test a new definition. The coh Working Group included: Dr. Stephen Gaetz, Director, Canadian Observatory on Homelessness, York University; Carolann Barr, Executive Director, Raising the Roof; Anita Friesen, Senior Policy Advisor, Program Policy and Planning, Family Violence Prevention and Homeless Supports, Alberta Human Services; Bradley Harris, Social Services Consultant, The Salvation Army; Charlie Hill, Executive Director, National Aboriginal Housing Association; Dr. Kathy Kovacs-Burns, Associate Director, Health Sciences Council, University of Alberta; Dr. Bernie Pauly, Associate Professor, School of Nursing, University of Victoria; Bruce Pearce, President, Canadian Housing Renewal Association; Alina Turner, VP Strategy, Calgary Homeless Foundation; Allyson Marsolais, Project Manager, Canadian Observatory on Homelessness. Based on national consultation, the definition was revised in 2017. Adapted from Gaetz, Barr, Friesen, Harris, Hill, Kovacs-Burns, Pauly, Pearce, Turner, and Marsolais 2017.1

appen d ix i i

Comparative Table of Older People with Lived Experience

Characteristic

N (40)

Gender

Women Men

11 29

Age

50–54 55–64 65+

10 (1 was 46*) 25 5

Indigenous status (self-reported)

Indigenous (First Nations, Métis, or Inuit) Non-Indigenous Missing/Unanswered

32 5

Birthplace

Canada – Quebec Canada – Elsewhere Outside Canada Missing/Unanswered

36 1 2 1

Primary language

Bilingual (English/French) English French

26 1 13

Civil status

Single Separated/divorced Widowed

22 15 3

Children

Yes No

23 17

Education

University College/Cégep** High school/Secondary school Less than high school/ secondary school Missing/Unanswered

11 7 6

3

15 1

246

Late-Life Homelessness

Characteristic

N (40)

Employment status

Employed Seasonally employed Unemployed Missing/Unanswered

2 2 34 2

Housing

Precariously housed (Shelter meals) Subsidized housing (Shelter services) Transitional housing (Longer-term units) Emergency shelter

1

Benefits

Disability benefits Government pension Private pension/other source No benefits Missing/Unanswered

3 19 17 10 6 2 10 12

*As discussed in the text, one person was 46 but had a profile consistent with an older person, and asked to remain in the study. ** Cégep is an acronym from the French term Collège d’enseignement general et professionnel, which means General and professional teaching college. In Quebec, Canada, Cégep is a public school that provides the first level of post-secondary education” (from https://www.cegepsquebec.ca/en/cegeps/presentation/what-is-a-cegep/).

Notes

c ha p t e r o n e 1 See for example Mullins, Rich, and Rich 1995; Warnes and Crane 2000 (United Kingdom, North American, and Australian comparisons); and Crane 1999 (cross-national comparisons). 2 See Centre for Policy on Ageing Rapid Review 2017 in the United Kingdom and the National Homelessness initiative in the United States for examples that Canada could follow (Larkin et al. 2016). 3 See Center for Urban Research and Learning et al. 2008; Fagan 2019; Maxmen 2019; Nagourney 2016. 4 For example, texts such as Vagnerova, Csemy, and Marek (2020) and Chau and Gass (2018) have been published since our study. 5 Later in the definition, the Oxford English Dictionary (2018) also notes that homelessness is “considered as a social problem.” 6 According to the Oxford English Dictionary (2018), the suffix “-less” forms an adjective to denote “the state or quality of not having or being free from the thing denoted by the first element of the compound, as homeless, guiltless.” 7 The material in Table 1.1 comes from the four sub-groups as they are defined by the Canadian Homeless Research Network (2012). The original material appears in text format and has been revised into table format for quick reference. 8 Note that at times, the term homeless is used in the international academic and policy literature to refer only to persons who live in temporary shelters or on the streets. The more specific term for people who tend to avoid shelters and outreach services is “rough sleepers” (see Crane and Warnes 2000b; O’Connell et al. 2004).

248

Notes to pages 11–13

9 Appendix I is a shortened version comprised of selections from the Canadian Definition on Homelessness. The full definition can be found here: https://www.homelesshub.ca/sites/default/files/COHhomeless definition.pdf. 10 The Government of Canada (2018b) outlines the eligibility criteria for public pension as follows: “The standard age to begin receiving a cpp retirement pension is age 65, which is the month after your 65th birthday. However, you can take a reduced cpp retirement pension as early as the month after your 60th birthday. You can also take an increased pension if your benefit starts after reaching age 65.” (https://www.canada.ca/en/ services/benefits/publicpensions/cpp/cpp-benefit/eligibility.html). Such benefits are considered to help stabilize some older people with experiences of homelessness because the person may begin to receive a monthly income. However, others are poorly served by such forms of protection (including not applying for benefits for which they are eligible) or have health needs (see Ploeg et al. 2008). One of the reasons for low income and poor coverage after age 65 in Canada is that the formula to qualify for full benefits is based on citizenship and roughly 40 years of full-time work. As such, groups with low levels of involvement in the labour force such as women, people with disabilities, and migrants who came to Canada after age 40 are particularly at risk for low income in later life. 11 Also see Cohen 1999; Hibbs et al. 1994; Hwang et al. 1998; Morrison 2009; Ploeg et al. 2008. 12 Hwang (2000) reports that “[m]en using homeless shelters in Toronto were more likely to die than men in the city’s general population. Mortality rate ratios were 8.3 (95% confidence interval [CI], 4.4–15.6) for men aged 18 to 24 years, 3.7 (95% CI, 3.0–4.6) for men aged 25 to 44 years, and 2.3 (95% CI, 1.8–3.0) for men aged 45 to 64 years. In most cases, however, the risk of death was significantly lower for men using homeless shelters in Toronto than for those in US cities” (2151). A follow-up study conducted by Hwang et al. in 2009 noted that “among those who were homeless or marginally housed, the probability of survival to age 75 was 32% (95% confidence interval 30% to 34%) in men and 60% (56% to 63%) in women. Remaining life expectancy at age 25 was 42 years (42 to 43) and 52 years (50 to 53), respectively” (1). 13 Also see Cohen 1999; Garibaldi, Conde-Martel, and O’Toole 2005; Gonyea et al. 2010; McDonald et al. 2007; Ploeg et al. 2008; Shinn et al. 2007. 14 Also see Echenberg and Jensen 2008; Kuhn and Culhane 1998.

Notes to pages 24–30

249

c h a p t e r t wo 1 Also see Statistics Canada 2019a; unfpa 2012. 2 See for example Walker’s 2017 report on frailty in Indigenous (First Nations, Inuit, and Métis) communities. Although this report is not focused on homelessness specifically, it draws attention to the comorbidities and historical issues that affect the health and access of Indigenous peoples in Canada. 3 Also see Hiam et al. 2018. 4 Also see Abramovich 2012; Christensen 2013. 5 Also see Crane and Warnes 2010; Culhane et al. 2013 for attention to the health disparities and issues of access among older people with experiences of homelessness. 6 Also see Davies and Denton 2002; Hungerford 2001. 7 Also see Belanger, Awosoga, and Head 2013; Canadian Population Health Initiative 2009; Christensen 2013; Currie et al. 2014; Folsom et al. 2005; Kidd, Gaetz, and O’Grady 2017; Menzies 2009; Patrick 2014; Thurston et al. 2013; Tutty et al. 2013. 8 Also see Bryant 2003. 9 A number of studies highlight that families with young children and youth are the fastest-growing group of homeless people in cities such as Toronto and Ottawa (see Eberle 2001). The PiT counts in a variety of Canadian cities also suggest that the proportional representation of older people is rapidly shifting along with population aging, and as a result of contemporary conditions. 10 For further information see http://homelesshub.ca/sites/default/files/ SOHC16_final_20Oct2016.pdf. 11 According to the Homeless Hub website, a “PiT (Point in Time) count provides an estimate of homelessness in a community within a specified time period, generally 24 hours. A PiT Count is not intended to be a comprehensive research study, nor is it designed to provide the absolute number of individuals experiencing homelessness in a community. Instead, it offers a snapshot of homelessness and when conducted consistently, allows communities to measure their progress in reducing homelessness. PiT Count Methods vary across communities. Until 2015 – when the Government of Canada’s Homelessness Partnering Strategy introduced a coordinated PiT Count methodology – a standard PiT Count methodology did not exist in Canada. Nonetheless, most PiT Counts share common elements.” (http://homelesshub.ca/toolkit/subchapter/what-pit-count).

250

Notes to pages 30–5

12 More recently, in Vancouver, “Seniors aged 55 and over represented 21% of the homeless population compared to 18% in 2014. This continues the upward trend of seniors in relation to the total homeless population that has been evident since the 2008 Count.” http://www.metrovancouver.org/ services/regional-planning/homelessness/HomelessnessPublications/ 2017MetroVancouverHomelessCount.pdf. “2017 Homeless Count in Metro Vancouver Final Report | September 2017.” Metro Vancouver Homelessness Partnering Strategy Community Entity. http://www.metrovancouver.org/services/regional-planning/ homelessness/HomelessnessPublications/2017MetroVancouver HomelessCount.pdf (accessed 17 September 2018). 13 The PiT count in Toronto on the night of 26 April 2018 found 8,715 people experiencing homelessness, and of these, 10 per cent were sixty and older (City of Toronto 2018, 6, 13). This compares to 5,253 people, 10 per cent of whom were aged sixty-one and over on the night of 17 April 2013 (City of Toronto 2013a, 3). 14 Note that the focus on Indigenous peoples tends to overlook differences that may exist between groups, namely the recognition of Inuit and Métis people (see Blackstock 2007). 15 The 2017 definition of homelessness was developed as a collaborative effort of the University of Calgary School of Public Policy (spp ), the Canadian Observatory on Homelessness (coh ), and the Canadian Alliance to End Homelessness (caeh ). The 2017 definition of homelessness can be found here: http://www.homelesshub.ca/sites/default/files/ COHhomelessdefinition.pdf (accessed 17 September 2018). 16 The material presented in Appendix I was selected from the online Canadian Definition on Homelessness. The collaborative team responsible for the development of the definition are noted at the end. Also see: https:// www.homelesshub.ca/sites/default/files/COHhomelessdefinition.pdf. 17 In 2017, the Canadian Observatory on Homelessness (coh) also recommended a national framework (https://www.canada.ca/en/employmentsocial-development/programs/homelessness/publications-bulletins/ advisory-committee-report.html#h2.06-h3.02) (accessed 17 September 2018). 18 See Gonyea, Mills-Dick, and Bachman 2010; Grenier et al. 2016b; McDonald, Dergal, and Cleghorn 2007. 19 Also see Caton et al. 2005; Crane et al. 2005; Crane and Warnes 2001; Shinn et al. 2007. 20 Also see Brown et al. 2012; 2013; Garibaldi, Conde-Martel, and O’Toole 2005. 21 Also see Gaetz 2010; McDonald et al. 2006. 22 Also see Baker et al. 2010; MacKenzie and Chamberlain 2006; Kim et al. 2010; Mallett, Rosenthal, and Keys 2005; Piat et al. 2015.

Notes to pages 35–40

251

23 Also see Crane 1999; Morris, Judd, and Kavanagh 2005. 24 Also see Abramovich 2012; Browne and Bassuk 1997; Koegel, Melamid, and Burnam 1995; Kushel et al. 2003; Shinn et al. 2007; Mercier and Picard 2011. 25 Also see Barak and Cohen 2003; Crane 1999; Dietz 2009; Morris, Judd, and Kavanagh 2005; Shinn et al. 2007; Toro 2007. 26 Also see Crane and Warnes 2005. 27 See Lee, Tyler, and Wright 2010; Tully and Jacobson 1995. 28 Also see Thurston et al. 2013; Tutty et al. 2013. 29 Also see Mallet, Rosenthal, and Keys 2005; van Wormer 2003. 30 Also see Jencks 1995. 31 Also see Kennett and Marsh 1999; Phelan et al. 1997. 32 Also see Cohen, Onserud, and Monaco 1992; Dietz and Wright 2005; Lee and Schreck 2005; North, Smith, and Spitznagel 1994. 33 Also see Crane and Warnes 2010; McDonald et al. 2006. 34 Housing First was adopted in 2014 by the federal government’s Homelessness Partnering Strategy (hps ) (esdc 2014). The province of Quebec opted out of Canada’s Housing First program due to historical concerns about federal and provincial jurisdiction. Quebec’s decision has been associated with political conflicts over federal involvement in housing, which is traditionally a provincial jurisdiction (see Fidelman 2014). 35 Canada’s Housing First initiative was based on the success of a nationwide demonstration project carried out in five Canadian cities (Montreal, Toronto, Winnipeg, Moncton, and Vancouver). The Canadian test project, “At Home / Chez Soi,” launched by the Mental Health Commission of Canada, ran between 2008 and 2013. The At Home / Chez Soi test pilot operated on the basis of five central tenets: immediate access to housing rather than conditions for readiness; client choices were valued and respected; individualized supports were provided to ensure each client received appropriate services; emphasis on harm reduction and no requirement for sobriety; striving for social and community integration (mhcc 2012). Findings demonstrated that Housing First could effectively reduce chronic homelessness, and was less costly than emergency responses. Preliminary findings suggested that twelve months after receiving immediate access to housing, participants fared much better than homeless individuals receiving the conventional interventions to homelessness that existed in each city (mhcc 2012; also see Goering et al. 2014). 36 Also see Tsemberis and Eisenberg 2000. 37 The idea behind Housing First began with New York City’s Pathways to Housing program in the 1990s. The Pathways to Housing approach in the United States reports high success rates in providing stable accommodations for “hard-to-house” populations. It has reported retention rates and

252

38 39

40 41

Notes to pages 40–53

successful engagement of at least 80 per cent of the chronically homeless enrollees. For further information on the history and outcomes of the Pathways to Housing approach see Tsemberis and Eisenberg 2000; Tsemberis 2010. Also see Bengtsson 2001; Leckie 1992; Bratt, Stone, and Hartman 2006; Mortensen and Seabrooke 2008 on housing as a social right. The following are examples of exceptions in Canada: Burns 2016; Burns, Sussman, and Bourgeois-Guérin 2018; Grenier et al. 2016b; McDonald et al. 2006. Also see Armstrong and Armstrong 2003; Battle 1997; Myles and Pierson 2001; Tully and St. Pierre 1997; Vosko 2006. Also see Auslander and Jeste 2002; Kutza and Keigher 1991; Sullivan 1991.

c h a p t e r t h re e 1 For example, the Canadian Association of Social Work has a Code of Ethics to guide social work practice in Canada. The six core values and principles are: 1) respect for the inherent dignity and worth of persons; 2) pursuit of social justice; 3) service to humanity; 4) integrity in professional practice; 5) confidentiality in professional practice; and 6) competence in professional practice. For more information see https://www.casw-acts.ca/ en/Code-of-Ethics. 2 Also see Guillemard 1980. 3 Also see Andersson 2002; Baars et al. 2006. 4 Notable differences exist between the United States and the United Kingdom. Where the work in critical gerontology in the United States includes strands from both sociology (more specifically political economy) and the humanities, in the United Kingdom the development has stronger roots in political economy and studies of poverty. 5 Also see Estes, Biggs, and Phillipson 2003; Guillemard 1980; Kastenbaum et al. 1992; Minkler and Estes 1997; Walker 1981; 1982. 6 Also see Blaikie 1999; Cole 1992; Gilleard and Higgs 2000; Woodward 1999; 2003. 7 The following quote speaks to the relationship between health and homelessness across the United States, Canada, and the United Kingdom. “A close connection exists between health and homelessness. Evidence is mounting of a high incidence among homeless people of tuberculosis, malnutrition, respiratory problems, skin ulceration, and a variety of other infectious diseases. In US cities there has been a concentration on such stopgap measures as emergency shelters and welfare hotels to deal with the growing homeless population. While Canada has a safety net of

Notes to pages 59–74

253

national health, welfare and social services, there is still a problem of obtaining access to the system; a comprehensive approach to the provision of housing, health care, and related community services has not yet evolved. In the UK the number of homeless households has almost quadrupled since legislation was passed in 1977. Inner city councils are struggling to keep up with the deluge, and have resorted to placing entire families in single hotel rooms. Experience to date in all three countries demonstrates that it is nonsensical to deal with one aspect of poverty in a vacuum. Comprehensive programmes are essential to ensure adequate service delivery for a variety of problems encountered by increasingly heterogeneous homeless populations” (Daly 1989, 22). 8 The age for inclusion in the study was set at a minimum of fifty years as per the accepted standard identified in recent scholarship via our literature review (Grenier et al. 2016b; also see Crane et al. 2005; Crane and Warnes 2007; McDonald et al. 2007). 9 Although we selected age fifty as an inclusive threshold, even this was found to exclude at least one person who self-identified as “old.” In our research, we interviewed one man with a long-term experience of homelessness who insisted on sharing his insights on aging, and whose narrative reflected themes of aging. This example illustrated how health and social disparities impact homelessness in late life. There was also a discrepancy in the case of one of the women who indicated that she was sixty-five on the demographic form, but in speaking about herself mentioned that she was fifty-three. 10 For other works that use a storied approach to policy see Biggs 2001; Hendricks 2004; 2012; Neysmith, Bezanson, and O’Connell 2005.

c ha p t e r f o u r 1 Also see Kohli 2007; Mayer 1986; Meyer and Jepperson 2000. 2 Also see Riley and Foner 1968. 3 Riley (1971) outlined two societal models with regards to age. The first model describes an age-segregated society wherein institutions and relations were organized in and around age. The second model is an ageintegrated society inclusive of social relations within and between all age groups. Where the first represented the context within which Riley was writing, the second was a vision for a better and more equitable society. 4 Also see Beynon 2009; Crane and Warnes 2001; McDonald, Dergal, and Cleghorn 2004. 5 Three of the four examples (one provincial and two municipal) that included older people were from the province of Quebec. Reasons for this

254

6 7

8

9

10

11

Notes to pages 74–89

inclusion may be that Quebec is the province with the highest proportional representation of older people; it could also be as a result of increased awareness of the issue, or, finally, that the province of Quebec is known to have the most socially minded policies in Canada, including a national daycare program and public automobile insurance (other provinces are primarily private, for-profit, or insurance-based). Drummondville is a city in the province of Quebec, meaning that 3 of the 4 available models at the time were in Quebec (the location for our study). Similar age-based criteria may exist where affordable or social housing is concerned. For example, municipalities may have a limited allocation of social housing for older people. Such programs are inconsistent across the country but are known to have long waiting lists, with demand far exceeding availability. Further, the existing programs also fall short in terms of the proportional representation of the population. The age-based nature of these programs and the shortage of seniors’ housing may mean that older people with experiences of homelessness may have high-level needs, but not qualify for social programs (with or without support). This may be compounded by a low income and the shortage of affordable housing. This idea is often conveyed through the notion of dependence as it is structured through a withdrawal from the labour force, and is central to critical approaches in gerontology (see Townsend 1981; Walker 1982). In recent years, there have been substantial policy efforts to redefine and reframe the policy discourse as it is organized around the notion of “dependence” (especially in the United Kingdom). These decisions have been criticized as part of a rationale to promote continued labour force involvement and change the pension structure through such measures as altering the age of eligibility. Our sample did not permit detailed comparisons for length of homelessness because length of homelessness was not collected. The stories, however, reveal that some people were homeless for longer periods while others were new to homelessness in late life. There was a difference between decision-makers and stakeholders who had direct “on the ground” experience with older people who were homeless. It was only those without direct experience who held the assumption that older people’s needs would be met elsewhere, such as through health care, family networks, social care, pension support, and/or long-term care. Shelter workers who had attempted to link older people with supports and services were fully aware of service gaps, and that older people’s needs were not met.

Notes to pages 94–102

255

12 For literature on subjective age, see Biggs 2017; Hurd 1999; 2000; Krekula 2007; 2010. 13 Notable differences exist between the way such ideas are framed in the social sciences and the humanities. In the social sciences, authors such as Calasanti (2003; with Slevin 2006), McMullin (2000), and Biggs (2017) use age relations to highlight the structural interpretations, inequalities, and differential positions of power in relation to the processes of production, reproduction, and distribution. In the humanities, scholars such as Coupland (2004) and Coupland (2009), Krekula (2010), and Nikander (2000; 2002; 2008) refer to “age-categorization” or “age-coding” as discursive and dynamic processes whereby age is enacted through codes, distinctions, and demarcations, at particular ages or points in life (also see Krekula, Nikander, and Wilinska 2018; Coupland, Coupland, and Giles 1991; Twigg 1999). 14 See chapter 1. The revised definition for homelessness can be found at http://www.homelesshub.ca/sites/default/files/COHhomelessdefinition.pdf. 15 Note that the 2017 revisions were made retrospectively to the 2012 version of the document. The updated versions can be found here: https:// www.homelesshub.ca/resource/canadian-definition-homelessness (accessed 12 June 2020). There is also a 2017 publication on the definition of “ending homelessness”: https://www.homelesshub.ca/EndingHomelessness. 16 While seniors are listed as a specific vulnerable group, the accompanying glossary uses the age categorization of sixty-five, which is not reflective of the trends within the literature, nor the high level of need that can be experienced by people over age fifty with experiences of homelessness. 17 Note that in “Opportunity for All,” older people are not mentioned in the intersectional section of disadvantage (although disability does appear), and their rates of poverty are cited at 5 per cent.

c ha p t e r f i ve 1 Although homelessness certainly extends beyond the idea of “being without a house,” the language associated with homelessness often alludes to a physical place or locale. This framing of homelessness is in part responsible for establishing individual-level solutions for people who are homeless, rather than paying attention to the structural outcomes of unmet need and disadvantage over time. 2 For more information see https://www.cdc.gov/healthyplaces/ terminology.htm.

256

Notes to pages 102–14

3 According to the Government of Canada (2012), “aging in place” means having the health and social supports and services one needs to live safely and independently in one’s home or community for as long as one wishes and is able. The checklist for “Aging in Place” can be found at: https:// www.canada.ca/en/employment-social-development/corporate/seniors/ forum/aging.html. 4 In Canada, homecare falls under provincial jurisdiction, and programs vary across the country. Generally speaking, access to homecare tends to be determined through a series of standardized eligibility assessments assessing the level of functional impairment, need, and the home environment. In Canada, this takes place within a system where only interventions considered medically necessary fall within the domain of health (with the exception of prescription medication), and are thus universal and covered under the Canada Health Act (1984). Needs that are social in nature (and in particular those that are within or outside of the home) are not covered by universal health care, and are more likely to be provided by community-based services or by kin (e.g., meal preparation, cleaning, visits, etc.). 5 Also see Molony 2010; Rowles and Bernard 2013; Somerville 1992. 6 Also see North, Smith, and Spitznagel 1994. 7 There was a discrepancy between the age cited on the form and in her interview. The form indicated that Marie was sixty-five, but in speaking about herself she mentioned that she was fifty-three. This may result from her speaking about the past without establishing that the comment was retrospective. It may also, however, represent a practice of being accustomed to saying one is older in order to be eligible for service. When making reference to Marie we cite her as being sixty-five, although it is possible she was fifty-three. 8 At the time of our study, there were no known programs addressing this need in Montreal. In Toronto, a service called peach, fostered by Inner City Health Associates (icha), provides palliative care for homeless people, and in 2018, the Journey Home Hospice, a partnership between the St Elizabeth Foundation, the Inner City Health Associates, and Hospice, was opened. For more information see https:// journeyhomehospice.ca/new-hospice-for-the-homeless-opens-indowntown-toronto/. 9 Also see Huynh, Henry, and Dosani 2015; Stroh 2018. 10 This incident, initially reported by the Canadian Press, was also reported internationally. See: “Death of Canadian Man Living in 24-Hour Coffee

Notes to pages 114–31

257

Shop Sparks Housing Outcry”: https://www.theguardian.com/world/2018/ jun/07/canada-death-homeless-man-tim-hortons-vancouver (see Kassam 2018). 11 Also see Kane, Kane, and Ladd 1998. 12 Also see Baines 2007. 13 Also see Peace 2005.

chapter six 1 The social determinants of health model has also been used to understand homelessness, although it is less prevalent in social gerontology and thus not included as part of the approach taken in the book. The social determinants of health model reveals gross inequalities within and between countries and situations, including how life expectancy can vary across geographic contexts, between population groups, and within cities (see Braveman, Egerter, and Williams 2011; Marmot 2005; Marmot et al. 2010; Raphael 2009). The key lesson from the social determinants of health model is that health disparities are socially produced, and result in a social gradient in health and enduring inequalities between population groups across a range of factors such as education, life expectancy at birth, work and labour histories, gender, and race (see Marmot et al. 2010; Raphael 2009). As such, it helps to articulate how some groups live longer than others (or die sooner) as a result of advantage or disadvantage, and have higher levels of comorbidity (multiple health issues and impairments). For further information on this approach see Dunn et al. 2006; Horn 2008; Hwang et al. 1998; Hwang 2001; 2002; Waldbrook 2013, as well as works on how within-group differences such as gender and/or Indigeneity further affect disparities (see Czyzewski 2011; Denton, Prus, and Walters 2004; Dunn and Dyck 2000; Mete 2005; Reading and Wein 2009; Richmond, Ross, and Egeland 2007; Wanless, Mitchell, and Wister 2010). 2 Also see Crystal and Shea 1990. 3 Also see Crystal 1982; 1986; Crystal et al. 1992. 4 Also see Crystal, Shea, and Krishnaswami 1992 on educational attainment as determinant for later-life economic security. 5 Also see Baker and Lester 2017; Šikic´-Mic´anovic´ 2010. 6 Also see Bhui, Shanahan, and Harding 2006; Cohen 1999; Dennis, McCallion, and Ferretti 2012; Garibaldi, Conde-Martel, and O’Toole 2005; Grenier et al. 2016b; Gonyea et al. 2010; Kim et al. 2010; Lipmann 2009; Ploeg et al. 2008; Quine et al. 2004.

258

Notes to pages 132–43

7 Also see Collins and Bilge 2016; Hankivsky et al. 2014; McCall 2008. 8 Also see Hankivsky et al. 2014. 9 The work, however, does not consider the impacts of racism and racialization. 10 For further information on substance use and aging in Canada see https:// www.ccsa.ca/sites/default/files/2019-04/CCSA-Substance-Use-and-AgingReport-2018-en.pdf. 11 Also see Beynon 2009; Khandor and Mason 2008. 12 See Bourgois and Schonberg (2009), the “Righteous Dopefiend,” for a discussion of the relationship between historical processes of trauma and substance use. 13 The language used throughout of “Indigenous” (First Nations, Inuit, and Métis) is intended to be inclusive of the range of groups across Canada (see Blackstock 2007). In Canada, the term “Aboriginal peoples” was historically used to refer to any one of the three legally defined culture groups in Canada (Métis, Inuit, and First Nations) . The term “First Nation” is often used to denote a reserve community or band. The term “Indian” was also historically used in legislation or policy, and although some remnants of these practices exist, it is not considered appropriate terminology. The term “Indigenous” is used to describe the descendants of groups in a territory at the time when other groups of different cultures or ethnic origin arrived there, groups that have almost preserved intact the customs and traditions of their ancestors similar to those characterized as Indigenous, and those that have been placed under a state structure which incorporates national, social, and cultural characteristics distinct from their own (Belanger, Awosoga, and Head 2013). 14 See Reading and Wein 2009 for further information on the impacts of colonization and assimilation in Canada, and Gaetz et al. 2014 on Canadian trends in homelessness more generally. 15 Of note, homelessness and inadequate housing in northern Canada also have been found to disproportionately affect Indigenous peoples (Abele, Falvo, and Hache 2010). The numbers for Indigenous peoples who are homeless after age fifty are not available. 16 At age sixty-five, the gap in life expectancy between First Nations [Indigenous] and non-Indigenous people was 4.6 (95% CI 3.8; 5.4) and 6.2 (95% CI 5.3; 7.2) years for men and women, respectively (Tjepkema, Bushnik, and Bougie 2019; also see Statistics Canada 2005). 17 At age sixty-five, the gap between Métis and non-Indigenous people narrowed to 2.7 (95% CI 1.4; 4.1) years for men and 3.8 (95% CI 1.7;

Notes to pages 143–58

18

19

20

21

22

23

24

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6.0) years for women (Tjepkema, Bushnik, and Bougie 2019; also see Statistics Canada 2005). At age sixty-five, life expectancy was 4.9 (95% CI 2.4; 7.3) years shorter for Inuit men and 5.9 (95% CI 2.7; 9.2) years shorter for Inuit women than for non-Indigenous men and women (Tjepkema, Bushnik, and Bougie 2019; also see Statistics Canada 2005). It is important to note that the representation of Indigenous peoples in homelessness varies across the country. A number of First Nations, Inuit and Métis people live in Montreal, and many of the Inuit do not speak French, meaning that they are also a language minority and experience difficulty accessing services. The study examined avoidable mortality among a cohort of 61,220  First Nations and 2,521,285 non-Aboriginal [Indigenous] peoples aged twenty-five to seventy-four who responded to the 1991 Census and were followed up for mortality to 2006: https://www150.statcan.gc.ca/ n1/daily-quotidien/150819/dq150819b-eng.htm. Note that there are similarities and differences with regards to the needs of homeless people with mental health issues and people with disabilities. However, both groups draw attention to the lack of public supports and services, and the impacts of historical policy decisions, including closing institutions without suitable alternate programming. There is little to no research on the aging of sub-groups that are over-represented among homelessness. This oversight may be related to the lack of attention to diversity within the older population, overlooking late-life homelessness, and/or the health disparities and accompanying patterns of early mortality. According to Hwang 2001, single women who are homeless are more likely to have mental illness alone, without any substance use. The prevalence of substance use in men is about twice that in single women.  Also see O’Rand 1996.

c h a p t e r s e ve n 1 The sections pertaining to exclusion and abandonment were presented at the University of Victoria, Canada in 2016. Thank you to Stephen Katz for suggesting the work of Povinelli (2011) and Sassen (2014). The material on social exclusion was presented to the Canadian Association on Gerontology in 2018. 2 See Silver (1994) on the historical evolution of the concept of social exclusion in European policy.

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3 Note that social exclusion is also a one of the identified targets in Europe’s 2020 strategy (European Commission 2011). Also see UK Government 2006. 4 Also see Arber 2004; Ballet 2001; Berghman 1995; Burchardt et al. 1999; Evandrou 2000; Martinson and Minkler 2006; Vranken 2001. 5 Also see Šikic´-Mic´anovic´ 2010. 6 See Walsh, Scharf, and Keating 2017 for a visual depiction of the six aspects of social exclusion and their sub-domains. 7 Also see Friedan and Kaplan 1975. 8 Other authors have focused on the notion of “non-decision making” which may be likened to techniques of stifling or stalling particular voices or actors (see McCalla-Chen 2000), or on responses that vary according to the degree of threat the population group poses to social norms (see Hill 1996). 9 Also see Doherty et al. 2008; Fitzpatrick, Bramley, and Johnsen 2013; Johnsen, Fitzpatrick, and Watts 2018; Petty 2016; Stephenson 2016. 10 The proportional share of homelessness among older people suggests that some would have been over the age of 50, thereby signalling the expulsion that may be occurring to older people. 11 See for example the current topics pursued by Leilani Farha, Special Rapporteur on housing, including housing as a human right, forced evictions, and financing housing for the poor (Salinas 2019; Gertten 2019). 12 See Kleinman, Das, and Lock 1997 on social suffering. 13 The point being made here is how different historical traditions about care and control and the construction of the subjects of older people as “deserving” have shaped and will continue to shape responses to older people and homelessness. 14 In the context of neo-liberalism, attention to neglect, indifference, and abandonment reveal the extent to which responses to homelessness are part of an active expulsion of those belonging to a moral underclass (Levitas 2005). The argument in this chapter extends this argument by connecting with social practices, cultural views, social justice, and shared responsibility. 15 Gullette writes on discourses of decline in relation to aging, and Kafer on the discourse of tragedy with regards to people with disability. Both are relevant where the analysis of discourses and responses to late-life homelessness are concerned. 16 The most poignant example here is my personal experience of attending the iagg /gsa conference in San Francisco in 2017, witnessing (and therefore participating in) countless acts of inhumanity whereby walking on the

Notes to pages 189–206

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street involved everyday acts of “stepping over and around” homeless people. This provoked a feeling that the dismissal of people’s humanity was increasingly accepted in a large American city (also see Fagan 2019).

chapter eight 1 Also see Dooling 2009 on gentrification and social justice. 2 Also see Padgett et al. 2006; Watkins and Hosier 2005. 3 Also see Bernardi, Huinink, and Settersten 2019; Bengston and Allen 2009; Clausen 1986; Elder and Pellerin 1998; Gee 1986; George 1993; 1996; Hagestad 1990; Hareven 1978; Hooyman et al. 2002; Neugarten 1976; Neugarten and Datan 1973 on life course perspectives in gerontology. 4 They comment that many of the participants they interviewed were “surprised to be alive” – a phenomenon also noted in our research on homelessness in Montreal. Language used here included discussions of being lucky, and discussions of how friends “did not make it.” 5 See Dannefer and Settersten 2010 on the distinction between personological and institutional models of the life course. 6 Also see Mayer 2009; O’Rand 2006. 7 Also see Chamberlayne, Bornat, and Wengraf 2000; Grenier 2012b; Gubrium and Holstein 1995; Hockey and James 2017; Ray 2007. 8 See Bell 2003 on the use of stories to better understand racism. 9 Also see the framework and questions outlined by Settersten 2003 (193–208). 10 Also see Phillipson 1982; Walker 1980. 11 See the Guardian on the 75th anniversary of the Beveridge report, and the question of whether the “5 giants” posed for social policy have returned: https://www.theguardian.com/society/2017/oct/10/beveridge-five-evilswelfare-state (Armstrong 2017). 12 According to the Canadian Mortgage and Housing Corporation, the Montreal Census Metropolitan Area vacancy rate reached a fifteen-year low, driving the national decline. Changes in Montreal’s vacancy rate have large impacts at the national level because 28.8 per cent of all purpose-built apartment units in Canada are in Montreal, with the share represented by Toronto (15.4 per cent) and Vancouver (5.4 per cent). https://www.cmhc-schl.gc.ca/en/housing-observer-online/2020-housingobserver/canadas-rental-vacancy-rate-declines (accessed 8 July 2020). 13 In gerontology, a number of researchers have explored human rights in relation to aging, particularly sub-populations such as people with

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16

17

Notes to pages 208–34

dementia (dementia as a human right), and/or advocated for a human rights framework (see Townsend 2006; Turner 2006). Also see Crane and Warnes 2000b for policy and service responses to sleeping rough among older people. Also see Crane and Warnes 2007; csh and Hearth, Inc. 2011; Pannell 2002; Rota-Bartelink and Lipmann 2007; Shelter Partnership, Inc, 2008; Petersen and Parsell 2015. Note that the problems of accessing homecare services across Canada are also generally considered inadequate. Homecare services in Canada are often reduced to basic medical personal care while overlooking social care needs. Access to services also tends to be fragmented, with inequalities across geographic locales (Martin-Matthews, Sims-Gould, and Tong 2012). The point made here is that older people who are homeless are excluded from even the minimal provision of these services, and therefore forced to use the most expensive services, such as emergency rooms (also see Schanzer et al. 2007; Salit et al. 1998). There is no “one national home care policy” in Canada. Rather, programs are delivered on a provincial basis, using ‘home’ or ‘domicile’ as a basis for eligibility. This is primarily related to distinctions between medical services that are universal (federal jurisdiction), and those considered social, provided by the community (fee, family, community/charity organization).

chapter nine 1 See Small’s 2007 book The Long Life, for an in-depth philosophical analysis of thinking with regards to longevity, and the ways in which ideas about longevity have shifted throughout history and over time. 2 The connections between resilience, adversity, and stress models tend to be implied and require the development of conceptual models. For more information on the models that underlie the focus on resilience see Cohen 1999; Goodman, Saxe, and Harvey 1991; Pearlin and Bierman 2013. For example, one promising model being developed by Vercruysse et al. 2018. 3 Also see McFerran 2010. 4 Also see Mohaupt 2009. 5 Also see Burns 1998; Epel et al. 1999. 6 Also see Fraser 2014; Levitas 2013; Linklater 1998. 7 In the field of aging, applications tend to lean more toward the application of human rights than justice – a difference that suggests the relevance of exploring the conceptual and practical differences and implications of linking the agenda on homelessness with concepts of rights or justice.

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a p p e ndi x i 1 For the complete definition see: https://www.homelesshub.ca/sites/default/ files/COHhomelessdefinition.pdf. Gaetz, S.; Barr, C.; Friesen, A.; Harris, B.; Hill, C.; Kovacs-Burns, K.; Pauly, B.; Pearce, B.; Turner, A.; Marsolais, A. (2012) Canadian Definition of Homelessness. Toronto: Canadian Observatory on Homelessness Press.

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Index

abandonment, 180–2, 210, 213, 216–19 Aboriginal people see Indigenous Peoples abuse, 27, 35, 89, 96–7, 133, 192; see also domestic violence; violence accessibility: to health care, 39, 232; mechanisms for, 203–4, 211–12; to pension income, 28, 36, 80, 188, 190; of physical spaces, 45, 58, 109–10, 237; to programs by age, 19, 69–70, 79–82, 88, 154, 163; to social housing, 28, 36, 172, 178, 239; to support systems, 20, 33, 38, 65, 115–16, 161, 174; through an age-lens, 95, 188 age: chronological age as determination to service, 79–82; chronological age vs disadvantage over time, 155–156; perceived vs chronological, 77, 94; segregated vs integrated, 253n3; as social construct, 95–6; social gerontological perspectives, 70–2; see also stage-based markers

Age-Friendly City initiatives, 101 “Ageing and the Life Course” (who ), 196 age-lens, 95, 200–3 age relations, 43, 80, 89, 95–8, 200–3, 216, 255n13 André (participant, with lived experience), 84–5, 110, 224 assessments, 72, 77–9, 95, 103, 256 “At Home / Chez Soi” (mhcc ), 251n35 Bakuet, 81–2, 148–9 Belanger, Yale, 142 Ben (participant, with lived experience), 106, 139, 151, 161, 167, 170 Betty (participant, with lived experience), 83, 105, 203 Bezanson, Kate, 196 Biggs, Simon, 8, 48, 255n13 Bourgeois-Guérin, Valerie, 6 Brückner, Hannah, 198 Bytheway, Bill, 88, 94 Calasanti, Toni, 255n13 Calgary, 142

330

Index

Canada Pension Plan (cpp ), 80, 85, 248n9 Canadian Alliance to End Homelessness (caeh ), 250n15 Canadian Association of Social Work (casw ), 46, 252n1 Canadian Homelessness Research Network (chrn ), 10–11, 247n7 Canadian Institute on Aging, 196 Canadian Mortgage and Housing Corporation (cmhc ), 261n12 Canadian Observatory on Homelessness (coh ), 250n15, 250n17 care work, 27, 90, 102–3, 181, 218, 231, 256n4, 262n16–17 care workers, 116, 118–19, 216 Centre de recherche et d’expertise en gérontologie sociale (creges), 6, 45, 54–5 Centre for Disease Control (us , cdc ), 101–2 Claude (participant, with lived experience), 172 Claudine (participant, with lived experience), 87, 140, 202 Code of Ethics (casw ), 46, 252n1 Cohen, Carl I., 52, 220 Collins, Patricia Hill, 133 colonization, 33, 89–90, 132–133, 141–4, 205, 217 Community Plan on Homelessness (Drummondville, QC), 74 couch-surfing, 31 Coupland, Justine, 255n13 Crane, Maureen, 52 creges (Centre de recherche et d’expertise en gérontologie sociale), 6, 45, 54–5 Crenshaw, Kimberlé, 132

critical gerontological perspective on aging, 6–9, 47–51, 94, 99, 128–129, 217–18, 235, 252n4 critical gerontology: about, 47–51, 252n4; and age, 94; and cad , 127–128; and politics of care, 235; and the study, 7–8, 16–17 Crystal, Stephen, 129 Culhane, Dennis P., 24–5 cultural gerontology, 8, 48–50 cumulative advantage and disadvantage (cad ) model, 127, 129–31, 154 Cutchin, Malcolm P., 101 Dannefer, Dale, 130, 192 Davey, Judith, 122 death: compared to homelessness, 105; of friend or family member, 36; a “good” one, 220, 231, 235; neglect until, 228; premature, 25; at shelters, 114, 232; see also mortality Death Is a Social Justice Issue (Reimer-Kirkham), 234 defensive architecture, 178 Degnen, Cathrine, 51 deinstitutionalization, 141–2, 146–7, 217, 259n21 deservedness, 175, 177, 180–2, 260n13 deVries, Michiel S., 182 disabilities: deinstitutionalization, 141–2, 146–7, 217, 259n21; and income support, 72, 82, 246; Kafer on, 260n15; as risk factor, 35, 37, 86, 175, 190, 248n10; study demographics, 60–3, 64, 146; term usage, 14

Index disadvantage over time, 127–56; about, 216–19; cad and intersectionality, 127–33; historical inequity, 152–6; histories of, 134–7; intersecting forms of oppression, 137–41 discharge to the streets, 39, 179, 212, 228–9, 232 discrimination: age-based, 88–9, 93, 95, 162, 165, 213; cumulative and intersectional, 156; and exclusion, 165, 173; gender-based, 37; labour-related, 138; racialized, 130–3, 194, 205–6 displacement, 28–9, 116, 143–4, 176–9, 189 diversity: and policy change, 239; of populations, 78, 95–6, 145, 194, 204, 259n22; in the studies, 11, 31–3; see also intersectionality domestic violence, 36, 87, 107, 134, 140; see also abuse; violence Drummondville’s Community Plan on Homelessness, 74 Economic and Social Development Canada (esdc ), 102, 256n3 Economies of Abandonment (Povinelli), 180 Edmonton, 142 education: lack of, 130–1, 135; as part of three-box framework, 199; policies on, 142; study demographics, 60–3, 64, 245 embodiment, 8, 50, 169 employment: affecting retirement income, 90, 92, 190; affecting women, 85, 141; changing

331

patterns of, 188; intersecting with other disadvantages, 138–9, 205, 217; lack of as pathway to homelessness, 35–7, 133–4, 136, 151, 177 Estes, Carroll L., 8, 48, 49, 121, 181 ethics/ethics of care, 46, 231, 252n1 Étienne, 139, 146, 164, 169, 207 evictions: from gentrification, 54, 179, 189, 212; lack of protection from, 87; as pathway to homelessness, 27–8, 36, 141, 177, 188, 229, 239; reasons for, 84, 134, 179, 193 exclusion, 157–84; from civic participation, 166–8; definitions and domains, 158–60; and discrimination, 165, 173; and the importance of place, 122–5; lived experiences of vulnerability, 168–73; from material and financial resources, 160–1; from neighbourhood and community, 163–5; from relationships, 165–6; responses of indifference, displacement, and abandonment, 173–82; from services, amenities, and mobility, 161–3, 262n16; in the shelters, 118; shift to expulsion, 177–9 families, changes in, 27–8, 35–6, 134, 136, 188, 192, 218 Fernando (participant, with lived experience), 108 Fine, Michael D., 231, 234 Fineman, Martha Albertson, 234 First Nations, 258n16, 259n20; see also Indigenous Peoples

332

Index

frailty, 38, 47, 71, 82, 134, 179–80 France, 128 François, 107, 164, 171 Fraser, Nancy, 234 Frédéric, 105–6, 190, 224 Gabriel, 148, 162, 169, 202, 221 gender issues: and civic participation, 167; domestic violence, 36, 87, 107, 134, 140; lgbt seniors, 132; and mental illness, 259n23; overlooked in studies, 33; and safety actions, 108; social support and impact on women, 41; and speaking about their histories, 137–8; and substance use, 259n23 genocide, cultural, 33 Gonyea, Judith G., 133 Grenier, Amanda M.: as interviewer/observer for study, 55–8; as social gerontologist, 46–7; and the vies team, 159; witnessing of homelessness, 260n16; see also study greying of societies, 24 Grizzly (participant, with lived experience), 109, 148, 171 guaranteed income, 85, 97, 211 Guberman, Nancy, 159 Gubrium, Jaber F., 52, 121, 195 Gullette, Margaret Morganroth, 260n15 Hahn, Judith, 25 health issues: accessibility to care, 39, 232; changes in body functions, 84, 105; comorbidities of older people, 38–9; difficult to address, 91; discharge to the

streets, 39, 179, 212, 228–9, 232; Indigenous Peoples, 248–9n2; Inner City Health Associates (icha ), 256n8; Mental Health Commission of Canada (mhcc ), 251n35; mental health issues, 29, 35–6, 90, 116–17, 134, 138, 147– 9, 259n21; palliative care, 211; and physical mobility, 40, 78–9, 105, 108–10, 159–63, 176, 213; social determinants of health, 131, 257n1; and vulnerability, 76; see also accessibility; death; deinstitutionalization; mortality Hendricks, Jon, 194, 204 Holstein, James A., 195 home, 103, 120–2, 202 home and community care, 102–3, 121, 256n4 Homeless Individuals and Families Information System database (hifis ), 59 homelessness: definition of, 33–4, 96–7, 247n5, 247n8, 250n15; and education, 36; groups at risk, 203–5; media on, 4–5; population statistics, 30, 249n9, 249n11; subgroups of people experiencing homelessness, 11; work as exit strategy, 81, 96, 213; see also employment; evictions; health issues; housing issues Homelessness Partnering Strategy (hps ), 57, 74–5, 251n34 hope, 225–8 Housing First program: about, 40–1, 122, 251n34–5, 251n37; and older people, 57, 73–4, 112, 190; and social justice, 206–10

Index housing issues: discharge to the streets, 39, 179, 212, 228–9, 232; and human rights, 206; physical place vs home, 122; rising costs, 36–7, 40, 85, 177, 189, 217; security/instability of, 133, 188, 211; social housing, 29, 254n7; structural factors, 27–9; see also evictions Hulko, Wendy, 132 human rights, 206–208, 261–2n13, 262n7 Hwang, Stephen W., 39, 248n12 (n12), 259n23 incarceration, 35–6, 90, 131, 189, 192 Indigenous Peoples: colonization, 33, 89–90, 132–3, 141–4, 205, 217; differences between First Nations, Inuit, and Métis, 250n14; health of, 248–9n2; and life expectancies, 143, 144; observations of at shelters, 78; overrepresentation of homelessness, 26, 33, 53–4, 142–4, 175, 258n15; as subpopulation of older people, 210; see also intersectionality Ingram, Helen, 175 Inner City Health Associates (icha ), 256n8 Inter-ministerial Action Plan on Homelessness (Quebec), 74 intersectionality, 128–30, 131–3, 137–41, 154, 255n17; see also marginalization Inuit: and languages, 259n19; and life expectancies, 259n18; see also Indigenous Peoples

333

invisibility: from ageism, 6, 41, 69, 73–5, 80, 94, 177; desire for, 165; and exclusion, 56; explanations for, 88, 91; see also discrimination; visibility Invitation to the Life Course (Settersten), 197 Jacques (participant, with lived experience), 146, 207 James (participant, with lived experience), 165 Jean (participant, with lived experience), 222 Joanne (participant, with lived experience), 135, 140 Journey Home Hospice, Toronto, 256n8 Justice Interruptus (Fraser), 234 Kafer, Alison, 260n15 Kant, Emmanuel, 228 Katz, Stephen, 225 Keating, Norah Christine, 159–60 Kenyon, Gary M., 196 Komp, Kathrin, 198 Krekula, Clary, 255n13 labour market, 24, 40, 85, 132, 138, 188 Laceulle, Hanne, 173 late-life homelessness see late-life homelessness, about; late-life homelessness, and age; late-life homelessness, ethnographic approach; late-life homelessness, prevention; late-life homelessness, structural issues; place late-life homelessness, about, 23–43; definition of, 10–14;

334

Index

federal policies, 39–41; gaps in knowledge, 42–43; pathways to homelessness, 34–7; recognition, 30–4; responses to, 210–14; see also employment; evictions; health issues late-life homelessness, and age, 69–98; age-based discrimination, 88–9; complexity of needs, 91–3; implications of policies, 93–7; lived experiences, 82–7; silos of support, 89–91; social gerontological perspectives, 70–2; see also study late-life homelessness, ethnographic approach, 44–66; critical perspective, 47–51, 65; framework of analysis, 45–7, 65; see also study late-life homelessness, prevention, 187–214; development of a life-course policy approach, 191–200; practical strategies, 208–14; preventive policy approaches, 200–8 late-life homelessness, structural issues, 23–30; longevity and rising inequality, 25–6; population aging, 24–5; structural disadvantages, 188–90; see also housing issues; neoliberalism; pensions; public supports Lavoie, Jean-Pierre, 6 Laws, Glenda, 120 lgbt seniors, 132, 210 life-course perspectives: development of, 191–6; and policies, 206–8; structuring of, 196–200 life stories, 195–6

lines, waiting in: experiences of, 146, 174, 221–3; older people first, 78, 105, 111, 179; for shelter and food, 58, 105, 108 loneliness, 164, 165, 171, 183 longevity, 25–6 low-income cut-off (lico ), 36–7 Lucas (participant, with lived experience), 86, 135, 221 Manon (participant, with lived experience), 109 Marc (participant, with lived experience), 87, 167, 222 Marcia (participant, with lived experience), 137 marginalization: from ageism, 5; and exclusion, 94, 115, 124, 158, 176–7, 230; experiences of, 165, 227; implications of, 16, 191, 213; and intersectionality, 28, 132, 145, 153, 205; and invisibility, 175; from neoliberalism, 121; in place, 110, 112–13, 118–19, 125; as risk factor, 25–6, 29; studies of, 7, 46, 52, 108, 220; and unmet needs, 91–2; and vulnerability, 169, 178 Marie (participant, with lived experience), 107, 113, 170, 203, 207, 256n7 Marier, Patrik, 198 Marshall, Victor W., 199 Martin, Wendy, 8, 50 McDonald, Lynne, 52 McMullin, Julie, 255n13 Melekis, Kelly, 133 Mental Health Commission of Canada (mhcc ), 251n35

Index mental health issues, 29, 35–6, 90, 116–17, 134, 138, 147–8, 259n21; see also deinstitutionalization Métis: and life expectancies, 258n17; in Montréal, 259n19; see also Indigenous Peoples migration, 27, 90, 132, 139, 205 Montreal: demographics, 30, 32–3, 52, 142; programs, 154, 204, 261n12; as study site, 52 moral imperative, 228–36 mortality: avoidability of, 143–4, 188, 259n20; premature, 26, 54, 130, 144, 175, 190, 259n22; rates, 12, 74, 248n12 narratives, 47, 64, 133, 153, 219, 221, 253n9; see also qualitative research National Housing Strategy (Canada), 97, 210 National Policy on Homelessness (Quebec), 74 National Poverty Reduction Strategy (Canada), 97 National Shelter Study (Canada), 30 neglect, 33, 158, 174–5, 181, 210, 217, 228 neoliberalism: and deinstitutionalization, 141–2; and deservedness, 180–1; expulsion of moral underclass, 260n14; and individual responsibility, 120–1; and lack of social supports, 29, 90, 103, 190, 205, 215, 217; and moral underclass, 260n14 New Dynamics of Ageing (UK), 196

335

Neysmith, Sheila M., 196 Nikander, Pirjo, 255n13 O’Connell, Anne, 196 Old Age Security (oas ), 85 Old Brewery Mission (obm ), 45, 54–5 Olympics and displacement, 177 Opportunity for All (Canada), 97, 255n17 Organization for Economic Co-Operation and Development (oecd ), 52–3 Padgett, Deborah K., 52, 192–3 palliative care, 113–14, 211, 234, 256n8 participants: on being alive, 261n4; on financial exclusion, 161; on hardships, 83–7, 105, 169, 189–90, 219–21; on histories, 135, 137; on hope, 170, 226–7; on housing/finding a home, 116–19, 221; men on violence, 146; men on work, 138–9, 151; on mental health issues, 148–9; on moments of pleasure, 224; on needs, 202, 203, 207; palliative care, 113–14, 256n8; on relationships/loneliness, 165–6, 171; rough sleepers, 104, 247n8; on safety, 164; on wisdom, 222–3; women on fear, 140; see also accessibility; death; discrimination; lines, waiting in; neglect Pathways to Housing program (New York City), 40, 251n37 Paul (participant, with lived experience), 84, 87, 166, 224

336

Index

peach (palliative care), 256n8 pensions: difficulty in accessing, 28, 36, 80, 188, 212; eligibility, 248n9, 254n9; lack of, intersection, 22, 36–7; participant demographics, 60–2, 64, 246; tied to work history, 27–8, 85, 190, 205 Phillipson, Chris, 8, 48, 50–1, 159 Pierre (participant, with lived experience), 161, 226 Pitié-Salpêtrière, Paris, 128 place, 99–126; aging in place, 101–3, 218, 256n3; displacement, 28–9, 116, 143–4, 176–9, 189; emergency shelters, 108–14; and exclusion, 122–5; long-term care facilities, 114–20; and marginalization, 110, 112–13, 118–19, 125; physical place vs home, 122; policies vs lived experience, 120–5; premature placement, 115–16; stakeholders on placement, 115–19, 230; on the street, 104–8 A Place to Call Home (Canada), 97 point in time (PiT) counts, 30, 249n9, 249n11 policies: on diversity, 239; on education, 142; federal policies, 39–41; implications of, 93–7; life-course approach, 191–200, 206–8; vs lived experience, 93–4, 120–5; National Policy on Homelessness (Quebec), 74; of neglect, 33, 158, 174–5; Policy Research Initiative, Canada, 196; practical steps for change, 209; preventive approaches, 200–8, 201; in Quebec, 74–5, 253–4n5; School of Public Policy (spp ),

University of Calgary, 250n15; Social Theory, Social Policy, and Ageing (Estes, Biggs, and Phillipson), 8; University of Calgary School of Public Policy (spp ), 250n15 political economy (critical gerontology), 8, 49 politics of care, 229–31, 232, 234 politics of neglect, 217 population aging, 24–5 poverty, 24, 35–6, 128, 133, 192, 217 Povinelli, Elizabeth A., 180–2, 183, 220, 227 power relations, 94–5 precarity see employment; health issues; housing issues; place premature placement, 115–116 public supports: declines in, 29–30; in discrete sectors, 82, 89–91, 254n9, 254n11; gaps in, 86–7; and pensions, 190 punishment, 178–9 qualitative research, 64–5, 130, 131, 192–3; see also narratives; participants; stakeholders; study Quebec: and hps , 251n34; Interministerial Action Plan on Homelessness, 74; National Policy on Homelessness, 74; policies on late-life homelessness, 74–5, 253–4n5 racial issues, 25–6, 131, 139, 205 Randall, William L., 196 Reaching Home Poverty Reduction, 210 Reimer-Kirkham, Sheryl, 234

Index René (participant, with lived experience), 165, 171, 189–90 resilience, 215, 262n2 retirement, 81, 254n8 Reyes, Adriana M., 129 Riley, Matilda White, 71, 253n3 Rita (participant, with lived experience), 106, 226 Robert (participant, with lived experience), 86, 135, 151, 162–3, 222–3 Rothwell, David W., 59 rough sleepers, 104, 247n8 Rowles, Graham D., 52, 122–3 Rowntree, Benjamin Seebohm, 128 San Francisco, 182 Sarah (participant, with lived experience), 137 Sassen, Saskia, 177, 179, 183 Scharf, Thomas, 159–60 Schneider, Anne, 175 School of Public Policy (spp ), University of Calgary, 250n15 Settersten, Richard A., 192–3, 197 Shea, Dennis, 129 Simon (participant, with lived experience), 138 Smith, Allison E., 159 social determinants of health, 131, 257n1 social gerontology, 70–2, 99, 122, 128–9, 132, 181 social justice, 229, 232–6 Social Theory, Social Policy, and Ageing (Estes, Biggs, and Phillipson), 8 social work practice, 46, 252n1 Sokolovsky, Jay, 52, 220

337

Spider-Man (participant, with lived experience), 202 stage-based markers, 70–1, 79–82, 87–8, 91–6, 127, 199, 238 stakeholders: on accessibility, 111–13; on chronological ages, 76–7, 81; on lack of support, 147–8, 232–3; on long-term homelessness, 149–50; on people with experience of homelessness and work, 151–2; on placement, 115–19, 230; on working with other sectors, 188–9 “State of Homelessness in Canada” (Gaetz, Dej, Richter, and Redman), 30 stigma: as chronic stressor, 192; countering of, 100, 200; feelings of people with experience of homelessness, 93, 119, 126, 145, 151–2, 157–8, 165, 172–3, 183; of Indigenous men, 145; perceptions of people with experience of homelessness, 5–6, 91, 175–6, 218, 224 Street Needs assessments, 31 structural vs individual issues, 199, 218, 235–6 study: about, 6–7; age limit, 55–56, 253n8–9; analysis, 64; data collection, 55–6, 59; findings and analysis, 73–82; framework of, 56–7; interviewee demographics, 60–3, 64, 83, 137, 254n10; languages of, 54; Montreal as site, 52; older people as invisible, 73–5; research team, 54–5 substance use, 35–6, 135, 145, 259n23 Sussman, Tamara, 56

338

Index

Swan, James H., 121, 181 Sylvie (participant, with lived experience), 83–4, 166 Telling Tales (Neysmith, Bezanson, and O’Connell), 196 three-box framework, 199 time and space, 50 Tim Hortons, 114, 257n10 Toronto: demographics, 142; general support programs and older people, 154; homeless population statistics, 30, 32–3, 249n11; housing availability, 261n12; peach (palliative care), 256n8; shelter experience of older women, 46 Townsend, Peter, 128 trauma, 35, 131, 133, 140 Trauten, M., 192–193 Twigg, Julia, 8, 50 unemployment, see employment unequal aging, 7, 15–18, 21, 26, 44, 50, 199, 216–19, 236–7; see also disadvantage over time; late-life homelessness United Kingdom, 4, 53, 128, 199, 252–3n7 United States, 4, 53, 58, 128, 130–1, 135, 193–4, 252–3n7 University of Calgary School of Public Policy (spp ), 250n15 Vancouver: demographics, 142; homeless population statistics, 32–3, 249n11; housing availability, 261n12; housing costs, 28; and inclusion of older people, 211 veterans, 33, 41, 210

victimization, 38, 106–8, 165, 178 vies team, 159 violence, 89, 131, 133, 140, 144–5, 165, 178–80, 224 visibility: from ethnographic analysis, 9, 15, 19, 51; men vs women, 105, 107–8; older people on the street, 3–6, 89, 174; see also invisibility vulnerability: definition, 171; experiences of, 168–73, 180; foundation for an ethical response, 234; older people in need of protection, 75–9; and resilience, 219–25; systemic vs existential, 172–3 Walker, Alan, 50–1, 158–9 Walker, Carol, 158–9 Walsh, Kieran, 159–60 Wanda (participant, with lived experience), 137 Warnes, Anthony M., 52 work see employment “World Report on Ageing” (who ), 101 Yuval-Davis, Nira, 133 Yves, 135, 162