Homeless for the First Time in Later Life: Uncovering More Than One Pathway

Homeless for the First Time in Later Life: Uncovering More Than One Pathway Abstract Background and Objectives Increasingly, researchers have recognized the heterogeneity with the growing population of older homeless adults. However, scant research has considered the complex pathways into first-time homelessness from the perspective of older adults themselves. Research Design and Methods Through in-depth interviews, this constructivist grounded theory study aimed to address this gap by exploring the pathways of 15 adults, aged 50 years and older, into late-life homelessness. Results Two divergent pathways were revealed: gradual and rapid. Individuals with gradual pathways endured many years of struggle related to poor housing conditions, lack of social support, and social distress. They had reached out for support on several occasions, with little success due to their limited social capital. In contrast, for individuals with rapid moves to homelessness, multiple unanticipated losses threatened their economic and social resources and they were propelled into homelessness with little warning. Despite having access to social networks to help buffer these losses, they preferred homelessness over asking for help and being perceived as dependent. Discussion and Implications Our study revealed that different pathways into homelessness require divergent strategies of prevention and support. For individuals with gradual moves, strengthening pre-homeless social supports and addressing social distress may have mitigated the eventual loss of housing. For individuals with rapid pathways, homelessness may have been prevented if independence and self-sufficiency were less idealized in our society. Homelessness, Home, Independence, Housing, Independence, Social support, Social capital Background and Objectives Increasing numbers of older adults are remaining active in their own homes and communities well into their 80s and 90s (Golant, 2015; Wiles, Leibing, Guberman, Reeve, & Allen, 2011). At the same time, older homelessness is rising at an alarming rate (Crane & Joly, 2014; Grenier, 2016). In the United States, homeless adults aged 50 years and older increased by 20% in the last decade (Culhane, Metraux, Byrne, Stino, & Bainbridge, 2013). In Canada, recent homelessness counts in major urban centers indicate the older population has risen fourfold in the last two decades (Latimer, McGregor, Méthot, & Smith, 2015; Rowland & Hamilton, 2016). Similar rises have been reported in the United Kingdom (Crane & Joly, 2014), Japan (Okamoto, 2007), and Australia (Petersen & Parsell, 2015). Within the growing older population is a subgroup of adults who are encountering homelessness for the first time. Compared to people who have aged homeless (i.e., chronic homeless), different risk factors have been associated with first-time homelessness in later life (Burns, 2016; Grenier et al., 2016; McDonald, Dergal & Cleghorn, 2007; Petersen & Parsell, 2015, Shinn et al., 2007). This population is comprised of more women, higher levels of education, closer ties to the labor market, and in better physical and mental health (Brown et al., 2016; Lee et al., 2016; McDonald et al., 2007; Shinn et al., 2007). Relationship breakdowns (divorce, separation, death of loved ones) and lack of general social support to buffer life changes have also been identified as chief factors associated with first-time homelessness (Brown et al., 2016; Lee et al., 2016; McDonald et al., 2007). Further, this population face additional challenges exiting homelessness because of their lack of familiarity with health and social care systems (Grenier et al., 2016; McDonald et al., 2007). Although there has been increased recognition of different trajectories into late-life homelessness, a dearth of accounts from older homeless adults themselves, and a lack of qualitative studies suggests a pressing need for more research in this area. Redressing these gaps in the literature, this constructivist grounded theory study (Charmaz, 2014) sought to answer the following research questions: 1. What types of circumstances work together to contribute to first-time homelessness in later life from the perspective of older adults themselves? 2. What, if anything, might have prevented these circumstances from leading to homelessness? 3. How do older adults negotiate the circumstances leading to first-time homelessness? 4. What do older adults’ pathways into first-time homelessness reveal about different service needs? Research Design and Methods This 3-year study (2012–2015) was informed by a constructivist grounded theory (ConGT) methodolody (Charmaz, 2014). ConGT is an evolution of grounded theory (Glaser & Strauss, 1967), a research approach underpinned by symbolic interactionism (Blumer, 1969), which assumes meaning is constructed by individuals who are interacting with other people, places, and things in particular contexts. Grounded theory studies aim to unearth a range of experiences related to social processes for which little is known (Charmaz, 2014; Glaser & Strauss, 1967). Hence, ConGT was determined to be an appropriate methodology to illuminate pathways into first-time homelessness from the perspective of older adults. Participant Selection Criteria Definitions of homelessness have expanded in recent years to account for diverse housing circumstances including living on the streets, in emergency shelters, and in substandard, precarious housing (Gaetz, Donaldson, Richter & Gulliver, 2013). In this study, we decided to recruit sheltered homeless because of the documented rise in older residents and an absence of appropriate services in Montreal, Quebec (Latimer et al., 2015). In line with existing definitions of older homelessness, participants were required to be age 50 and over, (Crane et al. 2005; Grenier et al., 2016) and experiencing their first episode of homelessness. Participant Characteristics Eight men and seven women, with an age range of 50–80 years participated in this study. Three were native English speakers and 12 were French speakers. All were single; one was a widower, about one-third (6/15) were divorced or separated, and the rest were never married. Most had children (10/15), though very few (2/15) remained in regular contact with them. All but two were high school graduates. The large majority (11/15) had some post-secondary education (technical training, university, or college). Work histories were nearly evenly split between those who had sporadic employment and those who had more stable careers, many for 20 years or more. Prior to becoming homeless, most were living alone in private-market rentals (11/15), two lived in subsidized apartments, one lived in a single-room occupancy hotel, and another lived in a condominium he was sharing with his ex-wife. One-third were receiving basic social assistance (approximately $600 per month). One-fifth were receiving long-term disability (approximately $900 per month), and one reported no income. The highest income earner ($2000/month) was receiving a relatively large private pension and was the only participant slightly above Canada’s low-income cut off for a single person residing in a large urban area (Statistics Canada, 2014). Six of the 15 participants were receiving minor contribution-based pensions, yet still had lower incomes than the Canadian median for adults aged 65 years and over (Statistics Canada, 2014). The length of time homeless at the time of the interview ranged from 1 week to 3 and a half years. About half of the participants (7/15) had been homeless less than a year, and the remaining participants had been homeless less than four years (see Table 1). Table 1. Participant demographics Name  Gender  Age  $Income/month  $Rent/month  Pre-homeless housing  Months homeless  Housing Status at interview  Mathilde  F  80  2000  570  PMR  <1  S  Danny  M  50  708  N/A  O  <1  S  Anna  F  61  770  300  SH  <1  S  Chris  M  54  1600  N/A  PMR  1  S  Florence  F  62  513  350  PMR  1  S  Tiger  M  58  1040  560  PMR  2  S  David  M  70  1347  500  PMR/O  2  S  Pete  M  58  719  N/A  PMR  4  S  Carole  F  51  604  300  PMR  5  S  Marc  M  58  1029  360  RH  6  S  Isabelle  F  64  1400  705  PMR  7  S  Patrice  M  68  1300  380  SH  12  A  Charlotte  F  64  740  596  PMR  18  S  Jean  M  60  800  200  SH  17  S  Nicole  F  54  1100  N/A  PMR  36  T  Name  Gender  Age  $Income/month  $Rent/month  Pre-homeless housing  Months homeless  Housing Status at interview  Mathilde  F  80  2000  570  PMR  <1  S  Danny  M  50  708  N/A  O  <1  S  Anna  F  61  770  300  SH  <1  S  Chris  M  54  1600  N/A  PMR  1  S  Florence  F  62  513  350  PMR  1  S  Tiger  M  58  1040  560  PMR  2  S  David  M  70  1347  500  PMR/O  2  S  Pete  M  58  719  N/A  PMR  4  S  Carole  F  51  604  300  PMR  5  S  Marc  M  58  1029  360  RH  6  S  Isabelle  F  64  1400  705  PMR  7  S  Patrice  M  68  1300  380  SH  12  A  Charlotte  F  64  740  596  PMR  18  S  Jean  M  60  800  200  SH  17  S  Nicole  F  54  1100  N/A  PMR  36  T  Note: A = apartment; PMR = private market rental; O = owner; RH = rooming housing; SH = subsidized housing; Housing status: S = shelter; T = transitional housing. N/A = lost home in divorce, couch surfing, live-in janitor, co-residing and not paying rent. View Large Table 1. Participant demographics Name  Gender  Age  $Income/month  $Rent/month  Pre-homeless housing  Months homeless  Housing Status at interview  Mathilde  F  80  2000  570  PMR  <1  S  Danny  M  50  708  N/A  O  <1  S  Anna  F  61  770  300  SH  <1  S  Chris  M  54  1600  N/A  PMR  1  S  Florence  F  62  513  350  PMR  1  S  Tiger  M  58  1040  560  PMR  2  S  David  M  70  1347  500  PMR/O  2  S  Pete  M  58  719  N/A  PMR  4  S  Carole  F  51  604  300  PMR  5  S  Marc  M  58  1029  360  RH  6  S  Isabelle  F  64  1400  705  PMR  7  S  Patrice  M  68  1300  380  SH  12  A  Charlotte  F  64  740  596  PMR  18  S  Jean  M  60  800  200  SH  17  S  Nicole  F  54  1100  N/A  PMR  36  T  Name  Gender  Age  $Income/month  $Rent/month  Pre-homeless housing  Months homeless  Housing Status at interview  Mathilde  F  80  2000  570  PMR  <1  S  Danny  M  50  708  N/A  O  <1  S  Anna  F  61  770  300  SH  <1  S  Chris  M  54  1600  N/A  PMR  1  S  Florence  F  62  513  350  PMR  1  S  Tiger  M  58  1040  560  PMR  2  S  David  M  70  1347  500  PMR/O  2  S  Pete  M  58  719  N/A  PMR  4  S  Carole  F  51  604  300  PMR  5  S  Marc  M  58  1029  360  RH  6  S  Isabelle  F  64  1400  705  PMR  7  S  Patrice  M  68  1300  380  SH  12  A  Charlotte  F  64  740  596  PMR  18  S  Jean  M  60  800  200  SH  17  S  Nicole  F  54  1100  N/A  PMR  36  T  Note: A = apartment; PMR = private market rental; O = owner; RH = rooming housing; SH = subsidized housing; Housing status: S = shelter; T = transitional housing. N/A = lost home in divorce, couch surfing, live-in janitor, co-residing and not paying rent. View Large Data Collection and Analysis All of the interviews were face to face, semi-structured, and conducted by the first author in either English or French at a location that was most convenient to participants (most often a private office space at the shelter). The initial interview guide included broad questions focusing on experiences of becoming homeless (e.g., Can you tell us how to came to live at the shelter? How did you feel your first night at the shelter?). At the end of each interview, participants were asked a series of sociodemographic questions regarding age, gender, ethnicity, marital status, education, language, employment, and sources of income. Trustworthiness of the findings was promoted by maintaining a rigorous audit trail which included the coded transcripts, case summaries, and on-going memos. Each interview was transcribed in its original language and transferred to Dedoose (2016), a web-based password-protected qualitative software program. After each interview, the authors wrote 8–10-page case summaries for each participant, an important step in advancing grounded theory analysis (Charmaz, 2014). The case summaries were used for cross case comparisons to identify divergent and similar trajectories into homelessness. After each interview, the two authors conducted line-by-line coding using gerunds, a hallmark of grounded theory that ensures an analysis remains close to the data (Charmaz, 2014; Glaser & Strauss, 1967). Examples of initial codes included “battling housing conditions,” “resisting help,” “feeling desperate,” “managing substandard housing,” and “seeking assistance”. Very early on, the two authors noticed two different pathways into homelessness based on pre-homeless housing stability: one more rapid and another more gradual. Becoming homeless also appeared to be a process that could extend beyond the physical loss of housing, which led to more extensive coding considering the distinction between being homeless and being housed. To flesh out these emerging categories, guided by grounded theory’s central tenet of theoretical sampling (Glaser & Strauss, 1967), the first author began to ask more focused questions regarding housing histories and the meaning of home (e.g., Can you describe your housing history specifically in relation to the relationship with your landlord, family, roommates, and/or neighbors?). Initial codes were brought up to a higher level of abstraction by comparing and contrasting them to sensitizing concepts (Glaser & Strauss, 1967) (e.g., home, place attachment, successful aging). An iterative process of coding and returning to the field to purposely sample additional participants continued until the theoretical categories were sufficiently filled out (a total of 15 participants were interviewed). The two authors consolidated their conceptual memos into a working draft of a manuscript that took shape around the core category: two divergent pathways into homelessness: gradual and rapid. We refer to theoretical sufficiency (Dey, 1999) rather than the more common concept of saturation because it recognizes that the theoretical lens and sensitivities researchers bring to the analytic process, shapes data analysis. The idea that new constructions of theory can emerge from the same data aligns well with ConGT which is situated in a constructivist paradigm (Guba & Lincoln, 1994). Co-conducting the analysis by researchers with different theoretical approaches also enhanced the study’s theoretical sensitivity, which in turn reinforced the originality and trustworthiness of the findings (Charmaz, 2014). Results Two Divergent Pathways into Homelessness: Gradual and Rapid All participants described complex, nuanced circumstances contributing to their pathway into homelessness. However, their housing circumstances, help-seeking behaviors, and reactions to homelessness were distinguished by two divergent pathways: gradual and rapid. Participants with gradual pathways lived in precarious housing circumstances, with little to no social support, and high levels of social distress (e.g., conflicts with roommates and landlords). These circumstances were endured for extended periods of time before physically losing their housing. Despite facing these challenges, many strived to improve their circumstances by reaching out for support and engaging in personal, creative strategies to maintain their housing. However, after years of seeking out help, they were unable to maintain their housing. Many expressed relief to finally receive support from a homeless shelter as Anna stated: Anyway, my toilet blocks often and the housing manager tells me that it’s my responsibility because I don’t put the right things in it! It blocks because it doesn’t work properly! And the last time, I would have to pay, and it would be over $200…the apartment is really not suited for me because of the materials. I am not able to maintain it. I have difficulties maintaining it. Here [the homeless shelter], it’s the best thing that could have happened to me, because I really had to get the hell out of where I was living! After 22 years, I am really, really burnt out. I’m very broken, psychologically and physically. I am exhausted. I couldn’t stay at home, all by myself with all those problems. In contrast, participants with rapid pathways tended to describe strong attachment to their housing that had been suddenly threatened by a series of losses that completely overturned their circumstances. Most resisted asking for help, and came to the shelter devastated by their losses. For example, David, whose life spiraled out of control following the sudden deaths of his mother, wife, and daughter, described the despair he felt when he ended up homeless: Losing them, let’s just say it evaporates over time. It’s the fact that I wake up like I am here that I can’t accept … homeless … in the street. I sold everything, every single thing! I never thought I’d end up like this. It’s like starting from zero. Although individuals with gradual pathways lacked social support, felt socially isolated, and battled social distress for years and in some cases decades, the rapid group’s social support system crumbled suddenly. Compared to individuals with gradual pathways, this group had more ready access to social networks to help buffer intense shocks and losses (e.g., closer ties to family, the labor market and friends), yet resisted asking for help as they feared losing their independent sense of self. Both pathways and their associated impact are pictorially depicted in Figure 1 and described further in the sections below. Figure 1. View largeDownload slide Two divergent pathways into first-time homelessness in later life: rapid and gradual. Figure 1. View largeDownload slide Two divergent pathways into first-time homelessness in later life: rapid and gradual. Gradual Pathways: Feeling “Homeless at Home” Participants with gradual pathways experienced greater housing instability and felt what Bennett (2011) refers to as feeling “homeless at home” for extended periods of time. This instability was linked to social distress, interpersonal conflicts with housing administration, neighbors, and/or roommates. For instance, for Jean, who had been experiencing ongoing harassment from the building’s janitor for over two decades, explained how he did not feel at home because his capacity to socialize with others in his apartment was compromised: It’s that he wouldn’t stop harassing me. For nothing. I had a friend who would come over, and he said, hey, I saw a guy at your place yesterday, I saw him go in by the back balcony. I was thinking, you spy on everyone like that? And then he said, I don’t like his face and I don’t want to see him at your place. Marc, who had been residing in a rooming house for 13 years, also described an ongoing conflict with the janitor combined with feelings of insecurity due to a constant presence of drug dealers in his building. When an ongoing bed bug problem that was not being properly taken care of overcame his possessions, he explained that what began as a hassle increasingly took control of his life. He was frustrated that the landlord was not taking proper measures to fix the problem: The problem with the bed bugs wasn’t fixed after a few exterminations. He [janitor] needed to hire a specialist, but he didn’t. He wanted to do it himself and save money and the problem always came back. Feeling homeless at home was also linked to long-term feelings of social isolation and loneliness related to family breakdown. For instance, Charlotte explained that since her divorce over 20 years ago, she has lived alone and never really felt at home, because for her, home is a place that is shared with family: The difference between my apartment and my home is that my home was our home, it was a shared environment, whereas my apartment, I don’t call it my home, it was my apartment, to me there’s a difference, home to me includes other people, because that’s what makes any place a home because you have people with you. In many ways, the social support obtained while residing at the homeless shelter seemed to fill a crucial social gap that existed when participants with gradual pathways were housed, as Tiger expressed: I got a family here. It’s not the same as the family you’re used to though. It’s like family here, I said to one of the service providers, you’re like a sister to me, I said, at least you and me are talking, my sister and me haven’t had a conversation in I don’t know how long. In sum, people with gradual pathways had been struggling for extended periods with intolerable housing conditions, lack of social supports, and social distress within their housing complexes. With minimal economic and social resources to move elsewhere, they were essentially homeless before physically losing their housing. Strikingly, despite their limited resources and difficult housing circumstances they managed to resist the loss of their housing for years and in some cases decades. Strategies of Resistance: Stopping at Nothing to Maintain Housing Participants with gradual pathways had little to no family or friends, and reached out for help to various organizations before coming to the shelter; however, their housing remained precarious. Active efforts to maintain housing were exemplified by Anna, who took many measures to prevent her homelessness: I went to a community organization X to see about how to manage my budget better, and I’m on a waiting list. They haven’t called me. So I haven’t been able to find a solution. I got behind in rent a couple months and I tried to fix it myself but I don’t have the financial resources, and I don’t have family or friends I can count on to help me out either. So to get out of this situation, I went towards the community resources that society offers to me. It’s certainly not my ideas that are lacking. I put a letter together listing all of the steps I’ve taken to find a solution that I would present to the housing administration, so that they would know that I was trying to find a solution, so they’d know that I wasn’t dicking off, if you know what I mean? Several participants spoke of submitting applications for subsidized housing but were on long waiting lists, as Marc expressed: I submitted applications for low-income housing, I’ve been on the waiting list, seven years is a long time, especially at my age. As extreme poverty was a more common characteristic amongst people in the gradual group (some participants were paying more than 80% of their income on rent), in addition to reaching out for external help, they engaged in creative personal strategies on a regular basis to maintain their housing. Such strategies included stretching their budgets by sharing meals with neighbors, using food banks, and repurposing household objects found in the garbage, as Charlotte explained: Because I know what it is to have no money and how for me then, I had after my rent, and one bill and hydro, and laundry I had $60 left. You don’t go anywhere on $60 so I started filling the blank by rescuing, repurposing things that were in the recycling or the garbage or whatever. Some also moved in with roommates to split the cost of rent, which as Tiger points out, created different problems for them: I had a roommate but I kicked her out, she was always texting at night when I was trying to sleep. She was drinking and she wasn’t supposed to be. I didn’t have the nerve to call the police and say that she was breaking a condition, she’s drinking. I said you’re out of here. She took the key I gave her and threw it, and missed my TV by about two inches. Several participants recognized that with age, they had more difficulty coping with daily stressors as Jean expressed: You know, I’m 60, I’m not 20 anymore. So that’s what makes you tired, you get stressed. So after that, they give you pills as a solution. I told the doctor, sorry I didn’t come here for pills, I came for housing. You know, I didn’t learn how to be a social worker, where to get the applications for the co-op. Many experienced relief when they came to the homeless shelter. For instance, Patrice explained that the help he received from one service provider provided him with new found hope for the future: I think it took becoming homeless to start to express myself. You know, I didn’t trust anyone.… Through this organization, I met a service provider who I could talk to, and it all came out, from my childhood [on verge of tears]. She liberated me. She let me talk and when she listened, I explained my story, I even cried. It all came out. In sum, participants engaged in creative strategies to meet their financial obligations and remain housed. When their housing conditions continued to deteriorate they explored all available avenues for improving their housing circumstances including applying for subsidized housing, and seeking assistance and guidance from community agencies. Eventually, the precariousness of their situations coupled with a lack of social support and suitable housing options resulted in the loss of their housing. Having endured this hardship on their own for many years going to shelter offered a sense of relief because it provided the instrumental and social support they were sorely lacking. Rapid Pathways: Abrupt Life Changes and Shocks Contributed to Homelessness Participants with rapid pathways tended to have stable personal and housing histories and were generally satisfied with their housing circumstances. For instance, David, who was married, had two children and worked four decades as an accountant, spoke fondly of his former apartment, where he resided for 27 years before becoming homeless: Yes, well, they would say out of the 22 apartments, they would say we had the nicest one, the nicest 4.5 out of the 22, because it was all decorated. I had paintings of [name’s painter] who was actually one of my clients. Mathilde, a retired nurse, expressed feeling attached to her apartment that she was forced to move out of because she was longer able to navigate the stairs: I: When you said that it made you sad to move, can you explain what you meant? M: You know, it grabs you right here (puts hand on her chest). The landlord and I took each other in our arms. I liked him a lot. We both cried. Individuals with rapid pathways often understood their homelessness as being associated with intense social losses. Some, such as David, experienced the loss of numerous loved ones or family breakdown. Others described experiencing a health crisis or injury in later life that disrupted their careers. For instance, Danny, a chef who had previously owned a condominium with his wife, described his “life changing dramatically in 24 hours.” Within a year, he went through a divorce, was diagnosed with cancer, and lost a well-paying job. In contrast to many participants with gradual pathways who were relieved to come to the shelter, he was in complete shock: It’s a living hell. My first night, I was crying. I said fuck wow! Even now, I have difficulty understanding what happened. I’m talking to you, but I haven’t talked to anyone about it. I really don’t understand what happened over the past eight months. It’s like a living nightmare. I had a normal life and it all fell apart! You know, I understand that I was sick, but not everyone who is sick ends up with their life in shambles! There is something that happened somewhere, in order for this to happen, it just doesn’t make sense! Along similar lines, after working 25 years for a government agency, Carole was diagnosed with cancer, lost her job, and was shocked to find herself homeless within a year: There are days where I sense how damaged my ego is. There are days where I feel I am going crazy. Frustrated, and you ask yourself so many questions. How it is possible to pay for housing your entire life and this happens? You feel sorry for yourself. I don’t understand how it got to this point, I understand in a way, I had cancer, I had an alcohol problem that is connected to it, but does life have to be this punitive? You know? I am trying to get out; I am trying and then pouf! I end up where I started. Pete, who was forced to stop working after experiencing a back injury, described how he felt his first night at the shelter: My first night here, all I could think about was suicide. How did I end up here? When I think a lot to myself, what the hell am I doing? I can’t work. What can I do for the society?” Individual with rapid pathways faced multiple losses that changed their social and economic situations dramatically. With little time to absorb these changes and a long history of independence, they were unable to access timely support. As a result, they experienced the simultaneous loss of house and home making their entry into a homeless shelter one of shock, disbelief, and intense shame. Strategies of Resistance: Preserving an Independent Sense of Self at All Costs Most participants with rapid moves to homelessness had family and friends they could have drawn on for support. However, many felt this option was so threatening to their sense of self-sufficiency and independence that they could not bring themselves to ask for assistance as Carole stated: It’s not that my daughter is mean or anything, or that we don’t get along. Helping my daughter out doesn’t bother me, but having her see me in this state is difficult. I can swallow my pride, but there is a limit! This group engaged in personal strategies to maintain their independence at all costs. For instance, some continued to work even though their health struggles made it difficult for them. This was the case for Florence, who suffered from severe arthritis and mobility issues, yet continued to clean houses, as it prevented her from needing to ask for help from her children: For sure, my kids have their own life too. My daughter left for Tunisia for a bit. You know, I can’t always, I can’t impose too much on their lives. My son is in Cuba. It’s not easy. Being older seemed to compound the shame of asking for help. For instance, when asked about his perception of some of the differences and additional challenges between being younger and being over 50 and homeless, Pete noted: The young ones they use the system, they get high, but the old ones, it’s like they are afraid to ask or they forget and they think they are too much of a bother … what do you call that? A burden. There was a time there where I lost confidence, I am usually a good survivor but I think sometimes when you get older there is a little bit of pressure that comes in. I don’t know if it is the lack of youth or something like that. Overall, individuals with rapid pathways tended to have pre-homeless histories characterized by more stable work, personal, and housing circumstances. When multiple unanticipated losses threatened their economic and social resources, they worked hard to maintain their independence and their housing. However, their long history of self-sufficiency came to a devastating and traumatic end when they were forced to enter a homeless shelter and accept their need for assistance. Discussion and Implications Two Different Pathways into Homelessness: Gradual and Rapid This qualitative study explored pathways into first-time homelessness in later life from the perspective of older adults themselves. Although research has begun to distinguish between the characteristics, needs, and experiences of newly homeless older adults (Crane et al., 2005; McDonald et al., 2007; Petersen & Parsell, 2015), our study makes an important contribution by presenting two different pathways into first-time homelessness: gradual and rapid. Participants with gradual pathways had long histories of housing instability, enduring many years of poor housing conditions, lack of support, and social distress. However, they managed to stay housed through their creativity, determination, and innovative problem-solving. This group was quick to identify their homelessness could have been avoided had they had more ready access to suitable housing and social support. Many expressed relief when they became homeless, as the shelter provided built-in support from service providers and residents, and a general reprieve from the stress related to their housing circumstances. In contrast, participants with rapid moves had relatively stable histories of work, housing, and family lives, a finding consistent with existing literature on newly homeless older adults (Brown et al., 2016; McDonald et al., 2007; Petersen & Parsell, 2015; Shinn et al., 2007). Our findings build on this work by qualitatively highlighting that not only did this group experience an intense series of shocks in later life, they resisted asking for help because of internalized concerns that reaching out to existing social networks was shameful and to be avoided. These reactions made becoming homeless that much more devastating and humiliating. They also seemed to have less insight into what may have prevented their homelessness, likely because they were still in a state of shock and disbelief at the time of the interview. Although pathways into late-life homelessness were diverse, lack of suitable housing coupled with insufficient social support in times of vulnerability were chief factors leading to late-life homelessness in both groups. Thus, in agreement with previous research (McDonald et al., 2007; Petersen & Parsell, 2015) we recommend an influx on affordable, quality housing with varying types and levels of support is a promising strategy to preventing late-life homelessness. However, we also recommended specific policy implications for each pathway. Preventing Invisible Homelessness by Building Social Capital The gradual group were part of what Gaetz et al. (2013) refer to as the invisible homeless, in that they were living in substandard precarious housing for years before physically losing their housing. They also had long histories of isolation and a scarcity of support and care networks. In other words, they lacked social capital (Putnam, 2000), which has demonstrated to be a key factor in promoting aging in place (Cramm, van Dikj, & Nieboer, 2012). Additionally, their housing instability was exacerbated by high levels of negative social capital (Bassuk, Mickelson, Bissell, & Perloff, 2002) as they battled ongoing interpersonal conflicts with janitors and neighbors. Advancing previous research recommending that identifying those with the highest risk of losing housing is needed to prevent chronic homelessness (Brown et al., 2016; Lee et al., 2016; McDonald et al., 2007), we suggest preventing homelessness through joint outreach work between the homeless and gerontology sectors (e.g., home care). Specifically, these joint interventions need to focus on creative ways to build social capital. For instance, when a person gets on a housing list for subsidized housing they could be automatically offered support and case management services to cope with their conditions and attain help building a network of support while waiting. This could include being connected to voluntary services to help with small domestic jobs; receiving support to address conflicts with neighbors and janitors; and receiving support with system navigation. These formal support networks would work in conjunction with people’s individual strategies to buffer many of the housing and social stressors that contributed to entering homelessness. Preventing Rapid Moves to Homelessness by Redefining Independence Participants with rapid pathways had more social capital and the advantages associated with it for most of their lives. However, when faced with intense life changes and shocks, they were reticent to ask for help form their existing social networks as they feared appearing dependent. Their reaction seems to be connected to widespread messaging around “successful aging” being equated with remaining independent at all costs (Katz & Calasanti, 2015). Asking for help meant depending on others and relinquishing an independent self of self, which was worse than becoming homeless. One important preventative strategy to mitigate this risk would be to contest dichotomies of dependence/independence through social media and public policies. If messaging continues regarding maintaining independence at all costs, older people will continue to experience various forms of shame around reaching out for help, and may ultimately risk becoming homeless. On a more micro level, individuals who more closely resemble the rapid group, may benefit from rapid housing coupled with intensive time-limited support to work through their feelings of shock disbelief and damaged sense of selves. Given their long histories of housing success, consistent with previous research (Brown et al., 2016), our findings show that these individuals may not require intensive and ongoing case management to help preserve their housing. However, without time limited intensive support their despair could become chronic and enduring. Revisiting Rehousing Interventions: No One-Size-Fits-All Solution Over the past two decades there has been a wholesale policy shift towards Housing First (HF) rapid rehousing models that promote living independently, most often in private market scattered-site housing with off-site supports (Goering et al., 2014, Padgett, Henwood & Tsemberis, 2015; Tsemberis & Eisenberg, 2000). HF has been widely embraced by communities in the Western world as it has demonstrated to be a highly successful rehousing strategy particularly for its target population: chronically homeless adults (Goering et al., 2014). Specifically, in order to access most HF programs, individuals are required to be visibly homeless (living in a shelter or on the streets) for a minimum length of time (six months to one year). Based on this criteria, most study participants would be not quality for HF programs because they would be considered too “new.” Moreover, it seems that many individuals in the gradual group have benefited from the intensive case management provided by HF models; however, in order to qualify they had to become visibly homeless. Thus, we recommend the eligibility requirements be expanded and made more flexible to give the opportunity to the invisible homeless and/or very recent sheltered or street homeless (less than six months) to access and potentially benefit from the program. However, this study also highlights that independent living in scattered-site apartments may not be appropriate for older adults with low levels of social capital. Research suggests that living alone can reinforce process of exclusion for older adults, because they are more socially isolated than any other age group and have additional health and social needs (Crane & Warnes, 2007; McDonald et al., 2007). Despite these recognized vulnerabilities, scant research has considered alternative types of supportive housing that may better promote housing stability, health, and well-being in older groups. We are inspired by congregate housing models with on-site support that have demonstrated to promote housing stability while also building a sense of community with vulnerable subgroups of homeless individuals such as Aboriginal women (Klodawsky, 2009). Overall, HF is only one approach to combat homelessness—given the diversity with the older homeless population, more research is needed towards developing innovative supportive housing that not only houses people but promotes a sense of “home.” Limitations and Future Research There are several limitations to our study. The study was conducted in Montreal and may not be transferable to other contexts. Although rich data was obtained from each interview, in some cases follow-up interviews with additional participants were requested but not possible, as participants’ contact information had changed. We only included the emergency sheltered homeless, and overlooked other environments older homeless reside including institutions, transitional housing, and cohabitating unstably which have been identified in previous research (Lee et al., 2016). Although the participants in this study had diverse backgrounds and pathways into homelessness, they shared a number of identity markers (e.g., all self-identified as white, were born in Canada, and had French or English as their mother tongue). Thus, their pathways into homelessness may not be applicable to subgroups of older adults (e.g., immigrants, transsexual men) who may face added discrimination and stigma. Despite these limitations, conceptualizing two divergent pathways into first-time homelessness provided a greater conceptual understanding of late-life homelessness and many useful jumping-off points for future research. Conclusion This study shed light on two different pathways into late-life homelessness: rapid and gradual. Each group had divergent needs and experiences and would likely benefit from different interventions. Individuals with gradual pathways felt homeless well before losing their physical housing, as a consequence of enduring many years of struggle related to poor housing conditions, lack of social support, and social distress. Intensive case management or informal support from community groups and volunteers may have mitigated their eventual loss of housing by supplementing their creative strategies for remaining housed. For individuals with rapid pathways, homelessness may have been prevented if independence and self-sufficiency were not so valorized in our society. Changes around the stigma of aging and homelessness are needed to ensure that older adults feel able to ask for help in times of vulnerability, and that when they do they have ready access to suitable, affordable housing with appropriate supports. Acknowledgments We would like to thank Oliver Fugler from Queer Editing for his editorial contribution. References Bassuk, E. L., Mickelson, K. D., Bissell, H. D., & Perloff, J. N. ( 2002). Role of kin and nonkin support in the mental health of low-income women. The American Journal of Orthopsychiatry , 72( 1), 39– 49. doi: 10.1037/0002-9432.72.1.39 Google Scholar CrossRef Search ADS PubMed  Bennett, K. ( 2011). Homeless at home in East Durham. Antipode , 43( 4), 960– 985. doi: 10.1111/j.1467-8330.2010.00788.x Google Scholar CrossRef Search ADS   Blumer, H. ( 1969). Symbolic interactionism: Perspective and method . Englewood Cliffs, NJ: Prentice Hall. Brown, RT., Hemati, K., Riley, E.D., Lee, C.T., Ponath, C., Tieu, L.et al.   ( 2016). Geriatric conditions in a population based sample of older homeless adults. Gerontologist . 2016. pii: gnw011. doi: 10.1093/geront/gnw011 Burns, V. F. ( 2016). Oscillating in and out of place: Experiences of older adults residing in homeless shelters in Montreal, Quebec. Journal of Aging Studies , 39, 11– 20. doi: 10.1016/j.jaging.2016.08.001 Google Scholar CrossRef Search ADS PubMed  Charmaz, K. ( 2014). Constructing grounded theory  ( 2nd edn). Thousand Oaks, CA: Sage. Cramm, J. M., van Dijk, H. M., & Nieboer, A. P. ( 2013). The importance of neighborhood social cohesion and social capital for the well being of older adults in the community. The Gerontologist , 53( 1), 142– 152. doi: 10.1093/geront/gns052 Google Scholar CrossRef Search ADS PubMed  Crane, M., Byrne, K., Fu, R., Lipmann, B., Mirabelli, F., Rota-Bartelink, A.,… Warnes, A. M. ( 2005). The causes of homelessness in later life: findings from a 3-nation study. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences , 60( 3), S152– S159. doi: 10.1093/geronb/60.3.S152 Google Scholar CrossRef Search ADS   Crane, M., & Warnes, A. M. ( 2007). The outcomes of rehousing older homeless people: a longitudinal study. Ageing & Society , 27(6), 891– 918. doi: 10.1017/S0144686X07006319 Google Scholar CrossRef Search ADS   Crane, M., & Joly, L. ( 2014). Older homeless people: Increasing numbers and changing needs. Reviews in Clinical Gerontology , 24, 255– 268. doi: 10.1017/S095925981400015X Google Scholar CrossRef Search ADS   Culhane, D. P., Metraux, S., Byrne, T., Stino, M., & Bainbridge, J. ( 2013). The age structure of contemporary homelessness: Evidence and implications for public policy. Analyses of Social Issues and Public Policy , 13( 1), 228– 244. doi: 10.1111/asap.12004 Google Scholar CrossRef Search ADS   Dedoose (2016). Web application for managing, analyzing, and presenting qualitative and mixed method research data (version 7.0.23) [software]. Los Angeles, CA: SocioCultural Research Consultants, LLC. Retrieved from www.dedoose.com Dey, I. (1999). Grounding grounded theory. San Diego, CA: Academic Press. Gaetz, S., Donaldson, J., Richter, T., & Gulliver, T. ( 2013). The state of homelessness in Canada 2013. Retrieved November 2, 2016 from http://www.homelesshub.ca/Library/The-State-of-Homelessness-in-Canada-2013–55941.aspx Glaser, B. G., & Strauss, A. L. ( 1967). The discovery of grounded theory . Chicago, IL: Aldine. Goering, P., Veldhuizen, S., Watson, A., Adair, C., Kopp, B., Latimer, E., … Aubry, T. ( 2014). National at Home/Chez Soi Final Report . Retrieved January 2, 2018 from https://www.mentalhealthcommission.ca/English/document/24376/national-homechez-soi-final-report Golant, S. ( 2015). Aging in the right place . Baltimore, MD: Health Professions Press. Grenier, A., Barken, R., Sussman, T., Rothwell, D., Bourgeois-Guérin, V., & Lavoie, J. P. ( 2016). A literature review of homelessness and aging: Suggestions for a policy and practice-relevant research agenda. 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Retrieved January 2, 2018 from https://ville.montreal.qc.ca/pls/portal/docs/page/d_social_fr/media/documents/rapport_denombrement_personnes_situation_itinerance.pdf Lee, C. T., Guzman, D., Ponath, C., Tieu, L., Riley, E., & Kushel, M. ( 2016). Residential patterns in older homeless adults: Results of a cluster analysis. Social Science & Medicine , 153, 131– 140. doi: 10.1016/j.socscimed.2016.02.004 Google Scholar CrossRef Search ADS   McDonald, L., Dergal, J., & Cleghorn, L. ( 2007). Living on the margins: older homeless adults in Toronto. Journal of Gerontological Social Work , 49( 1–2), 19– 46. doi: 10.1300/J083v49n01_02 Google Scholar CrossRef Search ADS PubMed  Okamoto, Y. ( 2007). A Comparative study of homelessness in the United Kingdom and Japan. Journal of Social Issues , 63( 3), 525– 542. doi: 10.1111/j.1540-4560.2007.00522.x Google Scholar CrossRef Search ADS   Padgett, D., Henwood, B., & Tsemberis, S. ( 2015). 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Journal of Health Psychology , 12( 5), 696– 708. doi: 10.1177/1359105307080581 Google Scholar CrossRef Search ADS PubMed  Statistics Canada. ( 2014). Canadian Incomes (2014) . Retrieved from: http://www.statcan.gc.ca/daily-quotidien/160708/dq160708b-eng.htm Tsemberis, S., & Eisenberg, R. F. ( 2000). Pathways to housing: supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatric services (Washington, D.C.) , 51( 4), 487– 493. doi: 10.1176/appi.ps.51.4.487 Google Scholar CrossRef Search ADS PubMed  Wiles, J. L., Leibing, A., Guberman, N., Reeve, J., & Allen, R. E. ( 2012). The meaning of “aging in place” to older people. The Gerontologist , 52( 3), 357– 366. doi: 10.1093/geront/gnr098 Google Scholar CrossRef Search ADS PubMed  © The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The Gerontologist Oxford University Press

Homeless for the First Time in Later Life: Uncovering More Than One Pathway

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© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
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Abstract

Abstract Background and Objectives Increasingly, researchers have recognized the heterogeneity with the growing population of older homeless adults. However, scant research has considered the complex pathways into first-time homelessness from the perspective of older adults themselves. Research Design and Methods Through in-depth interviews, this constructivist grounded theory study aimed to address this gap by exploring the pathways of 15 adults, aged 50 years and older, into late-life homelessness. Results Two divergent pathways were revealed: gradual and rapid. Individuals with gradual pathways endured many years of struggle related to poor housing conditions, lack of social support, and social distress. They had reached out for support on several occasions, with little success due to their limited social capital. In contrast, for individuals with rapid moves to homelessness, multiple unanticipated losses threatened their economic and social resources and they were propelled into homelessness with little warning. Despite having access to social networks to help buffer these losses, they preferred homelessness over asking for help and being perceived as dependent. Discussion and Implications Our study revealed that different pathways into homelessness require divergent strategies of prevention and support. For individuals with gradual moves, strengthening pre-homeless social supports and addressing social distress may have mitigated the eventual loss of housing. For individuals with rapid pathways, homelessness may have been prevented if independence and self-sufficiency were less idealized in our society. Homelessness, Home, Independence, Housing, Independence, Social support, Social capital Background and Objectives Increasing numbers of older adults are remaining active in their own homes and communities well into their 80s and 90s (Golant, 2015; Wiles, Leibing, Guberman, Reeve, & Allen, 2011). At the same time, older homelessness is rising at an alarming rate (Crane & Joly, 2014; Grenier, 2016). In the United States, homeless adults aged 50 years and older increased by 20% in the last decade (Culhane, Metraux, Byrne, Stino, & Bainbridge, 2013). In Canada, recent homelessness counts in major urban centers indicate the older population has risen fourfold in the last two decades (Latimer, McGregor, Méthot, & Smith, 2015; Rowland & Hamilton, 2016). Similar rises have been reported in the United Kingdom (Crane & Joly, 2014), Japan (Okamoto, 2007), and Australia (Petersen & Parsell, 2015). Within the growing older population is a subgroup of adults who are encountering homelessness for the first time. Compared to people who have aged homeless (i.e., chronic homeless), different risk factors have been associated with first-time homelessness in later life (Burns, 2016; Grenier et al., 2016; McDonald, Dergal & Cleghorn, 2007; Petersen & Parsell, 2015, Shinn et al., 2007). This population is comprised of more women, higher levels of education, closer ties to the labor market, and in better physical and mental health (Brown et al., 2016; Lee et al., 2016; McDonald et al., 2007; Shinn et al., 2007). Relationship breakdowns (divorce, separation, death of loved ones) and lack of general social support to buffer life changes have also been identified as chief factors associated with first-time homelessness (Brown et al., 2016; Lee et al., 2016; McDonald et al., 2007). Further, this population face additional challenges exiting homelessness because of their lack of familiarity with health and social care systems (Grenier et al., 2016; McDonald et al., 2007). Although there has been increased recognition of different trajectories into late-life homelessness, a dearth of accounts from older homeless adults themselves, and a lack of qualitative studies suggests a pressing need for more research in this area. Redressing these gaps in the literature, this constructivist grounded theory study (Charmaz, 2014) sought to answer the following research questions: 1. What types of circumstances work together to contribute to first-time homelessness in later life from the perspective of older adults themselves? 2. What, if anything, might have prevented these circumstances from leading to homelessness? 3. How do older adults negotiate the circumstances leading to first-time homelessness? 4. What do older adults’ pathways into first-time homelessness reveal about different service needs? Research Design and Methods This 3-year study (2012–2015) was informed by a constructivist grounded theory (ConGT) methodolody (Charmaz, 2014). ConGT is an evolution of grounded theory (Glaser & Strauss, 1967), a research approach underpinned by symbolic interactionism (Blumer, 1969), which assumes meaning is constructed by individuals who are interacting with other people, places, and things in particular contexts. Grounded theory studies aim to unearth a range of experiences related to social processes for which little is known (Charmaz, 2014; Glaser & Strauss, 1967). Hence, ConGT was determined to be an appropriate methodology to illuminate pathways into first-time homelessness from the perspective of older adults. Participant Selection Criteria Definitions of homelessness have expanded in recent years to account for diverse housing circumstances including living on the streets, in emergency shelters, and in substandard, precarious housing (Gaetz, Donaldson, Richter & Gulliver, 2013). In this study, we decided to recruit sheltered homeless because of the documented rise in older residents and an absence of appropriate services in Montreal, Quebec (Latimer et al., 2015). In line with existing definitions of older homelessness, participants were required to be age 50 and over, (Crane et al. 2005; Grenier et al., 2016) and experiencing their first episode of homelessness. Participant Characteristics Eight men and seven women, with an age range of 50–80 years participated in this study. Three were native English speakers and 12 were French speakers. All were single; one was a widower, about one-third (6/15) were divorced or separated, and the rest were never married. Most had children (10/15), though very few (2/15) remained in regular contact with them. All but two were high school graduates. The large majority (11/15) had some post-secondary education (technical training, university, or college). Work histories were nearly evenly split between those who had sporadic employment and those who had more stable careers, many for 20 years or more. Prior to becoming homeless, most were living alone in private-market rentals (11/15), two lived in subsidized apartments, one lived in a single-room occupancy hotel, and another lived in a condominium he was sharing with his ex-wife. One-third were receiving basic social assistance (approximately $600 per month). One-fifth were receiving long-term disability (approximately $900 per month), and one reported no income. The highest income earner ($2000/month) was receiving a relatively large private pension and was the only participant slightly above Canada’s low-income cut off for a single person residing in a large urban area (Statistics Canada, 2014). Six of the 15 participants were receiving minor contribution-based pensions, yet still had lower incomes than the Canadian median for adults aged 65 years and over (Statistics Canada, 2014). The length of time homeless at the time of the interview ranged from 1 week to 3 and a half years. About half of the participants (7/15) had been homeless less than a year, and the remaining participants had been homeless less than four years (see Table 1). Table 1. Participant demographics Name  Gender  Age  $Income/month  $Rent/month  Pre-homeless housing  Months homeless  Housing Status at interview  Mathilde  F  80  2000  570  PMR  <1  S  Danny  M  50  708  N/A  O  <1  S  Anna  F  61  770  300  SH  <1  S  Chris  M  54  1600  N/A  PMR  1  S  Florence  F  62  513  350  PMR  1  S  Tiger  M  58  1040  560  PMR  2  S  David  M  70  1347  500  PMR/O  2  S  Pete  M  58  719  N/A  PMR  4  S  Carole  F  51  604  300  PMR  5  S  Marc  M  58  1029  360  RH  6  S  Isabelle  F  64  1400  705  PMR  7  S  Patrice  M  68  1300  380  SH  12  A  Charlotte  F  64  740  596  PMR  18  S  Jean  M  60  800  200  SH  17  S  Nicole  F  54  1100  N/A  PMR  36  T  Name  Gender  Age  $Income/month  $Rent/month  Pre-homeless housing  Months homeless  Housing Status at interview  Mathilde  F  80  2000  570  PMR  <1  S  Danny  M  50  708  N/A  O  <1  S  Anna  F  61  770  300  SH  <1  S  Chris  M  54  1600  N/A  PMR  1  S  Florence  F  62  513  350  PMR  1  S  Tiger  M  58  1040  560  PMR  2  S  David  M  70  1347  500  PMR/O  2  S  Pete  M  58  719  N/A  PMR  4  S  Carole  F  51  604  300  PMR  5  S  Marc  M  58  1029  360  RH  6  S  Isabelle  F  64  1400  705  PMR  7  S  Patrice  M  68  1300  380  SH  12  A  Charlotte  F  64  740  596  PMR  18  S  Jean  M  60  800  200  SH  17  S  Nicole  F  54  1100  N/A  PMR  36  T  Note: A = apartment; PMR = private market rental; O = owner; RH = rooming housing; SH = subsidized housing; Housing status: S = shelter; T = transitional housing. N/A = lost home in divorce, couch surfing, live-in janitor, co-residing and not paying rent. View Large Table 1. Participant demographics Name  Gender  Age  $Income/month  $Rent/month  Pre-homeless housing  Months homeless  Housing Status at interview  Mathilde  F  80  2000  570  PMR  <1  S  Danny  M  50  708  N/A  O  <1  S  Anna  F  61  770  300  SH  <1  S  Chris  M  54  1600  N/A  PMR  1  S  Florence  F  62  513  350  PMR  1  S  Tiger  M  58  1040  560  PMR  2  S  David  M  70  1347  500  PMR/O  2  S  Pete  M  58  719  N/A  PMR  4  S  Carole  F  51  604  300  PMR  5  S  Marc  M  58  1029  360  RH  6  S  Isabelle  F  64  1400  705  PMR  7  S  Patrice  M  68  1300  380  SH  12  A  Charlotte  F  64  740  596  PMR  18  S  Jean  M  60  800  200  SH  17  S  Nicole  F  54  1100  N/A  PMR  36  T  Name  Gender  Age  $Income/month  $Rent/month  Pre-homeless housing  Months homeless  Housing Status at interview  Mathilde  F  80  2000  570  PMR  <1  S  Danny  M  50  708  N/A  O  <1  S  Anna  F  61  770  300  SH  <1  S  Chris  M  54  1600  N/A  PMR  1  S  Florence  F  62  513  350  PMR  1  S  Tiger  M  58  1040  560  PMR  2  S  David  M  70  1347  500  PMR/O  2  S  Pete  M  58  719  N/A  PMR  4  S  Carole  F  51  604  300  PMR  5  S  Marc  M  58  1029  360  RH  6  S  Isabelle  F  64  1400  705  PMR  7  S  Patrice  M  68  1300  380  SH  12  A  Charlotte  F  64  740  596  PMR  18  S  Jean  M  60  800  200  SH  17  S  Nicole  F  54  1100  N/A  PMR  36  T  Note: A = apartment; PMR = private market rental; O = owner; RH = rooming housing; SH = subsidized housing; Housing status: S = shelter; T = transitional housing. N/A = lost home in divorce, couch surfing, live-in janitor, co-residing and not paying rent. View Large Data Collection and Analysis All of the interviews were face to face, semi-structured, and conducted by the first author in either English or French at a location that was most convenient to participants (most often a private office space at the shelter). The initial interview guide included broad questions focusing on experiences of becoming homeless (e.g., Can you tell us how to came to live at the shelter? How did you feel your first night at the shelter?). At the end of each interview, participants were asked a series of sociodemographic questions regarding age, gender, ethnicity, marital status, education, language, employment, and sources of income. Trustworthiness of the findings was promoted by maintaining a rigorous audit trail which included the coded transcripts, case summaries, and on-going memos. Each interview was transcribed in its original language and transferred to Dedoose (2016), a web-based password-protected qualitative software program. After each interview, the authors wrote 8–10-page case summaries for each participant, an important step in advancing grounded theory analysis (Charmaz, 2014). The case summaries were used for cross case comparisons to identify divergent and similar trajectories into homelessness. After each interview, the two authors conducted line-by-line coding using gerunds, a hallmark of grounded theory that ensures an analysis remains close to the data (Charmaz, 2014; Glaser & Strauss, 1967). Examples of initial codes included “battling housing conditions,” “resisting help,” “feeling desperate,” “managing substandard housing,” and “seeking assistance”. Very early on, the two authors noticed two different pathways into homelessness based on pre-homeless housing stability: one more rapid and another more gradual. Becoming homeless also appeared to be a process that could extend beyond the physical loss of housing, which led to more extensive coding considering the distinction between being homeless and being housed. To flesh out these emerging categories, guided by grounded theory’s central tenet of theoretical sampling (Glaser & Strauss, 1967), the first author began to ask more focused questions regarding housing histories and the meaning of home (e.g., Can you describe your housing history specifically in relation to the relationship with your landlord, family, roommates, and/or neighbors?). Initial codes were brought up to a higher level of abstraction by comparing and contrasting them to sensitizing concepts (Glaser & Strauss, 1967) (e.g., home, place attachment, successful aging). An iterative process of coding and returning to the field to purposely sample additional participants continued until the theoretical categories were sufficiently filled out (a total of 15 participants were interviewed). The two authors consolidated their conceptual memos into a working draft of a manuscript that took shape around the core category: two divergent pathways into homelessness: gradual and rapid. We refer to theoretical sufficiency (Dey, 1999) rather than the more common concept of saturation because it recognizes that the theoretical lens and sensitivities researchers bring to the analytic process, shapes data analysis. The idea that new constructions of theory can emerge from the same data aligns well with ConGT which is situated in a constructivist paradigm (Guba & Lincoln, 1994). Co-conducting the analysis by researchers with different theoretical approaches also enhanced the study’s theoretical sensitivity, which in turn reinforced the originality and trustworthiness of the findings (Charmaz, 2014). Results Two Divergent Pathways into Homelessness: Gradual and Rapid All participants described complex, nuanced circumstances contributing to their pathway into homelessness. However, their housing circumstances, help-seeking behaviors, and reactions to homelessness were distinguished by two divergent pathways: gradual and rapid. Participants with gradual pathways lived in precarious housing circumstances, with little to no social support, and high levels of social distress (e.g., conflicts with roommates and landlords). These circumstances were endured for extended periods of time before physically losing their housing. Despite facing these challenges, many strived to improve their circumstances by reaching out for support and engaging in personal, creative strategies to maintain their housing. However, after years of seeking out help, they were unable to maintain their housing. Many expressed relief to finally receive support from a homeless shelter as Anna stated: Anyway, my toilet blocks often and the housing manager tells me that it’s my responsibility because I don’t put the right things in it! It blocks because it doesn’t work properly! And the last time, I would have to pay, and it would be over $200…the apartment is really not suited for me because of the materials. I am not able to maintain it. I have difficulties maintaining it. Here [the homeless shelter], it’s the best thing that could have happened to me, because I really had to get the hell out of where I was living! After 22 years, I am really, really burnt out. I’m very broken, psychologically and physically. I am exhausted. I couldn’t stay at home, all by myself with all those problems. In contrast, participants with rapid pathways tended to describe strong attachment to their housing that had been suddenly threatened by a series of losses that completely overturned their circumstances. Most resisted asking for help, and came to the shelter devastated by their losses. For example, David, whose life spiraled out of control following the sudden deaths of his mother, wife, and daughter, described the despair he felt when he ended up homeless: Losing them, let’s just say it evaporates over time. It’s the fact that I wake up like I am here that I can’t accept … homeless … in the street. I sold everything, every single thing! I never thought I’d end up like this. It’s like starting from zero. Although individuals with gradual pathways lacked social support, felt socially isolated, and battled social distress for years and in some cases decades, the rapid group’s social support system crumbled suddenly. Compared to individuals with gradual pathways, this group had more ready access to social networks to help buffer intense shocks and losses (e.g., closer ties to family, the labor market and friends), yet resisted asking for help as they feared losing their independent sense of self. Both pathways and their associated impact are pictorially depicted in Figure 1 and described further in the sections below. Figure 1. View largeDownload slide Two divergent pathways into first-time homelessness in later life: rapid and gradual. Figure 1. View largeDownload slide Two divergent pathways into first-time homelessness in later life: rapid and gradual. Gradual Pathways: Feeling “Homeless at Home” Participants with gradual pathways experienced greater housing instability and felt what Bennett (2011) refers to as feeling “homeless at home” for extended periods of time. This instability was linked to social distress, interpersonal conflicts with housing administration, neighbors, and/or roommates. For instance, for Jean, who had been experiencing ongoing harassment from the building’s janitor for over two decades, explained how he did not feel at home because his capacity to socialize with others in his apartment was compromised: It’s that he wouldn’t stop harassing me. For nothing. I had a friend who would come over, and he said, hey, I saw a guy at your place yesterday, I saw him go in by the back balcony. I was thinking, you spy on everyone like that? And then he said, I don’t like his face and I don’t want to see him at your place. Marc, who had been residing in a rooming house for 13 years, also described an ongoing conflict with the janitor combined with feelings of insecurity due to a constant presence of drug dealers in his building. When an ongoing bed bug problem that was not being properly taken care of overcame his possessions, he explained that what began as a hassle increasingly took control of his life. He was frustrated that the landlord was not taking proper measures to fix the problem: The problem with the bed bugs wasn’t fixed after a few exterminations. He [janitor] needed to hire a specialist, but he didn’t. He wanted to do it himself and save money and the problem always came back. Feeling homeless at home was also linked to long-term feelings of social isolation and loneliness related to family breakdown. For instance, Charlotte explained that since her divorce over 20 years ago, she has lived alone and never really felt at home, because for her, home is a place that is shared with family: The difference between my apartment and my home is that my home was our home, it was a shared environment, whereas my apartment, I don’t call it my home, it was my apartment, to me there’s a difference, home to me includes other people, because that’s what makes any place a home because you have people with you. In many ways, the social support obtained while residing at the homeless shelter seemed to fill a crucial social gap that existed when participants with gradual pathways were housed, as Tiger expressed: I got a family here. It’s not the same as the family you’re used to though. It’s like family here, I said to one of the service providers, you’re like a sister to me, I said, at least you and me are talking, my sister and me haven’t had a conversation in I don’t know how long. In sum, people with gradual pathways had been struggling for extended periods with intolerable housing conditions, lack of social supports, and social distress within their housing complexes. With minimal economic and social resources to move elsewhere, they were essentially homeless before physically losing their housing. Strikingly, despite their limited resources and difficult housing circumstances they managed to resist the loss of their housing for years and in some cases decades. Strategies of Resistance: Stopping at Nothing to Maintain Housing Participants with gradual pathways had little to no family or friends, and reached out for help to various organizations before coming to the shelter; however, their housing remained precarious. Active efforts to maintain housing were exemplified by Anna, who took many measures to prevent her homelessness: I went to a community organization X to see about how to manage my budget better, and I’m on a waiting list. They haven’t called me. So I haven’t been able to find a solution. I got behind in rent a couple months and I tried to fix it myself but I don’t have the financial resources, and I don’t have family or friends I can count on to help me out either. So to get out of this situation, I went towards the community resources that society offers to me. It’s certainly not my ideas that are lacking. I put a letter together listing all of the steps I’ve taken to find a solution that I would present to the housing administration, so that they would know that I was trying to find a solution, so they’d know that I wasn’t dicking off, if you know what I mean? Several participants spoke of submitting applications for subsidized housing but were on long waiting lists, as Marc expressed: I submitted applications for low-income housing, I’ve been on the waiting list, seven years is a long time, especially at my age. As extreme poverty was a more common characteristic amongst people in the gradual group (some participants were paying more than 80% of their income on rent), in addition to reaching out for external help, they engaged in creative personal strategies on a regular basis to maintain their housing. Such strategies included stretching their budgets by sharing meals with neighbors, using food banks, and repurposing household objects found in the garbage, as Charlotte explained: Because I know what it is to have no money and how for me then, I had after my rent, and one bill and hydro, and laundry I had $60 left. You don’t go anywhere on $60 so I started filling the blank by rescuing, repurposing things that were in the recycling or the garbage or whatever. Some also moved in with roommates to split the cost of rent, which as Tiger points out, created different problems for them: I had a roommate but I kicked her out, she was always texting at night when I was trying to sleep. She was drinking and she wasn’t supposed to be. I didn’t have the nerve to call the police and say that she was breaking a condition, she’s drinking. I said you’re out of here. She took the key I gave her and threw it, and missed my TV by about two inches. Several participants recognized that with age, they had more difficulty coping with daily stressors as Jean expressed: You know, I’m 60, I’m not 20 anymore. So that’s what makes you tired, you get stressed. So after that, they give you pills as a solution. I told the doctor, sorry I didn’t come here for pills, I came for housing. You know, I didn’t learn how to be a social worker, where to get the applications for the co-op. Many experienced relief when they came to the homeless shelter. For instance, Patrice explained that the help he received from one service provider provided him with new found hope for the future: I think it took becoming homeless to start to express myself. You know, I didn’t trust anyone.… Through this organization, I met a service provider who I could talk to, and it all came out, from my childhood [on verge of tears]. She liberated me. She let me talk and when she listened, I explained my story, I even cried. It all came out. In sum, participants engaged in creative strategies to meet their financial obligations and remain housed. When their housing conditions continued to deteriorate they explored all available avenues for improving their housing circumstances including applying for subsidized housing, and seeking assistance and guidance from community agencies. Eventually, the precariousness of their situations coupled with a lack of social support and suitable housing options resulted in the loss of their housing. Having endured this hardship on their own for many years going to shelter offered a sense of relief because it provided the instrumental and social support they were sorely lacking. Rapid Pathways: Abrupt Life Changes and Shocks Contributed to Homelessness Participants with rapid pathways tended to have stable personal and housing histories and were generally satisfied with their housing circumstances. For instance, David, who was married, had two children and worked four decades as an accountant, spoke fondly of his former apartment, where he resided for 27 years before becoming homeless: Yes, well, they would say out of the 22 apartments, they would say we had the nicest one, the nicest 4.5 out of the 22, because it was all decorated. I had paintings of [name’s painter] who was actually one of my clients. Mathilde, a retired nurse, expressed feeling attached to her apartment that she was forced to move out of because she was longer able to navigate the stairs: I: When you said that it made you sad to move, can you explain what you meant? M: You know, it grabs you right here (puts hand on her chest). The landlord and I took each other in our arms. I liked him a lot. We both cried. Individuals with rapid pathways often understood their homelessness as being associated with intense social losses. Some, such as David, experienced the loss of numerous loved ones or family breakdown. Others described experiencing a health crisis or injury in later life that disrupted their careers. For instance, Danny, a chef who had previously owned a condominium with his wife, described his “life changing dramatically in 24 hours.” Within a year, he went through a divorce, was diagnosed with cancer, and lost a well-paying job. In contrast to many participants with gradual pathways who were relieved to come to the shelter, he was in complete shock: It’s a living hell. My first night, I was crying. I said fuck wow! Even now, I have difficulty understanding what happened. I’m talking to you, but I haven’t talked to anyone about it. I really don’t understand what happened over the past eight months. It’s like a living nightmare. I had a normal life and it all fell apart! You know, I understand that I was sick, but not everyone who is sick ends up with their life in shambles! There is something that happened somewhere, in order for this to happen, it just doesn’t make sense! Along similar lines, after working 25 years for a government agency, Carole was diagnosed with cancer, lost her job, and was shocked to find herself homeless within a year: There are days where I sense how damaged my ego is. There are days where I feel I am going crazy. Frustrated, and you ask yourself so many questions. How it is possible to pay for housing your entire life and this happens? You feel sorry for yourself. I don’t understand how it got to this point, I understand in a way, I had cancer, I had an alcohol problem that is connected to it, but does life have to be this punitive? You know? I am trying to get out; I am trying and then pouf! I end up where I started. Pete, who was forced to stop working after experiencing a back injury, described how he felt his first night at the shelter: My first night here, all I could think about was suicide. How did I end up here? When I think a lot to myself, what the hell am I doing? I can’t work. What can I do for the society?” Individual with rapid pathways faced multiple losses that changed their social and economic situations dramatically. With little time to absorb these changes and a long history of independence, they were unable to access timely support. As a result, they experienced the simultaneous loss of house and home making their entry into a homeless shelter one of shock, disbelief, and intense shame. Strategies of Resistance: Preserving an Independent Sense of Self at All Costs Most participants with rapid moves to homelessness had family and friends they could have drawn on for support. However, many felt this option was so threatening to their sense of self-sufficiency and independence that they could not bring themselves to ask for assistance as Carole stated: It’s not that my daughter is mean or anything, or that we don’t get along. Helping my daughter out doesn’t bother me, but having her see me in this state is difficult. I can swallow my pride, but there is a limit! This group engaged in personal strategies to maintain their independence at all costs. For instance, some continued to work even though their health struggles made it difficult for them. This was the case for Florence, who suffered from severe arthritis and mobility issues, yet continued to clean houses, as it prevented her from needing to ask for help from her children: For sure, my kids have their own life too. My daughter left for Tunisia for a bit. You know, I can’t always, I can’t impose too much on their lives. My son is in Cuba. It’s not easy. Being older seemed to compound the shame of asking for help. For instance, when asked about his perception of some of the differences and additional challenges between being younger and being over 50 and homeless, Pete noted: The young ones they use the system, they get high, but the old ones, it’s like they are afraid to ask or they forget and they think they are too much of a bother … what do you call that? A burden. There was a time there where I lost confidence, I am usually a good survivor but I think sometimes when you get older there is a little bit of pressure that comes in. I don’t know if it is the lack of youth or something like that. Overall, individuals with rapid pathways tended to have pre-homeless histories characterized by more stable work, personal, and housing circumstances. When multiple unanticipated losses threatened their economic and social resources, they worked hard to maintain their independence and their housing. However, their long history of self-sufficiency came to a devastating and traumatic end when they were forced to enter a homeless shelter and accept their need for assistance. Discussion and Implications Two Different Pathways into Homelessness: Gradual and Rapid This qualitative study explored pathways into first-time homelessness in later life from the perspective of older adults themselves. Although research has begun to distinguish between the characteristics, needs, and experiences of newly homeless older adults (Crane et al., 2005; McDonald et al., 2007; Petersen & Parsell, 2015), our study makes an important contribution by presenting two different pathways into first-time homelessness: gradual and rapid. Participants with gradual pathways had long histories of housing instability, enduring many years of poor housing conditions, lack of support, and social distress. However, they managed to stay housed through their creativity, determination, and innovative problem-solving. This group was quick to identify their homelessness could have been avoided had they had more ready access to suitable housing and social support. Many expressed relief when they became homeless, as the shelter provided built-in support from service providers and residents, and a general reprieve from the stress related to their housing circumstances. In contrast, participants with rapid moves had relatively stable histories of work, housing, and family lives, a finding consistent with existing literature on newly homeless older adults (Brown et al., 2016; McDonald et al., 2007; Petersen & Parsell, 2015; Shinn et al., 2007). Our findings build on this work by qualitatively highlighting that not only did this group experience an intense series of shocks in later life, they resisted asking for help because of internalized concerns that reaching out to existing social networks was shameful and to be avoided. These reactions made becoming homeless that much more devastating and humiliating. They also seemed to have less insight into what may have prevented their homelessness, likely because they were still in a state of shock and disbelief at the time of the interview. Although pathways into late-life homelessness were diverse, lack of suitable housing coupled with insufficient social support in times of vulnerability were chief factors leading to late-life homelessness in both groups. Thus, in agreement with previous research (McDonald et al., 2007; Petersen & Parsell, 2015) we recommend an influx on affordable, quality housing with varying types and levels of support is a promising strategy to preventing late-life homelessness. However, we also recommended specific policy implications for each pathway. Preventing Invisible Homelessness by Building Social Capital The gradual group were part of what Gaetz et al. (2013) refer to as the invisible homeless, in that they were living in substandard precarious housing for years before physically losing their housing. They also had long histories of isolation and a scarcity of support and care networks. In other words, they lacked social capital (Putnam, 2000), which has demonstrated to be a key factor in promoting aging in place (Cramm, van Dikj, & Nieboer, 2012). Additionally, their housing instability was exacerbated by high levels of negative social capital (Bassuk, Mickelson, Bissell, & Perloff, 2002) as they battled ongoing interpersonal conflicts with janitors and neighbors. Advancing previous research recommending that identifying those with the highest risk of losing housing is needed to prevent chronic homelessness (Brown et al., 2016; Lee et al., 2016; McDonald et al., 2007), we suggest preventing homelessness through joint outreach work between the homeless and gerontology sectors (e.g., home care). Specifically, these joint interventions need to focus on creative ways to build social capital. For instance, when a person gets on a housing list for subsidized housing they could be automatically offered support and case management services to cope with their conditions and attain help building a network of support while waiting. This could include being connected to voluntary services to help with small domestic jobs; receiving support to address conflicts with neighbors and janitors; and receiving support with system navigation. These formal support networks would work in conjunction with people’s individual strategies to buffer many of the housing and social stressors that contributed to entering homelessness. Preventing Rapid Moves to Homelessness by Redefining Independence Participants with rapid pathways had more social capital and the advantages associated with it for most of their lives. However, when faced with intense life changes and shocks, they were reticent to ask for help form their existing social networks as they feared appearing dependent. Their reaction seems to be connected to widespread messaging around “successful aging” being equated with remaining independent at all costs (Katz & Calasanti, 2015). Asking for help meant depending on others and relinquishing an independent self of self, which was worse than becoming homeless. One important preventative strategy to mitigate this risk would be to contest dichotomies of dependence/independence through social media and public policies. If messaging continues regarding maintaining independence at all costs, older people will continue to experience various forms of shame around reaching out for help, and may ultimately risk becoming homeless. On a more micro level, individuals who more closely resemble the rapid group, may benefit from rapid housing coupled with intensive time-limited support to work through their feelings of shock disbelief and damaged sense of selves. Given their long histories of housing success, consistent with previous research (Brown et al., 2016), our findings show that these individuals may not require intensive and ongoing case management to help preserve their housing. However, without time limited intensive support their despair could become chronic and enduring. Revisiting Rehousing Interventions: No One-Size-Fits-All Solution Over the past two decades there has been a wholesale policy shift towards Housing First (HF) rapid rehousing models that promote living independently, most often in private market scattered-site housing with off-site supports (Goering et al., 2014, Padgett, Henwood & Tsemberis, 2015; Tsemberis & Eisenberg, 2000). HF has been widely embraced by communities in the Western world as it has demonstrated to be a highly successful rehousing strategy particularly for its target population: chronically homeless adults (Goering et al., 2014). Specifically, in order to access most HF programs, individuals are required to be visibly homeless (living in a shelter or on the streets) for a minimum length of time (six months to one year). Based on this criteria, most study participants would be not quality for HF programs because they would be considered too “new.” Moreover, it seems that many individuals in the gradual group have benefited from the intensive case management provided by HF models; however, in order to qualify they had to become visibly homeless. Thus, we recommend the eligibility requirements be expanded and made more flexible to give the opportunity to the invisible homeless and/or very recent sheltered or street homeless (less than six months) to access and potentially benefit from the program. However, this study also highlights that independent living in scattered-site apartments may not be appropriate for older adults with low levels of social capital. Research suggests that living alone can reinforce process of exclusion for older adults, because they are more socially isolated than any other age group and have additional health and social needs (Crane & Warnes, 2007; McDonald et al., 2007). Despite these recognized vulnerabilities, scant research has considered alternative types of supportive housing that may better promote housing stability, health, and well-being in older groups. We are inspired by congregate housing models with on-site support that have demonstrated to promote housing stability while also building a sense of community with vulnerable subgroups of homeless individuals such as Aboriginal women (Klodawsky, 2009). Overall, HF is only one approach to combat homelessness—given the diversity with the older homeless population, more research is needed towards developing innovative supportive housing that not only houses people but promotes a sense of “home.” Limitations and Future Research There are several limitations to our study. The study was conducted in Montreal and may not be transferable to other contexts. Although rich data was obtained from each interview, in some cases follow-up interviews with additional participants were requested but not possible, as participants’ contact information had changed. We only included the emergency sheltered homeless, and overlooked other environments older homeless reside including institutions, transitional housing, and cohabitating unstably which have been identified in previous research (Lee et al., 2016). Although the participants in this study had diverse backgrounds and pathways into homelessness, they shared a number of identity markers (e.g., all self-identified as white, were born in Canada, and had French or English as their mother tongue). Thus, their pathways into homelessness may not be applicable to subgroups of older adults (e.g., immigrants, transsexual men) who may face added discrimination and stigma. Despite these limitations, conceptualizing two divergent pathways into first-time homelessness provided a greater conceptual understanding of late-life homelessness and many useful jumping-off points for future research. Conclusion This study shed light on two different pathways into late-life homelessness: rapid and gradual. Each group had divergent needs and experiences and would likely benefit from different interventions. Individuals with gradual pathways felt homeless well before losing their physical housing, as a consequence of enduring many years of struggle related to poor housing conditions, lack of social support, and social distress. Intensive case management or informal support from community groups and volunteers may have mitigated their eventual loss of housing by supplementing their creative strategies for remaining housed. For individuals with rapid pathways, homelessness may have been prevented if independence and self-sufficiency were not so valorized in our society. Changes around the stigma of aging and homelessness are needed to ensure that older adults feel able to ask for help in times of vulnerability, and that when they do they have ready access to suitable, affordable housing with appropriate supports. 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