Grant: Project Grant

More than 25% of people experiencing homelessness in Canada are older adults (>50 years); in Toronto alone, more than 3000 adults older than 50 years are homeless. They are at higher risk of adverse outcomes such as death compared with people who have stable housing. These numbers grew during COVID-19 because of the increased cost of living and lack of supports. Individual circumstances such as social isolation and chronic health conditions including geriatric syndromes (e.g. dementia and mobility challenges) may increase the risk of homelessness. Older adults experiencing homelessness are 'older than their age' and experience geriatric syndromes more commonly than their housed counterparts. Shelter systems are not designed or resourced to meet their complex needs, which may be better met in long-term care homes (LTCHs). However, these older adults face barriers to LTCH admission with few assessed for LTCH admission and of those who are assessed, very few (<5%) are admitted to LTCH. Factors contributing to this include difficulties in accessing LTCH assessments within shelters and closure of applications when older adults move to other shelters. Older adults experiencing homelessness are often declined LTCH admission because of LTCH staff concerns about behaviour, substance use, and fears of street culture and risk to other LTCH residents. Thus, many older adults experiencing homelessness continue to have their care needs (e.g. living with dementia) unmet. Our primary goal is to work with shelter and LTCH partners (including older adults experiencing homelessness and their care partners, managers and clinicians) to co-develop and pilot an innovative LTCH model to transition these individuals from shelters to LTCH while receiving tailored geriatric care and to evaluate impact on outcomes that are important to older adults. This will be the first such study to do this and will lead to a LTCH model that other provinces and countries can use.