Elements of a shelter community model serving homeless older adults based on social determinants of health

Over the past several years, homelessness among seniors has risen dramatically and is expected to triple in the next 10 years. Many of these homeless seniors are on fixed incomes and are unable to afford rent in the Phoenix area, where the average one bedroom apartment rents for $1,119, while Supplemental Security Income from Social Security is currently set at $783 per month. Subsidized apartment units can have waitlists in excess of one to two years. In addition to these barriers to finding housing, older homeless adults have more health conditions than average and are more likely to report feelings of loneliness.

Taken together, these challenges point to the need for a model of service provision for older adults experiencing homelessness that is flexible and addresses social determinants of health (SDOH) such as housing instability, social connection, and access to care. Ozanam Manor is a transitional shelter community that has been serving homeless seniors in the Phoenix area for more than 35 years. The program is focused on fostering community among residents and providing flexible support to residents to meet their needs.

Matthies used a descriptive design approach to explore how select social determinants of health are addressed in a transitional shelter community. She conducted a literature review to identify rationale and best practices for the social determinants of health highlighted in this project. Program participants completed surveys about their health conditions and social supports. A small subset of these survey respondents participated in follow up interviews to obtain qualitative data. Matthies analyzed qualitative data first to find themes and then analyzed quantitative data from the surveys. She also analyzed data from three prior surveys of program participants.

Perceptions of safety in the shelter environment, relationships with staff, and participant accountability to the community emerged as important themes in survey responses. For residents, social cohesion is at least as important as access to care. Matthies and her team also learned that there is substantial value in the relationships that people experiencing homelessness build with program staff, and that staff's caring attitude has a positive correlation with participants' perception of the program.

Beyond advancing existing knowledge in this field and opening the door for further study of social determinants of health and homelessness, this project informed a new comprehensive initiative for Ozanam Manor focused on building social connections for its residents. Ultimately, Matthies hopes her work will shift the model for providing shelter to one based on social cohesion and flexible individualized care in order to improve quality of life, increase housing retention, and decrease health care costs for people experiencing homelessness.