Product Details

Author Information

Corresponding Author
Christine George
Loyola University Chicago Center for Urban Research and Learning
820 N Michigan Ave
10th floor
Chicago, IL 60611
United States
p: 312-915-8625
f: 312-915-7770
cgeorg@luc.edu

Authors (listed in order of authorship):
Marilyn Krogh
Loyola University Chicago Department of Sociology

Dennis Watson
Loyola University Chicago Center for Urban Researc

Judith Wittner
Loyola University Chicago Department of Sociology

Nancy Radner
The Chicago Alliance to End Homelessness

Christopher Walker
Loyola University Chicago

Christopher Wiens
Chicago Christian Industrial League

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Public Health, Social & Behavioral Sciences

What specific topics does your product address?

Health disparities, Homeless health, Policy development

Does your product focus on a specific population(s)?

Homeless

What methodological approaches were used in the development of your product, or are discussed in your product?

Focus group , Qualitative research, Quantitative research, Interview

What resource type(s) best describe(s) your product?

Policy brief

Application Narrative

1. Please provide a 1600 character abstract describing your product, its intended use and the audiences for which it would be appropriate.*

This policy report was developed out of a 2-year collaborative study of homeless people aged 50 to 64 in Chicago between Loyola University Center for Urban Research and Learning (CURL) and the Chicago Alliance to End Homelessness (The Alliance). This study had three goals: (1) to obtain a demographic profile of people who are homeless in Chicago and are between the ages of 50 and 64; (2) to understand how the various systems designed to serve this population do and do not meet their needs; and (3) to begin to suggest a range of policy and programmatic responses to meet the needs of this population. The researchers used a variety of qualitative and quantitative methods in their analysis. Key findings of this research are: the majority of older homeless in a 2003 data set became homeless for the first time in middle age; the number of older homeless people in Chicago is likely increasing; a majority of the population are able to work but hampered from finding employment; those who are less able to work suffer from a variety of work limiting conditions, such as chronic illness; and safety net and social welfare programs largely fail this population.

2. What are the goals of the product?

The aim of the study was to develop a profile of people who are homeless in Chicago and over the age of 50 to inform planning and policy. In particular, the project sought to answer three sets of research questions:
1.What is the detailed demographic profile of homeless individuals aged 50 to 64? What are recent and expected trends in the population?
2.What are the needs of this population? How are their service and housing needs unique among those of the homeless population in general? What challenges and opportunities are posed by these circumstances?
3.How well is this population being served by the systems that have been designated to serve them? Are they receiving the benefits and services they are meant to receive? Are there barriers to access? Are there gaps in the range of services offered? Is age discrimination occurring within the public systems or with private entities, such as employers.
A multi-level dissemination campaign of the findings was lead by The Alliance to End Homelessness. A press campaign including individual interviews with homeless individuals led to coverage in all major and various neighborhood print outlets in Chicago. The report was featured on the local NPR affiliate and the Executive Director of The Alliance was interviewed. The report was sent to key state and municipal policy makers. The report was launched at a city wide conference on homelessness, keynoted by the Mayor of Chicago, in which a panel of homeless and senior advocates discussed the findings. This was the beginning of new linkages between the homeless and aging system For example, the Chicago Department On Aging began to foster these linkages at the neighborhood level and has begun to investigate ways the older homeless population can be better served by the city’s senior centers. As a part of this process, they have begun discussions with The Alliance concerning research and program design for homeless seniors.
After the city wide conference 4 meetings were held with a total of 85 agencies providing services to seniors who were interested in learning more about the study findings to assist them in better targeting the needs of the seniors who are homeless or at risk of homelessness.

3. Who are the intended audiences or expected users of the product?

To ensure that this policy brief was utilized successfully, it needed to be disseminated to a wide range of stakeholders. First, there were the non-consumer stakeholders with in the homeless system, homeless providers, advocates,policy makers, government agencies. Here the intention was inform policy reform, program development and resource allocation. The second target audience were “aging system” providers, advocates and policy researchers. The key here was to develop linkages between the homelessness system and the aging system at various levels, from street level to city/state wide. Finally, the general public was the third target, to raise awareness and increase understanding of homelessness in Chicago,therefore laying the basis for support for policy changes and resource allocation.

4. Please provide any special instructions for successful use of the product, if necessary. If your product has been previously published, please provide the appropriate citation below.

Not applicable

5. Please describe how your product or the project that resulted in the product builds on a relevant field, discipline or prior work. You may cite the literature and provide a bibliography in the next question if appropriate.

Reports of the number of older homeless vary widely, with numbers ranging from near or around 25% who are over 50 (Rossi, 1989; Smith, 2003) to 6% between ages 55 and 64 (Dietz and Wright, 2003). Other studies in St. Louis (North, Eyrich, Pollio, and Spitznagel, 2004) and San Francisco (Hahn, Kushel, Bangsber, Riley, & Moss, 2006) found significant increases in the older homeless population in the past decade. In addition to these observed increases, Cohen (1999) has predicted a doubling of the older homeless population on the national level within 30 years, from 60,000-400,000 to 120,000-800,000.
There has been some fluidity in defining the age range of the older homeless population (Hatchett, 2004), but 50 and 55 are becoming increasing common lower parameters. Researchers have commonly observed that living on the streets can produce ageing effects that renders a person 10 to 20 years older in looks and behavior (Cohen & Skolovsky, 1989; Crane & Warnes, 2001; Gelberg, Linn & Mayer-Oakes, 1990), which has led many researchers to define the older homeless as those age 50 to 64 (Cohen, 1999).
Many researchers have determined that the service system’s response to the unique issues and needs of the older homeless are often inadequate, especially in the area of housing assistance (Cohen, Ramirez, Teresi, Gallagher, & Sokolovsky, 1997); requiring self-sufficiency in employment for older homeless with health issues (Hecht & Coyle, 2001); or the lack of employment programming for the older homeless which addresses ageism (Hatchett (2004).
In addition, homeless service systems have been pointed out as often wrongly conceptualizing or ignoring health issues related to ageing, both in terms of mental health (Crane, 1998; Dietz & Wright, 2003) and physical health (Hahn et al., 2006; Kutza & Keigher, 1991). Addressing specific needs of the older homeless population is important to their livelihood and well-being. As these issues are ignored, chronic medical conditions will take on increasing significance as the population continues to age.

6. Please provide a bibliography for work cited above or in other parts of this application. Provide full references, in the order sited in the text (i.e. according to number order). .

Cohen CI. Aging and homelessness. The Gerontologist 1999;39:5-14.

Cohen CI, Ramirez M., Teresi J., Gallagher M., Sokolovsky J. Predictors of becoming redomiciled among older homeless women. The Gerontologist 1997;37:67-74.

Cohen CI, Skolovsky J. Old Men of the Bowery. New York: Guilford Press; 1989.

Crane M, Warnes A. Older people and homelessness prevalence and causes. Top Geriatric Rehabilitation 2001;16:1-4.

Dietz TL, Wright JD. Homelessness among the elderly. In: The Encyclopedia of Retirement and Finance. Westport: Greenwood Press; 2003. p. 381-386.

Gelberg L, Lawrence SL, Mayer-Oakes SA. Differences in health status between older and younger homeless adults. Journal of the American Geriatrics Society 1990; 38:1220-1229.

Hahn JA, Kushel MB, Bangsber DR, Riley E, Moss AR. Brief report: The aging of the homeless populations—fourteen-year trends in San Francisco. Journal of Internal Medicine 2006;21:775-778.

Hatchett BF. Homelessness among older adults in a Texas border town. Journal of Aging and Social Policy 2004;16:35-57.

Hecht L, Coyle B. Elderly homeless: A comparison of older and younger adult emergency shelter seekers in Bakersfield, California. American Behavioral Scientist 2001;45:66-79.

Kutza EA, Keigher SM. The elderly “new homeless”: An emerging population at risk. Social Work 1991;36:288-293.

North CS, Eyrich KM, Pollio DE, Spitznagel EL. (2004). Are rates of psychiatric disorders in the homeless population changing?. American Journal of Public Health 2004;94:103-08.

Rossi PH. Down and Out in America: The Origins of Homelessness. Chicago: University of Chicago Press, 1989.

Smith J. Aging and homelessness: Research on people age 50 and older who are homeless or at-risk of homelessness in the Chicago region. UIC Urban Planning and Policy Program, 2002 [cited Feb. 12, 2008]. Available from http://www.heartlandalliance.org/usr_doc/davis_consequences_itl_pdf?section=4039

7. Please describe the project or body of work from which the submitted product developed. Describe the ways that community and academic/institutional expertise contributed to the project. Pay particular attention to demonstrating the quality or rigor of the work:

• For research-related work, describe (if relevant) study aims, design, sample, measurement instruments, and analysis and interpretation. Discuss how you verified the accuracy of your data.
• For education-related work, describe (if relevant) any needs assessment conducted, learning objectives, educational strategies incorporated, and evaluation of learning.
• For other types of work, discuss how the project was developed and reasons for the methodological choices made.

The goal of the research was to understand the demographic profile and the needs of 50-64 year old homeless individuals in Chicago. Seen as a preliminary investigation and restricted by limited private funding, the study design utilized a mixed methods approach, triangulating secondary data analysis, analysis of administrative data and qualitative data to begin to identify trends and older homeless individuals unique needs and therefore inform policy and program development.
Various data points:
oSurvey data from the 2001 Illinois Regional Roundtable study of a representative sample of 1324 homeless or near homeless individuals, 349 who were over 50: The strength of this data was that it was very large in scope, and surveyed a representative sample of people who were homeless in metropolitan Chicago. Therefore, it is possible to make reasonable generalizations from that study to the homeless population as a whole. The drawback of this data was that it was, at the time of research, 5 years old, and it could not identify the trajectories and interactions of older homeless individuals within Chicago’s homeless system.
o Administrative data: Over 5 years of administrative data was collected from 33 homeless agencies which served an estimated 75% of the homeless population in Chicago (originally we had aimed for a higher participation rate, but we encountered significant limitation in administrative records of a number of agencies (this was prior to effective implementation of the Chicago Homeless Management Information System). This data, although limited, allowed us to identify trends between 2001 and 2006 in the homeless population. We compared demographic data of the administrative and Roundtable data, and found them comprable. This allowed us to make certain limited estimations of trends.
o Consumer focus groups and interviews: We conducted 8 focus groups with 53 individuals who were homeless. The focus groups were organized to reflect the diversity of types of older homeless individuals identified from the Roundtable data and the literature. In addition, we also conducted 10 life histories of a sub set of these 53 individuals, to further examine trends and develop some preliminary concepts of homeless trajectories to inform further research.
o Provider interviews: We conducted interviews with 55 provider agencies. We identified potential agencies for participation with the help of The Alliance. While 129 agencies were initially identified, at first contact we ascertained that 25 did not serve an older population and 7 had ceased operation, leaving 97 agencies eligible for the study. Of those, 60% participated in one or more phases of the study, representing a broad range of service provision: shelter and housing, clinical services and case management, housing development, employment services, and other services (i.e. food pantries, financial assistance, and legal aid). A variety of recruitment decisions were made based on the structure of the homeless provider system and its various agencies. Many of the programs and agencies operate as relatively independent entities of larger organizations. An agency may have multiple housing programs or a number of agencies may be part of an umbrella organization with complex funding connections between them. In consultation with the agencies, we determined whether to interview one person within the larger organization or to treat programs within them as separate.
This mix-method approach allowed us to go beyond the limitation in each data point.

8. Please describe the process of developing the product, including the ways that community and academic/institutional expertise were integrated in the development of this product.

As described in section 7, this product was the result of a working collaborative project between The Alliance and CURL. Dr. George had been elected onto the board of The Alliance (then the Partnership to End Homelessness) to provide a research expertise. CURL’s main mission is to develop and implement university-community research collaborations, focusing on those that promote social justice and that impact the Chicago metropolitan area. Therefore, it supported Dr. George’s work with The Alliance. As the project developed, Dr. Judith Wittner, a sociology professor with expertise in qualitative methodology and Dr. Marilyn Krogh, a sociology professor with expertise in large data sets joined the research team and added their expertise. Also, a pilot project was carried out with the help of an undergraduate research fellow who assisted Drs. George and Wittner in interviewing providers and assisting in a review of the literature. Alliance staff convened meetings of providers and helped to identify interviewees for the pilot project. Dr. George and Nancy Radner, CEO of The Alliance, met with foundation representatives and jointly developed the research proposal.
During the implementation of the research segment of the full project, The Alliance convened periodic feed back and update meetings between researchers, providers, and consumers. In addition, The Alliance staff worked with the researchers to develop a complete list of all providers in the city and provided the initial introduction of researchers to the targeted providers. At the end of the project, the researchers produced a draft technical report. A joint committee of researchers and Alliance staff discussed the report and outlined a draft of key recommendations. A power point presentation and executive summary was then disseminated at a meeting of providers and consumers for their feedback. Subsequently, Dr. George assisted Alliance staff in developing the product. In addition, a media consultant and design consultant assisted in the final design and layout. The media consultant also designed a media campaign (which included interviews with clients) and a press release highlighting key findings. The product was first disseminated at a citywide conference key noted by the city’s mayor. CURL researchers developed a power point presentation of the findings for that conference. A panel, which included key stakeholders from the homeless system and the aging system, then discussed the findings. Dr. George and Nancy Radner then presented the findings at a number of meetings held with providers, advocates, and researchers who work within Chicago’s homeless and ageing systems.

9. Please discuss the significance and impact of your product. In your response, discuss ways your product has added to existing knowledge and benefited the community; ways others may have utilized your product; and any relevant evaluation data about impact, if available. If the impact of the product is not yet known, discuss its potential significance.

It is clear that a sizable number of the homeless in Chicago are between the ages of 50 and 65 and these numbers are increasing. This reflects the general aging of the population in Chicago. This does not necessarily mean that the average age of the homeless person is older, or that the number of homeless younger than 50 has decreased. It does underscore the age heterogeneity of the homeless population.
It is also clear that those individuals over 50, in addition to facing issues shared with the younger homeless cohort, also face unique issues: the cumulative effects of their life experiences and aging, especially impacting their health and hardiness; the dramatic changes in society since they reached adulthood, such as de-industrialization and technological changes leading to a vastly different job market; unique experiences during their life course, in particular the high percentage of men who participated in combat in the Korean and Vietnam wars; they are at a different stage of life, many are tired out and ready for retirement—they are less likely to be hopeful and have less time to pull things together and make it in the market economy; they experience discrimination because of age (ageism) that is both blatant and subtle; finally, they fall through the cracks in a system designed for either younger or older individuals—they are told they are too old for the job market and not yet eligible for many social welfare programs and benefits.
This was a preliminary study and raises as many questions as it answers. For example, we still need more clarity in understanding the dynamic that triggers middle age homeless and what factors could prevent that homelessness. The data suggests a stronger safety net, but are there individualized interventions or bridges that would help individuals bypass the homeless system? Second, it is clear that that there is some relationship between aging policies and programs that kick in at 62 and 65 and reduced homelessness, but the data is only suggestive. We need some longitudinal studies that look more closely into the effects of those policies on housing stabilization. By the same token, we also need to understand and investigate those older individuals who are housed and are still accessing aspects of the homeless system for support. This might help us understand some of the limits or supportive housing needs of a Housing First system as it applies to older individuals.
Probably the place this product has been most effective is within the aging system. For example the City of Chicago Senior services has developed working links within the homeless system, and some joint efforts are being discussed.

10. Please describe why you chose the presentation format you did.

The goal of the product was to affect policy. Our community partner, on the advice of their policy committee and a media/policy consultant took the lead on the design and message of the policy product. We jointly wrote the report. In addition, the research team, in consultant with our community partner, developed a power point presentation which was used at the city wide-conference and at various meetings described above (this presentation was modified for each meeting). The format we chose was the most appropriate considering the wide range of stakeholders. The presentation format is clear and concise, while still conveying important information. Additionally, we give a number of actionable recommendations that are easy to see and connect to the findings.

11. Please reflect on the strengths and limitations of your product. In what ways did community and academic/institutional collaborators provide feedback and how was such feedback used? Include relevant evaluation data about strengths and limitations if available.

The strength of our study was its use of mix-methods and triangulation to increase the reach of the individual data sets. In addition, our collaborative methodology facilitated our access to and cooperation with providers and consumers. Most importantly, the continuous feedback from consumers and providers enhanced our understanding of the findings, and facilitated effective dissemination of the findings in real time.
As mentioned above, this was a preliminary study and was limited in its methodological reach and limitations on the data available.
o The state of administrative data of agencies was uneven, so not every agency was able to provide complete data of each type, which placed restrictions on the analysis. In specific regards to the trends data, the use of a convenience sample was limited to those agencies and networks of agencies that were able to provide us with administrative data over time. In addition to this, since a varying number of agencies reported data in different years, the trends data has to be interpreted with caution.
o In considering the Roundtable data, one must be aware of its limitation. Although a well-designed and representative sample, it is now almost 7 years old, and the structural and economic context has not stayed the same. Also, the sub-sample of older Chicago cases is not as robust as would have been ideal, which has limited some avenues of analysis. However, we are confident of the findings from the analysis that we were able to conduct.
o Finally, in regard to the provider interviews, we learned during analysis that providers’ perceptions do not always accurately reflect what is happening within organizations. For instance, 41% of providers interviewed reported seeing an increase in the older homeless population within their agencies, but after comparing these providers’ statements to the administrative data from their agency, when possible, that percentage increased to 67%.

12. Please describe ways that the project resulting in the product involved collaboration that embodied principles of mutual respect, shared work and shared credit. If different, describe ways that the product itself involved collaboration that embodied principles of mutual respect, shared work and shared credit. Have all collaborators on the product been notified of and approved submission of the product to CES4Health.info? If not, why not? Please indicate whether the project resulting in the product was approved by an Institutional Review Board (IRB) and/or community-based review mechanism, if applicable, and provide the name(s) of the IRB/mechanism.

Researchers at Loyola University Chicago CURL have had a collaborative relationship with local Homelessness groups over the past 7 years . Dr, George, the PI on the project, had been recruited to fill the “research seat” on the the board of The Alliance (then known as The Chicago Partnership to End Homelessness). In board discussions issues surrounding the aging of the homeless population came to the fore. CURL, at the behest of The Alliance, mounted a small pilot to examine this issue further. In this pilot, 15 agencies representatives were interviewed and a review of the literature was conducted. Based on those findings, The Alliance, in collaboration with the Loyola researchers, requested funding for the combined research (to be conducted by the Loyola Researcher) and public education and policy advocacy (to be lead and primarily staffed by The Alliance) project from the Retirement Research Foundation. A key factor in the overall design of the project was a detailed feedback and communications loop, to insure that the research findings were thoroughly communicated to the homeless system and informed policy and program developed in a timely manner. To ensure this, research status reports and preliminary findings were reported to meetings of providers and consumers at periodic intervals during the research process.
While the university partner took the lead in the research implementation and analysis, The Alliance facilitated access to community agencies and both partners developed the policy and program recommendations. This approach ensured that all partnering organizations unique resources, values, and knowledge are utilized throughout the research process. The resulting policy report was composed by the researchers and reworked with input from The Alliance. Through this process, we were able to make sure that the policy report spoke appropriately to all of the audiences The Alliance felt were important. The Alliance took the lead with most of the dissemination activities, however, members of the research team were always available to provide additional information and presentation materials (i.e., PowerPoints) or act as representatives of the study when requested.
The Alliance has been informed of the submission to CES4 Health.info. The CEO of The Alliance is listed as one of the authors.