The Policy Failure Resulting in Unhoused Seniors – and Some Simple but Substantial Interventions

Headshot of Robert Feldman

By Robert Feldman, HAC Advocate

Almost a year ago exactly, HAC learned that our organization got funding for a new project focusing on unhoused seniors (aged 55+) in Alameda County, to help elder, unsheltered clients get on Social Security benefits and navigate the process of obtaining permanent supportive housing. I joined this small but mighty team of advocates and attorneys as we started our work last September in what we call the “The Unhoused Seniors Project.” As we approach one year on this project, I want to share some of my reflections and observations.

When I was in law school, inspired by my work as a clinical student at the Northern California Innocence Project, I wrote a memo about how stress during pregnancy – in particular, the stress on pregnant people of color dealing with racism – could potentially cause pathological signs in the newborn that could be mistaken for child abuse.

This work ultimately led me to a deeper inquiry into the ominous capacity of stress to cause and proliferate illness in all people. Since for the past decade I have been battling a currently-in-remission autoimmune disease that has previously caused three agonizing periods of serious illness, this new insight on stress helped me realize that to whatever degree my own choices could mitigate stress, I needed to make those choices. But obviously no one can totally shield themselves fully from environmental stress, especially for people like HAC’s clients, so many of whom face stressors like racism and poverty. So much of external stress is shaped by policy, and what circumstances someone finds themselves in.

So much of external stress is shaped by policy, and what circumstances someone finds themselves in.

I want to briefly summarize the biological mechanics of the stress response:

The stress response in the body is largely mediated by a group of hormone-secreting neuroendocrine glands – the hypothalamic-pituitary-adrenal (HPA) axis. When the stress response is triggered, the HPA axis increases the production of steroid hormones, including cortisol – a key component in the physiological stress response. Receptors for cortisol are present in nearly all tissues of the body.1

During stress, the body also produces chemicals called catecholamines, which increase heart rate and blood pressure, and cause inflammation-causing chemicals to spread throughout the body.2 When the body releases these stress chemicals chronically, they can lead to multiple negative pathological effects. These include damage to cells, systemic tissue degeneration, muscle breakdown, fatigue, and depression, amongst other undesirable ailments. Stress-induced widespread inflammation can also become the final straw in a chain of events contributing to the onset of an autoimmune disease.3

After law school, when I started working at HAC full time, it was clear to me that many of our clients have environmental stressors that are quite difficult to avoid or mitigate – including, but certainly not limited to resource scarcity and the lack of safe, predictable shelter. These and other stressors that unhoused and low-income people face undoubtedly expose them to poorer health outcomes. Indeed, HAC’s successful application to the U.S. Department of Housing and Urban Development for funding of the Unhoused Seniors Project cited a 2022 study finding that homeless older adults experience premature mortality.4 I am honored to be working on this project because it is a direct intervention in the factors contributing to a growing number of seniors as part of America’s unhoused population.

The Rising Population of Unhoused Seniors

Californians aged 50 and older comprise 40% of the state’s unhoused population, with Black, Indigenous, and Pacific Islander Californians disproportionately experiencing homelessness. Of this whole group of older unhoused Californians, 70% have a disabling health condition.5 Seniors are the fastest growing homeless population, with the number of unhoused people 55+ increasing 84% from 2017 to 2021, compared to a 43% increase across all ages during that period.6 Many of these elders entered homelessness for the first time, often due to low incomes and high housing costs.7

Social Security helps millions of Americans every month with cash benefit payments and Medicare coverage. However, misunderstandings about its funding often lead to austerity-centered policy that seeks to limit the payments it makes to beneficiaries of its programs. The U.S. Congress frequently threatens to raise the retirement age, and cost of living increases have been implemented that do not keep up with consumer inflation. Further, Supplemental Security Income (SSI), signed into law in 1972, was designed by Congress “to provide a positive assurance that the Nation’s aged, blind, and disabled people would no longer have to subsist on below-poverty-level incomes,” but presently pays below-poverty-level rates and enforces strict and outdated resource limits.8

Currently, the Federal Benefit Rate for SSI ($943 per month) amounts to only 75% of the current Federal Poverty Level ($15,060 annual income). Additionally, SSI’s resource limits restrict beneficiaries into having less than $2,000 in cash and resources for a single person, and $3,000 for married couple, providing limited exceptions like one vehicle used by the beneficiary for transportation, and the home the beneficiary lives in. But as one of my clients recently pointed out, these exceptions are often meaningless for beneficiaries who don’t already own the excluded resources like their own home, since the funds necessary to purchase things like a home would obviously require a beneficiary to save much more than $2,000.

SSI beneficiaries often become stuck in sub-poverty economic circumstances … For someone who is permanently disabled, there is likely no other option for meaningful monthly income.

And because of the extremely low resource limit, beneficiaries of SSI become stuck in sub-poverty economic circumstances as long as they remain beneficiaries. For someone who is permanently disabled, there is likely no other option for meaningful monthly income. Many have therefore advocated to raise or eliminate the SSI resource limit to give beneficiaries the opportunity to have a modest savings and spend accumulated money on expenses related to housing, health care, car maintenance and repairs, and other family needs.9 By either substantially raising or simply eliminating the resource limits and raising the benefit rate, SSI could actually finally meet its original purpose as defined by Congress. But for now, it is doing the exact opposite, by ensuring that its beneficiaries indefinitely subsist on below-poverty-level incomes.

Increasing retirement, disability, and survivors benefits and improving Medicare by eliminating copays and deductibles and covering dental and vision would give the most vulnerable Americans a better opportunity to live their lives in dignity and protect their health from the long-term damage of economic precarity and homelessness. Especially in the context of California, where the fastest growing homeless population is older adults who are squeezed out of their increasingly expensive rental units, benefit increases that are not only tied to consumer price inflation but are meaningfully increased to account for the added costs associated with growing older or managing a serious health condition could enable more people to acquire affordable housing and stay housed.

What can States, Counties, and Cities Do?

It gives me no pleasure to report that in the most recent Supreme Court term, Eighth Amendment protections for unhoused people were eliminated. Now municipal governments can get rid of homeless encampments regardless of whether there is any available shelter – an act that just a month ago constituted “cruel and unusual punishment” under the United States Constitution. In the constellation of below-poverty-level benefits, and inadequate, unaffordable health insurance, cities and municipalities now can either choose to participate in those harmful acts or refuse to be another source of chaos and trauma in the lives of people who do not have shelter. States and local governments can also reduce barriers to homeless and supportive services to people, and prioritize evidence-based homeless prevention strategies, like rental assistance to older adults at risk of homelessness.10

In light of the U.S. Supreme Court’s recent Grants Pass decision, cities now can either choose to participate in harmful acts or refuse to be another source of trauma in the lives of people who do not have shelter.

I want to conclude by returning to the concept of stress. To account for stress does not deny the resilience of humans. But this is a material reality – where research has unequivocally documented the long-term harm caused by chronic stress, clearly showing the link between experiencing poverty and homelessness, the attendant activation of the hypothalamic-pituitary-adrenal HPA axis, and the resultant damage to bodily systems that causes illness. Shoring up Social Security benefits and eliminating copays and deductibles from Medicare, as well as increasing the availability of permanent housing and other resources does not just give more people the basic things they need to survive, it has the capacity to decrease inflammation, lower blood pressure, and meaningfully reduce risks of developing health problems that lead to disease and early death.

With this accounting for the actual harm to unhoused people that scarcity-centered policy creates, we can prioritize policy that enables people to stave off more disease and illness. The growing number of unhoused older Americans is a disturbing trend. But we have policy options within the current slate of existing programs that could (and should) be deployed. In the meantime, I will do my best to work for and honor the dignity of the people I am lucky enough to call my clients.

  1. Chu, Brianna, Derek Ayers, Komal Marwaha, & Terrence Sanvictores, Physiology, Stress Reaction, National Center for Biotechnology Information, U.S. National Library of Medicine(October 10, 2020), https://www.ncbi.nlm.nih.gov/books/NBK541120/. ↩︎
  2. McEwen, Bruce S., Central effects of stress hormones in health and disease: understanding the protective and damaging effects of stress and stress mediators, National Center for Biotechnology Information, U.S. National Library of Medicine(Jan. 30, 2008), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2474765/. ↩︎
  3. Hannibal, Kara E., Mark D. Bishop, Chronic Stress, Cortisol Dysfunction, and Pain: A Psychoneuroendocrine Rationale for Stress Management in Pain Rehabilitation, National Center for Biotechnology Information, U.S. National Library of Medicine(July 17, 2014), https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4263906/. ↩︎
  4. Brown RT, Evans JL, Valle K, Guzman D, Chen Y, Kushel MB. Factors Associated With Mortality Among Homeless Older Adults in California: The HOPE HOME Study. JAMA Intern Med. 2022;182(10):1052–1060. doi:10.1001/jamainternmed.2022.3697 ↩︎
  5. Davalos, Monica, The Rise of Homelessness Among California’s Older Adults; How Policymakers Can Ensure Older Adults Stay Housed, California Budget & Policy Center (May 2024), https://calbudgetcenter.org/resources/the-rise-of-homelessness-among-californias-older-adults/. ↩︎
  6. Ibarra, Ana B., The fastest-growing homeless population? Seniors, CalMatters (February 10, 2023), https://calmatters.org/health/2023/02/california-homeless-seniors/. ↩︎
  7. Prunhuber, Patti, California’s Older Low-Income Renters Continue to Be Squeezed by Housing Unaffordability and Face a Growing Threat of Aging into Homelessness, Justice in Aging (March 13, 2024), https://justiceinaging.org/california-older-renters-unaffordability-homelessness/#0b46dc90-ab70-41db-8348-5f617b5be966. ↩︎
  8. S. Rept. No. 92-1230, Social Security Amendments of 1972, Committee on Finance, U.S. Senate (September 25, 1972), p. 384, available at https://www.finance.senate.gov/imo/media/doc/Rpt92-1230.pdf. ↩︎
  9. Nuñez, Luis, Kathleen Romig, & Arloc Sherman, The Case for Updating SSI Asset Limits; Raising or Eliminating Limits Would Reduce Administrative Burdens Without Dramatically Increasing Enrollment, Center on Budget and Policy Priorities (Updated September 20, 2023), https://www.cbpp.org/research/social-security/the-case-for-updating-ssi-asset-limits. ↩︎
  10. Ibid. Prunhuber (2024) ↩︎