Key learnings of the Erasmus+ Better support for elderlies who experienced homelessness project
Service providers need to consider ageing in relation to the support they provide to people experiencing homelessness. The experiences and hardships faced during prolonged homelessness contribute to serious health problems, including physical and mental health issues, often coexisting with addiction and substance misuse. Service providers must ensure access for older people to suitable accommodation, while new protocols and support tools need to be established within their services. To address the personal needs in connection to enhancing the health condition of older people, improved collaboration between health services and homelessness support services is necessary. Appreciating the experiences, skills and knowledge of those who face extreme poverty is not only a fundamental value but also an opportunity to listen to them, and leverage their insights to enhance participation in service setup, support, and to influence policies.
In this Erasmus+ project, knowledge was shared about partners’ existing programs and about how actors in partner countries operate in the housing, social, and health sectors. We identified the following key areas that influence how the needs of older people can be identified and addressed.
Key point 1: Understanding ageing
The harsh and unstable living conditions and challenges faced by people experiencing homelessness have serious impacts on physical and mental health and emotional wellbeing. Those without adequate housing constantly struggle for survival and face uncertainty over basic needs. Exposure to unsafe environments contributes to stress and anxiety, while periods of rough sleeping increase the risk of illness, because of a lack of nutritious food, limited hygienic opportunities and harsh weather conditions. Combined with social isolation and stigma, this enhances the risk of developing chronic diseases and mental health issues. By the age of 40-50, these factors can result in a deterioration of health that is typically experienced at a much later stage in the general population. In our program, we shared knowledge about the health condition and health support needs of homeless people.
Findings and results of connected research can be found here:
Supporting an elderly homeless population -presentation by Dr. Caroline Shulman
Care needs assessment- presentation by BMSZKI
Difficulties that older people face - slides from BMSZKI Pathways of elderlies presentation
Slides from Elderly homelessness in Italy -Fio.PSD presentation
A study on long-term housing needs of mid to later life Focus Ireland tenants
Dementia and homelessness- presented on the awareness raising event of Focus Ireland
Key point 2: Partnership working and collaboration
Ensuring the right to access appropriate health treatments and necessary medication is essential for those who face serious health issues. Health conditions affect people’s quality of life and their capability to be involved in social activities. People experiencing homelessness often face barriers in using primary and secondary healthcare such as consultations with general practitioners and mental health professionals, and they often are discharged from hospital wards without having an adequate place for their complete recovery. Collaboration between health services and homelessness support services is essential.
Partners shared their knowledge about the ways in which various actors in the health and community service sectors can be involved in providing support:
The Faculty for Homeless and Inclusion Health is a multi-disciplinary network focused on health care for people experiencing homelessness and other excluded groups. More about it can be found here: https://www.pathway.org.uk/faculty/
Key point 3: Participation and involvement
Participation is an important element of support as the knowledge of those who have firsthand experience of challenges and barriers provides valuable insights into the circumstances they face. The involvement of people with lived experience of homelessness in the decision-making processes empowers them and recognizes their dignity while helping service providers tailor interventions to better meet the needs that emerge. Active participation fosters trust between service providers and service users. When people experiencing homelessness feel heard and respected, they are more likely to engage, while the information coming from them challenges stereotypes and reduces stigma associated with homelessness. Their participation helps to humanise their experiences and fosters a greater understanding with decision-makers and within the community.
One of project partners, Groundswell, does not operate housing services but is committed to working with clients, and emphasises the importance of participation. Involvement of people experiencing homelessness is a core element of their activities. By conducting peer research exploring access to health services for people experiencing homelessness, they can provide valuable feedback on the effectiveness of community health services which can support service providers and decision-makers to identify areas of improvement.
More about this approach with examples can be found here:
An introduction to peer research – Groundswell presentation
Mental health peer research and campaign - Groundswell presentation
In Groundswell’s Homeless Health Peer Advocacy program, Peer Advocates play a crucial role by providing practical support, advocacy, and empowerment to people experiencing homelessness to improve people’s confidence in using health services and increase their ability to access healthcare independently. This approach is benefiting from the fact that Peer Advocates have faced similar situations, so they can draw on their own experiences to provide empathy, understanding, and practical advice. In their role they can assist with appointments, provide emotional support and facilitate the communication between health professionals and clients during medical consultations. They can also empower clients to become active participants in their own healthcare by providing them with information about their rights, available services, and self-care strategies. More about this activity:
Homeless Health Peer Advocacy Program and Floating Support - Groundswell presentation
Other programs built on participation:
Peer program of From Street to Homes Association
Participatory processes in low-threshold service for homeless people - Caritas Trieste presentation
Key point 4: Influencing policy
The primary function of the homelessness sector is to provide safe and accessible accommodation to meet the housing needs of people experiencing homelessness. Due to the multiple disadvantages and hardships that homeless people face, additional support is necessary in most cases. This includes support on achieving financial stability, accessing healthcare - including mental health services - addressing substance misuse, and engaging people in the community. There are different ways in which these kinds of support are available for homeless people in the partner countries, while the unanswered needs of those who are affected highlight the necessity of service development. Influencing policies refers to the process of advocating for changes or improvements in the strategies, programs and resources to address homelessness within a community.
Examples for these can be found here:
Preventing Homelessness & Supporting Sustained Exits from Homelessness –Focus Ireland presentation
Listen Up! –Groundswell presentation
Supporting elderly women – BMSZKI presentation
Less? - a film of personal stories from people who have experienced and overcome homelessness
Report on reducing health inequalities for people living with frailty
Key point 5: Housing First
Partners of this Erasmus+ program have different approaches to supporting people experiencing homelessness. Focus Ireland and From Streets to Homes! Association do not run conventional accommodation services, only supported housing. Their approach is based on the belief that providing stable and affordable housing in the earliest phase of a personal housing crisis is the best way to prevent adverse effects from emerging in such a situation. The multidisciplinary team-working method implemented in the Housing First approach can provide solutions for those who have complex support needs. This approach involves professionals from various fields in one team who work collaboratively to address the diverse needs that emerge. This diversity of expertise means that they can provide a comprehensive needs assessment. The support roles involved can be tailored according to clients’ individual needs, while also taking advantage of existing positive relationships between clients and individual professionals. By addressing various dimensions of an individual's life simultaneously, the team can better support the person's overall well-being. This is a client-centred approach where the individual's preferences, strengths and goals are considered.
More experiences from these programs can be found here:
Developing Housing First – From Street to Homes Association presentation
Ten years in forest – From Street to Homes presentation
The Importance of Wrap-Around Support in Housing First and Multi-disciplinary Team- Focus Ireland presentation slides 11th-26th
The accomodation service system of Caritas Trieste
Key point 6: Addressing mental health needs
Homelessness can lead to feelings of hopelessness, despair and constant worry about basic survival needs. This can contribute to the development of depression and anxiety. Many people experiencing homelessness have suffered from the effects of previous or repeating traumas, including childhood abuse, neglect, and interpersonal or institutional violence. Exposure to trauma can contribute to difficulties with memory, attention, and executive functioning, complicating people’s ability to navigate daily life and access services. Disconnection from supportive relationships and feelings of loneliness are common for people experiencing homelessness. They have profound effects on mental health, leading to feelings of alienation and worthlessness. Turning to drugs or alcohol can be a coping mechanism to self-medicate underlying mental health issues. Discrimination and stigma negatively impact self-esteem and can exacerbate mental health issues. Support methods regarding psychological wellbeing and access to mental health services are crucial for recovery.
We have collected several good practices for inspiration which can be seen here:
Elderly homeless health in Trieste- Caritas Trieste presentation
Mental-health and homelessness in Trieste – presentation by Caritas Trieste
Support for people living with mental health disorders –BMSZKI presentation
Grief processing – presentation by BMSZKI
Supporting an elderly homeless population – presentation by Dr. Caroline Shulman (slide 37th-57th)
Supporting End of Life Client- Groundswell presentation (slide 9th -20th)
Homeless Palliative care toolkit
More good practice examples and additional resources:
Italian Guidelines for combating severe adult marginalisation in Italy
John Conolly: presentation on trauma enhanced communication skills
Childhood trauma and the brain – short video from UK trauma council