Guest column: Homelessness and dying with dignity (opinion)
February 5, 2018
Americans who experience prolonged periods of homelessness die two decades earlier than the average U.S. citizen. As a social worker who ran a program that provided housing to people who met the federal definition of "chronic homelessness," I experienced this first-hand.
Over the course of five years, we were able provide housing to 292 people; 41 of them died at an average age of 57 years. Having clients die so young is hard especially when they've only recently been given a new lease on life through being provided the safety and security of having a home after years living on the streets.
Across the country, programs designed to serve the chronically homeless population will be struggling with death. That is, according to research conducted at the University of Pennsylvania, a large portion of people who have experienced chronic homelessness are part of a large group who first became homeless as young adults in the 1980s when there was a major economic recession. Many of these individuals remained or cycled in and out homelessness for years if not decades. Today, they are in their mid- to late-50s and aging quickly. To me, this raises three important points.
First, we need to get this vulnerable population off the streets. For too long communities did not have an effective approach to address chronic homelessness. Today, we have rigorous and extensive research that shows a housing first approach, which provides access to independent housing and support services, is a fiscally responsible and effective way to end chronic homelessness.
Second, as we work to end homelessness, we must provide housing and services that can accommodate or address accelerated aging experience by this population. Making sure that housing has adequate lighting or handrails to prevent falls, or that people receive proper nutrition through Meals on Wheels, even if they are younger than 60 years old, are things that are not typically discussed as part of homeless services. Although we cannot undue all the damage that people have incurred while homeless, there is much that can be done to lessen the impact.
Finally, we need to talk about death. Just five years ago my father died of pulmonary fibrosis at the age of 84. Six months prior he broke his hip — a common injury in the elderly that significantly increases the risk of death. With my mother as his caretaker, he was able to live at home in the house where I grew up until his final days in hospice where his pain could be managed. He died peacefully after loved ones could say good-bye. This experience made me think about all the people who will die alone on the streets, and has made me question how we can help all of our loved ones and neighbors — including those who have experienced homelessness — die with dignity.
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As a researcher who studies accelerated aging and early mortality among people who have experienced chronic homelessness, it is still hard for me to operationalize or quantify what it means for this population to die with dignity.
Clearly the three points above are a good start, but there also is a more basic adjustment that we can make, which is to stop looking past people who are experiencing homelessness or to stop seeing them as the problem of homelessness. That is, people are not born destined to be homeless and yet whether a person ends up homeless can be largely out of his or her control.
The reason there is a large group of people who fell into homelessness nearly four decades ago has more to do with being part of a population boom during times of severe economic contraction and limited job opportunities than it does any choice these people did or didn't make.
Today people are becoming homeless in California and elsewhere because housing has become a relatively scarce commodity that is unaffordable for large segments of the population. In Los Angeles alone there is a gap of over 500,000 units of affordable rental homes for low-income earners.
There is no doubt that effective public policy is needed to help address the problem of homelessness, and we have begun to see some sound policy decisions made in places like Los Angeles where the public recently authorized large increases in funding for housing and homeless services.
Such funding, however, does not change attitudes, and for those who have already been damaged by homelessness, dying with dignity also means living with dignity.
Treating people not as homeless but rather as people who are experiencing homelessness does not require more funding or policy change, it requires more empathy and less fear by each and every one of us.
Dr. Benjamin Henwood is an assistant professor at the University of Southern California's Suzanne Dworak-Peck School of Social Work and is the co-lead of the American Academy of Social Work and Social Welfare's Grand Challenge to End Homelessness.