The Gerontologist
Vol. 40, No. 5, 618–626
PRACTICE CONCEPTS
Copyright 2000 by The Gerontological Society of America
The Achievements of a Multiservice Project for
Older Homeless People
Anthony M. Warnes, PhD,1 and Maureen A. Crane, RGN, RMN, MSc, PhD1
not registered as homeless with local authority housing departments and, through a statutory obligation,
thereby given priority access to public or “social”
housing. Many have not approached a housing authority for help; some have been refused. Nearly all
single homeless people either sleep in temporary or
“direct access” hostels run by religious or voluntary
organizations or are “rough sleepers,” that is, they
live on the streets, in shop and office doorways, at
train stations and bus terminals, or in secluded locations such as abandoned buildings, cellars, disused
cars, subway tunnels, and barns. The equivalent U.S.
term for the latter is street people (Snow & Anderson,
1993).
This report of the achievements of an experimental multiservice center in London for older street people begins with reviews of the types of long-term accommodation available for
resettlement and the work of its outreach team, 24-hour open
access rooms, and residential, assessment, and resettlement
services. Two outcomes are examined: whether users returned
to the streets and whether they were resettled in long-term
housing. Those with alcohol dependency were most difficult
to resettle. Logistic regression analyses of the factors influencing the two outcomes indicate that the duration of residence
in the center was the the predominant influence.
Key Words: Homeless, Rehabilitation, Resettlement
The aim of this article is to assess the ways in
which older homeless people can be helped to return
to more conventional accommodation and lives. It
draws on the experiences of Lancefield Street Center,
an experimental multiservice program and hostel in
London (England) for older people who were sleeping on the streets. The article begins with three concise reviews: of the problems and needs of older
homeless people, of the recent development of policies and services for homeless people in the United
Kingdom, the United States, and Australia, and of
previous service innovations dedicated to the age
group. A broad account of the achievements and lessons of the Lancefield Street experiment is followed
by an analysis of the long-term accommodation outcomes for its residents. From this evidence, and the
experience of a few related projects, the conclusions
focus on the kinds of services and interventions that
do make a difference to single older homeless people’s lives.
Discussions of homeless people require terminological precision. In the United Kingdom, the term
single homeless people distinguishes those who are
The Problems and Needs of Older Homeless People
Until the mid-1980s, there was little evidence of
the problems and needs of homeless older people, although they had been included in all-age studies.
Subsequently, a few specialist studies in British, United
States, and Australian cities have identified some
common characteristics (Bissonnette & Hijjazi, 1994;
Cohen, Ramirez, Teresi, Gallagher, & Sokolovsky, 1997;
Cohen & Sokolovsky, 1989; Crane, 1997, 1999; Douglass et al., 1988; Iqbal, 1998; Keigher & Greenblatt,
1992; Kramer & Barker, 1996; Kutza & Keigher,
1991; Purdon, 1991; Rich, Boucher, & Rich, 1995;
Wilson, 1995). In the United Kingdom and the United
States, some older homeless people live on the streets
while some stay in hostels and night shelters (in the
U.K.) or public shelters (in the U.S.), while in Australia,
they concentrate in large hostels and night shelters
(Purdon, 1991). They exhibit high rates of isolation,
estranged family relationships, pessimism, and physical
and mental illnesses (the latter particularly among
women). Although drug abuse is rare among the
group, heavy drinking is common among men. Some
older rough sleepers claim no Social Security benefits
through ignorance of the system, have no income,
and survive with food from litter bins or soup kitchens (Cohen & Crane, 1996; National Coalition for the
Homeless, 1997). Some have been homeless for
more than 20 years and have become “entrenched”
in the lifestyle, whereas others became homeless for
the first time in old age (Grigsby, Baumann, Gregorich,
& Roberts-Gray, 1990). Commonly reported factors
This research was supported by The King Edward VII Hospital Fund for
London (The King’s Fund) Grant #94/58 and the Henry Smith Estate Charity. Our sincere thanks are extended to the residents and staff of the
Lancefield Street Center and to St. Mungo’s for their invaluable help in
gathering the information for this study.
Address correspondence to Anthony M. Warnes, PhD, Sheffield Institute for Studies on Ageing, University of Sheffield, Community Sciences
Centre, Northern General Hospital, Sheffield S5 7AU, U.K. E-mail:
[email protected]
1
Sheffield Institute for Studies on Ageing, University of Sheffield.
618
The Gerontologist
preceding homelessness include widowhood, marital
breakdown, retirement or redundancy, discharge from
the armed forces, and the increased severity of a mental illness (Crane, 1999).
Older homeless people tend to be unassertive and
undemanding of services, and their needs are met inadequately by both mainstream elderly services and
generic services for homeless people. The former are
often unable to respond to the distinct problems of
older homeless people (Doolin, 1986; Purdon, 1991)
and rarely seek out people who are reluctant or incompetent to ask for help (Crane & Warnes, 2000).
Most day centers and hostels for homeless people cater to all ages, but many older street people will not
use them because they dislike the noise and overcrowding, and they fear violence and intimidation by
young users who tend to dominate and are demanding (Coalition for the Homeless, 1984; Cohen &
Sokolovsky, 1989; Crane & Warnes, 1997b). Furthermore, generic outreach and resettlement workers who
work with homeless people often do not have the
time and resources to engage with older entrenched
rough sleepers, who are extremely hard to find and
more evasive of services than younger homeless people
(Randall & Brown, 1995; Sheridan, Gowan, & Halpin,
1993).
and counseling. In addition to federal aid, state and
local governments fund private and voluntary groups
to provide services, and local governments also operate
public shelters.
In the United Kingdom, in 1990, the Conservative
government initiated the Rough Sleepers Initiative
(RSI), which over three 3-year phases has allocated
more than £255 million for temporary and permanent accommodation for single homeless people,
and for outreach and resettlement workers (Department of the Environment et al., 1995). In addition,
there are funding programs specifically to help mentally ill homeless people. Following the election of
the Labour government in 1997, the RSI was replaced in April 1999 by the Homelessness Action
Programme, which promises a greater emphasis on
service development, prevention, and resettlement
(Social Exclusion Unit, 1998). More hostel beds,
“contact and assessment teams” working on the
streets and, in London, 24-hour access refuges are to
be provided and will herald more coercive actions to
stop street living (Rough Sleepers Unit, 1999).
Services Dedicated to Older Homeless People
Since the mid-1980s, services specifically for older
homeless people have been initiated in the larger cities of the United Kingdom, the United States, and
Australia. They include drop-in and day centers, temporary accommodation with rehabilitation and resettlement programs, and various long-term housing options, including shared, supported, and high-care
housing (Bisonnette & Hijjazi, 1994; Doolin, 1986).
These services have demonstrated that older homeless
people can be helped by intensive work and specialist
facilities, and can be rehoused in conventional accommodation. As examples, in London, Lowestoft
(England), Seattle, and Melbourne (Australia), older
men who had been resident for years in temporary
hostels and shelters have been rehoused in supported
housing, and have become more self-confident and
sociable. Some drink less, eat better, and take better
care of their personal appearance and rooms (Crane &
Warnes, 1997a; Elias & Inui, 1993; Hallebone, 1997).
Services specifically for older homeless people,
however, are not widespread for three reasons (Cohen, 1999). First, as mentioned, there is little awareness of the circumstances and unmet needs of older
homeless people. Second, despite the recent elaboration of policies and services for homeless people, the
age group is not a high priority for policy makers—
young homeless people are—and the services dedicated to older people have generally developed from
initiatives by nongovernmental organizations. Some
are long established in the sector, others have been
founded specifically for the purpose, as with Boston’s
Committee to End Elder Homelessness in 1991, Peter’s Place in New York City (a 24-hour drop-in center), and small rehabilitation houses that help their
residents build (or rebuild) living skills and prepare for
permanent housing (e.g., Program to Resettle Elderly
People (PREP) in Grangetown, Cardiff, Wales; the
Zambesi Project in Birmingham, England; and The
Policies and Services for Homeless People
Over the past 10 years or more, services for homeless people in the United Kingdom, the United States,
and Australia have developed in similar ways. Formerly, a high proportion of homeless people were
transient laboring men and were accommodated in
rudimentary hostels and reception centers in the
United Kingdom, in skid-row missions and singleroom occupancy hotels in the United States, and in
large hostels and night shelters in Australia. Some services provided only overnight accommodation and few
offered individualized help, counseling or treatment
programmes, or resettlement and rehousing support.
Many were developed by voluntary and charitable (nongovernmental) organizations.
Since the mid-1980s, it has been acknowledged
that many homeless people have health, social, and
behavior problems, and that the way forward is not
just to provide basic shelter and food but also to provide specialist and supportive services that encourage
rehabilitation and a move toward independent living. In
Australia, the Supported Accommodation Assistance
Program was introduced in all states and territories in
1985. This provides joint Commonwealth and State or
Territory funding to nongovernmental organizations
providing services to homeless people (Purdon, 1991).
In the United States, the 1987 Stewart B. McKinney
Homeless Assistance Act was the first comprehensive
legislation pertaining to homelessness (Daly, 1996). An
Interagency Council on the Homeless was established to
coordinate the activities of federal agencies responsible
for housing-assistance programs and grants. This has
encouraged the development of small transitional and
specialized shelters that offer care and support to homeless people and has funded health care, job training,
Vol. 40, No. 5, 2000
619
Dwelling Place in Washington, DC). Third, there
have been few formal evaluations or published reports of the experimental schemes (Crane & Warnes,
1997a). As a result, the outcomes of different types of
interventions are unknown, and good practice is rarely
disseminated. One exception is Project Rescue, a day
center near the Bowery in New York City for homeless
people aged 60 years and older. A 30-month evaluation
of the project identified the client characteristics that
predicted successful outcomes (Cohen, Onserund, &
Monaco, 1992, 1993).
The Lancefield Street Center
Research in London during the early 1990s showed
that many older homeless people had been sleeping
on the streets for years, were isolated, had untreated
physical and mental illnesses, and were not claiming
welfare benefits or accessing services (Crane, 1993).
This led to a proposal for an experimental center that
would provide multiple services from street outreach
to resettlement for people aged 50 years or older. It
was modeled on day centers and outreach work for
older homeless people in New York City and Boston
(Cohen & Sokolovsky, 1989; Doolin, 1986). The inclusion of a residential hostel was, however, unprecedented. Substantial financial support was provided
by a charitable trust, and a voluntary housing organization, St. Mungo’s, came forward to manage the
Center; however, the opening was delayed through
several refusals of permission by building lessees and
for planning (zoning) reasons.
The Lancefield Street Center opened in January
1997 and closed in December 1998 when funding
and the building lease expired. Its services comprised
two street outreach workers; an open-access, 24hour drop-in center; a 33-bed hostel providing temporary accommodation; access to health care and alcohol abuse programs; and a resettlement program.
Its overall aim was to provide services that would enable progression from street living to resettlement in
long-term accommodation (Figure 1). The objectives
and work of the four principal services are described
in turn.
Street Outreach Work
The prime objective of the two outreach staff was
to persuade street people to enter (and reenter) the
Center. By working during the day and in the evenings, they found 491 older people (448 men and 43
women) sleeping on the streets during the 23 months
of the project. Each month, they newly discovered at
least 10 older rough sleepers, and in most months,
more than 20. Some of the new contacts had become
homeless recently; some had been on London’s streets
for years; and others had been homeless for months
or years but had arrived in London recently. Many
were living in secluded places away from the central
business area (where young homeless people tend to
congregate). They were sleeping in derelict buildings,
phone booths, parks, woods, and sheds. The outreach
Figure 1. Pathways from the streets to resettlement, Lancefield
Street Center, London, 1997–1998.
workers also helped 78 older homeless people who had
only temporary accommodation, including hospitals
and night shelters.
The outreach team referred 239 clients to Lancefield Street and 62 to other hostels. Some were persuaded to take this step only after intensive work and
diverse help on the streets for many months. The clients were given food, clothing and blankets, taken for
medical treatment, and assisted with claims for wel620
The Gerontologist
fare benefits. When a client showed a willingness to
accept services, it was found to be important to respond immediately, which the continuously open
drop-in center made possible. Those who had been
homeless for years were most resistant to services,
and women who were sleeping rough were the most
difficult to help: many had severe mental health
problems and, compared with the men, they were
less willing to talk, more suspicious, and more reluctant to go to the Center.
tuberculosis, liver and renal failure, heart problems,
and neurological diseases. Many had not, however,
sought treatment while sleeping on the streets. The
residents received individualized help from the hostel staff and from specialist workers. Thirty percent
received help claiming welfare benefit entitlements,
40% received help with personal care and budgeting, 42% were referred for medical care, and 29%
(50) were admitted to a hospital on 107 occasions.
Sixty percent of those with mental health problems
were referred to psychiatric services, and 36% of
those with alcohol problems were seen by specialist
workers or admitted to detoxification units.
The Drop-In Center
The drop-in center comprised two sitting rooms, a
kitchen, and a bathroom. Users had access to the
hostel resident’s dining room and laundry, and staff
members were available at all hours. The facility was
used by 141 men and 13 women, and stays ranged
from 2 hours to 87 days. Twenty-five clients used it
on more than one occasion. It functioned as a refuge,
a “habitat,” and a “transit lounge” for those who
were distrustful and reluctant to book into the hostel,
too unsettled or disturbed to stay in the hostel, or
waiting for a vacancy in the hostel, a detoxification
unit, or elsewhere. It was an assessment center,
where information was collected about the users’ circumstances and needs, help and support were organized, and referrals were made to medical, psychiatric,
alcohol, and resettlement services. Beyond providing
for immediate needs, the facility provided a steppingstone from the streets. It enabled trust to be built in a
safe environment for many people who had previously
refused services, and it allowed the most wary of older
rough sleepers to be habituated gradually to conventional shelter.
Only a minority of the users immediately returned
to the streets: 59 first-time users (40%) moved into
the hostel, and 30% were referred to other services.
Those who had been homeless for less than a year
were the least likely to return immediately to the streets,
but even among the 55 users who had been homeless
for more than 10 years, 62% moved to temporary
accommodation, demonstrating that older people
with long histories of homelessness can be persuaded
to accept help.
Resettlement in Long-Term Accommodation
A resettlement worker assessed the housing needs
of the residents, found appropriate vacancies, in
many cases negotiated with statutory social and mental health services for special funding, and arranged
the move and follow-up support. Many residents
were difficult to resettle. Twenty-six heavy drinkers
refused to cooperate with programs to reduce their
alcohol intake, had high personal-care needs when
drinking, and were unsuited for independent accommodation. Twelve users feared being rehoused and
returned to the streets when housing was discussed
or accommodation became available. Twenty percent
of the 205 hostel admissions ended with the residents
returning to the streets. If unknown destinations are
added to this category, the total reaches 44% (Table
1). A lower percentage of the destinations following
the last episode, however, were returns to the streets
(37%). Of the 58 residents who moved to long-term
housing, 10 went to conventional independent tenancies, 24 to shared houses for ex-homeless people
with nonresidential daily support workers, 17 to residential group homes that are staffed 24-hours/day and
provide high care support, and 7 to special accommodation for mentally ill people or heavy drinkers
(Table 1). Over the life of the project, a rising proportion
of the residents were rehoused and correspondingly,
the proportion who left of their own accord or returned to the streets decreased.
The several progressive services at Lancefield
Street had recorded contacts with 664 older street
people, of whom 503 were homeless (Table 2). The
vast majority were contacted on the streets by the
outreach team: only 8 entered the drop-in center by
other paths, and only 4 hostel residents were not referred by them. The progression and outcomes of the
contacted individuals through the center’s services
are summarized quantitatively in Table 2. For detailed accounts of the reasons for the diverse outcomes (e.g., why some people could not be persuaded to leave the streets or why long-term housing
could not be found for some residents) the reader
should consult the full monitoring report (Crane &
Warnes, 1999). Overall, however, nearly two thirds of
the clients contacted on the streets were helped to enter
temporary accommodation, three quarters of those who
entered the drop-in center moved into hostel accommodation, and one third of the hostel residents were
The Residential Hostel
The hostel had 33 beds and was generally full;
only 6% of available bed-nights were not occupied.
One hundred fifty-seven men and 14 women were
admitted on 205 occasions. The duration of the 205
residence episodes varied considerably: 39% were
less than 30 days, whereas 32% were for more than 3
months and 11% exceeded 9 months. The average
duration of a residence episode was 101 days and
the median was 47 days. Of the 171 residents, 49%
were aged 60 years or older, 20% had been homeless for less than 3 months, and 42% had been homeless for more than 10 years. On admission, 55% had
physical health problems, 39% had mental health
problems, and 58% were heavy drinkers. Some had
severe physical illnesses, with cases of carcinomas,
Vol. 40, No. 5, 2000
621
Table 1. Accommodation Destinations of the Lancefield Street Residents, 1997–1998
All Residential Episodes
Last Residential Episodes
n
%
n
%
% Last/% All
58
10
24
17
7
52
41
11
5
49
41
205
28.3
4.9
11.7
8.3
3.4
25.4
20.0
5.5
2.4
23.9
20.0
100.0
56
9
24
16
7
47
37
10
5
43
20
171
32.8
5.3
14.0
9.4
4.1
27.5
21.7
5.8
2.9
25.1
11.7
100.0
1.2
1.1
1.2
1.1
1.2
1.1
1.1
1.1
1.2
1.1
0.6
Outcome
Long-term accommodation (total)
Independent tenancy
Shared house
High-care home
Special needs hostel
Temporary accommodation (total)
Other hostel
Other temp. accommodationa
Died
Not known
Return to streets
Total (all outcomes)
a
Includes hospital, detoxification unit and prison.
resettled in long-term accommodation. Positive outcomes were therefore predominant but far from universal. The final section of this article examines the factors
associated with two selected positive outcomes.
drinking habits, and morale. A semi-structured questionnaire recorded the residents’ progress every 4
months, the services they received, and the outcomes
of referrals, interventions, and medical treatment.
One researcher spent at least 2 days every week at
the Center, to upgrade the management registers,
collect information from the staff, build relationships
with the residents, and conduct the interviews. The
residents who were rehoused have been included in
a longitudinal study (1997–2001) of resettlement for
older homeless people.
This analysis concentrates on the associations between the onward destinations of the residents after
the final episode of residence and both selected personal characteristics and aspects of their hostel residence. Two outcomes have been examined: whether
The Outcomes of Hostel Residence
This section draws on a monitoring study of the
Center during its 23 months of operation (Crane &
Warnes, 1999). Three routine operational data files
were established about the outreach workers’ contacts, the users of the drop-in center, and the hostel
residents. In-depth interviews with 88 residents collected information about social and family relationships, accommodation histories, and experiences of
homelessness, physical and mental health problems,
Table 2. Clients of the Lancefield Street Center Services and Their Progression
Not Requiring
Accommodation
Service
Contact
Outreach
n
%
Drop-ina
n
%
Hostelb
n
%
Type of Move-On Accommodation
Progression
Had
To
own
Died or Without
To
To other or To drop-in residential To long-term Up
No
Down
Users accom. to custody accom. streets temp. accom.
center
hostel
accom.
a step change a step
652
100
161
25
0
0
491
100
190
39
62
13
141
29
98
20
0
0
301
61
190
39
—
—
154
100
0
0
0
0
154
100
40
26
43
28
—
—
69
45
2
1
114
74
—
—
40
26
171
100
0
0
7
4
164
100
63
38
49
30
—
—
—
—
52
32
52
32
49c
30
63
38
Notes: temp. ⫽ temporary; accom. ⫽ accommodation. The table describes the progress of people (rather than episodes of contact).
Temporary housing includes hospitals, police cells, and detoxification units. The estimates are in some instances problematic because of
the intricate, shuttling pathways followed by a few individuals. For example, 5 people’s first contact was admission to the residential hostel, but later they either transferred to the drop-in center or went to it via an episode on the streets. A few individuals were contacted by
the outreach team on the streets after they had stayed at Lancefield Street. Deaths and transfers to, returns from, and onward moves from
hospitals, detoxification centers, and police cells further complicate the flows.
a
Refers to outcomes of first-time use.
b
Refers to final departure.
c
Transfers to temporary hostels.
622
The Gerontologist
were just 14 women informants and disaggregation
by sex has not been analytically productive. The reference case for the full sample and the older agegroup models was specified as a resident who stayed
for no more than 25 days, who had been homeless
for more than 10 years, was aged 70 years or older, and
had neither an alcohol nor a mental health problem.
Age does not enter the model for those in their fifties.
Hypothetical models of the two outcomes were
developed inductively from the descriptive findings
and our observations of both the process of resettlement and the reactions of the residents. The most apparent influence was exposure to the support and
help that the center provided. Many of the residents
who stayed too short a time to enter resettlement
planning returned to the streets, and the few shortstayers who entered long-term housing went to live
with a relative. However, of the 10% of residents who
stayed the longest (average 430 days), none returned
to the streets. The relationship between the duration
of residence and the probability of not returning to
the streets was nonlinear: the probability increased
steeply from 0 for a 1-day stay to 0.95 for a stay of 90
days (Figure 2). Stays longer than 90 days first reduced the probability, partly because this group had
the resident on departure from the Center (a) returned
to street living and (b) was resettled in long-term accommodation or had been accepted into a resettlement program. Long-term accommodation was defined as conventional, supported, or high-care housing,
and did not include temporary hostels, hospitals, or
detoxification units. The second outcome allows for
the special arrangements on the closure of Lancefield
Street, whereby some residents who were awaiting a
tenancy or otherwise accepted for resettlement were
transferred temporarily to hostels. Mental health problems were attributed when a person reported current or
recent psychiatric treatment or displayed clear signs of
dementia or a psychosis (most often pathological delusions). An alcohol problem was recorded when the client
showed recurrent heavy drinking or alcohol addiction.
As both outcome or dependent variables are binary, logistic regression was selected as the method
of analysis (and the SPSS software was used; Norusis,
1990, page B-39). The distributions of and associations among the input variables have, however, been
examined for both interval and categorical forms.
Models have been calibrated for the full sample of
171 residents, for the 88 who were younger than 60
years of age, and for the 83 who were older. There
Figure 2. The relationship between duration of residence and the likelihood of returning to street living: Lancefield Street Center residents, 1997–1998. Equations: Logarithmic: y⬘ ⫽ ⫺0.227 ⫹ 0.215 ln(x), R2 ⫽ 0.903, F ⫽ 74.5, p ⬍ .000. Cubic: y⬘ ⫽ 0.067 ⫹ 0.143x ⫺
0.00008x2 ⫹ 0.00000011x3, R2 ⫽ 0.930, F ⫽ 26.7, p ⬍ .001.
Vol. 40, No. 5, 2000
623
a high prevalence of severe behavioral problems and
care needs, but durations of more than 250 days reestablished a positive relationship with the positive
outcome. Duration of residence (DURRES) was categorized into its four quartiles (see Table 3). There was
a similar nonlinear relationship between the duration
of the episode and the probability of being resettled
in long-term accommodation.
Having observed that many of the residents who
had been homeless for 10 years or longer were entrenched in the lifestyle and exceptionally wary of
accepting help or of moving to conventional housing—and that by contrast those who had recently become homeless predominated among those who were
most willing to accept help—it was secondly hypothesized that the duration of homelessness (DURHML)
would influence homelessness. Third, the exceptional
problems of finding (and financing) long-term accommodation for the residents aged in their fifties, the intensive personal care needs of a high share of the oldest
residents, and the delays in finding accommodation in
registered nursing homes suggested that age (AGE)
would influence the resettlement outcome. Finally,
because both alcohol and mental health problems
debar homeless people from some types of long-term
housing, but give eligibility to special-needs accommodation, these attributes (ALCPRO and MENTHE) were
hypothesized as influential on the two outcomes.
To check for covariance, the five hypothesized independent variables were cross-correlated. The distributions of the three available interval measures (DURHML,
DURRES, AGE) were brought to acceptable approximations of normality using logarithmic transformations.
For the entire sample, two bivariate correlations with
DURHML were significant at p ⬍ .05: ALCPRO gave
r ⫽ ⫹.20, and DURRES gave r ⫽ ⫺.17, so in neither
case was more than 4% of the variance explained.
Nonlinear associations were examined by calculating
the chi-squared statistic for all bivariate cross-tabulations. Only the association between ALCPRO and
DURRES (four categories) produced a significant result
(␹2 ⫽ 11.7, p ⫽ .008), because there was an excep-
Table 3. Logistic Regression Models of Two Positive Outcomes
Outcome:
Ages (years):
Model:
a
b
c
d
e
f
g
h
i
j
k
l
m
n
o
p
q
r
s
t
u
v
w
x
y
z
aa
bb
cc
dd
Prevalence (%)
⫺2 log likelihood
Base cases
Constant: B
p(outcome)
DURRES
R
26–53 days
B
p(outcome)
R
54–155 days
B
p(outcome)
R
145–610 days
B
p(outcome)
R
ALCPRO
B
p(outcome)
R
Model statistics
⫺2 log likelihood
Chi-squared
Degrees of freedom
Predicted correctly (%)
Prediction gain (%)
Sample size
Not Returned to the Streets
50–59
1
60⫹
2
Resettled or Resettlement Plans
All (50⫹)
3
50–59
4
60⫹
5
All (50⫹)
6
59
115.2
65
102.7
62
218.5**
31
108.5***
49
115.1
40
226.8*
⫺2.14**
0.11
⫺1.28*
0.22
⫺1.61***
0.17
⫺8.46
0.00
⫺2.35**
0.09
⫺2.30**
0.09
0.33***
0.39***
0.40†
0.00
0.36***
0.29†
2.45**
0.57
0.24
1.97**
0.67
0.22
2.06***
0.61
0.25
8.30
0.46
0.00
1.84*
0.38
0.14
2.19**
0.47
0.15
2.91**
0.68
0.27
3.07**
0.86
0.35
2.84†
0.77
0.33
8.84
0.59
0.00
3.04***
0.67
0.30
3.18***
0.71
0.25
5.13***
0.95
0.35
3.47**
0.90
0.35
4.14†
0.93
0.37
9.30
0.70
0.00
4.09†
0.85
0.37
3.71†
0.80
0.29
—
—
—
—
—
—
—
—
—
⫺1.25*
0.00
⫺0.16
—
—
—
⫺1.17**
0.03
⫺0.18
69.9
35.2†
3
76
30
85
73.4
29.3†
3
81
25
79
156.8
61.7†
3
79
27
164
85.5
23.0***
4
74
7
88
82.2
32.8†
3
77
34
83
175.6
51.2†
4
71
18
168
Notes: DURRES ⫽ duration of residence; ALCPRO ⫽ alcohol problem. Rows: Row b: The initial log likelihood (of a single outcome).
Row c: The base case individuals stayed in the hostel fewer than 26 days and in Models 4 and 6 did not have an alcohol problem. Rows
d, i, m, q, and u are the B partial regression coefficients (log odds of the positive outcome). Rows e, j, n, r, and v are the predicted probabilities of the positive outcome for individuals with the (category) characteristic. Rows g, k, o, s, and w are R partial (Wald based) correlations between the category value or variable and the outcome, n.b. if the Wald statistic is less than 2, R is set to 0 (see Norusis, 1990, p.
42). Row cc is the model’s percentage improvement in the share of cases correctly predicted over a single outcome prediction.
*p ⬍ .05; **p ⬍ .01; ***p ⬍ .001; †p ⬍ .0001.
624
The Gerontologist
tionally low prevalence of alcohol problems (34%)
among those who had been homeless between 1 month
and 2 years when compared with all others (64%).
Similar tests were carried out for the young and old
age groups. For those aged in their fifties on admission,
the linear interval correlation between DURRES and
MENTHE (r ⫽ ⫹.30, p ⫽ .007) was significant, and
that between DURRES and ALCPRO (r ⫽ ⫹.23, p ⫽
.04) was marginally significant. The categorical crosstabulations produced no significant chi-squared statistics at p ⫽ ⬍.05. For the older age group, there
was a significant linear interval association between
DURHML and DURRES (r ⫽ ⫺.25, p ⫽ .03), and
there was only one marginally significant bivariate categorical association, between DURHML and
ALCPRO (␹2 ⫽ 7.88, p ⫽ .049). The covariation that
is present is therefore modest for both age groups and
the full sample. The full theoretical model—that the
two outcomes are both influenced by duration of residence, duration of homelessness, age on admission,
and the presence of alcohol and mental health problems—was therefore retained.
In exploring the relationships, both backward and
forward stepwise selection using the likelihood-ratio
test have been used, the variable inclusion criterion
being an improvement to the model at p ⬍ .05, and
the exclusion criterion being p ⬍ .1. It was quickly
established that AGE, DURHML, and MENTHE had
no significant influence on any model. As they reduced the sample size (through missing data), they
have been excluded from the reported models. Similarly in the models that did not select ALCPRO, that
variable was excluded from the final runs.
reduces the probability of being resettled. The partial
correlation for ALCPRO is low (row w) and the influence is only marginally significant (row u). The younger
age group model does nonetheless produce a significant improvement over a single outcome prediction
(row z) if only a modest increase in the correct prediction of individual cases (row cc). Despite the weak associations of the individual terms, the model confirms the
very strong influence of variations in the duration of
stay. It predicts that residents who stayed in the hostel
just 0–25 days had a 0.0 probability of being resettled,
whereas for residents without an alcohol problem who
remained more than 144 days the probability rose to
0.70. For the longest stayers with an alcohol problem,
the probability of being resettled was raised to 0.40.
Discussion
Two summary findings emerge from these analyses. First, and unsurprisingly, the necessary condition
of all the positive long-term accommodation outcomes was a more-than-brief stay at Lancefield Street.
Among those who resided fewer than 20 days, the
Center’s interventions rarely disturbed a trajectory of
continuing homelessness. When residence reached
60 days, however, an even chance of being resettled
was reached, and for residents who stayed longer than
90 days, resettlement in some form was achieved for
more than two thirds. Second, the likelihood of resettlement among older homeless people, and particularly
those aged in their fifties, was related to whether they
were heavy drinkers; an identified alcohol problem
significantly reduced the probability of the positive
outcome. No significant association was found between
the two positive outcomes and whether individuals had
mental health problems, their duration of homelessness,
or their age (nor whether they had severe personal
hygiene deficits or had previously slept rough).
The Lancefield Street Center provided a “complete
pathway” from the streets to long-term housing for
many older rough sleepers. The outreach team initiated the majority of the users’ contacts with the project
and had an important role in engaging and building
relationships with those who were isolated and resistant
to services. The effectiveness of persistent and intensive
street outreach work with “hard-to-reach” street dwellers
has been noted in other U.S. and British reports (Morse
et al., 1996; Craig, 1995; Sheridan et al., 1993). The
drop-in center served as a stepping-stone from the
streets to the hostel for the distrustful and anxious,
and is comparable to the “community living room”
and the “street center” described in U.S. studies (Pollio,
1990; Segal & Baumohl, 1985). The drop-in center
and the hostel helped older street people to settle,
linked them to services, and encouraged them to consider more conventional accommodation. The resettlement component was crucial for completing the pathway and moving the residents to long-term housing,
and in releasing the hostel beds for others. The model
could be applied to other entrenched street people who
are severely incapacitated by mental health or substance
abuse problems.
Results
The three age-group models of whether the residents
returned to the streets have a similar structure, with
DURRES being the only significant variable (Table 3).
Moreover, the structure of influence of the individual
categories is shared. The base case models predict a
very low probability of the successful outcome (row e),
while the categories for longer stays are associated with
a progressively higher probability of not returning to the
streets (rows j, n, and r). The highest category is for residents who remained more than 144 days: all three agegroup models predict a probability of not returning to
the streets of at least 90%, compared with 12–27% for
the base case. In addition, all three models increase the
share of correctly predicted cases (over a single outcome prediction) by at least 25% (row cc).
The second set of models examines the factors influencing “resettled or not.” The relative frequency of the
positive outcome was significantly lower in the younger
than the older age group (␹2 ⫽ 6.25, df ⫽ 1, p ⬍ .02),
and the logistic regressions suggest some contrasts in
the structure of influences. DURRES is again included
in all models, and its successively higher categories (of
longer stays) produce similarly progressive increases in
the probability of a positive outcome. No other variable
enters the model for the older age group. In contrast, the
models for the younger and all-age groups also select
ALCPRO (the presence of an alcohol problem), which
Vol. 40, No. 5, 2000
625
Even in the short life of this scheme, several lessons have been learned about effective ways to develop services for older homeless people. Many older
rough sleepers who do not use generic homeless services will respond to the intensive encouragement
and support provided by dedicated services, can be
persuaded to take up residence in temporary accommodation, and will then accept more permanent
housing. The Lancefield Street Center reduced the
number of older people living on the streets of London.
Its interventions produced long-term accommodation
prospects for around one half of its residents, and the
early evidence from the longitudinal study of resettlement suggests that approximately one third will adapt
to conventional accommodation. Many older people
who were demoralized and resigned to homelessness
are already developing new roles and activities.
In describing the limits and lessons of the Lancefield Street Center experience, it becomes evident,
first, that it is important to identify and help people
soon after they become homeless; second, that older
homeless people must be encouraged to remain in
contact with services and support staff long enough
to benefit from help; and third, that more needs to be
understood about effective ways of helping those
with an alcohol problem. Heavy drinking reduced
the client’s ability to be rehoused and to live independently, increased the chances of returning to the
streets, compounded physical health problems, and
was associated with depression and pessimism. More
needs to be known about the types of counseling services and other interventions that effectively help people
to reduce heavy drinking and to rebuild their lives.
Further experimental services should be tried, and the
experience of each project should be rapidly disseminated. It is clear from the Lancefield Street Center initiatives that there are many older people living on the
streets and in temporary hostels who will respond to
empathetic individualized help and who will return
to conventional accommodation and daily routines.
Crane, M., & Warnes, A. M. (1997a). Coming home: A guide to good practice
by projects helping older homeless people. London: Help the Aged.
Crane, M., & Warnes, A. M. (1997b). Homeless truths: Challenging the
myths about older homeless people. London: Help the Aged and Crisis.
Crane, M., & Warnes, A. M. (1999). Lancefield Street: Achievements and
lessons. A Report to the Henry Smith Estate Charity and the King’s
Fund. Sheffield, England: Center for Ageing and Rehabilitation Studies,
University of Sheffield.
Crane, M., & Warnes, A. M. (2000). Policy and service responses to rough
sleeping among older people. Journal of Social Policy, 29, 21–36.
Daly, G. (1996). Homeless: policies, strategies, and lives on the streets.
London: Routledge.
Department of the Environment, Department of Health, Department of Social Security, Home Office and Department for Education and
Employment. (1995, October). Rough Sleepers Initiative: Future plans.
Consultation Paper. London: Department of the Environment.
Doolin, J. (1986). Planning for the special needs of the homeless elderly.
The Gerontologist, 26, 229–231.
Douglass, R., Atchison, B., Lofton, W., Hodgkins, B., Katowski, K., Morns,
J., Lenk, K., & Singer, L. (1988). Aged, adrift and alone: Detroit’s elderly homeless. Final Report to the Detroit Area Agency on Aging.
Ypsilanti, MI: Department of Associated Health Professions, Eastern
Michigan University.
Elias, C., & Inui, T. (1993). When a house is not a home: Exploring the
meaning of shelter among chronically homeless older men. The Gerontologist, 33, 396–402.
Grigsby, C., Baumann, D., Gregorich, S., & Roberts-Gray, C. (1990). Disaffiliation to entrenchment: A model for understanding homelessness.
Journal of Social Issues, 46, 141–155.
Hallebone, E. (1997). Homelessness and marginality in Australia: young
and old people excluded from independence. In M. Huth & T. Wright
(Eds.), International critical perspectives on homelessness. (pp. 69–
103). Westport, CT: Praeger.
Iqbal, B. (1998). Still counted out: Older homeless people in greater
Manchester. Manchester, England: Housing Projects Advisory Service.
Keigher, S., & Greenblatt, S. (1992). Emergencies and the etiology of
homelessness among the urban elderly. The Gerontologist, 32, 457–465.
Kramer, B., & Barker, J. (1996). Homelessness among older American Indians, Los Angeles, 1987–1989. Human Organization, 55, 396–408.
Kutza, E., & Keigher, S. (1991). The “new homeless” among the elderly.
Social Work, 36, 288–293.
Morse, G., Calsyn, R., Miller, J., Rosenberg, P., West, L., & Gilliland, J.
(1996). Outreach to homeless mentally ill people: Conceptual and
clinical considerations. Community Mental Health Journal, 32, 261–
274.
National Coalition for the Homeless (1997). Homelessness among elderly
persons. Fact Sheet #16. Washington, DC: National Coalition for the
Homeless.
Norusis, M. J. (1990). SPSS/PC⫹ Advanced Statistics 4.0. Chicago: SPSS Inc.
Pollio, D. (1990). The street person: An integrated service provision model.
Psychosocial Rehabilitation Journal, 14(2), 57–68.
Purdon, C. (1991). Needs of older homeless people: Supported Accommodation Assistance Program. Report to the Commonwealth Department
of Community Services and Health. Turner, ACT, Australia: Purdon
Associates.
Randall, G., & Brown, S. (1995). Outreach and resettlement work with
people sleeping rough. Ruislip, Middlesex, England: Department of the
Environment.
Rich, T., Boucher, L., & Rich, D. (1995). Old and homeless in Tampa Bay:
A survey. In D. Rich, T. Rich, & L. Mullins. (Eds.), Old and homeless—
Double jeopardy: An overview of current practice and policies. (pp.
119–137). Westport, CT: Auburn House.
Rough Sleepers Unit (1999). Coming in from the cold: The government’s
strategy on rough sleeping. London: Department of the Environment,
Transport and the Regions.
Segal, S., & Baumohl, J. (1985). The community living room. Social Casework, 68, 111–116.
Sheridan, M., Gowen, N., & Halpin, S. (1993). Developing a practice
model for the homeless mentally ill. Families in Society, 74, 410–421.
Snow, D., & Anderson, L. (1993). Down on their luck: A study of homeless
street people. Berkeley: University of California Press.
Social Exclusion Unit. (1998). Rough sleeping: Report by the Social Exclusion Unit. London: Stationery Office.
Wilson, D. (1995). We will need to take you in: The experience of homelessness in old age. Edinburgh: Scottish Council for Single Homeless.
References
Bissonnette, A., & Hijjazi, K. (1994). Elder homelessness: A community
perspective. Nursing Clinics of North America, 29, 409–416.
Coalition for the Homeless. (1984). Crowded out: Homelessness and the
elderly poor in New York City. New York: Coalition for the Homeless.
Cohen, C. (1999). Aging and homelessness. The Gerontologist, 39, 5–14.
Cohen, C., & Crane, M. (1996). Old and homeless in London and New
York City: A cross-national comparison. In D. Bhugra (Ed.), Homelessness
and mental health. Cambridge, England: Cambridge University Press.
Cohen, C., Onserud, H., & Monaco, C. (1992). Project Rescue: Serving the
homeless and marginally housed elderly. The Gerontologist, 32, 466–471.
Cohen, C., Onserud, H., & Monaco, C. (1993). Outcomes for the mentally
ill in a program for older homeless persons. Hospital and Community
Psychiatry, 44, 650–656.
Cohen, C., Ramirez, M., Teresi, J., Gallagher, M., & Sokolovsky, J. (1997).
Predictors of becoming redomiciled among older homeless women.
The Gerontologist, 37, 67–74.
Cohen, C., & Sokolovsky, J. (1989). Old men of the Bowery: Strategies for
survival among the homeless. New York: Guilford.
Craig, T. (1995). The homeless mentally ill initiative: An evaluation of four
clinical teams. London: Department of Health.
Crane, M. (1993). Elderly people sleeping on the streets in inner London:
An exploratory study. London: Age Concern Institute of Gerontology,
King’s College.
Crane, M. (1997). Pathways to later life homelessness. Unpublished doctoral dissertation, University of Sheffield, Sheffield, England.
Crane, M. (1999). Understanding Older Homeless People: Their Circumstances,
Problems and Needs. Buckingham, England: Open University Press.
Received July 13, 1999
Accepted February 21, 2000
Decision Editor: Vernon L. Greene, PhD
626
The Gerontologist