Nursing Homes Emerge as Last Resort for Older Adults Facing Homelessness
A growing number of seniors with low-care needs are ending up in nursing homes due to a lack of affordable housing and adequate support services.
Nursing homes are increasingly becoming a last resort for older adults experiencing homelessness, a situation driven by a shortage of accessible housing options and insufficient support services, according to research and interviews with professionals in the field.
As people in their 50s and 60s face medical crises that lead to job loss and housing instability, many find themselves without a place to go. While some enter medical respite care programs, their long-term prospects remain uncertain. A significant number of these individuals, even those who do not require extensive medical assistance, end up in nursing homes.
Research from the United Health Foundation indicates that one in 11 nursing home residents have "low-care needs," meaning they can manage most daily activities independently. The proportion of such residents varies by state, with Oklahoma reporting nearly 23% and Hawaii at 2.5%.
This housing solution comes at a substantial cost. The average annual expense for a nursing home is approximately $119,340, starkly contrasting with the around $16,000 per person per year for subsidized permanent supportive housing, which often includes services.
Systemic Failures and Growing Needs
Experts point to a widening gap in the social safety net as the Baby Boomer generation ages. By 2030, all Baby Boomers will be 65 or older. In 2025, nearly one in five individuals in emergency shelters or on the streets were aged 55 or older. This demographic shift is straining existing resources designed for younger homeless populations.
Traditional homeless shelters often lack the necessary accommodations for older adults, such as accessible bathrooms or private sleeping spaces. Furthermore, residents are typically required to leave during the day, posing challenges for those with mobility issues or chronic health conditions.
Permanent supportive housing, considered a more appropriate and cost-effective solution, faces significant barriers. Waitlists for such housing can exceed two years, and the available units may not be accessible to elderly individuals with mobility challenges. A shift away from permanent supportive housing under the Trump Administration towards time-limited transitional housing is expected to exacerbate these waitlists and potentially displace older adults from their current arrangements.
The Desire for Autonomy
Many older adults express a strong preference for aging in their communities, with surveys indicating that three out of four want to remain in their current homes. "Early institutionalization" can lead to separation from family, friends, and familiar surroundings, diminishing a person's sense of self and autonomy. This sentiment holds true for individuals experiencing homelessness, whether in shelters or even tents.
When short-term rehabilitation care concludes, patients are often expected to secure independent housing or pay for ongoing care. While Medicaid covers long-term nursing home care, eligibility rules differ by state. Some individuals who only need part-time assistance end up remaining in nursing homes, while others have been discharged to shelters, sometimes in violation of federal regulations regarding safe discharges.
Rethinking Long-Term Care
Professionals like Caitlin Synovec, assistant director of medical respite at the National Health Care for the Homeless Council, and Dr. Jeffrey Farber, geriatrician and CEO of The New Jewish Home, advocate for a fundamental rethinking of long-term care. Farber suggests a tiered system where hospitals focus on sub-acute care, discharging patients ready for home.
Individuals who are aging and homeless with manageable health conditions could be supported by subsidized housing with tailored programs. For those with complex medical needs requiring long-term monitoring, Farber proposes transforming nursing homes into "Compassionate Care Homes," emphasizing non-profit, mission-driven care with adequate funding and workforce training.
The impending surge of the Baby Boomer generation into older age is expected to overwhelm current senior housing, long-term care, and emergency shelter capacities. The practice of housing low-care individuals in nursing homes, already inefficient, will become unsustainable. Experts like Farber argue that the system is fundamentally broken and requires comprehensive reform rather than incremental changes.