Dennis Culhane on The Emerging Crisis of Aged Homelessness

Dennis Culhane is the Dana and Andrew Stone Professor of Social Policy at the School of Social Policy and Practice at The University of Pennsylvania.

Dennis Culhane’s research covers a wide range of topics related to homelessness, assisted housing solutions, and social welfare; his current research examines the relationship between homelessness and the aging of the “Baby Boom” cohort. With a special focus on vulnerable populations—those with disabilities, the elderly, and veterans—Culhane’s work has informed policy and discourse around homelessness for years. He specializes in integrating administrative data to inform policy development and analysis to yield more effective solutions for addressing homelessness.

In his recent publication, "The Emerging Crisis of Aged Homelessness: Could Housing Solutions Be Funded by Avoidance of Excess Shelter, Hospital, and Nursing Home Costs?," Culhane and his co-authors analyze the relationship between aging and homelessness, revealing that homelessness has disproportionately affected those born in the later years of the post-World War II “Baby Boom,” approximately 1955 to 1965, since 1990. In 1990, the largest cluster of homeless men were in their late 20s and early thirties; by 2020, Census data show that the largest cluster had progressed to their late-fifties and early sixties, with the homeless population over 60 more than doubling. Tracing the trajectory of the late Baby Boom cohort reveals the systemic strains that the large group has presented for the labor and housing markets over their life cycle. Culhane proposes a variety of solutions and interventions to remedy these forthcoming strains by considering the cost-benefit analysis of investing in proactive solutions, such as:

• Rapid Rehousing, for those needing relocation grants and case management services, and time-limited rental assistance as necessary 
• Shallow rental subsidies with relocation and case management services for those who need ongoing, modest rental assistance for shared living arrangements (e.g. with family, friends, partners or in boarding arrangements)
• Rental vouchers, like those available through HUD’s housing choice voucher program, in addition to light case management, for those expected to be living alone 

Culhane argues that proactive solutions are not only more humane and have greater potential to improve the quality of life of those experiencing homelessness but are also more fiscally responsible and efficient than reactive intervention services. He refers to these proactive solutions as “progressive engagement methods,” a term that encompasses services like rapid rehousing, rental subsidies, and expanded rental vouchers for seniors. Administrative data illustrates that individuals who use progressive engagement methods are significantly less likely to utilize more expensive services like shelters,emergency rooms, hospitals and nursing homess, ultimately reducing the overall cost of caring for homeless populations. 

One challenge associated with the aging of the late Baby Boom generation is the increased need for medical care and subsequent rehabilitation services. A recent article from the New York Times featured Dr. Culhane’s work about respite care, a service model that provides physical rehabilitation services for the homeless population after they receive medical care or undergo operations. “Hospitals use respite care to get indigent patients off their books, and then they’re often discharged back into homelessness,” Culhane said of his research to the Times. Recently, however, more organizations have begun offering respite care through a nonprofit model, offering some unhoused patients the opportunity to have life-altering procedures with the peace of mind of having a safe place to recover. Since some hospitals will not schedule surgeries or procedures without a recovery plan, respite care has become integral to the process of providing medical care to unhoused people. The article details stories of people who have benefitted from respite care services, providing a glimpse into the on-the-ground impact of Culhane’s research.

Homelessness and housing insecurity are some of the greatest social problems the United States faces, especially as the aging Baby Boom generation continues to strain the social services that are meant to assist those experiencing homelessness. Culhane’s research sheds light on why this phenomenon is occurring, who constitutes the most vulnerable groups among the population, and how we can address the issue more effectively moving forward. 

Excerpts from The Emerging Crisis of Aged Homelessness

Preceded by a surge in the supply of workers and in housing demand, people from the second half of the post-War baby boom faced crowded labor and housing markets with higher competition for employment, downward pressure on wages, and upward pressure on housing prices. Combined with back-to-back recessions in the late 1970s and early 1980s, young adults coming of age in the 1980s faced challenging economic circumstances. This was especially true for those with a high school education or less, as they were the least prepared to compete in these tightened marketplaces… The 1980s saw the emergence of a generational dislocation that would sustain a heightened risk for homelessness among this birth cohort. Now, that generation is prematurely aging and dying. Older homeless adults have medical ages that far exceed their biological ages. Research has shown that they experience geriatric medical conditions such as cognitive decline and decreased mobility at rates that are on par with those among their housed counterparts who are 20 years older (Brown et al., 2017; Brown, Kiely, Bharel, & Mitchell, 2012). As a result, health care and nursing home costs are likely to increase significantly over the next 15 years…

 Because increasing age is associated with higher service use, cost reduction estimates also increase with age …For those 55-59, the net offset (cost reductions minus the cost of the intervention) for a scaled housing intervention ranges from a cost of $1,500 ($5,498 - $6,978) in the more conservative scenario to a gain of nearly $2,000 ($8,869 - $6,978) in the less conservative scenario. For individuals 70 and older, the projection is for a break-even ($6,969 - $6,978) result in the more conservative projection and a net offset of approximately $4,400 ($11,346 - $6,978) in the less conservative scenario…

A coming wave of aged homelessness among the latter half of Baby Boomers is certain, and with it will come an equally certain increase in their aging related health care costs. The excess costs associated with their homelessness—not to mention the avoidable illnesses, exacerbated morbidity, premature disability, and accelerated mortality should compel us to reflect and act. By simulating potential cost offset scenarios and comparing those to potential intervention costs, this report is calling for urgent reflection on how society could advance funding for housing solutions, from the future savings to be realized from the avoidance of excess shelter, health, and nursing home costs. The complex streams of funding that are currently accessed to address homelessness and healthcare among this aged cohort make this no easy task. However, that large sums of public funding will go toward this crisis whether we act or not should motivate us to find the best and most responsible use of those funds. We can spend those dollars on potentially unnecessary hospital and nursing home days, or we can improve the quality of life of these vulnerable citizens, reduce the daily demands on hospitals and emergency departments to care for them, and relieve shelters of the burden for largescale, aging-related care for which they are ill-suited.”