Eloise Moller - Department Head of Health + Sport - Shares Insight Into Supporting Older Homeless People Facing Multiple Challenges
The Single Homeless Project’s Eloise Moller was interviewed for the Age UK and The Salvation Army Report which brought together professionals from eight organisations for “a series of case studies from professionals who are working with socially excluded older people, including older people who are homeless, former prisoners, living in poverty, or living with severe mental illness or addiction. It offers an insight into the challenges these older people are facing and provides best practice examples of services making a difference to older people’s lives.”
Eloise brings over three years experience to SHP, she heads the Sport & Health Project, a programme that provides opportunities for service users to be more active through sport & exercise sessions and engage with their health & health services. The programme has proven to prolong lives, improve mental and physical health, reduce isolation and improve overall quality of life. The Project houses the recently expanded Sport & Physical Activity Programme and has also seen the addition of a newly developed Health Programme.
Here is what Eloise shared for the Age UK and The Salvation Army Report:
Eloise Moller, Department Head of Health + Sport | Single Homeless Project
About the programme
The Single Homeless Project delivers a Sports and Health Programme to older homeless people, aged 55 and over, across 12 London boroughs. The aim of the programme is to support serviceusers to become active and improve their health. They achieve this by supporting people to take part in a minimum of 30 minutes of activity per week, as well as improving engagement with health services, such as by supporting clients to register with their GPs. Some people who have come through the programme now work in a freelance capacity as mentors and are being supported to gain coaching qualifications.
What are the main issues impacting older homeless people?
The older homeless people accessing the Sports and Health Programme are living with multi-morbidity, complex health needs, and substance misuse. On top of this they often lack a family support structure who can step in and provide help. Many older homeless people struggle to access the health and care support which they need. This can lead to an escalation of their needs and results in them needing crisis support and emergency care. When health issues are left too long it can also lead to them becoming untreatable.
“A lot of them get to the point that, when they do need health care, it’s A&E.”
What are the barriers which older homeless people face when accessing services?
Lack of awareness of services.
Many older homeless people do not know which services are available to them or what they need to do to receive help. Services rarely proactively reach out to homeless people, while the digitalisation of services is further excluding older homeless people, who are unlikely to have digital skills or access to the internet.
“No-one would come to us as a provider and say, ‘Try and get your guys to come along to this. It will be great to see them’.”
Practical barriers
Many older homeless people do not have a permanent address which can make it difficult for them to register with services. Information about appointments can be difficult to read and understand for anyone who has cognitive impairment or may have suffered brain injuries in the past. They may also face difficulties in managing appointments or be unable to afford to travel to services.
“When lots of them are rough sleeping they find it hard to register because they don’t have an address and they don’t know where their local nearest place is.”
“The other thing we’ve encountered recently as well is around communication. [..] Say we do get into the GP and then they need a referral to the hospital. The letters that come aren’t user-friendly sometimes. So, they’re massive A4 pages full of information. And some of our service users have brain injuries… Or they might not be able to read it, but they’re too embarrassed to ask someone to help them. That information is going to be lost.”
Stigma
When accessing services in the community, such as activities, clubs, or exercise classes, older homeless people often encounter stigma and are made to feel unwelcome. Previous experiences of judgement and stigma in the past also deters older people from engaging now.
“So, if they go, no one wants to talk to them and they feel they’re not wearing the right stuff, they’re conscious that they’re different from everyone else. That’s how everyone makes them feel when they’re there.”
Lack of support for people living with substance abuse issues.
Those who are living with substance abuse issues are often denied help as services will not engage with them until they have stopped drinking or taking drugs. For example, mental health services will not support people who are using drugs or alcohol, while dementia services will not conduct assessments.
“When they go and see a doctor, that’s their answer: ‘Why don’t you just stop taking drugs?’, instead of actually dealing with the health issues that they’ve gone there for.”
“We’ve got a few guys who we’re pretty adamant have early dementia or Alzheimer’s, but to get them tested and to get a diagnosis is really difficult if they’re using. Because they want to put it down to memory loss because of alcohol or drug use and it’s, yes, it’s an ongoing battle. A lot of the ambulances won’t come out to our hostels because they’ve had bad experiences.”
It’s important that staff working with older homeless people are able to identify and respond to the unique issues which older people may face. This includes supporting clients to access and use technology and making sure that they are aware of what support is available. It is also vital that staff understand and can identifying signs of health conditions associated with ageing, for example cognitive impairment or dementia.
Barriers to accessing care services.
Older homeless people may need full-time care which cannot be provided by hostel staff. However, accessing a care home is not easy. Care homes often refuse service-users because of their history of homelessness or substance abuse. Clients are also unlikely to be able to afford the cost of care and will not have family who can support them financially.
“Lots of times they get rejected from care providers. And if there is a care home that’s going to take them or somewhere like a care home, there’s the financial side of it. There’s no family to help out.”
Lack of available care services for older homeless people is placing a significant strain on hostel staff, who are having to provide personal care beyond the remit of their roles.
“I think our frontline staff that work in the hostels. We’ve seen a huge unofficial shift in their job roles. So, they’re having to pick up doing stuff that they shouldn’t be doing. So, there’s been a lot of, for instance, clients that are elderly, and they need help washing or incontinent or administering medication or changing sheets and stuff after accidents. That’s not their role. But unfortunately the way it is at the moment.”
Postcode lottery
There is inconsistency in the availability of services across London and support is dependent on where you live. This leads to older people falling through the gaps.
“What’s available in one borough won’t be available in the other necessarily. And then to get access to stuff you might have to prove that you’re a resident. That you belong to that borough.”
What works to support older homeless people?
The Single Homeless Project has found that older people are more receptive to receiving support from people who are familiar to them so building relationships and trust is a vital first step.
“In some boroughs, some of the outreach services might have volunteers that will come and attend the appointment with them. We tend to find that it doesn’t work because it needs to be someone they know.”
Staff at the SHP also try to take steps to make it easier for older people to engage with services. For example, they help people with cognitive impairment to manage their appointments by providing reminders and storing letters in folders for clients.
“We’ll have a folder where we’ll take a copy of the letter and it’ll be in the referral thing. Clients can ask for reminders. In some of our services, we’ve put provisions where they can ask for bus tickets.”