Seniors on the Street Are at High Risk of Violence. But There's a Solution
WHY YOU SHOULD CARE
Because getting people inside isn't enough.
By Carly Stern
As many as 40 women at a time might be seated in chairs inside A Woman’s Place, a 24-hour drop-in center in San Francisco. Sometimes the space is loud; sometimes it’s quiet. Some bring blankets for the hours they will sit there.
But what doesn’t change is why these unhoused women come back: safety. To many, the promise of physical security proves more compelling than the possibility of a shelter bed elsewhere for the night. While a person’s risk of assault declines with age among those housed, this risk spikes astronomically when older people experience homelessness.
One in 10 adults over 50 experiencing homelessness say they were physically or sexually assaulted in the last 6 months.
More than 10 percent of the 350 older adults interviewed by researchers from the University of California at San Francisco and the University of California, Berkeley, reported being physically or sexually assaulted in the last half-year. The unhoused population in general is far more likely to be assaulted than the general population. But while previous research found that homelessness among women increases the risk of physical or sexual assault by a factor of two, for older people, it’s closer to a factor of seven. Just 1.6 percent of adults over 50 in the general population reported an assault in the past year. This problem is expected to only grow more urgent given that more than half of those experiencing homelessness are over 50, according to earlier research, and America’s elderly homeless population is projected to nearly triple by 2030.
“We in the general population tend to see people who experience homelessness as a population to fear,” says Margot Kushel, a UCSF professor of medicine who led the study. “The people at highest risk are not us. It’s the people who are living it every day.”
Why does risk of victimization usually drop over a person’s lifetime? People becoming frail tend to stay in familiar environments and limit risk exposure in recognition of their heightened vulnerability, says Kushel. Being aware that they’d struggle to run, physically resist or hear an attacker approach can predispose people to stay inside and avoid strangers. But people experiencing homelessness can’t restrict their environments in response to risk factors like being alone on the street after dark.
Their vulnerability is amplified by premature aging: The physical toll of living on the streets (and a lifetime of poverty) can cause people in their 50s to display geriatric conditions typical of those in their 70s and 80s. Put simply: You’re easy prey by virtue of being homeless, says Jennifer Friedenbach, executive director of the Coalition on Homelessness in San Francisco. And the consequences are extra stark for groups already at elevated risk: If somebody is determined to attack a trans person, for example, they’ll have an easier time finding a target outside, says Friedenbach.
The longer we leave people out there, the more these harms accumulate.
— Margot Kushel, UCSF researcher
The research showed that once people were housed, their odds of victimization dropped by half. Notably, the study didn’t find that staying in a shelter was associated with a drop in victimization compared to living unsheltered. While housing offers people a measure of control over who they interact with and allow inside, shelters (which could also house people with a history of abuse) offer neither a guaranteed sense of sanctuary nor a door to lock. Though some shelters serve only older adults, the risk — or fear of it — can remain.
Physiological forces are at play too. Stress impairs people’s cognitive ability to negotiate their environments and make safety decisions, says Deborah Borne, the medical director of the Transitions Division for the San Francisco Health Network and San Francisco Department of Public Health, and this can make it more difficult for them to protect themselves. Living outside triggers stress. But it’s not enough just to put people inside. The type and quality of a place matters, notes Borne, adding that shelters can be highly stressful environments for some people, engaging one’s amygdala — the part of the brain associated with fear, anxiety and aggression.
Those walking by might question why someone would choose to sleep under a park bench instead of in a possible shelter bed, says Kushel. Others might wonder why women return to drop-ins like A Woman’s Place rather than seek longer-term services. But those judgments don’t take into account that people experiencing homelessness must make calculated risk assessments at every turn.
When city governments break up encampments, officials might not contemplate whether shuffling people from block to block or separating groups could further expose them to assault. Homelessness is a double-edged sword: Not only can traumatic experiences or violence push people into it, but trauma also directly stems from it. That trauma has a long tail, and shapes how a person does everything from moving through medical care systems to finding jobs. “The longer we leave people out there, the more these harms accumulate,” says Kushel.