Health Care Needs of Homeless Older Adults:: Examining the Needs of a Senior Center Cohort.

Objectives: To assess the medical status and health care needs of Wilmington's largest accessible group of homeless elders located at St. Patrick's Center in order to identify areas for improvement of medical screening, preventive health care delivery, and disease management.

Methods: A cross sectional study was conducted between December 2016 and August 2018 at St. Patrick's center in Wilmington, DE. Utilizing a structured health needs assessment, 64 unique individuals aged 50 years and older were interviewed. Descriptive statistics were used to compare data from homeless older adults with data from non-homeless older adults.

Results: Of the 64 total subjects, 17 self-reported as homeless at the time of interviewing. High rates of depressive and cognitive impairment symptoms were self-reported in both homeless and non-homeless participants. When compared to the non-homeless group at St. Patrick's Center, the homeless cohort was less likely to have received a non-acute assessment (such as a routine physical exam/well check-up) or a routine dental cleaning/x-ray within the past year. Tobacco and alcohol use and were frequently self-reported by homeless and non-homeless respondents and were more frequent in the homeless group. The homeless individuals were more likely to have engaged in illicit drug use. Overall, more than 90% of the subjects had some form of health insurance coverage. The most frequently cited reasons for lack of healthcare were inability to afford co-payments/deductibles and lack of transportation.

Conclusions: To address the health care needs of this population, new programs to improve care should focus on facilitating access to services which address areas of deficiency. This group of older adults has benefited from a range of available services that reflect the work of a staff aware of their medical needs, as indicated by the high rate of insured individuals. Licit and illicit substance use assessment and treatment and dental screening remain areas of need for the homeless older adults interviewed in this study. The high rates of depression and cognitive impairment in both the homeless and non-homeless older adult groups suggest the need for further services in these areas as well. Access to care may be improved by addressing concerns regarding co-payments, deductibles, and transportation to care.