Background: Homelessness in America is a growing problem. An estimated 1.59 million people spent at least one night in an emergency shelter or transitional housing program in 2010. Of this group, an estimated 2.8% were over the age of 62. The number of elderly homeless individuals is expected to increase by about 33% between 2010 and 2020 and more than double by 2050. Programs like the Health Care for the Homeless serve to both medically care for this growing population as well as collect data about their specific demographics and health care needs. Objectives: We studied demographic and health care needs unique to the rapidly growing elderly female population and reviewed current literature with the goal of identifying possible pathways to homelessness among this population as well as provider-based initiatives needed to better care for this homeless subset. Methods: Health Care for the Homeless data are collected in all fifty states, the District of Columbia, and Puerto Rico in the form of de-identified surveys completed by clinic personnel and submitted to the Uniform Data System (UDS), which compiles an aggregate report. The frequencies of key demographic variables and diagnostic and preventative health variables between 2006 and 2010 were analyzed using nonparametric Chi-square tests. Results: Between 2006 and 2010, the number of elderly female patients increased by almost a third. Chronic illness and gender-related cancer screens improved, but are well below national averages. Additionally, the housing and insurance statuses of the homeless population appear to be in flux. Fewer HCH patients are living in homeless shelters (-4.3%) and on the street (-0.7%) and more are reporting transitional housing (+1.6%) or doubling-up (+5.8%). Data further reveal fewer patients presenting without insurance (-5.3%) and more who have Medicaid (+3.7%), Medicare (+0.3%), other public insurance (+0.9%) and private insurance (+0.4%). There were no statistically significant changes between age, gender, housing, or insurance status groupings when comparing 2006 and 2010 aggregate data. Conclusion: The elderly homeless comprise a small, but growing subset of the national homeless population. This group is particularly susceptible to economic vulnerability and unmet health care needs. Elderly females are at an increased risk for common diseases and co-morbidities that affect individuals in their age group, including inability to perform activities of daily living, falls, impaired cognitive and executive function, frailty, and depression. Additionally, homelessness itself increases their risk of developing many acute illnesses and chronic conditions. This population is particularly susceptible to mental illness which may be further exacerbated by a lack of coping skills and resources to recover from their homeless situation.

Homeless infants are known to have poor birth outcomes, but the longitudinal impact of homelessness on health, health care use, and health spending during the early years of life has received little attention. Linking Massachusetts emergency shelter enrollment records for the period 2008-15 with Medicaid claims, we compared 5,762 infants who experienced a homeless episode with a group of 5,553 infants matched on sex, race/ethnicity, location, and birth month. Infants born during a period of unstable housing resulting in homelessness had higher rates of low birthweight, respiratory problems, fever, and other common conditions; longer neonatal intensive care unit stays; more emergency department visits; and higher annual spending. Differences in most health conditions persisted for two to three years. Asthma diagnoses, emergency department visits, and spending were significantly higher through age six. While screening and access to health care can be improved for homeless infants, long-term solutions require a broader focus on housing and income.