If you're unhoused and have dementia or serious mental illness, there's almost nowhere for you to go
There’s a growing need for senior specific services among unhoused older adults. But places that can care for homeless individuals living with conditions like dementia or serious mental illness are practically non-existent. So, where do they go?
It often starts with a phone call from the local hospital.
"And they've got somebody that they're discharging," explains Riann Balch with the city of Chandler’s Neighborhood Resources Department. She says they recently got one of those calls about an 80-year-old woman who appeared to have some type of undiagnosed dementia. "They don't know what to do next. And our best answer is the non-congregate shelter."
Chandler only has two types of shelter options: hotel rooms and non-congregate shelters. These private rooms are typically reserved for families, older adults and people with disabilities. They also partner with churches for overnight stays only — and often on the floor, which means you have to be able to get off the floor on your own.
"As of right now, there really is nothing specific to the older population, people with traumatic brain injury, people with substance use disorder and people with untreated mental health — there's no shelter that’s specific to meet those needs."
So, Chandler staff took the 80-year-old woman to a hotel — which was the safest option.
Hotel staff help keep an eye on things, and case managers are there every day. But clients, including this woman, are free to come and go as they please. And here’s where things can go sideways.
"If you can't care for yourself, or you aren't aware of what's happening around you, you're just really in danger.."
— Riann Balch
"She was wandering out of the hotel, at night, in the morning, for things, for food, for different things, things that we were bringing her, but she wasn't registering all of that. And she wasn't registering from day to day, who we were, and what we were there to help her with. And she couldn't tell us any history."
Like where she came from, if she had any family or if she had a diagnosis — of any kind — for dementia, a traumatic brain injury or even substance use disorder.
"And things can look really alike and things can be co-occurring," Balch explains.
A complex crisis that's getting worse
This story isn’t unique. Central Arizona Shelter Services, or CASS, in Phoenix is Maricopa County’s largest shelter. CEO Lisa Glow says seniors are the fastest growing population of homeless individuals in the nation and they are coming to shelter with complex, often undiagnosed, medical conditions like the woman in this story.
"We always put a lot of energy and focus on those particularly highly vulnerable clients. It's not the first time we've encountered that, but finding a placement that's available, that works with their health plan, if they don't have a health plan, getting them on the health plan."
CASS recently opened a temporary emergency shelter for seniors in the West Valley with enough space for each client to have their own room. CASS also started screening senior clients using the Montreal Cognitive Assessment, or MoCA.
"We're seeing all of these older adults coming into CASS. And we said, 'Well, hey, if they look like they have dementia, or some cognitive impairment, and they're here at CASS, let's stand up a screening program here in shelter,'" said Heather Ross, a professor of health and technology policy at Arizona State University. She and her team are overseeing the MoCA, a 10 minute exam that tests things like executive function and attention.
"So, that we can just understand what is the prevalence of people who are older, experiencing homelessness who have dementia, or mild cognitive impairment."
At the time of that interview with Ross, the prevalence was high. More than 90% of clients were screening positive for dementia.
“The awareness of the potential diagnosis screening impacts the services we provide. That's the most important thing. So they're aware, we're aware and then we can start to augment their case management support with other services," Glow said.
Somewhere in Mesa
Back in Chandler, Balch with the city's Neighborhood Resources says the MoCA screenings are an important first step.
"But then the next question is, ‘then what?’ What services are we going to have available for this population? How are we going to change the services we deliver to be able to serve this population? They're the most vulnerable. ... But if you can't care for yourself, or you aren't aware of what's happening around you, you're just really in danger."
A few days after this interview, Balch says staff was able to petition for a behavioral health evaluation. The diagnosis: schizoaffective disorder, which is a combination of schizophrenia and a mood disorder like depression. The woman was released without medication or a treatment plan. Balch says they offered her a spot in a group home, which she declined. Instead, she asked to be taken to another hotel somewhere in Mesa.