Tove Harnett

Docent

Collective Permanent Supportive Housing: A Sustainable Route to Dignity or Institutionalized Ageism?

Författare

Håkan Jönson
Tove Harnett

Summary, in English

Older people make up an increasing proportion of the homeless population and their homelessness is often combined with problems such as substance use, mental illness and physical problems. While much research has focused on short-term shelters, food and clothing, less is known about arrangement providing permanent supportive housing where older homeless adults can stay the rest of their lives. This study focuses on collective permanent supportive housing (CPSH) for older (above 50 years) homeless persons with dual diagnosis in Sweden. Residents have their own apartments, with security of tenure. Admission marks a shift where a harm reduction approach replaces attempts to provide treatment and achieve sobriety. CPSH resemble the single site form of Housing First, but resemble total institutions and may be labelled as care homes for older people. The aim of this study is to identify strengths and challenges associated with different forms of CPSH.

The study is based on (1) a national survey with responses from 148 of the 290 municipalities in Sweden with follow-up interviews with representatives of 25 facilities, and (2) interviews with 60 residents, 10 social workers and 20 staff members at five facilities. Data was analyzed using qualitative content analysis.

The overall finding was that CPSH provided much needed stability and improved wellbeing to older homeless people, who defined QoL and dignity with reference to self-determination, and often as a contrast to their previous life of homelessness and humiliating treatment. A challenge was lock-in effects where it was extremely difficult for residents to move on. The situation represents a type of institutionalized resignation that denies the ability among older people to change. There are no ambitions to integrate residents who change their situation and lifestyle into society outside the facilities. The study prompt two reforms to make collective permanent supportive housing promising practices for older homeless individuals. 1) To develop measures to prevent CPSH from becoming total institutions with the type of regulations, routines and borders that mark such facilities. 2) To develop programs with individual planning for each resident, maintaining security of tenure, but also enabling them to move on in cases where they are interested and capable of doing so.

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