Immediate past AHCJ board president and independent journalist Felice J. Freyer speaks before the Awards for Excellence in Health Care Journalism ceremony at HJ25 in Los Angeles. Photo by Zachary Linhares
Homelessness among older adults is a growing, severe problem. In 2023 alone, an estimated 138,000 older adults experienced homelessness on a single night, according to a 2024 U.S. Government Accountability Office report.
Programs that help unhoused older adults face new challenges as the economy, cuts to safety net programs and the demise of federal jobs training programs for older people are creating what advocates call an “emerging crisis”. In many states, Programs of All Inclusive Care for the Elderly, face a new twist in their program’s mission to help people stay in their own homes.
Health journalist and immediate past president of AHCJ Felice J. Freyer wrote about how PACE organizations around the country are helping people remain out of nursing homes and fighting the “national scandal” of elder homelessness for KFF Health News.
The following conversation has been lightly edited for brevity and clarity.
What inspired you to do a story on older adults and homelessness?
It came from a conversation I had with the people at PACE of Rhode Island; I had written about them when I was working for the Providence Journal, and they had reached out to me, because they were celebrating their 20th anniversary. I paid them a visit, just to chat, and they told me one of the issues that they were facing for the first time was that their clients were losing their homes. The whole purpose of PACE is to help people stay in their homes, and you can’t do that when the people don’t have a home. That looked like a story, and I learned it was a national story, certainly not unique to Rhode Island.
What surprised you during your reporting?
I was surprised by how severe the problem is and how it’s affecting so many seniors. There are people who’ve been chronically homeless, perhaps because they have mental illness or a substance abuse disorder, and then they get old. But that’s only part of the story. Another part of it is people who worked all their lives and played by the rules and always had a place to live.
And then it just takes one incident, to use the phrase from one of the people I interviewed, to tip you over into homelessness — the rent goes up, or your spouse dies, or people who are working lose their jobs, so they don’t have income.
Perhaps the most striking thing was how many people are right on that edge so late in life. It’s really, really concerning and scary.
Will elder homelessness become more prevalent because of economic challenges and because women tend to outlive men but don’t have as much of a financial cushion? What did the experts tell you about the future?
It really looks like it’s going to get worse. When you see these cuts in Medicaid and SNAP going into effect, people have to spend more money on food and they can’t make their rent. If they lose their health care, then they can’t maintain their health. When people get older, they start having more physical problems and many will start to have cognitive problems. If you’re living on the top floor of a triple decker and you have to walk up three flights of stairs to your apartment and you can’t get up there anymore because you have arthritis, that’s another trigger for becoming homeless.
You mentioned SNAP and Medicaid cuts and having to choose. How do you think that cities and states might be able to step in to make up some of these services?
Cities and states have their own financial issues and they’re going to be getting less money from the federal government. It makes it that much harder. One thing that really troubled me was the federal government ended this training program for older people to keep them in the workforce. They’re setting up work requirements for Medicaid and making it harder for people to work.
How did you find older people to speak with?
I relied on the PACE program to find people that they knew were in that situation. And it took them a while because many people were too embarrassed about being in that state and they didn’t want to talk to me. But this wonderful woman, Roberta, was so relieved that PACE had found a place for her to live that she was really, really eager to talk about it.
What’s your advice for how to approach not just older people, but anyone in a vulnerable situation?
Make them feel safe with you. And you do that by making clear that they are in control of the interview and of the situation. You explain what your purpose is, how you think it’ll help other people. And then you ask them, can you share your story with me?
If you’ve never been interviewed, it’s scary. You want to do whatever you can to take away that fear and to show that you’re trustworthy.
Be a person before you’re a journalist. You can say something like, “let’s just talk” and don’t take notes, so they can understand what you’re looking for. And then say, “What you said was really helpful to me. I want to write some of it down and share it with my readers” and then go from there. You’ve got to explain what you’re going to do with their words and who’s going to see it.
Do you share quotes with people you interviewed, if they ask?
It depends on the rules of the publication I’m working for, but to the extent I am free to do that, I think it’s a really good idea when you’re quoting a person who’s not an official, not a politician, basically a person who’s naive to the media, who’s sharing their personal life with you. When they open up to you, that’s a gift. They have a right to know how you’re telling their story. It’s important to do more than one interview if you can. Meet the person more than once. You’ll get additional tidbits.
I met with Roberta twice, and also called her to tell her how I had written her story.. She started sharing more information during the phone call. And she told me someone came to her apartment with a portable X-ray machine because her hip was hurting. It was just a little detail that I was able to throw in at the end of the story and that helped explain how PACE works.
Felice J. Freyer is a freelance writer based in Rhode Island and immediate past president of AHCJ