This article reports the experiences of 109 homeless people aged seventeen to twenty-five years in England who were resettled into independent accommodation during 2007/08. It focuses on housing, finances, employment and access to support services. After fifteen/eighteen months, 69 per cent of the young people were still in their original accommodation, 13 per cent had moved to another tenancy and 18 per cent no longer had a tenancy. Most were glad to have been resettled but found the transition very challenging, particularly with regard to managing finances and finding stable employment. The prevalence of debts increased substantially over time, and those who moved to private-rented accommodation had the poorest outcomes. People who had been in temporary accommodation more than twelve months prior to resettlement were more likely to retain a tenancy, while a history of illegal drug use and recent rough sleeping were associated negatively with tenancy sustainment.

This paper reviews the limited evidence on the causes of homelessness in old age and on the circumstances and problems of older homeless people, and it describes the few services dedicated to the group. Health care and social care professionals rarely encounter homelessness among the many problems of older people that present to them, but in many developed countries there is evidence that the number of older homeless people has recently been growing. Some among them have been homeless intermittently or continuously for years, but many became homeless for the first time in later life. The reasons for becoming homeless and the problems and needs of the group are exceptionally diverse. Many have been estranged from their family or have no living relatives, and they have a high prevalence of health problems and functional limitations. Although services for homeless people in general have improved since the early 1990s, few have targeted the needs of older people.

Older people who become homeless have attracted increasing attention in North America, Western Europe and Australia over the last 20 years, but there have been few projects dedicated to their support, and even fewer studies of the outcomes. This paper reports a longitudinal study of the resettlement of 64 older people who were rehoused into permanent accommodation from homeless people's hostels in England. Their progress was monitored for two years by face-to-face interviews. The theoretical model was that the outcomes of rehousing are a function of personal factors and behaviour, the support that people receive, and the characteristics of the new home. After 24 months, 28 respondents were housed and ‘settled’, 10 were housed but ‘unsettled’, 11 had abandoned their accommodation, and six had been evicted (nine had died or ceased contact). The factors that significantly associated with remaining housed and settled included: previous stable accommodation histories, revived contacts with relatives, taking up activities, and regular help from housing-support workers. Unsettledness and tenancy failure associated with prolonged prior homelessness, worries about living independently, and continuing contacts with homeless people. Rehousing older homeless people successfully is difficult, particularly among those with long histories of homelessness and instability, and more needs to be known about the types of accommodation and the types of support that promote tenancy sustainment.

During the last two decades, northern European retirement residence in the southern European sunbelt has grown strongly and its forms have rapidly changed, but standard demographic and social statistical sources provide no information about the flows, the migrants or their increasingly mobile and complex residential patterns. Considerable primary research has however recently been undertaken into the causes, conditions, experiences and consequences of international retirement migration (IRM) by investigators from Germany, Spain, Switzerland and the United Kingdom. Many collaborated when designing their studies and instruments, and all have subsequently worked together in a European Science Foundation Scientific Network. This paper compares the findings of six systematic social surveys in (to be more precise than the title) eight regions of southern Europe and the Canary Islands: all that have tackled similar research questions with similar methods and instruments. It presents interpretations of several comparative tables compiled from their original data, with a focus on the socio-economic backgrounds, motivations and behaviour of the various migrant groups and their relationship with the host and home countries. The paper presents new findings about the typical and variant forms of IRM, and additional understanding of the heterogeneity of the retirees of different nations and in the several regions.

This paper sets the scene and provides a conceptual framework for the articles in this special issue. They present the findings of research on European residents who have reached or are on the threshold of old age and whose current circumstances have been strongly influenced by a migration across an international border. Such ‘older migrants’ are scattered throughout Europe and they have especially diverse characteristics. They include some of the most deprived and socially excluded, and some of the most affluent and accomplished, but all to a greater or lesser extent are disadvantaged through an interaction between social policies and their ‘otherness’ by living in a foreign country. Some claim attention through the severity of their unmet health and welfare needs and poor capacity to access advice and treatment, while the affluent groups are of great interest to social gerontology because of their enterprising, developmental and positive approaches to old age. They include among the most innovative of the latest generation of older people, who pursue new combinations of family responsibilities, leisure pursuits and income generation. The paper proposes that the concept ‘human capital’ summarises variations in preparedness for old age, that is, the resources by which people cope with demands for income, roles, treatment, care and support. A typology of the ‘welfare position’ of international migrants in contemporary Europe is presented.

This paper examines the changed social circumstances of older people in South Korea and specifically the increased need for formal health and social services for those who are frail and have no informal carers. The article begins with a summary account of the country's exceptionally rapid demographic, economic and social transformations, which demonstrates a widening gap between the population's expectations and needs, and health and social service provision. It then examines the recently initiated and now burgeoning welfare programmes, with particular attention to health and social services for sick and frail older people. Most extant care services are accessed mainly by two minorities: the very poor and the rich. The dominant policy influence of physicians and a history of conflict between traditional and western medicine probably underlies the low current priority for ‘care’ as opposed to ‘cure’, as also for the management of chronic conditions and rehabilitation. Neither long-term care services nor personal social services are well developed. There is a marked disparity between the acute services, which are predominantly provided by private sector organisations in a highly competitive market and broadly achieve high standards, and public primary care and rudimentary residential services. The latter are weakly regulated and there are many instances of low standards of care.

Rough sleeping in Britain has a long history, and interventions have alternated between legal sanctions and humanitarian concern. This paper critically examines recent changes in homeless policies and services, with particular reference to the needs of older people who sleep rough. The characteristics and problems of the group are first described. Single homeless people were formerly accommodated in direct-access hostels but, from the 1970s, individualised rehabilitation and resettlement have spread. Most recently, services dedicated to older people have begun (although remain few and are unevenly provided). Their achievements are reviewed and drawn upon in formulating normative proposals of the appropriate service mix. The 1990s ‘Rough Sleepers Initiative’ and related programmes promoted a ‘social care market’ of not-for-profit organisations that compete for increased (but short-term) funds to provide services, and the new Labour government will build upon these changes and increase funds. Low tolerance towards the ‘social exclusion’ of homelessness is promised but unerringly constructed as exclusion from work; while rough sleeping is dubbed as anti-social, coercive approaches to achieve a two-thirds reduction are foreseen. The proposed target might stall the development of diverse and effective services, or reduce providers' capacity to combat the perversities of resource allocation. The overall prospects for the improvement and expansion of services to provide significant help to single older homeless people are uncertain.

This article examines the personal outcomes of overseas residence in later life, by analysing some findings from the first large-scale, comparative study of the retirement of British citizens to southern Europe. Four study areas are compared: Tuscany in Italy, Malta, the Costa del Sol of Spain, and the Algarve region of Portugal. The analysis focuses on the expressed reasons for moving to and residing in the areas, the reported advantages and disadvantages, and the respondents' predictions of whether they would stay or leave in response to adverse and beneficial events. Overall the subjects give very positive reports, but there are considerable differences among the four areas. The associations of individual variation in well-being with both a person's ‘temporal commitment’ to the area and to facets of their social integration are analysed. The onset of severe incapacity, sufficient to prevent the continued running of a home, is the event most likely to cause people to leave their adopted areas of residence.

A geriatrician's perspective

The problem and its roots

Who shall have when all will die?

RESOURCE ALLOCATION AND SOCIETAL RESPONSES TO OLD AGE

Special Issue of Ageing and Society, Volume 15 part 2, June 1995

Commentaries:

1.) And a Few Pinches of Politics and Economics

2.) The case of Alzheimer disease

3.) Professional and political influence on resource allocation for older people

Reply to Commentaries:

Facts, Values, Ideologies and Ageing

Burden is today often applied to elderly people in two senses, for the fiscal load of income support and health and social care costs, and for notions and scales of care-giving effort and stress. It does not however convey straightforward meanings for its understanding is affected by two millenia of metaphorical and rhetorical usage. The use of burden tends to simplify relationships, whether between age-groups of a population or between a carer and an elderly person, and it communicates senses of a nuisance and an excessive charge. Portentous implications are invoked from biblical senses and derogatory overtones are strengthened by association, earlier this century, with racial stereotyping. An etymological survey reveals many sources of the word's versatility and rhetorical power. Important extensions of usage towards the two contemporary gerontological applications are then studied. A bibliometric examination of the surge in the word's social science use since the early 1980s is undertaken, and the paper concludes with a discussion of current usage as evidence of current attitudes towards, and constructions of, old age on the part of politicians and policy analysts.