Nursing Homes Become Default Housing for Homeless Older Adults With Minimal Care Needs

The rising number of older adults experiencing homelessness is exposing critical gaps in the social safety net, with nursing homes increasingly serving as a default housing solution for individuals who do not require long-term skilled care. According to research from the United Health Foundation, approximately one in eleven nursing home residents has “low-care needs,” meaning they can manage basic activities such as eating, toileting, and moving without physical assistance. The prevalence of this phenomenon varies significantly by state, ranging from 2.5% in Hawaii to nearly 23% in Oklahoma.

This placement in nursing homes represents a substantial financial burden. The average annual cost of nursing home care stands at $119,340, whereas subsidized permanent supportive housing—which includes essential services for stable living—costs roughly $16,000 per person per year. Despite the availability of more appropriate and affordable alternatives, many older adults find themselves institutionalized due to a lack of accessible community options.

Caitlin Synovec, assistant director of medical respite at the National Health Care for the Homeless Council, highlights the case of a woman in her 50s who lost her housing after a stroke. Although she retained the ability to perform most daily tasks and wished to maintain her independence, she was unable to live in a family member’s second-floor apartment. After falling at a homeless shelter and being discharged to a nursing home, her situation illustrated a common trend: many shelters are ill-equipped for elderly residents, featuring bunk beds and inaccessible bathrooms.

The primary alternative, permanent supportive housing, currently has an average wait list exceeding two years and often lacks the necessary accessibility features for older adults with mobility issues. Under the Trump administration’s policy shift from permanent supportive housing toward time-limited transitional programs, experts warn that wait lists will likely lengthen and displacement could increase for vulnerable populations.

“They get to a point essentially where there’s not a place in the community for them to go,” Synovec said. “The option is long-term care—nursing home care—or they die on the street.”

Dennis P. Culhane, a University of Pennsylvania researcher specializing in housing policy, noted that the gap in care is widening as Baby Boomers age. In 2025, one in five individuals living in emergency shelters or on the streets was aged 55 or older. “We’re failing in every direction in terms of not providing shelter—exposing people to greater harm and health risk and disability,” Culhane stated.

Research by Ian Johnson, now at Boston University School of Social Work, indicates that many older adults prefer to age in place. Surveys by AARP show that three out of four older adults wish to remain in their current homes and communities. Johnson emphasized that early institutionalization disrupts autonomy and separates individuals from their support networks, a sentiment shared by those living in tents or shelters who also desire independence.

Conversely, some nursing homes discharge vulnerable residents to homeless shelters, sometimes leaving them without a destination. This occurs due to rule violations, depletion of insurance funds, or the expiration of short-term rehabilitation coverage, highlighting the system’s instability.

Dr. Jeffrey Farber, president and CEO of The New Jewish Home in New York City, argues that nursing homes currently serve three distinct populations, only one of which truly belongs in such facilities. He advocates for a systemic overhaul where hospitals provide sub-acute care and discharge patients only when ready to return home. For homeless older adults with manageable conditions, Farber proposes access to subsidized, age-friendly housing incorporating the “4 Ms” framework: mobility, medication, mentation, and what matters most to the individual.

Farber envisions transformed facilities, which he calls “Compassionate Care Homes,” dedicated to providing long-term monitoring and care for those with complex medical needs. These would be non-profit, mission-driven entities adequately funded with investments in workforce training.

With the oldest Baby Boomers turning 80 in 2026 and all Boomers reaching age 65 by 2030, the demand for senior housing and emergency shelter is projected to overwhelm current capacities. Farber stresses that housing low-care-needs individuals in nursing homes is unsustainable and calls for fundamental reform rather than incremental fixes. “The system is fundamentally broken,” he said, “and we’re not going to fix it with band-aids.”