By Kyle Bycroft
Arizona’s unhoused seniors are experiencing a dual crisis: Their ranks are steadily rising, and their unique health needs are going unmet.
This crisis is exacerbated by the heavy-handed treatment of unhoused individuals coupled with a lack of places for them to go. While the state and federal governments may soon bring some measure of relief, solutions may be flawed or get undercut by the de facto criminalization of homelessness—damaging unhoused seniors’ trust in government and offending their dignity.
By the last nationwide count in 2019, almost 250,000 Americans 55 or older were unhoused. Since 2020, Arizona’s unhoused population has increased by at least 23.4%—one of the highest rates in the nation.
Seniors are the most rapidly rising demographic within the nation’s unhoused population. Arizona’s Maricopa County, for example, counted at least 2,000 unhoused individuals 55 or older in January 2023—and almost one-third were at least 65 years old. This context is especially important when discussing situations like Phoenix clearing “The Zone”—a former tent city of unhoused residents covering 15 blocks near the state capitol.
Unhoused seniors have unmet health needs
Advocates and doctors say life on the street uniquely “ravages the human body.” Consequently, unhoused individuals in general experience senior health issues earlier than their housed peers. They also experience more health issues than their housed peers—like more frequent exposure to diseases, mental illnesses, substance abuse, and, especially in Arizona, extreme temperatures.
But Arizona’s unhoused community has few options for escaping temperatures that range from Phoenix’s summer highs to Flagstaff’s winter lows. In Phoenix, The Zone was cleared after it was declared a public nuisance following complaints from local business owners about crime in a lawsuit against the city. While Phoenix officials have tried to address the emergency directly by setting up shelters for unhoused seniors with specialized staff, results typically match the national experience: Current shelter systems are ill-equipped to serve the surging population, and nursing homes weren’t designed for unhoused seniors’ unique health issues.
Arizona’s most well-known shelter, Central Arizona Shelter Services (CASS), began construction in 2023 to convert a former Phoenix hotel into “The Haven,” a shelter geared specifically toward unhoused seniors. However, The Haven, which opened its doors in October with 40 beds, will eventually reach a capacity of just 170 people—hardly sufficient to address unhoused seniors’ needs. And there’s another issue: CASS has a budget shortfall of $1.5 million for the project—a gap it’ll have to close by March 30, 2024, to fully fund the services it provides to the unhoused.
The combination of heavy-handed law enforcement and inadequate social services has exacerbated this crisis for unhoused seniors. Both make it more difficult for unhoused seniors to achieve the best possible thing for their health—stable housing. Medicaid, which pays for nursing homes or assisted living for unhoused seniors, could provide some respite—but only for people who can’t take care of themselves, a standard that’s not often met.
With encouragement from federal government, state Medicaid programs are increasingly providing housing
States have responded to the national homelessness crisis by using Medicaid money for housing. Arizona has set aside $550 million to provide six months of rent for unhoused individuals. The federal government has encouraged this trend, pushing for Medicaid to cover additional social determinants of health other than health care. Health and Human Services (HHS) Secretary Xavier Becerra described the mechanism: States can apply for Section 1115 Medicaid demonstrations—waivers that offer flexibility within the Medicaid program—to “make it easier for health providers to reach and treat people where they are,” with the goal of improving health among people without secure housing.
Section 1115 demonstrations allow states to apply for HHS approval of “experimental, pilot, or demonstration projects that promote” Medicaid’s objectives. Demonstrations aren’t themselves contemplated by law—the HHS secretary must agree to waive portions of the law. This flexibility allowed Arizona to avoid some Medicaid restrictions, after obtaining the Biden administration’s approval, so the state could start covering six months of rent using Medicaid funds.
To be sure, Medicaid waivers are not going to immediately resolve the crisis. For one, it’s a struggle in Phoenix just to get housing vouchers at all. For another, not all healthcare providers or experts on the unhoused have embraced the trend of using Medicaid money for housing, pointing out that Medicaid is already notorious for failing to provide basic medical services, which often come with monthslong waits. Regarding Arizona’s six-month rent scheme, Professor Margot Kushel, a homelessness expert and doctor who treats low-income patients in San Francisco, expressed particular concern that such housing programs would be strictly temporary, which would be problematic: “By the time folks get into housing, they’re already really, really sick. . . . What happens at the end of six months when rental assistance like free rent runs out?”
Finally, this trend is unwieldy and abstract: States first need to decide to use Medicaid funds to find homes for unhoused seniors; then, they need to navigate the Medicaid program to accomplish that goal. The trend is likely to face political headwinds should the White House change hands in the near future; a second Trump administration is unlikely to continue the Biden administration’s policies. It must be emphasized that, while states have embraced allocating Medicaid money to combat the homelessness crisis, and more states are on the way, Medicaid is a federal program, and these policies ultimately require federal approval.
Any solution will require the unhoused community’s trust and the government’s respect for people’s dignity
Regardless of the precise method by which Arizona or the federal government address unhoused seniors’ needs, it will likely be insufficient if it doesn’t have the buy-in of the unhoused community, or if it fails to respect that community’s dignity. It will be difficult for the community to trust one hand offering help, if the other has been a blunt instrument.
Regardless of the city’s overall impact on the area, the image of Phoenix “clearing” The Zone and its estimated 900 inhabitants is stark. One former Zone resident, Jill Vinterella, wandered the area after her home for more than a year was cleared away, uncertain of where to go—until finding comfort in a friend, Johnathan Greathouse. Official aid offered to former Zone residents has sometimes been met with skepticism. Some people outright refused services, while others simply walked away without responding. Vinterella vented her frustration about the post-clearing offers of aid: “Everything they offered me has flopped.”
Kyle (he/him) is currently a 2L at Arizona State University’s Sandra Day O’Connor College of Law. Before law school, he graduated from Arizona State University in 2016 with a B.A. in history and a certificate in Islamic studies, and from Phoenix College in 2018 with a certificate in paralegal studies. His legal interests include elder law and probate law. Outside of school, Kyle enjoys watching movies with his brother and friends.
Law Journal for Social Justice 
