The Gray Wave & the Crisis of Senior Homelessness

COLUMBIA FALLS, Montana—Over two years ago, Kim Hilton and his partner walked out of their home for the final time. The house had sold, and the new landlord raised the rent.

They couldn’t afford it. Their Social Security payments couldn’t cover the cost of any apartments in northwestern Montana’s Flathead Valley.

Hilton’s partner was able to move into her daughter’s studio apartment. There wasn’t enough space for Hilton, so they reluctantly split up.

At 68 years old, he moved into his truck—a forest-green Chevy Avalanche.

Hilton quickly found out how hard it would be to survive. Hilton has diabetes. The first night, his insulin froze, rendering it useless.

Things didn’t get any easier that winter. On the coldest nights, temperatures dropped to about minus 20 degrees. Hilton kept the truck running, but eventually, his fuel pump failed. He was on his own in the cold.

Hilton is incredibly optimistic, but in that moment, he said, his spirit broke.

“I just said I want to go to sleep and not wake up and I won’t have to worry about anything. I’ll just sit here and be a little popsicle in the truck,” Hilton said.

Hilton was one of tens of thousands of seniors in the U.S. who became homeless for the first time in 2022. An increase in the number of homeless seniors nationwide has overwhelmed services for unhoused people.

Since 2021, older Montanans have especially struggled because of skyrocketing housing costs, partly due to the rise of remote work. The state has one of the nation’s fastest-growing homeless populations, according to federal data.

University of Pennsylvania researcher Dennis Culhane estimated the number of homeless people in the U.S. ages 65 and older would triple between 2019 and 2030. He has since updated that estimate using federal data for a published paper.

“We are on track to meet that prediction,” Culhane said. “In fact, the growth has been slightly higher than we predicted.”

According to Culhane’s research, the number of people 65 and older increased by a little over a third between 2019 and 2022 alone. By 2022, there were roughly 250,000 people over the age of 55 who were unhoused. As a result, about half of this population were homeless for the first time.

What researchers and advocates call the “gray wave” of homeless seniors has overwhelmed service providers.

Wendy Wilson, a case manager at Assist, has seen the gray wave coming firsthand. Assist is a nonprofit that aims to help Flathead residents who struggle to meet their medical needs. In the past, that meant helping them get free meals or finding a ride to the doctor’s office. Wilson has increasingly helped older people like Hilton find housing.

“They have medical issues,” Wilson said. “It’s not easy for them to be living in a truck or at the homeless shelter when you have medical issues going on.”

In early 2023, Wilson found Hilton a place to live at the Samaritan House in Kalispell, which has private rooms. However, after five months of living in his truck, Hilton’s health rapidly declined. He had several fainting episodes at the shelter, then-manager Sona Blue said.

“It scared us because we have no medical care in this facility,” Blue said.

Finally, Hilton took a bad fall, and shelter staff sent him to an emergency room.

The doctor who treated Hilton discovered he had developed pressure wounds from sitting for months in the same position in his truck. Because of the neuropathy in his limbs from his diabetes, Hilton couldn’t feel the pain. Those wounds never healed and became infected, which is another common complication of diabetes.

As a result, Hilton had one leg amputated. Later, his other leg was amputated, as well. Returning to the shelter in a wheelchair wasn’t an option for him, because there were no shelter staffers or medical personnel available to help with his basic needs.

At the time, a handful of homeless service providers—including shelter staffers and other medical case workers—tried to help Hilton find another place to go. They put him on waiting lists for the limited supply of subsidized housing in the area.

Wilson secured a Medicaid program slot that would help pay for assisted living for Hilton, but it could take a year or more for the units to open. So, Wilson hoped Hilton would get lucky before he was released from the hospital after his second amputation.

Many seniors across the country have been playing the same dangerous waiting game, said Caitlyn Synovec with the National Health Care for the Homeless Council.

“Sometimes they can’t be safely served in a shelter, because they have issues with incontinence or cognition,” Synovec said. “Then they’re more likely to be on the streets, and their conditions will worsen quite a bit.”

Communities have been looking for solutions. 

To serve aging people with complex medical needs, homeless shelters for seniors have cropped up in such cities as Salt Lake City, Utah, and Fort Lauderdale, Florida.

Montana got approval from federal health officials to use Medicaid funding to temporarily help people with medical conditions make rent.

But that’s not enough, according to Synovec. She said the real solution would be building more affordable housing so older Americans don’t become homeless in the first place.

Housing needs to be more accessible, too. Older homeless people like Hilton need homes they can safely navigate. Because of his new wheelchair, he needed a ground-floor apartment.

In the fall, Hilton finally got a spot in a facility that would take his Medicaid waiver. He also got an electric wheelchair to make it easier to get to doctor appointments.

Hilton said he hasn’t pushed his new wheelchair to its top speed yet. 

“It goes fast for a wheelchair. I’m going to find out when I go down to dinner. I’ll stretch it out, break it in,” he said with a laugh.

Hilton said he is grateful to finally have stable housing. Wilson is grateful, too. She said it was one of the few times she’s been able to help a senior regain housing.

“It was a woo-hoo moment,” Wilson said.

As long as facilities stay open and the Medicaid waiver program isn’t cut, Wilson said she is confident Hilton will make it through homelessness.