Millions of older adults struggle to make ends meet. They’re often faced with nearly impossible choices — food or medication; rent or a doctor visit. Some 9.2% of older adults were considered poor in 2017, according to the official poverty rate.

That’s an income of less than $11,756 per year to meet basic costs for food, housing, health care and transportation. Using a more realistic Supplemental Poverty Measure, even more older adults are considered poor, according to the Kaiser Family Foundation.

Studies show that disease burden is greater in lower income seniors. Poorer elderly are more likely to have more health problems than their economically better-off peers, but less able to afford necessary care or other services that can allow them to age with dignity. And in many cities across the United States, the actual cost of those minimum expenses is much higher, leaving even more seniors unable to pay for all their needs.

In San Diego, it takes $1,974 per month or $23,688 annually for a single senior who rents their residence to pay for food, housing, health care and transportation, according to Serving Seniors, a nonprofit that provides comprehensive social, supportive, health, housing and other services to thousands of low-income seniors free of charge. They say nearly half of all older adults in California (48%, or 1.7 million people), don’t have sufficient income to meet their needs.

There’s been an uptick in homeless seniors caused by several factors, said Paul Downey, Serving Seniors CEO. “From economic, to lack of support services to lack of affordable housing. These are all common issues among this population.”

These are not primarily homeless adults who are getting older, and struggling to manage their physical, mental and emotional health, he told me during the American Society on Aging Conference in New Orleans.

Rather, these are older adults who for various reasons, have found themselves in dire financial straits — some living in single-room-occupancy residences, others on the street, and who are not getting the health care, dental services, social supports, or even the basic nutrition they need for healthy aging.

The organization take a holistic, comprehensive approach to helping San Diego’s homeless and impoverished senior population, Downey said. “We strive to provide a welcoming and supportive environment that maintains the person’s dignity and respect.”

All services are provided free of charge through a combination of local partnerships, grants, and shared space arrangements with other organizations. Their 6.7 million annual budget provides a comprehensive array of care and support services for some 5,000 low income seniors annually.

“What we try to do as an organization is become that safety net for people who are living on $5 a day and keeping them healthy and independent,” Downey said.

Serving Seniors owns 412 units of affordable senior housing, which also provide meals, social services and socialization opportunities. That helps remove barriers to independent living.

“We also have a unique partnership with San Diego State University’s College of Health and Human Services,” Downey said. Seniors receive important health assessments and monitoring while medical students gain hands on experience and learn about the importance of integrated care. Nursing staff encourages healthy aging through chronic disease management, health assessments and screenings, help patients navigate local and state health systems, and conduct follow up. Culturally appropriate mental health counseling is also offered in partnership with Sharp Mesa Vista hospital.

Maintaining an older person’s dignity and sense of purpose is at the forefront of everything they do, Downey said. Little things can make a big difference in a person’s sense of self-worth. So volunteers serve the meals to clients in the congregate dining room, rather than having them form a more traditional “chow line.” Civic engagement empowers seniors to work together to identify and address issues of concern to the senior community. Encouraging meaningful activities and building relationships improves social mobility and provides a sense of purpose.

The organization has been helping poor seniors in San Diego since 1970. It’s been recognized as a national model and is one of the few in the U.S. to provide such a broad range of vital services to the neediest older adults. They’re at about financial capacity for current service offerings, but Downey said if more funding was available, they could easily double their offerings because the need is so great.

Journalists may want to look into what efforts are underway in their own communities to combat homelessness among the lowest-income senior population.  What kinds of housing options are available? Are there free clinics accessible to this vulnerable population which provide case management and follow up? What’s being done to help seniors cope with their financial situation?

Liz Seegert is an independent health journalist and AHCJ’s topic leader on aging. She covers older adults, baby boomers, health policy, and social determinants of health, as well as many other health issues. Her bylines include stories for PBS/NextAvenue.org. the American Journal of Nursing, TIME Health, Medscape, Consumer Reports, and Medical Economics, as well as dozens of other trade and mainstream media. Her articles have been syndicated in Forbes.com, the Los Angeles Times, the Hartford Courant, the Saturday Evening Post and other major outlets.