Finding Permanent Housing for the Elderly Poor in Boston

    • October 16, 2015

Originally Posted: October 31, 2005
Last updated:
October 16, 2015

Position at the time of the award: President, Committee to End Elder Homelessness, Boston, Mass.; Associate Professor, Boston University School of Nursing

Current Position: Board member, Hearth, Inc. (Formerly Committee to End Elder Homelessness); Boston, Mass.

It is difficult to find a healthy homeless person. They suffer from mental illness, substance abuse, undiagnosed conditions, and the effects of social isolation. When they go for care, they are rarely welcomed and often cursorily examined. Their problems grow worse when they are combined with advanced age. This is the population—the homeless elderly—that Anna Bissonnette has focused on. Anna is a visionary who can translate dreams into reality.—Administrator of a Boston Public Health Consulting Firm

I think you have to come with a great deal of adventure and conviction that you know what you’re doing. And that you can sort of get your hands around a problem well enough to target it and see that some change takes place. We’re change agents. I think this is something that all leaders feel—that we’re not missionaries. It’s just that you get real joy when you give of yourself, and do work that is so desperately needed. The feedback is just out of this world.—Anna Bissonnette

A concern for the elderly poor, and a reputation as a maverick. For most of her professional life, Anna Bissonnette, worked as a nurse, manager, and educator. Trained as a community health nurse with a specialization in the medical and social needs of elders, she arrived at the Boston University (BU) School of Medicine in 1972, and soon developed a reputation as a maverick—a woman who “consistently bypassed the system and broke the rules.” But her goal was not rebellion—Bissonnette was trying to expand the role of institutional health care providers into areas that her superiors, peers, and fellow staff deemed were not within their province. Though she often prodded them, she never lost their respect or admiration.

Bissonnette’s particular concern was long-term care for Boston’s elderly poor. Always an advocate, in 1978 she became a member of the Health and Long-Term Care Task Force of the City of Boston Commission on Elder Affairs and the Area Agency on Aging. In 1983, she was appointed to its advisory council. She helped establish the national reputation of the BU School of Medicine Home Medical Service as a provider of quality care for the homebound elderly, with the aid of a 1984 grant under The Robert Wood Johnson Foundation’s (RWJF) Program for Hospital Initiatives in Long-Term Care.

From 1993 to 2004, as an associate professor at the University’s School of Nursing, she has taught a socio-medical sciences course that helped students appreciate the opportunities in community health and exposed them to the multiple and very real needs of low-income elders. She also helped establish MATCHUP Interfaith Volunteers.

Evictions of elders by gentrification. By 1990, Bissonnette had had a full career, and was beginning to think about retirement. Little did she know that her most significant contributions still lay ahead of her. It was while supervising student home visits in the Boston area during the 1980s that she noticed the increasing frequency with which elderly patients living in rooming houses were being evicted under the pressures of gentrification—a trend that continues today. Unable to find affordable rooms elsewhere, aged people were walking the streets by day, and sleeping in shelters by night.

This experience shocked Bissonnette to the core. “I was naïve,” she recalls. “I had no idea of the number of homeless elders. Almost every unit of low-income single-unit occupancy in and around Boston was lost by people who had been living there for years and years.”

By the late ‘80s, even as the problem was becoming epidemic, it was being largely ignored. “It’s what we’d find in a third-world country,” Bissonnette says. “I just couldn’t walk away from what I was seeing.” She quickly went to work, building a coalition of service providers and obtaining funding from BU’s Medical Center for the Elders Living at Home Program (ELAHP)—a program she designed to help homeless elders find permanent, affordable housing, and to become functioning members of the community.

The homeless elderly. Having worked so hard to keep elders in their homes, Bissonnette’s next challenge would be the development of housing for those without homes. She recognized that the homeless elderly needed even more than a place to sleep—they needed social services, case management, and accessible health care. In 1990, Bissonnette planned a conference for public officials, advocates, and service providers for the elderly, with the goal of developing what many considered an impossible dream: a five-year plan to eliminate elderly homelessness in Boston. At the end of the conference, she invited those who wanted to explore solutions to leave their names. The result was the formation of a group of seven experienced professional women that incorporated as the Committee to End Elder Homelessness (CEEH).

CEEH’s approach was threefold: (1) to increase awareness of the problem of elderly homelessness; (2) to identify elders at risk of becoming homeless; and (3) to serve as a catalyst in the development of housing and services. Within months, CEEH acquired their first property, a Victorian-era boarding house on Bishop Street in the Jamaica Plain neighborhood. Within two years, the house had been renovated—with Bissonnette and her colleagues doing much of the painting and wallpapering themselves. Nine elderly women, formerly homeless, moved in. The occupants share a kitchen, but each had her own room and a new lease on life.

At first, the neighbors were not enthusiastic about permanent housing for the elderly poor on their block, but Bissonnette’s persuasiveness and persistence overcame their resistance. (This pattern repeated itself each time CEEH bought another building.) There was resistance, too, from Bissonnette’s medical and administrative supervisors and colleagues at BU, who did not accept her view that her activities were within the purview of the institution’s mission. But Bissonnette did not back down. “I have a reputation with BU,” she says, “and that is, that I just don’t deal with bureaucracy. I go right to the dean, or I go right to the administrator, and I get into difficulties because of that. But I just don’t have the patience. I tell them, ‘I’m an old lady now. I don’t have time to wait three years to get what I need.’”

She soon developed the same relationship at city hall. “I go right to the mayor when we are having difficulties,” she reported. “I just don’t have any tolerance for roadblocks.”

There were other challenges to face. CEEH at first expected to be able to manage with existing support services in the surrounding area. “A lot I knew,” Bissonnette recalls with a laugh. “We thought, ‘We’ll put in a kitchen, and everybody will have a little cupboard and pantry.’ But they don’t know how to shop. They don’t know how to cook. So we had to raise money to put at least one meal on the table and make it a real boarding house.”

Elder Shelter-to-Home Program. CEEH was learning on the fly. It took its newfound understanding into its next venture—the Symphony Shared Living Space. This mixed-use development on Huntington Avenue in Boston provided a home for 11 homeless elders with special needs, supported by appropriate staff and services. This second space opened its doors in 1995.

At the same time, CEEH expanded its existing outreach program to identify elders in need of housing, assess their needs, and advocate for homeless elders or elders at risk of becoming homeless. They called their new, expanded effort the Elder Shelter-to-Home Program. By fall 2000, the program had identified more than 1,000 vulnerable elders, and provided housing placement and follow-up stabilization services for some 300 of them.

During this period, the old Boston Aerated Bread Company building, which was being used as a warehouse for BU Medical Center, was under pressure from the city to clean up this “eyesore.” Bissonnette received approval from the CEEH board to lease and convert the building into housing for 41 elderly homeless people. She and her co-workers began raising the nearly $6 million necessary for the project to become reality. Over her vociferous objections, the space was named Anna Bissonnette House.

The Community Health Leader Award. In 1994, while fundraising efforts for Bissonnette House were underway, Bissonnette was nominated for, and won, the Robert Wood Johnson Community Health Leadership Award. The award came at a time when she was considering leaving her position at the hospital in order to devote herself full-time to the CEEH. “I had found that the program that we had started in trying to help people with their housing problems was more important than all the work we had been doing about delivering health care,” she remembers. “It’s really hard to deliver health care to an older person if they don’t have a home.”

“I had never thought of retiring, but I said, ‘If this is the only way that I can do the work that I feel I need to do...,’ and all of a sudden, the Leadership Award appeared on the horizon.” To Bissonnette, “It was like a message from above, saying, ‘Yes, Anna, this is what you should do.’”

The award helped her complete the transition from teaching and administration to developing an office at BU School of Medicine and Medical Center Hospital called the Coordinator for Health and Housing Services. Bissonnette used some of the $100,000 that came along with the award to augment her Social Security and pay herself a salary. This allowed her to put her full focus on her CEEH activities, and to spend more time as an advocate for the needs of the elderly homeless. She also bought a computer, which she learned to use with technical assistance from the Community Health Leadership Program. The remainder of the monies was used to hire part-time staffers and an executive director. “From that time on, the progress of CEEH just took off,” Bissonnette recalls.

Another benefit of the award was meeting other award-winning Community Health Leaders at the program’s annual retreats. As Bissonnette puts it, “We are all a bit cuckoo who do this work, and we need to come together with others who are as motivated and committed and who don’t want to take no for an answer.” To Bissonnette, leadership requires a sense of adventure, a conviction that you know what you’re doing, and an ability to motivate others. She believes these things can be taught, and indeed, several of her students have gone on to become leaders in health in their communities.

Since the award. Since Bissonnette won the award, CEEH has made great strides. As of 2005, the committee had an annual budget of $3.7 million a year and provides a continuum of services that include six affordable, permanent housings sites with supportive services, an extensive outreach program and integrated health services and wellness programs.

Anna Bissonnette House opened in 1997, and in 1999, CEEH opened another residence just across the city line in Brookline. This residence, Ruth Cowin House, was home to eight residents and an on-site staff. It offered services such as dental screenings, a monthly Sunday community meal prepared by BU medical students, and regular visits from physical therapy and nursing interns.

CEEH—now called Hearth, Inc.—also conducted two surveys of elderly homeless people in Boston and its environs, exposing the growing nature of the problem. Their outreach program continued to identify candidates for housing vacancies

 To Bissonnette, the rewards are in the doing. “You get real joy when you give of yourself,” she says. “If more people could just know what there is available to them, if they could just find it within themselves to reach out to people—the work is so desperately needed, and the feedback is just out of this world.”

For here, it’s not just about housing the elderly, it’s about putting meaning back into their lives. As one resident of Anna Bissonnette House put it, “Most of my relatives know where I live now. My telephone number is listed. People can find me now. There’s a place that I can call home.”

In spite of CEEH’s successes, the problem of elder homelessness is not going away—it is only getting worse. Says Ellen Feingold, former of CEEH, “The system fails them. We blind ourselves to the fact that they are us in a few years.” Bissonnette adds, “I want to know what’s going on in the minds of these residents, and what more we can do.”

Clearly, Anna Bissonnette is not going to be leaving the scene.

Postscript. As of October 2015, Bissonnette lives in Waltham, Mass., and continues to serve on Hearth’s board of directors. The agency has a budget of almost $4 million and, in 2013, placed some 145 elderly homeless persons in permanent housing.

She also continues her advocacy. She says the problem of elder homelessness has become more serious in Boston and elsewhere due to gentrification and regrets what she sees as the decline of advocacy.

RWJF perspective: The Foundation recognized the first 10 RWJF Community Health Leaders in 1993 – unsung and inspiring individuals who work in their communities, often among the most disenfranchised populations, to address some of the nation’s most intractable health care problems. The last round of leaders was chosen in the fall of 2012. The program closed at the end of 2014. For more information, see the Special Report.