Setting the GOLD Standard: Pioneering a New Approach to Geriatric Care for Boston’s Unhoused Population

In 2023, Emily Cohen, a nurse manager at the Boston Health Care for the Homeless Program (BHCHP), visited Pine Street Inn, the largest homeless services provider in New England. “It looked like a nursing home,” Emily recalled. 

Emily’s experience was not unique to one shelter, but reflective of the U.S.-wide graying of the population experiencing homelessness. The number of BHCHP patients over the age of 60 more than doubled in 15 years. These older patients have significant needs: More than 70% have more than one chronic illness – from dementia to diabetes to kidney disease – with some living with as many as 10 chronic conditions.

“As a primary care physician, I was seeing more and more elderly patients cycle between the hospital, shelter and emergency rooms, without anyone to coordinate their care or support their transition out of crisis,” said Dr. Peter Smith, BHCHP’s medical director. 

A team like no other 

In response, the Biogen Foundation provided a grant to help BHCHP pilot Geriatric Outcomes for Living with Dignity, or the “GOLD” Team, a specialized group focused on improving care for older adults experiencing homelessness. 

These older adults are among the frailest and most vulnerable BHCHP sees. “Yet unlike many high-risk younger patients,” Dr. Smith explained, “they often lack access to insurance-funded, integrated care management programs that could support their complex needs and improve outcomes.” 

The GOLD Team fills this gap. It follows what it calls the “5Ms” of caring for unhoused seniors: Medications, Mind (cognition), Mobility, Multi-complexity (simultaneously caring for multiple conditions) and Matters Most (honoring each patient’s personal priorities). 

“This population has such unique needs that it’s critical for a care team to have expertise both with homelessness and with geriatrics,” said Dr. Smith. “This is the only healthcare program in the Boston area that’s really devoted completely to elders experiencing homelessness.” 

The GOLD Team includes clinicians as well as a medical case manager, adding the support that helps patients follow a care plan and successfully connect to social services. “Cognitive impairment is a big part of the challenge with these patients,” GOLD Team Medical Case Manager Amelia Landess shared. “A lot of my responsibility is reminding them of appointments and making sure they are where they need to be.” 

Critically, the GOLD Team has the capacity and flexibility to care for patients in all contexts. “We meet patients where they are. Whether it’s a skilled nursing facility, a shelter, a new apartment or even a bench in Franklin Park. Being able to reach them in their own environments changes everything.” 

Building for scale 

The GOLD Team directly cares for approximately 30 patients, but demand has been high. To extend its reach and impact, in addition to providing direct care for the highest-need patients, the GOLD Team trains providers across the BHCHP network, based on the 5Ms approach, to improve geriatric care throughout the organization. 

“This model is more than a pilot; it’s a roadmap for how we can meet the needs of an aging, unhoused population,” said Dr. Smith. 

In its second year, the GOLD Team will scale to directly care for 45 patients, adding a gerontologist, new capacity for cognitive testing and more training opportunities for BHCHP staff. With ongoing support from the Biogen Foundation, the GOLD Team is positioned to deepen its impact, making a real difference for Boston’s most vulnerable patients.