"Waiting to go home": narratives of homelessness, housing and home among older adults with schizophrenia.

Journal of Aging Studies 29 (2014) 53–65

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Journal of Aging Studies journal homepage: www.elsevier.com/locate/jaging

“Waiting to go home”: Narratives of homelessness, housing and home among older adults with schizophrenia Lydia P. Ogden ⁎ Columbia University School of Social Work, 1255 Amsterdam Ave, New York, NY 10027, United States

a r t i c l e

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Article history: Received 19 June 2013 Received in revised form 6 January 2014 Accepted 6 January 2014 Available online 31 January 2014 Keywords: Older adults Schizophrenia Homelessness Housing Social services Narrative

a b s t r a c t This study used thematic narrative analysis to develop an understanding of how older adults with ongoing symptoms of schizophrenia who have experienced homelessness understand and express their life course and present-time narratives of homelessness, housing, and home. Findings were developed from 26 individual interviews with five study participants and 33 systematic field observations of their homes, treatment environments and neighborhoods. Presentation of the participants' narratives illuminates how participants experienced shared challenges in unique ways and the meaning they assigned to experiences of homelessness, housing and home, particularly in regard to identity and ongoing challenges. While all participants were housed, housing did not equate to a sense of being home. Implications for social work practice and policy, and directions for future research, are discussed. © 2014 Elsevier Inc. All rights reserved.

Introduction Homelessness, defined broadly as the lack of adequate, stable shelter (Hombs, 1994), has been attributed to a variety of contributing factors including socioeconomic structural inequalities (Shaw, 2004); housing policies and housing shortages (Blasi, 1990); deinstitutionalization of the mentally ill, urban renewal, the decrease in lower-skilled jobs, changing political priorities and bureaucratic obstacles (Wright, 2009), as well as a variety of individualistic explanations (Lee, Lewis, & Jones, 1992; Wright, 1990). The connection between homelessness and mental illness in Western countries has been well established, with mental illness viewed alternately as a contributing factor (Shaw, 2004) or a consequence of homelessness (Koegel & Burnam, 1992). A recent analysis estimates that 42% of homeless persons in Western countries have psychotic disorders, such as schizophrenia (Fazel, Khosla, Doll, & Geddes, 2008). Although embedded in policies and

societal structures, the experience of life course adversities such as homelessness and schizophrenia are ultimately those of the individual (Blasi, 1990; Shaw, 2004). While mental illness has long been associated with stigmatized identities (Goffman, 1963), interaction with, response to and interpretation of housing environments can also affect sense of self and confer a layer of prestige or stigma on one's identity (Blasi, 1990; Shaw, 2004; Wardaugh, 1999). Thus the experiences of homelessness, housing, and home go beyond the concrete issue of shelter to the meaning of housing for sense of self. Nested in narrative gerontology and framed by the theory of cumulative adversity and advantage, this article presents results from a thematic narrative analysis investigation focused on the identification of the meaning of housing and home in later life narratives of older adults with schizophrenia who have experienced homelessness, and how those meanings attach to later life narrative identity and ongoing challenges. Background

⁎ Lehman College, City University of New York, Social Work Department, Carman Hall, Room B16D, 250 Bedford Park Boulevard West, Bronx, NY 10468, United States. Tel.: +1 917 656 8764. E-mail address: [email protected]. 0890-4065/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jaging.2014.01.002

Ethnographic and narrative-focused research has been vital to the definition of modern homelessness, identification of its potential causes, and the development of related policies

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L.P. Ogden / Journal of Aging Studies 29 (2014) 53–65

(Baxter & Hopper, 1981; Hombs, 1994). Methodologically connected to those earlier investigations, a small but growing literature has begun to examine the meaning of housing and home, some of which focuses on persons who have been homeless and have serious mental illnesses. Prior research has formulated the meaning of home as that of an available safe haven and refuge from social forces and psychological stressors (Blasi, 1990; Shaw, 2004; Wardaugh, 1999). Extending from this, the concept of “ontological security” describes the sense of security and control that comes from having a home that provides constancy in a setting wherein life's daily routines are enacted, people feel most in control of their lives, and, free from surveillance, can formulate personal senses of identity (Dupuis & Thorns, 1998; Shaw, 2004). Gurney (1997) used episodic ethnography to explore the concept of home for working-class women in England, finding that the meaning of home was often constructed in relation to climactic events in people's life histories. Homes were experienced as the setting for identity-forming events and patterns, as well as a sense of fulfillment. Leith (2006) used phenomenological analysis of narratives to explore the meaning of home for older women in congregate care housing settings, finding that “home” was in part defined by internal factors, such as the deliberate resolution to make a place a home and to remain there. The Gurney (1997) and Leith (2006) findings make important contributions to the understanding of ontological security, the meaning of home and homemaking. However the participants in those studies did not have serious mental illnesses or histories of homelessness. Liebow (1993) used narrative and ethnographic methods to understand the lives of homeless women living in the shelters, some of whom might have had serious mental illnesses. The women engaged in an “unremitting struggle to remain human in the face of inhuman conditions” (p.3), seeking out self-respect, a sense of community and a sense of connectedness to the world, even in the face of struggling with day-to-day survival. They struggled “to remain human in an unremittingly dehumanizing environment” (p.222). Adequate shelter was required to achieve that goal. Padgett and Henwood (2012) used narrative analysis methodology among formerly homeless persons with mental illness and found that participant narratives shared appreciation of the benefits of having a home and gratitude for housing. The perceived advantages of housing were connected to those described by ontological security, however, obtaining and maintaining housing did not erase the lifetime of adversity experienced by many of the participants. The meaning of having a home is thus more than simply having a shelter. Home is a space in which self-esteem, identity, and when needed, a renewed sense of humanity may be developed. Snow and Anderson (1987) used ethnography to understand the meaning that persons experiencing street homelessness attach to that experience, and to their personal identities. Their narrative identity patterns fell into three categories: distancing themselves from their identities as homeless persons; embracing their identities as homeless persons; and engaging in fictive storytelling that explained their present circumstances. Through examining patterns of narratives, the authors concluded that a need for self-esteem,

identity, and to make meaning from life experiences remained, despite the hardships and threats to survival in their lives. Padgett (2007) used life history narrative interviews and grounded theory analysis to examine questions of ontological security among formerly homeless persons with mental illnesses. Participants valued the features of ontological security provided by independent housing, including control and self-determination, the ability to enact daily routines, and privacy and freedom from surveillance. As in the findings of Snow and Anderson (1987) and Liebow (1993), homelessness had been experienced as an assault to sense of self. Therefore, in addition to safe and stable shelter, housing was valued as the setting for identity re-construction and repair, and a symbol of having overcome years of adversity. Stigma, social isolation, and uncertainty about the future were ongoing challenges for the participants. Additionally challenges for formerly homeless persons with mental illnesses were identified in the Padgett, Hawkins, Abrams, and Davis (2006) case study and narrative analysis of life history interviews of formerly homeless women, including the need for increased autonomy, protection, and restoration of status and devalued identity. In Shibusawa and Padgett's (2009) narrative inquiry into the experience of aging among formerly homeless individuals with serious mental disorders, the importance of having the space and time to evaluate, reflect upon losses, and address ongoing issues were identified. These findings suggest that age, in addition to mental disorders, has the potential to affect the experience of and adaptation to housing. Adaptation to housing and home, and overall recovery from the experience of homelessness, may vary across populations dependent upon a host of internal and societal factors, such as age, mental illness, and available supports (Wright, 2009). As an especially vulnerable population, later life concerns of older adults with schizophrenia have been underexplored (Cohen, 2003; Harvey, 2005), particularly in regard to first-hand life course and present-time experiences of homelessness, housing and home. Improved understanding of the too often conjoint adversities of homelessness and schizophrenia, gained by listening to and observing those who have experienced them first-hand, has the potential to improve social service programs designed to address those challenges (Flanagan, Davidson, & Strauss, 2007; Strauss, 2008). Narrative research strategies are best suited to addressing research aims focused on understanding life experiences as narrated by those who live them (Chase, 2011), therefore the present study uses analysis of retrospective life history narratives of older adults with schizophrenia to explore and identify of the meaning of homelessness, housing, and home in later life narratives of older adults with schizophrenia who have experienced homelessness, as well as how those meanings attach to later life narrative identity and ongoing challenges Theoretical context In thematic narrative analysis, theory is used recursively to inform and frame the study, while at the same time the generation of new theoretical constructs is promoted through the use of inductive analysis. Stemming from a social constructivist paradigm, the specific theoretical setting for this article connects narrative gerontology and the theory of


cumulative adversity and advantage. Narrative research explores in-depth the meanings attributed to life events, such as housing challenges and homelessness, in retrospective accounts wherein autobiographical memories serve as metaphors, tying together memory and meaning (Randall, 2011). In narrative gerontology, the personal stories remembered are those that contain metaphors most relevant to our identities, reflecting our senses of self, personal values and the meanings we attach to experiences. Resolution of complex stories of self is a narrative one that occurs throughout the meaning-making process of storytelling, and is considered an essential task of later life development (Randall, 2011). For persons who have experienced the life course adversities of homelessness and schizophrenia, making meaning of those experiences through personal narratives can repair narrative identity and promote later life development. The collection and analysis of data was informed by the sociological theory of cumulative adversity and advantage, which provides a common structure for describing and understanding diverse life trajectories, particularly among those who develop mental illnesses (George, 2007; Hutchison, 2005). The theory recognizes long-term processes affected by mechanisms that are advantageous and promote resilience, health, and growth, as well as those that are adverse, introduce stress, and undermine well-being, health, and growth. It links with the core principles of the developmental life course perspective, which provides a vocabulary with which to structure life history narratives. These principles include examination of long-term temporal patterns in the timing of lives and biography; the intersection of biography and history; linked or interdependent lives; the role of human agency in decision-making; diversity in life course trajectories; and developmental adversity and advantage (Elder, 1994; George, 2007; Hutchison, 2005). Methods This inquiry began with the larger goal of identifying how older adults with schizophrenia understand and express their life course and present-time experiences of adversity and resilience. Initial analysis identified and led to focus upon narratives of the shared adversity of homelessness. The study's aim was thus narrowed to be the exploration and identification of the meaning of homelessness, housing, and home in later life narratives of older adults with schizophrenia who have experienced homelessness, as well as how those meanings attach to later life narrative identity and ongoing challenges. The study was approved by the Columbia University Institutional Review Board and the institutional review boards of the participating organizations. Study participants Participants were required to be at least 55-years old; English speaking; have a current diagnosis of a schizophrenia or schizoaffective disorder; and to be receiving ongoing treatment for active symptoms of the disorder. Exclusion criteria included cognitive impairment or symptom severity that would severely impair the ability to provide a generally coherent narrative and/or late-onset schizophrenia. Participants were only provided with the study contact information from staff at the

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recruitment sites if they met inclusion and exclusion criteria. Therefore receipt of the study contact information thus provided confirmation that the participant met inclusion and exclusion criteria. I recruited study participants from a senior residence (The Senior Residence) run by a larger non-profit organization that provided housing and psychosocial clubhouse services (The Clubhouse) to persons with serious mental illnesses, and from a day treatment program run by a non-profit organization that also ran housing programs (The Program). A third site, an inpatient psychiatric unit, did not produce participants. At The Senior Residence, I recruited participants through a presentation of the study to the residents. Residents meeting study inclusion criteria and interested in participating contacted their housing social service provider for study contact information. Staff confirmed eligibility and gave potential participants a study flyer with contact information. At The Program, I introduced social service staff to the study's purpose and participation criteria. Staff then gave eligible participants the study flyer with contact information. At both sites participants received staff assistance in contacting the study upon request. Upon contact from a potential participant, I used a telephone screening procedure to confirm the referral protocol had been followed, gain an initial sense of the potential participant's capacity to participate, and confirm that the potential participant met the participation criteria. I obtained verbal consent for the telephone interview and provided a synopsis of the study. I also asked participants a question parallel to one of the study's interview questions in order to determine that he or she would be able to answer interview questions and generally provide thick description. Thick description refers to the quality of data collected in qualitative investigations, which must provide detail in a way that deepens understanding of the phenomena under investigation by revealing participants' voices (Charmaz, 2006; Creswell, 2007). I ensured that participants could answer questions in a generally coherent fashion and could elaborate on their answers upon request. Once screened in, participants were scheduled for their first interviews and accepted participants provided written informed consent. Eight participants were recruited, with four from each site. I included the narratives of five participants in the final analysis. Of the three excluded, one was lost to follow-up; one did not ultimately provide thick description despite the initial screening; and a third had no experience of homelessness. The five participants were interviewed between four and six times each, for a total of 26 interviews (26 hours of recorded interviews). The average number of meetings was 5. The average duration of interviews was one hour. I additionally completed 33 field observation forms prior to achieving “thematic saturation” (Riessman, 2008). Saturation in qualitative research generally refers to the point at which no new themes are being identified, themes have been fully explored, and thus no additional data collection is needed (Padgett, 2008). In thematic narrative analysis specifically, thematic saturation occurs when data collection is no longer producing novel information that advances or deepens the case-based narrative theme. Each of the five participants produced a fully saturated narrative of housing and home.

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Procedures The data collection and analysis procedures occurred in four phases, which I conducted under the advisement of a team of project advisors from diverse interdisciplinary academic backgrounds. I was qualified to conduct all of the interviews due to my direct practice experience with the study population and license as a clinical social worker. I held most of the interviews in participants' homes, although a few were held in a private common area of The Senior Residence or in The Program's facility. I used multiple interviews to promote the reliability and credibility of the findings and to ensure that expectations based on my knowledge of the population would be moderated through repetition, confirmation and correction. At the same time, I allowed my knowledge of the study population to inform follow-up questions, analysis, and engagement with study participants. I structured my analysis and the development of interview questions for each type of interview around core concepts of the theory of cumulative adversity and advantage, intertwining data collection and analysis processes (Creswell, 2007). I maintained an ongoing log in which analytic memos highlighted my research processes and my progress throughout each participant's narrative. Case-centered constant comparative methods were the primary analytic method, with chronological sequences developed and preserved for each narrative during the coding process (Riessman, 2008) and through the use of life history and time diary research strategies (Belli, Alwin, & Stafford, 2009; Stafford, 2009). Narrative segments and categories found within each participant's interview were initially isolated through the process of analytic bracketing (Gubrium & Holstein, 1998), and subsequent cross-case analysis evaluated how participants experienced those shared challenges in simultaneously unique and parallel ways. Phase one. In the first phase I conducted semi-structured interviews, developed through the orienting framework of the study, to marshal participants' broad life history narratives and identify salient themes. A brief form collected basic information around demographics, current medications, education level, past and present psychiatric service utilization, and physical health. In this and all of the following phases, I used a field observation form to systematically record field observations, including descriptions of the physical environments where the interviews were held. The field notes served as a record of the research process, an analytical tool throughout the data collection process, and additional data that promoted saturation. After the interview, I then transcribed verbatim and coded each transcript and field observation forms, using principles and protocols of thematic narrative analysis (Riessman, 2008) and life history and time diary research strategies (Belli et al., 2009; Stafford, 2009), establishing emerging themes and followup questions for each participant. I established a chronology within each life history, and used the emerging themes and chronology to draft an initial life history calendar, using general time frames to mark the x-axis of a spreadsheet and emerging themes to mark the y-axis. Housing was not a focus of the semi-structured interview questions in phase one. Only one question addressed the topic: “Could you tell me a little about your current living situation?” Related probes addressed how participants came

to be living in their present situation, perceptions about their apartments, length of time in residence, living companions, neighborhood, community, safety and security. From that line of questioning, lengthy narratives of past experiences of homelessness, and past and present-time accounts of housing challenges, often sprung. Other questions in the initial interviews, such as, “What has been the most difficult time in your life?” and “What have your major challenges been?” also garnered responses that connected to narratives of housing challenges and homelessness. Phase two. In the second phase, the interview was designed to further establish chronological ordering of life course events, clarify and extend the life history narrative accounting, and to advance case-based thematic saturation. I collaborated with participants to further develop life history calendars from my initial drafts. I also guided participants in the completion of time diaries, which developed and ordered events as recent as the previous day or week. After transcribing and coding, I added newly established thematic codes to the y-axes of the life history calendars. I then filled the cells of each participant's life history calendar with direct interview excerpts from the first two interviews that represented a given code or theme and its timeframe in the life history. Data from field observations and time diaries were included where relevant. When I had examined all the data, now organized according to theme and chronology, I used it to compose a core life narrative for each participant. As much as possible, I used the participant's own words to describe the significant events in his or her life. The importance of home and housing was further signified in this phase, wherein recalling housing type and housing challenges helped participants to identify other significant events and daily activities during that period. Housing conflicts and loss and gain of housing were significant life events around which narratives could be organized. Analytic bracketing was used to develop a focused and cohesive narrative of home and housing for each participant (Gubrium & Holstein, 1998). Phase three. The third phase was focused upon memberchecking and cross-case comparisons. I used member-checking interviews to establish that I had correctly understood the participants' narrative account and to receive participant feedback around my initial analysis. Throughout these interviews, each participant corrected my construction of his or her narrative at several points and provided details that clarified events and the subjective meaning of the events. I revised the narratives accordingly and used the participants' insights in my ongoing analysis. The member-checking process therefore promoted the subjective accuracy of the narrative accounts and related analysis. After constructing the core narratives, I examined them for larger patterns and meanings (Creswell, 2007) by coding the final narrative accounts using a combination of a-priori codes from the theoretical framework and open coding. This process deepened the understanding and analysis of the salient themes within each narrative. The core narrative was thus co-constructed as I had identified the most significant aspects of the narrative in collaboration with each participant. I subsequently shifted the focus to cross-case comparisons, first to enhance case-based narrative and thematic development (Riessman, 2008) and then to illuminate more


fully the core themes shared across all of the participants' narratives. To accomplish this, I re-coded all participants' core narratives as a single unit, considering content, process, and relationship to the theoretical framework throughout. I analyzed overlaps, differences, and parallels across narratives using constant comparison to determine what themes were most essential. I further identified and deepened my understanding of essential themes across the narratives through the use of imaginative variation in which I imagined the text without an identified theme: If its absence did not appear to alter the meaning or structure of the narrative, then it was considered unessential and removed from the narrative (Caelli, 2001). Phase four. The fourth and final phase focused upon processing the experience of involvement in this study with the participants and had a member-checking component around final changes to the narratives and ongoing analysis. The final interviews also provided closure for the participants and opportunity to provide feedback around participation in this study, because they had provided large amounts of intimate information to me. Consideration of the fit of the data within existing research completed the analytical process.

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having a home. The fourth theme is that of complicated longterm relationships with housing-based social service organizations. Participants had complex understandings and experiences in their long-term relationships with the social service organizations connected to their present housing circumstances. In the following section I have organized and presented the narratives by participant, highlighting how the importance of the narrative of homelessness emerged, and each narrative's connection to the four core shared themes within the participant's account. I used this strategy of data presentation to allow the whole, complex human experience to become apparent, while including language and analysis that participants agreed upon. Each narrative begins with a description of the participant's demographics, followed by his or her narrative of homelessness and housing challenges that includes the estimated frequency, type and duration of homelessness. My description of each participant's current living situation appears at the end of each narrative. Pseudonyms are used throughout. To preserve the authentic voice of the participants, speech idiosyncrasies and grammatical errors have been preserved in the directly quoted text. Narratives

Findings For the participants in the present study, histories of homelessness connected to present-time meanings around identity, housing, and relationships with social service providers in housing. Life circumstances were viewed through the lens of past homelessness, present-time housing, and housing challenges. Most considered the experience of homelessness the greatest challenge of their lives. All of the participants' current living arrangements included housing provided by a social service agency. The three participants from The Program lived in The Program's housing: One lived in a psychiatric residence, with 24-hour staff and nightly meals provided, among other services; two lived in The Program's scatter-site housing that offered off-site case management services. Two participants lived in The Senior Residence. Both The Senior Residence and the psychiatric residence provided money and medication monitoring services. The study participants lived either alone or with roommates. Of the three who lived with roommates, only one had a close companionship with his roommate. The other two had cordial relationships with roommates but acted more as neighbors than living companions. Four shared core themes ran throughout the participants' narratives of homelessness, housing, and home. The first theme is that of the interweaving of housing status and sense of self. Participants' narrative identities were connected to and evolved around housing status. The closely related second theme is that of present-time housing as a symbol of personal resilience and overcoming adversity. Participants often discussed their current housing in juxtaposition with their experiences of homelessness, and their present-time circumstances were viewed as evidence of having prevailed over hardships. The third theme is called “waiting to go home,” a phrase used by one of the participants to describe his current living situation. The theme elucidates the gap that often appeared between the reality of participants' present housing and their dreams of

Doris. Doris was a 69-year old white woman, born and raised in a large northeastern American city to an Italian-American family. Raised in impoverished conditions, she left school before receiving a high school diploma in order to work to support her family. She was divorced twice and had two children, each with a different husband. She had sporadic work history, mostly as a receptionist. Her illness onset was insidious, but she was aware of first experiencing symptoms of schizophrenia in her 30s, and later made a suicide attempt. Although she was hospitalized after the attempt, she did not receive ongoing treatment afterwards. Instead, she was housed by family and worked when she could. She estimated that she became homeless in her late 40s or early 50s, for just over a year, in the context of increasing psychiatric symptoms and family conflict. At the time of the study she had been living in The Senior Residence for over a decade. The theme of homelessness emerged when I asked Doris about her greatest life challenge. “Homeless” was her single word answer. The worst part of it was, in her words, “Hungry.” The process through which she lost contact with her family and then lost her housing was something she struggled recall, and she acknowledged that was partly due to reluctance to recall the saddening events. The interweaving of housing status and sense of self became apparent as Doris explained how she became homeless. Her family had been providing her with housing, but she left “to go homeless” after they argued about her psychiatric symptoms. Her psychiatric symptoms, demeaning voices in particular, were bothering her at the time she became homeless: “If I have to go back and think now, how that I become homeless, that [schizophrenia] was it. And I couldn't tell my family because they didn't believe me. They still don't believe those voices… so, I just stayed on my own in the streets....”

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“I don't know how I did it. A couple of times I'd fall asleep with my bag next to me. And I'd wake up and it was gone… And that was all my i.d. I had. There wasn't any money, just i.d. So, I had to go and report it to the police station. And they gave me a paper, which had my i.d. on it. So that's in case the cops stop me, you know, I would have i.d. on me….” As a person experiencing homelessness she was required to have identification to show the police and other authority figures. Cast out of her family and home she was otherwise an unknown, anonymous person. When she lost her identifying papers, she lost what was remaining of her identity in relation to the greater world. She became both nameless and placeless. She describes: “[I] slept on the streets… Just ﬁnd a stoop that I could crawl on and go like this [curls up] and slept.... I just walked the streets… that was hard being in the streets, being hungry, and no roof over your head…”

“When I was homeless, I walked from New Jersey to Philadelphia. I walked… Stayed right on the highway. It took me straight there… But then when I got there… [a] cop car came right over to me, told me I couldn't go to Philadelphia… I had to walk all the way back again.”

Eventually she found herself living in a small shelter. Her identity at that point was that of “a homeless”:

“I met somebody that was a member here [at The Clubhouse]. And he got me in here. I was lucky… I must have looked like a homeless for him to take me [to The Clubhouse].” Soon after, she moved into a residence run by The Clubhouse, and later to The Senior Residence where she lived at the time of the study, attending The Clubhouse, and receiving treatment from a psychiatrist that included antipsychotic medication. The theme of complicated long-term relationships with housing-based social service organizations emerged as she began to frame her relationship with The Clubhouse in terms of luck, and later, as an act of God: When summarizing her period of homelessness she said, “That was a bad part of my life.... I remember it. It was just a hard time in my life… Thank God I got help.” The theme of housing as a symbol of personal resilience and overcoming adversity emerged in the physical environment of Doris's cozy studio in The Senior Residence. The comfortable furniture provided by The Senior Residence had a homey feel. Doris had decorated the apartment with photographs of family and friends, prints of landscapes, and religious statuettes. The phone often rang while we meet, sometimes a neighbor knocked, and sometimes she left the TV on. Doris described many friendships with neighbors and staff at The Senior Residence. Her apartment felt like the home of someone who was loved. The adversity of isolation that marked her loss of

identity as “a homeless” wandering alone through streets and sleeping on benches was gone, overcome through a stable and comfortable space crowded with faces and phone calls. She described a daily life marked by simple routines that rarely required her to leave the immediate vicinity of her apartment and neighborhood. When she did it was to visit family. She described looking forward to her “everyday life,” appreciating the constancy and everydayness of it. The theme of “waiting to go home” developed slowly in Doris's narrative because she expressed genuine gratitude for the community of The Clubhouse and The Senior Residence, and initially appeared to have made her apartment her home. However a sticking point for Doris was smoking. While she was not supposed to smoke in her apartment, she usually did. By our last meeting she was no longer permitted to even bring cigarettes into her building. Her cigarettes had to be checked at the front desk. This was a source of aggravation for her and added a new concern that her housing could be at risk if she smoked. Later she mentioned that she stopped going to The Clubhouse for nearly a year because she found it too depressing, but was pressured to return by social service staff of The Senior Residence. Those missing pieces of autonomy, while connected to the promotion of her health and well-being, seemed to contribute to Doris's later assertion that she hadn't “gotten somewhere” in her life. Although housed in a homey apartment, she was still not “somewhere” that she wanted to be. At the same time, this discrepancy evoked again the theme of complicated long-term relationships with housing-based social service organizations. Despite her gratitude for The Clubhouse and The Senior Residence, reminders that she was answerable to institutional rules also reminded her that she was “waiting to go home.” Peter. Peter was a 56-year old white man; born and raised in a large northeastern American city to a working-class Irish-Catholic American family that depended upon welfare at times. He had a high school degree and completed one semester of college. He was single, never married and had no children. His work history was sporadic and his longest held position was that of a security guard for about a year. His symptom onset began around the age of 23 in the context of polysubstance use, and he subsequently experienced constant auditory hallucinations, among other symptoms, throughout his life. Additionally, he had several periods of suicidality and multiple suicide attempts across his life. Since the last of his two periods of homelessness ended more than 20 years ago, he had lived in different types of housing provided by The Program and received The Program's psychosocial treatment that included psychiatric medication and therapeutic groups. At the time of the study, he had lived in his current scatter-site apartment with a roommate for four years. The narrative of homelessness was central in Peter's life history, emerging quickly in his account because he saw it, and his mental illness, as the explanation for his present living circumstance and the reason for remaining in it. Peter had experienced two episodes of homelessness across his life, both of which had been frightening experiences, marked by severe psychiatric symptoms including auditory and visual hallucinations and paranoia. Like many of the other participants, Peter couldn't give a clear account of the process through which he became homeless on either occasion.


In the first period of homelessness, Peter had been living with his brother, who went on a “business trip for one week.” Somehow Peter found himself sleeping in the parks as the result. The duration of the episode was also uncertain in his memory— at one point he said it lasted just one week and at another point he thought it had lasted an entire summer. He recalled vividly the discomfort of sleeping on a park bench. After a minor “earthquake” he became afraid of “being swallowed-up by the street,” and called his brother, who by then had returned from “the business trip.” His brother came to the park in a patrol car and took him into his home, providing him with housing, cigarettes and an allowance for several years. His best recollection of how he became homeless the second time was that he had been living in the apartment with his brother, but that his brother moved out. Over time, although Peter remained living there, the building somehow became derelict. He stayed in the derelict building for two years in the late 1980s, in a state that may be described as quasi-homelessness, since he had a roof over his head, but not much more. He says that this was the period of his life when his symptoms were at their worst. Connecting to the theme of the interweaving of housing status and sense of self, his description of the condition of his housing runs parallel to the description of his symptoms: “I was in a very bad situation psychiatric-wise. I was hallucinating like crazy. Voices everywhere. I would be yelling out the window at the voices… [The apartment had] no heat, no electricity… no water. Nothing.” Furthering the theme of the interweaving of housing status and sense of self, Peter's rescue from the housing conditions was also a rescue from his psychiatric condition, requiring the police, and eventually The Program, to “save” him: “I barricaded myself in my brother's room, old rooms. The police were outside… I went inside, there was a little lock… inside the door. I tried to lock it, the lock came off, and I was pressing my shoulder on the door.

“I heard the policeman say, ‘He's blockading the door with his shoulder. He won't come out.’ And he says, ‘Come on out. Come on out.’

“… I had to come out. I was trapped. I came out. I thought a monster was there… That made me really scared.” The police brought him to a psychiatric hospital, and after an 8½-month psychiatric hospitalization in the late 1980s, Peter was discharged to The Program's therapeutic residence for persons with mental illness. At the residence, his medications were dispensed and monitored by staff, and he was required to participate in chores, activities, meetings, and attend psychiatric treatment. He was given a weekly allowance out of his Social Security money, but most of the money went to pay his “rent” in the residence. The theme of the interweaving of housing status and sense of self appears in his narrative again when he describes how, at that time, “a certain amount of freedom” was lacking. He felt like an “invalid” for not having a key to his own apartment, the ability to make his own schedule, needing staff to let him in and

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out, and having to sign-in guests. Rather than someone who had been cured or rehabilitated, or a person who was merely unhappy with his housing situation, he in fact felt like a less valid person. After describing the sense of having lived as “an invalid” for 20 years in housing run by The Program, he went on to express what he nonetheless appreciated about the experience despite its shortcomings. He believed living in the therapeutic residence “put organization into” his life and he was “grateful” that he had “people to turn to” there. He had enjoyed taking long walks in the neighborhood and had good relationships with the onsite staff. After 20 years in the psychiatric residence, Peter moved to the more independent scatter-site apartment run by The Program, where he lived for the four years prior and during the interviews of this study. The theme of the interweaving of housing status and sense of self again arose as he considered his new housing, stating, “I'm free… I have key to my own apartment and live like a real person… I needed some independence.” This statement also spoke to the theme of present-time housing as a symbol of personal resilience and overcoming adversity in his narrative. His present-time housing made him “free” and “real.” His simultaneous expression of gratitude and objection towards being the recipient of The Program's therapeutic residence services connect his narrative to the theme of complicated long-term relationships with housing-based social service organizations. His realness and freedom, as found in his new identity in more independent housing, did not erase his ambivalent feelings toward The Program. Developing the theme, he expressed, “I especially love [The Program] because… they're housing me… and that's a lot…. [The Program] came along and saved me.” At the same time, he imagined the organization might “die away” so he could “be a butterfly and fly away.” Peter's ambivalence encompassed his feelings of gratitude and a sense of being beholden to The Program. At the same time, he further interweaved housing status and sense of self by turning his housing status into a metaphor for self. His current housing was a chrysalis, wherein he was the creature encased and transforming within. Housing free from oversight of The Program would represent his emergence into a new self, free to fly and unconstrained. The theme of “waiting to go home” was also apparent through his use of this metaphor. Using the image of a butterfly flying away rather than going home evokes the sense that he has neither become who he wants to be nor arrived at home. However he asserted that he did not feel ready to fly away, “not yet.” The physical location and appearance of Peter's current apartment and his neighborhood also spoke to his narrative's theme of “waiting to go home.” His new apartment was far from the therapeutic residence where he had lived for 20 years and he spoke of missing the comforts and conveniences of his former neighborhood. His new neighborhood was mostly Spanish speaking, contributing to Peter's sense of not belonging. Within his apartment, aside from a brightly colored quilt he had bought and kept on his neatly made bed, there were few personal items. The furniture provided by the social service organization was spare and institutional. The couch in his living room was the same as those sometimes used on psychiatric inpatient units. Two

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chairs surrounded a small table and a dead plant sat on a windowsill. The shades were usually drawn. His roommate's bedroom was down a long narrow hall, and their interactions seemed to be that of neighbors rather than living companions. While Peter was housed, he had not made the place his home. Although present-time housing was a symbol of overcoming adversity and personal resilience, because he was no longer an “invalid” and he was now “real,” it was also a symbol of Peter's “waiting to go home.” As Peter explained, “The thing is, I've still got a long way to go.”

Samuel. Samuel was a 73-year old Black man from a large northeastern American city, raised by a single mother. He never completed high school or worked, possibly due to the relatively early onset of schizophrenia at age 17. He was single, never married, and had no children. Although he did not detail his specific symptoms at illness onset, his symptoms at the time of the present study were mostly the negative symptoms of schizophrenia, including the appearance of having little emotional affectivity and amotivation. He had a history of alcohol abuse and multiple years-long psychiatric inpatient hospitalizations. He became homeless on two separate occasions, living in shelters and on the streets for what he estimated was a few years each time. At the time of the study, he had lived in The Senior Residence for five years, and for about ten years had attended The Clubhouse and received treatment from a psychiatrist that included antipsychotic medication. The significance of homelessness in Samuel's narrative emerged wherein he was able to provide thick description of his life and activities during his episodes of homelessness, when his psychiatric symptoms appeared to make that difficult for him elsewhere in his narrative. Homelessness appeared in the narrative with prominent and clear memories, or a stronger motivation to describe it, than most of his other autobiographical material. Samuel first became homeless after his discharge from a second long-term psychiatric hospital stay, at about the age of 40. Although he was uncertain for how long he was homeless at that time, he estimated that it lasted for a few years. To eat, he would get “a meal ticket” and “get on line for food” and he usually slept in a large men's shelter. The theme of interweaving of housing status and sense of self began to emerge when he spoke about his state of self when he was experiencing homelessness: “It was something. I didn't know where everybody was at [or] where I was. I, I couldn't tell where I was… I was sick.... I could have bust my tail you know.... I was in a daze walking.... I got drunk… so I would feel better… I started drinking—alcohol. Drinking wine. Half and Half… that was its name… I started drinking Half and Half to get steady. [When it didn't work] I started drinking Night Train. You've heard of Night Train.” Samuel eventually “found” his mother again and lived with her until she died. Her death led to another lengthy episode of street homelessness, which he estimated to have lasted more than a year, followed by another years-long inpatient hospitalization at about age 50 in a state hospital. When he was discharged, he lived in a transitional shelter, then another housing program run by The Clubhouse for five years, finally moving to The Senior Residence at 69, because

“they [The Clubhouse organization] said it would suit me better—if I stayed here.” In Samuel's narrative, complicated long-term relationships with housing-based social service organizations were perhaps the least complicated, despite over a decade of living in housing provided by the organization and needing to follow the institutional rules. He was pleased with his apartment and unbothered by the requirements connected to his housing. Because smoking was not permitted in The Senior Residence, Samuel quit at the time of his move. When asked how he felt about it, he simply shrugged and explained it was the rule. His length of time living there did not bother him, nor did the need to participate in The Clubhouse's activities. He quietly said, “At first I wasn't interested, then I got interested.” He said he felt his current living situation was “pretty good” and reminded me with a sense of satisfaction, “I live alone.” Overall he felt he was “fine.” The theme of present-time housing as a symbol of personal resilience and overcoming adversity was present in his narrative through his statement that he was feeling “fine” now, the significance of which is best understood through its context: he made this assertion immediately following a lengthier description of his homelessness, when things were distinctly not fine. He was “in a daze,” “sick,” and could have “bust [his] tail.” Although the theme was not as strong in Samuel's narrative as in those of other participants, the meaning of his current housing could nonetheless be understood through comparison with his experience of homelessness. It marked the difference between feeling “fine” and being in danger of “busting his tail.” Samuel offered a contrasting case, in that the theme of “waiting to go home” was absent from his narrative. Samuel's apartment was a spacious one-bedroom with a small kitchen and a large bathroom. It came furnished by The Senior Residence and had some of the same comfortable furniture as Doris's apartment. Landscapes with Bible passages decorated two of the walls. He kept a collection of animal figurines over his TV and stuffed animals on the windowsill that were gifts from a friend who worked at the nearby pawnshop. Since he moved in, a home health aid had come every morning to cook him meals, clean his apartment, do his laundry, and escort him to any medical appointments, although he could walk down the block to The Clubhouse and the pharmacy on his own. Perhaps because of the presence of the home health aid and gifts from a friend, his apartment felt like that of a well cared for grandparent, although he had no grandchildren. He felt his life was “alright,” with no complaints, qualifications or modifications to that sentiment. The appearance and feel of his apartment furthered the sense that Samuel was indeed home. John. John was a 70-year old Black man who in his early 20s had emigrated from a small Caribbean island to the U.S. He completed high school in his country of origin and later acquired a GED in the US. His work history was limited, but included a brief stint as a naval cadet (he was discharged for fighting) and work as a security guard. He claimed to have been divorced although he only met his wife at the wedding and never saw her again. He had no children. He first developed symptoms of schizophrenia in his early twenties, and described what appeared to be symptoms of paranoia


that led to violence. Although he had no history of suicide attempts, he had several episodes of violence that resulted in his arrest and psychiatric hospitalization. At the time of the study he had been living in a therapeutic residence run by The Program setting for over a decade (although he had moved once within The Program's housing sites). He also attended The Program's psychosocial treatment where he received medication from a psychiatrist and attended therapeutic groups. Homelessness was a central theme in John's life history narrative. He connected it to problems in his family relationships, his work, and his sense of self. In the late 1980s, after a final episode of violence with his family, the police brought John to a psychiatric hospital, where he was admitted for a second time in his life, and stayed for about a month. While he was in the hospital the family determined that he could not return to live with them and they moved from their home to ensure that he could not find them: “Then straight up I went my ways and they went their ways… It was their decision. Where they went to I don't know... They didn't explain why, maybe because of the misunderstanding between us. But I haven't seen them since. I'm not wanted anymore in the apartment. So I went my ways and they went their ways. I was homeless, went into the shelter to live.” He was discharged from the hospital to a shelter and shortly after moved into a rented room. However, after his radio was stolen he became “suspicious” of his surroundings and “worried for” his other belongings. So he left the room to sleep on the subway. For the next 15–20 years, John was homeless. Sometimes he slept on the subway, sometimes in churches with “two chairs pulled together”, and other times he stayed in shelters —including two longer stays at a shelter with connections to a psychiatric hospital. He said he was untreated for schizophrenia most of the time he was homeless. At the age of 59 he moved from a shelter to a therapeutic residence run by The Program. John's rent was paid from his social security check, his medications for medical and psychiatric issues were dispensed and monitored, and he received one meal every night. He received the rest of his meals at The Program, which the residence required him to attend 4 days per week. After several years, the residence closed for funding reasons, but he was moved to another therapeutic residence run by The Program and he continued to live there throughout the time of this study. The theme of present-time housing as a symbol of personal resilience and overcoming adversity appeared in his narrative when, acknowledging that it was a challenge to live in the “rough” shelters, filled with “fighting” and “incivilities,” John asserted with seeming pride that he “took the challenge,” having made it through. Although surviving the adversity of homelessness was personally symbolic of his resilience, having been homeless in the first place was still a source of shame, regret and confusion for John. The theme of the interweaving of housing status and sense of self appeared in his statement about his history of homelessness, which revealed that despite having been stably housed for more than a decade at the time of our

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interviews, his history of homelessness affected his ongoing sense of self negatively: “That's what makes me feel a bit off the track. I feel very ashamed about it. It's not a disgrace because… people live there and so on, but you know, it's just so bad. It make you feel that you're a bum when you live in a shelter… It was so fast the way it happened—It was so fast. I didn't expect that. I never heard of a shelter before or since.” The theme of complicated long-term relationships with housing-based social service organizations was readily apparent. He described mixed sentiments about his current apartment in a therapeutic residence, particularly about the fact that others had come and gone while he had lived there for over a decade. He explained: “I just came here to live, they told me, up to 3 years. They'll send me to live somewhere else or for independent living. I dreamt of some place of my own without a roommate, all by myself… They told me yes, they have that too—A place all by yourself with kitchenette and so on. A studio.... I'd like a room alone. That would be my lucky day. I go from here…. But I am waiting on whatever it is. I'm waiting on it. Because they still have to take care of everything… Some of them move out already—went to a place to live on their own. I don't only want with [The Program] but I mean independently, like a studio… I would like to live in [a different area] for a change… a long time since… since I lived in [a different area]… I like to live there. I have had enough of [this area] for now.” That statement also evokes the theme of “waiting to go home.” He “dreamt of a place on his own” independently housed, perhaps in a studio, and in another area in the city. The humble change in situation would indicate that his “dream” of home had been realized. While he resented the “waiting,” he nonetheless relied on and appreciated services from the residence staff for meals, medication monitoring and money management. “I am contented,” he said, explaining his overall feelings about his current living situation. In spite of the gap between his dream and reality, he was able to value in his current living situation, and in this way valued his complicated long-term relationship with the housing social service organization, despite his desire to terminate it. As I considered the push and pull between John's “contentedness” and his “dream” of home, I looked to the physical environment of his apartment in the residence where our meetings were held. It was small and partially furnished. It appeared as if someone had just moved in, although he had lived in that particular apartment for years. There were two small kitchen tables and three wooden chairs set around one of the tables, none around the other. There was a coffee table with an end table stacked on top of it, and a floor lamp, but there were no couches or armchairs. Sometimes John placed a fan in the middle of the living room floor, and for a while his roommate's stereo was there, but he never turned on either item. His bedroom had a twin-sized captain's bed and a TV at the far end. Papers and personal effects were stacked on the dresser and night table. Although our meetings took place in the living area, I often

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heard the radio playing in the bedroom and saw the TV was simultaneously running with no volume. He explained that he liked to “watch TV and listen to the radio” at the same time. Although he had a roommate, they had little interaction. Despite the presence of the roommate and availability of staff, John's home appeared empty and isolated. The apartment indicated that John was housed, but not yet home. And while he was contented, his dream was of a different home. Thus he was “waiting to go home.” Paul. Paul was a 61-year old Black man, born and raised in a rural area of the southern U.S. His grandparents raised him because his mother was a teenager when she had him. His grandparents worked as sharecroppers and he began helping them in the fields as early as age three. As a child he went to school sporadically, according to the cotton harvest schedule, and stopped going to school entirely at the age of 16. Although he was single, never legally married and had no children, he did have two relationships that he considered marriages, and a stepdaughter whom he considered his own child. After leaving the South, his work history was sporadic and involved working in steel mills and other factory labor. In terms of illness onset, he claimed to have heard the voice of God his entire life, as part of his spiritual world. However his more specific symptoms of schizophrenia, such as ideas of reference and command auditory hallucinations, appeared in his late twenties in the context of alcohol abuse. His auditory hallucinations continued throughout his life after that point. At the time of the study, Paul had been living in an apartment managed by The Program and that included off-site case management services. He had been living in various housing options provided by The Program for 15 years, and had the same roommate for the entire time. He attended The Program where he received medication from a psychiatrist and attended therapeutic groups, and was also involved in their vocational training program. The significance of homelessness and housing emerged in Paul's narrative as he structured the stories of his life around where he was living at the time in which the stories occurred. Furthermore, over time it became clear that Paul believed his future home would be a reward from God for his piety, which underlined its importance to his narrative. Paul's experience of homelessness had two unique features. First, his housing was marginal for many years before he became homeless. From the age of ten on, he moved back and forth between rural South Carolina, where the rest of his family lived in un-insulated cabins that relied on wood-burning stoves for heat, and a northeastern city where he stayed with various family members, but rarely had his own apartment. The last apartment where he lived with his wife before entering the shelter system was in poor condition, and he appeared to have been ‘squatting’ there rather than living with a formal lease agreement with a landlord. As he spoke about leaving it, the theme of the interweaving of housing status and sense of self became apparent. For Paul, leaving the apartment was a spiritual experience—God told him and his wife to leave so he could do God's work: “[The building] had nothing but crack head people smoking in there…. And they was trying to get rid of

them, get them out of there. They didn't know how. But God was getting a place, was planning a place for me and my wife to go, so that way… we can do the work. So after we moved out the place and God moved us out… the whole marshal and the police department… they came, and they had a big dumpster out there. And they got all that furniture and stuff they had in there and throwed it in the dumpster….” His leaving housing represented his willing entrance into a spiritual journey. He saw his self without a home as a spiritual self. That which was not spiritual, and removed by God, was thrown out into a dumpster. According to Paul, God sent his wife and daughter to a woman's shelter and he went to a men's shelter. He never saw either of them again. He remained in the shelter system for about 4–5 years and then moved into a therapeutic residence run by The Program, eventually transferring into their more independent housing programs. Paul coined the term “waiting to go home.” He used it to explain that he would stay in his current housing: “…Until God tells me to go somewhere… I'm waiting to go home… I'm going someday… The only reason I'm here at [The Program housing] ‘cause God got it like this way. Because when I was leaving from [the shelter], I thought I was going back to [my home town]. But God put a song in my heart, said this is the way God planned it. This is the way God planned it.” Although Paul had been stably housed for decades, he was not yet home. The theme of “waiting to go home” connected to the theme of the interweaving of housing status and sense of self wherein Paul's identity centered around his spiritual life and he saw his past experience of homelessness and current status of “waiting to go home” as part of God's plan for him. In that way, Paul provides a contrasting case wherein the meaning he attached to homelessness, particularly as it affected his sense of self, prevented it from becoming a low point in his life. Perhaps because of Paul's belief in God's plan for him, and his lifelong history of difficult housing situations, the theme of present-time housing as a symbol of personal resilience and overcoming adversity was less apparent than in other narratives. The conditions of his past housing was more problematic to Paul than the conditions he faced when he was homelessness, and neither his past housing problems nor his history of homelessness were central concerns in his narrative. However his sense of self came not from the fact of his resilience, but from his belief that he was waiting for God, solidifying his sense of self as a spiritual person. The theme of complicated long-term relationships with housing-based social service organizations was also connected to his beliefs about God. Because he believed that he was in his current living situation to serve God, he had developed the belief that he was in The Program housing and treatment in order to help the people who worked and received treatment there. While he seemed to like all of his providers, he expressed annoyance that they imposed rules in his life, and sometimes questioned his beliefs about hearing God's voice. He was there to help them, not to follow their rules.


In his current apartment, he and his roommate shared household responsibilities, and the apartment invariably smelled like dinner that one or the other of them was making. One or the other of them would also usually be playing music from his bedroom. The living room consisted of two deep-cushioned easy chairs and a matching couch, all of which were comfortable although worn, and situated around a coffee table that was covered in carefully stacked piles of papers and books. The apartment seemed lively with the presence of music, the smell of food cooking, and conversations between the two men. However there were some maintenance problems in the apartment that Paul said he was managing: There was a roach problem, a rat problem, a tub that wouldn't stop running steaming hot water, dark black mold running up the bathroom walls, and a smoke alarm that never stopped making the low-battery sound. Those maintenance problems remained throughout our ten months of interviews in the apartment, perhaps simultaneously diminishing the sense of present-time housing as a symbol of personal resilience and overcoming adversity and enhancing Paul's sense of “waiting to go home” to a place where the reality of housing was closer to his dream of home. Discussion This study is nested in the field of narrative gerontology, wherein stories used in reminiscence are considered those most relevant to identities, reflecting values and the meanings that are attached to experiences. When personal stories are interpreted through their telling, narrators are simultaneously interpreting themselves (Randall, 2011). In their retrospective accounting, participants' experiences of homelessness became interwoven with their sense of self. The findings connect to and extend earlier research around identity strategies used among homeless persons identified through the examination of narrative and identity among persons who have experienced homelessness. Paul′s narrative of homelessness fits the Snow and Anderson (1987) identity typology of “embracement” wherein he assigned spiritual meaning to his experience of homelessness and could thus embrace having had it. However the other participants' narratives did not fit as easily into the Snow and Anderson (1987) typologies. Participants did not use distancing nor did they appear to engage in fictive storytelling. In line with the task of later life narrative construction (Cappeliez, Guindon, & Robitaille, 2008), participants used the storytelling process to come to terms with the experience and what it meant about the past and present self. As in the findings of Padgett and Henwood (2012), the advantages of being housed did not erase the prior experiences of adversity; however, in line with Shibusawa and Padgett (2009), the participants appreciated having the space and time to re-evaluate their identities and lives. Furthering the findings around the interweaving of housing status and sense of self was the theme of presenttime housing as a symbol of personal resilience and overcoming adversity. Participants often integrated their endurance of the adversity of homelessness into a repaired and reconstructed identity that signified personal fortitude. This runs parallel to findings of Padgett et al. (2006) and Padgett (2007), wherein surviving the adversities of homelessness

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and housing challenges became part of participants' sense of worth. Likewise, for the older adults in this study, the value of housing was not solely in the shelter it provided, but in the sense ontological security that it delivered. For older adults who have experienced the life course adversities of homelessness and schizophrenia the provision of housing can also include the needed space for narrative identity repair, which is both a narrative task of aging (Randall, 2011) and a function of ontological security (Dupuis & Thorns, 1998). Ongoing challenges experienced by the participants lay in the extent to which housing programs provided, in addition to shelter, homes to their residents. This ability appeared to be hindered through challenges of balancing institutional rules, adequate support, community integration, and the provision of autonomy. In the present study, participants had lost their housing during or after an acute episode of psychosis; did not generally receive psychiatric treatment throughout the period(s) of homelessness; had no contact with their families throughout the period(s) of homelessness; required help from social services to return to stable housing; and had remained in treatment and housing accessed through those same social service agencies that first provided them with housing for years, and sometimes decades. While these findings mirror processes of becoming homeless delineated in previous research (Belcher, 1989; Wasson & Hill, 1998), the identification of ongoing but complicated relationship participants went on to have with the social service organizations that provided them with housing is important, as the participants struggled with the extent to which they wanted more autonomous housing. While participants had been “saved” by the housing provided by social service organizations, they had also been made “invalids” by them. Evidence of identity repair and expressions of gratitude, comfort and contentedness with housing appeared alongside an underlying sense that ongoing involvement with the social service organizations meant they were not “free.” The narratives of the present study thus identify the participants' need for support in housing at the same time that it identifies their conflicting need for more autonomy. This conflict was central to what made the relationships complicated. Similarly, the Padgett et al. (2006) analysis of retrospective narratives of homeless women found that the needs and wants of formerly homeless women included increased autonomy; and Leith (2006) found that having arrived in congregate care settings by autonomous choice helped older women to make the place a home. However research also supports that persons with schizophrenia appreciate support in specific domains of daily life that sustain independent living, such as practical housekeeping and financial help (Gunnmo & Bergman, 2011) and value the feature of security and stability (Padgett, 2007) in their social service provided housing settings. In this study, for the older adults with schizophrenia who had experienced homelessness, the absence of the desired level of autonomy contributed to a shared sense that they were not yet home, despite their appreciation of stable, comfortable housing. While much of what was important to participants was present in their housing environments, the prevailing meaning attached to home that was out of reach for the study's participants was the ability to act autonomously.

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Implications for policy and practice Growing evidence around housing for persons with mental illness who have experienced homelessness promotes more autonomous housing programs, such as through Pathways' Housing First Program (NERPP, 2012a), and shorter duration of housing-related social services, such as through Critical Time Intervention (NERPP, 2012b). However, research that evaluates optimal housing environments specifically for older adults with schizophrenia is needed. Participants' sense of not being home centered around challenges of autonomy in social service housing settings, but this sense did not negate their need appreciation of and need for supports and security provided by housing organizations: All participants were able to identify encouraging and affirming aspects of their current living situations and often viewed their housing as symbols of personal resilience. Interventions that focus on identityrepair post-homelessness may be effective in increasing the sense of “being home” once persons are housed. Further research is needed to understand how housing programs and direct social service providers in housing settings can best provide support in this area, and balance provision of support with promotion of autonomy. Conclusion This study found that for older adults with schizophrenia who have experienced homelessness, housing and sense of self were intertwined. The meaning of housing after homelessness for the participants was that of a triumph over adversity. It was a symbol of personal resilience. The meaning of home lay in the functions of shelter as well as the ontological security that housing could provide. However achieving a sense of home was hindered by a sense of a lack of autonomy. Limitations of the findings may stem from the potential influence of social desirability bias, particularly because participants were referred to me through social service providers. However the extensive member-checking process made it unlikely that the participants were misleading. Reliability of findings would have been enhanced through the use of an additional coder and the establishment of intercoder reliability in the coding process, but was established instead through the use of consultation with and feedback from project advisors, the scaffolded data and analysis structure, time triangulation of interviews, the use of field observations in addition to the interview data, and the use of in-depth member-checking interviews. This study's strengths include the use of multiple strategies for rigor, such as regular debriefing with project advisors, extensive member-checking, and the use of multiple interviews per participant (Padgett, 2008). Time diary and life history calendar methods improved the credibility and transferability of life history research through improving comprehensiveness of recall and encouraging participants to systematically include chronology (Belli, Alwin & Stafford, 2009). The involvement of the project advisors further promoted the reliability and credibility of the findings. The perspective of social workers and administrators from housing-based social service organizations would have added another important dimension to the findings, allowing for understanding of institutional rules that in this study generally appear to hinder autonomy but may have

promoted important goals, such as the sense of stability and security appreciated by the participants. The need for autonomy coexists with the need for support and security among older adults with schizophrenia who have experienced homelessness. While it has long been established that the provision of housing solves the problem of homelessness (Hombs, 1994), further identification and implementation of factors that make housing a home for persons who have endured the adversities of homelessness and schizophrenia has the potential to promote needed narrative identity repair in later life, and enhancing their ability to address the developmental tasks of their life stage.

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