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The aim of this research is to investigate life-course and structural determinants of positive subjective health amongst older Traveller and older homeless people, with a view to centralising the voice of these groups in effective, ethical and rights-based models of home care delivery.

Rationale:

With efforts to improve homecare (HC) services for older people in Ireland, and expected legislation to enshrine rights to these services, there is a critical need to ensure new HC reforms are accessible and relevant to the most marginalised older groups. Reflecting priority populations of the Health Service Executive (HSE) Social Inclusion Office, older adult Travellers and older homeless people (OTOH) are two such groups. However, OTOH voices are markedly absent from health policy and practice discourse (Smyth 2016). OTOH are also more likely to experience health inequalities and poor health outcomes (Abdalla 2010; Walsh 2013). This can be related to accumulated exclusions across the life course. Structural factors concerning discrimination/stigma, and lack of access to education and employment can construct disadvantage for OTOH (Reynolds et al. 2016).

Particular life-course experiences with respect to disability/ill-health, disrupted labour participation, family breakdown and irregular accommodation can dominate the life-paths of some OTOH (Coates et al. 2015; Watson et al. 2017). Such factors are reflected in greater prevalence of co-morbidities, higher rates of alcohol/substance abuse, and substantially lower healthy-life expectancies (McDonald et al. 2009). They are also reflected in complex challenges concerning care delivery. Therefore, although specific mechanisms of inequity are likely to differ for the two groups, OTOH can experience similar patterns of community, socio-cultural and political displacement within society. Critically, however, there is little focus on marginalised older adults who achieve more positive health outcomes, and healthy ageing biographies (Waldbrook 2015). The ways in which life-course and structural forces shape these more favourable trajectories, and perhaps experiences closer to that of health equity, are unknown.