“Everyone here [is] a customer”

This article examines the implementation of a harm reduction pilot project in a Canadian permanent supportive living facility for older people with experiences of homelessness (OPEH). Nearing the conclusion of the intervention, two nominal group technique (NGT) sessions were facilitated to identify key learnings from the project. The key learnings informed a secondary analysis of qualitative interviews with stakeholders from health and social services as well as with residents and staff at the intervention site. Participants stressed the positive impacts of their participation in co-designing the harm reduction programming throughout the intervention lifecycle, which enhanced the relationship between frontline care providers and OPEH residents. A major identified barrier to implementation of the programming was the underlying organizational accountabilities to funding bodies, which were perceived to be influenced by business decisions that emphasized maximizing efficiency and minimizingCritical Social Work, 2024 Vol. 25, No. 2 institutional liability. The competing priorities of the organization and OPEH care recipients resulted in a breakdown in communication and trust. We situate these tensions within the broader neoliberal policy framework that shapes organizational decision making and priority setting. The findings of this research will be useful for frontline care providers (of both health and social services) and program administrators in harm reduction settings looking to enhance harm reduction service delivery for OPEH. The findings point to a disconnect between the policies currently governing public service provision and the ethics in which harm reduction is grounded, while speaking to opportunities to challenge these conditions in research and practice contexts.