Barriers to vision care among older adults experiencing homelessness: a qualitative study.

OBJECTIVE: To characterize self-rated eye health, quality of life, access to care, and lived experiences of older adults experiencing homelessness in the Greater Toronto and Hamilton area. DESIGN: Qualitative framework analysis of semistructured interviews. PARTICIPANTS: Ninety-nine seniors (aged ≥50 years) experiencing homelessness and 2 frontline shelter staff (a registered nurse and case manager) who were recruited from inner-city shelters and transitional housing programs. METHODS: Individual semistructured interviews were conducted on-site between November 2024 and June 2025, alongside clinical surveys and ocular examinations. Field notes and verbatim excerpts were analysed using the framework method, with triangulation of participant and staff perspectives. RESULTS: Mean self-rated quality of life was 5.62 of 10 (SD 2.40) and vision quality was 5.84 of 10 (SD 2.01). Participants described homelessness as compounding physical, emotional, and environmental burdens that eroded eye health: 45.5% had glasses that were lost, stolen, or broken, and unsafe shelter environments contributed to ocular injury. Barriers to eye care existed at the individual level (competing survival priorities, mental health and substance use, older age, language) and system level (being turned away, fragmented referrals, financial cost, transportation). Despite these barriers, participants demonstrated resilience, and supportive caseworker relationships facilitated access. Staff recommended decentralizing care through shelter-embedded, on-site vision services and guaranteed transportation. CONCLUSIONS: Older adults experiencing homelessness face compounding, intersecting barriers to eye care across individual, provider, and system levels. Findings support shifting toward shelter-embedded, integrated models of vision care to improve access for this vulnerable population.