Context: Older people experiencing homelessness and substance use challenges, represent a growing population in addiction services. Harm reduction (HR) housing targeting the complex medical needs of these seniors is poorly understood. Objective: To inform service planning, this study assessed self-reported quality of life (QoL) and care needs of older people living in permanent HR accommodation in an urban setting. Design: Quantitative survey, participatory action research. Setting: 68-bed supportive living facility providing personal and health supports for men and women aged 55+, with ongoing substance use challenges. Residents worked with researchers to develop a survey tool. The final tool consisted of 68 items including validated tools exploring self-reported health status, QoL, service use, substance use, demographics and housing history. All residents were eligible to participate. To support residents’ participation, residents completed the survey with the help of one of the research team. Descriptive statistics are presented. Results: Thirty-four participants (50% of residents) participated at baseline; mean age 66 years, (75% male). Participants reported mobility issues (65%); moderate-extreme pain (62%); moderate-extreme depression or anxiety (47%). Despite good access to mental health care, only 24% indicated receiving mental health care in the past 6 months; 82% of participants smoked, 35% had problematic alcohol use and 15% used drugs other than alcohol. Only 41% were satisfied with how they spent their time and 50% experienced loneliness several times a month or more. Baseline findings have informed intervention co-design. Midpoint data collection has just been completed, 12-18 months from baseline. Discussion: Despite active managed alcohol and tobacco programs, residents experienced a range of physical and mental needs at baseline, similar to those of many older people. Efforts are underway to ensure HR for older people integrates care for addiction with good clinical care, with particular attention to mobility, mental health, pain management and social activities. Preliminary conclusion: Engaging older adults in the design of health and social services through purposeful needs assessment can help improve the “fit” of services to needs and preferences, with an aim to improve quality of life.