Design of a Demonstration of Coordinated Housing, Health and Long-Term Care Services and Supports for Low-Income Older Adults. III. Definition of the Policy Problem

05/11/2011

A large and rapidly expanding pool of low and modest-income seniors face the dual challenges of finding affordable and safe housing that can also accommodate changing needs as they grow older. Millions of older adults who rent or own their own homes face excessive housing costs and/or live in housing with serious physical problems. Data2 from the 2009 American Housing Survey (AHS) show that about 1.8 million very low-income older adults (incomes of 50% or less of the area median income) pay more than half their income for rent and/or live in substandard housing. Another 1.3 million elderly renters live in publicly subsidized housing. As they age, an increasing proportion of these seniors experience chronic health problems and/or disabling physical, cognitive and mental health conditions (Vladeck,Segel, Oberlink, Gursen & Rudin, 2010).

The current system of multiple payers--primarily Medicare and Medicaid provide few incentives for primary, acute and chronic care providers to collaborate with each other, let alone cooperate with low-income housing or aging and long-term care services providers. As a result, when many older adults most need integrated services; they experience a highly fragmented and poorly coordinated services system with often devastating consequences. The ability of older adults with chronic conditions and/or significant disability to continue living independently may be cut short, their health and safety compromised, and public and private health and long-term care costs may skyrocket as a result of premature transfers to more expensive nursing homes and residential care facilities, repeated trips by emergency medical technicians to an individual’s home, repeated trips to hospital emergency rooms (ERs), and frequent hospitalizations.

The aging of the baby boomers will increase the already high demand for affordable housing that incorporates health and long-term care supports. A potential policy approach to helping meet this demand involves capitalizing on independent, publicly assisted rental housing, largely unlicensed, multi-unit apartment buildings exclusively designated for seniors, or rental properties where large numbers of seniors now live. Such housing could act as a platform for purposefully organizing a system of coordinated health and long-term care services and supports for residents as well as similar poor and modest-income seniors in the surrounding community. Innovative housing providers across the country working with community agencies have, at their own initiative, developed many prototypes of affordable housing with services strategies to assist residents as they age. While significant research has been conducted on the benefits of supportive housing environments for vulnerable, low-income populations such as the homeless, limited research has focused on the outcomes associated with subsidized senior housing linked to services. The evidence base that has accumulated remains equivocal (Rabins, Black, Roca, et al., 2000; Ficke & Berkowitz, 1999; Harahan, Sanders & Stone 2006a; Castle, 2008; Golant, Parsons & Boling, 2010).

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