Senior housing and supportive services
Older Americans 2012: Key Indicators of Well-Being
Written by Alisha Sanders, MPAff, Senior Policy Research Associate, LeadingAge Center for Applied Research.
A significant number of older adults are economically challenged. In 2010, more than a third of all seniors had annual incomes below 200 percent of the national poverty level ($20,916). This number will certainly grow in the near term as many Boomers on the verge of retirement face declining home values, decreased earnings, rising debt, and depleted savings, with little time to recoup their losses. The long term picture is even less encouraging, given the aging of the population. By 2050, the number of individuals 65+ in the U.S. will double, and one out of every four of them will have reached extreme old age (85+).
The need for affordable housing
A growing number of elderly households are burdened by housing costs. Older adults are more likely than their younger counterparts to spend more than 30 percent of their income on their home. Almost half of the poorest seniors (those earning less than 50 percent of the area median income) pay more than half of their income for housing. For every unit of Section 202 housing (a federal-assisted housing program targeted to seniors) that becomes available, ten seniors are waiting. And while federal housing programs are meeting only a fraction of the need, funding for rental subsidies and new housing production is being slashed.
This convergence of trends places an enormous strain on older adults, family caregivers, and the U.S. health and long-term care systems. Research shows correlations among age, race/ethnicity, income, and chronic illnesses and disability, resulting in higher health and long-term care service utilization and costs. While older adults have an overwhelming desire to age in place, low- and modest-income seniors face the dual challenge of finding affordable housing that can also accommodate their changing needs and support their health and quality of life as they grow older.
Affordable housing options − such as Section 202 housing, low-income housing tax credit, or public housing − linked with health and supportive services may provide a cost-effective answer for meeting the needs of lower-income seniors. The strategy has several potential advantages, such as:
- Building on an existing infrastructure of housing and community services networks
- Offering economies of scale in organizing, delivering, and purchasing services, which can increase efficiency and affordability
- Assisting in several health and long-term care policy initiatives, including: reducing Medicare/Medicaid costs associated with unnecessary hospital use, enhancing service integration and care coordination, expanding community-based long-term care options, and improving delivery systems for dual eligibles
- Helping preserve seniors’ autonomy and independence
- Serving as a hub for service delivery and extending into surrounding neighborhoods to help even more seniors
Many proactive housing providers have cobbled together various public and private resources to help support their aging residents. These strategies have developed in an ad hoc manner, as coordination and collaboration is generally limited between the public entities responsible for financing, managing, and regulating housing and health and supportive services.
An important role for grantmakers
Funding in this area has primarily been around construction and rehabilitation of senior housing. Grants have also been made around specific services, such as transportation or nutrition programs. However, greater investment is needed in the following areas:
- Bringing together public officials, housing providers, and service entities.
- Developing more comprehensive and coordinated strategies to link housing settings with services.
- Staffing to provide more service coordinators, wellness nurses/care managers, and other care coordination roles
Grantmakers have been involved in the issue of affordable housing in various ways, typically focusing on supportive services rather than housing construction or rehabilitation of existing housing. One exception is the Harry and Jeanette Weinberg Foundation of Maryland, which provided capital funding for various projects to construct and rehabilitate housing for older adults.
- The SCAN Foundation funded an evaluation of the WellElder program, a program operated by Northern California Presbyterian Homes & Services for the Aging that pairs a service coordinator with a health educator to provide wellness and health education, health monitoring and assistance in identifying and accessing needed health resources.
- The John D. & Catherine T. MacArthur Foundation supported the “How Housing Matters” initiative, which supports research to explore the role housing plays in the long-term health and well-being of individuals and communities, including studying the linkage of affordable senior housing with supportive services.
- The McGregor Foundation funded regional forums to examine the merits, challenges, and opportunities for housing with services strategies. The Foundation also supported the development of a guide on how medical house call programs can work with senior housing properties.
- The Retirement Research Foundation supported case studies that compared the services programs of three affordable housing projects.
- The Jacob & Valeria Langeloth Foundation supported the development and pilot of a caregiver training program for caregivers of residents in affordable senior housing properties.
Source: LeadingAge Center for Applied Research October 2012
- Bringing housing and service providers together
- Integrating care
- Identify funding/financing mechanisms
- Rehabilitate old affordable housing stock
- Develop resident information tracking systems
- Addressing mental health needs
To learn more about these issues, visit Leading Age Center for Applied Research.
Basic References on Affordable Housing and Supportive Services
National Summit on Affordable Senior Housing and Services Report. Report from the American Association of Homes and Services for the Aging of a 2010 conference (supported in part by the McGregor Foundation) that includes summaries of the summit outcomes and background papers on the issues.
Housing as a Platform for Improving Outcomes for Older Renters. Report on senior housing and supportive services issues, published by the Urban Institute.
Supporting Aging In Place in Subsidized Housing: An Evaluation of the WellElder Program. Report from LeadingAge on the evaluation of a program that provides wellness and health services to senior housing residents.
Health-Related Needs Assessment of Older Residents in Subsidized Housing. Report of a study from Portland State University on how new owners of a senior housing project conducted a health and social needs assessment of residents and how such data can be used to enrich services.
Housing an Aging Population – Are We Prepared? Report from the National Housing Conference and the Center for Housing Policy of research on the housing situations and needs of the older population. Includes breakdowns by age categories, since the housing needs of younger older adults differ from those of oldest adults.
- Leading Age Center for Applied Research. LeadingAge’s Center for Applied Research studies the role that housing with services plays in meeting the growing need for health and long-term services and supports among low-income elders. The Center is actively engaged in developing and promoting effective housing with services models and evaluating existing programs to gauge their efficacy, cost-effectiveness and ease of replication.
- AARP Public Policy Institute. AARP’s site contains an extensive publications library on housing and independent living issues.
- Center for Housing Policy. The research affiliate of the National Housing Conference (NHC). Their publications resource center focuses on issues of housing affordability, housing solutions, and sustainable communities.
Resources Available through Grantmakers In Aging
- For All Ages: The GIA Guide to Funding Across the Lifespan (rev. 2012). The GIA toolkit for grantmakers shows how to incorporate aging into existing funding areas, or how to develop new initiatives on aging. Housing issues are explored in the Communities section.
- Home for Life (2006). An Issue Brief from Grantmakers in Aging that focuses on aging in place, livable communities, affordable housing, and supportive services.
- Aging in Place…With a Little Help From Our Friends. An Overview for Grantmakers about Aging in the Community. Grantmakers in Aging, April 2012. A guide for grantmakers on funding projects related to aging in place, housing options, supportive services, and community engagement.
- Strategies to Meet the Housing Needs of Older Adults. AARP Public Policy Institute, March 2010. This report discusses some of the housing challenges facing older adults today and explores strategies that, if pursued, would better enable older adults to age in place or in their community.
Grantmakers interested in starting a program area related to affordable senior housing, or expanding their funding in this area, are invited to contact Grantmakers in Aging at 703-413-0413 or GIA’s Director of Programs and Membership, Maria Gonzales Jackson, and by phone at 703.413.0413 direct or 301.233.2867 cell, for a referral to an expert on affordable senior housing (and on staff at a grantmaking foundation) who is willing to serve as a mentor to other grantmakers.
For more resources, please visit our Resource Center.