The projected middle-income senior affordable supportive housing crunch

I took advantage of the quieter work environment over the holidays to catch up on my policy reading. The Health Affairs top ten articles from 2019 included “The Forgotten Middle: Many Middle-Income Seniors Will Have Insufficient Resources For Housing And Health Care”. I flagged that one because I am interested in better understanding the intersection between seniors’ health care and social needs. If you are too, read on!

The researchers noted, “to our knowledge, this is the first study to project housing and functional health care needs of seniors by income group. This study creates an opportunity for policy makers to break down silos that heretofore have separately considered housing and healthcare needs.”

The researchers found that the private seniors housing industry has generally focused on higher-income people. They project that by 2029 there will be 14.4 million middle-income seniors, 60 percent of whom will have mobility limitations and 20 percent of whom will have high healthcare and functional needs. While many of these seniors will need the level of care provided in senior housing, The researchers project that 54 percent of seniors will not have sufficient financial resources to pay for it. The researchers go on to say that 'over the past forty years the housing market for seniors (people ages seventy-five and older), particularly assisted living and independent living communities, has experienced tremendous growth and evolution. Seniors housing provides residence and care to about two million older adults, roughly evenly split between independent and assisted living.”

Of course, seniors want to live in the least institutional, most homelike setting possible, with easy access to socialization and personalized care assistance. Indeed, private-paying residents who were previously cared for in nursing homes now often receive services in assisted living.

It is the middle-income seniors who will fall between the cracks as more affluent individuals are catered to by the private sector and low-income individuals can qualify for Medicaid funded long-term care housing and services. Many states offer a wide variety of long-term care options via home and community-based waiver services.

AARP has taken a leadership role on this issue. Their policy paper highlights the need for more affordable supportive housing.

“Between 2004 and 2018, the average cost of care in a private nursing room increased 54 percent and assisted living rose 67 percent. However, the availability of supportive housing options for older adults is insufficient to meet demand, and affordable supportive housing options—that is, those at prices that low-income older adults can afford—are extremely difficult to provide given the lack of availability and substantial funding. Federally subsidized supportive housing programs are funded at levels far below what is needed to meet current and growing needs.”

They go on to define supportive housing as “an umbrella term for residential settings that are designed to provide a range of onsite services while people maintain their own private living space. Housing may be temporary or permanent and can offer a wide variety of resources. Many different types of organizations are involved in supportive housing—from health care agencies to faith-based and community-based volunteer groups. Some older adults remain in their homes and rely on health and social services in the community to meet their needs. For others, supportive housing provides an alternative wherein residents can live in a community with integrated, onsite services. A key characteristic of all supportive housing is that health and other social services are provided in a residential, rather than an institutional, setting.”

Historically religious organizations have played an important role in providing housing to seniors. There is a natural fit for these types of organizations to play this role according to a 2010 poll by the Pew Research Center that found the following:

• 84 percent of those 60-69 consider themselves Christians as do 88 percent age 70 and up.
• 53 percent of those 65 and older attend church services at least weekly compared to 39 percent for the total population.
• 43 percent of those 65 and older read scripture daily; 68 percent pray daily.
• 69 percent of those 65 and older say religion is “very important” compared to 56 percent for the total population.

While private Medicare Advantage plans are starting to offer more services designed to fill in gaps related to social determinants of health, I view the need for senior supportive housing as a public health issue, more effectively addressed by community-based coalitions that can pull together the resources needed to provide best-in-class supportive housing for the seniors of their community.  Within these coalitions, faith-based organizations can be a strong influencer, financier and policy guide.

As more organizations become aware of the burgeoning need, I am hopeful that we will see more community-based organizations take leadership roles. 

Gretchen Mills is manager of market strategy for populations and payment solutions at 3M Health Information Systems.