Ideas. Action. Results.

Allyson Schwartz and Anand Parekh: Integrating Health Care and Housing to Promote Healthy Aging

Health Affairs

Monday, May 23, 2016

One of the most important public health findings over the last several decades has been that there are a number of factors, beyond medical care, which influence health status and contribute to premature mortality. Of these factors, social circumstances and the physical environment (particularly the home) especially impact an individual’s health.

Housing takes on even greater importance for older Americans since they spend a significant portion of their day in this setting. Ensuring a safe, age-friendly home and utilizing the home as a potential site of care for seniors should be seen as important policy objectives to support care management.

By 2030, 74 million Americans, representing more than 20 percent of the overall population, will be 65 years of age or more. Absent a comprehensive and sustained national response, the well-being and safety of millions of older Americans will be jeopardized by the following realities: increased demand for expensive long-term services and supports (LTSS), a high prevalence of chronic disease, grossly inadequate retirement savings, and a severe undersupply of affordable and suitable senior housing.

One set of possible solutions to these challenges requires greater integration of America’s health care and housing systems. A growing body of evidence is showing that more tightly linking health care with the home setting can reduce the costs borne by the health care system.

As an example, Vermont’s Senior Services at Home program, run by housing provider Cathedral Square, is demonstrating how housing—when combined with supportive services for seniors—can slow the rate of growth of Medicare spending. In addition, a recent study by the Center for Outcomes Research and Education in partnership with Enterprise Community Partners, Inc., found that Medicaid-covered residents who moved into affordable housing properties used more primary care, had fewer emergency department visits, and accumulated lower medical expenditures. Cost savings were highest for seniors and individuals living with disabilities.

Following are a set of opportunities to accelerate the integration between health care and housing for our nation’s seniors. These opportunities go beyond traditional Medicare’s home health care coverage and Medicaid’s coverage of nursing home care. Each involves key actors in the nation’s health care system: public and private insurers, health care professionals, and hospitals. (More detail on each of these recommendations can be found in a report released today from the Bipartisan Policy Center’s Senior Health and Housing Task Force.)