Connecting Health and Housing: Lessons from Philadelphia

The Bipartisan Policy Center recently hosted a forum in partnership with the Philadelphia Corporation for Aging (PCA) to explore policy opportunities that would better position communities to support the increasing and diverse health and housing needs of older adults. City and state leaders and practitioners in Pennsylvania have demonstrated their commitment to meeting these growing needs; they are at the forefront nationally in implementing innovative programs and policies that:

• Build needed affordable and physically suitable senior housing;
• Modify homes and communities for age-friendly living; and
• Improve health outcomes through integrated care delivery.

The event included three expert panels on those focus areas, personal testimonials from seniors living in the community, a demographic presentation, and remarks from two co-chairs of the BPC’s Senior Health and Housing Task Force. Here’s some of what we learned.

Place Matters

PCA’s Allen Glicksman, Ph.D., provided a demographic breakdown of health and housing in Philadelphia and the surrounding suburban counties. In 2014, eight percent of Philadelphia residents had incomes at less than 50 percent of the federal poverty level, compared to four percent in the surrounding suburbs.

As such, older adults in the city were more likely to cancel medical appointments because of lack of transportation and cut back on meals and prescriptions due to lack of money. Unsurprisingly, chronic conditions like asthma, diabetes, and hypertension were all more prevalent among residents over the age of 60 in the city than those living in neighboring suburbs. Even higher rates were reported among Philadelphia’s racial and ethnic minority populations, populations that are geographically concentrated within the city.

While Glicksman demonstrated how location relates to health, he also showed that housing conditions are associated with certain health outcomes. For example, of those older adults in the Philadelphia region that reported needing home repairs,

• 32 percent also reported poor health;
• 22 percent reported depressive symptoms in the past week;
• 29 percent had fallen in the past year; and
• 79 percent reported having a chronic condition.

By comparison, older adults that reported not needing home repairs fared better:

• 18 percent reported poor health;
• 10 percent reported depressive symptoms in the past week;
• 20 percent had fallen in the past year; and
• 66 percent reported having a chronic condition.

To sum it up, Glicksman explained, “We have to be thinking about place, about the house, about poverty, and about minority status.”

Stretch Every Dollar

The United States’ senior population is set to grow exponentially, with the number of Americans over 65 expected to increase by 18 million in the next decade. This population faces a number of key challenges explored in a recent BPC report including limited coverage for long-term care, insufficient retirement savings, an inadequate supply of affordable and physically suitable housing, and a high prevalence of chronic disease.

The Philadelphia region reflects this reality and, like many other communities, is feeling the strain from increasing requests for help. This sentiment was particularly emphasized on the panel discussing the construction of affordable and accessible senior housing.

According to John Wagner, deputy secretary and CEO of Catholic Health Care Services, “Money is so scarce, competition is so fierce.” Holly Glauser from the Pennsylvania Housing Finance Agency stressed how every single dollar of funding is prioritized based on affordability, accessibility, and accompanying services when determining project allocations throughout the state.

On the topic of expanding the supply of affordable and suitable senior housing, the panelists noted the importance and potential of:

• Partnerships with nonprofits, hospitals, and the Pennsylvania Department of Human Services, particularly in funding services;
• Cobbling together existing resources to keep people in their homes for as long as reasonable;
• Federal resources like the Low-Income Housing Tax Credit, Section 202 Program, Community Development Block Grant and others; and
• New capital expected from National Housing Trust Fund allocations.

Engage and Educate the Community

Civic engagement and education around aging and related resources, especially in Philadelphia’s underserved communities, were frequent topics throughout the day.

Leaders on aging issues in the city have worked for the past several years toward putting a plan in place to make the city “age-friendly,” an initiative led by AARP, PCA, and others. According to Angela Foreshaw, manager of State Operations and Community Outreach for AARP Pennsylvania, this process notably focused on civic engagement, along with housing and transportation.

Civic engagement is an important consideration when building social capital and a sense of community, creating neighborhoods where all people can be active and connected. According to PCA’s Allen Glicksman, such a focus is needed; Philadelphia’s older residents were less likely than suburban counterparts to report trusting neighbors and having neighbors that are often willing to help them out. They were also less likely to participate in a neighborhood group or activity. While education, cultural awareness, and engagement may not sound like innovative policy solutions, their importance cannot be underestimated. In particular, the panelists recommended:

• Partnerships with clinicians, hospitals, faith leaders and more to provide information and education on home modifications, aging in place, and other seniors’ needs;
• Low-cost measures, such as murals, that engender a sense of community;
• A marketing campaign to raise awareness about home safety for seniors and encourage home safety checks with families and friends;
• Third party validation of home modification providers and contractors; and
• Encouraging other communities to consider what it means to be age-friendly.

Encourage Government Collaboration

Siloed policymaking and program administration is a huge impediment to integrating health and housing, but government officials in Pennsylvania have been actively seeking opportunities to work together.

Jennifer Burnett, deputy secretary of the Pennsylvania Department of Human Services, and Holly Glauser frequently cited examples of their collaboration, both together and with federal officials, to expand the funding for services in low-income housing, facilitate home modifications, and more.

For example, the state is currently considering a proposal to establish a regional broker model for the coordination of home modification services and the Department of Human Services created a government position specifically devoted to housing coordination. The state is also embarking on Medicaid managed long-term services and supports in an effort to further meet the needs of low-income elderly individuals and help them age in place.

This was the Senior Health and Housing Task Force’s second regional forum to hear from local officials and practitioners. And Philadelphia had no shortage of successful examples and case studies for connecting health and housing, from the NewCourtland LIFE program to the home renovations and repairs conducted by Rebuilding Together Philadelphia.

There is a great deal to learn from communities like Philadelphia that are actively advancing policies that integrate health and housing to improve health outcomes for aging adults.