As America’s senior population expands, it should come as no surprise that the average age of households served by the U.S. Department of Housing and Urban Development (HUD) is rising too. Providing housing assistance for low-income seniors is fast becoming a major part of HUD’s mission, the result of powerful demographic trends that are transforming the country.
According to HUD’s Office of Policy Development and Research, the share of HUD-assisted households headed by someone 50 years of age or older has increased from 45 percent in 2004 to 55 percent in 2014. This trend is reflected in all three of HUD’s largest programs: Forty-seven percent of households served by the Housing Choice Voucher program are now headed by seniors or “near seniors,” with even greater shares for public housing (54 percent) and the project-based section 8 program (63.4 percent).
Most HUD-assisted housing was not originally designed for seniors and does not include many of the structural features like no-step entries, accessible switches and outlets, extra-wide hallways and doors, and lever-style door and faucet handles that can enable safe and independent living for the elderly. Not surprisingly, most homes in the United States—not just the assisted stock—also lack many of these same features.
Finding ways to effectively serve an older population in “age-appropriate” housing will be a considerable challenge for HUD in the years ahead. What’s needed are heavy doses of creativity and innovation, as well as a sustained commitment to work with the private sector, the non-profit community, and other government agencies to harness resources so they are used as productively as possible.
One very promising development is HUD’s Seniors and Services Demonstration. This new initiative will test how to enhance the delivery of supportive services such as health care using a home-centered approach. At the site of housing financed through HUD’s section 202 program, the demonstration will provide a full-time coordinator of these enhanced services in addition to a part-time preventive health nurse. On an ongoing basis, this support team will assess the needs of individual residents and connect them with the appropriate service providers.
By more closely linking services with housing, the goal is to enable residents to age in place, delay the need for nursing home care, and reduce avoidable hospitalizations and emergency room visits that can be costly to the health care system.
With the demonstration, HUD hopes to build on the exciting work of Vermont’s Seniors and Services at Home (SASH) program, run by housing provider Cathedral Square in partnership with housing and health care providers, councils on aging, and universities statewide. SASH provides an onsite service coordinator and wellness nurse who links residents with community-based services and facilitates health care coordination. The preliminary findings of a study conducted by the LeadingAge Center for Applied Research and RTI International indicate that the SASH program has significantly slowed the growth of annual total Medicare expenditures for program participants.
In addition to section 202, there are likely opportunities in other HUD programs to test the proposition that service-enriched housing can improve health outcomes for residents and reduce health care costs.
Highlighting the potential for better outcomes and cost savings was a recent study by the Lewin Group examining HUD-assisted individuals in 12 separate geographic locations. The study found that those assisted by HUD were much more likely to be dually enrolled in Medicare and Medicare than non-assisted individuals. The study also found that those assisted by HUD generally had poorer health and incurred higher health care costs than other dually eligible individuals. Developing a more comprehensive understanding of Medicare and Medicaid use by seniors in HUD-assisted housing will be a critical step to serving this population more effectively.
Beyond these concerns is the indisputable fact that the United States simply needs a much greater supply of affordable homes. As documented in the Bipartisan Policy Center Housing Commission report, our country suffers from an acute shortage of such housing, particularly for those families with the lowest incomes.
This lack of supply is a major factor contributing to unsustainable housing-cost burdens for many seniors. HUD recently announced that, in 2013, nearly 1.5 million “very low income” unassisted renter households headed by someone 62 years of age or older had “worst case” housing needs. The overwhelming majority of these senior renters paid in excess of 50 percent of their income just to cover housing costs.
With the over-65 population poised to grow dramatically in the coming years, increasing the supply of affordable homes suitable for seniors—as well as more tightly connecting the delivery of supportive services with housing—must be an urgent focus of national policy. All ideas that sensibly advance these objectives should be put on the table.