Ideas. Action. Results.

Middle-Income Seniors Face Obstacles to Healthy Aging at Home

By Andy Winkler

Wednesday, June 8, 2016

The Bipartisan Policy Center’s Senior Health and Housing Task Force recently released its recommendations to promote healthy aging among America’s rapidly expanding senior population. Given the many constraints on the federal budget and projected growth in the national debt, the task force worked from the premise that any additional federal spending proposed should primarily help the most vulnerable—namely low-income older Americans. Yet, as discussed in our report, policymakers clearly have a role to play helping middle-income older adults age with options in their homes and communities.

Older adults around the country face a number of distinct challenges. In particular, the personal savings and home equity needed to support aging in place and to pay for health care, long-term services and supports, and other needs will fall woefully short for millions of seniors. According to Urban Institute projections for BPC’s Commission on Retirement Security and Personal Savings, even individuals in the 75th percentile of retirement assets, with around $130,000 in retirement savings, will have difficulty financing a decades-long retirement.


The collapse of the housing market and subsequent recession wreaked havoc on the savings, home equity, and financial security of many Americans. Households and communities have not uniformly recovered, leaving even middle-income Americans around the country still struggling. One trend to emerge from the crisis is the increasing share of older homeowners carrying mortgage debt, and more of it, later in life. This will likely have an adverse impact on households with fixed incomes and restrain the ability of seniors to finance retirement and age with options in their communities. Additionally, the current homeownership rate for “near seniors”—those between the ages of 55 and 64—is 75.7 percent, about six percentage points below the rate of a decade ago. A growing number of older adults are renting and a growing number face housing cost-burdens (paying more than 30 percent of income on housing).

These stark realities define the challenge for middle-income seniors. Our report focuses on four specific policy opportunities: 1) building more affordable and suitable housing for older adults; 2) making homes and communities friendly for all ages; 3) better integrating health care and supportive services with housing; and 4) deploying technologies more widely to help all Americans age safely and comfortably. While the report’s recommendations are relatively modest in scope, we are convinced their adoption would have a materially beneficial impact on the growing number of middle-income seniors.

To boost the supply of affordable housing options, we call upon states and cities to adopt permissive  land-use policies that encourage alternative housing structures for seniors, such as accessory dwelling units or ADUs. An ADU, typically located within or attached to a primary dwelling, can be a great affordable housing option for a middle-income senior wishing to remain close to her family and friends. Many communities that are experimenting with more permissive land-use policies are demonstrating they can be a win-win for everyone—preserving the integrity of neighborhoods while expanding affordable housing options.

In our chapter on homes and communities, our proposals to establish a Modification Assistance Initiative at the Department of Health and Human Services, maintain protections and counseling services for the Federal Housing Administration’s Home Equity Conversion Mortgage program, develop a model senior zoning ordinance, and create a suitability-rating scale for age-friendly housing and communities that can help older adults at all income levels. We also recommend that Congress reauthorize and fund the Community Innovations for Aging in Place initiative to assess promising community living models such as the Village-to-Village Network and Naturally Occurring Retirement Communities. In scaling these models and identifying other innovative solutions, we can provide middle-class communities with access to and coordinated delivery of community-based health and social services. These efforts will enhance the ability of communities to support optimal health and wellbeing for seniors.

Communities with more permissive land-use policies are demonstrating they can be a win-win for everyone—preserving the integrity of neighborhoods while expanding affordable housing options.

In our health care chapter, we recommend expanding the Independence at Home Demonstration into a permanent, nationwide program to help frail, medically complex Medicare beneficiaries. We also call on hospitals to incorporate questions about housing issues as part of their discharge planning to prevent hospital readmissions. Our proposal for the Centers for Medicare & Medicaid Services and the states to provide greater reimbursement of telehealth and other technologies can also bring convenience and cost-saving solutions to the care of older adults, regardless of their income level.

The central aim of the Senior Health and Housing Task Force has been to develop an actionable policy agenda that more closely links health care with housing to foster improved health outcomes, cost savings, and enhanced quality of life for America’s aging population. Yet our aging population presents challenges that go far beyond the scope of a single report. In recognition of this, BPC is working on a number of senior-focused projects through our Senior Health and Housing Task Force, Long-Term Care Initiative, and Commission on Retirement Security and Personal Savings, which is releasing a major report later this week. Together, these initiatives are developing a range of policy options for improving the financial security, health, and well-being of middle-income Americans as they age.