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America’s Growing Senior Population: Assessing the Dimensions of the Demographic Challenge

With the 78 million baby boomers either entering or approaching retirement, the United States is on the cusp of a major and unprecedented expansion of its senior population. While this new demographic reality will challenge our nation’s health care and housing systems, it offers significant opportunities as well.

A strategic approach that seeks to capture these opportunities begins with bridging the gap between housing and health care. Rather than operating in isolation, those working in each field must move out of their separate policy silos and identify ways for greater collaboration. This collaboration must become the norm rather than the exception it is today.

The upside of a more coordinated approach is significant: by more tightly linking health care and housing, the United States has the potential to improve health outcomes for seniors, reduce the costs incurred by the health care system, enable millions of seniors to “age in place” in their own homes and communities, and enhance the quality of life for all Americans who will benefit from a healthier and more engaged senior population. Making these connections is all the more important as federal government spending on Medicare, Medicaid, and other health programs is projected to grow much faster than the overall economy over the next 25 years.

Fortunately, there are numerous examples throughout the country where housing and health care are being successfully integrated. Stewards of Affordable Housing for the Future, a network of 11 nonprofit organizations that support and provide affordable rental housing for low-income seniors, has done pioneering work showing how housing providers can work more effectively with the health care system, including with accountable care organizations and managed care entities. Vermont’s Senior and 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. Multistate housing providers like National Church Residences and Mercy Housing are proving that housing can be an essential platform for the delivery of health care and other services.

Medicaid Home and Community-Based Services waivers also provide opportunities for low-income seniors to receive critical services in their own homes and communities that allow them to remain there rather than move to more expensive institutional settings. Some states are successfully using Medicaid funds to provide housing-related services to enable individuals to transition out of more costly nursing homes and into community living.

Health care and social-services providers, employers, and insurers are demonstrating leadership as well, testing a variety of innovations, including telemedicine, home visits by care transitions coaches, and investments in equipment and home modifications that are not typically covered by health insurance.

At the same time, millions of seniors are successfully aging in place and understand all too well that their health and well-being depend on having a home that is affordable and safe.

These are all positive developments. But with millions of Americans about to enter the senior ranks, the current window of opportunity is small and narrowing. Strengthening the collaborative bonds between health and housing must become an urgent national priority as we prepare for the demographic changes ahead.

The Bipartisan Policy Center (BPC) is committed to assisting in this effort. Earlier this year, BPC formed the Health and Housing Task Force to underscore the connection between the health care and housing fields. The task force grows out of the BPC Housing Commission that identified accommodating the desire of seniors to age in place as one of the major public-policy challenges in the coming decades.

In April 2014, BPC also launched the Long-Term Care Initiative to develop policy recommendations to improve financing mechanisms and delivery of long-term services and supports, including better integration across the Medicaid and Medicare programs. In May 2015, BPC?s Prevention Task Force released policy recommendations focusing on opportunities to better integrate non-clinical health and social-service interventions with the delivery system as a means to help prevent costly and debilitating consequences of chronic disease.

Building upon past and ongoing BPC projects, the task force will focus its work in the following areas:

  • Identifying cost-effective ways to modify U.S. homes and communities to make independent living for seniors safe and viable.
  • Increasing the supply of affordable housing for seniors, particularly housing with supportive services.
  • Identifying barriers to the integration of acute care and home- and community-based services in the Medicare and Medicaid programs and exploring how to scale up successful models of care so that seniors can remain at home or in the community.
  • Highlighting best practices for integrating housing and health drawn from a range of politically diverse states and localities.
  • Identifying opportunities for further programmatic collaboration between the U.S. Department of Housing and Urban Development and U.S. Department of Health and Human Services to improve outcomes and promote greater efficiencies.

Fulfilling these objectives first requires an understanding of the dimensions of the demographic challenge the nation faces. The following pages attempt to provide some of this context.

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