Sometimes, you just have to say what is crashingly obvious. And when it comes to older adults aging at home, here it is: If seniors are going to avoid a nursing home, they need a safe, affordable alternative. Without one, they may die prematurely. And even if they live, they will almost surely need institutional care, which may be a bad alternative for them and, if they are poor, will cost the government a small fortune. In short, you can’t age in place without a “place.”
In a new report released this week, called Healthy Aging Begins at Home, the Bipartisan Policy Center made 30 recommendations for how government can improve access to quality housing for seniors. They include enhanced housing subsidy programs for low-income seniors, modest steps aimed at integrating housing with health care and supportive services, and encouraging greater use of technology to improve care at home.
BPC is a Washington-based organization that brings together former top policymakers of both parties to develop consensus reports on a wide-range of issues. For this one, BPC’s task force was made up of two former secretaries of Housing and Urban Development, Democrat Henry Cisneros and Republican Mel Martinez, and two former members of Congress, Republican Vin Weber and Democrat Allyson Schwartz.
The BPC recommendations are important, though modest. Appropriately, they are mostly aimed at increasing the number of subsidized rental units for low-income seniors. BPC estimates that there are about 11.2 million “extremely low-income” households in the U.S., including 2.6 million with older adults, competing for just 4.3 million affordable rental units. On average, these households have total annual incomes of less than $18,000.Without either direct financial support or government subsidies to developers, it simply is not possible for them to find a place to live.
And it isn’t just about money. Less than 4 percent of housing units are physically accessible to people with moderate mobility limitations, BPC estimates.
BPC also suggested making some fairly modest ways to combine housing with services such as care management, and even health care. In the end, fully integrating such care for low-income seniors probably requires a broad rethinking of Medicare, Medicaid, and government housing programs in a way that dramatically increases the flexibility of these programs. BPC didn’t go that far, but it did endorse some limited experiments as well as expanding a program called Independence at Home which provides primary care to people with chronic disease living in their own homes.
It also urged local governments to provide greater regulatory flexibility for non-traditional community housing alternatives. For instance, older adults increasingly are experimenting with shared housing in informal group homes. But in many cities, it is illegal for more than four or five unrelated adults to live in a single home.
The recommendations failed to address some other critical issues, many involving seniors who are not poor enough to benefit from government housing programs. For instance, care for middle-income seniors living in suburban neighborhoods is a serious but rarely discussed challenge. Delivering services to a population that is spread widely through a suburban county is difficult, time-consuming, and costly. Those single-family homes can be hard to keep up, and unsafe for a frail elder. Public transportation is often inaccessible. And it can be lonely living in suburban cul-de-sac when your young-family neighbors are off at work or school all day. Aging in place isn’t always the right answer.
Perversely, the property tax rebates that many local governments offer to seniors may encourage them to remain in those suburban homes, rather than move to downsized and more accessible (but unsubsidized) rental apartments. The BPC report praises these property tax breaks for making it possible for older adults to remain in their own communities. But there is a downside to those subsidies. More about all this in a future blog post.
The BPC report avoided some of the most contentious issues, such as how much flexibility states should have in mixing-and-matching federal funding for senior programs. It missed some important issues in its relentless focus on seniors remaining in their own homes, even if they may not be the best option. But overall, the BPC report shines a light on the challenges of housing for older adults—a problem that is so obvious that it is often hidden in plain sight.