Housing for Older Americans: Trends, Challenges, and Solutions

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Housing for Older Americans Trends, Challenges,
and Solutions

• White House Conference on Aging
• July 20, 2005
• Jon Pynoos, Ph.D. and Christy M. Nishita, Ph.D.
• National Resource Center on Supportive Housing
  and Home Modification
• Fall Prevention Center of Excellence
• Andrus Gerontology Center
• University of Southern California
• Los Angeles, CA 90089-0191
• www.homemods.org

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Why Housing is Important for Older Americans
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Housing Plays an Important Role for Older Adults

• A Costly Basic Necessity
• A Major Asset
• A Key To Aging In Place
• A Cost Saving Alternative To Nursing Homes
• An Important Element In Preventive Health Care

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Critical Housing Problems

• Affordability
• Accessibility and Usability
• Supportiveness

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Sub-Groups Requiring Special Attention

• Minority Groups
• Persons with Low-incomes
• Frail Older Adults
• Women
• Persons Living Alone
• Those Living in Rural Areas

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Affordable Housing
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gt30 Pay Too Much of Income for Housing
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Cost Burden Highest for Low Income
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Most Severe Housing Costs for Women Living Alone
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Government Subsidized Housing
Current Beneficiaries- 1.6 million older persons

• Section 202 Housing
• 350,000 older adults
• 3,500 facilities

• Section 8 rental subsidies
• 500,000 older adults

Other Programs 221d3, Public Housing, Rural
Housing Service programs
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Federally Subsidized Housing in Short Supply

• Only 1/3 of eligible older persons receive
  federal assistance
• Developers of subsidized housing paying off loans
  early and returning to market rents or opting not
  to renew their contracts
• 300,000 units lost between 1997-1999
• Production rate of 5-6,000 units per year of
  Section 202 far below the 20,000 units per year
  in the late 1970s
• In 1999, nine applicants waiting for each Section
  202 unit

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Preserve and Expand Affordable Housing

• Incentives for Developers to Retain Low-Income
  Residents or Transfer Complexes to Non-Profits
• Encourage Public/ Private Partnerships And
  Simplify Complex Financing To Expand Supply
• Create A National Housing Trust Fund To Provide A
  Steady Source Of Revolving Financing

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Reverse Mortgages

• Potential market 3-5 million elderly households
• 560,000 households in 1991 would have been above
  the official poverty threshold if they obtained
  HUDs Home Equity Conversion Mortgage (HECM)
• 119,000 HECMs originated since the program began
• Limitations an option only for homeowners,
  uptake slow, high closing costs

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Accessible and Usable Housing A Key to Aging in
Place
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Unmet Need

• 1.14 Million Elderly Households With At Least One
  Functional Limitation Report Unmet Need For Home
  Modifications

Peter Pan Housing
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Percent of Older Adults Who Prefer to Stay in
their Own Home and Never Move
Source AARP (1996)- Understanding Senior Housing
Into the Next Century. Percent of Respondents Who
Agreed With the Statement Id Like to Stay in
My Home and Never Move.
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3 Major Problem Areas Of The Home

• Outside Steps To The Entrance
• Inside Stairs To A Second Floor
• Unsafe Bathrooms

Source HUD (2001)
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Risk for Falls
Source National Health Interview Survey,
1997-1998 (Kochera, 2002)
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Home Modifications
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Barriers to Obtaining Home Modifications
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Expand Home Modification Programs to Reduce
Health And Long-term Care Costs

• Reconfigure Public/Private Sources
• Medicaid, Medicaid Waivers
• Community Development Block Grants
• Older Americans Act
• Private Pay
• Social Marketing Campaign to Raise Awareness
  Among Builders, Remodelers, Consumers, Health
  Providers, etc.

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Supportive HousingAccessible Settings and
Services
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Source Heumann, Winter-Nelson, Anderson, 2001
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Subsidized Housing A Valuable Resource

• The 20,000 federally assisted housing complexes
  are one of our best resources to meet the needs
  of low-income frail older persons in residential
  settings
• Contain concentrations of Medicaid eligible
  individuals at risk of moving to more expensive
  nursing homes
• Potential cost savings to Medicaid budget

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Improve Supportiveness of Subsidized Housing

• Expand the HUD service coordinator program
• Revise federal guidelines to permit additional
  service space in senior housing
• Greater coordination between HUD and HHS
• Retrofit complexes to better meet the needs of
  frail older persons

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Make Residential Assisted Living an Affordable
Option

• Support Conversion Of Section 202 Housing Into
  Assisted Living
• Allow Housing Sponsors Flexibility In Providing
  An Enhanced Level Of Service Without Costly
  Regulations And Standards
• Simplify Ability To Use SSI, Medicaid, And HUD
  Vouchers

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• Build Housing That
• Maximizes Independence

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Visitability

• A Small Set Of Accessibility Features That Enable
  Persons Of All Ages With Disabilities To Access
  The Main Level Of Single-Family Homes
• Can Benefit Residents, Friends And Relatives

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Key Visitability Features

• Zero Step Entrance To Home
• Wide Interior Doors
• A Wide, Level Route Though The Main Floor Of The
  Home
• Reinforced Bathroom Walls
• Raised Switches And Outlets

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Rise of Visitability Legislation

• As of 2003, at Least 5 States and 10 Cities and
  Counties Have Mandated Legislation
• H.R. 2532 Inclusive Home Design Act of 2003
• Requires visitability features in all
  newly-constructed, federally assisted,
  single-family homes and townhouses

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Universal Design

• Adaptable Housing and Neighborhoods Designed to
  be Useable by All Persons to the Greatest Extent
  Possible
• Different From Visitability Because It Applies To
  Entire Home

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Universal Design Features in Housing

• Wide and Level Entries
• Wide Interior Door Openings
• Lever Door Handles
• Variable Height Counters
• Supportive Bars in Shower and Bathroom
• Bathrooms and Kitchens Large Enough to
  Accommodate Walkers/Wheelchairs
• Stackable Closets for Elevators

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Approaches to Promote Visitability and Universal
Design
Consumer and Builder Tax Incentives
Social Marketing Campaigns
CODE CHANGES
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Create New Models of Housing and Liveable
Communities

• Mixed Use Housing
• Mixed Income Developments
• Intergenerational
• Second Units
• Co-location Of Programs And Services

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NORCs- Naturally Occurring Retirement Communities

• 27 of older people live in a building or
  neighborhood where more than 50 of the residents
  are over 60
• Economies of scale in the delivery of services

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Vision for the Future
Affordable
Accessible
Supportive
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Housing is a Cross-Cutting Issue

• Planning Along the Lifespan
• The Workplace of the Future
• Our Community
• Health and Long Term Living
• Social Engagement
• Marketplace

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Housing Strategies

• Preserve and Expand Affordable Housing Supply
• Reduce Health And LTC Costs Through Programs That
  Promote HMs
• Improve Supportiveness of Subsidized Housing
• Make Assisted Living an Affordable Option
• Develop Liveable Communities by Adopting
  Principles of Visitability and Universal Design
• Create New Models of Housing and Communities That
  Maximize Independence and Provide Choice

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We shape our dwellings And later our
dwellings shape us. Winston Churchill