Of the estimated 58 million Americans over age 65, about three million live in publicly supported, reduced-cost housing. As government-sponsored economic assistance, subsidized housing is intended to make living situations safer, more stable and affordable for people with lower incomes, so that they have less stress and more money for what they need, including health care.

But for many, life-long disadvantages and inequities still take a toll. Evidence from small-scale studies has indicated that older Americans living in subsidized housing are more likely to have chronic medical and psychiatric conditions along with functional and cognitive impairments. They are also more likely to be hospitalized and placed in a nursing home compared to older adults in the general population.

Now, a newly published national study from LDI Senior Fellow Rebecca Brown and colleagues has confirmed these findings and extended what is known about risk factors, disparities, and health care use among this population. Based on a 10-year retrospective analysis of a representative sample of Medicare enrollees participating in the National Health and Aging Trends Study (NHATS), the study compared 295 participants living in subsidized housing to 5,999 participants living in other community settings. Those in subsidized housing:

• Had more health disparities—including more frailty, functional impairment, and dementia.
• Had higher rates of hospitalization and short-term and long-term nursing home placement, particularly related to functional and cognitive impairment.
• Were older and less likely to have completed high school.
• Were more likely to identify as a racial/ethnic minority.
• Were more likely to be socially isolated.

Mitigating Disparities With Housing-Based Interventions

By providing evidence to better understand geriatric conditions and health care use among older adults in subsidized housing, the study’s findings can help inform interventions to improve health outcomes for this population.

In particular, Brown said, they indicate a role for housing-based interventions, which may involve regular visits in the home with a health care provider, such as an occupational therapist, social worker, or registered nurse. 

“Housing-based interventions can be particularly impactful for older adults because they address common barriers to clinic-based interventions, such as transportation, and because they’re delivered where individuals spend a lot of their time,” Brown said, highlighting the well-established link between housing and health. 

Such place-based interventions, she noted, can proactively catch changes in health and functional status while also helping older adults to change their health behaviors through ongoing in-person engagement and environmental support. In doing so, they can help reduce preventable health care use and costs and improve the potential for older adults to continue living in their homes and communities as they age.

Do Housing-Based Interventions Work?

As the population of older Americans continues to grow and more of them qualify for subsidized housing, interest in such interventions is growing. As part of the study, Brown and her research team reviewed the available evidence for these interventions. They found that the most successful ones share several key components: 

• They are individualized to the specific needs of each older adult.
• They deliver services on-site.
• They aim to address environmental factors that influence function and physical activity for older people, as well as individual factors such as health-related behaviors. 

“These components share ‘DNA’ with other evidence-based geriatric models of care that have been shown to improve care and outcomes for older adults,” Brown said. She noted that because delivering individualized programs is inherently resource intensive, targeting programs to older adults with the greatest needs—for example, those with or at risk for functional and cognitive impairment—can help with sustainability.

To further advance understanding of housing-based interventions, Brown and her research team now are developing and testing several aimed at improving functional status among older adults. The goal, she said, is to learn more about “how housing can serve as a platform to improve health for older adults, and how housing programs can be melded with geriatric models of care to improve health outcomes.”

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The study, “Geriatric Conditions and Healthcare Utilization Among Older Adults Living in Subsidized Housing,” was published on June 7, 2024, in the Journal of the American Geriatrics Society. Authors included Sarah E. Kler, L. Grisell Diaz-Ramirez, Kira L. Ryskina, Sun Young Jeon, Kanan Patel, Thomas K. M. Cudjoe, Christine S. Ritchie, Krista L. Harrison, W. John Boscardin, and Rebecca T. Brown.

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