Housing Affordability and Health Outcomes: a Longitudinal Study of Community Dwelling Older Adults in the U.S. from 2006-2016
Abstract: As U.S. healthcare shifts toward value-based payment, health systems and policy makers are starting to consider housing affordability as an important social determinant of health. However, little is known about the association of housing affordability with health outcomes among older adults. Several pathways may link housing affordability to health consequences among older people. First, housing affordability may act as a competing demand that diverts resources from one’s health and self-care, leading to higher healthcare utilization. Second, although housing assistance is not typically linked to healthcare delivery, one exception is care in nursing homes for adults with custodial care needs, where long-term housing is subsidized in part by Medicaid. This represents another pathway through which older adults with high housing cost burden may be at increased risk for nursing home admission and for hospitalizations that typically precede nursing home admission. Our specific aims are to (1) examine trends in housing affordability among older adults from 2006-2016 and to compare these trends among key subgroups; and (2) measure the association between housing affordability and hospital and nursing home utilization. We hypothesize that low housing affordability is associated with more hospitalizations and nursing home stays in older adults. In preliminary work, we found that higher rents are associated with longer nursing home stays. However, that study did not include at-risk patients in the community nor account for income, assets, or neighborhood housing affordability. We propose to use longitudinal data from the Health and Retirement Study linked to claims data to address these limitations.