Metrics, Morbidity, and Mortality Among the Elderly
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, whether housing affordability is associated with health outcomes is unknown. Several pathways may link housing affordability to health consequences among older adults. First, housing affordability represents a competing demand that may divert resources from one’s health and self-care, eventually resulting in 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 potential 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 longitudinal survey linked to claims data to address these limitations.