Housing, Homelessness, and Health: A Path Forward for Older Adults

The rise in housing insecurity and homelessness among older adults across the U.S. is creating critical challenges for health and social systems. As the U.S. aging population grows, the lack of affordable and accessible housing for older adults is becoming an increasingly urgent issue that can have serious implications for their health and ability to maintain stable housing.ⁱ  

Many older adults live on fixed or declining incomes, which can make it difficult to manage high housing costs. A report by the Joint Center for Housing Studies of Harvard University found that nearly 11.2 million older adults spend more than 30% of their income on housing costs, which is a significant increase from the 9.7 million people in 2016.ⁱⁱ And while many older adults would like to live in their homes as long as possible, only 10% of U.S. homes can accommodate older populations, indicating that there will be a greater need for homes with accessible features in the near future.^iii,iv  

The increasing rate of homelessness is an emerging trend among older adults. People aged 50 and older are one of the fastest-growing segments of the population who are experiencing homelessness, and these numbers are expected to triple by 2030.^v Because being unhoused can create challenges for managing healthcare needs effectively, homelessness can exacerbate health issues. Older adults experiencing homelessness often suffer from geriatric and medical conditions that lead to cognitive decline and reduced functional abilities typically associated with people who are 20 years older.^vi  Additionally, people who become newly homeless after age 50 are dying at a faster rate than the under-50 unhoused population.^vii 

Government programs such as the U.S. Department of Housing and Urban Development (HUD) Older Adults Home Modification Grant Program, the Section 202 Supportive Housing for Elderly Program, and Housing Choice Voucher Program aim to provide housing assistance to older adults. However, demand for these services often exceeds supply, leading to long waitlists.^viii This presents states and policymakers with an opportunity to explore additional pathways to support older adults’ housing needs.  

Addressing Housing and Homelessness Through Multisector Plans for Aging  

To meet these challenges, states are adopting innovative ways to address the unique housing needs of older adults, focusing on affordability, accessibility, and the desire to remain in their current community. One promising pathway that states are pursuing is the use of multisector plans for aging (MPAs) to create cross-agency partnerships between aging, housing, and health for older adults. MPAs help create age-friendly communities where housing stability can be a foundation to support broader healthcare needs.

Some strategies that states are considering within their MPAs include expanding available housing options, addressing affordability issues, expanding access and supports through Section 1115 waivers from the U.S. Department of Health and Human Services, or reviewing zoning policies to address availability of different types of housing. States such as California, North Carolina, Maryland, Missouri, and Pennsylvania are implementing or exploring policies that can help older adults maintain their independence through affordable housing, integrated care, and community-based services. By coordinating programs and initiatives across agencies and sectors, MPAs can begin to address the unique housing and care needs of older adults, preventing unnecessary hospitalizations and promoting healthier aging. 

Using Section 1115 Waivers 

Some states are using Section 1115 waivers to explore the potential for Medicaid to cover rent and temporary housing for specific populations. In 2022, the Centers for Medicare and Medicaid Services (CMS) launched a demonstration opportunity for states interested in pursuing initiatives to address health-related social needs.^ix Several states include housing support through Medicaid. Under their Section 1115 waivers, Arizona and Oregon now provide Medicaid coverage for housing supports such as rent and temporary housing for up to six months post-transition from certain settings.^x 

Conclusion  

MPAs provide a promising model to address these complex, interrelated needs, combining healthcare and housing services to improve outcomes for older adults. By investing in these cross-sector approaches and scaling successful models nationally, policymakers can help create a sustainable path forward for older adults facing housing insecurity. This integrated approach not only supports healthier aging but also reduces the long-term healthcare costs by addressing the root causes of instability, ensuring that older adults can age with dignity and housing stability.