With seniors and disabled people increasingly relying on rental assistance, integrated care programs need to be prioritized.
Housing assistance programs in the United States are falling far short of meeting a growing demand for aid in the years following the recession. My colleague Kriston Capps previously covered a report from the Center on Budget and Policy Priorities that found that federal rental assistance for families with children is at its lowest point in a decade, even as the number of very low-income families with children has increased by 53 percent in the same time frame.
Rental assistance, broadly, takes on two different forms: families either rent a below-market-rate property reserved for low-income tenants (project-based assistance), or receive a voucher to use for a particular unit within a designated cost bracket (tenant-based assistance).
A new report from the Public and Affordable Housing Research Corporation (PAHRC) documents the same slide in rental assistance for families with children, but also points to two groups who have seen an increase in rental assistance since 2005: seniors and people with disabilities. The group at the intersection of those two demographics is likely driving the increase, says Keely Stater, the research and industry intelligence manager for PAHRC. Seniors and people with disabilities share many of the same non-housing needs; access to healthcare is perhaps the most crucial. The PAHRC report suggests that subsidized housing could be more effectively tailored to serve as the basis for such necessary services to meet both groups’ needs.
Among the elderly and disabled, reliance on rental assistance will likely continue to increase, the report suggests. Since 2005, the number of disabled individuals receiving aid has increased by 56.6 percent. The share of seniors receiving rental assistance has risen by 7.8 percent. Meanwhile, the number of assisted households with children has dropped by 14.3 percent (click through the maps from PAHRC below). That the divergent trends hinge around age mirrors national population trends, Stater says. American families are having fewer children, and according to an estimate from Harvard University, with Baby Boomers growing older, one in five people will be at least age 65 by 2030. The PAHRC report notes that seniors also remain on assistance programs for longer periods of time—an average of 12 years, as opposed to seven for non-seniors.
Seniors on rental aid face higher rates of health concerns—including cancer, hypertension, diabetes, and heart conditions—than their low-income peers not receiving assistance; among non-seniors, disabilities are more prevalent among people receiving assistance than those who are not. The PAHRC report points to several solutions that could bolster the health and experience of those already receiving rental assistance, and potentially reduce other costs incurred through Medicare and Medicaid programs, Stater says.
Often, lacking access to other services, low-income people will seek out costly emergency room care for chronic conditions. A report from the Center for Outcomes Research and Education (CORE) on the impact of integrating health services with affordable housing notes that “concerns about keeping up with doctor appointments and medications are far outweighed by trying to pay their rent on time or finding safe and stable housing.”
In the forward to the CORE report, Megan T. Sandel, an associate professor of pediatrics at Boston University, argued that affordable housing programs could act as a convener for less expensive and more sustainable health services for those in need. Sandel wrote that, previously, the connection between housing and healthcare had largely been theoretical; data in the report provide the necessary statistical backbone to prove the relationship. In studying rental-assisted residents in Portland, the report showed that the presence of integrated healthcare services within a housing complex led to a 30 percent reduction in emergency room visits and a 60 percent increase in primary care visits for clients living on those properties.
The shape of these service integrations differs greatly across housing sites, Stater says. In some cases, Stater says, the U.S. Department of Housing and Urban Development (HUD) provides an on-site service coordinator who connects public housing residents with local healthcare systems and resources. In other cases, private housing providers might partner with a local nonprofit, school, or hospital to bring services onto properties. The School of Nursing and Pharmacy at Virginia Commonwealth University, for example, runs a weekly clinic at Dominion Place, a subsidized senior-living facility in Richmond.
Beyond the concrete programs taking shape across the country, rental assistance aids the health of its beneficiaries through the reduction of stress linked with trying to secure stable housing. Research shows that social factors, such as dwelling or neighborhood, contribute to 40 percent of an individual’s overall health outcome; for seniors and people with disabilities, who are often unable to work and consequently cut off from a recourse to alter those circumstances, the impact is even greater, the PARCH report notes.
The success of these growing partnerships across the U.S., Stater hopes, will incentivize Congress to consider the impact of housing policies going forward. “Housing really should be the number-one priority,” Stater says. “And if a service like healthcare is attached to housing, it’s going to be that much more effective.”