Elderly housing: the best is yet to be?
Using illustration-by-example, today’s New York Times (subscription required) focuses on assisted living, a fast-growing tenure option that is also a challenge for housing policy:
In the last decade the number of elderly Americans in assisted living has tripled, to nearly one million, and industry experts say the residents, overwhelmingly widowed women with an average age of 85, have steadily grown older and frailer. A study by the National Center for Assisted Living, an industry group, shows that half the residents have some degree of cognitive impairment, three-quarters need help bathing, 8 in 10 cannot administer their own medication and more than 90 percent can no longer cook or do housework.
Assisted living is part of the wellness continuum that includes elderly-only apartment properties:
and nursing homes:
Although these properties are often hard to rent up — until they have established their internal community — once they are fully occupied, residents stay as long as they can. What makes them leave? Not age, but money:
Residents who leave assisted living usually do so not because they die but because they run out of money, and go to nursing homes. There the impoverished, including middle-class men and women who have outlived their savings, are covered by Medicaid as they are not (except for a small percentage) in assisted living.
While some properties are born as assisted living or congregate housing, other properties evolve into it, such as those the Federal government has sponsored as elderly affordable housing in many forms, including:
-
Public housing specifically for the elderly: 3,400 properties, 540,000 apartments.
-
Pure non-profit with grant-type capital funding under Section 202, with more than 5,000 properties nationwide totaling over 300,000 apartments like this one, in Brooklyn, New York:
-
And public-private partnerships under Section 8 new construction, with more than 3,000 properties and 325,000 apartments. These properties are in every state, every county
As the property ages in place, so too do the residents, from a minimum 62 at move-in to an average today of 78. Not only are these residents old, and largely widowed women, they are also poor:
The typical resident is a single woman in her mid-70s with an annual income of less than $10,000.
The buildings that are now their cherished homes were built as apartments, not health centers, so that by degrees they have to add services. Here lies the paradox: Section 8 will not cover health-care charges, and Medicaid will not pay rent, except under waiver:
Most states in the last few years have begun small, experimental programs that permit Medicaid to pay a portion of the cost of assisted living: the personal care and medical services that are tacked on to the monthly charge, but not the rent itself. Nationwide, according to a 2002 study by the National Academy for State Health Policy, 102,000 assisted living residents, or 11 percent of the total, received this benefit, double the number in 2000.
But if 11% were aided, 89% were not … and Medicaid Section 1115 waivers are hard to come by. So those mission owners with elderly properties, often faith-based non-profits, find themselves increasingly in the health-care business — for which they are not compensated. As the blue-ribbon Seniors Commission put it in 2002:
The Commission’s key findings on the challenges to addressing the growing affordable housing and health services crisis are:
- One-third of senior households are expected to have housing needs;
- Almost one-fifth of seniors will likely have service needs, and existing programs are not well structured to meet those needs;
- Current production of affordable housing does not begin to meet demand;
- Subsidized rental units are being lost due to expiring Section 8 project-based rental assistance contracts and mortgage prepayments; and
- Federal housing and health policies are not synchronized, often leading to premature institutionalization as a more costly, yet practical option.
The Commission rightly called for convergence of seniors’ housing and health care needs. Yet today, nearly three years later, we see no movement.
The Victorian Romantic Robert Browning dreamed, “the best is yet to be.” If it is to be, then we must also follow Browning’s advice:
The critical ingredient is getting off your butt and doing something. It’s as simple as that. A lot of people have ideas, but there are few who decide to do something about them now. Not tomorrow. Not next week. But today. The true entrepreneur is a doer, not a dreamer.
