Senior housing providers must realize they aren't just in the housing management business anymore. Publicly subsidized housing communities, whether they are Housing and Urban Development (HUD), Housing Authority, or private cooperatives, are experiencing unprecedented numbers of seniors in need of support services.

BACKGROUND

Nationally, more than 4.3 million seniors are renters. And, 40 percent of all seniors-whether they rent or not-have low enough incomes to qualify for senior subsidized housing.¹ Housing providers are seeing increasing trends over the last several decades: tenants are not only aging in place, but they are moving into housing for the first time at a much older age and with many more needs than ever before. In 2006, the average age of a tenant in HUD supportive housing was 74 years old, and 31 percent of tenants were 80 years old or older. Additionally, 38 percent were disabled enough to be considered at risk for institutionalization, and most did not have spouses or other sources of informal support to prevent institutionalization.²  

For many housing owners and managers, supporting an aging-in-place model has been part of the plan since their buildings were constructed. Most notably, the HUD Section 202 Supportive Housing loan program, enacted in 1959, provided funds to produce housing specifically to support an aging population. Grab bars, handicapped accessible units, emergency response systems, and community and congregate space for dining, activities and wellness programs can be found in Section 202 housing. Some housing providers have implemented support services as their senior populations have become increasingly frail and in need, while others have yet to address the issue in any significant way.

WHY BUILD A NEW MODEL?

So why is it critical that housing providers, no matter what level of support services they currently provide, build a new business model for housing with services? Three primary factors drive the answer.

Demographics are the first, and perhaps most obvious, factor. Almost everyone knows the baby boomer generation will dramatically change the profile of the U.S. population over the next three decades. However, it's less clear to many providers what the actual demand in their primary and secondary market areas will be. What will national migration patterns for minorities and senior populations mean to them? Will there be a rise in a new minority population? Will population shifts among seniors impact growth and strategy?

Without clear answers to these questions, housing managers will be unable to plan and manage for the future. It will be virtually impossible to know what level and type of support services are necessary locally to build a sustainable future in senior housing. Additionally, it will be unclear as to where advocacy efforts should be focused. For whom should you be advocating to secure future public funding for support services?

Medicaid rebalancing. Secondly, housing providers will be affected by the rebalancing efforts of their state's Medicaid long-term care support service dollars. Rebalancing refers to serving a greater number of people with long-term care needs in their homes, or in more home-like settings in their communities, rather than in nursing homes. From 1999 to 2004, the nation made considerable progress in the number of older people and adults with physical disabilities receiving home- and community-based services (43 percent increase) compared to the number served in nursing homes (6 percent increase).³

Rebalancing efforts among states vary widely; however, every state is actively addressing these efforts legislatively and through public and private grant demonstration projects. Housing providers-with a low-income population reliant on public funding for housing and services-must know the specifics of rebalancing efforts in their states to optimize long-term care public support dollars.

Strategic future planning. Lastly, housing providers, regardless of what level of support services they currently offer, are going to be increasingly looked upon by consumers and state and federal policy makers as a cost-effective, desirable solution to the aging population dilemma. Therefore, providers must develop clear, concise, and well-informed strategic plans that allow them to build critical infrastructure and capital without delay.

Housing providers cannot wait for government funding to be adequate or to catch up to the needs of seniors before they develop an updated supportive services model. Housing is only a part of the business now.

References

1. Harvard University: State of the Nation's Housing 2002. Retrieved from www.jchs.harvard.edu/publications/markets/Son2002.pdf on Feb. 23, 2009.
2. U.S. Dept of HUD: Office of Policy Development and Research. Section 202 Supportive Housing for the Elderly: Program Status and Performance Measurement. June 2008.
3. AARP Public Policy Institute. A Balancing Act: State Long Term Care Reform. July 2008.

Lori Barrett is vice president of home- and community-based services for Health Dimensions Group, Minneapolis. She can be reached at lorib@hdgi1.com.