Commentary: Linking housing, health care for aging seniors

By Allyson Y. Schwartz

and Anand Parekh

Over the next 15 years, our nation's senior population will nearly double, approaching 73 million by 2030 and accounting for more than one in five Americans.

Philadelphia and Pennsylvania stand at the forefront of this dramatic demographic transformation. Philadelphia already has the highest proportion of senior citizens among the nation's 10 largest cities, a position it is unlikely to cede anytime soon. At the same time, the number of older adults in Pennsylvania now exceeds 2.1 million, the fifth-highest of any state in the country.

Our rapidly aging society requires us to more effectively integrate our housing and health-care systems to enable America's seniors to live healthy, independent lives for as long as possible in the communities they know.

A growing body of research shows our homes and communities have the potential to be powerful platforms for the delivery of health care and other supportive services that can improve the health of older adults and reduce medical costs.

Identifying how best to capture these opportunities is the goal of the Bipartisan Policy Center's Senior Health and Housing Task Force.

Earlier this year, we released a number of recommendations in our report, "Healthy Aging Begins at Home" (http://bit.ly/1sOdOAE) and hosted a public forum with the Philadelphia Corporation for Aging to discuss these critical issues.

As in any endeavor, it is important to set priorities. For us, priority number one must be increasing the supply of homes that are both affordable and suitable for the most vulnerable, lowest-income seniors.

High housing costs already eat into the household budgets of many older Americans, forcing some to spend less on other necessities like food and medicines. Rising demand for affordable homes without a substantial increase in supply will exacerbate these cost pressures. Those seniors who lack access to affordable housing and supportive services may find that care in a nursing home or other institutional setting is their only option.

The situation is urgent here in Philadelphia, where older residents experience poverty at almost twice the rate of senior citizens elsewhere in the nation.

Of course, many older Philadelphians own their homes and wish to live in them as long as possible to remain close to family and friends. This, too, can present challenges because most homes lack the full array of structural features like no-step entry, single-floor living, and extra-wide halls and doorways that enhance the capacity for safe, independent living.

This concern is not theoretical: Falls are the leading cause of injury and injury-related deaths for those 65 and over, accounting for more than $31 billion in Medicare costs in 2015. Yet, for many seniors, making significant structural modifications to their homes to enhance safety is either impractical or cost prohibitive.

Complicating the desire to "age in place" is the help many seniors will eventually require with activities like bathing, dressing, and medication management. For most of us, these "long-term services and supports" will be provided at home by family or friends or financed through private savings since Medicare does not provide coverage. In the absence of private insurance, receiving this type of care can be very expensive and consume large portions of a family's financial resources.

Beyond the home, many neighborhoods lack the infrastructure that can support successful aging. This includes access to transportation, pedestrian-friendly street lighting, healthy food markets, and safe, accessible public parks and recreation facilities. The demand for community-based services will also grow as more chronically ill beneficiaries age into Medicare or become dually eligible for the Medicare and Medicaid programs.

These services can play a critical role in providing an environment that is safer and more secure for seniors. There is also increasing recognition that these services and supports are critical to improving the management of chronic diseases, slowing disease progression, and improving health status.

While these problems are complex, solutions are possible. Here in Philadelphia, numerous private and nonprofit organizations are working diligently to improve living conditions for the city's burgeoning senior population. The Philadelphia Corporation for Aging has established the Age-Friendly Philadelphia initiative to help older adults remain healthy, active, and engaged in their communities for as long as possible. Catholic Health Care Services is a leader in providing affordable senior rental housing. Volunteers from Rebuilding Together Philadelphia are helping low-income homeowners, many of them seniors, repair and restore their homes.

National policymakers can learn from the experience of Philadelphia. But with millions of Americans poised to enter the senior ranks, the current window of opportunity is small and narrowing each day. Strengthening the collaboration between health and housing must become an urgent national priority in light of the demographic changes ahead.

Allyson Y. Schwartz represented Pennsylvania's 13th Congressional District from 2005-2015 and is co-chair of Bipartisan Policy Center's Senior Health and Housing Task Force. ays@allysonschwartz.com

Dr. Anand Parekh is BPC's chief medical adviser and leads the task force. aparekh@bipartisanpolicy.org