The voices of Urban Institute's researchers and staff
June 26, 2014

Linking housing and health for seniors: An important step forward

Federal rental assistance serves some of the most vulnerable individuals and families, including 1.3 million elderly. But until now, our knowledge of the health challenges these older residents experience—and the accompanying costs—has been limited by reliance on self-reported data and proxies, rather than actual medical treatment data.

What issues do these seniors face? How do they differ from seniors who don’t receive assistance? To get a better understanding, the US Department of Health and Human Services (HHS) and the US Department of Housing and Urban Development (HUD) created a dataset linking HUD-assisted residents with Medicare/Medicaid claims data, giving us a first look at the medical claims of seniors in assisted housing (consisting of tenant-based and project-based assistance).

Although this is a critical first step, the new analysis shows us that there’s still a lot we don’t know. Administrative data don’t tell us whether there is something fundamentally different about the health conditions between households living in HUD-assisted housing and those living in the private market.

For example, a core finding is that 70 percent of the HUD-assisted individuals receiving Medicare also were enrolled in Medicaid, compared with 13 percent of individuals not receiving federal rental assistance. These “dually enrolled” individuals tend to be low income, frail, and suffering from multiple chronic conditions.

According to analysis of individuals age 65 and older, HUD-assisted individuals who were dually enrolled in Medicare and Medicaid incurred higher medical costs and used more services than dually enrolled individuals who did not receive federal rental assistance. Fifty-five percent of the HUD-assisted group had five or more chronic conditions. They also had higher use of long-term services and supports. Could heavy users of health services “self-select” into HUD-assisted housing because their health costs consume more of their incomes and they need more affordable housing.

Higher usage rates may also be the result of successful efforts to better link HUD-assisted seniors with services. One of HUD’s programs, Section 202, funds service coordinators to help residents access services so that they can remain in their home and community. Many public housing authorities are working to improve residents’ health by partnering with community health centers. HHS-funded Public Housing Primary Care health centers, located on or near the premises of public housing developments, give residents greater access to comprehensive primary health care services.

But more importantly, is greater usage of services and care linked to better health outcomes? At this point, we don’t know, but the ability to link administrative data is key to addressing the question. Additional research is necessary, so it is good news that HUD has proposed research with HHS to examine the cost effectiveness of promising housing and service interventions to enable people to age in place and avoid the high costs of institutionalization.

We need to better understand how housing and health relate to improve outcomes for low-income—particularly very low- and extremely low-income—seniors. Just as we need to be able to match HHS and HUD data, we need to have better collaboration among housing providers and health providers to make the most of available resources and provide better outcomes for seniors. Urban Institute, in partnership with the MacArthur Foundation, will be exploring these relationships in greater detail later this year through roundtable discussions with researchers, policymakers, and practitioners. Stay tuned.

The Assisted Housing Initiative is a project of the Urban Institute, made possible by support from Housing Authority Insurance, Inc. (HAI, Inc.), to provide fact-based analysis about public and assisted housing. The Urban Institute is a non-profit, nonpartisan research organization and retains independent and exclusive control over substance and quality of any Assisted Housing Initiative products. The views expressed in this and other Assisted Housing Initiative commentaries are those of the authors and should not be attributed to the Urban Institute or HAI, Inc.

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