Chrystal Kornegay
Massachusetts is the second-best state for health care with the third-highest housing costs in the country; it also has a growing senior population. The commonwealth’s housing affordability crisis impacts all residents, but it is particularly acute for the elderly. Still there are several reasons why Massachusetts is well-positioned to be a leader in developing innovative solutions that combine housing and health care, especially for our older adults.
Aging in a service–enriched community is widely viewed as a best practice for the elderly; unfortunately, creating affordable housing communities with supportive services is challenging because it is difficult to find a reliable funding stream to cover those services.
Consider that in 15 years, 25 percent of Bay State residents will be over 65. Just under 400,000 of them will be eligible for affordable housing, but only one–third will be eligible for services. In almost every municipality in Massachusetts, more than half of the households that qualify for affordable housing make too much money to qualify for the service programs that enable seniors to age gracefully and with dignity.
Senior Housing Costs Demand New Approach
To meet the demand of an aging population, we need to think differently about how we build, finance and operate housing for older adults. We can build resilient, inclusive, age-friendly communities by creating new linkages between housing and health care systems, and by viewing housing not just as shelter, but as a vaccine that boosts the health of its residents and immunizes them against illness that too often results in medically unnecessary trips to a hospital.
If housing instability or a lack of a service-rich environment drives overutilization of the health care system, health care providers should be able to write a prescription for an affordable home, equipped with supportive resident services.
MassHousing is eager to be a partner in creating a system that will allow hospitals to be among the sources of financing for a housing development, where they can prescribe supportive senior housing directly to individuals. Such a step would enable health care providers to spend in a more targeted and cost-efficient manner.
The argument that safe, stable and supportive housing boosts health care outcomes is not new. We know the Housing First model of addressing chronic homelessness stabilizes individuals’ health and human services needs by providing them a safe place to live. Similarly, affordable senior housing developers provide on-site supportive services because those services improve residents’ health. At the same time, though, it has been difficult to take these strategies to their logical end and deploy housing as a primary strategy for improving older adults’ health.
Fee-for-service models fund health care procedures, instead of health care outcomes. And patient mobility in the health care system makes it difficult for hospitals and insurance companies to finance creative prevention strategies, since they may never realize the savings resulting from their investments in prevention and wellness.
Health Care Providers Should Partner on Housing
The scale of the state’s senior housing needs, combined with the sheer size of government’s health care expenditures, means we all have a stake in breaking down the walls between the housing and health care systems. Through collaborative efforts, senior housing developers and health care providers can deliver high-quality care in residential settings that will ultimately lower costs by reducing emergency room visits and unnecessary hospitalizations.
MassHousing is already working to advance this kind of new senior housing system. The agency is collaborating with 2Life Communities and Hebrew SeniorLife, on rigorous studies of age-friendly supportive housing strategies. This work will help determine the right mix of on-site services necessary to reduce hospitalization and nursing home utilization, while delivering measurable improvements in clinical outcomes.
The housing finance system cannot deliver a dynamic new mixture of housing development and supportive services to scale on its own. However, incorporating housing with health care – treating it like medicine – will benefit seniors and reduce the strain on health care budgets.
The vision of a doctor diagnosing your illness and writing a prescription for a safe, affordable home is within our reach. We stand ready to aggressively push these ideas so that the vision becomes the new reality.
Chrystal Kornegay is the executive director of MassHousing, co-chair of the housing workgroup of the Governor’s Council to Address Aging in Massachusetts, and a member of the Urban Land Institute.
