Effects of Housing Affordability and Quality on Chronic Condition Management and Nursing Home Entry Among Low-Income Older Adults

About This Grant

PROJECT SUMMARY Chronic conditions such as hypertension, diabetes, coronary heart disease, arthritis and asthma/COPD affect over 88 percent of adults over 65 and comprise 8 of the 10 leading causes of death in the United States. These conditions are strongly associated with disability and have an estimated financial burden of $47 trillion worldwide by 2030. Lifestyle and environmental factors are major contributors to the risk of developing chronic disease. These factors are strongly influenced by where an individual lives, meaning that housing affordability and neighborhood quality are likely important moderators of the risks and burden of chronic disease. Housing needs evolve as adults age, and low-income older adults face challenges in securing suitable housing, particularly due to accessibility issues and fixed incomes amid rising costs. These barriers can result in older people living in lower-opportunity neighborhoods, inappropriate physical environments, and experiencing housing instability, which may increase the risk and negative consequences of chronic disease and accelerate nursing home entry. The Housing Choice Voucher (HCV) program, the nation’s largest rental assistance program, is designed to increase housing affordability and housing quality. Low-income elderly adults–those with the highest incidence of chronic disease–comprise around 50% of households participating in the HCV program, representing a large, clinically high-risk population. However, there is no robust research that has used variation in the HCV program to assess how increased housing affordability and quality may reduce the negative consequences of chronic conditions or the probability of nursing home entry for older Americans. Previous research indicates that expanding housing affordability and quality reduces rent burden and homelessness, but its effects on health outcomes remain underexplored. By linking HUD administrative data on approximately 1.5 million unique households to Medicare data on health outcomes (e.g., diabetes and hypertension management, medication adherence, avoidable hospitalizations, nursing home entry, and mortality), this study will use quasi-experimental variation in rental assistance access and generosity over time as mechanisms to examine how improved affordability and increases in housing and neighborhood quality may affect health. The study has three specific aims: to describe the characteristics and health status of older adults with housing assistance, to quantify how housing stability affects chronic disease management and other health outcomes, and to assess the impact of increased housing and neighborhood quality on these same outcomes. The findings from this study can be translated into action. Clinicians can screen for housing instability and, for patients with the housing-related risk factors our study may uncover, target more appropriate health screening and testing to these individuals; health systems can help connect their highest-risk enrollees to housing-related supports; and at-risk older adults and their families can better understand how housing can improve management of their chronic conditions.