Understanding the Pandemic and Senior Housing Equity
The coronavirus pandemic has disproportionately affected seniors, who are more prone to severe illness and death from COVID-19; are more likely to live in congregate settings; and are more likely to require in-person services, which increase their risk of exposure. At the same time, elderly Americans, particularly those who rent, have become increasingly cost burdened. Even before the pandemic, more than 2 million very low-income older Americans faced worst-case housing needs, meaning that they paid more than half of their household income as rent, lived in severely inadequate housing, or both; in 2016, slightly more than one-half of all renting seniors paid more than 30 percent of their income toward rent. All these factors underscore the importance of providing and maintaining safe housing for seniors.
In October 2022, the Joint Center for Housing Studies of Harvard University (JCHS) and the Hastings Center released Advancing Housing and Health Equity for Older Adults: Pandemic Innovations and Policy Ideas, a report examining why certain approaches to supporting seniors were successful and how those lessons can impact future senior care and senior housing initiatives. In a webinar hosted on October 6, 2022, participants reviewed the report’s findings and discussed concrete examples of success. Panelists included Robin Lipson, deputy secretary of the Massachusetts Executive Office of Elder Affairs; Jennifer Molinsky, project director of the Housing an Aging Society Program at JCHS; Tam Perry, associate professor at the School of Social Work at Wayne State University; and Lauren Taylor, assistant professor in the Department of Population Health at the Grossman School of Medicine at New York University. Nancy Berlinger, a research scholar at the Hastings Center, moderated the discussion, and Chris Herbert, managing director of JCHS, introduced the panel.
The Importance of Strong and Trusting Ties
Molinsky reviewed the report’s findings, beginning with those emphasizing the importance of strong relationships among service providers, policymakers, the seniors themselves, and other members of seniors’ networks. The report found that the most effective responses to shifts in seniors’ care and support during the pandemic emerged from existing networks of organizations relating to health, housing, and elder services. The researchers found that such networks were highly effective at processing and disseminating novel information and advocacy. In Massachusetts, Lipson’s office helped coordinate outreach from the University of Massachusetts to teach occupational health workers how to make and use masks in the early days of the pandemic, before masks became ubiquitous and their efficacy against the spread of the coronavirus became clear; these efforts helped reduce the mortality rate of seniors who still needed in-home services.
Service coordinators for dedicated senior housing facilitated the formation of strong personal connections, so seniors could easily communicate their needs to known and trusted coordinators; those coordinators could in turn access their own network of contacts to help meet needs, communicate with family members when visits were not allowed, or perform wellness checks. In Detroit, Perry described how a senior housing coalition formed before the pandemic functioned as a de facto clearinghouse and advocate for agencies in the absence of a dedicated municipal senior department. Beyond meeting immediate needs, seniors also proved to be critical allies in policymaking. Gathering and incorporating feedback from older adults was critical for crafting effective strategies.
Overcoming Known Barriers
Some of the report’s findings focused on well-understood aspects of building a senior-friendly environment. The pandemic, reported Molinsky, emphasized the importance of designing accessible housing and neighborhoods. Factors that encourage good health and independence, such as easy access to green outdoor spaces, affordable internet service, and the ability to adapt housing to allow aging in place should be made equitably available to seniors, said Molinsky.
The uncertain atmosphere of the early days of the pandemic required policymakers to be nimble. Regulatory flexibility combined with enhanced funding, the report showed, advanced important changes, such as allowing electronic signatures on certain documents to avoid unnecessary contact. Lipson reported that implementing electronic signatures was one of the first changes her department implemented as part of a broader effort to limit service providers’ contact with clients who needed personal care. More broadly, Taylor implored policymakers to remember that during the crisis, they did succeed in eliminating red tape that long felt immovable.
Finally, the report identified persistent barriers to more equitable access to senior housing and senior care, including housing services that often are disconnected from healthcare providers or the underfunding of supportive care given by a senior’s family members. Taylor emphasized that, in many cases, service providers have already deployed solutions that are more effective than those pursued in the prepandemic system, such as the Program of All-Inclusive Care for the Elderly (PACE), which has been shown to be effective in helping seniors age in place with the help of wraparound care. Agencies, however, have lacked the funding needed to bring these solutions to scale.
Adopting a Housing Lens
A holistic focus on the centrality of housing to the well-being of seniors, Berlinger said, forms what the report describes as a “housing lens” approach. Rather than adopt an approach centered on health care, in which seniors are either healthy or in need of care, the housing lens approach puts a person’s dwelling at the heart of their well-being. Moving beyond medicine, the housing lens examines neighborhood safety, the adaptability of the home to aging bodies, the social vibrancy of the community, and the reliability of public transit, among other factors. Translating this framework into policy will not be easy, said Taylor, as the qualitative nature of well-being is not easily translated into the kinds of metrics that well-crafted policies typically require.