Tag Archive for: Housing

MassPACE Joins Healey-Driscoll Administration Roundtable Discussion with Health Care Leaders on the Impact of the Housing Crisis on Public Health

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This was originally posted on LinkedIn. Read the post here.

Last Thursday, MassPACE’s Executive Director, Jennifer Maynard, had the honor of participating in a crucial roundtable discussion alongside Governor Healey, Lt. Governor Driscoll, and distinguished leaders like Health and Human Service Secretary Kate Walsh and Housing and Livable Communities Secretary Ed Augustus. The focus? The indispensable link between housing and healthcare.

Moderated by Secretaries Walsh and Augustus, the “Housing is Health Care” roundtable brought together industry experts, including representatives from hospitals, community health centers, and organizations like MassPACE. Together, they delved into the challenges healthcare providers and communities face due to the lack of affordable housing and its impact on patient outcomes.

Governor Healey rightly underscored the Affordable Homes Act’s potential to enhance public health and equity through investments in rehabilitating public housing, expanding supportive housing, and promoting environmental justice. Secretary Walsh brought up PACE as a solution to keep people in their homes, ensuring they can age in place. Upham’s Community Care CEO Jay Trivedi emphasized the vital role PACE plays in bridging healthcare and housing.

During Jenn’s remarks, she cited the new opening of 2Life’s JJ Carroll Senior Housing complex, which has a PACE day center built on the first floor. Jenn shared with the group information on our report on Considerations for Combining PACE with Housing, completed with the help of EOEA and Leading Age. The report details some of the different partnerships that exist between PACE and senior housing, such as supportive housing, rest homes, assisted living, housing authorities, and more. Some of these partnerships within senior housing have embedded 24/7 staff members in case residents need services to remain at home.

Jenn expressed our hope is to encourage housing partners, to continue to incorporate integrated comprehensive solutions— that bring housing and healthcare together to address the social determinants of health. PACE programs are committed to their mission of keeping people in the community and need these critical resources to support the aging population. She urged those at the table to explore opportunities such as re-purposing of closed senior care communities to infuse more housing now.

We are happy Jenn was there to add the perspective of aging adults. As we tackle the housing crisis in Massachusetts, we all need to work together, so communities can support folks as their needs change.

On behalf of: Upham’s Community Care Fallon Health Summit Eldercare Element Care PACE Neighborhood PACE Cambridge Health Alliance PACE, Trinity Health PACE Serenity Care Harbor Health Services, Inc. PACE

Thank you:Office of Massachusetts Governor Maura Healey
Massachusetts Executive Office of Health and Human Services

Addressing the Needs of Increasing Numbers of Housing Cost-Burdened Seniors Will be a Major Issue in Coming Years, According to JCHS and BPC

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This article was originally published on Novogradac.

A worrying trend of increasing rates of housing cost-burden seniors is sweeping the country, according to recent reports and seminars from the Harvard Joint Center for Housing Studies (JCHS) and Bipartisan Policy Center (BPC).

The JCHS, Housing America’s Older Adults report found that nearly 11.2 million older adults, defined by JCHS as aged 65 and older, were cost burdened (spending more than 30% of their household income on housing costs) in 2021. This figure, which represents an all-time high, is up from 9.7 million in 2016 and 8.8 million in 2011.

The research also covers other hardships facing older renters and homeowners as they struggle to cover housing and healthcare costs. Those facing the most difficulties are finding themselves at risk of homelessness as the number of households eligible for housing assistance is growing while available funds cannot meet demand. In the face of this research, scholars and working professionals have come to identify certain problems and potential solutions to the current housing crisis among this age group. The JCHS hosted a December 2023 seminar detailing the report’s release with panelists sharing potential solutions to the affordability issues older Americans are facing and ways to encourage healthy aging.

Additionally, in a Nov. 7, 2023, the BPC seminar, Aging Without Housing: Addressing the Rising Tide of Senior Homelessness, panelists explore the reasons why adults aged 65 and older are the fastest growing segment of the unhoused population.

The Current State of Housing for Aging Americans

Citing the Housing America’s Older Adults report, Samara Scheckler and Jennifer Molinsky of JCHS provided an overview of the report during the seminar that contextualize the current state of housing for older Americans. Scheckler explained that households headed by someone in their 80s will double in number to around 17 million by 2040. The number of older adults that are cost burdened has been rising for two decades, as displayed in the graphic below, though roughly a third of older households have remained cost burdened from 2016 to 2021. Housing cost burdens can make it more difficult for older adults to afford other basic needs, such as food and healthcare. According to Molinsky, middle-income older adult households may also struggle to afford quality healthcare as they make too much money to qualify for social services. The report classified the group of Americans living alone aged 75 and up as “GAPS households,” as they are households in the “gap” between “assisted living” and “public support.” GAPS households have incomes at or more than 50% of the area median income (AMI) but still cannot afford all-in-one assisted living, out-of-pocket healthcare and miscellaneous costs.

While most adults over 65 years old live in their own homes, mostly alone or with a spouse, homeownership rates among households aged 50-64 years old have fallen, suggesting future declines among older adults. Though homeownership rates are declining, an increasing share of older homeowners still have mortgages. The median mortgage debt increased by more than 400% from $21,000 in 1989 to $110,000 in 2022 dollars. This growth was even more drastic among homeowners aged 80 and over, increasing by more than 750% during the same time from $9,000 to $79,000 in 2022 dollars. Scheckler continued by stating that in 2022, older homeowners held nearly 50 times the net wealth of older renters, and incomes of older adults tended to decline and converge as they age regardless of tenure and race/ethnicity. Although a significant share of older adults are cost burdened across the country and the number of older renters in need of housing assistance climbed, federal programs still only support just over one-third of eligible households, according to the JCHS report. In 2021, there were nearly 5.9 million very low-income renters–defined as households with incomes at or below 50% of AMI–age 62 and older, but only 37% of them were assisted by federal programs.

Trends in Older Adult Homelessness

In a Nov. 7, 2023, BPC seminar, Dennis Culhane, professor of social policy at University of Pennsylvania, also showed discrepancies between the research behind premature aging and housing policies. His research shows that people 55 and older experiencing homelessness are showing symptoms of medical conditions typically seen in people aged 65 and over. Despite this, supplemental security income (SSI), a program that provides monthly payments to low-income individuals with disabilities, only considers people over the age of 65 to qualify for the program. According to Paul Downey, the president and CEO of Surviving Seniors, a lack of communication within housing and health systems has caused a vicious cycle of homelessness among some individuals. He has seen a rise in post-traumatic stress disorder, depression, and anxiety among unhoused people, which can cause them to struggle with acts of daily living (ADLs). Failure to meet these ADLs can cause someone to be rejected from a shelter or emergency room. More focus on preventative measures is needed to end the cycle of homelessness, including safety nets for medical expenses and job loss, shallow subsidy diversion, and more transitional housing.

Need for Coordination Between Housing and Healthcare

In the seminar, Molinsky raises the point that housing and healthcare systems need further cooperation since they are inherently intertwined for older Americans. Most long-term care services are provided within the home, according to the JCHS report, and health and housing are both major cost burdens. The report states that rising rents, property taxes, utility costs and insurance all contribute to these housing cost burdens among older adult households. Scheckler cited the JCHS report and demonstrated just how expensive health aid is by showing that the median cost of home health aid is $27 per hour, which typically must be purchased in four-hour blocks. This adds up to a total cost of more than $40,000 per year, while the median annual cost of assisted living is $63,000 per year. This is especially concerning as she states that most adults turning 65 today will need long-term care services at some point in their lives. Molinsky finally argues in the JCHS seminar that climate change threatens to increase these cost burdens for older people, as they are more vulnerable to extreme temperatures and poor air quality and may need more accommodations.

Potential Solutions for Affordable Housing Among Older Americans
During the JCHS and BPC seminars, panelists detailed possible programmatic solutions to the challenges facing older Americans. In the BPC seminar, Dennis Culhane stated the importance of shared living spaces for older adults and emphasized the shortage of affordable assisted living programs. One potential solution to this issue among older Americans was detailed by Elizabeth Chen, the Massachusetts Secretary of Elder Affairs. In the JCHS seminar, she gave an in-depth analysis of the success of Programs for All Inclusive Care for the Elderly (PACE) in her state. These programs establish resident service coordinators within affordable housing properties, which place a trusted person on-site to handle medical concerns. This reduces the cost for emergency medical services and hospital admissions, and provides care in a more timely manner, according to Chen.

On top of this, PACE programs set aside built-in living spaces for individuals with high level needs of care to ensure that everyone’s health needs are met in an efficient manner. PACE programs also help middle-class patients that may be struggling, as you do not need to have Medicaid to qualify for it, but patients still pay Medicaid pricing. This allows PACE programs to remain affordable for those just outside the income range to qualify for financial assistance. Overall, Chen states that Massachusetts has found success in funding PACE programs, and they continue to expand across the state. However, one barrier that Chen has found with PACE programs is workforce constraints, as providers must possess a wide array of knowledge and must have a strong interest in working with elderly patients.

Kramer states PACE programs have been picking up on a national level, and according to the report, there are now 155 PACE programs that operate in 32 states and the District of Columbia, serving 71,000 individuals. Kramer also emphasized that there has been an expansion of accessory dwelling units which can help to create more affordable housing. He adds that elimination of restrictive zoning laws and the implementation of age-friendly city and state designs are also key factors towards creating affordable living spaces for elderly Americans.

Another state that has seen advancements in their programs to care for the elderly is California. According to Meghan Rose of LeadingAge California, who presented during the JCHS seminar, the California Advancing and Innovating in Medi-Cal (CalAIM) program helps to fill in the gaps of coverage for adults who qualify for both Medicaid and Medicare to keep down the costs. Through CalAIM, all dually eligible patients are being moved into managed care through a capitated rate model which serves to create better health outcomes among their participants. Further, Rose states that CalAIM has been successful in providing housing transition navigation and housing deposits. She elaborates that they have also announced a plan to provide six months of transitional rent services for qualifying individuals who are currently experiencing or at risk of experiencing homelessness.

A Push for Housing Options that Prioritize Healthy Aging
The JCHS’ State of the Nation’s Housing 2023 report details the increasing housing cost burdens that renters feel today. The JCHS will also be releasing another report later this month that details the state of the nation’s rental housing market. Harvard’s JCHS states that LIHTC remains a critical tool for increasing the supply of affordable rental housing.

The LIHTC is the largest annual federal tax expenditure for new affordable rental housing for older adults with low incomes, and is there is continued support for expansion along with the need for affordable housing. The Affordable Housing Credit Improvement Act (AHCIA, H.R. 3238, S. 1557) expands the LIHTC and includes provisions that will facilitate the creation of more affordable rental housing for low-income seniors and other Americans. Programs such as PACE and CalAIM that work to combine health and housing services serve as a model to make housing for older adults more affordable and appropriate.

Considerations for Combining PACE with Housing

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In recent years, there has been a recognition of the importance of social determinants of health, including the impact of where a person lives on their overall health and well-being. This is especially true for older adults, for whom safe, accessible, housing with integrated health and long-term care services (such as home care, housekeeping, and nutrition support) is the key to remaining in the community.

Housing providers have been increasingly interested in seeking programs and developing relationships aimed at enabling older residents to remain safely in their homes for as long as possible. In Massachusetts, there are many organizations that operate programs designed to assist older adults. These range from organizations that provide companionship, villages that support affinity groups, home health agencies that provide in-home assistance with activities of daily living, adult day health centers, adult foster care, and care coordination programs.

The Program of All-Inclusive Care for the Elderly (PACE) offers all these services and more and has proven to be a valuable partner to housing agencies that operate affordable housing for older adults.

Massachusetts recently launched an initiative to expand PACE to every zip code in the Commonwealth, making this an ideal time for housing agencies to learn more about PACE and PACE-Housing Partnerships.

There are already many PACE-Housing partnerships in place across the state, and while these models can vary in their design and structure, all PACE-Housing models seek to maximize the ability of residents to remain in their homes through access to housing stabilization services, enhanced support, health-related services, and collaboration between PACE Organizations and housing partners.

This document is designed to introduce and provide examples of PACE-Housing partnerships to stakeholders in the housing arena (e.g., landlords, property managers, developers, etc.), and to highlight opportunities for housing agencies to further support tenants through relationships with PACE Organizations.

Continue reading this article by downloading the Considerations for Combining PACE with Housing PDF here.

Aging with Dignity in a Supportive Community

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On June 2, 2022, 2Life Communities, Element Care, and partner organizations and funders launched the construction for the redevelopment of the J.J. Carroll BHA building that will have 142 additional affordable units for older adults in Brighton

It was a beautiful day on Chestnut Hill Avenue in Brighton, where old and new colleagues gathered around the construction site of the John J. Carroll apartments. The Boston Housing Authority, 2Life Communities, and its partners, including MassHousing, the City of Boston, and Element Care PACE gathered in celebration of the unveiling of the redevelopment of the property. The building was chosen for modernization and currently holds 64 units; the new construction plans will create 142 new units and an 11,000-square-foot PACE center.

Amy Schectman, 2Life’s President and CEO, led the ceremony and started the event by bringing to the stage the city’s new Mayor, Michelle Wu. As a longtime housing advocate, Mayor Wu celebrated the planning process, which was inclusive of its residents in the design process. She then applauded the team’s collaborative efforts, choosing to partner with Element Care to include a PACE center on-site, ensuring these residents can age in place with the services they need. She closed her speech by switching to Spanish to ensure everyone heard her message.


L-R: Jennifer Crampton, Wells Fargo; Mayor Michelle Wu, Secretary Marylou Sudders

Secretary Marylou Sudders of the MA Executive Office of Health and Human Services followed Mayor Wu, stressing the importance of upholding the value of respect. She described how we respect our older adults by ensuring they have affordable housing and long-term care in their community. She praised 2Life for its creativity and innovation and for making it a priority for residents to remain in their communities, stay active, be taken care of and thrive. Secretary Sudders, a supporter of the PACE model, described her vision of having more PACE/Housing partnerships: “We are taking this model across the State, we can do it in Boston, and we plan to do it across the Commonwealth.”

Undersecretary Jennifer Maddox of the MA Department of Housing and Community Development echoed Secretary Sudders’ praises for the PACE model of care for older adults, “a few retire in Florida, [but] most want to stay in the community with family and friends.” Amy Schectman described how PACE shares 2Life’s goal of focusing on “holistic and preventive care” and keeping residents in their units, adapting as they age, based on need.


At the Podium, Bob Wakefield of Element Care

MassPACE’s longest-serving Board Member and Executive Director of the Element Care PACE program, Bob Wakefield, closed the event with key takeaways – the importance of affordable housing, the strength of the PACE model, and collaborative efforts like the JJ Carroll renovation, that combine the two visions. Bob describes the JJ Carroll project as a particularly innovative partnership that he believes will “address the social determinants of health on a scale that has never been seen before.” With on-site amenities such as an urgent care center, Bob believes we are one step closer to eliminating the need for long-term care facilities.

The event’s energy was contagious. The group of people gathered at the event were those who worked day-in and day-out during the pandemic to ensure those they served avoided the deadly COVID-19 virus. Their tireless efforts allowed them to form and strengthen connections. Together, they are creating an inclusive and supportive environment that gives older adults the respect they deserve. 2Life’s board chair, Jeffery Sach, summarized the project ‘s mission: “to encourage aging with dignity in a supportive community.”