The Dual Burden of Housing and Care for Older Adults

This article was originally published on Joint Center for Housing Studies.

As the first baby boomers turn 80 in the coming decade, a growing number of older households will face challenges paying for both housing and the supports and services they will need to remain in their homes. In a new paper out this week, we find that after paying for housing and basic living expenses, only 24 percent of single and partner households age 75 and over had sufficient income to afford a daily paid visit from a home health aide. Affordability rates were even lower for renters, households of color, and those with functional difficulties more likely to need care services. The paper builds on analysis reported in Housing America’s Older Adults 2023 and summarized in a 2024 blog post by including both single and partner households, expanding the metros included in the study, and focusing on in-home care.

A majority of older adults will need long-term care (LTC) services at some point in their lives, such as assistance with dressing, bathing, or managing complex medication regimens. Most older adults prefer to receive such care in their own homes. Yet the cost of paid LTC services is out of reach for many households. In 2021, one daily in-home visit by a health aide at the median national rate added up to $41,000 per year. Medical insurance, including Medicare, does not cover most LTC needs, and relatively few older adults have private long-term care insurance. LTC services at home are most likely to be paid for by Medicaid Home and Community Based Support (HCBS) waiver programs, which do not operate as entitlements, vary in coverage and availability by state, and are only available to those enrolled in Medicaid. Perhaps unsurprisingly, most LTC services are provided by unpaid caregivers, and the burden on family and friends can be high.

Our analysis of multiple data sources outlined in the paper found that only one quarter of the nearly 10 million households in our sample had enough income to pay for a daily care visit on top of housing and basic costs of living. Partner households were better positioned with 43 percent able to cover a daily visit (serving both partners) compared to 19 percent of those living alone. Tenure also mattered: less than 9 percent of renters were able to afford housing, basic expenses, and daily care compared to 30 percent of owners.

We found that Black and Hispanic households were least likely to afford care, with only 14 and 11 percent respectively able to fund LTC services out of income alone, compared to 26 percent of their white counterparts. And just 19 percent of households with a resident who struggled with mobility, self-care, and/or independent living were able to afford a daily care visit, though they were far more likely to need LTC services.

While a daily paid visit was out of reach for most, slightly more than half of households could afford one visit per week, and 30 percent could afford 5 weekly visits (Figure 1). Practically, periodic paid care could provide respite to unpaid family caregivers. However, even without considering the cost of a daily LTC visit, only 63 percent of the entire sample could afford their housing and basic costs of living (Figure 1, far left column). The remainder lacked sufficient income for any LTC care services.

Read the full article online here.