Centering the Perspective of Older Adults and the Disability Community in New Health and Housing Federal Partnerships

As the eviction moratorium has ended and housing costs continue to rise, people with disabilities and older adults continue to struggle to find safe, accessible housing. Housing and supportive services are key pillars to full community integration for people with disabilities, yet they remain chronically underinvested. As a result, more than 30 years after the passage of Americans with Disabilities Act, many of the original aims of the legislation remain unachieved for many people with disabilities, especially those with low incomes. Low-income older adults are increasingly cost burdened, with Black and Latinx older adults more likely to experience severe cost burdens. As our nation’s population lives longer, these inequities in housing become further pronounced. It does not have to be this way.

Investments in affordable housing, paired with innovations in integrating supportive services with housing, are a solid step forward at realizing the ADA’s original goals of dignified independent living. Integrated supportive services are also critical for keeping older adults in their homes and out of restrictive and dangerous congregate settings. As the COVID-19 pandemic continues to threaten these groups, safe and supportive housing is more important than ever. A federal investment in affordable housing and supportive services is especially critical, which is why the new HHS and HUD partnership, the Housing and Services Resource Center, is a welcome development.

The new partnership between the federal agencies seeks to break down the silos between health and housing systems. Historically, services addressing housing needs and those addressing health needs do not coordinate across sectors, even though they are both serving the disability community and older adults. All too often, these dual systems are so difficult to navigate that people with disabilities and older adults are forced to live in dangerous institutional settings like nursing homes against their will. Due to the lack of affordable and accessible housing options, as well as a lack of access to supportive health services, people with disabilities disproportionately experience homelessness. Older adults are the fastest growing segment of the homeless population, and this surge has a stark racial divide. For example, in California Black adults are five times more likely to experience homelessness than white individuals. 

Health and housing integration are integral to ensuring older adults and people with disabilities have all the supports they need to live with dignity, independence and safety. Integration makes it more difficult for people to fall through the cracks and experience the negative health outcomes that come with inadequate supports. It is also an essential tool to addressing racism and ableism in affordable housing access and related health outcomes. Greater collaboration between federal agencies would better coordinate resources and ensure older adults and people with disabilities have everything they need to live independently: affordable, accessible housing and supportive services like HCBS (home and community-based services) and behavioral health.

The Center for Consumer Engagement in Health Innovation at Community Catalyst also recognizes the importance of breaking down these siloes, and has committed to furthering research on innovative models that integrate affordable housing with supportive services. Our recent report explored policy options for integration older adults, identifying five key building blocks for success. While emphasizing collaboration is one of the building blocks, importantly, so is ensuring resident control and being aware of what matters most to residents. In order to build health and housing systems that effectively serve those most in need of support, both elements most be present.

As federal stakeholders recognize the importance of collaboration, it is equally important that they center the voices of older adults and people with disabilities who are most impacted by these policies, with an emphasis on communities of color and low-income people. Those living in affordable housing communities and utilizing supportive services know best regarding what needs to be improved and what ought to be prioritized. Federal policymakers will only be able to achieve equity and efficacy their collaboration if they ensure the robust knowledge and feedback of older adults and people with disabilities is incorporated into every policy decision. The Center applauds this new collaboration and urges federal policymakers to center the voices of those with disabilities and complex health needs in their new partnership.