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Healthy Aging Begins at
Home
A N A N D PA R E K H , M . D., M . P. H .
BPC SENIOR ADVISOR
THE NATIONAL CHALLENGE
• The U.S. older adult population is growing. As a country we face:
– Higher Demand for LTSS:
• Spending on LTSS is expected to increase from 1.3 percent of GDP in 2010 to 3 percent
of GDP in 2050.
– Increased Spending on Chronic Conditions:
• 93 percent of Medicare spending is for seniors with multiple chronic conditions.
– Inadequate Personal Savings:
• Nearly 40 percent of individuals over the age of 62 are projected to have financial
assets of $25,000 or less.
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SENIOR HEALTH AND HOUSING TASK FORCE
Co-Chairs:
Henry Cisneros
Former Secretary, HUD
Mel Martinez
Former Secretary, HUD;
Former U.S. Senator
Allyson Y. Schwartz
Former U.S. Representative
Vin Weber
Former U.S. Representative
Priority Areas:
Lack of a Home Impacts
Health
Problem: Many seniors are priced of the housing market or tenuously able to afford
their rent.
- Understand the need deficit.
- Evaluate efforts to expand affordable housing.
- Identify opportunities to expand access to more seniors.
A Home Impacts Health
Problem: Housing stock does not accommodate the physical and cognitive difficulties
that come with aging.
- Identify most critical home & community-based modifications.
- Understand current barriers to implementation.
- Identify policy solutions to accelerate these modifications.
Home as a Place for Health
Services
Problem: Seniors could substantially benefit from in-person or in-home health services.
- Identify integrated models of care.
- Estimate cost savings implications of these models.
- Propose plans to scale them nationally.
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HEALTH BEGINS AT HOME: THE OVERRIDING NEED FOR
MORE AFFORDABLE SUPPLY
We recommend:
• Preventing and ending homelessness among older adults;
• Increasing federal support for the Low Income Housing Tax Credit;
and
• Adequately funding the Section 202 Supportive Housing for the
Elderly program and also creating and funding a new program for
senior-supportive housing.
Supply-Demand Imbalance in Available and
Affordable Rental Homes
SUPPLY
DEMAND
12
2.6 Million
Senior
Households
10
Millions
8
6.9 Million
Needs Gap
6
8.6 Million
Other
Households
4
2
4.3 Million
Available
0
Available and Affordable Rental Homes
Extremely Low-Income Renter
Households
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AGING WITH OPTIONS: TRANSFORMING OUR HOMES
AND COMMUNITIES
We recommend:
• Authorizing a new Modification Assistance Initiative to coordinate
federal resources for home modifications on an interagency basis;
and
• Establishing and expanding programs to assist low-income seniors
with home modifications through property tax credits, grants,
forgivable loans, and targeted tax relief.
The aspiration should be to help
seniors not just to age in place but to
age with options.
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INTEGRATING HEALTH CARE AND SUPPORTIVE
SERVICES WITH HOUSING
We recommend:
• Launching an initiative that coordinates health care and LTSS for
Medicare beneficiaries living in publicly-assisted housing;
• Ensuring Medicare and other programs support falls prevention; and
• Encouraging greater reimbursement of telehealth and other
technologies with the potential to support successful aging, improve
health outcomes, and reduce costs.
Falls are the leading cause of
injury-related deaths in older
adults, and most falls occur
in the home setting.
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INTEGRATING HEALTH CARE AND SUPPORTIVE
SERVICES WITH HOUSING
Recommendation: CMS should encourage incorporation of housingrelated questions in health risk assessments (HRAs) used by Medicare
providers and Medicare Advantage plans.
• CMS requires Medicare providers to administer HRAs as part of the
annual wellness visit.
• HRAs are also commonly used by Medicare Advantage plans and are
occasionally administered in the home.
• CMS should encourage all providers, but specifically Medicare
Advantage plans, through questionnaires or in-home visits, to
include assessments of the following needs in HRAs:
•
•
•
•
Frailty and falls risk,
Living situation (e.g. lives alone),
Home safety/accessibility, and
Modifications.
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CONCLUDING THOUGHTS
• The best the way to increase value in healthcare is through clinicalcommunity linkages.
• The “game-changers” for better health and lower costs will come
from inside and outside the clinical setting.
• Integration of health & human services will be paramount to
reducing health care costs.
• Identifying and replicating best practices of Medicare Advantage
plans with regards to partnering with community-based health &
human services organizations is needed.
• Identifying statutory or regulatory barriers that impede partnerships
and then addressing them will be critical.
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