PRB

Housing is a basic necessity. Yet, in recent years, the rising cost of living—particularly for renters—has shed light on how precarious housing can be for some Americans. For older adults, this hazard may spill over to health outcomes.

For those with secure housing—such as homeowners without a mortgage—health-related concerns may be centered on accessibility and aging in place. In contrast, renters’ housing is often more tenuous and health outcomes may be strongly linked to underlying socioeconomic distress and ongoing financial challenges.

Researchers, with support from the National Institute on Aging (NIA), are uncovering strong links between housing affordability and health outcomes for older Americans. These findings can be used by policymakers to center housing interventions when seeking to improve older Americans’ health and well-being.

Financial Stress Contributes to Poor Health Among Older Renters

Recent studies highlight how crucial the interrelationship between financial security and housing is for older Americans’ health. Financial challenges contribute to less secure housing—unstable rental situations, trouble paying mortgages or rent, and poorer housing conditions—which influence older adults’ health outcomes.

For older renters, financial distress is a key contributing factor for poor health. Renters over age 50 have lower self-rated health and more hospitalizations than homeowners—above and beyond their financial burden—which Roshanak Mehdipanah of the University of Michigan and coauthors find is, “consistent with our hypothesis that housing is a social determinant of health. ”¹

They also find that both homeowners and renters who experienced financial strain and difficulty paying bills had lower self-reported health and more heart conditions. Financial stress for older adults has a direct impact on their health, and unaffordable housing costs and potential displacement likely add to their negative outcomes.

“Our results highlight the need for more robust and inclusive policies and programs aimed at assisting older populations remaining in their homes and communities,” Mehdipanah says.

Similarly, Meghan Jenkins Morales and Stephanie A. Robert of the University of Wisconsin-Madison find that among low- and moderate-income older renters, experiencing persistent housing-cost burden was associated with greater odds of self-rated health decline and developing additional activities of daily living (ADL) limitations (eating, toileting, bathing, dressing, getting around inside the home, or getting out of bed). Persistent housing-cost burden occurs when more than 30% of income is spent on housing expenses over a two-year period. The authors suggest that living in unaffordable housing could both contribute to poor health and be a consequence of health challenges.²

“More research is also needed to understand the pathways connecting housing-cost burden to health decline,” Jenkins Morales argues. “However, it’s likely that financial tradeoffs play a role; cost-burdened older adults need to make difficult decisions about covering housing expenses or paying for food, medications, and other health-related expenses.”

Poor Housing Quality Is Linked to Worse Health Outcomes Among Older Adults

Poor housing quality—such as plumbing problems, holes and cracks in walls and floors, and pests—is associated with lower self-reported health and increases in medical appointments and hospitalizations.³ While the reasons may vary, pest-related allergens, mold, poor insulation and heating, and pollutants in homes contribute to poorer health outcomes. Older adults, who tend to spend more time at home, are among the most vulnerable to the indoor environment.⁴

In 2021, just 4% of households headed by older adults had moderately or severely inadequate housing, classified as having major electrical, plumbing, or structural issues. Despite this small share, such issues can produce major health problems for older residents.⁵

A recent study finds that older adults living in poor housing conditions have increased risk for cardiovascular and metabolic problems and diseases. Renters are especially affected because of the compounding factors of both poor housing conditions and greater financial insecurity relative to homeowners.⁶

“Homeowners enjoy far better housing conditions than renters,” says Sarah Mawhorter of the USC/UCLA Center on Biodemography and Population Health and lead author of the study. “Many long-term renters are exposed to potentially harmful housing conditions over the course of their lives.”

Further, poor housing quality is associated with risks from accidents, such as falls among older adults. Safiyyah M. Okoye of Johns Hopkins University and coauthors find that for those who had more than two falls in the last year, socioeconomic factors, as well as home disrepair and a lack of sidewalks, were associated with the accidents. The findings were especially notable for older Black adults who had more financial hardship than others in the study.⁷

Care Facilities for Vulnerable Older Adults Are Not Keeping Pace With Population Growth

As their health starts to fail, many older adults transition to care facilities. In 2020, about 1.3 million older adults were estimated to reside in nursing homes, with an estimated 800,000 residents in assisted living facilities.⁸

The shortage of available beds for the number of older people across the United States who want or need to be in facilities will only grow as the population ages. Katherine Miller of the University of Pennsylvania and coauthors find that across 140 metropolitan statistical areas from 2015 to 2019, the number of senior housing communities had grown, but the supply was not keeping pace with population growth.⁹

Further, the likelihood of entering nursing care facilities—often covered by Medicaid for people with lower incomes—may be driven by individuals’ financial and housing challenges. A recent study from Meghan Jenkins Morales and Stephanie A. Robert of the University of Wisconsin-Madison looked directly at the links between housing-cost burden and whether older adults moved to nursing homes.¹⁰

They found that older low- and middle-income renters experiencing housing-cost burden were the most likely to move to a nursing home—beyond demographic, economic, and health indicators—suggesting that these moves were motivated by a lack of affordable housing and not solely by health needs. In 2015, 4.0% of cost-burdened older renters moved to a nursing home within three years, compared with just 0.5% of cost-burdened older homeowners. (See figure.)

“Given the current long-term care and housing contexts in the United States, renters with housing cost burden also might be pulled toward nursing homes as the only long-term care and affordable option,” they write.

FIGURE. Older Renters Who Are Housing-Cost Burdened Are Most Likely to Move to a Nursing Home

Characteristics of Low- and Moderate-Income Community-Dwelling Adults Ages 65+in 2015, by Place of Residence Three Years Later 

Source: Meghan Jenkins Morales and Stephanie A. Robert, “The Effects of Housing Cost Burden and Housing Tenure on Moves to a Nursing Home Among Low- and Moderate-Income Older Adults,” Gerontologist 60, no. 8 (2020): 1485-94.

In another study, the same authors explore differences among older Black and white adults living in nursing homes compared with assisted living facilities. They find that compared with their white peers, older Black adults more often move to nursing homes than assisted living facilities. Access to assisted living may be a greater challenge for older Black adults because they have fewer financial resources (enabling factors) and worse health (need factors), on average, than older white adults. Even after accounting for financial and health factors, Black-white differences in the type of care used persist, suggesting that residential racial segregation and discrimination may contribute to these disparities.¹¹

People with dementia move into facilities more often than others, and Mawhorter and coauthors find in their 2023 paper that in the years around the onset of dementia, more than half (56%) of older adults move—sometimes multiple times—while 44% stay in place. If they move, people with dementia are more often moving to another home or into a nursing home, especially if they are older and at the peak of onset, indicating greater needs for care.¹²

Bolstering Affordable Housing Could Reduce the Burden on the Health Care System

In 2021, more than three-quarters of all householders ages 65 and older were owners (78%) and most of them had no mortgage (68%).¹³ Owning a home free and clear—especially for those on fixed incomes—can provide financial security later in life.

In contrast, older renters are less financially secure. In 2021, renters ages 65 and older had more than double the poverty rate relative to homeowners (31% versus 13%) and over half (56%) had less than $25,000 in income.¹⁴ For renters, financial insecurity over the course of their lives may have hampered homeownership opportunities.

Older renters are more often people of color, too. Looking at householders over age 65 in 2021, there were two times more renters who were Black (37%) and Hispanic (36%) than white (18%).¹⁵ In part, these differences reflect practices and policies of systemic racism—such as redlining, blockbusting, and credit access challenges—which pose barriers to homeownership for people of color.¹⁶

Older adults’ housing challenges reflect social and financial inequalities. With high-quality and affordable housing having direct links to better health outcomes in older adults, strengthening housing policies becomes an important public health matter, especially for those who may have more disadvantages.

Andrew Fenelon and Sarah Mawhorter argue that one of the most powerful policy solutions to help this group would be to fully fund federal rental assistance programs for all eligible older adults. Current recipients of federal rental assistance report better health outcomes, thus expanding the program’s coverage and reach could offer tremendous benefits.¹⁷

These research findings also point to the need for more opportunities for people to buy homes earlier in life to prevent housing instability in later life.¹⁸

Considering the high cost of health care issues that are worsened by an insufficient supply of affordable housing, bolstering policies and programs that help Americans reduce their housing cost burden—regardless of whether they own or rent—could have far-reaching benefits for individuals and their families and could reduce burdens on the health care system.