Report: Housing Crunch Prevents Seniors with Low Incomes, Disabilities from Returning to the Community


FOR MORE INFORMATION: Jeff Van Ness, (202) 204-7515



Up to 1 in 5 nursing home residents could live in less-restrictive environments; Safety Net Health Plans developing solutions to address transitional homelessness

WASHINGTON—A new report from the Association for Community Affiliated Plans (ACAP) closely examines a little-discussed crisis: the lack of housing available for low-income seniors, many of whom could live in homes in the community but instead are in higher-cost, more-restrictive environments such as long-term care facilities.

The new report, Bridging the Health and Housing Gap, examines the work of five ACAP-member Safety Net Health Plans to transition seniors who have low incomes or disabilities into the community and out of institutional settings.

The need for finding community-based solutions is acute given shifts in demographics: by 2035, an estimated 79 million seniors will live in the U.S. 70 percent of them – more than 50 million in all – will need long-term care services. Yet even today, there is insufficient affordable housing to accommodate the needs of low-income seniors who could live in lower-cost, community-based settings for lack of alternatives. Additionally, many seniors who live with disabilities could also benefit from living in the community, provided they have adequate support services in place.

“When appropriate, it’s far preferable for seniors to live in a house or apartment than for them to be institutionalized. But there’s just not enough affordable housing to meet the needs that are out there,” said ACAP CEO Margaret A. Murray. “The retirement of the baby boomers will swamp the resources currently available. Safety Net Health Plans are working to develop exactly those kinds of solutions, even though little funding for such efforts–or coordination between housing and health policy—exists today.”

The paper profiles five plans and their efforts to connect seniors with low incomes or disabilities to available housing:

  • Health Plan of San Mateo, whose Community Care Settings Pilot aims to transition people living in nursing homes back to the community and features partnerships with organizations in the community to deliver case management, housing and other services;
  • CareSource, a plan that has developed several programs to transition members in institutions back to the community, offers a full continuum of care-support services, and is developing a permanent supportive housing model;
  • Inland Empire Health Plan, which is developing a multi-year initiative to address housing issues that will measure the effects of housing on costs, member satisfaction, health, and quality of life;
  • Cardinal Innovations Healthcare, which is working to assure that its members in North Carolina who live with Severe Mental Illness or Severe Persistent Mental Illness (SPMI) have the option to live in their communities, or in the least-restrictive setting of their choice; and
  • L.A. Care Health Plan, which is using a full spectrum of state programs to help transition institutionalized members to the community, and is focusing on caregiver and provider support programs to assure that transitions to the community are as smooth and successful as possible.

The effort to transition members from institutions to the community requires going well beyond the traditional realm of health care; both health and housing agencies need to cooperate in a closer fashion than has traditionally been the case.

“We’ve long said that housing is health care — example after example shows that stable housing can lead to better health outcomes, higher quality of life, and lower program costs,” added Murray. “But without a concerted effort to develop affordable housing alternatives, seniors may be forced into housing situations that come with lower outcomes, and higher costs.”

The full report, Bridging the Health and Housing Gap, is available at

About ACAP
ACAP represents 61 not-for-profit Safety Net Health Plans in 29 states, which collectively serve more than 21 million people enrolled in Medicaid, Medicare, Marketplaces, the Children’s Health Insurance Program (CHIP), and other health programs. For more information, visit

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