Examining Health Differences Among Older Adults with Federal Rental Assistance in the United States.

About 1.8 million older adults receive rental assistance in the United States, but surprisingly little is known about their health, especially among the growing number of older housing choice voucher (HCV) holders. This is the first known study to use nationally representative data (2006-2018) from the National Health Interview Survey merged with Department of Housing and Urban Development (HUD) administrative data to describe the health of older HUD renters (N = 4,582) living in public housing, multifamily housing, or receiving an HCV. Logistic regression models were used to examine potential health differences by HUD program type. Contrary to expectations, the results suggest that older HCV holders were more likely to experience health challenges compared to older adults with project-based assistance. The results bring awareness to the health challenges experienced by older HCV holders and emphasize the need for future research to examine why older HCV holders are more likely to experience these health challenges. Policy makers and program administrators must consider how the HCV program has significantly aged in the past two decades and consider what program and policy changes are necessary to ensure that older adults have access to affordable housing that matches their changing needs and preferences.

Does Subsidized Housing Prevent Health Decline and 2-Year Mortality Among Low-Income Older Renters?

BACKGROUND AND OBJECTIVES: A growing number of older adults in the United States need subsidized housing, but only 36% of eligible households receive assistance. The purpose of this study is to examine if older renters living in subsidized housing are less likely to experience health decline and mortality over 2 years compared to low-income older renters who are likely eligible, but do not receive assistance. RESEARCH DESIGN AND METHODS: Baseline data include 671 subsidized and unsubsidized low-income older renters from the 2015 National Health and Aging Trends Study. Outcomes of interest include self-rated health decline, developing a new activity limitation, or 2-year mortality between 2015 and 2017. Weighted stepwise logistic regression models test (a) if subsidized older renters were less likely to experience health decline or 2-year mortality compared to unsubsidized older renters, and (b) if housing quality and neighborhood factors mediate the association between subsidized housing and health decline/mortality. RESULTS: Subsidized older renters were less likely to develop a new activity limitation compared to unsubsidized older renters, but there was not a statistically significant difference in experiencing self-rated health decline or 2-year mortality by subsidized housing status. Housing quality and neighborhood factors did not significantly mediate this association. DISCUSSION AND IMPLICATIONS: The results provide some support that improving access to subsidized housing for low-income older renters may have additional health benefits, even in the short term. To inform program improvements and maximize potential health benefits, more research is needed to understand the specific health-promoting features of subsidized housing.

Examining Consequences Related to Unmet Care Needs Across the Long-Term Care Continuum.

OBJECTIVES: To examine how different care arrangements across the long-term care continuum are associated with experiencing unmet care need consequences (UCNCs), such as skipping meals, going without clean clothes, or taking the wrong medication. METHODS: We include older adults receiving assistance with at least one self-care, mobility, or household activity (for health/functioning reasons) in the 2015 National Health and Aging Trends Study (N = 2,388). We examine the likelihood of experiencing a UCNC across the long-term care continuum: those receiving unpaid community care only, paid community care, and residential care. Cross-sectional logistic and longitudinal multinomial logistic regression models examine if type of care arrangement in 2015 is associated with UCNCs in 2015 and change in UCNCs by 2017. RESULTS: In adjusted cross-sectional models, paid community care recipients had roughly 2 times greater odds of experiencing a UCNC in 2015 compared to those living in residential care or receiving only unpaid care. In adjusted longitudinal models, the risk of experiencing persistent UCNCs (compared to having needs met in both years) was 4.81 times higher for those receiving paid community care compared to those in residential care and 2.17 times that of those receiving unpaid care only. DISCUSSION: Older adults receiving paid care face significant and consequential gaps in care, particularly in comparison to those in other care arrangements. More attention is needed to determine how paid care arrangements can be improved and/or expanded to meet the needs of the growing number of older adults receiving paid care in the community.

Housing Cost Burden and Health Decline Among Low- and Moderate-Income Older Renters.

OBJECTIVE: To examine the association between housing cost burden (HCB) and health decline among low- and moderate-income older renters in the United States. METHOD: Baseline data include low- and moderate-income community-dwelling older renters (N = 1,064) from the nationally representative 2015 National Health and Aging Trends Study. HCB was defined as the percentage of monthly income spent on rent, categorized as "no HCB" (<30%), "moderate HCB" (30%-49%), and "severe HCB" (≥50%). We used weighted logistic regression models to estimate whether HCB status in 2015 and change in HCB between 2015 and 2017 were associated with self-rated health decline and developing a new limitation related to activities of daily living (ADL) or instrumental activities of daily living (IADL) between 2015 and 2017. RESULTS: Older renters with severe HCB in 2015 were the most likely to develop a new ADL/IADL limitation (63.4%) over time (p < .05). The association between HCB status in 2015 and self-rated health decline was not statistically significant, but older renters with persistent HCB had 1.64 times greater odds of self-rated health decline (p < .05) and 2.01 times greater odds of developing a new ADL/IADL limitation (p < .01), compared to older renters with no HCB at baseline and follow-up. DISCUSSION: Even in the short term, HCB contributes to health decline in later life. Efforts to promote equity and healthy aging in the community must consider how to best address housing affordability among the growing population of older renters.

Dismantling Systemic Racism in Long-Term Services and Supports: A Call to Action for Social Workers.

Given the rapidly changing Long-Term Services and Supports (LTSS) system in the United States, it is essential for social workers and other health professionals to critically examine how this evolving landscape continues to shape racial inequities in formal LTSS and subsequent health outcomes. This commentary seeks to inform social work education, research, and practice by describing how systemic racism impacts the use and quality of formal LTSS. We present a call to action for social workers to dismantle systemic racism in LTSS that perpetuates ongoing racial inequities.

The Effects of Housing Cost Burden and Housing Tenure on Moves to a Nursing Home Among Low- and Moderate-Income Older Adults.

BACKGROUND AND OBJECTIVES: In the United States, a growing number of older adults struggle to find affordable housing that can adapt to their changing needs. Research suggests that access to affordable housing is a significant barrier to reducing unnecessary nursing home admissions. This is the first empirical study we know of to examine whether housing cost burden (HCB) is associated with moves to nursing homes among older adults. RESEARCH DESIGN AND METHODS: Data include low- and moderate-income community-dwelling older adults (N = 3,403) from the nationally representative 2015 National Health and Aging Trends Study. HCB (≥30% of income spent on mortgage/rent) and housing tenure (owner/renter) are combined to create a 4-category housing typology. Multinomial logistic regression models test (a) if renters with HCB are most likely (compared with other housing types) to move to a nursing home over 3 years (2015-2018) and (b) if housing type interacts with health and functioning to predict moves to a nursing home. RESULTS: Across all models, renters with HCB had the greatest likelihood of moving to a nursing home. Moreover, self-rated health, physical capacity, and mental health were weaker predictors of nursing home moves for renters with HCB. DISCUSSION AND IMPLICATIONS: Results suggest that older renters with HCB are most likely to experience unnecessary nursing home placement. The growing population of older renters experiencing HCB may not only signal a housing crisis, but may also challenge national efforts to shift long-term care away from nursing homes and toward community-based alternatives.

Black-White Disparities in Moves to Assisted Living and Nursing Homes Among Older Medicare Beneficiaries.

OBJECTIVES: Investigate black-white disparities in older adults' moves to assisted living and nursing homes and draw from the Andersen Healthcare Utilization Model to test explanations for any disparities. METHODS: Data are from a nationally representative sample of older community-dwelling Medicare beneficiaries from the 2015 (N = 5,212) National Health and Aging Trends Study (NHATS). We use stepwise multinomial logistic regression to examine black-white disparities in moves out of community housing to assisted living or a nursing home over 2 years, before and after adjusting for predisposing (age, gender), enabling (income, housing tenure, Medicaid, living arrangement) and need (activities of daily living [ADL] limitation, physical capacity, self-rated health, and dementia) factors. RESULTS: Black older adults are less likely to move to assisted living and are more likely to move to a nursing home compared to white older adults. Black-white disparities in moves to nursing homes are explained by black-white differences in enabling and need factors, whereas black-white disparities in moves to assisted living remain even after adjusting for enabling and need factors. DISCUSSION: Unmeasured factors related to systemic racism (e.g., residential racial segregation, racial discrimination) and/or black-white differences in care preferences might further explain black-white disparities in moves to assisted living and warrant further investigation.

The Greater St. Louis LGBT Health and Human Services Needs Assessment: an examination of the Silent and Baby Boom generations.

This study sought to understand differences and similarities between lesbian, gay, bisexual, and transgender (LGBT) Baby Boomers and members of the Silent generation in the greater St. Louis region in relation to perceived barriers to service use, LGBT identity disclosure, experiences of violence and victimization, and mental health. An online survey was completed by 118 Baby Boomers and 33 Silents. Baby Boomers were found to perceive more barriers to health care and legal services, have fewer legal documents in place, feel less safe in their communities, and have experienced an increased rate of verbal harassment compared to their predecessors. Differences may be attributed to higher levels of LGBT identity disclosure among Baby Boomers across their lifetime. These findings support the current work of Services and Advocacy for GLBT Elders Metro St. Louis, with implications for other communities, and shed light on the need for continued advancement in the development and implementation of programs as LGBT Baby Boomers age.