Age-Forward 2030: The Intersection of Housing and Health Care

Current Demographic & Preference Trends

• 76% of adults over 50 prefer to age at home, according to AARP.
• Over 50% of middle-income seniors cannot afford both housing and care simultaneously.
• The Milken Institute's "H4 2030" report identifies affordable housing and integrated care as top local priorities for enactment by 2030.
• The population of households headed by someone over 80 is projected to rise from 7 million today to 16–17 million within 20 years.
• 80% of older Americans currently live in single-family, low-density housing, increasing risks of social isolation.

Economic & Housing Insecurity Statistics

• Approximately 5 million elderly households spend more than 50% of their income on housing costs.
• When housing costs exceed 50% of income, households first cut spending on food, followed by health care.
• 68% of Americans have experienced at least one unmet social need (housing, food, transportation, or social isolation).
• 25% of Americans report that unmet social needs act as a direct barrier to accessing health care (e.g., choosing between rent and medication copays).
• The typical renter holds only a few thousand dollars in net wealth, compared to $100,000–$200,000 for the typical homeowner.

Health Outcomes Linked to Housing Stability

• Homeless hospital stays last 2–3 days longer than those of housed patients.
• Hospital readmission rates are 50% higher for homeless individuals upon discharge.
• The mortality rate for homeless individuals is 3–4 times higher than for those with housing.
• Total cost of care for homeless individuals is 3–4 times higher than for housed individuals.
• Homelessness is associated with a 27-year reduction in life expectancy.

Policy Initiatives & Government Roles

• California Governor Newsom signed an executive order for a state-level "Master Plan for Aging," with housing and transportation integrated into the plan; the report is due October 2020.
• City Health, a Kaiser Permanente initiative, is supporting 40 U.S. cities in adopting nine evidence-based policies, including inclusionary zoning.
• The "Mayors and CEOs for U.S. Housing Investment" coalition (24 bipartisan mayors) is advocating for federal infrastructure bills to include affordable housing and the expansion of veteran vouchers.
• Oregon has eliminated single-family zoning at the state level, and Minneapolis is following suit to allow for higher density.
• Kaiser Permanente allocated $200 million in 2023 to preserve and expand affordable housing, requiring health plan partnerships as a condition of funding.

Innovative Housing & Care Models

• Capable Model: Johns Hopkins' program uses occupational therapists and nurses to assess needs and fund home modifications (e.g., grab bars, ramps) for complex chronic patients.
• Oakland Shared Housing: A pilot program placed 515 homeless individuals into stable housing in eight months; 70% moved into shared housing arrangements rather than permanent supportive housing alone.
• Intergenerational Co-location: Models in D.C. pair homeless LGBTQ youth with isolated seniors, providing housing and training for youth to provide care services.
• Multi-Generational Housing: Research suggests living arrangements across generations (including non-blood relatives) improve health outcomes for all age groups.
• Co-located Facilities: Gensler designed a facility in D.C. co-locating a federally qualified clinic, affordable housing, and job training under one roof.

Design & Community Features

• Life expectancy can vary by up to 25 years between adjacent neighborhoods in New Orleans based on zip code and design.
• Gentrification is viewed as a potential tool to build healthier communities if it includes mechanisms to retain existing residents and culture.
• Future design goals include "complete streets" (safe for all modalities), mixed-use developments, and "new urbanism" principles to reduce car dependency.
• Retrofitting existing housing stock (e.g., adding bathrooms on the first floor, removing rugs) is critical for aging in place but requires significant capital investment.

Barriers to Implementation

• Fragmentation: Historically, housing, transportation, and health care have been treated as separate budget and policy silos at the state level.
• Developer Incentives: Developers prioritize consumer demand; a "Peter Pan" mindset (refusal to plan for aging) currently drives market supply.
• Regulatory Complexity: Governmental red tape prevented the inclusion of PACE (Program of All-Inclusive Care for the Elderly) programs in some co-located facilities in D.C.
• Funding Gaps: Middle-income seniors often preserve savings ("nest eggs") to avoid spending them on care, leading to catastrophic financial outcomes later.

Forward-Looking Vision for 2030

• Social Health Integration: Health systems must embed social health metrics alongside physical and mental health in care delivery.
• Cultural Shift: Communities must eliminate stigma around aging and integrate seniors into social circles and workforce participation.
• Systemic Change: Requires coordinated action across federal (funding/policy), state (master planning), and local (zoning/land use) governments.
• Diverse Housing Supply: Expect a proliferation of niche housing solutions (co-housing, granny flats, shared housing) as the "age-forward" population diversifies.
• Leveraging Senior Assets: Programs must recognize older adults not just as care recipients but as contributors of institutional knowledge and community mentorship.