To live successfully in the community and mitigate the risk of needing to move to an institutional setting, low-income older adults and younger people with disabilities who require long-term services and supports (LTSS) need both affordable, stable housing and appropriate services. Thus, while past versions of the LTSS State Scorecard have focused on states’ performance in the area of home- and community-based services, the 2020 edition highlights another key driver in creating more choices for individuals with care needs: affordable housing.1
Some states have, in fact, developed solutions in this area. This report highlights how such states have addressed both housing and service concerns for Medicaid and state-funded LTSS beneficiaries by linking affordable housing properties with LTSS and other supportive services.2 While most states and their managed care plan vendors primarily view affordable housing merely as an alternative source of shelter for individuals who are transitioning from nursing homes to the community, the state programs presented in this report take a more proactive approach to linking housing with services. For these states, housing with services is a platform for helping low-income LTSS beneficiaries to successfully remain in their own apartments and communities—reducing the likelihood of a move into a higher care, higher cost living environment like a nursing home or other licensed residential care setting.
Further, such solutions may address other impending challenges. The home care workforce is projected to add nearly 1.1 million new jobs—more than any other occupation—over the period of 2018 to 2028. In addition, an estimated 3.7 million home care workers will change occupation or retire, leaving their positions to be filled.3 One analysis predicts a shortage of approximately 446,000 home health aides by 2025.4 The economies of scale created by clustered service delivery in a congregate setting can help address worker shortages and potentially reduce state home care costs. Under that approach, people with LTSS needs may live in the same community, in close proximity to one another, allowing for services to “cluster” nearby and service delivery to be cost effective and efficient.
1 Susan Reinhard et al., Advancing Action: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers (Washington, DC: AARP, September 2020), https://www.longtermscorecard.org/2020-scorecard/preface.
2 The term affordable housing, also called subsidized housing, refers to apartment communities that receive some form of public subsidy to make the rents affordable to individuals with incomes below a certain eligibility level (e.g., public housing or Section 202 Supportive Housing for the Elderly).
3 PHI, Direct Care Workers in the United States: Key Facts (Bronx, NY: PHI, September 2020), https://phinational.org/ resource/direct-care-workers-in-the-united-states-key-facts/.
4 Mercer, Demand for Healthcare Workers Will Outpace Supply by 2025: An Analysis of the U.S. Healthcare Labor Market (Washington, DC: Mercer, LLC, 2018), https://www.mercer.us/our-thinking/career/demand-for-healthcare-workers-will-outpace-supply-by-2025.html.