Housing is central to older adults’ life outcomes. Housing’s affordability, physical quality, and location can impact physical and mental health. Housing policies and practices have systematically limited access to homeownership for persons of color and segregated many into disadvantaged neighborhoods. For many, this has curtailed economic and wealth building opportunities over the life course and exposed them to negative health consequences of segregated neighborhoods. Encouraging and supporting equitable access to safe and quality housing options for older adults should be a role for all aging services stakeholders.
housing policy, social determinants of health, homeownership, equity, discrimination, COVID-19
Housing policy tends to be overlooked when it comes to older adults. Attention is focused on programs and services that help older adults to stay in their homes—homemaker supports, personal care assistance, or meal deliveries—but housing fails to command the same consideration.
Maybe this is because housing policy, in my opinion, has broadly been a backburner issue. Despite the housing affordability “crisis” that has been impacting broad swaths of American households for years, for example, housing is infrequently addressed in presidential or other election campaigns.
Part of the challenge is that housing in America is viewed as a private market good, and framed as a way to build wealth. As such, housing policies, regulations, and practices are largely viewed through the lens of homeownership, increasing and protecting home values, and allowing market forces to dictate response. For example, the largest federal housing subsidy remains the mortgage interest deduction, even after the Tax Cuts and Jobs Act of 2017 lowered the cap on the size of the mortgage on which interest can be deducted (Thornton and Estep, 2019). In many cities, a large proportion of land is zoned exclusively for single-family homes (Manville, Monkkonen, and Lens, 2019).
Recently, however, the aperture on housing has been expanding. As the social determinants of health gain attention and racial and ethnic inequities are spotlighted, we’re recognizing housing’s role in physical and mental health and life opportunities.
Social Determinants of Health
The social determinants of health are the social, economic, and physical conditions under which people are born, grow, live, work, and age. These conditions affect a person’s health risks and outcomes. Housing—including stability and affordability, physical structure, and location—is a key social determinant.
Affordability and stability: Individuals who are unstably housed, which may mean they are falling behind on rent, moving frequently, or staying with friends or relatives, are more likely to experience poor health than those who are stably housed. Research has found that people who are housing insecure are less likely to have a usual source of medical care, more likely to delay doctor’s visits and to use the emergency room for treatment, report poor or fair health, or report poor health that limits their daily activities (Stahre et al., 2015; Braveman et al., 2011).
‘Housing in America is viewed as a private market good, and framed as a way to build wealth.’
Studies also have found housing instability is related to elevated stress levels, depression, and hopelessness (Center for Housing Policy and Enterprise, 2007). Unsurprisingly, high housing costs can force people to make tradeoffs with other essentials like food, healthcare and medications, and heating or cooling (Joint Center for Housing Studies of Harvard University [JCHS], 2019).
Physical structure: Quality and safety deficits in one’s home can be detrimental to health. Water leaks, poor ventilation, dirty carpets, or bug infestations can produce mold, dust mites, or other allergens associated with poor health. Lack of heating or air-conditioning, leading to extreme high or low indoor temperatures, has been associated with increased mortality. Structural features such as steep stairs, holes in floors, or inaccessible bathrooms and kitchens can result in accidents and injuries (Braveman et al., 2011).
Location: The environment in which one’s home is located can also impact health and well-being. Older adults often spend decades in their communities and thus experience higher levels of exposure to neighborhood conditions. In addition, as older adults retire or become less mobile, they may spend more concentrated time in their neighborhood.
Research shows that living in disadvantaged neighborhoods—characterized by high poverty—is associated with weak social ties, problems accessing healthcare and other services, reduced physical activity, health problems, mobility limitations, and high stress. The difference can be explained, in part, by the characteristics of people living in these neighborhoods, but also studies suggest that neighborhood characteristics may independently influence older residents’ health and well-being. Disadvantaged neighborhoods often have more crime, more pollution, poorer infrastructure, and fewer healthcare resources. Walkability; accessibility (including public transportation); safety; availability of public resources, like community centers, parks and libraries, and grocery stores with nutritious food; and healthy air all are related to health behaviors and outcomes (Mather and Scommegna, 2017, Bell et al., 2013, Braveman et al., 2011).
Today’s neighborhoods are shaped by mortgage lending practices started almost 100 years ago. In the 1930s, the Home Owners Loan Corporation graded neighborhoods according to lending risk, which was based largely on their minority makeup. Neighborhoods with racial and ethnic minorities were deemed “hazardous” and outlined in red on maps. The newly created Federal Housing Administration (FHA) would not insure loans in or near these neighborhoods, which effectively led to the entire mortgage industry refusing to make home loans to persons of color. As home ownership is a key source for building wealth in this country, this set the stage for the racial wealth gap that persists today.
Additionally, the FHA also encouraged the use of race restrictive covenants by lowering the mortgage risk on individual properties with exclusionary deed language. It also often required that developers receiving construction loans place race restrictive covenants in their subdivisions’ property deeds (Rothstein, 2017). This denied African Americans the opportunity to participate in the postwar housing boom and to move to new suburbs, trapping them in inner cities that faced declining investment.
Discriminatory lending practices were legal until 1968, when the Fair Housing Act was passed. Despite being outlawed, discriminatory and predatory lending practices and residential segregation continue today (Massey, 2015).
It is important to understand the impact of these housing practices on many current and future older adults of color.
‘In 2018, 82 percent of white adults ages 65 and older owned a home, compared to 62 percent of black older adults.’
Black older adults have had less opportunity to purchase a home. In 2018, 82 percent of white adults ages 65 and older owned a home, compared to 62 percent of black older adults (JCHS, 2019). For those who were able to buy, many have been limited to neighborhoods with lower home value appreciation and-or may have only had access to unfavorable loan products and terms. In 2012, the median home value for black households ages 65 and older was $93,000, compared to $165,000 for older white households (Butrica and Mudrazija, 2016).
These circumstances inhibited minority older adults’ opportunity to accumulate wealth over their lifetime. In 2013, the median net worth of African American older adult households ($56,700) was roughly one-fifth of the median net worth of white older adult households ($255,000) (Rosnick and Baker, 2014). While this difference cannot be attributed to home ownership alone, home equity is a primary way for American households to gain wealth
Because the housing stock in redlined areas tends to be older, older adults’ homes in these neighborhoods may be in greater need of repair (Perry and Harshbarger, 2019). With lower home values or growth in home values, older adults of color may have less equity that could be tapped into to finance needed repairs or modifications to help maintain the safety and accessibility of their home. This could put them at risk for falls or other injuries. Also it could limit their ability to ambulate in and out of the home, leading to social isolation. Similarly, they have less equity to tap into to pay for services to help them age in place, if needed.
Historically redlined neighborhoods have been and generally remain more segregated and more economically disadvantaged today than other neighborhoods (Perry and Harshbarger, 2019). These neighborhoods have faced a legacy of disinvestment, which has impacted economic opportunities, access to resources, and the physical environment.
Evidence suggests segregation is a primary cause of racial difference in income by impacting access to education and employment opportunities (Williams and Collins, 2001). Lower incomes in addition to lower opportunity for home ownership has impacted the ability of older adults of color to build wealth to help support them in retirement.
Disadvantaged and segregated neighborhoods have less access to options for buying affordable and healthy food and fewer healthcare resources (United States Department of Agriculture, 2009; Gaskin et al., 2012).
Disadvantaged neighborhoods also often have higher crime, more environmental pollution, and poor infrastructure (sidewalks, street lighting, and traffic-calming measures). These elements can influence residents’ sense of safety and willingness or ability to engage in physical activity (Center on Social Disparities in Health, 2015).
The COVID-19 Effect, on Housing
Housing is probably not the first thing that comes to mind when considering the effects of COVID-19 on older adults. The economic impact of the pandemic, however, is potentially concerning, particularly for near retirees. Drawing on the 2008 Great Recession for comparison, experts predict the COVID-19 pandemic could diminish current and future retirement savings, as well as threaten public and private retirement systems (Johnson, 2020).
Older adults may be more inoculated from the economic impact of the pandemic than younger persons, as many are already retired and-or own their home outright. However, some near retirees may have lost their jobs, thus potentially impeding their ability to save for retirement. This could impact their future ability to sustain housing costs or inhibit future choices about housing, such as making repairs or modifications, or moving to an alternative housing type. For some lower-wage near retirees without a savings cushion, it could have a more immediate and lasting impact on their ability to afford housing costs.
Why Does This Matter for Aging Services Stakeholders
Housing is a broad and complex topic, and aging services stakeholders may not understand the connection to their role, or know how to engage. But the discussion above shows that an older adult’s housing situation plays a fundamental role in their ability to maintain health and quality of life. Aging services providers and policymakers should consider it a key platform supporting the implementation or success of their services and initiatives.
Affordability: Housing affordability is a fundamental problem in this country, including for older adults. Nearly 10 million older adult households, both owners and renters, are cost-burdened and pay more than 30 percent of their income for housing (JCHS, 2019). Excessive housing costs can lead to tradeoffs on other necessities like food or medications, living in unsafe conditions, or, at the extreme, homelessness.
Options: Zoning and other land-use regulations often create and protect single-family development, which can limit the range of housing types and impact affordability in neighborhoods. Rental housing or alternatives such as accessory dwelling units or cottage housing may be excluded. This limits opportunities for older adults to leverage their housing for income or care needs or to downsize or move to an alternative housing type to fit their changing needs and interests and remain in their neighborhood, where they have history and a social network.
Opportunity: Older Americans’ life course contributes to their health (Vega and Wallace, 2016). The ability of many older adults of color to purchase a home has been systematically limited, impeding a primary path for building economic opportunity and wealth; and many have been segregated into disadvantaged neighborhoods, limiting economic opportunity and exposing them to environments that increase risks for health problems.
While many aging services stakeholders may not be engaged in housing delivery or policy, the success of their services and supports often is intertwined with the stability and quality of their client’s or constituent’s housing. Aging services providers and policymakers should look for opportunities to support or encourage initiatives that will provide older adults (particularly lower income elders and older adults of color) with adequate housing. This could include paying attention to and being an ally around funding for the creation and preservation of affordable housing stock and rental subsidies, mechanisms for financing home repairs and adaptations, reforms to local and state land-use regulations and building inclusionary zoning opportunities, granting approvals for construction of new affordable senior properties, promoting and enforcing equitable housing finance opportunities, and eliminating barriers to fair housing.
Where we live has a profound impact our opportunities and outcomes in life. It’s important to recognize this for today’s older adults and to shape the prospects for future older adults.
Alisha Sanders, M.P.Aff., is director of Housing and Services Policy Research at LeadingAge, in Washington, DC.
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