May 10, 2018 / 3:14 PM / a year ago

Vermont can show Washington the way on senior housing policy

CHICAGO (Reuters) - Hey, Ben Carson - how about a field trip to Vermont?

U.S. Secretary of the Department of Housing and Urban Development Ben Carson testifies before a Senate Banking Committee hearing entitled "Oversight of HUD" on Capitol Hill in Washington, U.S., March 22, 2018. REUTERS/Kevin Lamarque

It is lovely up there this time of year, and the trip would afford the chance to rethink the slash-and-burn vision of affordable housing offered last month in your role as secretary of the U.S. Department of Housing and Urban Development.

In particular, I recommend stopping in Burlington to meet Molly Dugan, who directs one of the nation’s most innovative health programs for low-income seniors. Called Support and Services at Home (SASH), the program demonstrates how stable housing for low-income seniors can be a platform for improving health outcomes while saving Medicare money. It is operated by Cathedral Square Corp, a Vermont non-profit low-income housing provider.

Secretary Carson, as a physician you will find SASH very interesting. It should give you reason to reconsider the dramatic overhaul of federal housing subsidies you proposed last month, which would triple rent for the poorest households and ease the way for housing authorities to impose work requirements on residents.

The proposals, which require approval by the U.S. Congress, could affect all residents of federally-subsidized affordable housing.

SASH, by contrast, uses housing as a platform for preventive measures that make a difference. Each housing facility has a wellness nurse working with care coordinators.

“We focus on things that address chronic conditions like hypertension, diabetes and prevention of falls,” Dugan says.

The program started in 2009. After one year, the number of residents admitted to hospitals fell 19 percent. The number of falls dropped as nutrition scores rose.

Today, SASH serves 5,000 low-income senior residents in the state. It receives $3.7 million in Medicare funding and has documented reduced spending of $1,200 annually per patient.


Cathedral Square has a waiting list of 500 low-income seniors seeking shelter, and that is just a sneak peek at the senior housing shortage looming as the nation ages.

By 2035, one of every three U.S. households will be headed by someone aged 65 or older, according to the Harvard Joint Center for Housing Studies, an increase of a whopping 66 percent to 50 million households. Households headed by people aged 80 and older will increase at the fastest rate, more than doubling to 16 million (

Affluent people will have the means to adapt their housing to fit their needs, but the bulging population of low-income seniors will pose a crisis. The number of seniors earning less than 80 percent of their area median income will nearly double by 2035, according to the Harvard researchers, to 27 million.

These households will face enormous challenges paying for housing and supportive services, with housing expenses sapping resources badly needed for food and healthcare. By 2035, some 8.6 million people will be paying more than half their income for housing, according to the Harvard researchers.

Secretary Carson, your proposal would only worsen the problem. Initially, it would exempt most of the 1.5 million seniors currently receiving federal housing assistance for six years. But it would lift the current minimum age of qualification for senior subsidies from 62 to 65, and revise the federal formula used to define income from adjusted to gross income.

That would remove seniors’ ability to deduct medical expenses, notes Linda Couch, vice president for housing policy at Leading Age, an association representing 6,000 aging services agencies.

“These are seniors whose rents were designed to accommodate high medical costs,” Couch said. “The proposed changes sets seniors up to have to choose between paying for rent, health care and food.”

A lack of housing stability means more low-income seniors will be homeless, or live in structures ill-suited for aging.

Most housing was not designed for an elderly population. “You don’t find grab bars in bathrooms, the appropriate lighting and broader hallways and ramps,” says Anand Parekh, a physician and chief medical advisor at the Bipartisan Policy Center.

Dr. Parekh notes that falls are the leading cause of injury-related deaths in the United States. Data from the Centers for Disease Control and Prevention shows 2.8 million older people are treated in emergency rooms annually for falls, and 800,000 are hospitalized.

In 2015, total medical cost for falls totaled more than $50 billion, with Medicare and Medicaid paying 75 percent.

Secretary Carson - how about that trip to Vermont?

(The writer is a Reuters columnist. The opinions expressed are his own.)

Editing by Lauren Young and David Gregorio

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