Affordable Senior Housing Model Held Back By Financing Challenges

Demand for affordable housing to accommodate the changing needs of low-income seniors is growing, but non-Medicare and Medicaid payment models to finance the services are sorely lacking.

That is the main takeaway from a new report from LeadingAge LTSS Center @UMass Boston that also offers possible solutions to what is a growing crisis, Alisha Sanders, Director, Housing and Services Policy Research at the Center, told Senior Housing News.

LTSS Center researchers, along with colleagues from the National Well Home Network and the Harvard Medical School Department of Health Care Policy, studied various financing options for affordable senior housing as a platform for delivering health and supportive services, which were found to have a positive impact in helping seniors maintain a better quality of life, age in place longer, and reduce the need for acute care services.


“It’s a complex issue,” Sanders said. “The average age of residents in these communities is increasing.”

A need for sustainable financing

Researchers discovered few payment models to support the housing-plus services model, outside of Medicare and Medicaid. This raises the question: how can the housing-plus-services model be financed in a manner that is scalable and sustainable?

The research team looked at Medicare and Medicaid as a baseline, because it is a primary payer of the onsite services these communities provide and because it is a sustainable financing mechanism, Sanders said.


A major concern for housing-plus-services financial models is the volume of residents that would be covered by a payer entity. Affordable housing communities vary in size; smaller properties would be unlikely to support the full-time caregiver staff that is the backbone of the housing-plus-services model.

The research suggests a possible solution would be to join with other communities in an area to deliver housing-based services, Sanders said.

“If there are multiple properties in one area or a cluster of housing properties, operators could consider how they can aggregate in order to create volume for a potential health partner,” she said.

Using Medicare and Medicaid presents its own challenges.

“This population-based and housing-based model is at odds with traditional Medicare fund services, which typically go through doctors’ offices,” Sanders said. “[The report is] trying to figure out how to match this different delivery model with the Medicare program.”

Exploring alternative payment models

With Medicare and Medicaid as a foundation, researchers suggest the industry explore creating alternative payment models (APM) — payment approaches that give providers added incentive payments, through government or private sector payers, to provide high-quality and cost-efficient care.

APMs can apply to a specific clinical condition, a care episode, or a population, and economists who assisted in the study said it is an option that makes sense.

“It incentivizes providers to do more care coordination,” Sanders said. “The concept could be a vehicle to incentivize providers to collaborate with housing or provide a framework for providing a payment mechanism for the housing service.”

If an APM can be built and is sustainable, it can lay the foundation for increased affordable senior housing and care as more low-income seniors enter the space.

“We’re offering a different type of delivery model,” Sanders said. “But the payment model isn’t there yet.”

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