Older adults in the “forgotten middle” market are still struggling to access senior housing, but certain changes to legislation and policy could help make their situation less dire.

That was the consensus during a webinar hosted by NORC at the University of Chicago Oct. 25.

NORC research over the years has found that millions of older adults currently can’t afford access to senior housing as it is currently priced. That cohort of older adults, part of a larger group often known as the “forgotten middle,” with incomes ranging between $26,000 to $103,000; could number almost 16 million people by 2033. Another 11.5 million older adults would be unable to afford senior housing if they suffered a debilitating event, such as breaking a hip or developing dementia.

Many of those older adults are “near-duals,” meaning they are old enough to qualify for Medicare but just outside the income range required for Medicaid. Those older adults have annual incomes between $11,000 and $28,000, and up to $26,000 in assets.

According to Dianne Munevar, vice president of healthcare strategy with NORC, the issue is exacerbated by housing shortages, increasing healthcare costs and workforce shortages.

“When we combine these issues, the U.S. healthcare system needs to find innovative solutions that cross multiple sectors and enlist the help of both the public and private sectors,” Munevar said. “The middle market faces a policy crisis with no clear solution.”

By 2033, the “forgotten middle” is anticipated to nearly double in size with an increasing number of health needs. Over half of the cohort are anticipated to have three or more chronic health needs and almost one-third are anticipated to have cognitive impairments. According to Munevar, nearly three-quarters of middle income seniors won’t be able to afford private assisted living without selling their homes.

“These individuals are literally one fall, one hospitalization, away from spending down to poverty within one or two years,” Munevar said.

NORC is also focusing efforts on highlighting the disparities seen by Black and Hispanic families. Munevar said between 2020 and 2035, home ownership rates for older Black adults is expected to drop from a share of 82% to a share of 69%, which will greatly complicate their ability to age in place. Black and Hispanic adults are also less likely to have liquid assets to help pay for senior care, such as stocks and Roth IRAs.

“Overall, older adults of color in the forgotten middle are clustered at the poorest end of the financial spectrum,” she said. “They tend to have the lowest income and assets to support themselves in older age.”

NORC’s research also shows that both the forgotten-middle older adults and near-duals have very similar needs for long term care and services. Munezar said a useful benefit for near duals would be utilization of Medicare Savings Programs – but only 18% are enrolled, “indicating there’s real potential lack of access to a program for which many are eligible.”

While the situation appears grim, Munevar said it is still solvable, and NORC is working on policy ideas including developing a pathway for a new benefit under Medicare for home and community based services, expanding Medicaid eligibility requirements, expanding the scope and eligibility of home modification programs and increasing national funding for community based programs.

“This research portfolio was scoped with the clear understanding that the research was performed in service of proposing policy solutions that were informed by rigorous research,” Munevar said. “There is a clear call to action here.”