scholarly journals The Effects of Housing Cost Burden and Housing Tenure on Moves to a Nursing Home Among Low- and Moderate-Income Older Adults

2020 ◽  
Vol 60 (8) ◽  
pp. 1485-1494
Author(s):  
Meghan Jenkins Morales ◽  
Stephanie A Robert
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Affordable Housing ◽  
The United States ◽  
Community Dwelling ◽  
Housing Tenure ◽  
Housing Cost ◽  
Cost Burden ◽  
Housing Cost Burden

Abstract Background and Objectives In the United States, a growing number of older adults struggle to find affordable housing that can adapt to their changing needs. Research suggests that access to affordable housing is a significant barrier to reducing unnecessary nursing home admissions. This is the first empirical study we know of to examine whether housing cost burden (HCB) is associated with moves to nursing homes among older adults. Research Design and Methods Data include low- and moderate-income community-dwelling older adults (N = 3,403) from the nationally representative 2015 National Health and Aging Trends Study. HCB (≥30% of income spent on mortgage/rent) and housing tenure (owner/renter) are combined to create a 4-category housing typology. Multinomial logistic regression models test (a) if renters with HCB are most likely (compared with other housing types) to move to a nursing home over 3 years (2015–2018) and (b) if housing type interacts with health and functioning to predict moves to a nursing home. Results Across all models, renters with HCB had the greatest likelihood of moving to a nursing home. Moreover, self-rated health, physical capacity, and mental health were weaker predictors of nursing home moves for renters with HCB. Discussion and Implications Results suggest that older renters with HCB are most likely to experience unnecessary nursing home placement. The growing population of older renters experiencing HCB may not only signal a housing crisis, but may also challenge national efforts to shift long-term care away from nursing homes and toward community-based alternatives.

scholarly journals Black–White Disparities in Moves to Assisted Living and Nursing Homes Among Older Medicare Beneficiaries

2019 ◽  
Vol 75 (9) ◽  
pp. 1972-1982 ◽  
Author(s):  
Meghan Jenkins Morales ◽  
Stephanie A Robert
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Assisted Living ◽  
Multinomial Logistic Regression ◽  
Living Arrangement ◽  
Community Dwelling ◽  
Housing Tenure ◽  
Medicare Beneficiaries ◽  
Nationally Representative

Abstract Objectives Investigate black-white disparities in older adults’ moves to assisted living and nursing homes and draw from the Andersen Healthcare Utilization Model to test explanations for any disparities. Methods Data are from a nationally representative sample of older community-dwelling Medicare beneficiaries from the 2015 (N = 5,212) National Health and Aging Trends Study (NHATS). We use stepwise multinomial logistic regression to examine black-white disparities in moves out of community housing to assisted living or a nursing home over 2 years, before and after adjusting for predisposing (age, gender), enabling (income, housing tenure, Medicaid, living arrangement) and need (activities of daily living [ADL] limitation, physical capacity, self-rated health, and dementia) factors. Results Black older adults are less likely to move to assisted living and are more likely to move to a nursing home compared to white older adults. Black-white disparities in moves to nursing homes are explained by black-white differences in enabling and need factors, whereas black-white disparities in moves to assisted living remain even after adjusting for enabling and need factors. Discussion Unmeasured factors related to systemic racism (e.g., residential racial segregation, racial discrimination) and/or black-white differences in care preferences might further explain black-white disparities in moves to assisted living and warrant further investigation.

scholarly journals HOUSING COSTS BURDEN AND SELF-RATED HEALTH: PRELIMINARY FINDINGS FROM A U.S. SAMPLE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S938-S938
Author(s):  
Ji Hyang Cheon ◽  
John Cagle ◽  
Amanda Lehning
Keyword(s):  
Older Adults ◽  
Well Being ◽  
Policy Implications ◽  
Housing Cost ◽  
Cost Burden ◽  
Linear Regression Models ◽  
Assistance Programs ◽  
Self Rated Health ◽  
Housing Cost Burden ◽  
Using Data

Abstract Self-rated health is a multidimensional construct that includes not only physical health but also emotional and social well-being. Previous research has demonstrated that multiple factors contribute to individual self-rated health, including income. Because income is a somewhat limited indicator of older adults' financial circumstances, alternative measures such as housing cost burden may enhance our understanding of contributors to self-rated health. Further, because homeowners and renters may have a different attachment to their home and neighborhood, homeownership may moderate the association between housing cost burden and self-rated health. This study examined these relationships using data from 3,212 older adults in round 7 (2017) of the National Health & Aging Trends Study. Findings from multiple linear regression models indicate that the housing cost burden is associated with lower self-rated health, and this association is stronger for renters compared to homeowners. The findings indicate the potential for reduced housing cost burden to have a positive effect on health. The poster will conclude with practice and policy implications, including the potential benefits of expanding rental assistance programs to older adults who may not meet current income requirements but are experiencing high housing cost burden, as well as research implications, including the need for longitudinal approaches.

scholarly journals LOOKING UPSTREAM: THE ASSOCIATION BETWEEN AFFORDABLE HOUSING, NURSING HOME USE, AND UNMET CARE NEEDS IN THE COMMUNITY

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S155-S156
Author(s):  
Meghan Jenkins Morales ◽  
Stephanie Robert
Keyword(s):  
Nursing Home ◽  
Affordable Housing ◽  
Protective Factor ◽  
Population Aging ◽  
Community Dwelling ◽  
Housing Cost ◽  
Housing Crisis ◽  
Care Needs ◽  
Nationally Representative ◽  
Income Model

Abstract In the U.S., population aging is coinciding with a growing affordable housing crisis. Evidence suggests that housing security contributes to health, but less is known about how affordable housing affects aging in place. We use a nationally representative sample (n=5,117) of older community-dwelling Medicare beneficiaries from the 2015 National Health and Aging Trends Study to test the association between housing cost burden (HCB) and moving to a nursing home, death, or remaining in the community by 2017. Among 2017 community-stayers (n=4,836), we also test the association between HCB and unmet care need, defined as experiencing a consequence related to 12 mobility (e.g., stayed in bed), self-care (e.g., skipped meals) and household (e.g., no clean laundry) activities. HCB is the proportion of income spent on rent or mortgage: low (<30%), moderate (30-50%), severe (≥50%), or home paid off (referent). Among nursing home movers, 26% had moderate or severe HCB in 2015 compared to 16% of community-stayers. Informed by the person-environment fit perspective, weighted stepwise regression models (multinomial and logistic) adjust for race, age, sex (Model 1), self-rated health, probable dementia (Model 2), living with others and high income (Model 3). Severe HCB is significantly associated with nursing home entry (RRR=2.66, SE=0.89) and this association is only partially mediated by health factors (RRR=2.16, SE=0.72) and resources (RRR=1.95, SE=0.64). Among community-stayers, severe HCB is significantly associated with unmet care need across all models. This study suggests that affordable housing is an important protective factor for older adults to age well in the community.

The High Price of Obesity in Nursing Homes

2015 ◽  
Vol 16 (1) ◽  
pp. 14-19 ◽  
Author(s):  
Cindy L. Marihart ◽  
Ardith R. Brunt ◽  
Angela A. Geraci
Keyword(s):  
Older Adults ◽  
Nursing Home ◽  
Nursing Homes ◽  
Home Care ◽  
The United States ◽  
Nursing Home Care ◽  
Health Concern ◽  
High Price ◽  
Obese Adults ◽  
Obese People

This article provides a commentary on the costs of obese nursing home patients. We conducted a comprehensive literature search, which found 46 relevant articles on obesity in older adults and effects on nursing home facilities. This review indicated obesity is increasing globally for all age groups and older adults are facing increased challenges with chronic diseases associated with obesity more than ever before. With medical advances comes greater life expectancy, but obese adults often experience more disabilities, which require nursing home care. In the United States, the prevalence of obesity in adults aged 60 years and older increased from 9.9 million (23.6%) to 22.2 million (37.0%) in 2010. Obese older adults are twice as likely to be admitted to a nursing home. Many obese adults have comorbidities such as Type 2 diabetes; patients with diabetes incurred 1 in every 4 nursing home days. Besides the costs of early entrance into nursing facilities, caring for obese residents is different than caring for nonobese residents. Obese residents have more care needs for additional equipment, supplies, and staff costs. Unlike emergency rooms and hospitals, nursing homes do not have federal requirements that require them to serve all patients. Currently, some nursing homes are not prepared to deal with very obese patients. This is a public health concern because there are more obese people than ever in history before and the future appears to have even a heavier generation moving forward. Policymakers need to become aware of this serious gap in nursing home care.

scholarly journals Housing Cost Burden and Well-Being in Older Adults Moderated by Neighborhood Cohesion and Disorder

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 949-949
Author(s):  
Ji Hyang Cheon ◽  
Min Kyoung Park ◽  
Todd Becker
Keyword(s):  
Older Adults ◽  
Well Being ◽  
Future Research ◽  
Housing Cost ◽  
Neighborhood Disorder ◽  
Cost Burden ◽  
Neighborhood Cohesion ◽  
Research Questions ◽  
Housing Cost Burden ◽  
Neighborhood Level

Abstract Although aging in the community promotes well-being in older adults, contextual factors (e.g., housing cost burden, neighborhood cohesion, neighborhood disorder) may impact this relationship. Identifying such risk factors represents a first step toward improving older adult well-being. NHATS data (Rounds 5–8) were used to answer two research questions (RQs). RQ1: “Is housing cost burden significantly associated with well-being?” RQ2: “Is this association further moderated by neighborhood cohesion and neighborhood disorder?” Participants were 18,311 adults ≥ 65 years old. Well-being was assessed by summing 11 commonly identified indicators. Two items were merged to assess housing cost burden (categories: “no burden,” “no money for utilities,” “no money for rent,” and “no money for utilities or rent”). Neighborhood cohesion and disorder were combined (categories: “no cohesion, no disorder,” “yes cohesion, no disorder,” “no cohesion, yes disorder,” and “yes cohesion, yes disorder”). Both RQs were assessed through a random coefficient model controlling for established covariates. RQ1 results revealed that, compared to “no burden,” “no money for utilities or rent” (B = −1.22, p = .003) and “no money for rent” (B = −1.50, p = .007) were significantly associated with well-being. RQ2 results revealed that “no cohesion, no disorder” significantly moderated the association between “no money for utilities or rent” and well-being (B = −2.44, p = .011). These results indicate that increased housing cost burden is associated with decreased well-being, especially for those reporting no neighborhood cohesion. Future research should examine neighborhood-level protective factors promoting cohesion for older adults to support well-being.

Housing Cost Burden and New Lawful Immigrants in the United States

2009 ◽  
Vol 29 (2) ◽  
pp. 143-171 ◽  
Author(s):  
Eileen Diaz McConnell ◽  
Ilana Redstone Akresh
Keyword(s):  
United States ◽  
The United States ◽  
Housing Cost ◽  
Cost Burden ◽  
Housing Cost Burden

scholarly journals Patterns and Predictors of Transitions Across Residential Care Settings and Nursing Homes Among Community-Dwelling Older Adults in the United States

2020 ◽  
Vol 60 (8) ◽  
pp. 1495-1503
Author(s):  
Linda C Chyr ◽  
Emmanuel F Drabo ◽  
Chanee D Fabius
Keyword(s):  
Older Adults ◽  
Nursing Homes ◽  
Socioeconomic Factors ◽  
Residential Care ◽  
Behavioral Model ◽  
The United States ◽  
Community Dwelling ◽  
Age In Place ◽  
Cognitive Limitations ◽  
Increased Risk

Abstract Background and Objectives Older adults prefer to age in place, but sociodemographic, health, and socioeconomic factors may influence their decision to remain in the community. Guided by Andersen’s behavioral model, we characterize incident transitions out of the community into residential care settings or nursing homes and identify predictors of these transitions. Research Design and Methods Study participants include 2,725 (weighted n = 13,704,390) community-dwelling U.S. older adults of the National Health and Aging Trends Study from 2011 to 2018. We examined the associations between sociodemographic, socioeconomic, and health factors and the probability of transition using a multinomial logit model. Results Over the study period, 86.2% of older adults remained in the community, whereas 9.0% and 4.9% transitioned to residential care settings and nursing homes, respectively. Older age, living alone, having functional and cognitive limitations, and hospitalization were associated with increased risk of transitioning to residential care settings or nursing homes from the community. Blacks and Hispanics were less likely to transition to residential care settings or nursing homes. Adults with lower income had a greater risk of transitioning to nursing homes. Medicaid enrollment did not affect the likelihood of transition. Discussion and Implications Majority of older adults remained in the community, and incident transition to residential care settings was more common than to nursing homes. Policy should target sociodemographic, health, and socioeconomic factors that enable older adults to age in place. Future work should examine whether these new residential care settings enhance the quality of life or result in subsequent transitions back into the community.

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