From Solomon, Steiner & Peck
Many older adults will have trouble paying for long‑term care services, particularly after covering their housing costs. This struggle to afford the costs of both housing and long-term care services creates the dual burden, according to a recently released paper from Harvard University’s Joint Center for Housing Studies (JCHS) titled Older Adults Struggle to Meet the Dual Burden of Housing and Care,
The study found:
- A significant majority of older adults (nearly 70 percent) will require some form of long-term care, but many struggle to afford these services after covering housing costs, creating a “dual burden.”
- There are significant disparities in the affordability of long-term care services across different demographics, with renters and households of color being less able to afford care compared with homeowners and white households.
- The struggle to afford housing and long-term care is driven by rising housing costs, high costs of long-term care services, limited insurance coverage, increasing care needs with age, and persistent wealth inequality among older adults.
Long-Term Care Services
Long-term care (LTC) services can include assistance with activities of daily living (ADLs) such as bathing and dressing and help with medical-related tasks, such as managing complex daily health care regimens. Older adults may also use LTC services for housekeeping tasks, such as doing laundry, cooking, and shopping. LTC services are often essential for many older adults who want to continue living independently by delaying or avoiding institutionalization in a nursing home.
Paid professionals or unpaid family members or friends may provide LTC services for seniors, with most older adults relying heavily, or exclusively, on unpaid support. The JCHS paper states that less than half of adults receive paid care. In fact, family members and friends provide 70 percent of all care given to people who have significant needs.
Although some people need LTC services only for a short time, such as when recovering from an injury or illness, many older adults rely on them for an average of three years, with 20 percent needing them for more than five years.
Core Findings
The JCHS found that in single or partnered households with at least one person aged 75 or older, just 24 percent were able to pay for a single daily visit from a paid home health aide after paying for housing and basic living costs. Only about 63 percent of households can afford basic housing and living costs without the additional cost of LTC services.
Older adults are struggling to meet the costs of housing and long-term care for several reasons: rising housing costs, high costs of long-term care, limited insurance and financial safety nets, growing care needs with age, and persistent wealth inequality, the story found.
When older households can’t afford adequate care, unpaid family caregivers — often themselves older or working — bear substantial financial and emotional burdens. Many older adults must choose between staying in their homes and maintaining independence but possibly sacrificing care and well-being or living in an institutionalized setting, such as a nursing home.
There is no easy way to ease the high costs of both housing and long-term care, especially as costs rise for both. This is especially true when funding for federal programs is uncertain. Fully funding Medicaid HCBS waivers would help older adults with the greatest affordability needs. Millions more would greatly benefit if Medicare covered LTC services.
Addressing housing needs would also help older adults stay in their homes longer. This could be done by expanding rental subsidies as well as providing home repair and modification assistance that would ensure seniors’ homes are suitable, safe, and comfortable.
