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Introduction¹

Accessible and affordable housing can enable community living,² maximize independence, and promote health for vulnerable populations. However, the United States faces a shortage of affordable and accessible housing for vulnerable low-income older adults and individuals living with disabilities. This shortage is expected to grow over the coming years given the population shifts leading to greater numbers of older adults and of individuals living with disabilities.

Housing is a social determinant of health and has direct effects on health outcomes, but this relationship has not been thoroughly investigated. To better understand the importance of affordable and accessible housing for older adults and people with disabilities, the barriers to providing this housing, the design principles for making housing accessible for these individuals, and the features of programs and policies that successfully provide affordable and accessible housing that supports community living for older adults and people with disabilities, the Health and

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¹ The planning committee’s role was limited to planning the workshop, and this Proceedings of a Workshop has been prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.

² For the purposes of this Proceedings of a Workshop, “community living” refers to individuals being able to live at home in their communities as opposed to living in a residential facility, unless stated otherwise in the text.

Medicine Division and the Division of Behavioral and Social Sciences and Education, both of the National Academies of Sciences, Engineering, and Medicine (the National Academies), with support from a group of sponsors (see page ii for a list), jointly convened a public workshop on December 12, 2016, in Washington, DC. The Forum on Aging, Disability, and Independence³ (the forum) and the Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities⁴ (the roundtable) hosted the workshop. The forum meets to discuss how to support independence and community living for people with disabilities and older adults. The roundtable promotes health equity and the elimination of health disparities by advancing the visibility and understanding of the inequities in health and health care among racial and ethnic populations; by amplifying research, policy, and community-centered programs; and by catalyzing the emergence of new leaders, partners, and stakeholders.

An ad hoc committee (see Box 1-1 for the planning committee’s state-

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³ For more information, see http://www.nationalacademies.org/ADIForum (accessed May 11, 2017).

⁴ For more information, see http://www.nationalacademies.org/hmd/activities/selectpops/healthdisparities.aspx (accessed May 11, 2017).

ment of task) planned and designed the workshop to meet the following objectives:

• Summarize the knowledge on housing as a social determinant of health and as a platform for health and independence for vulnerable older adults and individuals with disabilities.
• Highlight successful and promising collaborations for providing affordable and accessible housing, with consideration for differences between rural, suburban, and urban settings.
• Explore sustainable and scalable strategies, policies, and practices to support linking affordable housing with services to benefit health and optimize independence.
• Discuss data needs and research gaps to measure the effectiveness of models of housing with supportive services for vulnerable older adults and individuals with disabilities.

Under the National Academies guidelines, workshops are designed as convening activities and do not result in any formal findings, conclusions, or recommendations. Furthermore, the Proceedings of a Workshop reflects what transpired at the workshop and does not present any consensus views of the planning committee or workshop participants. The purpose of this proceedings is to capture important points raised by the individual speakers and workshop participants. Speaker presentations slides are also available on the workshop website.⁵

OPENING REMARKS

In her introductory comments at the workshop, Teresa Lee, the executive director of the Alliance for Home Health Quality and Innovation, noted that housing is clearly a significant social determinant of health, particularly in the Medicare home health context. “It is one of those issues that is often too big for us to even think straight about,” she said, “so I am excited that today we are going to have a chance to delve in and think hard and long about how housing has an effect on health care and what we can do in concrete terms.”

Lee also pointed out that there is no one-size-fits-all solution to making housing more affordable and accessible, and she predicted that the day’s presentations would reflect that by describing what strategies are working well in different parts of the United States. Lee said that her hope was that the examples provided at the workshop would trigger discus-

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⁵ See http://www.nationalacademies.org/hmd/Activities/Aging/AgingDisabilityForum/2016-DEC-12.aspx (accessed January 18, 2017).

sions about how to apply and adapt promising programs to other regions of the country and about how to scale these programs to meet the needs of more people, particularly in underserved communities. She also predicted that a common theme across the presentations would be the crucial role that partnerships at the federal, state, and local levels can play in creating successful programs.

ORGANIZATION OF THE PROCEEDINGS

An independent planning committee (see page v for the list of committee members) organized the workshop (see Appendix A for the agenda) in accordance with the procedures of the National Academies. This publication describes the presentations and discussions that occurred during the workshop. Generally, each speaker’s presentation is reported in a section attributed to that individual. Chapter 2 recaps the two keynote presentations which provided a foundation for the remainder of the workshop’s discussions. Chapter 3 examines issues regarding the affordability of and financing for housing that promotes health and independence among vulnerable older adults and people with disabilities; Chapter 4 considers some of the design features that make housing accessible for these populations; and Chapter 5 describes six models that use affordable and accessible housing as platforms for health and independence. Chapter 6 discusses the potential policies and research needed to support efforts to increase the supply of affordable and accessible housing for vulnerable older adults and individuals with disabilities.

In accordance with the policies of the National Academies, the workshop attendees did not attempt to establish any conclusions or recommendations about needs and future directions, focusing instead on issues identified by the speakers and workshop participants. In addition, the planning committee’s role was limited to planning the workshop. Workshop rapporteurs Joe Alper, Karen Anderson, and Sarah Domnitz prepared this Proceedings of a Workshop as a factual summary of what occurred at the workshop.