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In Focus
Only a handful of dedicated academics and advocates noticed the final report of the Commission on Affordable Housing and Health Facility Needs for Seniors in the 21st Century published last year. The 18-month study, titled "A Quiet Crisis in America," was mandated by Congress and resulted in the most comprehensive examination of the unmet housing needs of this country's elderly population through 2020. The commission recognized the increasingly blurred boundaries between housing and care and how artificial programmatic barriers prevent their integration. It focused on older households that have difficulty paying for their housing costs or are living in physically substandard or design-insensitive dwellings. Beyond that, the commission looked at physically or cognitively impaired elders, who need affordable long-term care alternatives that would allow them to live with dignity in noninstitutional settings. The commission proposed a wide-ranging set of solutions to address these problems.
The commission also concluded that current community-based care, supportive service programs and affordable assisted-living options inadequately address the needs of the almost 20% of today's elders with physical or cognitive impairments. Even though a decreasing proportion of tomorrow's older adults are likely to experience these disabilities, the rapid growth expected in the size of the older population means that housing and health policies in the United States will be ill-prepared to meet the future age wave. The commission report shows that federal and state long-term care policies lack synchronization, the U.S. departments of Housing and Urban Development and Health and Human Services fail to coordinate their related programs, older people still enter nursing homes prematurely and state governments incur excessive long-term care expenditures. In the United States, more than 35 million people are 65 or older, and most younger people have parents, grandparents or other elderly relatives. Thus, one might have expected that a large share of the public would be very interested in the report, yet the media have only covered the commission's findings anemically. Why do they ignore a story so relevant to most Americans? The easy answer is that housing for older people is not a very sexy topic. It fares poorly as dinner party conversion next to the war in Iraq or tax cuts. But there are other reasons. Other reasons are only whispered. Some harbor the belief that the adult children of older people--not the government--should be held accountable for assuming financial and care responsibilities. Others don't understand why they should sympathize with older homeowners who are having difficulty paying their bills. After all, the thinking goes, elders live in highly valued properties they can refinance, use to secure reverse mortgages or sell. Regardless of these attitudes and misapprehensions, however one dices, slices and chops the numerical estimates of older people who are living in inadequate housing and denied affordable long-term care solutions, the gap between need and availability is alarming and becoming more so. The commission agreed on guiding principles underlying their recommendations for change: "Preserve and renovate the existing housing stock; expand successful housing production, rental assistance programs, home- and community-based services, and supportive housing models; link shelter and services to promote and encourage aging in place; reform existing federal financing programs to maximize flexibility and increase housing production and health and service coverage; and, create and explore new housing and service programs, models, and demonstrations." Although the commission was divided enough to issue majority and minority reports (see the adjacent article, "Affordable Housing Commission Divided"), what seemed clear to everyone on it is that the "quiet crisis" should no longer be quiet. American society should not tolerate the unacceptable shelter and care arrangements endured by millions of older people, especially when solutions exist. Stephen M. Golant is a professor of geography and a core faculty member at the University of Florida Institute on Aging in Gainesville. Parts of this article are reprinted with permission from Responses to an Aging Florida, winter 2003, published by the Florida Council on Aging in Tallahassee and from Shelterforce, issue #128, March-April 2003, published by the National Housing Institute.
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