The Effects of Housing Costs on Nursing Home Diversion

Abstract

This article examines the effect of the housing market on nursing home diversion and/or transition. Prior evaluations of federally funded diversion/transition efforts indicate that lack of housing may be a significant impediment to diversion policy efforts. We test this charge by examining the transition rates in all 351 municipalities in Massachusetts, using a data set of over 15,000 individuals seeking to remain or transition home between 2010 and 2014 through Massachusetts' Options Counseling program and their relation to key indicators of housing quality and affordability, including housing burden, crowding, and incomplete kitchen and plumbing facilities. We also control for demographic indicators identified in previous findings, which are age, level of frailty, and whether seniors live alone. We do not find a significant relationship between housing affordability or quality and successful nursing home diversion. This fact suggests that consumers are not as sensitive to housing costs and conditions as previously expected. Future research should continue to investigate the economic and social conditions behind this fact in the context of home value appreciation, incidence of home ownership, and the ability of seniors to offset nursing home costs through accumulated home equity.

Keywords:

• Elder care
• housing costs
• nursing home diversion
• options housing

Notes

1 The official acronym for the Centers for Medicare and Medicaid Services is CMS.

2 Information about the program is available at: https://www.mass.gov/service-details/options-counseling- program

3 Although it is counter intuitive to refer to the seniors in the program as “consumers” since the service is free, it is the accepted jargon among case workers

4 Available at: https://www.census.gov/programs-surveys/acs/library/keywords/housing-characteristics.All.html

5 Also see Kaiser Family Foundation (2007). Update on the public’s views of nursing homes and long-term care services. Available at: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/7719.pdf

6 Discussed in some detail in American Association of Retired Persons Public Policy Institute. (2008). A balancing act: State long-term care reform. Washington, DC, available at: http://assets.aarp.org/rgcenter/il/2008_10_ltc.pdf.

7 According to Centers for Medicare and Medicaid Services (CMS) (2015), SSI and Spousal Impoverishment Standards, available at: https://www.medicaid.gov/federal-policy-guidance/downloads/cib-2015-ssi-and-spousal-impoverishment-standards.pdf

8 https://www.hud.gov/program_offices/comm_planning/affordablehousing/

9 As specified in Public Law No. 97-35, S 302(b)(2) and Title 42. U.S.C. S 55306 (1982) of the Property Rights of Citizens Act.

10 See US Department of Housing and Urban Development, Office of Policy Development and Research. (1978). "How Well are We Housed?" Washington DC: U.S. Government Printing Office.

11 US Census. (2014). Selected Housing Characteristics, retrieved from http://factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_14_1YR_DP04&prodType=table

12 Specifics are outlined in sections 3.4 and 3.5b in https://www.mass.gov/regulations/651-CMR-3-home-care-program

13 Available at: www.housing.ma

14 https://www.census.gov/construction/nrc/definitions/index.html

15 For a concise summary, see Florida, R. (2018, April 13). “Is Housing Inequality the Main Driver of Economic Inequality.” available at: https://www.citylab.com/equity/2018/04/is-housing-inequality-the-main-driver-of-economic-inequality/557984/

16 For detailed analysis of home value appreciation nationally, see Martin, E. (2017, June 27). “Here’s How Much Housing Prices Have Skyrocketed Over the Last 50 Years in Every US State.” cnbc.com, available at: https://www.cnbc.com/2017/06/27/how-much-housing-prices-have-increased-since-1940-in-every-state.html

17 Conti, K. (2017, July 25). “Median Home Price in Mass. Tops $400,000 for the First Time.” The Boston Globe, available at: https://www.bostonglobe.com/business/2017/07/25/median-home-price-massachusetts-tops-for-first-time/rVsP7BwWZCtKwP9BqZQOKJ/story.html

18 Which in general correlates with being healthier and having fewer severe illness and frailty conditions that require special care.