Past leaders of the U.S. Department of Housing and Urban Development often embraced one or two “signature” issues to define their stewardship of the agency. Jack Kemp championed tenant management of federally assisted housing. Henry Cisneros sought to revitalize public housing through initiatives like Hope VI. Mel Martinez made reducing chronic homelessness a key priority.
As one of America’s leading physicians, Dr. Ben Carson, President-elect Trump’s choice to serve as HUD secretary, is uniquely positioned to spearhead a national effort to better integrate health care and supportive services with housing. "Health and housing” could be one of his signature issues.
There’s a greater understanding today that housing is a social determinant of health. If you live in substandard housing or in a home contaminated with toxic substances like lead or with indoor asthma triggers, chances are your health will be negatively impacted, perhaps severely. Alternatively, if you live in a home that is safe and affordable and within a community that provides ample access to vital services, your health will likely benefit.
With the aging of the 78 million Baby Boomers, more tightly linking health care with housing will be even more important. Not only do older Americans spend much of their time in the home setting, the home can serve as a platform for the delivery of health care and other critical services.
As explained by the Bipartisan Policy Center Senior Health and Housing Task Force, about 70% of those who reach 65 will eventually need help with basic activities like medication management, food preparation and bathing. Today, these “long-term services and supports,” also called LTSS, are primarily provided in the home, usually by other family members or private caregivers. With the senior ranks expanding, the home will also play an increasingly important role in the management of chronic disease.
Here are four steps that Carson can take as HUD secretary to help bridge the policy gap between health and housing:
1. Educate the public that access to affordable housing is a health issue.
Families who struggle with high housing costs often have less to spend on other necessities like nutritious food and medical care. For seniors, access to affordable housing is essential for the provision of LTSS and other home-based services. For the homeless, the lack of shelter has an obvious detrimental impact on health. As HUD Secretary, Dr. Carson has the opportunity to educate the public about these important health-housing connections. He can also be a powerful advocate for initiatives to strengthen the Low-Income Housing Tax Credit, reduce homelessness, eliminate regulations that artificially raise the cost of housing, and increase the supply of “service-enriched” housing for seniors. All enjoy bipartisan support.
2. Highlight the need to transform our homes and communities to enable “aging in place.”
Despite the overwhelming desire of older adults to remain in their homes and communities as they age, doing so is often not safe and viable. Home modifications, which can range from low-cost solutions like removing rugs and fixing lighting to higher-cost adaptations like adding ramps and widening doorways, are essential to preventing falls, the leading cause of injury-related death for older Americans. As HUD secretary, Carson should ensure the department’s current programs adequately support home modifications and work with his Cabinet colleagues to better coordinate the numerous federal programs outside of HUD that are available for this purpose. In addition, Carson could drive the development of a model “senior zoning ordinance” to help cities and towns better connect seniors to important amenities like transportation, health care, social services, and retail stores.
3. Launch a major supportive-services initiative for Medicare beneficiaries in publicly-assisted housing.
Carson should team up with Dr. Tom Price, tapped to lead the U.S Department of Health and Human Services, to launch an initiative that would enlist health care organizations to coordinate health care and LTSS for Medicare beneficiaries living in HUD-assisted housing. Working with the Centers for Medicare & Medicaid Services, participants in the initiative would introduce evidence-based programs like A Matter of Balance (a program that has reduced the incidence of falls among seniors) and Support and Services at Home (a care coordination model that has slowed the rate of growth of Medicare spending).
Approximately 1.3 million older adult renters live in HUD-assisted housing, with the vast majority dually eligible for Medicare and Medicaid. These “dual eligibles” have more chronic conditions and higher health care utilization rates than those without assistance, so the potential for improving health outcomes and lowering costs is significant. While HUD supports service coordination at some of its properties, a much larger initiative is in order.
4. Promote the use of telehealth and high-speed broadband in HUD-assisted housing.
Telemedicine, remote monitoring, and other cutting-edge technologies that can be deployed in the home hold great potential to reduce medical costs and improve health outcomes. For lower-income Americans living in HUD-assisted housing, expanding access to affordable high-speed broadband is essential to fully utilizing these technologies and exploiting their benefits. The private sector can be a critical partner in this effort.
Beyond any specific initiatives, what is needed most is inspired national leadership that recognizes the deep connection between health and home. With his background in medicine and considerable communications skills, Carson is ideally suited to provide this leadership.