By Ayse Akincigil, Uri Amir Koren, & the Hub for Aging Collaboration

The concept of “aging in place” resonates as individuals strive to maintain their residence despite evolving requirements for supportive services during the natural course of aging. This process hinges on the integration, augmentation, or adaptation of supportive services to accommodate an individual’s physical or cognitive decline. These services span a spectrum, encompassing hands-on assistance with fundamental activities of daily living, including bathing, dressing, toileting, mobility, and eating.

When informal (such as assistance from family or friends) or formal (paid) home-based support systems prove inadequate or unavailable, individuals may consider alternative housing options like Assisted Living Residences (ALRs) or Comprehensive Personal Care Homes (CPCHs). These facilities are licensed to provide apartment-style accommodations with embedded assisted living services, thereby offering a viable solution when support becomes necessary.

However, challenges persist, particularly for older adults residing in publicly subsidized senior housing. These individuals, often constrained by limited incomes and historical issues related to healthcare access and complex medical needs, are eligible for Medicaid-supported services. Yet, accessing ALRs or CPCHs proves difficult due to the scarcity of units allocated for Medicaid beneficiaries. Only 10% of housing units in ALRs and CPCHs are designated for Medicaid, primarily comprising those who initially entered as private payers and transitioned to Medicaid after asset depletion. Consequently, many older adults in publicly subsidized housing, in need of support services, face an unfortunate trajectory towards premature nursing home placements due to being priced out of alternative options.

In New Jersey, an innovative model has emerged, capitalizing on economies of scale within publicly subsidized housing complexes to facilitate aging in place. This innovation leverages the concentration of eligible clients within these complexes, utilizing the housing sites themselves as program hubs rather than necessitating the operation of licensed ALRs or CPCHs. These Assisted Living Program providers, sanctioned by the New Jersey Department of Health, deliver comparable levels of care within publicly subsidized housing, circumventing potential limitations imposed by federal, state, or local housing regulations in expanding ALRs or CPHCs in these housing complexes.

While Assisted Living Programs (ALPs) hold promise in addressing the considerable long-term service and support needs within the state, they often are labelled as a “well-kept secret” due to their limited market penetration. Advocates and consumers alike postulate that ALPs could yield cost savings for Medicare and Medicaid by deterring premature nursing home admissions, minimizing travel costs for service providers, and fostering proactive care and effective management of chronic conditions. Despite the enthusiasm surrounding this program, the number of ALP sites in New Jersey remains notably limited, with only 17 currently operational.

Expanding these models necessitates identifying suitable buildings housing a critical mass of eligible tenants requiring services. However, the decentralized nature of affordable housing information, with many subsidized buildings overseen by municipal or local housing authorities, poses a hurdle. To address this challenge, a collaboration between the New Jersey State Policy Lab and Rutgers School of Social Work faculty has generated a comprehensive census of publicly subsidized housing communities suitable for ALP operations. This initiative compiles data from diverse public funding sources spanning local, state, and federal levels, inclusive of entities like the NJ Department of Community Affairs, NJ Housing and Mortgage Finance Agency, NJ Commission of Affordable Housing, county-level senior services, US Department of Housing and Urban Development, and the National Housing Preservation Database. This information unlocks a key to identifying opportunities for establishing Assisted Living Programs in affordable housing units, thereby supporting older adults’ ability to access necessary care while continuing to reside in their homes.