The PDF, which includes footnotes and endnotes, in which this article appear can be found in Bifocal Vol. 46 Issue 4.
April 29, 2025
Continuum of Housing for Older Adults
By Olivia O’Connell and Kyle S. Page, PhD, ABPP
Living in a place of our choosing is a fundamental experience of adulthood and many of us place great importance on remaining in our own homes and communities. The phrase “aging in place” emphasizes this aspect, along with a multidimensional view of home. Beyond the physical space, a home provides a sense of identity, autonomy, connection, and security, among other attributes. Most older adults relocate infrequently and will remain in their homes, facilitated by a range of in-home or community supports and services. Unfortunately, others may face unforeseen challenges forcing a relocation. This may happen during a time of great upheaval or life transition (e.g., death of a partner, loss of income, inaccessible home after a stroke). Have you ever considered under what conditions you would consider a relocation? Awareness of housing options helps legal professionals navigate the complex landscape and be better prepared to assist their clients in planning for transitions or protecting crucial housing rights. In this article we review several housing arrangements for older adults. Due to variability in availability and regulation, we offer a general introduction and encourage those working with older adults to explore the specific options and resources available in their community.
Homelessness
Homelessness among older adults is a growing issue, driven by financial instability, limited housing options, and accessibility barriers. Ageism and unemployment often make it difficult for older adults to regain financial stability after life changes such as illness, disability, or the loss of a loved one. Additionally, fixed incomes frequently fall short of rising housing costs, further exacerbating the problem. As a result, older adults are now the fastest-growing demographic among those experiencing homelessness, making up nearly half the homeless population, with numbers projected to triple by 2030.
There are several terms used to describe individuals who are currently or at risk of homelessness. Since the 2000s, the term “unhoused” has gained traction as a way to reduce stigma, emphasize housing as a structural issue, and recognize that those without housing may still have communities or spaces they consider home. Other terms like “housing insecure,” “at imminent risk of homelessness,” or “hidden homelessness” refer to individuals struggling to pay rent or utilities, facing frequent moves, living in motels, or are at risk of losing housing without resources for permanent solutions.
Independent Living
While many envision independent living environments to be spaces where older adults live entirely self-sufficiently at home, the reality is that many older adults in the community require some form of functional support and assistance. Services such as housekeeping, cooking, and personal care can be brought into the home to facilitate aging in place. However, many older adults face financial constraints and live in housing that lacks necessary modifications. Subsidized housing is also often inadequate and/or unavailable for those with disabilities or increasing care needs.
- Single Family/Multifamily Dwellings - Residential units or multifamily structures such as free-standing homes, apartment buildings, duplexes, or condominiums. Most older adults (88.2%) live independently in their own residences. In recent decades, there has been a public health emphasis on promoting “aging in place,” where individuals are able to receive supports in their home and community as they get older.
- Housing Programs - Government programs that assist older adults in securing affordable and suitable living arrangements. For example, Supportive Housing for the Elderly Program (Section 202) provides rental assistance and supportive services to income-limited individuals ages 62 and above. Housing Choice Voucher Program (Section 8) offers rental assistance to low-income individuals across the lifespan, where participants pay a portion of rent based off their income.
- Retirement Communities – These settings are residential developments specifically designed for older adults, typically without personal care or support services.
- Senior Cohousing and Other Intentional Communities - Senior cohousing involves private units with shared common spaces, emphasizing social interaction and interdependence. Other intentional communities, such as retirement communities for marginalized populations, are growing in popularity and aim to address lack of inclusive housing that addresses unique healthcare needs.
Supportive Living Environments
Supportive living environments provide additional or higher functional support (e.g., transportation, cleaning, meal preparation, dressing) in home-based, community-based, and residential settings. These options vary in availability, accessibility, cost, quality, regulation, and level of assistance provided. Importantly, older adults face many barriers to accessing or receiving care in these environments, including high costs, limited availability, accessibility, and staffing shortages.
- Congregate Housing – A residence where an individual may have a private room but otherwise share the rest of the space (such as kitchen, living room) with others. Some assistance is available, but the older adult remains largely independent.
- Personal Care Boarding Homes & Foster Care – Settings where room and board are provided with more supervision and assistance (such as shopping, meal preparation, reminders to take medications) than congregate housing. These settings may be licensed, but do not involve healthcare professionals.
- Continuing Care Retirement Communities – In comparison to retirement communities noted above, these settings offer a broader range of living options and services. There may be a continuum of housing arrangements, ranging from apartments for independent living to nursing home care. These settings are designed to allow a seamless transition between care levels within the same organization, if and as needed.
- Assisted Living Facility – These facilities provide housing with continuous support and certain health services, which vary by location and often come at additional cost. Residents can increase their level of support over time without moving (e.g., add on laundry services if they are no longer able to do this themselves). Additionally, recreational activities enhance quality of life. This support is less intensive than in nursing homes, but some facilities offer specialized care for individuals with cognitive impairment (“memory care”). The number of assisted living facilities has grown significantly in recent years.
Long-Term Care
Long-term care represents the most intensive option on the supportive living spectrum. Long-term care facilities may also be known as nursing homes, but there is some debate about when to apply these terms, and the definition of what is included in “nursing home” varies. Nursing homes provide not only room and board but also continuous supervision, nursing care (e.g., medication administration, health monitoring), and assistance with functional needs (e.g., bathing, dressing, toileting). Some facilities may also advertise specialty focus on those with dementia. Nursing home settings typically also provide for recreational and social activities. Only a small proportion of adults (~4%) reside in a long-term care facility at a given time. Older adults face hardship in accessing or receiving care in this setting, including cost, availability, proximity to desired community, and staffing challenges. Notably, most nursing home facilities also provide healthcare services that are short-term in nature, such as respite care, skilled nursing (e.g., wound care), and rehabilitation (e.g., occupational, physical, and speech therapy).
Summary
This article outlines the range of housing options available for older adults. Despite the variety of living arrangements available, significant barriers related to affordability and accessibility persist, disproportionately affecting low-income and under-resourced older adults. Staying informed about these options and collaborating with older adults and their families is essential in planning future arrangements that promote well-being and preserve their ability to choose where to reside.