BRISTOL, R.I. Roberta Rabinovitz became aware that she had nowhere to go when she was eighty-two. She was a widow who had lived with one of her daughters before losing the other to cancer, nursing them until they passed away. After that, she lived in Florida with her brother until his death as well.
Thus, Rabinovitz, who was recuperating from lung cancer, found herself at her grandson’s house in Burrillville, Rhode Island, last fall. There, she slept on the couch and found it difficult to climb the high stairs to the shower. That was untenable, and Rabinovitz became one of the increasing number of older Americans who had nowhere to sleep at night due to unaffordable housing rents.
Rabinovitz, however, was lucky. Through the PACE Organization of Rhode Island, a nonprofit organization dedicated to health care, she was able to find housing. For these PACE groups, which receive funding from Medicaid and Medicare, finding housing is a relatively new and expanding difficulty across the nation. Aiming to maintain frail elderly people in their homes, PACE stands for Program of All-Inclusive Care for the Elderly. However, without one, a patient cannot remain at home.
More people 55 and over without homes
Organizations in charge of providing medical care are recognizing that they need to go outside of their comfort zone in order to guarantee that their patients have a place to live as housing expenses climb. Realizing that housing is essential to good health, hospitals in Denver, New Orleans, New York City, and other places have begun to invest in it.
Additionally, the need is particularly increasing among elderly persons. One in five homeless Americans in 2024 were 55 years of age or older, and the number of elderly adults experiencing homelessness increased by 6% from the year before.According to Dennis Culhane, a professor at the University of Pennsylvania who studies housing policy and homelessness, the number of males over 60 residing in shelters nearly tripled between 2000 and 2020.
“It’s a national scandal, really, that the richest country in the world would have destitute elderly and disabled people,” Culhane stated.
Culhane has spent decades researching the predicament of those born between 1955 and 1965 who grew up throughout recessions and were never able to establish themselves in the economy. Many members of this group have experienced homelessness on and off throughout their lives, and aging is making their problems worse.
Other older folks who are homeless, however, are unfamiliar with the situation. According to Sandy Markwood, CEO of USAging, a national organization that represents what are known as local agencies on aging, many people are on the verge of destitution. A single event, such as a spouse’s death, losing their job, having their rent increased, getting hurt, or becoming unwell, can push them into homelessness. An elderly person may fail to make their mortgage payment if cognitive deterioration begins. Rising property taxes and maintenance are frequently beyond the means of even individuals who own paid-off homes.
“No one imagines anybody living on the street at 75 or 80,” Markwood stated. “But they are.”
According to Yolanda Stevens, a program and policy analyst with the National Alliance to End Homelessness, the recent budget law signed by President Donald Trump will worsen the situation for older individuals with limited incomes because it significantly reduces federal funding for Medicaid, the public insurance program for those with low incomes or disabilities. It will be more difficult for them to maintain their health and make their rent payments if they lose their health insurance or if their neighborhood hospital closes.
“It’s a perfect storm,” commented Stevens. “It’s an unfortunate, devastating storm for our older Americans.”
The Labor Department recently discontinued a job training program designed to keep elderly, low-income individuals in the workforce, which further complicates matters.
New partners for PACE
These conditions have forced PACE health plans across the nation into unknown territory, leading them to open offices in senior housing buildings, collaborate with housing providers, or even establish their own with nonprofit developers.
PACE organizations were acknowledged as a sort of Medicare and Medicaid provider by a 1997 federal law. Currently, there are about 185 in the United States, each catering to a certain geographic area and servicing over 83,000 individuals.
In addition to enrolling individuals 55 and older who are sufficiently ill for nursing home care, they also give their patients all the resources they require to remain at home in spite of their frailty. They also manage facilities that serve as adult daycare centers, medical clinics, and transit hubs.
These groups mostly assist low-income individuals with complicated medical conditions who qualify for both Medicaid and Medicare. They work under a predetermined budget for every participant and combine funds from both programs.
PACE officials fear states would reduce support if federal funding for Medicaid programs declines. According to Robert Greenwood, a senior vice president of the National PACE Association, the PACE idea has consistently had bipartisan support due to the fact that its services are far less costly than nursing home care.
Because of the financial structure, PACE can do whatever it takes to keep participants living independently, including sending a patient’s dog to the veterinarian or purchasing an air conditioner. Addressing the housing problem is an additional step in the same direction.
PACE Southeast Michigan, which serves 2,200 people in the Detroit area, collaborates with the owners of senior citizen housing. The landlords consent to maintain reasonable rent, and PACE offers its members services to their tenants. Housing providers “like to be full, they like their seniors cared for, and we do all of that,” added Mary Naber, PACE Southeast Michigan’s president and CEO.
The Michigan nonprofit has leased a wing in an independent living facility where it offers 24-hour supportive care to members who grow too ill to live alone. In Eastpointe, which is just outside of Detroit, the group is also collaborating with a nonprofit developer to build a complex of 21 shipping containers that have been transformed into tiny homes. The renovated containers, which are still in the planning stages, are likely to rent for between $1,000 and $1,100 per month, according to Naber.
As chronically homeless adults move into housing in San Diego, the PACE program at St. Paul’s Senior Services provides them with health services as well as the support they need to stay in their homes, like advice on how to keep their apartments clean and pay their bills on time.
According to Carol Castillon, vice president of St. Paul’s PACE operations, the program also assists those who are currently in housing but are clinging to unstable living circumstances. In order to reduce costs, the organization helps people fill out housing assistance forms, connects them with local services, and provides meals and home goods, she said.
About 10 to 15 participants at PACE Rhode Island, which supports close to 500 people, experience homelessness or the threat of homelessness each month. Five or six years ago, this was an uncommon occurrence, according to CEO Joan Kwiatkowski.
Although the group has contracts with assisted living homes, its members are occasionally turned away due to past criminal histories, substance abuse, or medical requirements that the facility managers believe are too great for them. Also, there are frequently no vacancies at public housing providers.
According to Kwiatkowski, PACE Rhode Island intends to purchase its own homes. Additionally, four flats in a Bristol assisted care facility have been reserved by PACE for its participants; rent is paid when the apartments are vacant. Rabinovitz just moved into one.
Housing and medical care
Rabinovitz, whose main source of income today is her Social Security check, was a senior credit analyst for a health care organization. The remainder of the check is used for rent, which includes meals, and she keeps $120 for personal items.
A PACE van takes Rabinovitz to the organization’s center once a week or so, where she receives medical care, including dental work, physical therapy, and medicine, all of which she claims are provided by “incredibly loving people.” PACE sends someone to her when she isn’t feeling well enough to go on the walk. She recently slept in her own bed in her new studio apartment as a technician with a portable X-ray machine scanned her aching hip.
When she described the flat, she stated, “It’s tiny, but I love it,” because purple is her favorite color.
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