By Saskia de Melker and Melanie Saltzman
The full transcript of the PBS NewsHour Weekend story shown above follows here:
SASKIA DE MELKER: This is the regular dinner scene at Saettedammen, a co-housing community 45 minutes outside Denmark’s capital of Copenhagen.
Stig Brinck, an architect, and his wife, an artist, and the teenage daughters they’ve raised here, are responsible for tonight’s meal…for themselves and 20 neighbors in the common house.
STIG BRINCK: We eat together four times a week, for those who want to participate.
SASKIA DE MELKER: What’s it like cooking for 25 people? How do you do that?
STIG BRINCK: First of all, we have a kitchen that’s capable for it. So we have the tools to do it. That’s very important.
SASKIA DE MELKER: Communal meals are a staple at Saettedammen, where 71 people live in 28 houses clustered around shared recreational and outdoor spaces — walkways, gardens, and parking — and a common house. Residents are expected to clean shared areas and take turns tending the grounds. Everyone shares resources like laundry facilities, outdoor tools, and play equipment. Small groups of families rotate leading monthly community meetings.
STIG BRINCK: You live in kind of a small, small village. You know everybody around you, and you share as much as possible. So you are very close neighbors, and you are kind of depending on each other, but you’re not obligated to any strict rules.
SASKIA DE MELKER: The Saettedammen community is made up of a range of singles, couples, retirees, and families with children. Every family has privacy in a home with its own bedrooms, baths, and kitchen.
The land is cooperatively owned, but residents own their homes — a structure similar to a condominium association in the U-S. The cost of homes here is comparable to other homes in the area, but an average sized household pays about $3,500 dollars a year for communal resources.
Saettedammen started 46 years ago and is recognized as the first co-housing community in the world. Britta Bjerre and her husband, Arne, were among the first families to move in.
BRITTA BJERRE: We didn’t want our family to spend our lives in an insular way in a house on a suburban street somewhere. And one day we saw a newspaper ad saying that some people had their eyes on a plot of land, and they were looking for twenty-five to thirty families to buy it and build houses as well as a communal house.
SASKIA DE MELKER: Lisa Berkman, a professor of public policy and epidemiology at Harvard University says that co-housing harkens back to the kinds of communities that used to naturally dominate our societies.
LISA BERKMAN: You know, when you think about the apartment buildings that were designed at the turn of the century, they were designed as two-family houses or three-family houses, each on a floor. And those enabled multi-generation households to live together and still have their own housing.
SASKIA DE MELKER: Berkman says that cohousing can reduce social isolation and the detrimental health effects associated with it.
LISA BERKMAN: Social isolation relates to the number of ties and the quality of relationships that you have: religious ties, community ties, work ties. People who are very isolated, who are disconnected, have a mortality rate that’s about three times as high That is, they’re about three times as likely to die over maybe a decade, as people who have many, many more ties.
SASKIA DE MELKER: 70-year-old Jytte Helle has lived in Saettedammen for 30 years.

JYTTE HELLE: It’s important to me to be with a mixed group, not only with other older people, because then we would just talk about our diseases and aches and pains. Older people can’t give the same energy as younger people can.
STIG BRINCK: So having neighbors and knowing their kids, I think that’s // just like it’s a benefit of having a big family.
SASKIA DE MELKER: Is this replacing the idea of the extended family?
STIG BRINCK: Indeed it is. I see it very much as the extended family.
ELLA POULSEN: It’s like nice to have a friend nearby always that you can talk to.
SASKIA DE MELKER: 14-year old Ella Poulsen has lived in Saettedammen her whole life.
ELLA POULSEN: It’s kind of like everyone’s a parent, and everybody will take care of the kid if there’s something wrong and the parents aren’t there. I think it’s just very safe.
SASKIA DE MELKER: It’s estimated that at least 1 percent of the Danish population lives in co-housing arrangements. In the United States, the Cohousing Association of America estimates there are about 150 communities.
Rocky Hill Cohousing in Northampton, Massachusetts was established 12 years ago. It has 28 households with residents ranging from age 2 to 80. With a similar financial model to Saettedammen, Rocky Hill has a variety of common spaces, resources, activities, and shared chores.
CAROL RINEHART: I love knowing that somebody’s out there plowing the path on a snowy morning. That’s lovely, knowing that there are mixed ages of people who can help with keeping the place up, and we have our jobs divided.
SASKIA DE MELKER: Carol Rinehart is 72-years-old and just retired from her job as a hospice coordinator. She’s lived at Rocky Hill since its formation.
CAROL RINEHART: You don’t get up some day in the morning and say, “You know, I think this is the day I’m going to have a community.” You know, you build a community.
SASKIA DE MELKER: The number of Americans 65 and older is expected to nearly double by 2050. According to the Pew Research Center, 61 percent say they would prefer to stay in their homes even when they can no longer take care of themselves.That’s compared to 17 percent who would opt for an assisted living facility. Just 8 percent would prefer to move in with a family member.
Harvard Professor Lisa Berkman says co-housing allows people to age in their homes.
LISA BERKMAN: With the aging of the population and the increasing frailty that people will experience as they age, at some point everybody needs a little help. Americans are particularly vulnerable to social isolation in part because we value independence so much, and because we’re so mobile. And we live in a very, very big country.
SASKIA DE MELKER: Berkman says that while older Americans are especially vulnerable to social isolation, young families often struggle to maintain social networks as they juggle work and family.
College professor Gary Felder lives at the Rocky Hill co-housing community with his wife and their two young children. He says their social life is built in, unlike other families who don’t live in a co-housing arrangement.
GARY FELDER: You’ve got to arrange babysitting, you need to figure out the timing, and then you’ve got to rush back and so on. And that was just never a big deal for us. We would put our kids down, we would throw in a baby monitor and we would go spend an evening with our friends. Every week.
SASKIA DE MELKER: Cause you’re right next door, to the common house?
GARY FELDER: Yeah, absolutely. And if one of our kids woke up, two minutes later we were in the bedroom.
SASKIA DE MELKER: Felder admits that this lifestyle isn’t for everyone, and about one family a year decides to leave.
GARY FELDER: The biggest challenge is that you’re making decisions with 27 other households. That is the definition of hell for some people.
SASKIA DE MELKER: But Felder says that for his family the benefits they get from an intergenerational community outweigh the difficulties.
GARY FELDER: The other thing which our kids get, which is even more rare in this society, is they have regular interactions with elders, with seniors. They’re very aware of the whole process of people getting older and retiring and having physical problems and dying.
SASKIA DE MELKER: Rocky Hill residents are coming up with new guidelines to help aging community members, including ride sharing and connecting residents with financial and medical services.
CAROL RINEHART: Could we even make a space here in the common house for somebody who lives and is a licensed practical nurse and taking care of several different families who may be in that area of need.
SASKIA DE MELKER: At the Saettedammen community in Denmark, maintaining an intergenerational community is getting harder. More than half of the residents are now over 65. The community is encouraging younger families to move in when homes become available. Many long time residents, like Jytte Helle, don’t want to leave their social support network.
JYTTE HELLE: We’ve been a part of creating this, and want to feel the benefits that come with getting old in a cohousing community like this.
SASKIA DE MELKER: Do you think there is something about this community, does it keep you younger?
JYTTE HELLE: Yes. Definitely. I’m convinced that If I lived exclusively with elderly people, I would degenerate. So the fact that I’m living with younger people is a gift on a daily basis.
(This story originally appeared on PBS NewsHour Weekend.)
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Learn How Two Communities Prevent Social Isolation

According to an AARP report from 2020, there are approximately 53 million family caregivers. And 25% of family caregivers belong to the Millennial generation. Additionally, a report cited in Refinery29 shows that 54% of millennials feel lonely.
Family caregivers often report feeling lonely and isolated despite spending significant time with their care partner or recipient, according to the Family Caregiver Alliance. 
"The fact is that many people across America are living longer but cannot fiscally or mentally afford the cost of living alone."Unlike the baby boomer generation and Gen-X, a report by ABC News indicated that "experts say first-time millennial prospective homebuyers are facing a major crisis stirred by a perfect storm of rising housing prices, interest rates and tougher competition from several generations of buyers." At the same time, aging adults are also being impacted by the housing crisis. 
Loneliness is a common through-line in my lived experience and many of my interactions. 
Imagine, then, a millennial caregiver seeking community while worried about how they will afford rent or if they will be able to achieve the "American dream" of home ownership while also providing much-needed care for an aging or disabled family member. 
What are their options? How can they find belonging among the isolation of caregiving and the precarity of housing insecurity? While it may seem like millennial family caregivers are doomed to face isolation and lack of community, many developments seek to address these societal issues. These advancements give older adults, and their caregivers, hope for a new future.
Full Disclosure: Close to Home
I am a millennial and have been a caregiver for over a decade. I cared for my mother from her frontotemporal degeneration (FTD) diagnosis in 2013 until her passing in July 2023. Frontotemporal degeneration is the leading form of dementia for people under the age of 60. 
I also care for my father, who is a stroke and prostate cancer survivor and lives with vascular dementia and stage-3 chronic kidney disease. When not caring for my parents, I am the manager of training at Caring Across Generations, where I train family caregivers, older adults and disabled people on public advocacy and storytelling tactics. 
Loneliness is a common through-line in my lived experience and many of my interactions. Despite the availability of virtual spaces and the often persistent presence of at least one other person in their home, many family caregivers feel something I have termed isolation. The term reflects that although many caregivers have a constant companion, they also experience a profound loss of connection.
Lonely, Not Alone
Avis Hitchcock, a 30-year-old from Florida, has cared for their parents for six years. Both of their parents have battled two types of cancer, from which both are currently in remission. However, due to the deteriorating effects of the disease, chemotherapy and radiation treatments, caregiving remains a necessity. 
"I think for me, the biggest thing is the advocacy piece… because questions get asked and they aren't in the space to talk about it or retain information." 
Hitchcock uses they/them pronouns and describes their life as "beautiful and wild." Their daily tasks include "taking to and from appointments, advocating, especially when they're in the hospital." They spend a lot of time in the hospital to ensure things are getting done and receiving support and care. 
"I think for me, the biggest thing is the advocacy piece… because questions get asked and they aren't in the space to talk about it or retain information," says Hitchcock. 
Hitchcock also discussed helping with showers, changing urostomy bags, and other activities most often associated with medical professionals. When asked about how they experience loneliness, they explain, "There's a sense when I'm sitting with them in a room doing these things, I'm with them, and they're with me, but there's this deep sense of… the reality that I can only imagine they feel lonely on their end because they are going through it and I have no idea what that's like." 
"Moreover, they have no idea what I'm going through. We're working with each other as best as possible, but there's a divide in it. I'm having to do things for them… there's a big surrender of having to rely on someone," Hitchcock says. 
"There should be things out there to support people so it's not like this for caregivers in the future."
"The loneliness is very much the reality in that I'm alone when I'm not physically alone. I thought my life would be is different from where it is. There is a deep, consistent sacrifice that has to be made on a daily basis," Hitchcock notes. "It's almost like I'm living a life that is worthy and beautiful, but why do we have to live this intensity? There should be things out there to support people so it's not like this for caregivers in the future. I don't feel like it's sustainable in a mental or physical health way."
Hitchcock's family owns their own home, and neighbors occasionally assist with grocery shopping and taking out the trash. Friends call and text until they answer to ensure they and their parents are doing okay. However, despite these acts of kindness, the reality remains that there is a lack of community. 
Hitchcock explains: "My parents [are not] being open to getting help and support outside of me, which is a little bit of a struggle [when] people ask 'what can we do to support you?' But I don't get it in the main ways I could use support. It's hard when I care for people who don't like getting outside support."
Why Is Loneliness So Significant?
In 2023, the World Health Organization (WHO) declared loneliness an epidemic. When prolonged, loneliness can be as dangerous as smoking two packs of cigarettes per day, according to the Centers for Disease Control and Prevention (CDC). Lonely people have poorer health outcomes than those with robust social lives.
Avis Hitchcock notes that they have lost many relationships throughout their caregiving journey. "It's been tough, the reality of friendships ending because my life has changed, or the reality that I have to push myself out the door to have some semblance of my own life so I don't feel even more lonely." 
She says that most of her family is in Mexico, where intergenerational households are much more common. "It is normal. It is not a strange thing."
Ariana Tellez, 30, of Saint Paul, Minnesota, is a mother, spouse and former caregiver to her mother, who died from metastatic breast cancer in 2020 at the age of 67. She notes the critical role multigenerational housing played in getting her through the pandemic. 
"We all had each other in our home… it was all of us and our pets. My mom was a fan of multigenerational housing, but it just made sense for us to all live together," Tellez says.
She says that most of her family is in Mexico, where intergenerational households are much more common. "It is normal. It is not a strange thing. [In the United States] I feel like you hear someone [say] 'I live with my parents, and I am 30,' and people are like 'Oh, that is weird,'" but it is not, at least culturally speaking, in Mexico where my family lives."
However, not everyone has a family they can live with during crises or situations of need. According to a 2023 article by The Hill, nearly 15% of the U.S. population lives alone. However, living with a parent, partner, grandparent, child or other family member is not an automatic solution to curbing feelings of loneliness. Future trends are on the rise toward an intentional community where residents can depend on and build relationships with one another.
Where Does Housing Fit In?
An additional stressor to the loneliness epidemic is the current housing crisis sweeping the United States as rent and mortgage prices continually rise, gentrification increases, and predatory practices undermine communities of color – disproportionately impacting older adults and their caregivers. 
People facing the trifecta of a housing crisis, caregiving and feelings of isolation may be unsure about their future.
The fact is that many people across America are living longer but cannot fiscally or mentally afford the cost of living alone. While families with care partners are familiar with this truth, many observed for the first time, throughout the COVID-19 pandemic, that perpetual independence is unsustainable. The evidence is clear that we must rely instead on interdependence for overall health and well-being.
For centuries, many cultures worldwide have practiced interdependence through co-housing and communal living models. However, the stronghold of capitalism in Western culture means that we define success as freeing ourselves from our nuclear family structures and pursuing ultimate independence in home ownership. 
However, a slow resurgence of coliving models is occurring across the U.S. to address the rising need for care, unaffordable housing costs, and loneliness across generations. In their 2023 book "Design & Solidarity," architect Rafi Segal and artist Marisa Morán Jahn explore how housing and intentional, accessible design can be used in part to make space for the advancement of communal living in the United States. 
The Baltimore, Maryland-based Carehaus project founders Segal, of Boston, and Jahn, based in New York City, along with Ernst Valery in Baltimore, help redefine what home means and who has access to it. Carehaus, set to break ground in 2024, is designed to provide housing for low-income older adults and disabled people, their care partners and their families. The development responds to the lack of housing and care for older adults, answering the question: "What if we build in celebration of care?"
Carehaus is the first care-based co-housing project in the United States. In addition to providing practical living space, the innovative coliving community relieves a multitude of burdens with "shared meals, child care and various other activities such as art, fitness, physical therapy, financial literacy courses and horticulture" and culturally relevant art programs, as well as utilities, tools and other resources. 
A slow resurgence of coliving models is occurring across the U.S. to address the rising need for care, unaffordable housing costs, and loneliness across generations. 
The result is cost savings that create "higher-quality care for residents and sustainable wages for caregivers," according to Segal and Jahn. With shared resources and the caregiving community at the forefront of its design, Carehaus is set to disrupt how aging, disability, care and family are viewed in this country.
Other intergenerational developments, like Bridge Meadows in Beaverton, Oregon, also seek to create interdependence within its model, which brings together youth in foster care with aging and disabled adults. 
Another example of interdependence and care is the brainchild of author, speaker and aging advocate Elizabeth White, a past Next Avenue Influencer in Aging. NUUage Coliving is a new, more affordable take on the old active adult community model. 
The future mixed-income property for older adults without family is based on the concept "...that sharing resources and aging in a community that balances privacy and social interaction will help older adults without traditional family support systems reduce their housing costs, maintain their independence, and preserve their physical well-being and cognitive health." 
White, the project's founder, aims to create space for the feeling of independence alongside the opportunity for community care. With the shared communal space, utilities and other cost-saving features, NUUage is yet another example of a return of Western culture to communal living to make a dent in the mounting housing crisis and the isolation of older adults.
Better Together
People facing the trifecta of a housing crisis, caregiving, and feelings of isolation may be unsure about their future. Retirement planning may now include the globally-common models of coliving as viable options for millions of people living in the United States. 
Aging in a community with care in mind has both concrete and intangible benefits that will lead to improved health outcomes. If independence is the ultimate goal, may all roads lead through interdependence. It may take a few more generations to weave caregiving and intergenerational co-living into the daily lives of aging people and their family caregivers. 
However, it may be just the solution to end the crises of unattainable housing, indescribable loneliness and challenging caregiving, replacing them with stable homing, tangible belonging and easeful caring.


Companioned Isolation: The Untold Story of Caregiving, Housing and Loneliness

Aisha Adkins

From 2001 to 2004, Bonnie McGowan found herself dealing with a lengthy discrimination lawsuit. She had purchased 157 acres in New Mexico with plans to build an LGBTQ-friendly retirement village and was promptly sued by the surrounding community. McGowan and her lawyers were able to demonstrate that a housing development that would be accepting to gay, lesbian and trans residents would not be discriminatory against heterosexual families who lived nearby.
Kate De Haven and her wife Nancy Kelly at Village Hearth, a co-housing community for LGBTQ+ people 55+
Regardless, locals scrambled to find reasons to extend and appeal the lawsuit, eventually warning McGowan not to  "bulldoze our way of life." The judge assigned to McGowan's case said in a public hearing: "Ms. McGowan, if I could rule against you, I would. But you've done nothing wrong." The case was ultimately thrown out by the New Mexico state supreme court.
The acres McGowan bought are now home to the Birds of a Feather retirement community in Pecos, N.M.
"I think the pandemic and politics really just drove people to seek more peaceful, safe communities of people of like minds."
Since McGowan's experience, LGBTQ-friendly senior housing has come a long way.
The New LGBTQ-friendly Senior Housing Communities
Hundreds of LGBTQ senior living facilities have opened around the country and more are coming on stream, sometimes targeted to low-income people.
McGowan noted that there has been a massive spike in demand since the beginning of COVID-19. "I think the pandemic and politics really just drove people to seek more peaceful, safe communities of people of like minds. Last year I was just insanely busy," said McGowan.
Pat McAulay, a co-founder of Village Hearth, a co-housing community for 55+ LGBTQ people and allies in Durham, N.C., said she has experienced the same increase in demand. Since Village Hearth started move-in in May 2020, it has been inundated with calls from people looking for housing.
Many activists hope the number of LGBTQ-friendly housing options will continue to grow.
"People are finding creative ways, which we always have done in LGBTQ communities, to take care of one another when government and systems fail."
Sydney Kopp-Richardson, director of the National LGBT Elder Housing Initiative at SAGE (Services and Advocacy for GLBT Elders), noted that LGBTQ older adults are especially at-risk when it comes to housing insecurity and poverty. 
Exacerbating this issue, many LGBTQ people  feel discriminated against in senior housing.
"We see the long-term impact of discrimination on someone's ability to successfully age," Kopp-Richardson said.
Many older LGBTQ people don't have children or have been rejected by their original nuclear family. "It's a lot harder to get to a point of economic security and mobility if you don't have a support network," said Kopp-Richardson. Recent studies show that one-third of LGBTQ people 50 and older live below the federal poverty threshold. 

Considering the proven adverse health effects of social isolation and discrimination, many LGBTQ older adults recognize the need to age in communities that accept and celebrate their identity.
A Welcoming Home
Nancy Kelly, a resident at Village Hearth, is familiar with the feeling of social rejection. Through the years, neighbors have pelted her home with eggs, teachers have targeted her daughter and a clergyman publicly denied her communion at her family church due to her sexual orientation.
Bonnie McGowan built the Birds of a Feather LGBTQ+ retirement community in New MexicoAs Kelly grew older, she witnessed an aging friend feeling petrified to come out as gay in her nursing home due to the opinions of the other residents. Said Kelly: "You can do all the work you want with staff, so that they don't discriminate. But when you have fifty other elders who bring their own values with them to a congregate living facility, you can't tell them what to think or how to act."
That' s why she was so relieved to hear about Village Hearth. Said Kelly: "[My wife Kate DeHaven ] and I held hands walking to the common house the other day. We feel very safe. We feel very comfortable. It just makes all the difference in the world that you're not a minority anymore to be living in co-housing that has an intentionality about being LGBT. You can be who you are."
Village Hearth bungalows cost between roughly $300,000 and $400,000 with shared monthly fees of about $300 to $400. McAulay lamented not being able to make the units even more economical. "We tried to keep it affordable," she said. "But in these times, it's just impossible on a one-off project without any federal funding."
There are at least 1,100 affordable units of housing in the U.S. for older LGBTQ people, according to SAGE.
Crowdsourcing an LGBTQ Apartment Complex
Also opening: new places like the G.L.I.T.S. House, a Queens, N.Y. community designed to house predominantly trans women of color, people who have been sex workers and ones who have been housing  insecure. (G.L.I.T.S. stands for Gays and Lesbians Living in a Transgender Society.)
G.L.I.T.S. House, which has 12 apartments, was built with the support of crowdsourcing and community-based fundraising.
Said Kopp-Richardson: "People are finding creative ways, which we always have done in LGBTQ communities, to take care of one another when government and systems fail."
When it comes to LGBTQ senior housing, said McGowan, "People just want safety. They want peace. They want to live out the rest of their life feeling safe."
If you're looking for LGBTQ-friendly retirement housing, SAGE has a useful directory. And the National Fair Housing alliance site has valuable resources on housing discrimination and legal help.


What's Ahead for LGBTQ Senior Housing?

Mary Siobhan Brier

Ann Francis remembers vividly the time she and her partner Nancy Lombardi were searching for a life plan community they might live in, allowing them to get increasing levels of onsite long-term care if they ever needed it.
Ann Francis, left, and Nancy LombardiFrancis, a former GM pipefitter and supervisor, and Lombardi, a one-time community college administrator and graphic designer, found one possibility. "And we just outright asked them, 'Would we be welcome? How would it be for us coming as out lesbians to your facility? Would people treat us right?'" Francis recalls. "'The woman said: 'Well, we have a policy to treat people right, but we cannot guarantee that our residents would treat you right."
The couple, who were Lansing, Michigan residents, didn't relocate there.
A Place Where They'd Be Supported 
Instead, in 2015, they found a warm and welcoming, mission-driven life plan community in Ohio — Kendal at Oberlin, one mile from Oberlin College — and moved into one of its independent living cottages. "We were really looking for a place where we felt we would be supported," says Francis, 80. 
"And we just outright asked them, 'Would we be welcome? How would it be for us coming as out lesbians to your facility?"
When Francis met with Kendal at Oberlin staff initially and was asked, "How do you want to be treated?" She answered simply: "'With respect.'' And people here do treat us respectfully."
She now helps run an LGBTQ+A (the A stands for Allies) interest group for residents and staff of Kendal at Oberlin, where the single-occupancy entry fee starts at $54,445 and the monthly cost ranges from $3,334 to $6,697.
"One of our goals was to make sure that Kendal not only said they were welcoming and affirming, but that we actually met the criteria for what it meant to be a welcoming and affirming community," says Francis.
The Long-Term Care Equality Index 2023
The criteria is spelled out in the new and groundbreaking Long-Term Care Equality Index 2023, a report from SAGE (Advocacy & Services for LGBTQ+ Elders) and the Human Rights Campaign (HRC) modeled after HRC's Healthcare Equality Index for health care facilities. It's the first validated survey on LGBTQ+ inclusion in long-term care and senior housing communities.
"The goal is to ensure that LGBTQ older adults can access welcoming and respectful care wherever they live. In the United States, that's just not the case now," SAGE CEO Michael Adams told me at the American Society on Aging's On Aging 2023 conference in Atlanta in March.
A 2018 AARP study found that 70% of LGBTQ+ older people said they were concerned they'd have to hide their identity in a long-term care community. In 21 states, there are no explicit laws prohibiting housing discrimination on the basis of sexual orientation, gender identity or both.
The need for inclusivity is especially acute, Adams says in the SAGE/HRC report, for LGBTQ+ elders of color, transgender older people and LGBTQ+ elders living in rural areas who often face the greatest challenges.
4 Key Criteria for Inclusivity
For the Long-Term Care Equality Index report, SAGE and HRC invited skilled nursing, assisted living, independent living, life plan/continuing care retirement, memory care, free-standing hospice and senior housing communities to fill out their comprehensive survey to measure whether they met more than 60 benchmarks for LGBTQ+ inclusion in four key areas:
Non-discrimination and staff training: ensuring legal protections for LGBTQ+ residents and staff along with staff trainingResident services and support: demonstrating progress toward LGBTQ+ resident care and supportEmployee benefits and policies: assuring that LGBTQ+ employees receive equal treatment and access to health-related benefits and policiesResident and community engagement: best practices from communities to publicly demonstrate their commitment to the LGBTQ+ communityThe Survey Says ...
Just 200 long-term care and senior housing communities in 33 states and Washington, D.C. — a small fraction of the total number in America — participated in the survey, which was conducted during the depths of the pandemic.
Of those, only 13 (or about 7% of them) qualified as Long-Term Care Equality Leaders, the highest level of the report's three tiers. To reach it, the facility must offer at least one trans-inclusive health care plan.
Another 137 communities in the report (68%) were High Performers, eight (4%) were not as far along and deemed Builders. Another 42 (21%) didn't rise to any of the three tiers.
The three states with the highest number of communities participating in the study: Ohio, New York and California, in descending order. The 17 with zero participants: Alaska, Arkansas, Hawaii, Idaho, Kansas, Kentucky, Louisiana, Maine, Montana, Nevada, New Hampshire, North Dakota, Oklahoma, South Carolina, South Dakota, Vermont and Wyoming.
"'Should the time come when I need long-term care support, will I be able to find a place to live that supports me, that recognizes me, that treats me with dignity?'"
Sherrill Wayland, SAGE's senior director of special initiatives and partnerships, believes that over time, long-term care communities and senior housing developments in all 50 states and in more rural areas will participate in the biannual survey.
The Beginning Stages of LGBTQ+ Inclusion 
"We recognize that in this industry, we are in the beginning stages" of LGBTQ+ inclusion, says Dan Stewart, associate director of the Human Rights Campaign Aging Equality Project and a gerontologist. "I think as time continues, individual institutions will see that not only is this the right thing to do, but it's smart business sense."
Explaining why her United Church Homes senior living facility in Beavercreek, Ohio takes LGBTQ+ inclusion so seriously (it's a designated Leader in the report), executive director Laura Farrell says: "United Church felt this was an underserved population in senior care and senior housing."
That's also the reason the nonprofit is developing a primarily LGBTQ+ independent living community in Dayton, Ohio, working with the city and planning commission. The goal: breaking ground at the end of 2023.
"One of the biggest concerns we continue to hear from our older LGBTQ+ people is, 'Should the time come when I need long-term care support, will I be able to find a place to live that supports me, that recognizes me, that treats me with dignity?' And that doesn't discriminate against me because I'm LGBTQ+,'" says Wayland.
Fears Based on History 
The question comes from lived experience.
"Ten-plus years ago, [long-term care and senior housing] providers were adamantly saying, 'There are no LGBTQ elders that live here,'" says Stewart. "Thankfully, I believe we've now seen with growing awareness, growing social context and conversation and recognition that the LGBTQ community exists across all spectrums of identities and that includes age."
Stewart notes that although many Millennials, Gen Zers, Gen Xers and boomers have been out and open for decades, "some members of our community in their late 70s and 80s have a history that often led to them being in the closet, out of fear of receiving poor treatment and access to services."
Farrell says many in the LGBTQ+ generation who want to live in long-term care communities and senior housing are "pre-Stonewall and live a little bit in fear" after facing years of discrimination.
Wayland says SAGE has seen people being denied entrance into long-term care communities because they're gay, lesbian, bisexual or transgender.
"These are true concerns and at a time when people are needing support but sometimes don't have the ability to pick up and move to another area of the country where they may feel more supported," she adds. "There definitely are real challenges out there."
Being Who They Were
Farrell recalls a lesbian couple who lived in Beavercreek a few years ago: "One of them said it was the first time she was ever able to feel safe having a public relationship with her longtime partner. They could walk up and down the halls holding hands. For the first time in 60 years, they could be who they were."
In the Long-Term Care Equality Index 2023, 73% of participants said they have rooming policies that are inclusive of same-sex couples and 84% took part in or supported one or more LGBTQ+ related events or initiatives in their service area.
But just 14% have medical and comprehensive health benefits to domestic partners of benefits-eligible employees.
A Need for Social Supports 
One reason older LGBTQ+ adults long for a welcoming environment in long-term care is that they're twice as likely to be single and live alone and four times less likely to have children than others their age. So, they have fewer family members who could offer social support and assistance when needed.
AARP's 2018 research found that 76% of LGBTQ+ adults age 45+ surveyed were concerned about having adequate social support to rely on as they age.
The most important sign of LGBTQ+ inclusivity in long-term care and senior housing, Stewart says, is whether the facility has a non-discrimination policy for residents.
Ninety percent of the communities participating in the SAGE/HRC study have updated their resident — and employee — non-discrimination policies to include protections based on sexual orientation and gender identity.
One reason older LGBTQ+ adults long for a welcoming environment in long-term care is that they're twice as likely to be single and live alone and four times less likely to have children than others their age. 
By contrast, when SAGE and HRC researched such policies for their 2021 report, only 18% of the communities had published such an enumerated resident non-discrimination policy and 36% had a written policy for employees.
Useful Online Research Tools 
You can search for each of the 200 communities that participated in the SAGE/HRC report and see how they fared by using the online Long-Term Care Equality Index search tool on the Human Rights Campaign site.
SAGE and HRC's free online guide, "Finding an LGBTQ+ Inclusive Long-Term Care Community," offers helpful suggestions on what to look for and questions to ask when comparing prospective long-term care communities and senior housing developments.
"One indication of a space not being welcoming is if there's no visibility for LGBTQ+ people," Adams told me. "It's as simple as when you walk into the lobby, what are the pictures you see on the wall? Do you see a Rainbow sticker anywhere?"
All the collateral materials for United Church Homes' Beavercreek community, for example, have Rainbow flags and their front door has a Rainbow sticker, says Farrell. "To signify to folks that we are a safe place that's inclusive, open and affirming," she notes.
Stewart believes most aging-service providers want to foster an environment that lets people be themselves. But Wayland says some long-term care providers don't know how to be more inclusive and welcoming to LGBTQ+ residents and staff. She hopes the SAGE/HRC report will give them answers.
"There's always room for improvement," says Wayland.
A follow-up survey from the two groups will open in Summer 2024; results will be released in 2025.
6 Signs of an Inclusive Long-Term Care Community
The SAGE/HRC online guide says these are important elements to look for:

A written non-discrimination policy for residents that mentions sexual orientation, gender identity or both. It may be on a community’s website or in its marketing materials.An equal visitation policy saying residents have a right to see any visitor of their choosing at any time, and with privacy. This might be posted in the building, in a marketing packet or online.An LGBTQ+ inclusive rooming policy ensuring a resident can live with their same-sex partner and that residents will be placed in a room based on their gender identity. Ask a staffer for a copy of their rooming policy when touring a community.Evidence that the community tries to reach or support LGBTQ+ people. It could be participating in local Pride events or working with LGBTQ+ organizations. See if LGBTQ+ people appear in the community’s pictures or stories on its website or in its marketing materials.Proof the community has programs or facilities that are inclusive of LGBTQ+ people. You might ask whether couples’ activities are inclusive of same-sex couples.Training and diversity efforts to support LGBTQ+ staff and residents. These indicate a greater acceptance of LGBTQ+ older adults.

Making Long-Term Care Communities More LGBTQ+ Welcoming

Richard Eisenberg

Long-term care costs, social isolation, dementia and financial insecurity are all notable problems facing many older Americans. But perhaps their biggest challenge of all is housing.
A small and growing number of communities — especially on the West Coast — are now allowing Accessory Dwelling Units (ADUs) to help counter high housing costs.As more than two dozen experts explained at "Raising the Roof: America's Housing Crisis and Our Longer Lives," the Columbia University Age Boom Academy program for journalists (where I served as a panel moderator and mentor), a tormenting triad has created an untenable situation.
Call these problems the 3 A's: affordability, accessibility and the ability to remain in your own home.
Better Housing, Better Health
"Our society is at a critical juncture in planning for an aging population while confronting one of the worst housing crises in our lifetimes," said Dr. Linda Fried, director of the Age Boom Academy and dean of the Columbia University Mailman School of Public Health.
Caitlin Hawke, Age Boom's project lead, said the 2023 version of the academy focused on housing as a determinant for health in aging. "The more we learned, the more we realized what a dearth of affordable options there are for older people to remain in their communities as they age," she noted.
"Our society is at a critical juncture in planning for an aging population while confronting one of the worst housing crises in our lifetimes."
Fortunately, the Age Boom panelists said, a few novel programs and housing communities — from nonprofits, real estate developers and the federal government — are helping address housing problems facing older Americans.
Here's a look at the key housing challenges and what's being done to reduce them:
Affordability
"The precarious state that many older people live in could be addressed by getting a handle on the cost of housing," said gerontologist Jan Mutchler, creator of The Elder Index measure of what it costs older adults to stay in their homes and remain independent.
Roughly one-third of people aged 50 and over pay more than 30% of their incomes for housing — making them "rent burdened" according to the federal Department of Housing and Urban Development (HUD).
"The story of homelessness is a story of affordable housing."
The high cost of houses and apartments in many places is a leading reason why older adults are now the fastest growing group of homeless Americans, according to the Joint Center for Housing Studies at Harvard University.
Elder homelessness rates haven't been this high since the Great Depression. One in three people experiencing chronic homelessness in 2020 were 55 or older, according to HUD. Chronic homelessness means living without a home for at least 12 months or having four episodes of homelessness adding up to 12 months over three years.
"The story of homelessness is a story of affordable housing," said Mutchler.
Jonathan Rose, whose Jonathan Rose Companies builds and buys affordable, green housing, noted that only 50,000 new units of affordable housing are built in the U.S. annually. They exist due to small federal subsidies Congress has authorized.
The Overlooked Lower Middle Class
"Affordable housing can only be built with subsidies," said Rose. "As much as I hope that we'll develop the financial resources to solve these issues [of affordability], looking at Congress today, I don't think it's going to be likely."
Dr. Jack Rowe, a faculty member at the Robert N. Butler Columbia Aging Center, said at Age Boom that he's especially concerned about housing affordability for the older Americans he calls "the forgotten middle" — the lower half of the middle class. They are not eligible for low-income housing and often can't afford market-rate rents or home ownership. "They're faring much less well than their predecessors 20 years ago," said Rowe.
The demand by older adults for affordable housing is enormous.
Wayne Ho, president and CEO of the Chinese-American Planning Council, said that when his group opened a senior affordable housing building in New York City's Chinatown last year, it received 22,000 applications for 110 units.
Big Idea: Small Houses
Two reasons affordable housing is in such short supply: builders see bigger profits by going upscale and local zoning ordinances often prohibit low-income construction.
"The problem with housing is that in many communities, there really aren't affordable and reasonable downsizing options that would let people stay in their community," said Mutchler.
But a small and growing number of communities — especially on the West Coast — are now allowing Accessory Dwelling Units (ADUs) to help counter high housing costs. ADUs are typically small houses built in the backyard of existing houses, though they can be modified apartments and townhouses.
"In many communities, there really aren't affordable and reasonable downsizing options."
At Age Boom, Rodney Harrell, vice president for family, home and community at the AARP Public Policy Institute, called ADUs the "Swiss army knife of housing" because they are affordable and often one-story, so residents needn't worry about climbing stairs.
A Joint Center for Housing Studies report noted that before statewide ADU legislation passed in California in 2016, localities there issued about 1,200 ADU permits annually. In 2022, that number rose to over 24,000.
The Biden administration's 2022 Housing Supply Action Plan called for more ADUs nationwide, especially for low- and moderate-income people, with pilot programs for federal ADU loans.
Accessibility
Fewer than 4% of U.S. homes are fully accessible and adhere to the principles of universal design, Federal Housing Administration (FHA) Commissioner Julia Gordon said at the recent Stanford Center on Longevity 2023 Century Summit.
The U.S. Census Bureau says in 28% of households with an adult aged 65 and over are in houses that are difficult for older adults to use. For example they may have trouble climbing stairs, getting into the bathtub or using the kitchen.
"When we go into homes and do major repair work, we see measurable improvements to the health of the older adult resident."
As a result, even though surveys show most people want to age in place, their homes won't let them — at least not without costly renovations, if they are even possible.
Making homes accessible not only keeps older residents safe, it often has other benefits.
"When we go into homes and do major repair work, we see measurable improvements to the health of the older adult resident," said Tawkiyah Jordan, vice president for housing and community strategy at Habitat for Humanity International, at Age Boom. "We also hear from them self-reported improvements in their sense of well-being, and a significant decrease in depression."
Ability to Remain in Your Own Home
Now that pandemic moratoriums on evictions and foreclosures have been lifted, experts at Age Boom said, there are growing fears of older adults being forced out of their homes by predatory landlords and lenders.
Roughly 200,000 renters over age 65 receive an eviction filing every year; about half of them are later evicted, Nick Graetz, a research associate at The Eviction Lab at Princeton University, said at Age Boom.
"There is $1.1 billion of wealth at stake to be lost due to 'tangled title' issues, the majority of which is Black wealth."
One especially pernicious problem pushing older people out of their homes is known as "a tangled title." That is when someone loses ownership or cannot transfer the home to the next generation because they lack the proper title to it.
"The Pew Charitable Trusts did an interesting study out of Philadelphia that noted there's $1.1 billion of wealth at stake to be lost due to tangled title issues, the majority of which is Black wealth," Lily Hoffman, Habitat for Humanity International associate director of programs, said at Age Boom.
The Economic Hardship Reporting Project's new book of essays about financial precarity, "Going for Broke: Living on the Edge in the World's Richest Country," has a sad story about a woman whose tangled title caused her to lose her Detroit home.
"People often assume it's young people who are struggling to make ends meet," said Alissa Quart, the project's executive director and book's co-editor. "It turns out, a lot of our grant recipients experiencing financial hardship are older."
What Works to Fix These Concerns
Age Boom panelists described six novel ways affordable or accessible housing is being created around the nation:
Bridge Meadows: Oregon's three Bridge Meadows multigenerational, affordable housing developments feature universal design and on-site mental health specialists. They're comprised of apartments with low-income renters who are 55+ and townhouses for families adopting or fostering youth. "You might not recognize that it's affordable housing," said Derenda Schubert, the nonprofit's executive director.
CAPABLE: This Johns Hopkins School of Nursing program (full name: Community Aging in Place-Advancing Better Living for Elders) brings together an occupational therapist, a registered nurse and a handy worker to make a low-income older adult's home safer and keep them healthier. It has also reduced their need for hospitalization and nursing home stays. CAPABLE is now in 23 states.
Colma Veterans Village: Working with the Veterans Administration and low-income housing developer Mercy Housing, geriatrician Dr. Anne Fabiny created this apartment complex in Colma, California, with health care for chronically homeless, frail and medically or psychosocially complex older veterans. Residents — primarily Vietnam vets — pay no more than 30% of their income for housing. The 65-unit complex has primary and mental health care teams on site as well as occupational and recreational therapy. The Veterans Administration is extending the Colma model nationwide.
Habitat for Humanity: Although this nonprofit is best known for building houses, it also repairs and restores them to help inhabitants age in place. Through rezoning, Habitat for Humanity is rebuilding some older adults' homes in Tacoma, Washington. to create a multigenerational, affordable housing development with shared living spaces.
Section 202 Housing: HUD's Supportive Housing for the Elderly program, which is based on Section 202 of the Housing Act of 1959, provides loans to build, buy or rehab apartments for people aged 62 or older earning less than 50% of the area median income. Its rent subsidies help make the apartments affordable. "Section 202 was dormant for several years and then revived," Linda Couch, vice president, housing and aging services policy at the LeadingAge nonprofit, said at Age Boom. "It's HUD's flagship older-adult housing program and brings consistent, stable affordability to tenants."
The Gale Eckington Project: After Amazon committed to preserve housing affordability in Washington, D.C., for its employees there, the Jonathan Rose Companies bought the 603-unit Gale Eckington apartment building with a low-cost loan from the powerhouse retailer. Half its units will be rented to residents earning 80% or less of the local median income. "We were able to create 300 new units of affordable housing simply by changing the regulatory environment on a very nice building," said Rose.


New Solutions to Older Adults’ Housing Challenges

If baby boomers have made one desire patently clear it's that they do not expect to age the way their grandparents and parents did. Those aged 59 and older are working longer, expect to live more active lives, and show a greater interest than previous generations in choosing how and where they live as they grow older, according to a report by the Population Reference Bureau.
Daniel Parvin playing pianoBusinesses across the country, especially in the housing industry, are paying attention. Where assisted-living and 55-plus communities once were the main focus, today an increasing number of entrepreneurs look to "intergenerational housing" as the wave of the housing future. The result is a list of growing options for older adults interested in housing options as they age.
2 Problems, 1 Solution
The interest in offering different housing options is inspired by both financial and social needs. Affordable housing is in short supply in cities across America. At the same time, many older adults are challenged to pay the bills in the house they currently inhabit and worry they will not be able to age in place.
Alternative housing options that unite generations rather than separate them offer additional plusses, proponents say. Interaction between generations can help address or prevent many of the problems associated with aging, such as social isolation and general feelings of uselessness.
The interest in offering different housing options is inspired by both financial and social needs.
A 2023 Surgeon's General report, for instance, estimates that social isolation among older adults accounts for about $6.7 billion in additional Medicare spending annually. Providing generations more exposure to each other can also help combat ageism.
First, a clarification of terms. Multigenerational and intergenerational housing are both often mentioned when discussing housing options. While they sound similar and do share some traits, ultimately they are different.
Defining the Terms
In both forms of housing, multiple generations live in close proximity to each other. Multigenerational housing, which quadrupled between 1971 and 2021 according to the Pew Research Center, is what many think of as an extended family: grandparents, parents and children who are related, live in one house and often eat together.
Intergenerational housing involves people of different ages who are not necessarily related but live together — perhaps in a building complex, such as those often found in assisted living situations, or in a community designed for people of different ages. In this latter concept, the residents may share daily tasks and meals or participate in organized events, depending on the community.
Regardless of the nuances of each version, this much is clear for both: Different generations living in close proximity to each other can help everyone involved to have a better understanding for groups with which they might not otherwise interact much. And that, say proponents, is a win-win for everyone.
Three Models
To illustrate how intergenerational housing is developing, here is a look at three models across America.
Judson Manor, a retirement community in Cleveland, takes a more traditional senior independent living opportunity and adds a twist — a music residency in collaboration with the Cleveland Institute of Music.
Since 2010, two CIM graduate students have joined the retirement community for a year as artists-in-residence. In exchange for performing throughout the year, the students, who live at Judson for two years while they earn graduate degrees, receive free room and board.
They are obligated to play three concerts annually, two of them as individual musicians and one in collaboration with each other. Students are chosen after being interviewed and writing an essay explaining why they are interested in this intergenerational living experience.
Participants say the program has been life-changing for Judson Manor residents and CIM students alike. Eugene Brand, 91 and a retired minister, has served on the entrance committee for several years and loves both the music and the chance the program offers to interact with the students.
John Fawcett playing the violin."To have this kind of music, which is always high quality, makes you feel good to be a part of this," he says. "In addition, there are the one-to-one relationships that develop. Some of them last beyond the time of their residency here."
Students are encouraged to join social events, such as non-alcoholic happy hours and floor parties. "They do get to know people and get involved in the community," Brand says.
The program's positive influences are echoed by recent CIM residents. Luke Ratcliffe, 26, just finished a doctorate at CIM and a residency at Judson. The program, says the pianist, helped him personally and professionally.
A Real Love of Music
"I could talk shop with people," he says, noting Judson Manor's residents include several current and former professional musicians. "There was a real love and support for music and what I was trying to do. I was able to sharpen my skills and share what I can," he says, noting he wants to be a performer and have his own studio.
"You can understand each other," echoes John Fawcett, a 22-year-old violinist from Oregon who just finished his first year at CIM and Judson and who has enjoyed making friends with musician residents. "Sometimes with someone with more life experiences, you can gain a lot and learn a lot from them just by talking with them, especially people who did what you're doing."
But it was the social aspects of intergenerational living that really inspired the students. Ratcliffe went to dinner with residents, participated in some events and loved making new friends.
The Profundity of Performing
All of it, Ratcliffe says, helped him to regard the aging process differently. "My grandmother played a big role in my musical development, so this was not a big stretch for me," he says.
"Some people did die while I was there," he adds. "It was a big deal for me to know that some of my concerts were the last live music they ever heard. You feel the profundity of that."
"We're the same in many ways. You can have friends my age or their ages. You can learn from so many different people."
Fawcett says the experience changed his perspective on aging. "It seems like how I grew up and most people my age look at senior citizens and groups as the 'other,'" he says. "It gave me more perspective that they're not the other. We're the same in many ways. You can have friends my age or their ages. You can learn from so many different people."
Another approach to intergenerational living is The Treehouse Community in Easthampton, Massachusetts. It was designed to expand affordable housing for older adults and young people in foster homes and the adoption system. The Treehouse Foundation partners with Beacon Communities LLC to unite foster and adoptive families with older adults in a planned neighborhood.
The Easthampton community — a second Treehouse development is in the works in Boston — includes 12 family homes, each with three, four or five bedrooms, as well as 48 one-bedroom cottages for older adults.
Training Older Residents
The older residents are vetted and receive training before moving in, and are expected to participate in the community, sharing their life experiences and expertise. They must meet affordable housing requirements.
"They understand our vision," Judy Cockerton, founding executive director of The Treehouse Foundation, says. "They understand there are expectations that they will support their neighbors, the expectation that this is a community, that this is an intergenerational community, that it's an intentional neighborhood."
"The outcomes for the kids are tremendous."
The foster or adoptive families receive social services support as long as needed while being in a stable, multigenerational environment. Over 100 people typically live at Treehouse, which was formed in 2006 and usually has a waiting list for both families and older singles. Staff members bring people together in organized programs.
"The outcomes for the kids are tremendous," Cockerton says, ticking off higher rates for finishing school as just one example. "And they continue to be rooted in their family and a community that fully supports them. People are investing in their hopes and dreams and their lives, and it really matters."
Cockerton sums up the benefits she's seen with the story of an 85-year-old who has lived at Treehouse since it opened.
Neighborhood Connections
"She said to me, 'I never thought when I would turn 85 that I would be seen and valued and cherished and needed and loved," Cockerton recalls. "That's what I feel in this community because I'm so connected to my neighbors.'"
Holly Handfield has benefitted from both sides of the Treehouse community. When she moved in 16 years ago, she was 57 years old, single and had seen firsthand how social isolation affected older adults while an outreach worker at a senior center. "I couldn't see myself doing that," she says, noting she has always been surrounded by children.
"I never thought when I would turn 85 that I would be seen and valued and cherished and needed and loved."
About a year after moving in, though, her daughter dropped her two grandsons at the door with an 80 pound dog and cat. "I found myself in a spot where a lot of other grandparents find themselves — raising a new family," Handfield says.
Fortunately, as a Treehouse resident already, she had options, and eventually moved from a cottage to a house. "When I raised my own children, I didn't have any of this," she says of the support she received dealing with children with special needs. "It was beyond me."
With her grandchildren grown, she now spends a lot of her time mentoring children in the community kitchen and volunteering in art classes.
Older Adults Feel Useful
"I'm surrounded by this extra family that I have, this support system," says Handfield. "It's not that it makes me feel younger. It makes me feel useful.
"When you're older, being useful is a big thing," she adds. "It's a great feeling to be part of all of it."
Sue Brow, now 61, is a foster parent who also has an adopted son with special needs. She has been a Treehouse resident for five years.
"From the beginning, having support while raising kids who have had trauma was the appeal," she remembers. "It was like moving into a really welcoming neighborhood. It's not like living in an apartment complex at all. It's people who really care for you."
A Different Approach
Nesterly, a company based in Boston and expanding into Columbus, Ohio, Louisville, Kentucky, and other cities, is taking a wholly different approach to building communities and providing affordable housing.
Rather than a closed community, like Judson Manor or Treehouse, Nesterly matches older adults who want to age in place with younger people interested in renting a room at a below-market rate in exchange for help with certain chores.
While Nesterly spokesmen declined to be interviewed for this article, their website outlines some of the details for participation. Homeowners can list their homes for free. Nesterly staff screen potential renters, check references, do background checks and confirm employment. They also handle leases, collect the monthly rent and facilitate any disputes that may arise.


Housing Harmony Between Generations

Janet Reynolds

Deb Morgan, 74, made the decision in 2021 to sell her home in Aiken, South Carolina, and move closer to her son in Cincinnati. While the booming real estate market helped her get more for her Aiken home than she imagined, the market also worked against her when finding a new place to live.
Deb Morgan"There just doesn't seem to be anything affordable for middle-income seniors."
Morgan didn't want to pay an inflated home price and she wasn't even sure she wanted to own another home. "I called two senior apartment complexes and they both had income requirements for the maximum amount I could make," Morgan says.
Morgan learned she earns $1,000 per year too much to qualify to live in what is considered low-income housing. She declined to disclose her exact income, saying only that it is less than $3,000 per month.
While she makes too much for low-income housing, "I don't make enough to live in a luxury senior living complex," she says. "There just doesn't seem to be anything affordable for middle-income seniors."
Low-Income Thresholds
There are some local and state low-income programs, but most are funded by the federal Department of Housing and Urban Development, with apartments allocated based on whether HUD considers an applicant to be low-income or very low income. Low income is no more than 80% of the median income for the city or county in which you live. Very low-income is no more than 50% of the local median income. The figures vary by location.
Jennifer Molinsky, project director of Housing an Aging Society Program at the Joint Center of Housing Studies at Harvard University in Cambridge, Massachusetts, says Morgan's situation is so commonly raised among those studying housing for older adults that they refer to it as being "trapped in the gap."
"There are very few options devoted to middle-income senior housing. This is true of market-rate independent housing as well as assisted living."
"There are very few options devoted to middle-income senior housing," adds Molinsky. "This is true of market rate independent housing as well as assisted living."
She says that as people age, they typically want to sell their homes, if they own, or otherwise downsize or move closer to family or city centers where there are more services. "They cannot afford the options, even if there is senior housing available, and when you throw accessibility into the mix, it becomes more complicated," Molinsky explains.
Anne Louise Feeny, 82, moved to Pittsburgh from New Jersey in 2003 partially in search of a lower cost of living. A retired teacher, Feeny visited a financial adviser and learned she would not be able to afford luxury senior housing — and with her income, which she says is less than $30,000 per year, she made $200 a month too much to qualify for low-income senior housing in her area.
She considered renting but didn't want to "throw away money on that." She put a 20% down payment on a small condominium, but she says Social Security hasn't kept up with the cost of living, which includes condominium fees and increases in Medicare and supplemental health insurance.
Feeny and her daughter have spent more than a year searching for a home to share, but she says when they find a house they can afford, there is a bidding war, which brings the price up. "I don't know what will happen next," Feeny says of her situation.
Lack of Market Incentives
Molinsky says the primary reason there are so few housing options for middle income older adults is the fact developers have little financial incentive to develop housing for that group. "With the high cost of construction, builders have a hard time making the numbers work," Molinsky says. "They may be required by municipalities to do a percentage of low-income in an area, but they have no incentive to build for middle-income seniors."
Development costs are a hindrance. CBRE, a leading commercial real estate and investment firm, says the cost of developing senior housing increased by 17.8% in 2020 to $317,400 per unit or $333 per square feet. Builders cite higher costs for labor and materials as the main reasons.
The National Association of Home Builders (NAHB) addressed in 2020 what it characterizes as the "missing middle" of middle-income older adults. It suggested that builders start meeting the demand for middle-income senior housing by:
Finding reasonably priced land near public services and shoppingWorking with municipalities to speed the processes for obtaining all necessary permits and inspections for this type of housingDiscovering ways to bring construction costs downDemand May Double
The number of middle-income older adults seeking affordable housing is likely to increase. A joint study headed by NORC, an independent, nonpartisan research institution based at the University of Chicago, estimated the number of middle-income older adults will have nearly doubled between 2014 and 2029, from 7.9 million to 14.4 million.
Middle-income people also will comprise a larger share of the country's total population of older adults, rising from 40% in 2014 to 43% in 2029, the NORC study says.
Molinsky says there aren't many things being done nationally to ease housing costs on middle income older adults by government agencies, although she says there are a few local initiatives.
Lowering income requirements likely wouldn't help, she says, because there already is a shortage of housing for low-income older adults who already qualify. "Just because people qualify for low-income housing doesn't mean they can get it," she says.
Molinsky suggests other alternatives, such as finding like-minded roommates through a home-sharing service or building an accessory dwelling unit (ADU) on a family member's property.
Limits on Guest Houses
An ADU is an option Morgan says she investigated, but the communities in which her children own homes (she also has a daughter in the Seattle area) don't allow ADUs. Morgan ended up renting a market-rate apartment for which her income didn't meet the minimum requirement to rent. However, the complex allowed her to use her modest savings to qualify.
"Just because people qualify for low-income housing doesn't mean they can get it."
The building in which Morgan lives was constructed in the 1960s and has stairs, which may present a future mobility issue for her. It also lacks central air conditioning and heat, relying instead on costly window units and inefficient baseboard heating.
Morgan says she has everything she needs and is making ends meet but is still uncomfortable paying more than 30% of her income toward housing costs, the standard to which she has always adhered.
"The thing that surprises me the most is the fact I've had to watch how I spent money all my life," Morgan says, "and I'm still having to do that at this age."


Trapped in the Affordable Housing Gap

Kerri Fivecoat-Campbell

The number of Americans aged 65 and older jumped by more than 30% in the last decade, and will only continue to climb. As it does, more older adults are likely to struggle to find affordable, accessible housing as they age, according to a new report.
Tony Thomas, 50, displays some of the contents of a hygiene kit from Manna House, a nonprofit serving unhoused people two days a week in Memphis, Tenn.Many will face the difficult choice of paying for housing or health care, while some older Americans will end up homeless. People over 80 years old — the fastest growing segment in the coming decade and one with urgent needs for accessible housing and services and supports at home — may be the most impacted, according to Housing America's Older Adults 2023, a new report from the Harvard Joint Center for Housing Studies.
"The demand for suitable, affordable, accessible housing that's well-connected to services is about to skyrocket," says Jennifer Molinsky, Project Director of the Housing an Aging Society Program at the Center. "We're really on the cusp of a lot of change."
A Ballooning Population
At the same time, the U.S., for its part, lags behind other advanced economies in preparing for this unprecedented population surge, the report notes. But there are many opportunities for public, private and nonprofit organizations to address the mismatch between a rapidly aging population and insufficient supply of affordable, accessible housing. Help could take the form of zoning changes to increase housing options and more government rent assistance, among other efforts, Molinsky says.
"The demand for suitable, affordable, accessible housing that's well-connected to services is about to skyrocket."
From 2012 to 2022, the number of Americans aged 65 and over climbed from 43 million to 58 million, according to the report. That number will continue to increase as the first baby boomers turn 80 within the current decade.
Part of the reason older adults struggle to stay in the home of their choice or to find new housing is because of their fixed or declining incomes. In 2021, an all-time high of around 11.2 million older adults were cost burdened, meaning they spent more than 30% of their income on housing. This was especially true for renters, homeowners with mortgages and householders age 80 and over.
Choose Housing or Health?
"We know that people who are unaffordably housed might forgo prescriptions, spend less on food or forgo making modifications to their home that could help them live more safely," Molinsky says.
"We know that people who are unaffordably housed might forgo prescriptions."
More older adults have mortgage debt, too. Between 1989 and 2022, the share of homeowners aged 65 to 79 with a mortgage rose from 24% to 41% and the median mortgage debt more than quintupled, from $21,000 to $110,000. More than 30% of homeowners aged 80 and over carry mortgages, up from just 3% three decades ago. Renters, for their part, can be vulnerable to rising housing prices in ways owners are not.
Meanwhile, accessible housing for older adults in the U.S. is in short supply. Fewer than 4% of U.S. homes offered the three key features of accessible housing — single-floor living, no-step entries and wide hallways and doorways — according to data from the latest American Housing Survey.
Older adults are also balancing high health care costs with their housing needs. The majority of older adults will need long-term care services, which cost, on average, over $100 per day nationwide. Older adults with low incomes are the most likely to need these services but the least likely to be able to afford them.
When these care services are added to housing costs, only 14% of single people aged 75 and over can afford a daily visit from a paid caregiver, according to the new report, while just 13% can afford to move to an assisted living center.
"Having less (home) equity limits your options."
The burden is especially steep for renters and homeowners of color who may not have enough home equity to tap into to pay for care or services. Older renters have only 2% of the net wealth of older homeowners. Older Black homeowners have the lowest housing equity at $123,000 versus $251,000 for older white homeowners, $200,000 for older Hispanic owners, and $270,000 for older owners who are Asian, multiracial, or another race. 
"Having less equity limits your options," says Molinsky.
Climate change is playing a part, too. With increased floods and fires across the U.S., property damage is a rising concern and it contributes to costs. In Florida alone (home to 8.3% of the nation's older population), severe storms caused $228 billion in property damage from February 2020 through April 2023.
More Older Adults Are Homeless
With so many challenges, there's a real risk of homelessness for older adults. In fact, older adults are one of the fastest-growing groups experiencing homelessness, says Jennifer Kye, a senior attorney at the nonprofit Justice in Aging.
"This act would be a game changer because we know these programs work."
Among other reforms, the group is advocating for Congress to pass the bipartisan Eviction Crisis Act, which would establish a permanent emergency rental assistance program similar to the help that was temporarily available during the pandemic.
"These were lifelines for older adults who couldn't pay their rent," Kye says. "This act would be a game changer because we know these programs work. With homelessness, prevention is really key. Once older adults lose their housing, they generally face more challenges than younger people in trying to regain it."
Planning for Older Age
A big part of the solution is more funding — from the government and other groups — to subsidize housing and help pay for accessibility upgrades to properties, Molinsky says.
Home modifications like no-step entries and walk-in showers could go a long way toward helping older adults age at home, a scenario a majority of people prefer. "There's a lot to be said for planning ahead," she says.
For example, people in the midst of a home improvement project could consider add-ons that might help them in older age so that accommodations are in place when they need them. If you're opening up a bathroom wall, says Molinsky, put in blockers, or pieces of wood inside the wall, so you can eventually add grab bars.
"If you want to stay in your home community, think about what kinds of support, services and modifications you might need in the future to make it a more comfortable experience," she says.
Renters: Know Your Rights
People living in rental properties should know their rights around landlords providing reasonable accommodations to make their dwelling accessible, says Kye.
"It's really important to ensure more housing providers are complying with civil rights laws."
For example, some older adults who need a live-in aide have found that building management won't let a caregiver live with a tenant unless the aide is on the lease.
"It's really important to ensure more housing providers are complying with civil rights laws and that they provide older adults with disabilities with the reasonable accommodations they need," Kye says.
Older adults who need help getting reasonable accommodations and filing a complaint may find help from sources that offer legal services to low-income people and those living in poverty: local Legal Services groups; fair housing organizations, legal aid offices, or disability rights groups to see if they qualify for their free services, says Kye.
Potential Solutions to the Shortage
Zoning reforms could help with the housing shortage, too, by encouraging a wider variety of living options in communities for older adults. "There's an opportunity for people to advocate for more local housing options," says Molinsky.
"We have to support people. The need is only growing, as is the urgency to act."
More safe and affordable mortgage products would be welcome as well, she says. Borrowing could help older adults access cash for basic needs or care as they stay in their communities. This could make a big impact in rural and other low-density area where housing choices are more limited.
Often, people don't want to tap into their home equity because they think it's for an emergency or they want to pass on wealth to their children. "But what constitutes an emergency?" says Molinsky. "If you could use your home equity to make your life better — to buy hearing aids, for example — maybe that's a good investment."
Molinsky is optimistic about solutions. The time for action, however, is now. "The fact that we have a growing older population means we have improved longevity, and this is a good thing," she says. "But we have to support people. The need is only growing, as is the urgency to act."


Left Out in the Cold

Deborah Lynn Blumberg

It was the morning of August 16, 2017. Anna Smith (name changed to protect privacy) sat in a meeting at the intermediate care facility (ICF) where her brother Matthew Smith (name changed to protect privacy), then 55, had been living for approximately one month. ICFs are supposed to provide comprehensive health care for people with intellectual or developmental disabilities or IDD. Matthew had a condition called Dandy-Walker syndrome, a rare congenital birth defect of the brain. 
That day, staff at the ICF told Anna that Matthew was healthy and eating well. Five days later, he was sent to the emergency room due to severe dehydration and constipation. He was there for 38 days.
Prior to that, Matthew had spent over two-thirds of his life at a different ICF — one of the largest residential state ICFs in Connecticut known for its abusive conditions. However, Matthew was never abused or mistreated, according to his sister. 
In fact, Anna believes that it was one of the only facilities that could adequately care for her brother.
"His medical health and all his abilities declined over the years. He was hand-fed and wasn't able to even hold a spoon because he was very contracted. His health concerns were my biggest fear — that he wasn't going to be able to be taken care of [at a different facility]," Anna explains. 
However, with the larger ICF facility losing monetary support, she knew the next best option would be to transition him to a smaller ICF.
A Mother and Her Sons
Jamie Lemon is also nervous about leaving her son in the hands of others. Lemon is the mother of two autistic teenagers — 16-year-old Wyatt and 17-year-old Caleb. After spending a year on a waiting list, Caleb was placed in a group home in Gilbert, Ariz., due to his physical aggression. 
"He tends to be aggressive towards females. I'm five-foot and he's almost six-foot now," says Lemon. In January of 2019, when her husband was sick in the hospital, Caleb got worse. 
"Caleb started attacking me for hours — bit me from head to toe. I still have no feeling in my back. It was really bad,"  his mother says.
"We just see so much evidence of what an inclusive and engaged life can be like that we will always encourage people to explore that."
Although Lemon's youngest son, Wyatt, tried to intervene, only the police were able to make Caleb stop. 
Like Smith, Lemon has her own worries, including fears about the future.
"It would be my biggest fear to pass away because I can't be involved in being an advocate for my son if I'm gone. His stepfather has almost died twice from non-alcoholic liver failure. His brother is higher-functioning, but I don't know," Lemon says.
On top of this, her extended family lives out-of-state and doesn't have the means to help Caleb. Ultimately, Lemon knows that the state of Arizona will have to care for Caleb after she passes away.
While Lemon and Smith found a housing arrangement that works for their loved ones, both worry about the potential for abuse or neglect without their constant supervision.
Histories of abuse at larger institutions, such as Willowbrook State School in Staten Island, N.Y., — which was known in the mid-1900s for its neglect, its uncontrolled hepatitis outbreak and an understaffed and overcrowded facility — have led many to advocate for smaller community-based homes. 
But even those settings aren't always optimal. 
The Complexities of Housing
Jon Meyers, executive director of The Arc of Arizona, a disability advocacy group, believes in moving people with IDD out of institutions and into community placements.
"Since the beginning of the organization back in the early 1950s, there's been a strong emphasis on moving people out of institutions — whatever can help individuals become more integrated into their communities, more included in the lives of their communities," says Meyers. "We just see so much evidence of what an inclusive and engaged life can be like that we will always encourage people to explore that."
However, he also recognizes that nursing facilities such as ICFs and other community-based solutions aren't fully removed from abusive practices and institutional form, meaning they maintain some of the characteristics of institutions. 
"The real reason that the folks at Hacienda were prosecuted was that what happened there was so horrific and received so much media attention there really was no alternative."
Perhaps one of the most egregious examples of abuse occurred in 2019 when a caregiver raped an incapacitated woman in an Arizona ICF, Hacienda Healthcare — she later gave birth to a baby boy. 
Meyers was on the Abuse and Neglect Prevention Task Force that was created after the incident.
"Not surprisingly, what happened at Hacienda really kick-started a lot more work and generated a lot more public attention than we (the IDD community) had ever gotten before then," explains Meyers. "Still, a lot of skilled nursing facilities and retirement homes tend to have the characteristics of a congregate setting. They are, by nature, designed to provide a consistent environment and a controlled environment."
An Impossible Choice
Sara O'Neal learned firsthand the abuses that can occur behind closed doors in some group homes. On September 2, 2021, her 16-year-old autistic and epileptic son, Austin, was found with severe rug burns and bruising on his body. O'Neal and the doctors at Phoenix Children's Hospital suspect that it resulted from caretakers dragging him from his room into the shower.
According to O'Neal, the problem with many group homes is that even if abuse occurs, and staff are held responsible or even charged with a crime, the home itself is unlikely to close.
"What we still haven't done in Arizona is adequately funded the systems that are supposed to care for people with IDD on a daily basis."
One reason why, according to Meyers, is because of deinstitutionalization — the process of moving individuals from large institutions to community-based alternatives. 
Since then, there has been a tremendous need for housing in the IDD population. As such, state governments are reluctant to close down these facilities. For any action to be taken, Meyers believes there needs to be a large media following of the incident.
"The real reason that the folks at Hacienda were prosecuted was that what happened there was so horrific and received so much media attention there really was no alternative for the state of Arizona," says Meyers. "The event was so far beyond what anyone could stomach."
Despite what happened, Hacienda's ICF remains open. Even at the time, there were some families who urged the state to allow Hacienda to continue operate because they had so few options.
Ultimately, finding the right housing solution isn't easy, especially if the person is aging, has a significant disability and requires additional medical care. 
Politics and Money
President Joe Biden has pledged $150 billion in the Build Back Better agenda — which was passed by the House on November 19 — to help alleviate this caregiving crisis; the plan includes investing in community-based alternatives, raising wages for the 2.4 million home care workers, and eliminating the 820,000 person waiting list for community-based care nationwide.  
The money couldn't come at a better time. Group homes are struggling to keep up with the demand and, with many caregivers earning only minimum wage, there is a turnover rate of roughly 51%. 
"What we still haven't done in Arizona is adequately funded the systems that are supposed to care for people with IDD on a daily basis. Provider staff are turning over at such a high rate," says Meyers. "It's almost this revolving door. It seems like we take two steps forward and one step back, or sometimes we take one step forward and two steps back."
"I don't think we lack a solution, we lack the political will to make the solution happen."
Despite the fact that over time, community-based alternatives can save states more money than large institutions, group homes aren't adequately financially supported.
"There's about 45,000 people in the developmental disability system in Arizona alone. And it increases every year and is projected to steadily increase," explains Kelli O'Toole, the president and CEO of The Opportunity Tree, which supports mostly older individuals with IDD in their residential program. "But here's the issue: Our system, with all the people that we support, is $150 million underfunded."
This financial problem is exacerbated because people with disabilities are living longer and require further resources as they age. "People with Down syndrome are living longer. So what are we seeing? We're seeing dementia. And there isn't a lot of support out there for that," says O'Toole.
Parents Take Matters Into Their Own Hands
Fortunately, advocates are creating alternative options for individuals with IDD. After struggling with her son's group home, O'Neal has decided to create her own group home, a process she estimates will take more than eight months. 
To combat the high turnover rate of caregivers, she intends to pay above minimum wage and create a community center with one to two-bedroom apartments surrounding it. In doing so, she hopes to establish a sense of community that is absent in most group homes.
"I'm doing it as a nonprofit and I am bringing on other professionals to utilize everybody else's expertise. I can hire quality staff, and I can be in control of the staff that is with him [her son] — the quality assurance is in my hands and not the state's," explains O'Neal. "I will have my career on top of it. But in the beginning, it'll be something I have to do full time." She hopes to hire a director once the first group home opens to help create a community of group homes.
Disability advocates, families and guardians are doing the best they can to mitigate the caregiving crisis in the U.S. However, without adequate funding, it is increasingly difficult to keep this vulnerable population safe and healthy. 
"I don't think we lack a solution, we lack the political will to make the solution happen," says Meyers. "In the next two decades, we're going to see a massive number of people with disabilities who no longer have [loved ones]. As a nation, we're going to have to make the investment that's required to ensure that they can be taken care of."


The Housing Challenges Facing People With Intellectual and Developmental Disabilities

Juliet Schulman-Hall

Will Watson, 68, is of the LGBT+ generation first impacted by HIV. "Most of my peers are gone. I lived wildly and carefree. I tested positive for HIV by the mid-eighties," he said, adding that he hid the test results from his family. 
Maintaining a support system that includes both younger and older friends can ease feelings of loneliness and provide decision making support for older LGBTQ+ adults Although Watson's family did not know his diagnosis, he recalled a big family dinner when his brother-in-law "took the plate and silverware and the glass I had been using and threw it in the trash in front of everyone." [His family] assumed being gay made you an HIV carrier.
"Who would you ask to pick you up at the hospital if you weren't allowed to take a taxi home?" 
Watson lives alone in Chicago. According to SAGE (Advocacy and Services for GLBT+ Elders), older gay adults like Watson are twice as likely to be single and living alone, and four times less likely to have children than their heterosexual counterparts. In addition, LGBT+ elders are more vulnerable to social isolation when living alone.
Linda Scaparotti, a California-based lawyer who specializes in estate planning and family law, said that often LGBT+ elders have no children or extended family members to serve as agents for written Power of Attorney (POA), health care directives, wills and trusts. This impacts who will take on legal or conservator-type roles if LGBT+ elders become disabled or suffer cognitive decline.
Frederick Hertz, who also practices law in California and has expertise in premarital and cohabitation agreements and mediation of dissolutions, explained that if LGBT+ elders have no friends or relatives to step in, or if they remain closeted, they may avoid, or be fearful of, completing these essential documents. 
Who to Trust with Decision-Making
Though not unique to the gay community, Hertz said "these [legal] problems are often harder to manage because of the history of oppression and lack of community."
Who to trust with decision-making can be challenging and overwhelming. Hertz recommends answering a straightforward question: "Who would you ask to pick you up at the hospital if you weren't allowed to take a taxi home?"
According to Hertz, there are critical legal rules impacting unmarried LGBT+ elders if they are alienated from their families. First, decision-making authority goes to legal relatives if the POA and health care directive doesn't exist. "The laws may slightly vary state to state, but not in any significant way," he said.
Second, if you die intestate (without a will), your property will be inherited by legal relatives. "If you don't want your relatives taking over your care or, upon your death, inheriting your assets, you need to have a signed POA and health directive as well as a will or trust," Hertz said.
Professional fiduciaries can be appointed to fulfill these roles, said Scaparotti, adding that more LGBT+ people under 60 are needed to become professional fiduciaries for the older population.
Scaparotti recommends setting up a trust instead of a will, as trusts are harder to challenge; they are "privately administered and do not have to be filed with the court and become public record," she said.
Finding Affordable and Welcoming Housing 
Housing protections vary, according to SAGE: "Twenty-one states and five territories have no explicit laws prohibiting housing discrimination (based on) sexual orientation and/or gender identity."
Finding LGBT+-friendly assisted living facilities is challenging. Hertz notes that many gay people, especially those with complicated medical histories, feel uncomfortable in conventional nursing homes, like religious, working-class and Medicaid nursing facilities.
LGBT+ elders who left home when they were younger often settled in more accepting metropolitan cities, albeit more expensive, so without the financial resources for higher-end facilities, those who don't qualify for Medicaid, for example, may be forced to leave familiar surroundings for affordable institutional care, explained Hertz. 
Watson's ability to afford housing suffered because of his increased medical expenses upon retesting positive for HIV, requiring medication. He had to "spend down" to qualify for assistance programs.
After a year of "couch surfing," Watson said, he received housing help from CEDL (Center for Disability and Elder Law) and began receiving Medicaid and Social Security once the Affordable Care Act became law.
"I would love to hang out with gay people my age ... I'm lonesome in that sense. I don't know how else to describe it." 
He now lives in subsidized senior housing with straight and gay residents. Watson is out, but many LGBT+ residents in similar facilities live in the closet; according to SAGE, "34% of LGBT+ older people worry about having to hide their identity to access senior housing."
Watson, who describes his housing as transitional because the building has fallen into disrepair, says that for the past five years he has been on a waiting list for Section 8 LGBT+ housing. "I have that in my back pocket," he said.
The Importance of a Support Network 
While money may solve tangible situations, it cannot solve the intangibles of loneliness, fear and decision-making support. For LGBT+ elders, Hertz recommends these strategies:
Work to maintain a support system, one that includes younger, socially responsible friendsEngage in community interaction that provides long-term support like a church, synagogue or political associationAnticipate problems in advance: "Do I have enough money? Do I have a place to live?"Watson has a health care directive and POA; he said he trusts one woman in her 40s, a fellow church choir participant, to serve as his agent. He plans to make a will through CEDL, as he is concerned that his niece and nephews may try to inherit money from him.
After losing his last two gay friends during the pandemic, Watson is independent, but lonely. Although no longer singing in the Chicago gay men's chorus or church choir, he remains a churchgoer.
His female friend is married and has a three-year-old boy. Watson calls him "his heart."
"I adore him ... but loneliness exists because I don't have a partner," said Watson. "I would love to hang out with gay people my age. I would love to sit on a park bench and shoot the breeze. I'm lonesome in that sense. I don't know how else to describe it." 


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