A longitudinal analysis of the relationship between housing insecurity and physical health among midlife and aging adults in the United States

National Overview of Nonprofit Hospitals' Community Benefit Programs to Address Housing

BACKGROUND

Housing is a critical social determinant of health that can be addressed through hospital-supported community benefit programming.

OBJECTIVES

To explore the prevalence of hospital-based programs that address housing-related needs, categorize the specific actions taken to address housing, and determine organizational and community-level factors associated with investing in housing.

RESEARCH DESIGN

This retrospective, cross-sectional study examined a nationally representative dataset of administrative documents from nonprofit hospitals that addressed social determinants of health in their federally mandated community benefit implementation plans. We conducted descriptive statistics and bivariate analyses to examine hospital and community characteristics associated with whether a hospital invested in housing programs. Using an inductive approach, we categorized housing investments into distinct categories.

MEASURES

The main outcome measure was a dichotomous variable representing whether a hospital invested in one or more housing programs in their community.

RESULTS

Twenty percent of hospitals invested in one or more housing programs. Hospitals that addressed housing in their implementation strategies were larger on average, less likely to be in rural communities, and more likely to be serving populations with greater housing needs. Housing programs fell into 1 of 7 categories: community partner collaboration (34%), social determinants of health screening (9%), medical respite centers (4%), community social determinants of health liaison (11%), addressing specific needs of homeless populations (16%), financial assistance (21%), and targeting high-risk populations (5%).

CONCLUSIONS

Currently, a small subset of hospitals nationally are addressing housing. Hospitals may need additional policy support, external partnerships, and technical assistance to address housing in their communities.

Exposing Pittsburgh Landlords To Asset-Framing Narratives: An Experiment To Increase Housing Voucher Participation

Landlords are essential actors within the rental housing market, and there is much to be learned about their willingness to participate in rental assistance programs that improve access to stable housing. Because the success of these programs, such as the Mobility (Location-Based) Voucher program in Pittsburgh, Pennsylvania, can be derailed by landlord opposition, it is important to test strategies that increase landlords' participation. Using data from a unique survey of Pittsburgh landlords, we found that exposing landlords to an asset-framing narrative that highlighted the social, economic, and health benefits of receiving a mobility voucher increased landlords' reported willingness to rent to a mobility voucher recipient by 21 percentage points. Reported willingness was also higher among landlords who believed that housing affordability was connected to health. Our findings offer insight into how to increase landlords' participation in affordable housing programs that require their engagement to succeed.

Hospitalization and Housing: A Qualitative Study Exploring the Perspectives of Hospitalized Patients Experiencing Housing Insecurity

Although housing insecurity has clear negative impacts on health, little is known about how it impacts patients' experience of hospitalization. In this qualitative study, we interviewed 22 hospitalized patients experiencing housing insecurity. The following three major themes emerged: 1) adverse social and environmental factors directly contribute to hospitalization, 2) lack of tailored care during hospitalization leaves patients unprepared for discharge, and 3) patients have difficulty recuperating after a hospital stay, leading to the risk of rehospitalization. Within these themes, participants described the roles of extreme physical and psychological hardship, chaotic interpersonal relationships, substance use, and stigma affecting participants' experiences before, during, and following hospitalization. Our results, based directly on the patient experience, suggest a need for hospital systems to invest in universal in-hospital screening for housing insecurity, incorporation of trauma-informed care, and robust partnerships with community organizations. Future research should explore the feasibility and impact of these interventions.

In the wake of a crisis: Caught between housing and healthcare

Objective

To measure the association between housing insecurity and foregone medication due to cost among Medicare beneficiaries aged 65+ during the Recession.

Methods

Data came from Medicare beneficiaries aged 65+ years from the 2006-2012 waves of the Health and Retirement Study (HRS). Two-wave housing insecurity changes are evaluated as follows: (i) No insecurity, (ii) Persistent insecurity, (iii) Onset insecurity, and (iv) Onset security. We implemented a series of four weighted longitudinal General Estimating Equation (GEE) models, two minimally adjusted and two fully adjusted models, to estimate the probability of foregone medications due to cost between 2008 and 2012.

Results

Our study sample was restricted to non-proxy interviews of non-institutionalized Medicare beneficiaries aged 65+ in the 2006 wave (n = 9936) and their follow up visits (n = 8753; in 2008; n = 7464 in 2010; and n = 6594 in 2012). Results from our fully adjusted model indicated that the odds of foregone medication was 64% higher among individuals experiencing Onset insecurity versus No insecurity in 2008, and also generally larger for individuals experiencing Onset Insecurity versus Persistent Insecurity. Odds of foregone medication was also larger among females, minority versus non-Hispanic white adults, those reporting a chronic condition, those with higher medical expenditures, and those living in the South versus Northeast.

Conclusion

This study drew from nationally representative data to elucidate the disparate health and financial impacts of a crisis on Medicare beneficiaries who, despite health insurance coverage, displayed variability in foregone medication patterns. Our findings suggest that the onset of housing insecurity is most closely linked with unexpected acute economic shocks leading households with little time to adapt and forcing trade-offs in their prescription and other needs purchases. Both housing and healthcare policy implications exist from these findings including expansion of low-income housing units and rent relief post-recession as well as wider prescription drug coverage for Medicare adults.

More Problems, More Pain: The Role of Chronic Life Stressors and Racial/Ethnic Identity on Chronic Pain Among Middle-Aged and Older Adults in the United States

There is a high prevalence of chronic pain among middle-aged and older adults in the United States. Chronic life stressors have been shown to have detrimental consequences for myriad health conditions, including chronic pain. However, there is limited evidence on the types of chronic life stressors that affect middle-aged and older adults and how these stressors influence the chronic pain burden in this population. Moreover, the interaction between chronic life stressors and racial/ethnic identity remains poorly understood as it relates to chronic pain. The current analysis used the 2018 Health and Retirement Study to investigate relationships between chronic life stressors and odds to experience any chronic pain and high-impact chronic pain. Chronic life stressors were characterized, overall and by racial/ethnic identity, and the main and interaction effects were calculated to evaluate relationships between chronic life stressors, racial/ethnic identity, and odds of experiencing any chronic pain and high-impact chronic pain. Results indicate that in 2018, the most common chronic life stressor among middle-aged and older adults was dealing with their own health problems (68%), followed by dealing with the physical or emotional issues affecting a spouse or child (46%). Adjusted analyses showed that a higher total of chronic life stressors increased the odds of middle-aged and older adults experiencing any chronic pain and high-impact chronic pain. There were no significant interactions between the overall chronic life stress burden and racial/ethnic identity as a predictor of odds to experience any chronic pain or high-impact chronic pain, but significant interaction effects were found related to specific chronic life stressors. Findings underscore the significant impact of chronic life stressors on the chronic pain burden among middle-aged and older adults in the United States, which cut across racial/ethnic identity.

Housing insecurity of medicaid beneficiaries with cognitive disabilities during the COVID-19 pandemic

BACKGROUND

While people with cognitive disabilities are more vulnerable to COVID-19, and the COVID-19 pandemic significantly increased housing insecurity in the general population, less is known about Medicaid beneficiaries with cognitive disabilities' housing insecurity during the pandemic.

OBJECTIVE

This study's aim was to explore housing insecurity of Medicaid beneficiaries with cognitive disabilities during the pandemic (April 2021-May 2022).

METHODS

We analyzed Household Pulse Survey data from 473,626 (unweighted) people; frequency-person weights were applied. Data were analyzed using descriptive statistics, chi-square, and binary and ordinal logistic regression models.

RESULTS

Findings revealed 26% of Medicaid beneficiaries with cognitive disabilities who rented or owned with a mortgage were behind on their housing payments between April 2021 and May 2022; more than half of which (52%) were very or somewhat likely to face eviction/foreclosure. Most (70%) were concerned about their ability to make their next housing payment. Medicaid beneficiaries with cognitive disabilities were more likely to experience housing insecurity than all other people with disabilities and nondisabled people. The people with Medicaid beneficiaries with cognitive disabilities more likely to experience housing insecurity included: renters; people with visual disabilities; cisgender women; transgender people; Black people; 'another' race or multiracial people; people with graduate degrees; people from lower income households; households that experienced income loss; and larger households.

CONCLUSIONS

Attention to Medicaid beneficiaries with cognitive disabilities' experiences with housing insecurity during the pandemic is critical in order to develop programs and policies to facilitate housing security.