BRISTOL, R.I. \u2014 At age 82, Roberta Rabinovitz realized she had no place to go. A widow, she had lost both her daughters to cancer, after living with one and then the other, nursing them until their deaths. Then she moved in with her brother in Florida, until he also died.<\/p>\n
And so last fall, while recovering from lung cancer, Rabinovitz ended up at her grandson\u2019s home in Burrillville, Rhode Island, where she slept on the couch and struggled to navigate the steep staircase to the shower. That wasn\u2019t sustainable, and with apartment rents out of reach, Rabinovitz joined the growing population of older Americans unsure of where to lay their heads at night.<\/p>\n
But Rabinovitz was fortunate. She found a place to live, through what might seem an unlikely source \u2014 a health care nonprofit, the PACE Organization of Rhode Island<\/a>. Around the country, arranging for housing is a relatively new and growing challenge for such PACE groups, which are funded through Medicaid and Medicare. PACE stands for a Program of All-Inclusive Care for the Elderly, and the organizations aim to keep frail, older people in their homes. But a patient can\u2019t stay at home if they don\u2019t have one.<\/p>\n As housing costs rise, organizations responsible for people\u2019s medical care are realizing that to ensure their clients have a place to live, they must venture outside their lanes. Even hospitals \u2014 in Denver<\/a>, New Orleans,<\/a> New York City<\/a>, and elsewhere<\/a> \u2014 have started investing in housing, recognizing that health isn\u2019t possible without it.<\/p>\n And among older adults, the need is especially growing<\/a>. In the U.S., 1 in 5 people<\/a> who were homeless in 2024 were 55 or older, with the total older homeless population up 6% from the previous year. Dennis Culhane,<\/a> a University of Pennsylvania professor who specializes in homelessness and housing policy, calculated that the number of men<\/a> older than 60 living in shelters roughly tripled from 2000 to 2020.<\/p>\n \u201cIt\u2019s a national scandal, really, that the richest country in the world would have destitute elderly and disabled people,\u201d Culhane said.<\/p>\n Over decades of research, Culhane has documented the plight of people born between 1955 and 1965 who came of age during recessions<\/a> and never got an economic foothold. Many in this group endured intermittent homelessness throughout their lives, and now their troubles are compounded by aging.<\/p>\n But other homeless older adults are new to the experience. Many teeter on the edge of poverty, said Sandy Markwood<\/a>, CEO of USAging, a national association representing what are known as area agencies on aging<\/a>. A single incident can tip them into homelessness \u2014 the death of a spouse, job loss, a rent increase, an injury or illness. If cognitive decline starts, an older person may forget to pay their mortgage. Even those with paid-off houses often can\u2019t afford rising property taxes and upkeep.<\/p>\n \u201cNo one imagines anybody living on the street at 75 or 80,\u201d Markwood said. \u201cBut they are.\u201d<\/p>\n President Donald Trump\u2019s recent budget law, which makes substantial federal cuts to Medicaid<\/a>, the public insurance program for those with low incomes or disabilities, will make matters worse for older people with limited incomes, said Yolanda Stevens, program and policy analyst with the National Alliance to End Homelessness<\/a>. If people lose their health coverage or their local hospital closes, it will be harder for them to maintain their health and pay the rent.<\/p>\n \u201cIt\u2019s a perfect storm,\u201d Stevens said. \u201cIt\u2019s an unfortunate, devastating storm for our older Americans.\u201d<\/p>\n Adding to the challenges, the Labor Department recently halted<\/a> a job training program intended to keep low-income older people in the workforce.<\/p>\n Those circumstances have sent PACE health plans throughout the country into uncharted waters, prompting them to set up shop within senior housing projects<\/a>, partner with housing providers, or even join forces with nonprofit developers<\/a> to build their own.<\/p>\n A 1997 federal law recognized PACE organizations as a provider type for Medicare and Medicaid. Today, some 185 operate in the U.S., each serving a defined geographic area, with a total of more than 83,000 participants<\/a>.<\/p>\n They enroll people 55 and older who are sick enough for nursing home care, and then provide everything their patients need to stay home despite their frailty. They also run centers that function as medical clinics and adult day centers and provide transportation.<\/p>\n These organizations primarily serve impoverished people with complex medical conditions who are eligible for both Medicaid and Medicare. They pool money from both programs and operate within a set budget for each participant.<\/p>\n PACE officials worry that, as federal funding for Medicaid programs shrinks, states will curtail support. But the PACE concept has always had bipartisan support, said Robert Greenwood, a senior vice president at the National PACE Association<\/a>, because its services are significantly less expensive than nursing home care.<\/p>\n The financing structure gives PACE the flexibility to do what it takes to keep participants living on their own, even if it means buying an air conditioner or taking a patient\u2019s dog to the vet. Taking on the housing crisis is another step toward the same goal.<\/p>\n In the Detroit area, PACE Southeast Michigan<\/a>, which serves 2,200 participants, partners with the owners of senior housing. The landlords agree to keep the rent affordable, and PACE provides services to their tenants who are members. Housing providers \u201clike to be full, they like their seniors cared for, and we do all of that,\u201d said Mary Naber, president and CEO of PACE Southeast Michigan.<\/p>\n For participants who become too infirm to live on their own, the Michigan organization has leased a wing in an independent living center, where it provides round-the-clock supportive care. The organization also is partnering with a nonprofit developer to create a cluster of 21 shipping containers converted into little houses in Eastpointe, just outside Detroit. Still in the planning stages, Naber said, the refurbished containers will probably rent for about $1,000 to $1,100 a month.<\/p>\n In San Diego, the PACE program at St. Paul\u2019s Senior Services<\/a> cares for chronically homeless people as they move into housing, offering not just health services but the backup needed to keep tenants in their homes, such as guidance on paying bills on time and keeping their apartments clean. St. Paul\u2019s also helps those already in housing but clinging to precarious living arrangements, said Carol Castillon, vice president of its PACE operations, by connecting them with community resources, helping fill out forms for housing assistance, and providing meals and household items to lower expenses.<\/p>\n At PACE Rhode Island, which serves nearly 500 people, about 10 to 15 participants each month become homeless or at risk of homelessness, a rare situation five or six years ago, CEO Joan Kwiatkowski said.<\/p>\n The organization contracts with assisted living facilities, but its participants are sometimes rejected because of prior criminal records, substance use, or health care needs that the facilities feel they can\u2019t handle. And public housing providers often have no openings.<\/p>\n So PACE Rhode Island is planning to buy its own housing, Kwiatkowski said. PACE also has reserved four apartments at an assisted living facility in Bristol for its participants, paying rent when they\u2019re unoccupied. Rabinovitz moved into one recently.<\/p>\n Rabinovitz had worked as a senior credit analyst for a health care company, but now her only income is her Social Security check. She keeps $120 from that check for personal supplies, and the rest goes to rent, which includes meals.<\/p>\n Once a week or so, Rabinovitz rides a PACE van to the organization\u2019s center, where she gets medical care, including dental work, physical therapy, and medication \u2014 always, she said, from \u201cincredibly loving people.\u201d When she\u2019s not feeling well enough to make the trek, PACE sends someone to her. Recently, a technician with a portable X-ray machine scanned her sore hip as she lay in her own bed in her new studio apartment.<\/p>\n \u201cIt\u2019s tiny, but I love it,\u201d she said of the apartment, which she\u2019s decorated in purple, her favorite color.<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n