Tag Archives for NORC

Study takes look at income inequity of Black and Hispanics’ “Forgotten Middle”

Published in RINewsToday on March 18, 2024

Millions of Black and Hispanic middle-income older adults will lack the financial resources to pay for senior housing and health care expenses as they age, warns a new report released by  NORC at the University of Chicago, commissioned by the Long-Beach, California-based SCAN Foundation, an independent public charity dedicated to creating a society where older adults can access health and supportive services of their choosing to meet their needs.

The “Forgotten Middle” study’s analysis, a third follow-up to its landmark 2019 Forgotten Middle Study, shows the number of middle-income seniors of color will increase from 12% in 2020 to 25% by 2035, yet this population will be least likely to afford senior housing and care when compared to the middle-income seniors as a whole.  

Widening income gap creates challenges

The study, released last month, points to widening gaps among Black and Hispanic middle-income seniors around home ownership, home equity, financial assets, and marriage rates compared to their white peers. This gap results in fewer financial resources to afford senior housing and care. The researchers say that case studies and an analysis of existing literature highlight the challenges middle-income older adults may face in rural areas.

“Wealth is not distributed evenly across the Forgotten Middle. Now we know that Black and Hispanic older adults are the worst off,” said Sarah Rayel, senior director in NORC’s Health Care Strategy department in a Feb. 15, 2024 statement announcing the study’s findings. “Black and Hispanic middle-income older adults have fewer liquid assets and less equity than other middle-income older adults, which is making it harder to leverage their home to support future housing and health care needs,” she says. 

The “Forgotten Middle” consists of older adults aged 75+ who do not qualify for Medicaid but lack sufficient resources to pay for assisted living, senior housing, and future care needs as they become afflicted with age-related physical and cognitive challenges. Consistent with previous NORC research findings, middle-income seniors are defined as having annuitized income and assets ranging from $26,000 to $103,000 in 2020 dollars.

The researchers found that home ownership by younger Black older adults is declining and expected to fall substantially by 2035 with Black and Hispanic homeowners projected to have lower home equity. 

The analysis and findings also reveal that marriage rates are expected to drop below 50% across all racial groups, leaving those living alone at a greater risk of adverse health events and social isolation. By 2035, only a quarter of Black older adults and 40 percent of Hispanic older adults will be married, says the researchers.

According to the report’s findings, Black and Hispanic older adults tend to have higher rates of health complications across multiple health indicators, including chronic conditions and mobility limitations. These health complications likely increase the need for additional care.

And the findings noted that middle-income older adults in rural areas may face distinct challenges in their ability to age well due to poorer health outcomes, lower financial resources, lack of support services, and workforce shortages.

“Every older adult deserves to age well, with purpose, regardless of economic circumstances,” said Dr. Sarita A. Mohanty, president and CEO of The SCAN Foundation. “The impending crisis facing people who won’t qualify for Medicaid and won’t be able to afford private home care will impact older adults of color much more acutely. Policymakers, as well as the healthcare and senior housing communities have substantial work to do to ensure that race does not become a hindrance to aging well.”

Rhode Island’s “Forgotten Middle”

For many years, the Senior Agenda Coalition of Rhode Island has been concerned about the so-called “Forgotten Middle” – older persons who are not eligible for Medicaid and other benefits – as they may have income and assets just above the state eligibility guidelines, says Maureen Maigret, SACRI’s policy advisor. According to Maigret, older Rhode Islanders and persons with disabilities living in the community cannot have income over the federal poverty level ($15,060 for a single person; $20,440 for a couple) or, with just a few exceptions, assets of more than $4,000 for a single person or $6,000 for a couple. Most other Medicaid populations can access Medicaid at higher incomes of 138% of the FPL and with no asset limits.

”We believe this is a major inequity for older persons.  As the NORC study points out, persons of color are especially impacted by a wealth gap as they age,” she says noting that they are more likely to have lower incomes during their working years so saving for retirement is a challenge, they have less home equity and are less likely to have retirement accounts.

“Women also are significantly more impacted by a wealth gap in their older years, and this is more pronounced among older women of color,” says Maigret. Citing Rhode Island specific-Census data, she remarked that Hispanic older women are two and a half times more likely to have income below the poverty level compared to older men. And 25% of Black older women vs. 17% of Black older men are living below the poverty level. 

“This is why the Senior Agenda Coalition has consistently worked to address economic security issues and why this year we are advocating to expand the Medicare Savings Program (MSP), also referred to as Medicare Premiums Plan (MPP),” she says. This legislation, now being considered by Rhode Island lawmakers, would help low-income people on Medicare pay for Premiums and co-payments freeing up their limited dollars to pay for basic needs such as food and rent.

Researchers says that findings from their data analysis and literature review revealing disparities across the “Forgotten Middle” must be considered in future policies.  

For a copy of NORAC’s “Forgotten Middle” study, go to  https://www.norc.org/research/projects/understand-historically-marginalized-communities-forgotten-middle.html.

For additional information on the study’s findings and research design rayel-sarah@norc.org.

Caregivers Find it Difficult to Shop at Retail Stores

Published in the Woonsocket Call on September 22, 2019

Survey findings from a recently released national study, by the Washington, DC-based AARP and NORC at the University of Chicago, will send a strong message to America’s businesses.

With the graying of America, retail stores must change the way they do business in order to attract customers who provide unpaid family caregiving to their loved ones.

The study, “Family Caregiver Retail Preferences and Challenges,” and its survey findings were presented at the AARP Executive Summit, The Price of Caring, on September 10 in Washington, D.C. The summit’s mission was to highlight public- and private-sector solutions to support Americans who care for an older or ill loved one.

In-store Shopping is a Struggle

While juggling a multitude of caregiving tasks, caregivers say a lack of accommodations for their frail family members is a problem for shopping at retail stores. The study’s findings reveal that in-store shopping is a struggle for one-third of the nation’s 40 million unpaid family caregivers. Many leave their loved ones at home or choose to shop online, despite strongly preferring the in-store experience.

A whopping 93 percent of caregivers surveyed say they shop for the person they care for. Among these caregivers, most report shopping monthly for groceries (87 percent), basic household items (65 percent), toiletries (61 percent), prescription drugs (58 percent) and other health products (52 percent for persons they regularly care for.

“Americans who take care of loved ones are often strapped for time, and many face logistical challenges doing something as simple as going to the grocery store,” said Nancy LeaMond, AARP executive vice president and chief advocacy & engagement officer, in a September 10th statement announcing the study’s findings. “Retailers can score big with caregivers if they make it easier for them to bring their loved ones along when they shop,” says LeaMond.

The AARP survey findings detail simple but important changes retailers should consider to enhance the shopping experience of caregivers. Businesses can provide dedicated parking spots and ample comfortable reserved seating for older shoppers to rest, wider aisles that easily accommodate both wheelchairs and shopping carts, longer store hours, and train their staff to specifically work with caregivers.

The Pros and Cons of In-Store and On-Line Shopping

The survey findings in the 26-page study reveal that 82 percent of the caregiver respondents prefer to shop in-store because of the ability to touch the products and they don’t have to wait for a product’s delivery or pay for shipping charges. But 84 percent say they shop online for ease and convenience, despite preferring an in-store experience. Forty three percent of the respondents say a major reason they leave their loved one at home when shopping is because the store environment is too difficult for the recipients of their care.

More than 56 percent of the caregiver respondents say that when shopping on behalf of their loved ones they spend at least $50 per month. Forty one percent note they spend more than $250 or more a month when shopping for a loved one.

Businesses Must Listen to the Shopping Needs of Caregivers

We listen to a lot of caregivers and it seems clear that, regardless of the challenge, the help they want most is for somehow to find a convenient, time-efficient and accommodating means of getting what they need, when they need it,” said Rhode Island AARP State Director Kathleen Connell. “In retailing, convenience is a huge competitive advantage these days. But there are aspects of convenience that – for caregivers – go beyond finding what you need on Amazon and having it delivered the next day or two,” says Connell.

“Some caregiver needs are in the ASAP category and they head for brick and mortar retail establishments. Shopping for food and clothes, picking up a prescription or medical supplies, even simple things such as picking up dry cleaning feel like ‘emergencies’ because time is so. Imagine this in the context of being with someone in a walker or wheelchair,” notes Connell.

Connell urges retailers to take this report to heart. “There is an incredible amount of goodwill to be earned if you think about caregivers, as well as those in their care, and give them the consideration that makes their tasks a little easier.”

The AARP survey was conducted by NORC at the University of Chicago and is based on a nationally representative survey of 1,127 Americans who provide unpaid care for an adult age 18 or older. The survey was funded by AARP and used AmeriSpeak®, the probability-based panel of NORC at the University of Chicago. Interviews were conducted between Aug. 1-19, 2019, online and using landlines and cell phones. The overall margin of sampling error is +/- 4.1 percentage points at the 95% confidence level, including the design effect. The margin of sampling error may be higher for subgroups.

To read the full report, visit: http://www.aarp.org/caregivershopping.

For more details about AARP’s Caregiver Shopping study, contact Laura Skufca, AARP Research, Lskufca@aarp.org.

Study Calls for Action on Creating Senior Housing for Middle-Income Seniors

Published in the Woonsocket Call on August 18, 2019

A recently released report sends a stark warning to federal and state policy makers and to the private senior housing sector. The report forewarns that in the coming years, a large number of middle-income seniors, who need assisted living with supportive services, will be priced out of this level of care.

Seniors housing in the United States is paid out of pocket by seniors with sufficient assets. A relatively small percentage of Americans have long-term care insurance policies to defray the costs. For seniors with the lowest incomes, Medicaid covers housing only in the skilled nursing setting, but increasingly also covers long-term services and supports in home and community-based settings. Programs such as low-income housing tax credits have helped finance housing for economically-disadvantaged seniors.

The researchers call on the government and the senior housing sector to step up and to assist the projected 14.4 million middle-income people over age 75, many with multiple chronic conditions, who won’t be able to afford pricey senior housing.

According to this first-of-its-kind study that appears in the April 24 2019 edition of Health Affairs, 54 percent of middle-income older Americans will not be able to meet yearly costs of $60,000 for assisted living rent and other out-of-pocket medical costs a decade from now, even if they generated equity by selling their home and committing all of their annual financial resources. The figure skyrockets, to 81 percent, if middle-income seniors in 2019 were to keep the assets they built in their home but commit the reset of their annual financial resources to cover costs associated with seniors housing and care.

Accompanying the senior housing study are two perspective pieces in Health Affairs on how society can adapt to aging and supporting aging in communities.

The study, “The Forgotten Middle: Many Middle-Income Seniors Will Have Insufficient Resources For Housing And Health Care, was conducted by researchers at NORC at the University of Chicago, with funding provided by the National Investment Center for Seniors Housing & Care (NIC), with additional support from AARP, the AARP Foundation, the John A. Hartford Foundation, and The SCAN Foundation.

Learning About the Needs of the Emerging ‘Middle Market’

“We still have a lot to learn about what the emerging ‘middle market’ wants from housing and personal care, but we know they don’t want to be forced to spend down into poverty, and we know that America cannot currently meet their needs,” said Bob Kramer, NIC’s founder and strategic adviser in a April 24, 2019, statement. “The future requires developing affordable housing and care options for middle-income seniors. This is a wake-up call to policymakers, real estate operators and investors,” he adds.

The report notes that significant financial challenges are expected to coincide with many middle-income seniors seeking seniors housing and care properties due to deteriorating health and other factors, such as whether a family member can serve as a caregiver. The study projects that by 2029, 60 percent of U.S. middle-income seniors over age 75 will have mobility limitations (8.7 million people), 67 percent will have three or more chronic conditions (9.6 million people), and 8 percent will have cognitive impairment (1.2 million people). For middle-income seniors age 85 and older, the prevalence of cognitive impairment nearly doubles.

The researchers say that this ‘middle market’ for seniors housing and care in 2029 will be more racially diverse, have higher educational attainment and income, and smaller families to recruit as unpaid caregivers than today’s seniors. Over the next 10 years, growth in the number of women will outpace men, with women comprising 58 percent of seniors 75 years old or older in 2029, compared to 56 percent in 2014, they say.

Bringing the Public and Private Sector Together

“In only a decade, the number of middle-income seniors will double, and most will not have the savings needed to meet their housing and personal care needs,” said Caroline Pearson, senior vice president at NORC at the University of Chicago and one of the study’s lead authors.

“Policymakers and the seniors housing community have a tremendous opportunity to develop solutions that benefit millions of middle-income people for years to come,” says Pearson.

Researchers say there is an opportunity for policymakers and the seniors housing and care sector to create an entirely new housing and care market for an emerging cohort of middle-income seniors not eligible for Medicaid and not able to pay for housing out of pocket in 2029.

The study’s analysis suggests that creating a new ‘middle market’ for seniors housing and care services will require innovations from the public and private sectors. Researchers say the private sectors can offer more basic housing products, better leverage technology, subsidize ‘middle-market’ residents with higher-paying residents, more robustly engage unpaid caregivers, and develop innovative real estate financing models, among other options.

As to the public sector, the researchers call on government to create incentives to build a robust new market for middle-income seniors by offering tax incentives targeted to the ‘middle market,’ expanding subsidy and voucher programs, expanding Medicare coverage of nonmedical services and supports, creating a Medicare benefit to cover long-term care, and broadening Medicaid’s coverage of home and community-based services.

“This research sets the stage for needed discussions about how the nation will care for seniors who don’t qualify for Medicaid but won’t be able to afford seniors housing,” said Brian Jurutka, NIC’s president and chief executive officer. “This discussion needs to include investors, care providers, policymakers, and developers working together to create a viable middle market for seniors housing and care,” he says.

Adds, Lisa Marsh Ryerson, President of AARP’s Foundation, “All seniors want to live in affordable, safe and supportive housing, and more than 19 million older adults are unable to do so. We must act now to implement innovative solutions – including robust aging-in-community efforts – to accommodate what is sure to be an increasing demand for housing that meets the needs of older adults.”

Is Rhode Island prepared to meet the senior housing needs of the state’s middle-income seniors in 2029? If not, the state’s federal delegation, lawmakers, state policy makers and the senior housing industry must begin to chip away at this looming policy issue.

To view the study, go to http://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05233.