Factors Associated with the Health-Related Needs Screening Participation Among Older Adults in the Subsidized Housing

Background and Purpose: America is an aging society. With an aging population that continues to grow, the number of older adults living in subsidized housing has also been increasing. It is reported that 3.9 million older adults over age 62 were eligible for subsidized housing assistance in 2011. While the number of older adults in subsidized housing is growing, there has been little research into their unique health needs. We do know that, in comparison with older adults living in unsubsidized housing, older adults in subsidized housing have more chronic illnesses, have lower levels of activities of daily living, and are more likely to experience mental health issues. Thus, it is essential that older adults living in subsidized housing have timely screenings of their health-related service needs so that they can be connected with necessary assistance in order to maintain their independence and avoid being admitted to nursing homes.

CommonBond Communities (CBC), a nonprofit organization that provides housing for low-income families and individuals, used Live Well at Home-Rapid Screen, a validated health-related needs screening tool, to screening their tenants age 60 and above. However, the screening rates vary across 26 different facilities from a low of 10% to a high of 94%. The purpose of this study is to investigate the factors associated with screening participation. The study hypothesizes that both individual factors and shared environmental factors are associated with screening participation.

Methods: The study uses administrative data from CBC. The data include demographic information, screening participation status (participation and non-participation), and housing program information. The study includes 1493 older adults age 60 and above from 26 low-income housing facilities. Multilevel logistic regression was used to model the binary dependent variable, screening participation status.

Results: In the unconditional model, the Intraclass Correlation Coefficient (ICC) indicated that 35% of the odds of completing the screening was explained by between-housing differences. The full model showed that level one variables, age (OR = 1.03, p < 0.001) and gender (OR = 1.40, p < 0.05) were strongly associated with the likelihood of completing the screening. Level two variable, number of residents in a building (OR = 0.997, p < 0.05), was also significantly associated with the likelihood of completing the screening, although its effect may be too small to have some practical implications.

Conclusion: The ICC indicated that shared environmental factors play a significant role in explaining the variation in screening participation. Moreover, housing services coordinators may adjust their approach when screening older adults in subsidized housing in order to increase screening participation. For example, housing services coordinators may motivate male older adults to complete screening since they are less likely to participate compared to female older adults, with other conditions being equal.