Preserving Independence: Evaluating an Innovative Model for Low-Income Seniors Living in Subsidized Housing

Background and purpose

Traditional Assisted Living Facilities (ALFs) remain unaffordable for many low-income older adults, leaving them with limited long-term care options. In response, New Jersey developed an innovative Assisted Living Program (ALP) model that decouples supportive services from residential facilities. This model allows seniors to receive personal care, nursing, and social services while continuing to live in publicly subsidized housing. This study, conducted by researchers at the Rutgers Hub for Aging Collaboration and funded by the Henry & Marilyn Taub Foundation and the New Jersey State Policy Lab, uses a qualitative SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis to evaluate the ALP model’s effectiveness, feasibility, and potential for broader adoption.

Method

This qualitative study is part of a larger mixed-methods project. Data were gathered through semi-structured interviews with ALP providers, review of coalition meeting transcripts, and analysis of relevant policy and operational documents. The research team engaged directly with stakeholders, including program administrators, advocates, and policymakers, to understand how the ALP model functions within New Jersey’s regulatory and service delivery systems. Using a thematic SWOT framework, the analysis focuses on internal program characteristics and the broader policy environment influencing its implementation and scalability.

Findings

Strengths: The ALP model offers a cost-effective, person-centered alternative to institutional care for Medicaid-eligible older adults. By integrating services into existing public housing infrastructure, ALPs avoid capital costs associated with facilities while enabling flexible, tailored support that promotes autonomy. Medicaid reimbursement provides a relatively stable funding stream, and program flexibility allows adaptation to resident needs.

Weaknesses: Expansion is hindered by recruitment challenges, limited client awareness, and dependence on housing administrators for referrals. Regulatory barriers and billing inconsistencies with Managed Care Organizations complicate operations. Additionally, ALP providers often lack the staff capacity to engage in advocacy or community outreach.

Opportunities: In partnership with the New Jersey State Policy Lab, the research team created a publicly available interactive map and searchable database of affordable housing suitable for ALP expansion. This initiative synthesized data from federal, state, and local sources, identifying over 360 viable housing sites across New Jersey. This tool provides actionable insights for planners, policymakers, and providers aiming to scale the ALP model and address geographic gaps in aging-in-place services.

Threats: Program sustainability is at risk due to rising labor costs, reimbursement delays, and restrictive Medicaid eligibility criteria. Regulatory misalignment between housing and healthcare systems complicates enrollment and retention. Workforce shortages and inconsistent assessments for care eligibility further threaten program success. As the program relies heavily on Medicaid, any cuts to funding would significantly threaten access to care for low-income older adults, increasing the risk of premature institutionalization.

Conclusions and Implications

The ALP model represents a scalable, equity-focused solution to long-term care for low-income older adults. With strategic policy support and tools like the statewide housing map, New Jersey is positioned to expand aging-in-place services that are cost-effective, sustainable, and responsive to community needs. Broader adoption of this model could inform national aging policy and reduce reliance on institutional care.