The housing crisis is colliding with a shortage of healthcare workers, and the combination could threaten the ability of seniors to age in place.
Today, the U.S. is short nearly 85,000 physicians across all specialties. By 2038, that deficit is projected to grow to 141,000 physicians, according to the Health Resources and Services Administration (HRSA).
The shortage is most acute in nonmetropolitan areas, where it’s harder for medical centers to recruit and retain the personnel they need to stay fully staffed. These areas will face a 58% physician shortage by 2038, compared with a 5% shortage in metro areas, according to HRSA estimates.
But it’s exactly these areas that are offering seniors something rare: affordable homes. That creates a cruel bargain. For many older Americans, the places where they can afford to live may not be the places where they can easily get care.
The cost of inaccessible care
There are many ways to think about this nexus of crises, but the way that I think about it is through my grandmother’s experience.
Earlier this year, she needed a hip replacement. The surgery required her and her husband to drive more than an hour to Flagstaff Medical Center, because there was no such equivalent facility in Cottonwood, AZ, where they live.
After the surgery, she unexpectedly needed inpatient care at a rehabilitation facility. Again, the nearest facility was in Flagstaff. So for the weeks that she was there, her husband would drive two hours roundtrip to see her, and my mom would drive four hours roundtrip from Phoenix.
My grandmother is one of the 10 million seniors who live in rural areas and drive more than twice the distance of urban residents—a barrier which contributes to approximately $19 billion in preventable hospitalizations and emergency care every year in the U.S.
The Government Accountability Office found that more than 100 rural hospitals closed from 2013 through 2020. After those closures, residents had to travel about 20 miles farther for common services such as inpatient care, and about 40 miles farther for less common services.
That distance can reshape the meaning of aging in place for seniors and their family members.
Aging in place often depends on someone else being able to leave work, drive across counties, sit in waiting rooms, coordinate follow-up care, and absorb the cost of distance.
In 2009 alone, family caregivers arranged or gave an estimated 1.4 billion rides to older adults, according to a study by the National Aging and Disability Transportation Center.
The rise of the ‘med-à-terre’
The obvious solution, then, is proximity. And some affluent older Americans are taking note, purchasing second homes or apartments with close proximity to premiere medical centers and doctors.
A recent Wall Street Journal article dubbed this trend the med-à-terre—a play on pied-à-terre, which refers to a second home that allows a foothold in a city for business or leisure.
Not everyone has this luxury, of course—my grandmother being one of them. What brought her to Cottonwood in the first place was an affordable place to live. She and her husband purchased a manufactured home there in February of this year for $253,500.
Meanwhile, the median home price in Flagstaff was $818,000, according to data from Realtor.com®.
That price gap is just one slice of the dilemma facing America’s increasingly aged population. The place with the hospital, rehab center, and medical infrastructure to support care in old age was also the place where home prices had skyrocketed—pricing out first-time buyers and those on fixed incomes alike.
Affordable homes and fragile care systems
Jake Krimmel, senior economist at Realtor.com®, says that edge cuts both ways.
“Healthcare workers will only be able to work and provide those services where they can afford to live. As housing gets more expensive and demand for healthcare workers grows, something will have to give,” he explains. “Either their wages will get bid up, or the workers themselves will leave expensive cities and states in favor of places where they don’t need to live paycheck to paycheck.”
It’s the other side of the aging-in-place crisis. Healthcare workers need affordable places to live just as much as their patients do.
That can be especially difficult to find for direct care workers, whose wages are often low relative to the importance of their work. These workers make a median salary of $34,900, leaving just $873 a month for housing expenses before becoming rent-burdened. That’s roughly half the national median asking rent today.
Mapping the healthcare shortage
So, where does that leave seniors in search of accessible healthcare and affordable housing? It depends on how you measure it.
One way to look at it is the current and projected supply of doctors relative to patient need. By that metric, ironically, some of the most expensive states appear to outperform more affordable parts of the country.
For example, New York state has a surplus of nearly 13,000 healthcare workers, while Florida is short 16,000 today. By 2038, Florida’s deficit is projected to grow to 32,000, while New York is expected to remain in a surplus.
At the same time, the median home price in Florida is $425,000, compared with $687,000 in New York, according to Realtor.com data. Krimmel notes that both states include major metro areas that are far more expensive than their statewide medians suggest.
“This complicates things for seniors on a fixed income, especially for those who aren’t mobile enough or wealthy enough to move states themselves,” he adds.
To his point, the median asking rent in New York City is over $3,600, and over $2,950 in Miami—well over what a direct-care provider can afford.
But provider supply is only one way to measure access. Another is to look at what happens when older adults cannot get consistent care before a health problem becomes a crisis.
Researchers often measure this through preventable hospitalizations or hospital stays for conditions that can often be managed or avoided with timely outpatient care. A Health Affairs study found that rural Medicare beneficiaries (a majority of whom are seniors) with complex chronic conditions had a 40% higher rate of preventable hospitalizations and a 23% higher mortality rate than their urban peers.
It’s a stark reminder that America’s housing and healthcare crises are now colliding in the places where seniors are trying to age. As more older Americans search for communities where their savings can stretch further, the real test is whether those places can support the full chain of aging.
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