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Social Care Services Evidence Summary: Housing Assistance Services

This evidence summary includes a broad range of research/resources on housing assistance services and is primarily focused on 

health care impact. It is not intended to be an exhaustive compilation of research/resources on this topic. The information 

presented in this summary can inform the value proposition of partnering with a community-based organization (CBO) or a network 

of CBOs to offer these services and supports as part of a strategy to address social determinants of health (SDOH).

Housing assistance services include a wide array of programs and supports including, but not limited to, environmental 

modifications, rental assistance, and independent living supports. The wide variety of services that support housing quality, safety, 

stability, and affordability are increasingly considered vital SDOH (Taylor, 2018). This is especially true for older adults and individuals 

with disabilities (Bipartisan Policy Center, 2016; Justice in Aging, 2016; Oliver et al., 2020).

Research on the impact of housing assistance and support in improving health outcomes is strong with respect to both health status 

and health spending. Housing supports have the potential to improve health outcomes such as chronic disease management (Keene 

et al., 2018) and the overall health status of low-income individuals in poor health (Pfeiffer, 2018). Housing supports also have the 

potential to reduce costly health care services such as emergency department use, in patient care, as well as long term services and 

supports among vulnerable populations such as individuals experiencing homelessness and dually eligible older adults (Peng et al., 

2020; Szanton et al. 2017). Likewise, research supports the positive benefit of individualized housing supports on quality of life 

metrics such as autonomy, self-determination, and choice (Oliver et al., 2020). As housing supports and assistance are diverse and 

complex, there are calls for further research and investigation on the role of housing and housing supports on health outcomes and 

spending, especially the integration of the health and social services and supports related to housing (Bipartisan Policy Center, 2016; 

Taylor, 2018).

For specific, further detailed information on this evidence, please review the resources listed below.
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Housing Assistance Services Research and Evidence

Study Population Studied Objective of Study Type of Analysis Findings / Results

Keene et al.

(2019)

Low-income 

residents of New 

Haven, 

Connecticut, who 

had a diagnosis of 

type 2 diabetes; 

Forty (40) 

participants took 

part in the study 

This study draws on 

interview data to examine 

transitions into rentassisted housing as they 

relate to diabetes selfmanagement behaviors. 

Primary interview 

questions related to 

diabetes care.

This study employed 

qualitative interviews 

using an inductive 

grounded theory 

approach (semistructured format, 

relying on an interview 

guide that included 

broad and open-ended 

questions with followup probes). Interviews 

were conducted at 

baseline (n=40) and 

approximately 9 months 

later (n=26).

Study results indicated 

improvements in diabetes selfmanagement accompanied the 

receipt of rental assistance. Rental 

assistance facilitated environmental 

control that supported diabetes

routines, improved participants’ 

ability to afford diabetes-related 

expenses, and mitigated healthdemoting financial stress. 

Oliver et al.

(2020)

Adults with 

disabilities and 

complex needs; 

the total number 

of individuals 

varied by study 

and ranged from 6 

to 8,892 people

The purpose of this 

scoping review was to 

determine what is 

currently known about 

outcomes associated with 

individualized housing for 

adults with disability and 

complex needs.

The study employed a 

scoping review method 

(a method of searching 

existing literature based 

on key words with the 

aim of answering a 

broad research 

question). The scoping 

review included 5 

databases and reviewed 

literature from January 

1999 through January 

Individualized housing was 

positively associated with personcentered outcomes such as selfdetermination, choice, and 

autonomy. Individualized housing 

also demonstrated favorable 

outcomes regarding domestic tasks, 

social relationships, challenging 

behavior, and mood. However, 

outcomes regarding adaptive 

behavior, self-care, scheduled 

activities and safety showed no 
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Study Population Studied Objective of Study Type of Analysis Findings / Results

2019. The analysis 

included studies that 

reported on outcomes 

associated with 

individualized housing 

for adults with disability 

and complex need. 

Twenty-two (22) peerreviewed articles met 

the inclusion criteria for 

the review.

difference, or less favorable results, 

when compared to group homes.

Peng et al.

(2020)

Persons with 

disabilities 

experiencing 

homelessness; a 

total of 17,182 

participants across 

26 studies were 

included in the 

review 

The review compared the 

effects of Housing First 

versus Treatment First 

model of approach to 

housing supports to 

compare the effects of 

both approaches on 

housing stability, health 

outcomes, and health 

care utilization among 

persons with disabilities 

experiencing 

homelessness.

The review included a 

systematic search using 

8 databases for relevant 

studies on the effects of 

“housing first,” 

“treatment first,” and 

“supportive housing.” 

The search included 

literature from 

inception of the 

databases to February 

2018. 26 studies met 

inclusion criteria. 

Housing First programs improved 

housing stability and reduced 

homelessness more effectively than 

Treatment First programs.

Compared with Treatment First, 

Housing First programs decreased 

homelessness by 88% and improved 

housing stability by 41%. For clients 

living with HIV infection, Housing 

First programs reduced 

homelessness by 37%, viral load by 

22%, depression by 13%, emergency 

departments use by 41%, 

hospitalization by 36%, and 

mortality by 37%.

Pfeiffer 

(2017)

The study focused 

on low-income 

renters aged 25-

69, including two 

This study uses survey 

data to assess the impact 

of assistance from public 

housing or Section 8 

This study employed 

statistical analysis 

(linear and logistic 

regression and 

The article finds evidence to support 

that providing rental assistance to 

low-income households may lead 

them to have more efficient health 
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Study Population Studied Objective of Study Type of Analysis Findings / Results

subpanels of 

survey 

participants. The 

first subpanel 

included 16,111 

respondents and 

the second 

included 19,1112 

respondents. 

voucher programs on lowincome renters’ reported 

health status and 

spending. 

propensity score 

matching) using data 

from the Survey of 

Income and Program 

Participation (SIPP). The 

study used samples 

from the 2001, 2004, 

and 2008 survey panels 

of the SIPP. 

care spending and that moving into 

public housing may improve the 

health of low-income renters who 

are in poor health. 

Szanton et al.

(2017)

Intervention 

group: 204 

individuals dually 

eligible for 

Medicaid and 

Medicare;

Control group: 

2,013 dually 

eligible individuals 

To determine whether 

the Community

Aging in Place, Advancing 

Better Living for Elders

(CAPABLE) program, a 

program that includes 

interprofessional team 

comprised of a RN, 

occupational therapist,

and a handyman to help 

older adults attain selfidentified functional 

goals, saves Medicaid 

more money than it

costs to provide.

Single-arm clinical trial 

with a comparison 

group 

Average Medicaid spending per 

CAPABLE participant was $867 less 

per month than that of their 

matched comparison counterparts 

(observation period average 17 

months, range 1–31 months). The 

largest differential reduction in 

expenditures were for inpatient 

care and long-term services and 

supports (LTSS).
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Additional Resources

Resource Author Description of Content Target Audience

Bipartisan Policy Center

(2016)

This report examines four challenges 

facing healthy aging at home in the United 

States and provides recommendations to 

address each of the following challenges: 

1) the need for a much greater supply of 

homes affordable to our nation’s lowestincome seniors; 2) the importance of 

transforming homes and communities so 

that seniors can age with options, a desire 

shared by the overwhelming majority of 

older adults; 3) the imperative to better 

integrate health care and supportive 

services with housing, recognizing that this 

integration has the potential to improve 

health outcomes for seniors and reduce 

the costs borne by the health care system;

and 4) the need to deploy technologies on 

a far wider scale to help all Americans age 

successfully.

Decision-making stakeholders including members of 

Congress, public officials serving in state and local 

governments, the private sector, and leaders in the 

nonprofit and philanthropic communities. Additional 

audiences include payers and providers, especially 

entities engaged in value-based payment initiatives. 

Health and Human 

Services, Department of 

Housing and Urban 

Development, & United 

States Department of 

Agriculture (2020)

This publication is a joint bulletin aimed at 

providing information to public health and 

housing agencies with information to 

better understand existing federal 

resources and programs that are intended 

to improve health and housing outcomes 

in rural America and support individuals 

State Medicaid agencies, state and local housing 

agencies, state and local public health agencies, and 

other health and housing entities that jointly support 

individuals with disabilities in rural communities. 
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Resource Author Description of Content Target Audience

with disabilities to remain in their homes 

and communities. 

National Association of 

Area Agencies on Aging & 

University of Southern 

California Leonard Davis 

School of Gerontology

(2020)

Area Agencies on Aging (AAAs) plan and 

coordinate services for older adults in their 

communities across the country. The 2019 

National Survey of AAAs found that 61 

percent of responding AAAs provide home 

modification or repair services, and 46 

percent make referrals to local programs 

that make home modifications or repairs.

These services support older adults to 

remain in their homes and communities as

they age. 

Health plans, social service agencies, research and 

practitioners who support older adults and may be 

interested in collaborating with AAAs to enhance 

coordination of services and supports for older adults in 

their communities. 

Justice in Aging (2016) This special report outlines the problem, 

the reasons for increased homelessness 

among older adults, and recommends 

policy solutions that can be put in place 

now to ensure that all older adults have a 

safe place to age in dignity, with affordable 

health care, and sufficient income to meet 

their basic needs.

Policy makers and advocates interested in solving 

issues of homelessness and factors that contribute to 

homelessness and housing instability among older 

adults.

Taylor (2018) Past research supports the notion that 

housing is a high impact area in the field of 

SDOH. The impact of housing on health is 

now being widely considered by policy 

makers. As a result, many health care 

systems, payers, and government entities 

are seeking to better understand the 

totality of the health and housing 

literature to determine where they might 

Healthcare systems, payers, and government entities 

seeking to better understand the totality of health and 

housing literature to determine where they might 

intervene effectively. 
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Resource Author Description of Content Target Audience

intervene effectively. The brief outlines the 

literature and provides high-level direction 

for future research and policy agendas.

University of Southern 

California Leonard Davis 

School of Gerontology & 

Advancing States (2020)

This report provides a summary of how 

State Units on Aging (SUAs) play key roles 

in supporting older adults to remain in 

their homes and communities with home 

modification and repair (HMR) support. 

The Administration for Community Living 

(ACL), in collaboration with the University 

of South California (USC) Leonard Davis 

School of Gerontology, implemented the 

“Promoting Aging in Place by Enhancing 

Access to Home Modifications” project to 

address barriers to home modification 

access and service delivery by increasing 

the availability and awareness of home 

modifications at the national, state, and 

local levels. 

Policy makers, including staff of SUAs and practitioners 

that support older adults’ ability to age in place with 

the goal of increasing availability and awareness of 

HMR support and services.