NIC Notes

Insights in Seniors Housing & Care


By: Dianne Munevar  |  November 28, 2023

Would you Rather Solve Senior Housing or Health Care for Older Adults?

Ideas and Discussion  |  NIC MAP Vision  |  Senior Housing  |  healthcare

Munevar-Dianne_desktopProfileWell, what if you didn't have to choose? For 40 years and counting, senior housing owners and operators have prepared for and responded to the housing needs of aging adults. This market, which includes assisted living and independent living as well as memory care and nursing homes, has seen immense growth. But two problems remain: affordability and integration with comprehensive health services. These issues will persist for future generations if we don’t start solving them today—to allow our grandparents, parents, and eventually ourselves to live in the settings we choose with the appropriate set of health care services we need to age with dignity. 

As of 2021, there were nearly 56 million seniors in the United States. By 2034, this population is expected to outnumber the 18-and-under population for the first time in U.S. history, indicating many millions will need to decide where to live as they age. Foreshadowing my own personal decision, I will have to consider which setting supports my holistic health needs including my physical, mental, and financial health, as well as my social support needs. 

Housing and health care shouldn’t be an either/or — it needs to be both. 

For the past few years, NORC’s Health Care Strategy team (HCS) has produced ground-breaking research supported by The National Investment Center for Seniors Housing & Care (NIC) and The SCAN Foundation. We are currently engaged in a multi-year research portfolio with NIC to understand the individual health events precipitating a move into congregate living. Our research will also highlight the potential value of senior housing as it relates to the longevity and health of older adults. What we’ve found thus far is that in the year prior to moving into a senior housing property, people experience an escalation of adverse events and conditions that increase their level of medical complexity, often referred to as “frailty,” as defined by the Harvard claims-based frailty index. Hospitalizations, trips to the ER, accelerated cognitive decline, exacerbations of chronic conditions like diabetes or kidney diseases, combined with the loss of a spouse or partner increase a person’s likelihood of experiencing further deterioration in health and independence. 

But we found improvement—even a potential reversal of sorts. In 2019, about 97,000 people moved into senior housing properties tracked in the NIC MAP Vision database. In the year after move-in, frailty levels of residents improved—there was a 10 percent decline in frailty relative to peak levels. While we might be inclined to attribute that health improvement to their move into a senior housing property, we know that correlation is not causation. Today, HCS is digging into the reasons for this marked improvement in a comprehensive health measure like frailty. Over the next few months and into 2024, HCS will produce research that analyzes longevity and health outcomes for residents of senior housing. We aim to better understand the correlation between senior housing and health outcomes. 

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This research portfolio will provide invaluable insights for myriad audiences and stakeholders including our loved ones, and ourselves, who will soon make decisions about where to spend our golden years. Likewise, other stakeholders, like payers and health plans, and increasingly providers, will need a plethora of solutions to manage risk. Senior housing needs a seat at the health care table, aligned incentives, and payer/provider partnerships.

Housing and health care shouldn’t be an either/or—it needs to be both. A comprehensive solution allowing comfort, care, and dignity to seniors needs to be readily available and affordable so that more people aren’t forced to choose if they’d rather have housing or health care.


This commentary originally appeared in NORC Views, a health care strategy newsletter published by NORC at the University of Chicago.

About Dianne Munevar

Dianne is the vice president of Health Care Strategy at NORC. In her role, she works to leverage the depth and breadth of NORC’s diverse social sciences expertise and research assets to help health care clients meet their business objectives. Dianne also leads NORC Labs—NORC’s innovation hub which supports NORC staff as they incubate ideas that align with the organization’s mission to produce quality research and insights, designed to make NORC smarter, better, and faster at responding to emerging client needs. As vice president, Dianne drives business development strategy and oversees client engagements. With over 17 years of experience working with a diverse range of health care entities, including private and government payers, providers, trade associations, life science companies, foundations, and nonprofits, she has tackled some of the most challenging policy and strategy issues. Dianne combines her subject matter expertise and analytical skills with storytelling and evidence translation to support sound public policy and business strategy. She specializes in maternal health, social determinants of health, health disparities, post-acute care, seniors housing, and end-of-life care. Recent projects of interest include an analysis to estimate the value of hospice care in Medicare, examining disparities in maternal health in Medicaid, and survey research to gain a national perspective of consumers’ and physicians’ trust in the U.S. health care system, with a special focus on the impact that COVID-19 and discrimination has on the relationships between patients and their providers. Dianne was the Director of Innovation at Blue Cross Blue Shield Association, where she developed programs to improve health outcomes for members with various conditions, such as diabetes and behavioral health issues. In that role, Dianne led the Care Management Accelerator, collaborating with Blues Plans to scale new programs and technologies. Before BCBSA, she worked as Director of Data Analytics at Avalere Health supporting health care organizations across the spectrum, and as a health services researcher at RTI, focusing on post-acute and long-term care issues. Dianne has an MPP from the Harvard Kennedy School and a BA from Colgate University.

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