Housing assistance and health care access among older adults with alzheimer's disease and related dementias: Evidence from multisource linked survey-administrative data

OBJECTIVES: To examine health care access among older adults, with specific attention to the importance of the US Department of Housing and Urban Development (HUD) housing assistance participation and Alzheimer's disease and related dementias (ADRD) diagnosis. 

DESIGN SETTING AND PARTICIPANTS: We used a multisource survey-administrative data linkage, combining the 1999-2016 National Health Interview Survey (NHIS), 1999-2018 HUD administrative housing records, and 1999-2018 Medicare enrollment and claims records. The sample included 46,269 NHIS participants aged 65 and above who were linked to the Medicare enrollment and claims file and who were eligible for linkage to the HUD administrative record, regardless of participation in HUD programs. 

MEASURES: ADRD status was determined based on a documented diagnosis in Medicare claims. Participation in HUD housing assistance was determined through HUD records. Health care access measures were having no usual source of care, delayed/forgone needed care due to cost, and forgone needed medications due to cost. 

RESULTS: Among adults with ADRD, 10% received HUD housing assistance, compared to 5% in the overall sample. Adults with ADRD receiving housing assistance were 2.3 percentage points less likely (95% CI: 1.1-3.7) to report no usual source of care but were more likely to report delayed/forgone care (5.9 percentage points) and forgone medications (4.2 percentage points) compared to those with ADRD but not receiving housing assistance. 

CONCLUSIONS: In this nationally representative study of the older adults with ADRD, those receiving housing assistance tended to maintain a usual source of care, but experience cost-related barriers to necessary care.