WI20-09: The Demographics Behind Aging in Place: Implications for Supplemental Security Income Eligibility and Receipt

Although the US population is aging, the population living in nursing homes has fallen. The decline is the largest among low income older adults. This report explores two possible demographic drivers of this decline: (1) increasing racial and ethnic diversity and (2) increasing life expectancy among men. Using decennial census and American Community Survey data from 1980, 1990, 2000, 2008—2010, and 2014—2018 and nonlinear regression decomposition techniques, I estimate the share of the overall decline in institutional residency attributable to these demographic trends. Additionally, I explore which living arrangements have risen as institutional residence fell and discuss implications for the Supplemental Security Income (SSI) program. I am able to explain 99 percent of the decline in institutional residency, of which changes in racial and ethnic diversity alone explain 19 percent. Medicaid Home and Community Based Care waiver programs alone explain approximately 60 percent. As nursing home residency fell, assisted living rose but not by enough to fully offset the decline in institutional residence and very unequally by race. Coresidence with persons other than a spouse and unmarried partnerships both grew dramatically. Findings indicate increases in community-residence may increase SSI payments and rising rates of coresidence may lead to more complex benefit determinations and greater administrative cost.