How Housing Influences Nursing Home Utilization in the United States: An Integrative Review

Abstract

Objectives Given the growing housing crisis, researchers increasingly point to housing as a possible risk factor for nursing home utilization, yet the exact pathways from housing to nursing home utilization are unclear. The purpose of this review is to describe how housing acts as a mechanism that influences nursing home utilization in the United States. Design Integrative review. Setting and Participants Studies involving individuals at risk for long-term nursing home placement or residents at risk for continued nursing home use in the United States. Methods Five databases were searched in April 2024. Articles were included if they (1) operationalized housing pathways as factors in nursing home utilization, (2) focused on long-term nursing home utilization, (3) used data after 1999, and (4) were based in the United States. The quality of articles was assessed and constant-comparative approach guided data synthesis. Results Sixteen articles met inclusion criteria. Three themes were identified describing housing's influence on nursing home utilization: (1) Housing as Financial Asset vs Strain represents how housing operates as either a protective financial asset or a financial strain that can act as a risk factor for nursing home use; (2) (Mis)match Between Needs and Housing represents how evolving functional needs create misalignments with housing environments, potentially leading to nursing home use; (3) Compounding Systemic Inequities represents how socioeconomic disparities related to housing contribute to risk of nursing home utilization among marginalized communities. Conclusions and Implications This review provides evidence of the relationship between housing and nursing home utilization; however, because of a weak quality of evidence and limited methodologic diversity, more research is needed to strengthen the evidence base. Clinicians, researchers, and policy makers should still recognize the significance of the role housing plays in nursing home utilization and target policies and interventions toward improving housing conditions for older adults and people with disabilities.