As we grow older, most of us share one simple dream: to remain in our own homes, surrounded by familiar comforts and cherished routines. Nearly 80 percent of Americans hope to age in place for as long as possible. Yet for older adults who live in supportive housing—many who’ve overcome homelessness, substance use disorder, or poverty—this basic dignity is at risk of slipping away without proper intervention. Their independence hangs in the balance while an underutilized but highly effective health care solution sits within reach: occupational therapy (OT).
As the CEO of Project Renewal, one of the largest supportive housing providers in New York City, I have seen firsthand how precious independent living can be. The ability to maintain one’s own space—to decide when to wake up, what to eat, and how to spend the day—represents a freedom many of us take for granted. To help older adults maintain their routines and age with dignity, we have worked to expand access to existing OT services.
Nonprofits and other providers will need to significantly expand OT services as the proportion of older adults living in affordable and supportive housing increases in the years to come. A confluence of factors is driving instability in senior housing. The older adult population is growing, and their poverty and homelessness rates have risen dramatically. Today in New York state, nearly 1 out of 8 adults over age 65 lives in poverty. That’s 420,000 total, a number that has surged nearly 50 percent over the past decade.
Underlying this problem is a shortage of affordable housing for older adults. In New York City as of 2024, 520,000 applicants were sitting on waiting lists for affordable senior housing. Although OT will not directly address this issue, it will support those who are housed and enable them to remain where they are.
The uncertain future of Medicaid—which currently pays for 60 percent of the nation’s extended nursing home stays—makes it particularly urgent for this population to have the opportunity to age in place for as long as possible. Cuts to Medicaid could force nursing homes to lay off staff, resulting in lower-quality care, and reduced capacity. Investing in aging-in-place health care programs reduces reliance on nursing home care and also costs far less: one study pegs savings for Medicare and Medicaid at more than $1,500 per month.
Occupational therapy is a tool that can support aging in place for our most vulnerable older adults. At Project Renewal, we offer occupational therapy services to seniors; it’s a replicable model. The Helping Older People Engage (HOPE) program was piloted at one of our supportive housing residences in 2017, and our second HOPE program was launched in 2023. Today, a team of 5 occupational therapists, along with multiple OT student interns, provide services to about 130 older residents. Many of these clients face challenges beyond just aging, including histories of homelessness, trauma, mental illness, incarceration, and substance use.
[RELATED ARTICLE: Which U.S. Laws Require Accessibility in Housing—And How Well Do They Do?]
Our occupational therapists work with residents to first assess the strengths and weaknesses of their functional skills and determine likely barriers to their successful performance of daily life activities. The therapists then create client-centered, personalized support systems for these activities, including self-care, emotional regulation, health and home management, cooking and nutrition, harm reduction, and more.
…Individuals who are more connected to coordinated care systems rely less on emergency services and nursing facilities.”
Take laundry as an example. Our occupational therapists break down the activity into its constituent parts, determining the capabilities required to complete each task, and assessing whether these are achievable given a client’s current functional skills. For instance, does a client have the digital dexterity to turn a knob? Do they have the back strength to carry their laundry? Do they have the working memory to remember to transfer washed clothes to the dryer? From there, the occupational therapist will offer personalized support, such as reminding a client when to move their load to the dryer.
Interventions are adapted as clients’ needs evolve, focusing on ensuring that each resident develops the skills, compensatory strategies, and supports necessary for optimal engagement and connection to care. Additionally, group programming, which includes activities such as music, art, writing, cooking, and brain games, enables residents to engage with peers in a meaningful way. These activities foster a sense of belonging and self-worth while creating a sense of hope for the future.
Research shows that individuals who are more connected to coordinated care systems rely less on emergency services and nursing facilities. We know that integrated care models that address physical, mental, and social well-being, such as the model offered by HOPE programming, also improve overall health outcomes and decrease dependence on emergency health services and institutional care settings. This approach supports aging with dignity in the environment people prefer to live in, aligning with broader findings on the benefits of connected, community-based care.
Since launching occupational therapy at Project Renewal, we have collaborated with Columbia University to significantly expand the scope of OT services for all groups. Today, we employ a team of 20 occupational therapists, providing services across more than 20 different programs—from supportive housing to mobile clinics—serving more than 1,500 New Yorkers. In addition, we train 50 OT interns each year from 16 different colleges across the country, working to bolster the pipeline of skilled occupational therapists in community-based behavioral health settings.
Rising senior poverty and an affordable housing shortage are threatening seniors’ housing stability. Looming Medicaid cuts are poised to reduce the quality and accessibility of care at nursing homes. In this policy environment, we have a responsibility to accommodate seniors’ desire to age in place. In addition to growing the supply of affordable and supportive housing for older adults, we must expand investments in training and embedding occupational therapists within these settings to ensure residents can age in place with dignity.
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