Why ‘One Size Fits All’ Solutions Won’t Fit the Forgotten Middle

One of the best things about this New York Times piece is that it shines a light on something many don’t appreciate: There are multiple layers to the “forgotten middle” challenge looming over housing and healthcare for older adults. Grasping that fact is vital to solving the problem.

Paula Span’s Times piece was well-timed. It was published a few days before the Milken Institute released a report — sponsored by the National Investment Center for Seniors Housing & Care (NIC) and CVS Health — examining innovative financing models to scale affordable housing and care solutions for this same group.

Both the Times and Milken make it clear that the forgotten middle is a very broad cohort. And because of that, there will never be a one-size-fits-all solution for this group’s housing and long-term care needs.

Instead, solutions will have to be tailored to the income and resources, as well as the healthcare needs, of those being served.

(All of this, of course, builds off the seminal Forgotten Middle study published in Health Affairs, authored by Caroline Pearson and the research team at NORC at the University of Chicago and underwritten by NIC. See link at the bottom of this post.)

The Times piece paints a vivid picture: There are two very different markets for healthcare and housing among older adults in the American middle class. The upper half has, in many instances, seen their financial situation, health and longevity all improve over the last two decades.

Meantime, the lower half of the forgotten middle has not seen those gains. In fact, many have lost ground — both financially and in terms of their health and longevity.

The lower middle class tends to be sicker with more chronic conditions and less financial stability. They’re often one fall or other health incident away from falling into poverty and qualifying for Medicaid.

We need to understand those differences if we’re going to be able to craft programs that meet all of the forgotten middle’s needs — making long-term care and housing affordable and accessible for all.

I applaud the leadership of NIC which, through its case studies, research and programming at its conferences, not only first brought attention to this issue, but now is focusing on the variety of strategies and models needed to serve this huge demographic cohort. It’s a segment of the population that will total nearly 16 million in less than a decade — so the time to act is now!