The Older Adult Housing Crisis
February 9, 2026
Throughout my career, I’ve learned that most families don’t call me on a “good day.”
They call when facing a hospital discharge that seems too soon. After the relapse that shocked everyone, even though the signs were there. After a mental health episode that didn’t quite meet criteria for a group home, but absolutely made “traditional” senior living feel unsafe, unsuitable, or simply impossible. Or when they feel overwhelmed and unsure and can’t see their way through to what seem like viable options for themselves or loved ones.
And then we arrive at a problem that is far bigger than one family:
There are not enough housing options for older adults who need some behavioral health support, but not institutionalization. In the U.S., we’ve built a senior housing ecosystem that often assumes social drinking is “normal,” casino trips are “community-building,” and a resident who is anxious, reactive, depressed, or in recovery from addiction of one type or another should be able to “just adjust.”
That assumption quietly pushes many older adults to the margins.
Older adulthood does not protect someone from mental illness, substance use disorder, or gambling-related harm.
These numbers translate into a lot of people who need housing that is safe, stable, and recovery-informed for those who struggle with mental health, substance use disorder, and other forms of addiction, let alone trauma, which often accompanies these issues.
These trends are not happening in isolation — they reflect a generational shift in who today’s older adults are.
Today’s older adult population in the U.S. includes a disproportionately large group of Baby Boomers (born 1946–1964), who continue to shape the face of aging due to their sheer numbers and unique life experiences. By 2030, more than 72 million Americans will be 65 or older, driven largely by the aging Baby Boomer cohort.
Substance use among older adults is rising in part because this generation had greater lifetime exposure to alcohol and illicit drugs compared with previous cohorts. Research shows that illicit drug use among adults aged 50–64 has increased substantially over time, driven largely by the Baby Boomer generation.
We’re also seeing evidence of increasing overdose risk among older adults: age-adjusted drug overdose death rates for adults aged 65+ have climbed markedly over recent decades, with deaths rising from 2.4 per 100,000 in 2000 to 8.8 per 100,000 in 2020.
Alcohol remains the most widely used substance among older adults, and patterns of use are shifting. National surveys indicate that millions of older adults continue to drink, and health professionals have noted increased alcohol misuse within aging populations. Given that many older adults are likely on more medications that should NOT be mixed with alcohol, this is especially scary.
Another important factor is the lived experience of many older adults who are military veterans. Veterans historically have higher rates of alcohol and drug misuse than the general population — for example, data shows that more than 80% of veterans in one recent analysis abuse alcohol and nearly 27% abuse illegal drugs, underscoring how trauma and service experiences contribute to ongoing substance use vulnerability.
Combined with all of the above is the fact that age alone is a significant factor in how our bodies process substances and how addiction manifests. Older adults' organs are much more vulnerable to substances than they were when they were younger, a fact which they may not realize. This can result in significant physiological deterioration and harm. Partying just can’t continue the way it used to without detrimental impact on the older adult’s well-being.
Taken together, the size of the Baby Boomer cohort, their greater exposure to substances earlier in life, and the behavioral health sequelae tied to trauma and military service for many help explain why addiction and mental health concerns among older adults are significant and growing.
Many older adult communities are designed around social rituals that can be risky for someone with a behavioral health history:
For a resident in long-term recovery (or early recovery), this isn’t “just a cocktail hour.” It can be a daily trigger, a source of isolation (“I don’t belong here”), or an environment where relapse risk quietly climbs.
For many people, gambling is entertainment. But for someone with a gambling disorder history, an environment that normalizes betting outings can be destabilizing—and it can also be embarrassing to explain, so people often don’t. Those who do not struggle with a gambling addiction may not be able to relate to the fact that seemingly harmless bingo can, in fact, pose a real threat to someone who struggles with this disorder.
Some older adults don’t need a group home, but they do need:
When that support isn’t available, residents are labeled “difficult,” and families are left scrambling.
“Marie,” 72, is widowed and living with depression and anxiety. Years ago, she also faced alcohol misuse and has been stable in recovery for a long time.
After a fall and a brief rehab stay, the discharge planner suggested assisted living. The first community looked perfect—beautiful dining room, activities, friendly residents.
But every day at 4:00 p.m., the lobby transformed into “wine and cheese social.” Her neighbors invited her warmly. Staff offered her a glass casually. She started staying in her room. Her anxiety escalated. She stopped eating well. Her family interpreted it as “decline,” when it was really an environmental mismatch. Screening for admission had not included questions that would identify these issues.
Her daughter told me, “We finally found a place that felt physically safe. But emotionally, it wasn’t.”
This is the gap: housing that supports both aging and behavioral health without forcing people into institutional settings.
In my professional opinion: not consistently, and not at scale.
We do have pockets of excellence—supportive housing programs, behavioral health supportive housing models, and strong local systems in certain regions. But families often encounter:
No system is perfect, but some countries offer structural approaches that the U.S. can learn from—especially around supportive housing and housing-first models (stable housing paired with wraparound services).
Why this matters for older adults with mental health/addiction needs:
When housing is stable first, services can be delivered consistently, and people don’t have to “fail” repeatedly to qualify.
Why this matters:
This model can flex for people who don’t need a nursing home but do need a little more scaffolding—including residents with mental health conditions.
Why this matters:
These systems more explicitly treat housing as part of the care continuum, not separate from it.
Why this matters:
When older adult mental health is named, staffed, and structured, housing and care planning can coordinate around it more intentionally.
This is the part I want families—and policymakers—to hear clearly:
We don’t have to reinvent aging services. We have to update them.
Here are real, workable design principles that close the gap:
(If a community can accommodate food allergies and fall risk, it can accommodate recovery.)
Not everyone needs 24/7 staff. Many people need:
Supported housing models are designed for this, combining housing and support services to help people live as independently as possible.
Families panic when a loved one’s needs change because moving is disruptive and traumatic.
Communities should offer:
Finland’s example shows what happens when systems treat housing as the platform for health and safety, not a prize for perfect behavior.
When you tour or evaluate a community, ask direct questions—because vague answers cost families months.
3. Behavioral health readiness
4. Care coordination
5. Environment fit
As an advocate, I also encourage families to document needs in writing early. “We’re fine” becomes “we’re in crisis” faster than anyone expects—and the best outcomes come when we plan before the emergency.
This is not about asking senior communities to “do everything.” It’s about recognizing that aging intersects with mental health, recovery, trauma, and relapse risk—and pretending otherwise creates quiet harm.
When we build housing that supports the whole person, we protect:
This is a housing crisis—just a different kind than we usually talk about.
And it’s an area in which we can do much better than we have been!!
Our older adults deserve care and respect, regardless of their circumstances. We have much we could learn from other countries and cultures. And remember, we will all be in their shoes soon enough!
Take care,
Lee
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