Strategy Snapshot
Supporting Older Adults’
Safety, Health, and Independence
October 2025
Introduction
Older adults are a vital part
of our communities,
representing nearly 20%
of Americans and a growing
share of the population.
Yet many live on a fixed budget and struggle with maintaining their homes, meeting basic needs, and covering the rising cost of their health care. More than 35% of older households spend over one-third of their income on housing, utilities, and related expenses, making it hard to afford other essentials. About 17 million Americans ages 65 and older (30%) are low income, and roughly 25% sacrifice food, clothing, medication, or other necessities to manage their health care costs.1
These difficulties undermine older adults’ ability to remain in their homes and communities. And as the U.S. population ages more rapidly in the coming years, all these numbers stand to grow.2
The Harry and Jeanette Weinberg Foundation aims to connect older adults with the support and services they need to live independently and with dignity, which includes safe, accessible housing and access to quality health care.
The Challenge: Enabling Older Adults to Stay Independent, Connected, Healthy, and Safe
Older adults overwhelmingly want to stay in their homes.
Even when they must move to accommodate their changing mobility and home-safety needs, they still want to be part of a community and maintain their independence.3
But as they age and require regular assistance with daily activities, older adults face the additional costs of getting help, further stretching already tight budgets. Limited public, private, and philanthropic investment in such long-term care often leaves them or their families shouldering that burden alone. Although philanthropic support for nonprofits serving older adults has grown over the past decade, many programs do not consider all the needs of older adults, including challenges with accessibility, physical and mental health, and social isolation.4
Several proven and cost-effective programs have demonstrated success in supporting older adults and their independence. To address their full range of needs, these programs take a comprehensive approach, bringing together services for housing, home health care, medical care, occupational therapy, and other critical assistance for daily living.
Yet the up-front costs and requirements for establishing these programs, coupled with lack of awareness, have impeded their expansion. Without intentional investment in these efforts, millions of older individuals will continue to lack the essential support they need to age with stability, dignity, and the freedom to remain in their communities.
The Strategy: Taking Evidence-Based, Cost-Effective Programs Serving Older Adults to Scale
Over the past decade, the Weinberg Foundation has invested in expanding two evidence-based programs serving older adults in communities throughout the country.
Community Aging in Place, Advancing Better Living for Elders (CAPABLE)
Developed in Baltimore by Johns Hopkins University’s School of Nursing in 2009, CAPABLE combines home repairs with occupational therapy and the care of a registered nurse to improve mobility, manage chronic symptoms, and decrease health care costs for older adults struggling with daily living. Today, the five-month program operates in 33 sites across 21 states and Canada, serving over 3,400 people typically referred by health care providers, nonprofits, or local government agencies.
With a $3,000–$5,000 investment per home, CAPABLE improves safety, accessibility, and quality of life for participants — preventing falls, injuries, and hospitalizations — and can save up to $30,000 in medical expenses. Participants also report notable improvements in their physical and mental health, medication management, and nutrition.5 In one study, participants saw a 50% increase in their ability to do everyday activities such as walking, bathing, and shopping, along with a 30% decrease in symptoms of depression.6
Program of All-Inclusive Care for the Elderly (PACE)
Started in 1971 as a pilot program in the San Francisco Bay Area, PACE has grown into a national model covered through Medicare and Medicaid, with facilities in communities across the country. PACE centers coordinate comprehensive medical care, physical therapy, meals, recreational and social opportunities, and other support for individuals who need the level of care a nursing home would provide. The program allows most participants to continue living at home while having their needs met.
PACE has more than 380 centers in 33 states, serving nearly 90,000 individuals — about 95% of whom live at home.7 The program reduces hospitalizations, emergency room visits, and nursing home stays, while increasing longevity and quality of life.8
Research has consistently documented the effectiveness of CAPABLE and PACE in improving health and quality of life, while significantly reducing the costs usually associated with emergency room visits and hospitalizations.9 Both demonstrate the future that is possible when people have the support and quality of care they need to maintain their independence and remain in their homes and communities.
Despite the success of both programs, their growth had been gradual when the Weinberg Foundation began supporting them a decade ago. The Foundation and several national and local philanthropic partners saw an opportunity to support significant expansion of the programs to areas with unmet needs.
To successfully bring CAPABLE and PACE to more people and places, the Foundation invested in two key approaches:
- Strengthening national networks and partnerships to support expansion.
- Developing new facilities and providing home repairs and modifications that improve the lives of older adults.
The Impact
A national clearinghouse to drive CAPABLE’s expansion. Drawing on experience with the National PACE Association, which has ensured program quality and guided PACE’s growth since 1994, the Foundation supported the creation of the CAPABLE National Center in 2022. Launched by Johns Hopkins and Care Synergy (a network for community-based home health care providers), the center aims to sustain the CAPABLE model and promote its adoption in more communities. To that end, the center is a hub for training and supporting the faithful implementation of the model, as well as a source of national data and evidence on CAPABLE’s impact and success.
A 42% increase in CAPABLE sites and a 26% increase in PACE centers from 2020 through 2024. The research documenting CAPABLE’s success in improving older adults’ daily living and well-being has fueled its growth. Reduced costs resulting from those improvements also contributed, matching a broader trend in health care that recognizes the economic benefit of enabling older adults to live healthier lives.10
For PACE, a key driver of growth has been the National PACE Association’s ambitious target set in 2017: reaching five times the number of people served through the program, or 200,000 individuals.11 To achieve that goal, the National PACE Association has assisted organizations already operating PACE centers to determine their capacity to develop more centers; engaged additional entities, such as community health centers or hospice centers, to adopt the PACE model to support their patients; and provided research and data on the program’s health benefits and cost-savings to encourage more states to support its growth in their communities.
Investments in constructing new facilities and expanding home improvements to enable both programs to serve more individuals and communities. While often overlooked, these brick-and-mortar expenditures are a critical foundation for bringing high-quality services to more people and places. For example, creating a PACE center typically requires millions in initial financing.12 Providing grants for construction or renovation not only accelerated the timeline for getting a center off the ground but also enabled the participating nonprofits to direct more resources to serving older adults.
- Through its existing funding, United Way of Long Island’s CAPABLE program, Safe at Home for Seniors, could only cover simple fixes in clients’ homes, such as installing grab bars for accessibility, which fall short of the modifications many require for homes built before 1975. The Foundation’s additional support nearly doubled the resources available for safety updates, enabling United Way to provide wheelchair ramps, roof repairs, and mold remediation.
- San Diego’s San Ysidro Health launched its first PACE center in 2015 and a second one in 2019. With the Weinberg Foundation’s support to build additional facilities, San Ysidro Health was able to launch its third and fourth centers in 2021 and 2022, respectively.
Innovations that tailor PACE services to community needs. The Foundation has supported local efforts to customize PACE and its services in ways that effectively reach older adults with specific challenges or in underserved communities.
- The Foundation has supported On Lok in reaching LGBTQ+ older adults and immigrant communities in the San Francisco Bay Area. The organization has leveraged its expertise to develop a feasibility study with partners in Hawaiʻi that explores the potential for bringing PACE to the state. On Lok also has built its services and care for diverse populations, hiring bilingual caregivers, providing home-cooked ethnic meals, and offering the popular Chinese game mahjong as a recreational activity, among other cultural considerations.
- With the Foundation’s support, Selfhelp and RiseBoro Community Partnership teamed up to build a PACE center next to a 190-unit apartment building in Brooklyn, N.Y., that includes 57 units reserved for older adults who have experienced homelessness. This pairing makes it easier for older residents to receive the medical care and other services they need to remain stable and independent.
- Although federally qualified health centers provide primary care and support services to low-income communities, they generally do not focus on the comprehensive needs of older adults. To connect older residents in California’s Marin and Sonoma counties with more specialized care, the Foundation supported the partnership of Santa Rosa Community Health Centers with LifeLong Medical Care to create AgeWell PACE, a first-of-its-kind center serving 300 individuals.
Conclusion
Everyone deserves to age
with respect, dignity, and the support necessary to thrive.
CAPABLE and PACE are best-in-class programs, demonstrating that this ideal is an attainable norm. Greater philanthropic investment in these programs will help make that norm the everyday standard for the millions of older Americans in communities across the country, while simultaneously saving them, their families, and our nation from the heavy costs of long-term care. Endnotes
1 Joint Center for Housing Studies of Harvard University. (2023). Housing America’s older adults 2023. https://www.jchs.harvard.edu/housing-americas-older-adults-2023. And, Jacobson, G., Cicchiello, A., Shah, A., Doty, M. M., & Williams II, R. D. (2021, October 1). When costs are a barrier to getting health care: Reports from older adults in the United States and other high-income countries. The Commonwealth Fund. https://www.commonwealthfund.org/publications/surveys/2021/oct/when-costs-are-barrier-getting-health-care-older-adults-survey. And, National Council on Aging. (2024, June 1). Get the facts on economic security for seniors. https://www.ncoa.org/article/get-the-facts-on-economic-security-for-seniors. And, Willcoxon, N. (2022, June 15). Older adults sacrificing basic needs due to healthcare costs. Gallup. https://news.gallup.com/poll/393494/older-adults-sacrificing-basic-needs-due-%20healthcare-costs.aspx
2 Schaeffer, K. (2024, January 9). U.S. centenarian population is projected to quadruple over the next 30 years. Pew Research Center. https://www.pewresearch.org/short-reads/2024/01/09/us-centenarian-population-is-projected-to-quadruple-over-the-next-30-years/. And, Abalo, T. (2025, January 15). America’s population is rapidly aging. Can philanthropy keep up? [Blog post]. Dorothy A. Johnson Center for Philanthropy. https://johnsoncenter.org/blog/americas-population-is-rapidly-aging-can-philanthropy-keep-up/
3 Gavin, K. (2022, April 13). Most older adults want to ‘age in place’ but many haven’t taken steps to help them do so. University of Michigan News. https://news.umich.edu/most-older-adults-want-to-age-in-place-but-many-havent-taken-steps-to-help-them-do-so/. CAPABLE. (n.d.). News, events, and research. https://capablenationalcenter.org/news-events-publications/. And, Rosenblum, S., & Rizer, A. (2023, July 24). The CAPABLE program: An effective intervention for dual eligible individuals in integrated programs. Health Affairs Forefront. https://www.healthaffairs.org/content/forefront/capable-program-effective-intervention-dual-eligible-individuals-integrated-programs. And, Habitat for Humanity. (n.d.). Habitat and the CAPABLE model. https://www.habitat.org/our-work/aging-in-place/CAPABLE-model
4 Joint Center for Housing Studies of Harvard University. (2023). And, National Institute on Aging. (2023, October 12). Paying for long-term care. https://www.nia.nih.gov/health/long-term-care/paying-long-term-care. And, Horstman, C., Gumas, E. D., & Jacobson, G. (2023, February 16). U.S. and global approaches to financing long-term care: Understanding the patchwork. The Commonwealth Fund. https://www.commonwealthfund.org/publications/issue-briefs/2023/feb/us-global-financing-long-term-care-patchwork. And, West Health & Gallup. (2024, June 5). 2024 healthcare in America report. https://westhealth.org/resources/2024-healthcare-in-america-report/
5 Ruiz, S., Snyder, L. P., Rotondo, C., Cross-Barnet, C., Colligan, E. M., & Giuriceo, K. (2017, March). Innovative home visit models associated with reductions in costs, hospitalizations, and emergency department use. Health Affairs, 36(3). https://www.healthaffairs.org/doi/10.1377/hlthaff.2016.1305. To learn more about CAPABLE and its effectiveness, visit https://capablenationalcenter.org/news-events-publications/.
6 Paone, D., Li, Q., & Szanton, S. (2022, January 27). CAPABLE: Implementation initiative evaluation report (2018–2021). Habitat for Humanity. https://www.habitat.org/sites/default/files/documents/CAPABLE_model_Habitat_report_2022.pdf
7 2024 data provided by the National PACE Association.
8 Berry, L. L., Naber, M. K., Letchuman, S., & Fitzgerald, P. (2023, June 15). A more human model for eldercare in the U.S. Harvard Business Review. https://hbr.org/2023/06/a-more-humane-model-for-eldercare-in-the-u-s. And, Wieland, D., Kinosian, B., Stallard, E., & Boland, R. (2013, January). Does Medicaid pay more to a Program of All-Inclusive Care for the Elderly (PACE) than for fee-for-service long-term care?, The Journals of Gerontology: Series A, 68(1), 47–55. https://academic.oup.com/biomedgerontology/article/68/1/47/549686?login=false. And, Wyoming Department of Health. (n.d.). Wyoming Medicaid SFY 2020 annual report. https://health.wyo.gov/wp-content/uploads/2021/03/SFY-2020-Wyoming-Medicaid-Annual-Report.pdf
9 See, for example, CAPABLE. (n.d.). News, events, and research. https://capablenationalcenter.org/news-events-publications/. And, National PACE Association. (n.d.). Bibliography of PACE studies. https://www.npaonline.org/pace-operations/research-data/bibliography-of-pace-studies
Specific studies on CAPABLE: Rosenblum, S., & Rizer, A. (2023, July 24). And, Habitat for Humanity. (n.d.). And, Boffy-Ramirez, E., Dougherty, Y., & Versen, E. (2024). Colorado Community Aging in Place–Advancing Better Living for Elders (CAPABLE) evaluation: Final report (Report No. 23-10B). Colorado Evaluation and Action Lab at the University of Denver. https://coloradolab.org/resources/technical-report-findings-of-the-statewide-family-time-study-2/
Research on PACE: Perry, M., McCall, S., Nardone, M., Dorris, J., Obbin, S., & Stanik, C. (2024). Program of All-inclusive Care for the Elderly (PACE) organizations flip the script in response to the COVID-19 pandemic. Journal of the American Medical Directors Association, 25(2), 335–341. https://www.jamda.com/article/S1525-8610(23)00981-7/fulltext. And, National PACE Association. (n.d.). Program of All-Inclusive Care for the Elderly (PACE) key research findings: Quality care, improved health, cost-effective. https://www.aha.org/system/files/content/11/111212postacutecall-npabrief.pdf. And, National PACE Association. (n.d.). Environmental scan of PACE articles 2009–2022. https://www.npaonline.org/docs/default-source/uploadedfiles/2009-2022_npa_pace_research_bibliography_0.pdf?sfvrsn=120831ed_1
10 For more on this trend, see Centers for Medicare & Medicaid Services. (2025, February 27). Value-based care. https://www.cms.gov/priorities/innovation/key-concepts/value-based-care. And, Meyer, H. (2021, December 9). CAPABLE: Supporting older people with disabilities to improve health and well-being at home [Blog post]. The Playbook, Center for Health Care Strategies. https://bettercareplaybook.org/_blog/2021/8/capable-supporting-older-people-disabilities-improve-health-and-well-being-home
11 The Weinberg and John A. Hartford foundations, as well as West Health, collaborated with the National PACE Association to set and execute this goal, known as PACE 200K. Funding has supported the construction and renovation of facilities for new PACE centers, which is a substantial up-front cost and hurdle for nonprofits operating them.
12 Higgins, C. (2022, June 2). Understanding the cost structure of a PACE program [Blog post]. Health Dimensions Group. https://healthdimensionsgroup.com/insights/blog/cost-of-pace/