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Understanding Historically Marginalized & Minoritized Communities in the Forgotten Middle

Senior couple looking at each other at home
A deep dive into disparities among middle-income older adults’ finances, housing, and health status
  • Client
    The SCAN Foundation
  • Dates
    2023 - 2024


Many middle-income older adults, particularly Black, Hispanic, and rural populations, may not be able to access critical care and housing supports in the next decade.

The Forgotten Middle, a term coined in our landmark 2019 study, represents middle-income older adults who are unlikely to qualify for Medicaid long-term care, but are also unlikely to have the financial resources to pay for certain housing and care supports. The original study examined how the middle-income older adult population would change in the coming decade. In 2022, we reproduced the analysis with updated data, finding that the Forgotten Middle will double in size and become increasingly racially and ethnically diverse by 2033. That analysis found that nearly 75 percent of middle-income older adults will be unable to pay for private assisted living without selling their home. An additional analysis in 2022, focused specifically on California, found that 89 percent of California’s middle-income older adults will not be able to afford assisted living by 2033.  

These analyses also found that middle-income older adult population is diversifying across racial and ethnic groups, with an increase in the middle-income population from historically marginalized and minoritized groups. Research has demonstrated that fewer Black and Hispanic adults have retirement accounts compared to white adults. According to a recent Government Accountability Office report, the median balance for white households was double that of all other races. Furthermore, additional research has found that the gap between white and Black home ownership has increased in recent years. Research has also found that rural communities have lower availability of home and community-based services and other health care resources. Older adults from historically marginalized and minoritized communities face distinct financial and care access challenges that may impact their ability to age well.


NORC conducted an in-depth analysis across racial groups and produced illustrative case studies to explore challenges among rural older adults within the Forgotten Middle.

Our analysis used Health and Retirement Study (HRS) data from 2020 to update our national Forgotten Middle analysis, with a focus on marginalized and minoritized populations. Our research takes a deeper dive into differences across racial groups within the Forgotten Middle to better understand resource disparities that may affect older adults’ capacity to age with choice and dignity. We also examine the existing literature and develop illustrative case studies that highlight the aging experience and challenges of rural older adults. 

To examine differences across racial groups, we studied individuals 60 and older in the 2020 HRS data and modeled their probability of living to 2035 (age 75+) to establish the future older adult cohort. We looked at their demographic attributes and modeled their health status, home ownership, and financial resources, growing their actual income and assets in 2020 based on the historical rate of change and annuitizing them across each person’s life expectancy. We analyzed all the data by race to identify trends and inequities across racial groups. 

For rural communities, we developed descriptive case studies informed by a literature review and the data. Case studies were developed by drawing from real respondents in the HRS and include illustrative details to exemplify the range of potential experiences older adults may face depending on where they live.


Findings from our data analysis and literature review reveal disparities across the Forgotten Middle that must be considered in future policies.

This work led to six key findings:

  • Black and Hispanic older adults are clustered in the lowest financial quartile of the middle market. By 2035, older adults of color – defined using the HRS as Black, Hispanic, and “Other” – will comprise nearly one-quarter of the middle-income older adult (75+) population. Within the Forgotten Middle, Black and Hispanic older adults disproportionately fall into the lowest quartile of financial resources.
  • Black and Hispanic older adults in the Forgotten Middle have fewer liquid assets and less equity. White and "Other" older adults tend to hold more assets in traditional retirement financial tools such as the stock market or an IRA. Hispanic and Black older adults tend to hold most of their assets in savings accounts or in a vehicle. Holding fewer liquid assets may make affording housing and care options more difficult.
  • Among Black and Hispanic older adults, home ownership is decreasing. Home ownership for Black older adults is anticipated to fall substantially by 2035, driven by the 75-84 age group, which limits aging in place opportunities and decreases collateral that could be used to move into private pay housing options.
  • Compared to their urban counterparts, rural adults tend to have lower incomes. Our literature review found longstanding financial earning disparities between rural and non-rural individuals, which impacts the ability to afford care and housing options in the future.
  • Transportation remains a substantial challenge for rural older adults who aim to age in place. Since 90% of rural trips occurs in private vehicles, rural older adults face the additional consideration of how to remain mobile if driving becomes impractical or infeasible.
  • Rural communities tend to have poorer health outcomes and more limited access to certain care services. The literature also substantiates the widening gap in health outcomes between rural and non-rural individuals while also indicating that they often face lower access to and availability of certain health and care services.

Chart Pack & Case Studies

This slide deck provides more detail on the data analysis and case studies analyzing historically marginalized and minoritized communities within the Forgotten Middle.

Project Leads

Data & Findings

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Enhancing Maine’s All-Payer Claims Database

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Human Services Research Institute (HSRI)

Understanding California’s Middle-Income Older Adult Population

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The SCAN Foundation, West Health