Affordable Senior Housing with Services

Robyn I. Stone, DrPHExecutive Director, Center for Applied Research Senior Vice President of Research, LeadingAge

The SCAN Foundation Policy Roundtable Series – The Future of Affordable Housing with Services: How Can Residential Care Evolve to Serve Low-Income Seniors?

October 4, 2012

Characteristics of Seniors in Publicly Assisted Housing

Roughly 2 million lower-income seniors live in independent, federally subsidized rental properties

Median income - $10,236 They are growing older

– Median age = 74 years old; about 30% are age 80+– Median age moving in in 2006= 70; almost 20% were age 80+

They are racially/ethnically diverse– Hispanic – 13%– White – 56%– Black – 19%– Other – 9%

Data is for residents of Section 202 properties, 2006

Characteristics of Seniors in Publicly Assisted Housing

Chronic conditions and functional limitations more prevalent among advanced ages, lower incomes and minorities

Twice the prevalence of disability as their home owner counterparts

One-third have difficulty with routine activities 12% have cognitive impairments A 1999 survey estimated 30% of Section 202 residents

transferred to a nursing home

Resident Profile of 4 San Francisco Properties

71% health fair to poor; 29% good to excellent

54% report 3+ chronic conditions

Functional limitations– No IADLs/ADL – 25%– Only IADLs – 21%– 1+ ADL – 55%

35% fall in the past year 32% ER visit in past year 20% hospital stay in past year

Median age – 78 years old Gender – 37% male, 63% female 60 % live alone Race/Ethnicity

– Hispanic – 9%– White – 34% (Russian immigrants)– Black – 3%– Asian – 58%– Native Hawaiian/Pacific Islander

– .3%– American Indian/Alaska Native –

1% Diversity

– 14% born in the U.S.– 16% English first language

Resident Profile of 5 Atlanta HA Properties

Median age – 67 years old (large younger disabled population)

Gender – 37% male, 63% female

60 % live alone Race/Ethnicity

– Hispanic – 3%– White – 23% – Black – 61%– Asian – 10%– Native Hawaiian/Pacific Islander –

0%– American Indian/Alaska Native –

2%

48% health fair to poor; 52% good to excellent

60% report 3+ chronic conditions

Functional limitations– No IADLs/ADL – 55%– 1+ IADLs – 45%– 1+ ADL – 27%

29% possible depression 29% fall in the past year 40% ER visit in past year 27% hospital stay in past year

Policy Rationale

Residents are aging, seeing some degree of declining health and functional levels

Residents want to stay in their apartments Fair housing laws allow them to stay, in most cases Low-income residents have few affordable alternatives Feds and states are looking for opportunities to enhance

community-based options, improve health outcomes and lower health and long-term care expenditures

Possible opportunities to create some synergies

Value of Linkages with Affordable Housing Properties

Potential large concentration of duals and high cost/high risk individuals

Economies of scale offer potential service delivery efficiencies Available infrastructure – service coordinator

– Knowledge of residents – greater understanding of needs, abilities, resources

– Trusting relationships with residents – draw out information and encourage action

Linkages and assistance accessing resources and services– 85% of doctors say unmet social needs lead to worse health outcomes– 4 out of 5 say they don’t have the capacity to address

Value of Linkages with Affordable Housing Properties

Regular eye on residents – potentially catch problems early, encourage follow-up

Onsite services enhance access – may encourage greater usage and follow-through

Why Affordable Housing Plus Services Links are Important to Policy Makers

Affordability of assisted living and nursing home care is big problem for seniors and for government

Promise of meeting some long-term care needs through existing housing linked to services instead of new facilities is appealing

Targeting affordable housing residents in communities with lots of services offers chance to provide additional services at low marginal cost

Multi-unit housing offers potential economies of scale/increased service delivery efficiency

Why Affordable Housing Plus Services Links are Important to Providers

Providers are experiencing an aging resident base

Without supports, this can lead to:health and safety problems for disabled residents and other

community membersserious management problems (poor housekeeping,

dwellings in poor repair, etc.)evictions and unnecessary tenant turnovercrisis/off-hour emergency callsincreased pressures on housing

managers

Why Important to Providers (cont.)

With supports, aging in place is possible:aging services providers can work with frail/ confused

residents to eat regularly, pay bills, take care of their apartments, etc.

providers can organize willing family members, neighbors, friends to respond to unscheduled needs

health providers can deliver personal care, transportation to doctors, and access to primary care and preventative services

Why Affordable Housing Plus Services Links are Important to Residents

Most older residents in affordable housing want to remain where they are, even as health declines

They want to control their own lives and decisions, maintain neighbor and friendship networks, and avoid the trauma of relocation

They want services brought into their homes, just as older homeowners do

This paradigm has driven large investmentsin HCBS over past decade

Seniors Aging Safely at Home (SASH)

Connects health and long-term care systems to affordable housing settings

Core elements– Person-centered– Team-based care management

• Housing-based staff – SASH coordinator, wellness nurse• Community-based providers – home health agencies, area agencies on aging, PACE,

mental health providers, others

– Information sharing • Connected to state’s health information exchange

– Prevention and wellness through health aging planning • Comprehensive assessment• Individual and community plans

Seniors Aging Safely at Home (SASH)

Incorporated into state’s Blueprint for Health and Medicare Multi-Payer Demonstration

SASH teams serve as extenders of community health teams that support medical homes

Medicare pays for SASH coordinator and wellness nurse Will roll out to 112 subsidized housing communities across

state

Oregon

Proposed pilot in state’s duals demo– Up to 3 sites that will deliver services at subsidized housing

properties through a consortium of community providers Develop comprehensive service package based on a

community needs assessment – May include service coordination, home and personal care,

resident inclusion and involvement, recreation/community inclusion, money management, emergency fund, technology support, transportation

Partner and coordinate with Coordinated Care Organizations (CCOs) for primary care, wellness programs, behavioral supports and substance abuse treatment

Other Potential Activities

California– Request for Solutions seeking managed care providers for

duals – applicants asked to describe how they would partner with housing providers

Massachusetts– Housing providers discussing partnerships with Senior

Care Organizations (SCOs) – would link health care providers with coordination and supportive service abilities of housing providers

LeadingAge Center for Applied Research Resources

www.leadingage.org/research– Click on “Expanding Affordable Housing plus Services”– Click on “Housing plus Services Publications”

Contact– Robyn Stone – rstone@leadingage.org– Alisha Sanders – asanders@leadingage.org