investments in housing for vulnerable seniors conf 10.18...training & education policy reform...

Investments in Housing for

Vulnerable SeniorsCourtney Christenson

October 18, 2019

Improving Lives

© All rights reserved. No utilization or reproduction of this material is allowed without the written permission of CSH.

What We DoCSH is a touchstone for new ideas and best practices, a collaborative and pragmatic community partner, and an influential advocate for supportive housing.

Lines ofBusiness

Training &

Education

Policy Reform

Consulting &

Assistance

Lending

Research-backed tools, trainings and knowledge sharing

Powerful capital funds, specialty loan products and development expertise

Custom community planning and cutting-edge innovations

Systems reform, policy collaboration and advocacy


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Presentation Notes

CSH offers capital, expertise, information and innovation that allow our partners to use supportive housing to achieve stability, strength and success for the people in most need.

Homelessness, Health & Aging

*Information presented by Dr. Rebecca Brown from University of California, SF, Division of Geriatrics, Dept. of Medicine© All rights reserved. No utilization or reproduction of this material is allowed without the written permission of CSH

Poor physical and behavioral health causes homelessness

Homeless adults 50+ have higher rates of chronic illnesses similar to housed individuals 65+

Homeless adults 50+ are 4X more likely to have 1+ chronic illnesses compared to younger homeless adults

Homeless adults 50+ have geriatric conditions of those 70+ in general population

Those w/ geriatric conditions more likely to frequent ER (4+ times/year) and more likely to be institutionalized

Housing Impacts Health

Communicable Diseases Malnutrition Harmful Weather

No Medication Storage Violence


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It isn’t just the lack of housing that causes health to decline. Rather, the situations people are put in while trying to seek shelter actually cause health to decline. People who experience homelessness face many hazards and situations that impact their health. In shelters people are often exposed to communicable diseases by living in close quarters such as shelters and not having access to appropriate facilities necessary for maintaining hygiene. We see individuals contracting more frequent common illnesses, which can easily develop into large problems such as infections or pneumonia. Without access to a regular, stable place to call home, Lisa was exposed to harmful weather and lacked a place to store medications or supplies safely. The injury she experienced from her assault may not heal properly due to her living conditions. All of these extremely difficult situations have potential to cause or exacerbate behavioral health issues such as mental health or substance use issues in people like Lisa, which can continue their cycle of instability.

Highest Need

Adult Homes/ Assisted Living

Licensed residential programs

Supportive Housing

NORCs

Affordable Senior Housing

Highest Rent Subsidy &

Support Service Need

Lowest Rent Subsidy &

Support Service Need

Housing & Support Service Needs for a Growing Aging Population

© All rights reserved. No utilization or reproduction of this material is allowed without the written permission of CSH

Presenter

Presentation Notes

Where does SH fit in the continuum of senior affordable housing…. We know that there are various housing options (though all limited) for those wishing to age in place, but where we see PSH in this continuum/ hierarchy of needs is that it provides more support services and case management than your typical senior housing with services (e.g. 202 or NORC) but is still independent living. And as you go up this continuum, there is both a higher service need and rental subsidy. But we see it as successful intervention delaying premature placement in costly NHs. Especially for your most vulnerable (homeless and currently institutionalized) given the multiple, high risk physical and behavioral health conditions experienced by this group, the provision of permanent, affordable housing linked to a comprehensive array of supportive services is essential. Housing is the first step towards stabilization of physical and mental health, for many older/elderly adults experiencing homelessness. Without SH, healthcare is likely to be received intermittently in emergency rooms and other crisis oriented health facilities, which is expensive and results in fragmented care. SH is a proven intervention that reduces the use of emergency services, resulting in significant savings of public dollars, while providing the coordination of physical and behavioral health services that is essential for older homeless adults. Supportive housing also reduces the likelihood that homeless older adults will be placed in nursing homes or convalescent care facilities.

CSH’s Focus On Aging Adults • Our focus: Older Adults with Housing & Service

Needs Wishing to Age-in-Community

• Includes Adults 50+ • experiencing homelessness, • inappropriately institutionalized, or • currently aging in place in SH who desire to age

healthily and safely in their own homes for as long as they can

• SH seen as an ideal solution to address needs of aging tenants with adaptable housing models and flexible service packages


Making the Case for Healthcare Investment in Housing

1. Patient Health• Homelessness Poor Health Outcomes + High Costs

2. Community Leadership• Anchor institutions with community responsibility• Positioned to catalyze collaboration

3. Realignment of the Traditional Hospital and Managed Care Business Models• Affordable Care Act New requirements and incentives

• Hospital Community Benefit• Value-Based Purchasing Models (VBP)

4. Cost Savings and Cost Avoidance• Study after study shows: Supportive Housing lowers or

prevents costs for frequent utilizers


Not A One-Size-Fits-All Approach

Health Systems are exploring the myriad of ways they can address social determinants like housing:1. Hospital Community Benefit2. Donating Underutilized Hospital Land3. Financial Investment/ Donation4. Leveraging LIHTC/ Federal, State & Local

Resources5. Respite


Quality Supportive ServicesA variety of housing models exist with common factors including:

Located in within safe neighborhoods with close proximity to:• Transportation• Employment opportunities • Services• shopping, recreation and socialization.

Tenants have a lease identical to those of tenants who are not in supportive housing.

Services are voluntary and consumer-driven. They focus on ensuring that tenants can obtain and thrive in stable housing, regardless of barriers they may face.

The housing and its tenants are good neighbors, contributing to meeting community needs and goals whenever possible.


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High quality supportive housing can be achieved using a variety of housing models and with projects that are as diverse as the communities in which they are located.

Core Supportive Housing Services

Housing: AffordablePermanentIndependent

Support:Flexible

VoluntaryTenant-centered

Coordinated Services

Supportive housing combines affordable housing with services that help people who face the most complex challenges to live with stability, autonomy and dignity.

Peer Support helps tenants access other services and foster a sense of community!© All rights reserved. No utilization or reproduction of this material is allowed without the written permission of CSH.

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Supportive housing is affordable housing where supportive services providers actively engage tenants in flexible, voluntary and comprehensive services and work with property and housing management to support tenant stability and ensure that the housing remains a positive community asset for the long-term. Supportive housing is an innovative and proven solution to some of communities' toughest problems Supportive housing is the scaffolding for the delivery of more effective and responsive public services.


Boston Medical Center

• Invested $6.5M in Affordable Housing to Improve Community Health and Patient Outcomes, Reduce Medical Costs

• 25% of BMC patients admitted to the hospital are homeless

• $1M for a no-interest loan and operating subsidy to support a new, Good Food Markets in a new housing development in Roxbury

• $1M for a stabilization fund that will provide grants to CBOs to help Boston families avoid eviction

• $1M million to the Pine Street Inn, the Boston Health Care for the Homeless Program

• BMC’s $6.5M investment also represents the 1st time that a MA hospital has put ALL its required community health investment into one social determinant of health -housing

“The ROI for projects like these is two-fold. There is a direct health benefit, but that in turn creates significant savings in health care spending. Most importantly, we are building healthy communities.”-Megan Sandel, MD, BMC pediatrician

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https://www.bmc.org/news/press-releases/2017/12/07/boston-medical-center-invest-65-million-affordable-housing-improve Last year, BMC invested $6.5M over 5 yrs to support a wide range of affordable housing initiatives, in an innovation lab approach that will be studied closely to determine the best ways that health care systems can improve both community and patient level health and reduce medical costs by addressing homelessness and housing insecurity Through their CHNA, they found that 25 percent of patients admitted to the hospital are homeless. Children’s HealthWatch data from BMC’s pediatric Emergency Department shows that one in three families are housing insecure, meaning they have unstable housing or are in jeopardy of eviction. $1 million for a no-interest loan and a $400,000 operating subsidy (for over 4 years) to support a new, Good Food Markets in a new housing development in Roxbury. The market’s lease will subsidize 323 units of affordable and market-rate housing in Dudley Square. $1 million for a stabilization fund that will provide grants to community-based organizations to help families avoid eviction in and around Boston. $1 million over 2 years to the Pine Street Inn, the Boston Health Care for the Homeless Program and other community partners to create a housing stabilization program for individuals with complex medical problems, including substance use disorder. •$200,000 over two years to support modest unit upgrades at Boston Housing Authority (BHA) properties to better meet tenants’ health needs $80,000 over two years to support a Community Wellness Advocate who will be based at BMC and serve as a liaison with BHA when tenants are in need of comprehensive health care. The advocate will also train BHA staff on difficult health issues, such as domestic violence and substance use disorder. $105,000 over three years to study the impact of the housing investments on BMC’s accountable care organization by reducing health care costs and improving quality of care. BMC is making a long-term commitment to housing for health, and will reinvest loan repayments, equity fund returns and tax credits from this initiative back into affordable housing.

NYS Senior Supportive Housing Pilot

• State “Medicaid Redesign Team” launched in 2011 to transform how health care is delivered and paid for under Medicaid

• Included half-billion dollar investment in supportive housing to address the social drivers of preventable utilization and disparate health outcomes

• $500,000 to 8 SH agencies for capital improvements and supportive services


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Frail, older adults residing in nursing homes, adult homes, and long-term rehabilitation who do not require such high levels of care remain institutionalized because they would otherwise fall into homelessness. The inefficient use of these high-cost public services has been a major motivator for supportive housing, which has been shown to help tenants reduce service cost while improving tenant outcomes. As part of this strategy, in 2014 the NYS Department of Health made funds available for a Senior Supportive Housing Pilot program. The Pilot Program would fund up to eight innovative projects to make capital improvements and provide supportive services for low-income, Medicaid-eligible seniors aged 65+ for two years. C Senior Supportive Housing Services Pilot Program funding for unit modifications and supportive services to seniors experiencing homelessness, living in an institutional setting, or precariously housed. This pilot initiative was designed to assist low-income seniors remain housed in their current apartments for as long as possible. Eight providers were awarded a maximum of $500,000 for a two-year contract

Chicago’s FLEXIBLE HOUSING POOL SOLUTION

• Modeled on LA County Program • 67.5% ER visits• 76.5% inpatient days• 59.5% use of mental health

crisis stabilization services

• Rapid connections to supportive housing, increase access to needed services

• New model to deliver flexible resources, applying best practices in coordination between housing and health care

• 3,000 individualssuccessfully housed in supportive housing


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Christine Building on a successful model from LA County, the Flexible Housing Pool will break the cycle of chronic homelessness and crises, reducing costs to public systems and improving health outcomes for many of Chicago’s most vulnerable residents.

Informed by pilot initiatives from UI Health, Swedish Covenant Hospital, and Cook County Health

Phase 1: House 50-80 people while gathering data and testing processes

Fundraising: $12 M to serve 750 patients in two to five years

FHP Coordination Agency:Center for Housing and Health

Participating Health

Care Entities

(CCH, AAH)

HOW IT WORKS


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Carlos

NJ Housing and Mortgage Finance Agency Investment in SH

• NJ HMFA committed in summer 2018 to provide $12 million in capital financing and guidance on SH development to hospitals through the Hospital Partnership Subsidy Pilot Program

• CSH serves as technical assistance provider on SH development, operations, and partnerships

• NJHMFA will match hospitals’ funding contributions for mixed-use developments that must include units set aside for special needs residents and/or frequent users of hospital emergency room services

“A stable living environment is critical to maintaining good health...Hospitals serve as anchors in a community, and this innovative partnership not only addresses the need for housing that is affordable but also helps some of our residents who are most in need maintain better health through permanent housing.”

- NJHMFA Executive Director Charles A. Richman


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CSH’s role Provide context and justification for healthcare investment in housing Describe the development process and how to build an effective team; Provide an explanation of the capital, operating, and service funding currently available in NJ that can be leveraged to invest into housing to improve community health

SAVE THE DATE

CSH SUMMIT 2020

PHILADELPHIA, PA

MAY 27-29, 2020

investments in housing for vulnerable seniors conf 10.18...training & education policy reform...

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