Transcript Slide 1

Affordable Senior Housing
with Services
Robyn I. Stone, DrPH
Executive 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,
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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
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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
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Median age – 78 years old
Gender – 37% male, 63% female
60 % live alone
Race/Ethnicity
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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
 71% health fair to poor; 29%
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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
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
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Hispanic – 3%
White – 23%
Black – 61%
Asian – 10%
Native Hawaiian/Pacific Islander –
0%
American Indian/Alaska Native –
2%
 48% health fair to poor; 52%
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good to excellent
60% report 3+ chronic
conditions
Functional limitations
– No IADLs/ADL – 55%
– 1+ IADLs – 45%
– 1+ ADL – 27%
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29% possible depression
29% fall in the past year
40% ER visit in past year
27% hospital stay in past year
Policy Rationale
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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
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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
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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
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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
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Targeting affordable housing residents in communities with lots
of services offers chance to provide additional services at low
marginal cost
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Multi-unit housing offers potential economies of
scale/increased service delivery efficiency
Why Affordable Housing Plus Services Links
are Important to Providers
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Providers are experiencing an aging resident base
Without supports, this can lead to:
health and safety problems for disabled residents and other
community members
serious management problems (poor housekeeping,
dwellings in poor repair, etc.)
evictions and unnecessary tenant turnover
crisis/off-hour emergency calls
increased pressures on housing
managers
Why Important to Providers (cont.)
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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
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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
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They want services brought into their homes, just as older
homeowners do
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This paradigm has driven large investments
in HCBS over past decade
Seniors Aging Safely at Home (SASH)
 Connects health and long-term care systems to affordable
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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)
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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
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Proposed pilot in state’s duals demo
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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
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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
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www.leadingage.org/research
– Click on “Expanding Affordable Housing plus Services”
– Click on “Housing plus Services Publications”
Contact
– Robyn Stone – [email protected]
– Alisha Sanders – [email protected]