Transcript Aging Gracefully: An Anticipated Future in Housing First

Aging Gracefully:
An Anticipated Future in Housing First
Presented
by
Patrick J. O’Dwyer
&
Erica Alexander M.A.
Services Offered in Our Permanent Supportive
Housing Model
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Mental Health Services
Chemical Dependency
Supported Employment Services
Payee Services
24/7 on site support
Some meal provision/ shopping
Emergency call systems in apts.
Meaningful Activities
On site RN (some sites)
Long Term Services and Supports (LTSS)
 Home and Community Based Services
 Assisted Living Facilities
 Home Health Agencies
 Skilled Nursing Facilities
 Hospices
What’s So Great About HCBS?
 Vital services are brought to residents who need them, allowing
them to age in place.
 Has the potential to substantially raise residents quality of life
 Way, way cheaper to provide than institutional care (national
average for institutional LTSS care $42,800 annually per person)
Home and Community Based Services
Non-Medical
 Housekeeping
 Bathing/Hygiene
 Dressing
 Laundry
 Cooking
 Shopping
 Some Transportation
 Meaningful Activities
Medical
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Physical Therapy
Occupational Therapy
Medication Management
Outreach Nursing
...Not So Great?
Practical Issues
Relational Issues
 Not designed to serve
our population
 Assessment Issues
 Keeping scheduled
appointments
 Not 24/7 service
 Accountability/Turnover
 Resource allocation
 Interpersonal Challenges
(alliance necessary)
 HR/HF/TIC values lacking
 Flexibility
 Substance use
 Escalated behaviors
All this to say?
 Don’t assume that just because a service connection has been
made between HCBS and a resident that it will be effective or
long lasting.
 In the name of resident dignity and for the sake of their
quality of life, be prepared to flex and assist residents while
solutions are sought.
 Our folks deserve better
Current/ Projected Age Demographics
Nationally
Number of people utilizing LTSS expected to nearly double in
the next 35 years from 15 million currently to 27 million
Overall U.S. population 65+ projected to “boom” from 40.2
million to 88.5 million during the same period
Organizationally
 DESC housed 1006 residents in 2013
DESC’s resident populations average age is 51 years old
57% of residents housed by DESC in 2013 were 50+ yrs. old
What’s the Point?
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As the general population ages and the demand for HCBS
increases it will be even more difficult to connect the
population that we house with these critical services.
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Organizations should anticipate these difficulties and
cultivate partnerships with service providers who can
effectively bring these services to our population in their
homes or, depending on your own demographics, consider
forming a HCBS program to meet the needs yourself.
On the Ground at DESC’s Canaday House
My Immediate Concern…
 Average age of 82 Canaday House residents is 56 years old
 66% are 50 or older (55/82)
 27% are 60 years or older (21/82)
 22% are enrolled in chore services that they pay for (19/82)
 Only 4% are enrolled in HCBS (3/82)
Supportive Housing Model
The model is designed to assist individuals in achieving their
highest level of self-determination using a housing first harmreduction based practice. The design of the facility, staffing
patterns, program values and ways of interacting with residents
all combine to create a program that helps people succeed over
the long term.
Service delivery roles:
•Project Manger
•Residential Counselors
•Clinical Support Specialists
•Case Managers/CD Counselors
•On site nursing care/coordination
How Can We Assist You?
 Jane was a 59 year old African-American woman who was
living in supportive housing when she was diagnosed with
terminal cancer. Jane also suffered from gout, hepatitis C,
vascular ulcers in her legs and memory loss. In addition to the
medical conditions Jane also struggled with major depression,
severe crack cocaine addiction with occasional alcohol use and
she regularly smoked tobacco.
 Jane wished to stay in her home and refused to consider an
Adult Family Home due to income restrictions, not knowing
the staff and being away from family and losing her sense of
independence.
Issues and Interventions
Challenges
 Residents right and
choice to be ill in their
own home when they
are beyond our scope of
care
 Staff lack medical
training/knowledge
 Facilities are not
equipped to work with
substance addictions
and behavioral issues
related to mental health
 Rapport and sense of
community
Interventions
 Housing staff
 Home and Community
Services (COPES)
 Primary care and
Hospice
 Neighbor Care
partnership
 Case Management
 Family
 Skill Building
 Flexible nursing facility
What we have learned…
 Our population is aging and there are not enough resources to
meet the needs of the residents we serve
 Higher level of care facilities are not equipped to treat/care for
individuals with severe mental health and/or addiction issues
and the associated behavioral issues that may accompany
major disorders
 Services need to be brought to the individual so they can
remain in their homes
Please feel free to contact us via email
Patrick can be reached at [email protected]
Erica can be reached at [email protected]