Our aging population is growing, and most older adults want to age safely in their own homes and communities. What if we had a network of housing designed specifically to provide the care and services to make this wish a reality for American seniors? Could we use that housing as a platform to move beyond providing costly, episodic care and focus on providing coordinated, personalized, resident-directed care that helps older adults age safely and comfortably in their own homes? Could we help seniors reach their goal of aging in place while simultaneously improving their health and saving our healthcare sector money?

The answer is yes, and the time is now. We have compelling and mounting evidence that providing coordinated health services in an affordable housing setting can improve health outcomes and reduce costs for older adults. While effective models exist, there’s no national infrastructure in place to replicate these models and bring them to scale. Through our Well-Home Network and projects like Aging Gracefully, NCHH is developing the necessary infrastructure and realize the full potential of using affordable housing as a platform for improving senior health, containing costs, and transforming lives and communities.

The Well-Home Network

In collaboration with LeadingAge and Families USA, NCHH proposes to conduct a planning effort that will lead to a long-term effort to design and implement a national “Well-Home Network” of housing-based service models (HBSMs) at affordable nonprofit housing organizations. HBSMs provide a full range of high-quality shelters, nonmedical supports, social services, and health promotion/wellness activities, in collaboration with the medical system and social service partner agencies, to ensure that low-income older adults age successfully in their communities. The network’s goals are to achieve better health and well-being and social engagement of elderly residents and their peers in the surrounding neighborhoods and to reduce Medicare and Medicaid costs.

Given the extensive and complex needs of our aging population, proven interventions like these will be essential to achieving healthcare reform’s promise to deliver better care, smarter spending, and healthier people. According to a comprehensive study completed by the Lewin Group and LeadingAge in February 2015, seniors living in HUD-assisted housing are ill more often and spend more on Medicaid and Medicare than their counterparts in non-HUD-assisted housing.

There are several well-developed models of health system reform, built on the platform of affordable housing, that are proving to reduce costs, improve health, and/or increase access to services, including models developed by these cutting-edge nonprofits:

• Vermont’s Support and Services at Home (SASH) model has reduced Medicare expenditures, increased access to primary care services, and improved health conditions by building integrated health teams into the network of affordable housing communities across the state. These high-quality residential communities provide the perfect setting for health interventions at home.
• Cedar Sinai Park in Portland, OR, has partnered with the state’s largest Medicaid payer, CareOregon, to form a limited liability corporation serving 11 of the largest low-income housing developments in the city. Their model focuses on the distinct needs of seven populations, including Hispanics, Russians, Iranians, and several Asian cultures. They are increasing services for hard-to-reach populations through resident engagement.
• Presbyterian Senior Living in Harrisburg, PA, has partnered with PinnacleHealth System to reduce emergency room usage by low-income seniors. The results have been stunning‎ – the hospital has seen significant reductions in ER use.

In all of these models, housing is an asset to the healthcare system – it’s a key partner in health reform.

Aging Gracefully

For older adults, moving into assisted living facilities places a huge financial burden on the person, his or her family, or both. By keeping older adults healthy, safe, and independent at home, families are able to save money, which can then be used for other needs.

For the Aging Gracefully project, NCHH will investigate how partners in four U.S. regions replicate the Johns Hopkins School of Nursing’s CAPABLE (Community Aging in Place-Advancing Better Living for Elders) model.[i] [ii] [iii] This model, which has shown initial promise in Baltimore, MD, is an integrated, client-directed, home-based set of interventions utilizing occupational therapist (OT), registered nurse (RN), and home improvement professional services to increase elderly residents’ control over their physical function and improve their housing conditions so that they can remain and move more safely in their own homes and move more independently within their communities. The Aging Gracefully project will demonstrate the impact of the CAPABLE model on resident health and physical function and also evaluate the national partners’ process of implementing the model using a variety of organizational structures, housing stocks, and client bases.

[i] Szanton SL, Thorpe RJ, Boyd C, Tanner EK; Leff B; Agree E; Xue Q-L; Allen JK; Seplaki CL; Weiss CO; Guralnik JM; Gitlin LN. 2011. Community aging in place, advancing better living for elders: A bio-behavioral-environmental intervention to improve function and health-related quality of life in disabled older adults. J Am Geriatr Soc 59:2314-2320.

[ii] Szanton SL, et al. 2014. CAPABLE trial: A randomized controlled trial of nurse, occupational therapist, and handyman to reduce disability among older adults: Rationale and design. Contemporary Clinical Trials, 38(2014): 102-112. doi: 10.1016/j.cct.2014.03.005.
[iii] Szanton SL, Wolff JL, Leff B, Roberts L, Thorpe RJ, Tanner EK, Boyd CM, et al. 2015. Community aging in place, advancing better living for elders: A patient-directed, team-based intervention to improve physical function and decrease nursing home utilization: The first 100 individuals to complete a Centers for Medicare and Medicaid Services Innovation Project. J Am Geriatr Soc 63(2015):371-375.

Resources

Innovative SASH Program Earns Prestigious Award from Archstone Foundation and APHA [url; NCHH, 2016] Community Based Health Systems: Using Housing as a Platform Webinar (September 21, 2016)
[url; YouTube, 2016] Healthy Housing for Older Adults Webinar (June 7, 2016) [ppt; NCHH, 2016] Healthy Housing for Older Adults Webinar (June 7, 2016) [url; GoToMeeting, 2016] Healthy Aging Begins at Home [pdf; Bipartisan Policy Center, 2016] Support and Services at Home (SASH) Model Called a ‘Success Story’ [url; Vermont Business Magazine, 2016] Vermont’s Innovative Elder Care Program, SASH, Cited as a National Model [url; Vermont Public Radio, 2016] Support and Services at Home (SASH) Evaluation: Second Annual Memo [pdf; RTI International, 2016] Healthy Housing for Older Adults [pdf; NCHH, 2016] NCHH Blog: Green Renovation and Senior Living — Three Years of Healthier, Happier Residents [url; NCHH, 2015]