Summit on Aging in Public Housing 
Author: Alisha Sanders and Robyn Stone
Publication Date: May 2011
This report summarizes the proceedings from a summit on support seniors to age in place in public housing properties. 

WellElder Program Evaluation - Full Report 
Author: Alisha Sanders and Robyn Stone
Publication Date:  April 2011
This report provides full details on the evaluation of the WellElder program, a program linking low-income residents of subsidized senior housing communities with the health and supportive services they need to remain healthy and independent for as long as possible. 

WellElder Program Evaluation - Project Brief 
Author: Alisha Sanders and Robyn Stone
Publication Date:  April 2011
This brief highlights the key findings of the evaluation of the WellElder program, a program linking low-income residents of subsidized senior housing communities with the health and supportive services they need to remain healthy and independent for as long as possible. 

National Summit on Affordable Senior Housing and Services Report
Author: Alisha Sanders, Robyn Stone and mary Harahan
Publication Date: 2010
The report summarizes the proceedings from the summit on affordable senior housing and services.

Affordable Senior Housing: The Case for Developing Effective Linkages with Health Related and Supportive Services
Author: Alisha Sanders, Mary Harahan, Robyn Stone
Publication Date: 2010
This brief outlines the rational for linking affordable senior housing settings with services to help meet the needs of lower-income seniors.

Implications and Practice and Policy Issues of Affordable Senior Housing with Services Options
Author: Alisha Sanders, Mary Harahan, Robyn Stone
Publication Date: 2010
This brief discusses the potential implications of expanding affordable senior housing with services options and the practice and policy issues that may have to be addressed to do so.

Research on Affordable Senior Housing with Services Strategies
Author: Alisha Sanders, Mary Harahan, Robyn Stone
Publication Date: 2010
This brief outlines the current research of the effectiveness of affordable senior housing with services strategies.

Affordable Senior Housing with Services Programs and Models
Author: Alisha Sanders, Mary Harahan, Robyn Stone
Publication Date: 2010
This brief illustrates some of the potentially promising strategies and models of affordable senior housing with services that have been implemented.

Aging in Place Partnerships: A Training Program for Family Caregivers of Affordable Senior Housing Residents - Project Brief 
Author: Alisha Sanders, Robyn Stone, Rhoda Meador and Victoria Parker
Publication Date: 2010
This brief describes a project to examine the role of family caregivers in affordable senior housing projects and develop a training program to enhance caregivers' skills and capacity. 

 Affordable Senior Housing and Health-Related Services 
Author: Alisha Sanders and Mary Harahan
Publication Date: 2009
This guide provides examples of strategies and programs to bring health and wellness services to affordable senior housing properties.

Doctor at Your Door: The Senior Housing Community's Guide to Medical House Call Programs 
Author: Alisha Sanders and Mary Harahan
Publication Date: 2008
This guide illustrates how senior housing communities and medical house call programs can partner to benefit frail and chronically ill residents, the housing property and the house calls practice.

Connecting Affordable Senior Housing and Services: A Descriptive Study of Three Colorado Models 
Author: Michelle Washko, Alisha Sanders, Mary Harahan, Robyn Stone and Enid Cox 
Publication Date: 2007
This report describes and compares how three affordable senior housing communities in Colorado helped residents maintain independent living in the face of growing frailty and/or disability. 

Inventory of Affordable Senior Housing with Services Strategies 
Author: Alisha Sanders, Mary Harahan and Robyn Stone
Publication Date: 2006
This document provides examples of a range of strategies and programs employed around the country to bring health and supportive services to residents of affordable senior housing properties.

Findings from the Regional Workshops on Affordable Housing Plus Services Strategies for Low- and Modest-Income Seniors 
Author: Alisha Sanders, Mary Harahan and Robyn Stone
Publication Date: 2006
This report details the discussions of four regional workshops that brought together a range of stakeholders to debate the promises and challenges of linking affordable senior housing settings with health and supportive services to meet the needs of low-income residents.

Creating New Long-Term Care Choices: A Synthesis of Findings from a Study of Affordable Housing Plus Services Linkages 
Author: Alisha Sanders, Mary Harahan and Robyn Stone
Publication Date: 2006
This document synthesizes the rational for creating affordable senior housing with services strategies, examples of strategies and programs being implemented around the country and the findings from a series of regional workshops that debated the promise and challenges of linking affordable senior housing settings with health and supportive services to meet the needs of low-income residents.

Now that Wisconsin’s dramatic June 5 recall election is over, it’s time for Gov. Scott Walker (R) and Wisconsin legislators to get back to the business of running their state. 


I certainly hope the future of long-term services and supports is on the agenda.


I recently had the opportunity to brief Wisconsin lawmakers about some of the issues I believe they should be addressing as they prepare for a 28% increase in their state’s over-85 population. 


But my remarks, offered during a meeting sponsored by the Evidence-Based Health Policy Project, really apply to all states, their legislatures and their regulatory bodies.


Shifting to HCBS


It’s no secret that many states are focusing quite intently on shifting the provision of long-term services and supports away from institutions like nursing homes and toward home and community-based settings. 


This approach makes sense for a variety of reasons. However, our collective enthusiasm for home and community-based services (HCBS) should not cause us to overlook the important role that nursing homes continue to play in communities nationwide.


Nursing homes face both short-term and long-term challenges during this time of shrinking financial resources and increasing concerns about a burgeoning older population. 


Taking deliberate steps to strengthen these organizations – and connect them more closely with other providers of long-term services and supports – is particularly important now. 


We need a variety of providers, working together, to help us ensure that older adults receive the right services, at the right time, in the right place and for the right reasons.


Short Term Challenge: Serving 2 Populations


Economic realities and the advent of health reform have spurred many nursing homes to offer post-acute care as a short-stay option on their menu of services. 


These organizations are also continuing to serve traditional nursing home residents, who typically stay for longer periods of time and are likely to have greater care needs and higher rates of dementia than ever before.


How will nursing homes meet the challenges associated with caring for both of these populations, which have very different care needs and who require a very different workforce? 


Legislators can help, in part by allocating additional funds and supporting regulatory changes that foster the recruitment and training of qualified workers who can provide complex care at both ends of the continuum. 


Long-Term Challenge: Renovation or Reinvention?


Will nursing homes have the infrastructure they need to support future demands for their services? If Wisconsin is any indication, the answer is no. 


The average Wisconsin nursing home is 31 years old – too old to incorporate modern design elements that are cost-efficient and person-centered. 


These aging nursing homes have 2 choices as they prepare for the future:


  1. They can update their infrastructures so they can do their current work more efficiently. 

     
  2. Or, they can transform themselves completely by moving away from traditional bricks-and-mortar delivery models to serve older adults in community settings and in collaboration with other providers. 

Legislators can help nursing homes choose the second option by introducing much-needed flexibility into the nursing home setting. For example, revised scope-of-practice regulations could enhance the delivery of person-centered care. 


Similar flexibility could help foster the development of models like Greenhouses, where older adults receive nursing care in an atmosphere similar to a small group home. A more flexible view of the continuum of care could erase the artificial demarcations that exist between institutional and community-based care. 


That way, providers and policy makers alike could focus their attention on the consumer, not on the care setting.


A Valuable Asset


Now is not the time to think about thinning the ranks of nursing homes in Wisconsin or in any other state. Instead, our challenging times call for innovative approaches that will help these facilities do their best work in the present and position themselves to help their states meet future challenges associated with an aging population.

LeadingAge members have long viewed themselves as active and important participants in the “Aging Network,” that complex, multi-level system that serves and represents the needs of America’s older adults. 

This designation has made sense for many decades. But now it’s time to also begin thinking of ourselves as integral partners in the nation’s public health system – and to help public health officials see themselves as our partners in serving older adults.

A new book called Public Health for an Aging Society tries to do just that. The book is designed to help future public health professionals incorporate the concerns of aging Americans into a field that has traditionally been focused on issues relating to children and youth, reproductive health and infectious disease. 

I co-authored a chapter in the book that educates readers about “Financing and Organizing Health and Long-Term Care Services for Older Populations.”

Aging and public health

My background in public health has convinced me that we can’t help our older population achieve significant and sustainable health gains unless we take a more holistic view of the challenges seniors face and the myriad strategies that can help address those challenges. 

The anticipated growth in the older population makes that holistic approach even more critical.

The coming age wave will obviously affect the elderly among us. But it will also affect every other population group living in our local communities. On the positive side, younger people could benefit from the “silver tsunami,” perhaps by participating in a potentially vibrant business sector that caters to the needs of older adults. 

But if we’re not careful, the burgeoning older population could unwittingly spur intergenerational competition for limited community resources.

A new way of thinking

We can avoid the latter outcome by exploring public health strategies that encourage us to think about the medical needs of the entire population, and to explore how the physical, environmental and social aspects of our communities can dramatically impact the health and wellbeing of all. 

Those LeadingAge members who take this broad, public-health view are more likely to find innovative and effective ways to:

  • Work with community partners to integrate, coordinate and finance services and supports for people with frailty and disability, no matter what their age. 
  • Take additional steps to safeguard the health of younger populations, including our employees, so we can become part of community-wide public health solutions.
  • Educate public health officials about aging, and explore how we can work together to meet public health goals. 
  • Distribute community resources equitably, sensibly and in relation to population needs. 
  • Invest in programs and services that enhance quality of life, prevent disease and foster aging in place.
  • Target limited resources effectively and use them efficiently so all receive the support they need.

LeadingAge members must continue working hard to improve the health of the older populations we serve. 

But by viewing our work through the public health lens, we have a good chance of creating a national health and wellness infrastructure that serves not only older adults, but the entire population. In my view, that’s a worthwhile goal to pursue.

I am pleased to share with you an announcement that the LeadingAge Center for Applied Research has received a $698,000 grant from the John D. and Catherine T. MacArthur Foundation.

Over the next 3 years, we will be conducting the first national effort to assess whether affordable housing settings can serve as effective platforms for meeting the health and long-term care needs of low-income older residents while helping to reduce care costs.

We are very excited about this research project because, among other things, it reinforces 3 of the LeadingAge Leadership Imperatives. Our Board of Directors believes that these driving forces will profoundly influence the fulfillment of LeadingAge’s mission over the next decade:

  • Strengthening not-for-profit leadership.
  • Creating the new financing paradigm.
  • Leading innovation.

We also believe the data generated from this project will support LeadingAge’s advocacy agenda around affordable housing and home and community-based services. And, as always, we are looking forward to involving a sample of LeadingAge members in our work through a limited number of case studies and a survey that will gather information about services available to residents of federally subsidized housing. 

Research staff and partners

Tremendous kudos go to the staff of the LeadingAge Center for Applied Research for their efforts in winning this grant: 

  • Alisha Sanders, senior policy research associate.
  • Natasha Bryant, managing director/senior research associate
  • Adrienne Ruffin, deputy director.
  • Felita Kamara, executive administrator. 

I am also grateful to all of the LeadingAge staff members who support our proposals and dissemination efforts.

In addition, I’d like to introduce our partners in this research project: The Lewin Group, a national health and human services consulting group, and Synovate, which provides expertise on a range of market and survey research activities.

For more information

For more information about the MacArthur-supported research project, please visit Center for Applied Research. In addition, I hope you will stay tuned for updates on this exciting work! We will keep you informed through regular reports on LeadingAge.org/Research, in LeadingAge magazine, and during our conferences. 
 

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