CFAR Will Help Implement HUD’s Housing Plus Services Demonstration

CFAR | February 23, 2017 | by Geralyn Magan

The Lewin Group, LeadingAge Center for Applied Research (CFAR), and National Center for Healthy Housing have been selected by the U.S. Department of Housing and Urban Development (HUD) to serve as the Implementation Team for a major new randomized control trial testing a service-enriched housing model for low-income older adults.

The Lewin Group, LeadingAge Center for Applied Research (CFAR), and National Center for Healthy Housing have been selected by the U.S. Department of Housing and Urban Development (HUD) to serve as the Implementation Team for a major new randomized control trial testing a service-enriched housing model for low-income older adults.

Forty HUD-assisted senior housing properties have been selected to participate as intervention sites in the 3-year Supportive Services Demonstration for Elderly Households in HUD-Assisted Multifamily Housing.

“This project provides a tremendous opportunity to learn more about how to best implement housing plus services strategies, and to build the evidence base for interventions that allow low-income seniors to remain healthy and independent in their homes and communities while saving health care dollars” says Alisha Sanders, director of housing & services policy research at LeadingAge.

Designing the Demonstration

The Implementation Team is working with HUD to finalize the design of the demonstration. That design was partially informed by earlier research that CFAR and The Lewin Group completed in March 2014 for HUD and the Department of Health and Human Services (HHS). In addition to other tasks, the HUD/HHS-supported research identified potential demonstration design options based on case studies and evaluations of housing plus services models, including the Support and Services at Home program.

The new demonstration program will provide $15 million in funding to help the 40 intervention sites employ a full-time enhanced service coordinator and a part-time wellness nurse. Those property-based staff members will engage proactively with residents by:

  • Conducting comprehensive, individual assessments of all residents who choose to participate in the program. The enhanced service coordinator/wellness nurse team will then work with each participating resident to develop care plans that address his or her goals and needs. The team will also support residents as they work to implement their individual plans.
  • Assessing and addressing property-wide needs. The enhanced service coordinator and wellness nurse will use aggregated data from the individual assessments to identify and deliver appropriate evidence-based programming at the housing property.
  • Providing care coordination to individual residents as health issues emerge. For example, the housing-based team will follow up with a resident after an Emergency Room or hospital visit to help ensure that he or she has a safe transition home, says Sanders.

Training and Technical Assistance

The Implementation Team will provide training and technical assistance to grantees to ensure that the demonstration program is implemented in a standardized fashion across the 40 intervention sites, and that the staff has the skills and capacity to effectively carry out the demonstration components.

“Because this is a randomized controlled trial, the 40 sites will be given a pretty specific framework for what they need to do and how they need to do it, although there will be a certain level of flexibility to respond to the specific needs and circumstances of the residents and the community," says Sanders.

Training topics might focus on skill-building areas, such as how to conduct motivational interviewing or work as a team, or on knowledge-building topics such as cognitive impairment and falls prevention. In addition to group programming, targeted training and technical assistance will be offered to individual grantees as needed.

The demonstration’s success will be evaluated by an outside entity that will compare the experiences and outcomes of residents in the intervention sites with residents in 40 housing properties in a control group. Properties in the control group will carry out “business as usual” during the grant period, says Sanders.

Hopes for the Demonstration

If successful, the demonstration could spur a greater investment in housing plus services models by showing that the enhanced service coordinator/wellness nurse team can help residents of affordable senior housing age in place and reduce their use of unnecessary health care services.

In addition, says Sanders, the demonstration should provide a good framework, and a number of valuable tools, that affordable senior housing properties could use to bring services to their residents. The demonstration could also bolster the role of the service coordinator in affordable senior housing properties.

“This presents an opportunity to highlight and elevate the service coordinator as an aging services professional,” says Sanders.