Why Housing Plus Services is a “Bright Spot” in Efforts to Support Dual Eligibles

CHPS | January 05, 2016

A recent article in describes the results of research from the LeadingAge Center for Housing Plus Services as one of the few “bright spot” in the federal government’s efforts to improve care and curb health care spending for Americans who are dually eligible for both Medicare and Medicaid.

A recent article in The Wall Street Journal describes the results of research from the LeadingAge Center for Housing Plus Services as one of the few “bright spots” in the federal government’s efforts to improve care and curb health care spending for Americans who are dually eligible for both Medicare and Medicaid.

The article, published in late December, paints a gloomy picture of the federal-state “duals demonstration” program, which was authorized by the Affordable Care Act to coordinate care for the so-called “dual eligible” population. The demonstration program is “off to a rocky start,” reports the Journal, due to lower than expected enrollment rates.
 

Housing Plus Services: The Bright Spot in a Gloomy Report Card


The Journal lists 3 notable exceptions to its gloomy report card, including high satisfaction levels with the duals demonstration among California beneficiaries.

Housing plus services models loomed large in the 2 other “bright spots” cited by the Journal. While neither of these initiatives is part of the duals demonstration, both serve dual eligible individuals.
 

  • Value of Service Coordinators: The Journal cited a recent study by LeadingAge and the Lewin Group, which found that basing service coordinators at affordable senior housing properties reduced by 18% the odds of having a hospital admission among residents.

    Researchers analyzed health care utilization and spending among 8,706 older adults in 507 properties located in 12 communities around the country. More than half (56%) of the residents were eligible for both Medicaid and Medicare. The study, funded by the John D. and Catherine T. MacArthur Foundation, was released in November at the Gerontological Society of America’s annual scientific meeting.
  • SASH:The Wall Street Journal also cites research by LeadingAge and RTI International on the Support and Services at Home Program (SASH) program in Vermont.

    The program uses a housing-based team of wellness nurses and service coordinators to help older affordable housing residents address and coordinate their health and social service needs. During the first year of a 3-year evaluation of the program, researchers found that SASH lowered the growth of annual total Medicare expenditures for early program participants.

 

High Stakes

 


States and the federal government spend roughly $300 billion a year treating about 10.7 million dual eligibles, according to The Wall Street Journal. These beneficiaries are some of the most expensive individuals using government insurance and are more likely than those on either Medicare or Medicaid to have mental health challenges or chronic conditions, says the newspaper.

“Clearly, the stakes are high,” says Robyn Stone, executive director of the LeadingAge Center for Applied Research (CFAR). “We desperately need to find a sustainable model that brings a coordinated set of services and supports to dual eligibles so they can continue living independently in the least restrictive environment, while avoiding higher and more expensive levels of care.”

CFAR has been studying the housing plus services model for almost a decade. In early 2013, CFAR and LeadingAge established the Center for Housing Plus Services to expand efforts to create an evidence base for housing plus services programs and work with stakeholders in the policy, housing, and health worlds to hone the model and promote its adoption.

“It is very gratifying to be able to document the positive health outcomes associated with housing plus services models in general and service coordinators in particular,” says Alisha Sanders, managing director of the Center for Housing Plus Services. “Our research clearly shows that federal and state agencies, as well as health care providers, should consider partnering with affordable senior housing properties to coordinate services for vulnerable older adults.”