National Academies Report Explores Housing Plus Services

CHPS | May 23, 2017 | by Geralyn Magan

Three programs share their strategies for using housing as a platform for delivering services and supports to older adults.

The potential health benefit of housing plus services models was on the agenda late last year when the National Academies of Sciences, Engineering and Medicine convened a public workshop to examine housing as a social determinant of health. A report on the workshop was released in May.

“Accessible Community-Based Housing for Vulnerable Adults” was co-hosted by the Roundtable on the Promotion of Health Equity and the Elimination of Health Disparities, and the Forum on Aging, Disability, and Independence. LeadingAge President and CEO Katie Sloan is a member of the Forum.

In addition to exploring models for connecting affordable housing and services, the National Academies workshop also shed light on:

  • The importance of affordable and accessible housing for older adults and adults with disabilities, and the barriers to providing this housing.
  • The design principles for making housing accessible for vulnerable populations.
  • Policy implications and research needs associated with supportive housing initiatives. Robyn Stone, senior vice president for research at LeadingAge, served on this panel.

Representatives from 3 supportive housing programs shared their strategies for using housing as a platform for delivering services and supports to older adults.

CAPABLE

Sarah Szanton from the Johns Hopkins School of Nursing described Community Aging in Place—Advancing Better Living for Elders (CAPABLE). The Baltimore-based program combines occupational therapy sessions, nurse visits, and home modifications to improve the ability of older adults to engage in activities of daily living (ADL) and instrumental activities of daily living (IADL).

Over the course of 4 months, CAPABLE participants receive 6 visits from an occupational therapist, 4 visits from a nurse, and up to $1,300 in repairs and modifications by a licensed repair person. Studies of program outcomes have shown that participants experienced reductions in depression and in ADL and IADL limitations. CAPABLE participants also required fewer stays in nursing homes and fewer hospitalizations, according to the workshop report.

CAREOREGON

Rose Englert from the nonprofit CareOregon health plan explained her organization’s participation in a Portland-based consortium of housing and service providers that delivers onsite services in 11 subsidized senior housing communities. CareOregon care teams work onsite at the participating housing communities to:

  • Help residents navigate health care services, regardless of their insurance provider;
  • Conduct one-on-one wellness checks with members within a week after they return from the emergency room or an inpatient hospital stay; and
  • Provide enrollment assistance for individuals who need help finding care.

SUPPORT AND SERVICES AT HOME (SASH)

Molly Dugan, statewide director of Vermont’s Support and Services at Home (SASH), described how her program coordinates the resources of social service agencies, community health providers, and nonprofit housing organizations to help 5,000 Vermonters in 140 housing communities live independently at home.

SASH participants work with a service coordinator and wellness nurse team to set broad health-related goals, and partner with community providers to help follow through on those goals. An ongoing evaluation of the program by LeadingAge and RTI International shows that SASH slows the growth of annual total Medicare expenditures for program participants in the early adopting panels of residents.

NEED FOR MORE RESEARCH

Several small studies have shown that supportive housing can improve health status while reducing risky behaviors and the risk of death for high-need, high-cost populations. But more research is needed to link better health outcomes with supportive housing, according to Peggy Bailey, director of the Health Integration Project Center on Budget and Policy Priorities.

Such research could “induce health systems to advocate for and invest in affordable housing as a means of meeting their mission and improving the measures by which they are judged,” according to the workshop report.

That theme was echoed by Robyn Stone, who suggested that data from the LeadingAge/RTI evaluation of the SASH program “is the kind of evidence that health plans want to see” before investing in programs that integrate housing and health care. Despite some promising studies, however, there is still not enough hard evidence to persuade the government to invest in these service-enriched housing programs.

“I think the potential is there, but the evidence base needs to be built,” said Stone.