LTSS Center Will Study Financing Options for Housing Plus Services

CHPS | May 23, 2017 | by Geralyn Magan

The LeadingAge LTSS Center @UMass Boston (formerly CFAR) will spend the next year exploring potential financing mechanisms for programs that integrate housing and health care.

The LeadingAge LTSS Center @UMass Boston (formerly CFAR) will begin work in July on a 1-year project to explore financing mechanisms that can support the development and implementation of housing plus services models. The work, which is supported by a grant from the Gordon and Betty Moore Foundation, will be managed by the LTSS Center’s Washington, DC office at LeadingAge.

For more than a decade, LeadingAge has been studying the role that publicly subsidized congregate housing with services could play in meeting the growing need for health and long-term services and supports (LTSS) among low-income elders. Digging further into the financing piece of the puzzle is the next logical step in those research efforts, says Alisha Sanders, director of housing & services policy research at LeadingAge.

“Many providers of low-income senior housing would like to adopt housing plus services models, but until we can find a mechanism to support the service enhancement component of these models financially, we’re never going to be able to replicate and sustain them,” says Sanders. “This grant is all about identifying those possibilities, particularly through the Medicare program, which covers the health care of most older adults in the U.S.”


Various studies, including several by LeadingAge, are beginning to demonstrate the benefits that integrating housing and health care can offer elderly housing residents, as well as housing communities and health care providers and payers. Yet, financing challenges remain.

Primarily, those challenges are associated with the fact that residents of an independent housing community are often patients or members of a variety of physician practices, hospital/health systems, Medicare Advantage/Special Needs Plans, or other managed care plans. As a result, health care entities may decide that a particular housing community does not house a large enough volume of its patients to justify an investment in a housing plus services program.


During the 1-year grant period, the LTSS Center will explore mechanisms that could be used to finance programs that integrate housing and health care. The team will:

  • Identify a range of financing options,
  • Ascertain the pros and cons of each approach, and
  • Determine the policy and practice challenges and barriers to implementation and sustainability.

“We’re planning to examine whether there is a way to tweak existing funding mechanisms like Medicare so they apply to housing with services strategies,” says Sanders. “It is easier to build on something that already exists than to create a whole new funding source.”

Findings from the LTSS Center’s exploration will be shared with a stakeholder group of policy makers, financing specialists, and representatives from housing communities and health care plans/systems. The stakeholder group will then assess the potential for implementing alternative financing strategies, and make recommendations for next steps in developing financing options that could be tested at the state or local level.


Sanders is hopeful that the financing exploration will jumpstart efforts to find sustainable funding for a model that is gaining the attention of federal policy makers and health care entities.

“Over the past few years, with the advent of health care reform, we have seen the potential for health care entities to be interested in supporting housing with services models,” says Sanders. “But, up until now, that support has come through a statewide Medicare demonstration in Vermont, and through one-on-one mechanisms in other communities, such as when a housing organization convinces its local hospital to build a housing with services program into its community benefit program. We are catalyzing a more detailed discussion about system-wide financing solutions that could be applied in various ways across the country.”