When Can I Stop Chasing My Own Tail?

Alisha's Blog | June 28, 2018

Moving the housing plus services agenda forward isn't always easy. But Alisha Sanders finds reason for hope in real-life stories and a new recommendation from the Bipartisan Policy Center. 

Sometimes I feel like I’m chasing my own tail.

We need to find a funding mechanism to support services in affordable housing … so we can show housing is a valuable platform to help manage health care and other service needs and control expenditures … so we can get a greater investment in affordable housing … but we need a way to fund the services.

Just when I think I’ll never catch my own tail, I hear a story like this one:

A resident of an affordable housing community was released from a hospital and got home late in the afternoon with 4 new prescriptions. The pharmacy only filled 3 of those prescriptions, and mixed up the prescriptions it did fill.

The resident didn’t realize that anything was amiss. But, fortunately, a wellness nurse at the housing community noticed the mistakes and began working with the pharmacy to correct them. The pharmacy said it would be 3 days before it could fill one prescription for schizophrenia. But by 9 p.m. that evening, the wellness nurse had everything sorted out, including getting the important psychiatric medicine to the resident.

Potential crisis averted. One more reason to keep working to bring housing and services together.

Singing the Same Tune

Whenever I’m tempted to become discouraged about our slow progress in moving the housing plus services agenda forward, I think about stories like this. And I also remind myself that I’m not doing this work alone. Others, like the Bipartisan Policy Center (BPC) are on the same mission.

BPC recently released a set of recommendations to help the U.S. departments of Housing and Urban Development (HUD) and Health and Human Services (HHS) build on their ongoing collaboration to bring housing and services together.

The LeadingAge LTSS Center @UMass Boston worked with The Lewin Group and RTI International on 2 of these HUD/HHS collaborations. These projects included:

  • An effort to link HUD data with data from the Centers for Medicare and Medicaid Services (CMS) to better understand the health characteristics, and health care use and expenditures, of HUD-assisted older adults. We found that more than half (55%) of HUD-assisted older adults who were dually eligible for Medicare and Medicaid had 5 or more chronic conditions, compared to 43% of dual-eligible older adults not receiving HUD assistance.
  • A multiyear evaluation of the Supports and Services at Home (SASH) program in Vermont, which brings supportive services to residents of affordable senior housing communities across the state, and to older adults living in the neighborhoods surrounding those housing communities. We found that SASH helps to slow the growth of annual total Medicare expenditures for certain program participants.

These 2 research initiatives helped inform the development of HUD’s current Integrated Wellness in Supportive Housing (IWISH) demonstration program. The LTSS Center, along with The Lewin Group and the National WellHome Network, are providing support to the 40 senior housing communities around the country that are implementing supportive services interventions through the study.

Recommendations for the Future

The BPC report, entitled HUD-HHS Partnerships: A Prescription for Better Health, gives HUD and HHS much credit for the work they’ve done together so far, but it also highlights opportunities to do more.

For example, the report contains several recommendations around HUD and HHS collaborations that would benefit aging in place, including calls for:

  • HUD and HHS to better coordinate programs that provide support and resources for home assessments and modifications;
  • CMS, in partnership with state Medicaid agencies, to examine the extent to which older beneficiaries dually eligible for Medicare and Medicaid and at risk for institutionalization are using specific housing-related services, and the impact of these services on beneficiary outcomes.

These recommendations are valuable. But I’m partial to one recommendation in particular, which could help lead to sustainable and scalable partnerships and funding support for affordable senior housing plus services programs.

The recommendation calls on CMS to develop a demonstration project with health care entities that are willing to be accountable for quality health outcomes and total costs of care for Medicare beneficiaries living in publicly-assisted housing. The demonstration would include development of a payment model to help support those housing-health partnerships.

This recommendation speaks directly to the concerns I raised in my last blog about the lack of sustainable and scalable funding mechanisms to support housing-based services models. It would also address the related challenge of enticing health entities to collaborate with housing communities.

Despite the growing evidence-base and the logic of how housing can help health care address many of its goals, we are seeing limited partnership between affordable senior housing and health care entities. That’s why I’m partial to BPC’s recommendation for a CMS demonstration in this area.

With the structure that demonstration could help build, I might actually be able to leave tail chasing to my cat