I am pleased to share with you an announcement that the LeadingAge Center for Applied Research has received a $698,000 grant from the John D. and Catherine T. MacArthur Foundation.

Over the next 3 years, we will be conducting the first national effort to assess whether affordable housing settings can serve as effective platforms for meeting the health and long-term care needs of low-income older residents while helping to reduce care costs.

We are very excited about this research project because, among other things, it reinforces 3 of the LeadingAge Leadership Imperatives. Our Board of Directors believes that these driving forces will profoundly influence the fulfillment of LeadingAge’s mission over the next decade:

  • Strengthening not-for-profit leadership.
  • Creating the new financing paradigm.
  • Leading innovation.

We also believe the data generated from this project will support LeadingAge’s advocacy agenda around affordable housing and home and community-based services. And, as always, we are looking forward to involving a sample of LeadingAge members in our work through a limited number of case studies and a survey that will gather information about services available to residents of federally subsidized housing. 

Research staff and partners

Tremendous kudos go to the staff of the LeadingAge Center for Applied Research for their efforts in winning this grant: 

  • Alisha Sanders, senior policy research associate.
  • Natasha Bryant, managing director/senior research associate
  • Adrienne Ruffin, deputy director.
  • Felita Kamara, executive administrator. 

I am also grateful to all of the LeadingAge staff members who support our proposals and dissemination efforts.

In addition, I’d like to introduce our partners in this research project: The Lewin Group, a national health and human services consulting group, and Synovate, which provides expertise on a range of market and survey research activities.

For more information

For more information about the MacArthur-supported research project, please visit Center for Applied Research. In addition, I hope you will stay tuned for updates on this exciting work! We will keep you informed through regular reports on LeadingAge.org/Research, in LeadingAge magazine, and during our conferences. 

During my February trip to Singapore, I marveled at the intentional way in which our partners in this Southeast Asian city-state are approaching the anticipated growth in their nation’s aging population. Seven percent of Singaporeans are over age 65, but that figure is expected to reach 19% by 2030.

Singapore is responding to its coming “age wave” by looking beyond its national borders to find and replicate proven ways to support a growing older population. I’m pleased to report that through our participation in the International Association of Homes and Services for the Ageing (IAHSA), the LeadingAge Center for Applied Research has been able to assist in that effort.

The partnerships we’ve forged through IAHSA have brought me to Southeast Asia 5 times in the past 3 years. 

During each trip, I’ve been able to provide technical assistance to Singaporean researchers, aging advocates and government officials, and to participate in university lectures, workshops and conferences designed to explore promising aging-in-place strategies.

On my most recent trip, I offered several workshops on applied research to students in the Master of Gerontology program at SIM University (UNISim), a well-respected institution of higher education in Singapore. 

These workshops provided students, who work primarily in government agencies, with the tools they will need to carry out ongoing research as Singapore evaluates new aging-in-place models. 

The Impact of Partnerships 

With our help, Singapore has begun to view its plentiful supply of subsidized housing as a valuable asset that can be used to help older adults remain healthy and independent for longer. To help our partners take full advantage of this asset, the Center for Applied Research has been working hard to share what we know about the housing-with-services models that could work well in Singapore’s multigenerational “housing estates.”

My recent visit convinced me that this work is beginning to have an impact: 

  • Our research partner, the TSAO Foundation, is preparing to replicate the Program of All Inclusive Care for the Elderly (PACE), a U.S. model of capitated managed care featuring medical and social service delivery to frail elders living in the community.
  • The Singapore government is preparing to test a variety of aging-in-place strategies through demonstrations that will bring services into 4 housing estates and will explore ways to improve the physical environment of those housing communities so older adults can remain mobile and engaged.

These initiatives illustrate the important supportive role that American researchers and program experts – including the Center for Applied Research – are playing in Singapore’s efforts to plan age-friendly communities. 

Because Singapore is an economic leader among Asian nations, the models it develops will eventually influence the entire region, where IASHA has many members.

The countries of the world have much to learn from one another as we all deal with an unprecedented demographic phenomenon that will affect the health of our citizens, our workforces and our economies. 

The Center for Applied Research intends to continue sharing its research and expertise with the global community so that, together, the world’s nations can develop policies and practices that improve the lives of older people and their caregivers.


The disturbing workforce statistics included in a new report from PHI (the Paraprofessional Healthcare Institute) won’t come as a surprise to providers of long-term services and supports. But the report’s data, which describe the plight of home health workers, do serve to remind us of the significant workforce issues facing every single LeadingAge member. 

These issues must be addressed; they are not going away anytime soon.  

According to Caring in America, A Comprehensive Analysis of the Nation’s Fastest-Growing Jobs: Home Health and Personal Care Aides, our home and community-based workforce faces a number of serious hardships, including: 

  • Low wages: In 34 states, average hourly wages for personal care aides were below 200% of the federal poverty level wage ($10.42) for full-time workers in 1-person households.
  • Economic insecurity: More than half of home health aides (56.2%) relied on Medicaid or food stamps in 2009. More than a third (37%) had no insurance.  
  • A hazardous profession: Home health care workers are twice as likely as general industry workers to lose workdays due to on-the-job injuries or assaults.
  • Inadequate training: Only 5 states meet the 2008 Institute of Medicine recommendation that certified nursing assistants and home health aides receive 120 hours of training.

What do the Numbers Mean for Us? 

Our nation is hurtling toward a time in the not-so-distant future when we will need many more frontline workers to provide services and supports to our rapidly growing older population. Yet, the workforce we’re depending on to care for this future aging cohort is clearly undervalued. 

These workers hold the country’s lowest paying jobs. Their training requirements are both inadequate and poorly aligned with wages. They have paltry health coverage, high injury rates and unpredictable hours. They rely heavily on public benefits.

LeadingAge and its Center for Applied Research provide a host of resources to help aging services organizations change these troubling statistics. For example, we’re currently working on a project, in partnership with Social and Scientific Systems, Inc., to analyze the 2007 National Home Health Aide Survey for the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services. 

Over the next few months, we’ll be evaluating the interrelationship among the characteristics of this workforce, their job quality and the quality of care they provide. We’ll keep you posted on this work.

In the meantime, I urge you to review the materials that we’ve developed, in collaboration with LeadingAge members, during several workforce initiatives. These initiatives include:  

  • Better Jobs Better Care, which identified and tested myriad strategies aimed at changing long-term care policy and practice in order to reduce vacancy and turnover rates, and improve workforce quality.
  • The LeadingAge Commission on Ethics in Aging Services, which made a number of recommendations to help providers develop ethical workplaces that provide fair wages, good benefits and career ladders.

These and other resources are the tools LeadingAge members need to become part of the workforce solutions that our field and our nation so desperately need. I hope you will use them to change the lives of the people who work for you, improve the quality of care they provide, and set a shining example that other organizations will follow.

Late last year, the LeadingAge Center for Applied Research held a call with the state associations in the 15 states selected for the Center for Medicare and Medicaid Services (CMS) State Demonstrations to Integrate Care for Dual Eligible Individuals project to find out whether and how affordable senior housing settings were being considered in the states’ proposals. Following the call, Aging Services of California kicked it into high gear. 

JoAnne Handy, the association’s CEO, had already been attending stakeholder meetings held by the state, and had been the only one to bring up the role of housing. Aging Services of California convened a conference call with several of their affordable housing members to explore ways to capitalize on this opportunity to play a pivotal role in health care transformation. 

They also developed a white paper to be shared with housing providers, health care providers and state health and housing officials about what affordable senior housing settings can offer to complement CMS’s three part aim of better care, better outcomes and lower costs for dual eligibles. 

Capitated managed care model

Like several of the states developing demonstrations, California will lean on a capitated managed care model to provide dual eligibles seamless access to a full continuum of medical care and social supports and services. 

The state recently released a Request for Solutions to identify applicants who can fulfill this role. As recommended by Aging Services of California, applicants are asked to describe how they would “partner with housing providers, such as senior housing, residential care facilities, assisted living facilities, and continuing care retirement communities, to arrange for housing or to provide services in the housing facilities for beneficiaries.” 

In early March, Aging Services of California will hold a roundtable with select leaders of affordable senior housing, managed care plans, and state health and housing departments to explore ways in senior housing properties can benefit health care providers and managed care organizations by facilitating interventions within their communities that promote independence and healthy outcomes.

Oregon and Vermont are driving solutions, as well. Cedar Sinai Park and LeadingAge Oregon have been working with the state to include a small pilot within their state’s demonstration proposal that would include a consortium involving health care, mental health, substance abuse treatment, home care and care management professionals working as a multi-disciplinary team to provide services in affordable housing services. 

Likewise, Cathedral Square Corporation and LeadingAge Vermont are dialoguing with the state to include the Senior’s Aging Safely at Home (SASH) program in the state’s demonstration. 

SASH is a care coordination program, anchored in affordable senior housing properties, that links health and supportive services to the home to support older adults’ ability to manage their care needs and age in place.

The Center for Applied Research is partnering as a subcontractor to the Lewin Group to provide technical assistance to states and other organizations seeking to improve the recruitment and retention of individuals who provide support services for people with disabilities. 

The National Direct Service Workforce Resource Center was created to respond to the large and growing shortage of direct service workers. The resource center offers:

  • An on-line searchable database.
  • Access to information from a team of direct service workforce policy professionals.
  • Technical assistance for selected State Medicaid Agencies awarded through an annual application process.   

The project was funded by the Center for Medicare and Medicaid Services.

It seemed particularly fitting to mark the 50th birthday of the Senate Special Committee on Aging at the end of 2011, a year in which economic and social upheaval dramatically impacted our legislative agendas and the lives of our most vulnerable citizens. The Committee has been an important voice for aging Americans during many other times of economic and social upheaval. Older adults need its strong voice now more than ever.

The Aging Committee celebrated its anniversary on Dec. 14 during a Capitol Hill forum hosted by Committee Chair Sen. Herbert Kohl (D-WI) and former Chair Sen. Chuck Grassley (R-IA). I was invited to participate in the forum and to provide my perspective on the past, present and future of long-term care and housing policy.

During my testimony, I commended the Committee for its ongoing attention to nursing home quality, its promotion of home and community-based services, its support for the paid long-term workforce, and its commitment to service integration and care coordination. I also recommended that, over the next year, the Committee explore: 

  • How new models of service delivery might evolve in response to consumer preferences, the ability of consumers to purchase care, and changes in public policy.
  • Whether and how a quality, competent paid workforce will be developed to meet changing demands for services and supports.
  • How these services and supports can be made affordable for the vast majority of older adults who will need to use them. That affordability is critical, especially in our current economic environment.

Affordable Housing and Integrated Services

Five decades ago, one third of the elderly lived in poverty. That percentage decreased precipitously with the advent of Medicare and Medicaid, but the latest recession has dramatically expanded the gap between the “haves” and the “have nots.” 

And who suffers the most? Moderate-income older adults do, because they don’t have the wherewithal to purchase services and supports, and they don’t qualify for government help unless they spend down their assets and move to a nursing home. Only then will Medicaid pay both their housing and their service bills.

This scenario doesn’t make economic sense. And it’s not what consumers want. That is why I recommended that the Senate Special Committee on Aging host a national conversation that explores innovative ways to deploy our long-term care and housing resources more effectively.

Specifically, I challenged the Aging Committee to explore a model that could deliver integrated services and supports to large groups of seniors living in affordable housing properties. Several states, including Vermont and Oregon, are already pursuing this housing-plus-services model in the belief that it will produce service-related savings that can then be used to support housing affordability.

Affordable shelter and services are essential elements of any viable community-based long-term care option. As a bipartisan, investigative body, the Senate Special Committee on Aging is uniquely positioned to begin its 6th decade with a ground-breaking exploration of innovative models that link shelter and services as a way to keep older people healthy while reducing costs and honoring consumer preferences to age in place.

The 2007 National Home Health Aide Survey is the first national probability survey of home health aides. 

LeadingAge Center for Applied Research, in partnership with Social and Scientific Systems, Inc. (SSS), will be conducting analyses using this survey to provide technical assistance and policy analysis to the Office of the Assistant Secretary for Planning and Evaluation (ASPE). 

The goals of the analyses are to describe workforce characteristics and to evaluate the interrelationships among workforce characteristics, job quality, and other worker and facility characteristics and quality of care. 

The goal of analyses underpinning the "Workforce Characteristics" report is to understand the supply of workers by demand, geographic location, policy variation, agency characteristics, and recruitment strategies.

The team will prepare reports and manuscripts with results from these analyses.

This project is funded by ASPE and the Center is a subcontractor to SSS.


The aim of a our report, Community-Based Telemonitoring for Hypertension Management: Practical Challenges and Potential Solutions, is to summarize practical considerations related to operations and logistics of a unique community-based telemonitoring pilot study targeting rural seniors who utilize community-based senior centers. The reprot reviews the technological challenges encountered during the study and proposes solutions relevant to future research and implementation of telehealth in community-based, congregate settings.

Older adults residing in rural areas often lack convenient, patient-centered, community-based approaches to facilitate receipt of routine care to manage common chronic conditions. Without adequate access to appropriate disease management resources, the risk of seniors experiencing acute events related to these common conditions increases substantially. Further, poorly managed chronic conditions are costly and place seniors at increased risk of institutionalization and permanent loss of independence.

Novel, telehealth-based approaches to management of common chronic conditions like hypertension may not only improve the health of older adults, but may also lead to substantial cost savings associated with acute care episodes and institutionalization.

Adults living in publicly assisted housing are primarily low-income single women in their mid-70s to early 80s. Findings from a range of studies indicate that significant numbers of these people experience chronic illnesses, disabilities, or both. Left unmet, this population’s needs compromise their health and quality of life, reduce their ability to continue independent living, contribute to higher Medicare and Medicaid costs, burden housing managers, and pose a safety risk to themselves and others. Over the next 20 years, a rapidly aging population will exacerbate these challenges.

The August issue of the online American Medical Directors Association publication features an article - Making Public Housing LTC Housing - by Dr. Robyn Stone on the need for publicly assisted, service-enriched senior housing and its potential for helping older adults to age in the community. This housing model responds to the preferences of most elderly residents – and their families – that these individuals age in place even as their health declines. With an existing infrastructure (public housing) and paid service coordinators (facility managers) already working in many of these buildings, the core of a housing system that is affordable for low-income seniors yet is linked to services is already in place.

Because publicly assisted housing serves critical masses of elderly residents in discreet locations, it offers an economy of scale in organizing, delivering, and purchasing services. Such housing also makes possible on-site staff who can respond to residents’ health and other needs as they arise. Incorporating communities, including the medical community, into service-enriched housing strategies may further increase their power to improve seniors’ health while lowering medical and long-term care costs. Dr. Stone's article highlights several studies that suggest positive results with these types of models and programs.


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