LeadingAge Magazine · January/February 2016 • Volume 06 • Number 01

After the Assessment: Turning Information Into Programming in Senior Housing

January 17, 2016 | by Gene Mitchell

For housing plus services to thrive as a model for the future, providers must be able to turn resident assessment data into creative programming. Here is a look at two organizations doing just that.

Just as GE must rely on product engineers to turn market research data about customer needs and wants into the latest consumer products, senior-services leaders must turn painstakingly collected resident assessment information into services. While that can be challenging for any not-for-profit providers, it’s especially so for providers of affordable senior housing due to limited staff and resources.

As the case for housing plus services as a promising part of the future of our field grows stronger, the need to assess needs and innovate with new programming is growing.

Data gathered with a tool such as the one created by the LeadingAge Center for Applied Research in partnership with Enterprise Community Partners can help the “product engineers” operating affordable housing communities to draw up action plans—typically increased services, often provided via partnerships with outside organizations.

The Community Builders (TCB), a Massachusetts-based organization that owns or manages 120 housing communities serving people of all ages in 15 states, did its first resident assessment for seniors in 2015, says Elana Kieffer, community life operations manager, senior sites. Twenty-seven of TCB’s communities are dedicated senior housing properties, most of them HUD Section 202 buildings. The organization serves more than 11,000 households, including approximately 2,700 adults aged 62 and older.

TCB created an instrument, the Community Life Questionnaire for Seniors, based on the Resident Assessment Guide developed by the LeadingAge Center for Applied Research and Enterprise Community Partners. TCB also used elements of the Senior Risk and Resiliency Review created by Mercy Housing, and added some of its own elements.

“We knew before creating our survey,” says Kieffer, “what areas we would focus on. Our three focus areas are housing stabilization, health and wellness, and decreasing social isolation, which we call social engagement.”

The 2015 survey of senior residents lasted from spring through the end of summer. The survey had a 62% completion rate (349 out of 557 seniors). The instrument collected demographic information and asked questions about: perceptions of safety; housekeeping; participation in on-site activities; self-rating of health; chronic conditions; emergency room visits; prescription medications; physical activity; transportation; civic engagement; financial stability; and more.

Kieffer says administering the surveys one-on-one was somewhat of a burden for the TCB service coordinators, but they had good success. The survey takes about 30 minutes to complete, she says.

“The hardest part is finding the time convenient for the seniors to meet with the service coordinators,” Kieffer adds. “This year we’re going to try to have the service coordinators conduct the surveys right after the residents have their annual recertification meetings with the property manager.”

Data from the surveys is compiled using ETO (Efforts to Outcomes), a software package from Social Solutions.

Gathering data is a prerequisite for the real challenge for a housing provider: creating programming to meet identified needs and desires of residents.

TCB used the data to set goals based on its 3 priority focus areas:

  • 60% will maintain housing and financial stability in their homes
  • 80% will manage their own health with home and community-based practices
  • 70% of residents will regularly participate in on-site and community-based programs

Kieffer says she was pleasantly surprised by the survey data, “because we found residents are relatively independent and relatively healthy. What concerns me, however,” she says, “is that they have a lot of chronic conditions. Something like 45% are not managing all their chronic diseases. Another concern is around financial affordability—the fact that almost half are just living hand-to-mouth. It’s not surprising but … to my mind it’s not OK for seniors to have to live like that.”

“Now that we have our 3 goals, I’ll work with service coordinators at the 10 sites we surveyed plus an additional 6 we’re adding this year, to help us reach those goals,” says Kieffer. Annual administration of the survey instrument will allow TCB to track the effectiveness of the programming.

 

POAH Communities owns and operates 78 affordable housing communities—both family and senior—in 9 states and the District of Columbia. It folds its assessments into its strategic planning process for each community; the idea is that better services and satisfaction for residents go hand-in-hand with the organization’s operational priorities.

Trevor Samios, POAH’s director of resident services, says the new approach began about 18 months ago as a way to “look at how our staff and the communities engage with each other.”

Samios says the effort is aimed at 2 priorities: “supporting resident opportunities with our property management and maintenance operations,” and “encouraging and collaborating with residents to identify and work toward individual and family goals.”

The first priority is reached by using the usual points of contact between staff and residents—move-ins, inspections, annual recertifications and rent collection—as opportunities to engage residents about their needs and wants.

The second priority depends on those points of contact, plus annual surveys, to learn about what residents need and to get feedback on how POAH’s operations are perceived.

“We do not have service coordinators in every one of our sites,” says Samios. “In some places it’s just a property manager and a maintenance supervisor. On the property management end we want to improve collections, retention, and vacancies, which drive better financial performance. On the people side, we’re interested in ensuring stable housing, giving all residents an opportunity to realize goals by removing barriers to remaining in their homes.”

One outcome area POAH focuses on, for instance, is employment.

“Many seniors are not able to sustain paying their rent, manage their budgets or do the things they want to do within their fixed income. Folks are making hard choices about how they spend their money every day,” says Samios. “We try to set up partnerships with local employers and educational institutions, particularly organizations like area agencies on aging that offer programs for residents to participate in community service or even re-enter the workforce. We have a program by which residents in senior and family communities participate in our community improvement program and receive monthly stipends funded by us to work on projects they collaborate with management on. It’s paid as a reinvestment [from] our own operating funds. Early data shows a decrease in economic vacancies, an increase in retention and general quality of life, and a reduction in lease violations, just by getting people more engaged in their community.”

In some communities there are residents who help set up appointments for other residents when a nurse is onsite for a day, or alert residents about a health fair, and receive a stipend for their effort. Other residents help organize events or coordinate visits to local food banks.

Partnerships with local banks help encourage financial stability for low-income residents. POAH recruits banks to offer financial coaching, no-fee savings accounts and other services for residents to help stabilize and grow their finances.

“The majority of our staff and property management teams are working for a not-for-profit affordable housing organization because they’re more interested in the social or people outcomes than working for some market rate developer,” Samios says.

At The Community Builders, a 2-year “community success plan” will be created for each site, with the plan reflecting the unique circumstances of each community.

“Because we have a focus on local partners, there will be a range [of plans],” says Kieffer. “Each site is different; some are urban, some rural. We will have general guidelines; for instance, every state has an area agency on aging, so [they will] make sure they are connecting with one of those, but only Massachusetts has an ASAP, an ‘aging service access point,’ so it will be a combination.”

Kieffer notes that some sites have only 40 seniors in a building while others have almost 200. “Some sites have a lot of non-elderly disabled residents and we need to work them in as well,” she says.

She will hold monthly meetings, in person or via phone, with service coordinators to follow the progress of each site’s goals.

POAH requires each community to go through an annual strategic planning process. An outline of priorities is created for each site, to be translated into strategic objectives and achievable goals. The organization focuses on 6 outcome areas:

  • Stable housing
  • Health
  • Education
  • Employment
  • Financial stability
  • Community engagement

“We have a wealth of information on who lives in our communities—income information, asset information … major indicators of financial stability and more,” says Samios. “Combined with that is [data from] our annual questionnaire that asks how many times [residents] visited an ER, or if they have regular Internet access or whether they are interested in specific community programs and activities.”

Based on its data, each community staff develops a core goal or 2 around each outcome area. For instance, if they see a trend toward lease violations associated with bullying, then one of their goals might be trying to reinforce community codes of conduct, developing a bullying policy and engaging residents in conversations about how to combat it and tracking progress towards a reduction in housing instability for those residents.

LeadingAge Thrive provides resources to help members better serve seniors and their communities. The 7 major topic areas in Thrive include questions designed to stimulate discussion among your leadership team and board of directors. Thrive also includes resources such as white papers, articles, tools, presentations and business intelligence.

Under the “Quality” section of Thrive, see the resources connected to these questions:
  • How do we use quality measurement for continuous process improvement?
  • Does the board review and support the quality measures selected and do the measures align with our strategic plan?
  • Do we have a regular interval for reporting these measures to staff and leadership within the organization?
  • Do we utilize your data and quality reports to differentiate your services to potential referral sources?
  • Do front-line staff have a key set of “dashboard” measures that are routinely shared with them, and do they have input to areas of needed improvement?
Under the “Strategic Planning” section of Thrive, see the resources connected to these questions:
  • Do we have clearly defined goals to inform strategic and operational decision making?
  • Do we have a mechanism to measure outcomes and evaluate progress to determine if the implementation of our strategy is successful?
  • Is staff informed about our priorities for the next several years?
  • Do we engage in partnerships and collaborations with other organizations to study, develop and offer new service/care models and practices to improve the quality of aging services and care?
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“If we see a rise in hospitalizations or see that residents don’t have primary care practitioners, we work with our health partners to see that that’s resolved,” Samios adds. In many communities residents have expressed interest in learning English, especially in POAH’s Boston sites. Staff might arrange partnerships with local community colleges to provide language classes.

“It’s more challenging when you don’t have a dedicated staff person but we have staff that’s engaged, and it’s no surprise that our staff was working on these partnerships anyway,” Samios says. “When someone’s knocking on your door 10 times a day for help in filling out Social Security paperwork or with issues managing prescriptions or healthcare appointments, it behooves you to find an organization that helps you do that. If bullying or language acquisition is a continuing problem, it helps to have a partner.”

Progress is tracked using a system called Integratec, which POAH has modified to handle resident services workflow and map the financial and social performance of each of site.

POAH staff are encouraged to set manageable, achievable goals. One community in Miami, for instance, is making efforts to help residents quit smoking, and improving its collections process based on rising numbers of evictions. The latter meant bringing in volunteers from a tax assistance program to help residents get tax credits they qualify for (e.g., the Earned Income Tax Credit for those still working), or helping residents learn to better manage their money.

Samios says the new approach is working well. One of his challenges is to present this program to site teams in a way that engages them in the work to embrace a new way of planning: “It was hard to get people acclimated to using a system on a day-to-day basis but now they can see in real time the fruits of their labor and how one thing on the x axis has an impact on something on the y axis. The more they increase participation in health programming, for example, the more they get participation in other programs. The more they’re able to work with residents to get financially stable and pay their rent on time, the more they see people participate in other programs. It’s so important to us that our community teams see their impact in the communities we serve, so it’s an exciting time for us.”