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Housing with Services
Session Objectives
• Learn about the national need for services in Affordable housing
• Learn about innovative approaches to services• Explore potential service delivery options in a
housing environment.• Learn about the role of the Service
Coordinator in the delivery of those services
A Change in the National Mindset
• By 2050, 88 million people will be over the age of 65 in the US – 1/5th of the total population, 19 million 85+ -Atlantic Monthly.
• Medicaid will not be able to house the growing number of low-income frail older adults in nursing homes and assisted living center.
• Most people will want to remain at home whenever possible.
• Economics and a focus on self-directed care are changing the drive from institutionalization to home.
Lewin Group Study
• Medicare and Medicaid Use in Affordable Housing• HUD-assisted residents had more chronic conditions
• 55% of HUD-assisted MME’s (dual eligible) residents 5 or more compared to 43% of unassisted MME’s.
• Medicare payments and utilization: HUD-assisted MME beneficiaries' average Medicare FFS per
member per month (PMPM) payment was 16% higher than unassisted MMEs in the community ($1,222 compared to $1,054).
Higher utilization by HUD-assisted MMEs for home health visits (31% higher), ambulatory surgery center visits (45% higher), physician office visits (26%), and emergency department visits (13%) drove the higher payments.
• Medicaid payments and utilization• HUD-assisted MMEs Medicaid FFS PMPM payment was 32% higher
than unassisted MMEs ($1,180 vs. $895).
• HUD-assisted MMEs used over 100% more Personal Care services, 80% more "other HCBS", and over 67% more durable medical equipment services
• Medicaid payments and utilization• HUD-assisted MMEs Medicaid FFS PMPM payment was
32% higher than unassisted MMEs ($1,180 vs. $895). • HUD-assisted MMEs used over 100% more Personal Care
services, 80% more "other HCBS", and over 67% more durable medical equipment services
Medicare Service Utilization per 1000 Member Months
HUD-Assisted MMEs with Medicaid FFS
(N=106,764)
Unassisted MMEs with Medicaid FFS(N=227,186)
Ratio of HUD-Assisted vs. Unassisted MMEsMean Mean
Personal Care services 4,512.4 2,149.1 2.09**
Residential care38.9 63.7 0.61**
DME380.0 227.7 1.67**
Other HCBS2
3,309.8 1,840.6 1.79**
LeadingAge Center for Housing Plus Services
• 12 housing providers across the country
• Associated Catholic Charities in Baltimore, MD, • Cedar Sinai Park in Portland, OR• Cathedral Square Corporation in Burlington, VT, • Evangelical Lutheran Good Samaritan Society in Sioux Falls, SD, • Housing Authority of Milwaukee in Wisconsin, • Mercy Housing California in San Francisco.• National Church Residences in Columbus, OH,• NewCourtland in Philadelphia, PA.• Peter Sanborn Place in Reading, MA, • Presbyterian Senior Living in Dillsburg, PA, • Presbyterian Villages of Michigan in Southfield, MI, • Selfhelp Community Services in New York, NY,
Learning Collaborative
• Each is working with a service provider either internal or external
• Came together to:• Identify the essential elements and practices of
promising Housing Plus Services• Develop indicators and mechanisms to measure whether
these models can improve health outcomes for seniors while creating cost savings for the health care system.
• Explore how regulatory and financing models could help bring these models to scale so they can serve the large and rapidly growing population of older Americans.
Support and Services at Home SASH: A Collaborative Partnership
• Based in Vermont• Over 50 housing, home health, hospital and social service
agency partners• Funded by state Medicaid and other resources• Preventative health care and services coordination• Self-management education and coaching, particularly
relating to chronic health conditions such as diabetes and arthritis
• Transitions support after a hospital, nursing home or short-term rehab facility stay
Benefits to SASH Participants
• Comprehensive health and wellness assessment
• Individualized Healthy Living Plan
• Money savings through preventative health care
• Check-ins and health coaching
• Convenient access to a wellness nurse
• Planning for successful transitions
• A trusted guide to help navigate long-term care
• An informed team to help in a crisis
• Access to prevention and wellness programs
• Medication management assistance
Self-Provided Services
• Larger organizations and companies• Typically multi-divisional including Home and
Community Based Services• Licensure and regulatory responsibilities lie outside of
housing provider• Consultation and support services available in-house
• Legal and Risk Management• Fundraising• Accounting • Medicare and Medicaid billing where applicable
Lutheran Foundation Grant
• Overview• Funded innovative approach to housing with
wellness services
• Outreach to seniors in surrounding community
• Technology
• $384,000 over 3 years, awarded in March, 2015
Funded Under the Grant
• Telehealth Kiosk for the remaining communities in Metro St. Louis area
• Free access to residents and participants
• Bump in Service Coordinator salary
• Wellness Nurses
• Administrative financial assistance
The TeleHealth Kiosk
• Blood pressure, weight, pulse, blood glucose• Alerts when any results are out of acceptable
parameters • Health Questions• Hospitalization questions• Isolation and depression related questions• Lifestyle questions
Role of the Service Coordinator to Increase Wellness Participation
• Identifying residents who have had falls, hospitalizations, and heart health problems.
• Marketing• Phone calls and flier reminders• Incentive programs
• Monitoring and follow-up on kiosk alerts • Partner with Wellness Nurses
Role of the Wellness Nurse
• Monitoring and follow-up on kiosk alerts • Information and referral• Encouragement • Promote lifestyles • Partner with Service Coordinator
Future Expansion
• Chore worker services• LSS HCBS Private Duty• Subsidized fee scale
• Expanded responsibilities of Service Coordinator• Care Coordinator• More in-depth care plans
Wrap Up
• Housing with Services will be the norm
• Strong collaboration and partnerships necessary to provide services• Start building your network now
• Reliable funding streams needed
Questions?
Contact Information
Susan HutchinsonExecutive Director of Affordable HousingLutheran Senior Services1150 Hanley Industrial CourtSt. Louis, MO 63144(314) [email protected]
ResourcesLewin Group Study: http://aspe.hhs.gov/daltcp/reports/2014/HUDpic.shtml
LeadingAge Center for Housing with Services: http://www.leadingage.org/Center_for_Housing_Plus_Services.aspx
LeadingAge Strategies and Tools: http://www.leadingage.org/Housing_Plus_Services_Strategies_and_Tools.aspx
Support and Services at Home (SASH): http://www.sashvt.org/
Atlantic Monthly article: http://www.theatlantic.com/business/archive/2015/05/living-and-dying-at-home/391871/
