Hearth, Inc.

Recognizing and addressing the uniqueneeds of Boston’s rapidly growing older adult homeless population and those at

risk of homelessness

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Massachusetts's Aging Population

Source: U.S Census Bureau, Population Division,Interim State Population Project, 2005

Over the next 20 years, Massachusetts population growthwill occur almost entirely in the 60+ age groups

Change in population 2010 - 2030

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Older Adult Homelessness is Growing

Sources: HUD’s 2008 Annual Homeless Assessment Report to Congress, July 2009 & Boston Homeless Census Report 12/2008

The nation’s sheltered homeless population over a year’s time (2007-2008) included approximately 1,092,600 individuals (68%) and 516,700 persons in families (32%). Nationally, between 2007 and 2008 the number of individuals in shelter was down by 3.7%, but age 51+ was up by 4.5%.  Approximately one third of Boston’s homeless adult shelter population is over 50 years old.

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Who are the Elderly Homeless?

● People in their fifties who have chronic health problems

● Our grandparents, our aging parents, and our uncles and aunts who may suffer from mental illness, addictions or poverty

● Older adults living on fixed incomes

● People in their fifties who experience job loss and prolonged unemployment

● For many elders, a “trigger event” or “transition” may precede their homelessness; these events include widowhood, divorce, domestic violence, eviction and the declining health or death of the family member who cared for them

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Unique Challenges Faced by Homeless Elders

Source: 2009 Hearth Report

● Homelessness often leads to unsafe and unsanitary living environments. These conditions not only aggravate older adults’ pre-existing health problems but may also interfere with effective treatment of their diseases.

● Surveys of homeless older adults reveal that more 50% have serious medical problems. In fact, in a recent study, 61% of Hearth’s survey participants have active medical problems and 51% are living with chronic pain.

● Most are post-employment.

● Needs will tend to increase with time.

Homeless older adults face challenges that are very different from those experienced by younger adults or families. For seniors, the ravages of homelessness can accelerate and magnify the effects of aging, including:

• increased physical frailty

• chronic disease

• impaired mental function

• loneliness and isolation

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The Hearth Model

Founded in 1991, Hearth partners with many organizations serving the homeless on a targeted approach for older adults age 50 and over.

Hearth Housing & Services

7 sites, 137 units(additional 59 units under construction)

Hearth Outreach1,100 elders placed

3,000 served (capacity to help 350

elders annually)

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Common Physical Health Problems

● Cardiac-Circulatory & HTN: 69%

● Diabetes-61%

● Arthritis/ Muscular-Skeletal Problems: 52%

● Vision: 32%

● Pulmonary Disease: 28%

● Dental Problems: 21%

● Hearing Problems-20%

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Health Issues, cont.

● Almost three-quarters of Hearth’s residents are coping with some level of depression or anxiety

● A significant number of Hearth’s residents are also coping with cognitive impairments, including Alzheimer’s disease (13%) and developmental disabilities (10%)

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Mental Health Issues

● More than half of Hearth residents have one or more diagnosed mental health problem.

● Most frequently diagnosed disorders are schizophrenia, depression, paranoia, anxiety and bipolar disorders.

● These mental health problems, coupled with the sensory problems associated with old age (i.e. hearing loss & reduced vision) may lead to greater paranoia, distrust and isolation.

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What is the Hearth Model?

● Permanent well-managed housing for formerly homeless elders

● The right services for each resident

● Outreach to the whole population of homeless elders

● Research demonstrating our value linked to advocacy for the right public policy

● Collaboration with public, private and philanthropic partners

● Confidence we can truly end the shame of elder homelessness

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Hearth Housing

● Hearth has successfully created 136 units of permanent service-enriched housing located in seven different residences throughout the Greater Boston area.

● Each of Hearth’s seven residences has a unique character and community for the elders who live there and call it home.

● One of these sites is a 43-unit assisted living facility in Boston targeted to low income elders.

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Hearth’s Service Delivery Model

● Hearth’s model integrates housing, mental health, medical and social services supports in a manner that permits even very frail elders to live with considerable independence in their own apartments.

● Hearth’s team is comprised of a Property Manager, MSW’s, RN’s, Site Directors, Resident Assistants, Personal Care Homemakers, Activity staff and a Representative Payee.

● Students, interns and volunteers provide countless hours of service to our residents including work with:

• Harvard Geriatrics Fellowship Program

• Northeastern University Physical Therapy Program

• Social Work Interns

• Art Therapy Internship Program

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Services Provided

● Behavioral health management

● Medical management including physician collaboration, medication assistance, health education and health screening

● Crisis intervention

● Substance abuse and brief mental health counseling

● Personal care and homemaking

● Socialization

● External referrals

● Close collaboration with property manager

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● The cost of Hearth housing is at most one-half the cost of institutional alternatives such as long term care or shelter beds.

● There are high costs associated with leaving elders in shelter or on the street which include costs such as increased use of emergency medical care for routine care.

● At over $58,000 a year on average in Massachusetts for assisted living and $107,000 for nursing home care, assisted living is generally unavailable to most poor and minority elders.

● At Ruggles, Hearth is able to provide access to this high level of care for Boston’s very low income, frail elders who otherwise would be living in nursing homes on Medicaid’s tab.

Supportive Housing Makes Sense

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Hearth Outreach Program Helping those who Hearth can’t house

food income insurance health care mental health substance abuse financial assistance legal socialization stress management crisis services food income insurance health care mental health

HOUSING SEARCH andCASE MANAGEMENT

PLACEMENT andSTABILIZATION

HEARTH OUTREACH OPERATING MODEL

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Homeless Elders 50+ Safe, Affordable

Permanent Housing

The demand for Hearth housing is high and availability is limited. The Hearth Outreach Program enables Hearth to assist homeless elders in locating alternative affordable housing opportunities and the social services critical to their long term housing success.

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● HUD Section 8

● SSIG - Supplemental Security Income-G

● Mass Health: GAFC - Group Adult Foster Care

● DMH - Department of Mental Health

● EOEA - Executive Office Of Elder Affairs

● SCO - Senior Care Option

● Grants/Private Philanthropy

Public/Private Programs that Support Hearth:

Financing of the Model

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Hearth’s Sources of Revenue

Nearly half of Hearth’s revenue comes from rental fees and program revenues.

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Outcomes for Hearth Residents

● Housing with integrated supportive services leads to good outcomes for elders who have struggled with the consequences of poverty and homelessness.

● 95% of Hearth’s survey respondents report a visit with a primary medical care provider within the previous six months, demonstrating Hearth’s success in forging connections between its elder residents and critically important community-based care.

● Access to safe, affordable housing and a supportive living environment promotes stability, wellness, and life satisfaction among formerly homeless older adults.

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Outcomes for Hearth Residentscontinued

Many of those participating in a recent Hearth survey reported positive assessments of their health and well-being as residents of Hearth’s housing, despite the numerous and serious health challenges they experience:

● 68% of respondents rate their health (including physical, emotional, and mental health) as either good, very good, or excellent.

● 70% of respondents report being either satisfied or very satisfied with their lives, in general

● 78% of respondents express satisfaction with their living environments, with an additional 10% expressing neither satisfaction nor dissatisfaction.

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Contact Information

May Shields RN, MSN mshields@hearth-home.org

T: 617 369 1573W: www.hearth-home.org

Hearth, Inc.1640 Washington StreetBoston, MA 02118