Financial challenges of housing-with-health-services models for low-income older adults

A groundbreaking study published in the journal Aging Research Highlights the financial challenges of housing-plus-health-care models for low-income older adults. The report explores strategies to ensure the sustainability of these beneficial efforts

The study was conducted in partnership with Hebrew Senior Life, a Harvard Medical School-affiliated nonprofit organization serving older adults in the greater Boston area. It drew on insights from 31 key informant interviews and three focus groups with payers, housing providers and community partners.

The Right Care, Right Place, Right Time (R3) program deploys wellness teams to affordable housing sites. These teams include coordinators and nurses who take an “eye-to-eye” approach, train all housing staff, and contribute to resident care coordination. Teams bridge housing and health care efforts, supporting residents where they live and aiming for better health outcomes and prolonged independence.

Despite the recognized potential of these programs to improve the lives of low-income older adults, finding reliable funding sources remains a significant barrier.

Key findings of the study, “Promoting Sustainability in Housing with Services: Insights from the Right Care, Right Place Right Time Program,” include the following:

• Recognized value: Participants unanimously recognized the value of housing-with-services programs in improving the well-being of older adults.
• Funding Needs: There was little consensus on how to secure ongoing funding for these programs. Responsibility for individuals in housing sites is distributed among health victims, hospitals and community service providers, making it challenging to encourage investment.
• Role of government: The study suggests that government mechanisms, perhaps at the federal level, are needed to channel funds towards supportive services Without reliable funding sources, these housing models for low-income seniors will be difficult to replicate.

The study emphasizes the need for innovative solutions to secure funding for supportive services. Sustaining and financing these models has proven to be a complex issue, with separate systems of publicly funded housing and healthcare.”

Mark A. Cohen, co-author, co-director, LeadingEdge LTSS Center, Department of Gerontology, University of Massachusetts

Housing models that integrate supportive services have proven popular among well-off individuals who can afford a private-pay environment. Yet options for older people with fewer resources remain limited due to scarce government funding. The Section 202 low-income housing program established by the US Department of Housing and Urban Development is an option for affordable housing for people age 62 and older. Service coordinators were added to the program in 1990; Yet it has been limited in scope and underfunded for years, leaving many older adults without access to supportive housing environments.

“We hope these findings contribute to a broader understanding of how to develop and sustain housing-with-services models that benefit low-income older adults,” said Kim Brooks, Chief Operating Officer, Senior Living, Hebrew Senior Life.

The study examined the experiences and perspectives of individuals involved in the Boston-area Right Care, Right Place, Right Time program, which enrolled 400 older adults across seven intervention sites. Four sites were operated by Hebrew Senior Life and three were operated by partner providers, including Milton Residences for the Elderly and Wynn Company.

Lead author of the study was Pamela Nadash, PhD, associate professor, Department of Gerontology, University of Massachusetts. Co-authors include Edward Alan Miller, professor and chair, Department of Gerontology, University of Massachusetts; Elizabeth J. Simpson, MPH, Department of Gerontology, University of Massachusetts; Molly Wiley, Department of Gerontology, University of Massachusetts; Natalie Shellito, Department of Gerontology, University of Massachusetts; Ian Lin, Department of Gerontology, University of Massachusetts; Taylor Jansen, PhD, Department of Gerontology, University of Massachusetts; And Mark A. Cohen, co-director, LeadingEdge LTSS Center, Department of Gerontology, University of Massachusetts and Center for Consumer Engagement and Health System Transformation, Community Catalyst.

This work was supported by Hebrew Senior Life, which designed and piloted the R3 program and secured additional funding for the evaluation and intervention. Funders include the Commonwealth of Massachusetts Health Policy Commission’s Health Care Innovation Investment Program; Beacon Community LLC; Boston Scientific Foundation; Coveris Community Healthcare Foundation; Enterprise Community Partners; Massachusetts Department of Housing and Community Development; mass housing; and Pioneer Institute.