The evidence is building for the benefits of using affordable senior housing communities as a platform for delivering services.
Two recent evaluations add to the evidence on the positive outcomes of linking affordable senior housing communities with services. A third study examined loneliness in senior housing, finding a high prevalence of this condition, which can greatly impact health outcomes.
Together, these new learnings add to the argument that senior housing communities can be an effective place to reach a high-risk population and deliver interventions that can decrease use of expensive health care services.
HOUSING-BASED SERVICES AND HOSPITALIZATIONS
Rutgers University’s Michael Gusmano and his research team recently published the results of their evaluation of the Selfhelp Active Services for Aging Model (SHASAM) program. SHASAM is provided by Selfhelp Community Services, a LeadingAge member operating 11 affordable senior housing communities across New York City.
SHASAM provides interested residents with a host of services, including:
- An assessment,
- Counseling and advocacy,
- Health education,
- Wellness programs,
- Physical activity programs,
- Socialization,
- Evaluation for and referral to public benefits and entitlements,
- Evaluation and referral for mental health concerns, and
- Educational programs to help control chronic disease.
At residents’ request, Selfhelp also provides in-home technologies, including motion detectors, telehealth systems that allow residents to check vital signs, and a virtual senior center. Services are supported through operational budgets, foundation grants, and corporate sponsorships.
Gusmano’s team compared Medicare beneficiaries living in 6 Selfhelp communities offering the SHASAM program with Medicare beneficiaries living communities in the same zip code. The evaluation found that residents in the Selfhelp communities experienced a 32% lower hospital discharge rate than the comparison group. Among Selfhelp residents who were hospitalized, the mean length of stay was one day shorter than among the comparison group.
The analysis also found that the odds of being hospitalized for an ambulatory care sensitive condition (ACSC) were more than 43% lower for the intervention than for the comparison group. ACSCs are conditions that can generally be managed with outpatient care and generally do not result in hospitalizations, if properly managed. For example, uncontrolled diabetes would be considered an ACSC.
HOUSING-BASED SERVICES AND CHRONIC CONDITIONS
In another study, a team led by Sojung Park, a researcher at Washington University in St. Louis, MO, published results of an analysis the team conducted using data from the Health and Retirement Study (HRS). The HRS is a longitudinal panel study that surveys a representative sample of approximately 20,000 people age 50 and over in America every 2 years. Park’s team examined the extent to which a senior housing environment moderates the effect that having multiple chronic conditions could have on hospitalizations over time.
The study compared 2 groups of HRS participants:
- Individuals who were over age 75, had incomes below 300% of the poverty level, and lived in “senior housing,” and
- Similar individuals who lived in conventional housing.
The HRS defines senior housing as a “retirement community, senior citizen’s housing, or other type of housing that offers services for older adults or someone with a disability.” While this broad definition is a limitation of the study, Park’s team attempted to approximate affordable senior housing communities by limiting the income range of the study sample.
At baseline, which was when an individual was first interviewed for the survey, individuals living in senior housing were more likely than those living in conventional housing to experience moderate (1-3 times per year) or high (3+ times per year) levels of hospitalizations. But analysis found that, over time, those individuals living in senior housing were less likely to experience a high level of hospitalization.
Park’s team also looked at the extent to which living in a senior housing environment moderates the effect that having multiple chronic conditions could have on hospitalizations over time. Researchers found that, at baseline, individuals with multiple chronic conditions living in senior housing experienced hospitalization rates that were similar to individuals living in conventional housing. However, over time, individuals with multiple chronic conditions who lived in senior housing were less likely to be hospitalized.
THE PREVALENCE OF LONELINESS
A final exploratory study, also conducted by researchers at Washington University, examined loneliness among residents of Section 202 housing communities. This study surveyed residents in 3 housing communities about loneliness. It did not evaluate a specific intervention.
Using the Hughes 3-item loneliness scale, the survey revealed that 43% of the respondents were moderately lonely and 27% were severely lonely. The authors note that this prevalence is high in comparison to older adults residing in conventional homes/apartments. Other studies have found that 19% to 29% of older adults living in conventional homes and apartments have a high prevalence of loneliness.
Analysis of the survey data found that loneliness was related to depressive symptoms. It also found that a high rate of attending group meetings—that is, attending a group activity every week or several times a week—was marginally associated with being less lonely.
This study cannot be generalized across affordable housing communities, but it does indicate the potential that a sizeable portion of residents could experience loneliness.
Given that loneliness has been linked to negative health outcomes and higher health care utilization, the study helps support the argument that building services and supports into affordable senior housing settings can help reach vulnerable older adults, potentially mitigating adverse outcomes that are costly to our health and long-term services and support systems.
Alisha Sanders is director of housing and services policy research in the Washington, DC office of the LeadingAge LTSS Center @UMass Boston. Her work focuses on identifying, evaluating, and advancing strategies and policies that link affordable housing settings with health and supportive services.