By Geralyn Magan
Connecticut, New Jersey, and Massachusetts are taking proactive steps to deliver home and community-based services to residents of subsidized housing.
A new report supported by AARP, AARP Foundation, The Commonwealth Fund, and the SCAN Foundation examines how three states—New Jersey, Connecticut, and Massachusetts—are taking proactive approaches to linking affordable senior housing with services so older adults with low incomes can remain in their own apartments and communities.
The report was co-authored by Alisha Sanders and Robyn Stone of the LeadingAge LTSS Center @UMass Boston, and Rodney Harrell and Shannon Guzman of the AARP Public Policy Institute. It is part of a collection of Promising Practices published in July 2021 in conjunction with the release of Advancing Action, 2020: A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers.
The scorecard, a compilation of state data and analysis issued every two-to-three years, showcases measures to help states gauge their progress in creating a high-quality system of care for older adults and people with physical disabilities and their family caregivers. Previous versions of the scorecard focused on states’ performance around home and community-based services (HCBS). The scorecard’s latest edition also focuses on affordable housing as a key driver in creating more choices for individuals with care needs.
AFFORDABLE HOUSING AND LTSS
Sanders, Stone, Harrell, and Guzman begin their report, entitled Affordable Housing as a Key Piece of Older Adults’ Long-Term Services and Supports: Solutions that Consider the Whole Equation, by citing recent LTSS trends that underscore the importance of linking affordable housing and long-term services and supports (LTSS). In addition to providing affordable and accessible shelter, they write, subsidized housing communities can also help states meet the growing demand for HCBS at a time when state Medicaid budgets are strained and the supply of direct care workers who provide HCBS is shrinking.
“Strategies that purposefully link LTSS programs with subsidized housing communities present a promising option for efficiently delivering HCBS with fewer financial and human capital resources,” write the authors, who urge states to “explore ways in which affordable housing arrangements can facilitate delivery of LTSS and how Medicaid and state-funded LTSS can help keep people with increasing levels of disabilities living independently in community-integrated settings.”
CONNECTICUT, NEW JERSEY, AND MASSACHUSETTS
The Promising Practices report details how three states—Connecticut, New Jersey, and Massachusetts—are taking proactive steps to deliver HCBS services to residents of subsidized housing.
Connecticut: In 2000, Connecticut expanded its assisted living program to make it available in independent affordable senior housing communities, including the state’s 24 Congregate Housing for the Elderly Program properties. Thirteen congregate properties and seven federally assisted properties now offer the program.
New Jersey: In 1994, New Jersey used a demonstration grant from the Administration on Aging to develop an assisted living model that would be compatible with subsidized housing settings. After a pilot period and an evaluation study, the state amended its assisted living regulations to accommodate the program, which is now available in 15 subsidized housing properties.
Massachusetts: The Massachusetts Supportive Housing Program contracts with Area Services Access Points (ASAP) to create a supportive living environment in state-funded public housing properties serving older adults and people with disabilities. ASAPs, which are state-designated entities responsible for coordinating and delivering HCBS to eligible individuals, provide services in 41 state-funded housing communities and in several federally funded public housing communities that meet state requirements.
PROGRAM OBSERVATIONS
The authors gleaned several observations from the state programs they examined:
- Enhanced Efficiency and Effectiveness: Clustering service delivery in congregate housing settings can reduce the number of aides needed to serve the same number of people and allow aides to see participating residents more flexibly and regularly.
- Staff Collaboration: A purposeful connection between the LTSS provider and housing property allows staff from both entities to share information, when resident permission is granted, and potentially coordinate around resident needs.
- Aging in Place: The more continual and flexible presence of on-site staff helps facilitate aging in place by providing more extensive assistance or monitoring and preventing or delaying a resident’s need to move to a higher level of care.
- Financial Sustainability: If enough residents do not participate in housing-based programs clustering delivery of home care services, providers can have difficulty covering staffing and other costs and maintaining financial viability. This situation could lead providers to discontinue existing programs or hesitate to initiate new ones.
For more details, read Affordable Housing as a Key Piece of Older Adults’ Long-Term Services and Supports: Solutions that Consider the Whole Equation.