“We Can Do Better Together” Partnerships for Low-Income Health, Housing, and Social Support...

“We Can Do Better Together” Partnerships for Low-Income Health, Housing,

and Social Support Services: Livable Communities for All Ages

Fellowship Project Conducted in Partnership with:

Department of Health & Human Services, Administration for Community Living,

Health Resources and Services Administration, and Department of Housing and Urban Development

Lori Simon-Rusinowitz, MPH, PhD2014-15 Health and Aging Policy Fellow

University of Maryland School of Public HealthSeptember 10, 2015

Health, Housing, and Social Support Services 1

Project Mentors and Planning Team Members:

• HHS Administration for Community Living: Bob Hornyak, Elena Fazio, Lan Marshall

• HHS Health Resources and Services Administration:Suma Nair, Jacqueline Rodrigue, Kent Forde, Shafa Al-Showk

• Department of Housing and Urban Development Jennifer Ho, Ron Ashford, Leigh van Rij


Agenda

• Background Information• Project Goals and Approach• Webinar Description• Comprehensive Agenda to Encourage more Successful

Partnerships• References


Why Increased Interest in “Livable Communities” Now?

• U.S. Trends in Aging Demographic and economic imperatives.

Increased recognition about the importance of and demands on family caregivers, the backbone of our long-term services and supports (LTSS) system.


U.S. Trends in Aging• In 2013 there were 44.7 million Americans age 65 and older

representing 14.1% of the U.S. population. By 2040, the number of older Americans is expected to grow to 82.3 million or about 21.7% of the U.S. population (Administration on Aging, 2014).

• An estimated 70% of people who turn 65 will require long-term services and supports (LTSS) in their lives (e.g., personal care, medication management, care coordination, household tasks, transportation, etc.) (DHHS 2015).

• Source: www.census.gov/population/www/projections/summarytables.html• Source: http://longtermcare.gov/the-basics/who-needs-care/


http://www.census.gov/population/www/projections/summarytables.html

U.S. Trends in Aging• In 2013, about 40 million family caregivers in the U.S. provided an

estimated 37 billion hours of care to an adult with limitations in daily activities. The estimated economic value of their unpaid contributions was approximately $470 billion in 2013, up from an estimated $450 billion in 2009 (Reinhard et al. 2015).

• Older adults prefer to receive LTSS in their own home and community, as opposed to institutional settings (e.g., nursing homes).– 88% prefer to remain in their current residence for as long as possible

(Keenan 2010)– 92% prefer to remain in their local community for as long as possible

(Keenan 2010)

• Source: http://assets.aarp.org/rgcenter/general/home-community-services-10.pdf• Source: http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-new.pdf


http://assets.aarp.org/rgcenter/general/home-community-services-10.pdf

What is a “Livable Community”?

• Multiple terms: Housing Plus Services, Livable Community, Livable Communities for All Ages, Communities for a Lifetime, Age-Friendly Community, Dementia Friendly Community

World Health Organization (WHO, 2007) framework for a broad set of services that supports people aging in their own community rather than an institutional setting.


World Health Organization Framework (WHO, 2007)

World Health Organization (Ed.). (2007). Global age-friendly cities: A guide. World Health Organization. Retrieved from http://whqlibdoc.who.int/publications/2007/9789241547307_eng.pdf?ua=1

Age-friendly city

Outdoor Spaces & Buildings

Community Support &

Health Services

Social Participation

Housing

Transportation

Communication & Information

Civic Participation &

Employment

Respect & Social Inclusion


Why Increased Interest in “Livable Communities” Now? Health Care Reform is Changing the Policy Landscape

• Affordable Care Act policies and incentives (i.e. value-based payment and population health) are changing health care providers’ priorities and behavior.

• To achieve the “triple aim” of better care for individuals, better care for populations, and lower per capita costs, providers need to keep people healthy and out of hospitals (IHI, 2015).

• Health care providers can benefit from partnerships with affordable housing and social support programs to help meet these goals (LeadingAge, 2014).

• Institute for Healthcare Improvement (IHI). IHI Triple Aim Initiative. http://www.ihi.org/engage/initiatives/tripleaim/pages/default.aspx . Accessed August 29, 2015. • LeadingAge Center for Housing Plus Services (2014) Housing and Health Care : Partners in Healthy Aging. http://www.leadingage.org/housinghealth/ Accessed August 29, 2015.


http://www.ihi.org/engage/initiatives/tripleaim/pages/default.aspx%20.%20Accessed%20August%2029

http://www.leadingage.org/housinghealth/

Benefits of Affordable Housing, Social Support, and Health Care Partnerships• Health care and affordable housing partnerships can offer residents:

– easy access to health care services and programs (important for high service users),

– health education programs and follow up care in a cost-effective setting,

– health care providers who have an improved understanding of social factors effecting health conditions,

– a service coordinator who knows residents and can follow up when needed.

• LeadingAge Center for Housing Plus Services (2014) Housing and Health Care : Partners in Healthy Aging. http://www.leadingage.org/housinghealth/ Accessed August 29, 2015.



Partnerships for Low-Income Health, Housing, and Social Support Services Can Increase Access to Health Care

• Housing Plus Services can help address the following health care challenges:- avoid unnecessary hospital re-admissions,- address medication complications,- manage chronic health,- conduct patient education and encourage patient engagement,- address social determinants of health,- address “super utilizers,” and- link older residents to social support services via local Aging & Disability

Resource Centers and Area Agencies on Aging (e.g., case management, personal care, transportation, homemaker services).

LeadingAge Center for Housing Plus Services (2014) Housing and Health Care : Partners in Healthy Aging. http://www.leadingage.org/housinghealth/ Accessed August 29, 2015.



Health and Housing Partnership: Public Housing Primary Care Program

• HRSA operates Federally Qualified Health Centers (FQHC), the primary care, safety net health system for low income, vulnerable populations.

• These health centers offer comprehensive primary care for all ages.

• HRSA funds approximately 80 Public Housing Primary Care Centers that are either located in a public housing building or within one mile.

• This program serves about 22 million patients; however, only 7% are over 65 years old (about 1.5 million patients).

• FQHC Opportunity: Health centers can expand their capacity to serve the growing elderly population.


• US HHS Heath Resources and Services Administration, Bureau of Primary Care, Public Housing and Primary Care Health Centers. http://bphc.hrsa.gov/qualityimprovement/supportnetworks/specialpopulations/. Accessed August 29, 2015.

http://bphc.hrsa.gov/qualityimprovement/supportnetworks/specialpopulations/


Social Service Community Partnerships: “No Wrong Door” Approach to Services• ACL Goal: A LTSS system that is consumer-driven and cost-effective.

• Steps:– Outreach and coordination with referral community services– Person-centered counseling (focus on the person’s goals)– Streamline eligibility to public programs– State agency support: must include governor, Medicaid

agency, consumers, key stakeholders in service design and oversight

• Administration for Community Living (2015), Center for Integrated Programs, Office of Consumer Access and Self-Determination, Aging & Disability Resources Centers, Program, No Wrong Door System, http://www.acl.gov/Programs/CIP/OCASD/ADRC/index.aspx. Accessed August 29, 2015.Health, Housing, and Social Support Services 13

http://www.acl.gov/Programs/CIP/OCASD/ADRC/index.aspx

Health, Housing, and Social Support Services14

“No Wrong Door” System Organizations

14

Why Focus on Interagency Partnerships?• A Government Accountability Office Report (May 2015), entitled, Older Adults. Federal

Strategy Needed to Help Ensure Efficient and Effective Delivery of Home and Community-Based Services (HCBS), calls for the Administration for Community Living to lead collaborations between:

– Departments of Housing and Urban Development, – Transportation, – and Agriculture, – as well as the Centers for Medicare and Medicaid Services,

to meet the growing needs of elders for social support services.

• With limited resources and growing needs, partnerships can leverage existing programs to better serve this population.

• This report focused on non-medical services; it did not address primary care offered by FQHCs. However, social support services are essential to the successful outcomes of primary health services.

• Federal interagency partnerships require time and attention. Each agency has its own priorities, and culture. Successful partnerships bridge these differences.


Agenda

• Background Information• Project Goals and Approach• Webinar Description• Comprehensive Agenda to Encourage More Successful



Project Goals: Obtain Maximum Program Benefits for Consumers via Interagency Partnerships, Encourage More Partnerships

Social Support Services

Health Services

Housing Services


Project Approach

• Identify existing health, housing, and social support partnerships, and program characteristics that make them successful or create barriers to success.

• Highlight exemplary programs in a webinar designed to teach us about successful partnerships. Invite policymakers, providers, researchers, and others.

• Identify ways to share lessons from the “early innovators” with the wider health, housing, and social support communities.

• Develop a comprehensive agenda to encourage more successful partnerships.


Key Project Steps

• Propose project to leaders in each agency, and obtain their support.

• Agency leaders identify interagency team members. • Review literature and conduct background discussions

with health, housing, and social support stakeholders to inform the webinar.

• Identify successful partnerships to highlight.• Identify appropriate webinar audience members.• Conduct webinar with audience polling questions.• Develop a comprehensive agenda with recommendations.


National Initiatives Indicate Growing Interest in Livable Communities

• AARP Livability Index (2015)• National Association of Area Agencies on Aging

(2015). “Making Your Community Livable for All Ages”

• Grantmakers in Aging: Improving America for All Ages (2013)

• AARP’s network of age-friendly communities (2012)• LeadingAge “Housing Plus Services” Center, Learning

Collaborative (2012)


National Initiatives Indicate Growing Interest in Livable Communities• National Center for Health in Public Housing: 2015 national symposium

includes a plenary session and workshops on healthy aging in public housing.

• Association of State and Territorial Health Officers, 2015 Annual Meeting showcases effective healthy aging programs, Association has a position statement on healthy aging in community settings.

• Altarum Institute (2015) “MediCaring Communities,” financing model for community support services.

• US HHS Assistant Secretary for Planning and Evaluation (2014a), evaluation of Support And Services at Home (SASH), a Vermont statewide housing, health, and social support program.


Current Literature Indicates Growing Interest in Livable Communities

• Public Policy and Aging Report (2015). Making a home in the city: The age-friendly community movement.

• The Gerontologist (2015): Toward the 2015 White House Conference on Aging: Creating an aging policy vision for the decade ahead, addresses “age-friendly communities.”

• LeadingAge (2014): Combined HUD and Medicare database documents higher health costs among HUD-assisted elders.

• Generations (2013-14): issue on “age-friendly communities.”

• Journal of Aging and Social Policy (2014), two-volume issue on “age-friendly communities.”


Agenda




Webinar Description

• Webinar Overview and Introductions• We Need to Learn From You: Audience Polling Question• What Does Research Tell Us About “Housing Plus Services”?• Learning from Partnerships in Vermont, California, and

Hawaii• We Need to Learn From You: Audience Polling Questions• Audience Discussion


Webinar Audience Members

• Planning team members invited key stakeholders from their own health, housing, and social service networks.

• We aimed for 50 key stakeholders.• Over 100 people registered for the seminar, and

included people from:- eight federal agencies or offices, - national associations/technical assistance providers. - direct service providers, - foundations, and - researchers.


Health, Housing, and Social Support Services

Bob HornyakDirector, Office of Performance and Evaluation

and Lori Gerhard

Director, Office of Integrated ProgramsHHS ACL

26


Suma NairDirector of the Office of Quality ImprovementHealth Resources and Services Administration’s

Bureau of Primary Health Care

27

28Health, Housing, and Social Support Services

Jennifer HoSenior Advisor on Housing and Services

U.S. Department of Housing and Urban Development


Robyn StoneExecutive Director, Center for Applied Research,

LeadingAge

Building the Evidence Base for Affordable Senior Housing + Services

Robyn I. Stone, DrPHExecutive Director, Center for Applied Research, LeadingAgeJuly 29, 2015


“A Picture of Housing & Health”

Researchers compared Medicare and Medicaid cost and utilization for HUD-assisted Medicare beneficiaries and unassisted beneficiaries in the community.

They found that HUD residents: – included a much larger percentage of people who are dually

eligible for Medicare and Medicaid than people who do not receive HUD assistance, and

– have more serious health conditions, use more Medicare and Medicaid services, and have greater health care costs than those outside of HUD assisted programs.

Stone, R., (2015). Building the evidence base for affordable senior housing + services. Presented during the webinar, entitled Partnerships for Health, Housing, and Social Support Services: Livable Communities for All Ages, July 29.


How Housing and Services Matter

Two data sources help illustrate outcomes:– Researchers surveyed 2,017 HUD properties in the HUD/Medicare-Medicaid data set, and reviewed services available and health outcomes.

– They also studied three “housing plus services” programs:

• Vermont: Support And Services at Home (SASH)• Pittsburgh, PA: Staying at Home Program• Harrisburg, PA: Presbyterian Senior Living & PinnacleHealth Partnership


How Housing and Services Matter

Sample Findings Indicate Positive Outcomes: HUD/CMS Survey: The availability of HUD building services were

associated with several positive resident health outcomes. Support And Services at Home (SASH): Early findings over two years

indicated that growth in annual total Medicare expenditures was $1,756 - $2,197 lower for SASH participants in well-established panels than for two comparison groups.

Staying at Home: Participants were less likely to visit the ER, have unscheduled hospital stays, report negative health conditions, and move to a nursing home.

Presbyterian Senior Living & PinnacleHealth: Over a two-year period, partnership participants had fewer ER visits and inpatient visits.



Molly DuganDirector

Support And Services at Home (SASH), Vermont

34

The Intersection of Health & Housing

“Housing is a point of natural aggregation of high risk individuals” at 128 locations across Vermont!

• SASH – Statewide, part of Vermont’s Health Care Reform Initiative

• Housing as a platform for health care

• 65 partner agencies part of SASH Collaboratives

• Available in all types of HUD housing


The SASH Model Focuses onThree Components of Care Management

• Coordinates with discharge staff, family and neighbors• Personal visit to review discharge instructions• Helps ensure a safe home transition

Care Coordination

• Develops healthy living plan• Coaches SASH Participants• Provides reminders and in person check ins• Organizes presentations and evidence based programs

Self Management

• Conducts wellness assessment• Convenes SASH team• Understands participants needs and preferences• Coordinates individual/community healthy living plans

Transitional Care


Primary Challenges

• Sustainable funding source• Lack of administrative funding• Keeping housing at the “table.”• Information sharing – IT systems, HIPAA• Capacity for mental/behavioral health services• Multiple funding sources=multiple applications, reports, outcomes, etc.


Success Drivers• Housing sector included in statewide health care reform discussions/initiative

• Population-based approach with focus on social determinants of health

• Medicare Demonstration funds allow flexible spending to match need – capitated model

• SASH designed with participants not for them

• Real-time data and ability to regularly share outcomes

• Statewide platform to build upon



Marty LynchCEOand

Brenda GoldsteinPsychosocial Services Director

LifeLong Medical Care, California

Services located in Oakland, Berkeley, West Contra Costa County

48,000 patients served annually

12 Primary Care Clinics, Urgent Care, Adult Day Health, Supportive Housing, School-Based Clinics, Dental

Special history with elders and care for complex adult populations including disabled and homelessHealth, Housing, and Social Support Services 40

Partnerships and FundingCity/County Government

Behavioral Health Housing Departments Public Health

HospitalsManaged Care PlansCenter for Independent LivingHealth Care for the HomelessHousing DevelopersCommunity Based Organizations


Structural Drivers

California has decentralized health care delivery systems – delegated from state to local managed care plans

Housing availability and cost

Fee for service billing and unaligned financial incentives


Financing Challenges

Funding case management by non-licensed providers

Fragmented & diagnosis driven funding

Blended funding = multiple reporting/documentation requirements

Productivity concerns – longer appointments needed for

complex populations which include family members, support teams etc.

Need to demonstrate cost savingsHealth, Housing, and Social Support Services 43

Service Delivery Challenges

Unlinked, multiple IT systems creates challenges

Identifying target populations

Tracking patient utilization

Assessing outcomes across the system of care

Staff recruitment/retention

Aging homeless population – needs exceed access to in home services or appropriate institutional based careHealth, Housing, and Social Support Services 44

Opportunities

Medicaid eligibility expansion

Improved coverage of mental health services

Integration of primary/behavioral health care

Managed care plans focus on high cost members

Recognition of impact of social determinants of health (especially housing)

Increased need for medical respite care given focus on reducing hospitalizations



Merlita ComptonDirector, Elder Services

AndLaura TaylorGrant Writer

Kokua Kalihi Valley, Hawaii

July 29, 2015Merlita Compton

Laura Taylor

Addressing the social determinants of health among the multi-ethnic elders of Kalihi.


Patient Demographics, 2014

91%

8% 1% 0-100% of poverty level

101-200% of poverty level

18%

60%

17%5%

Uninsured

Medicaid/Quest

Private In-surance

Medicare

Micr

ones

ian

Filip

ino

Sam

oan

Asian

Hawai

ian

Other

Pac

ific Isla

nder

Other

0%

5%

10%

15%

20%

25%

30%

35%

30% of KKV’s patients live in public housing

10.5% of KKV’s patients are 65 or older


Elder Care Program History

1999 2001 2002 2003 2005 2007 2011 2013 20140

200

400

600

800

12 24 45 80 120226

539 571

734

# of clients

Elder Services Established with

Case Managemen

t

Health Maintenan

ce,Senior

Volunteers

Caregiver Support &

Transportation

MD, BH, nutrition

ed, eligibility services

Dental &

CDSMP

MD clinicexpan

ds

Personal Care,

Gardening


Dept of Public Health… eval

Key Partnerships

Public Housing communities

University of Hawai‘i

Law School

School of Medicine

School of Nursing

Office of Public Health Studies

Hawaii Department of Health, Executive Office on Aging

Honolulu C&C, Elderly Affairs Division (Area Agency on Aging)


KKV Elder Care GoalsAssist Kalihi’s kupuna to maintain:

Highest level of physical/mental abilities

Highest quality of life

Save medical costs

Prevent or delay institutionalization

Reduce premature death

Improve quality of life

Reduce the risk of falling

Improve health

Promote mental well-being

Delay onset of disability

Empower elders to live independently and remain in their community

Nana Perpetua Amian, 101 years old


Funding partnerships, challenges in a changing landscape

66%

12%

22% City

Private

KKV

Elder Care Funding Sources


Agenda




Comprehensive Agenda: Process • Establish an ongoing interagency workgroup that leaders from each

agency can support with adequate time and resources.

• Include Department of Transportation and CMS team members as transportation and financing are key components of livable communities for all ages.

• Develop intentional steps to create an interagency workgroup. Each agency needs to understand each others’ mission, priorities, and culture.

• Build on existing knowledge – research, evidence-based interventions, best practices, and discussions with key stakeholders.


Comprehensive Agenda: Content • Address workforce issues, including shortages among direct care

workers, geriatricians, and other providers.

• Work with the newly funded HRSA Geriatrics Workforce Enhancement Program (GWEP) to address workforce issues (e.g., develop guidelines to expand FQHCs’ capacity to serve elders and adults with disabilities).

• Develop guidelines to address issues such as:– hiring and retaining geriatricians and other geriatric providers, – training for primary care providers who see elders and adults with

disabilities, – developing approaches to address multiple chronic conditions, and – providing adequate time for complex consumers.


Comprehensive Agenda: Content (continued) • Address the need for oral health services, physical therapy, occupational

therapy, and other services that support the chronic care needs of elders and adults with disabilities.

• Incorporate technology that can help support consumers, direct care workers, and family caregivers. Technology would need to include financing and training.

• Build on quality indicators/benchmarks for each service area (health, housing, social support services), and benchmarks for integrated services (e.g., continuity of services, communication among providers, level of consumer-direction infused into services).

• Facilitate states’ efforts to offer individual budget community-based service programs if they choose to do so. This evidence-based consumer-directed option offers maximum flexibility to consumers and their families in purchasing services and hiring direct care workers.


Comprehensive Agenda: Research• Develop an ongoing literature review from health, housing, and social

support partnerships (including seminal work informing current literature). Update the literature review regularly to include evolving literature.

• Identify gaps in knowledge related to a low-income, diverse older populations and adults with disabilities.

• Develop a research agenda, including suggested questions to address in a demonstration and evaluation of evidence-based “housing plus services” programs (e.g., implementation with diverse populations and in diverse geographic areas).

• Develop and test messages designed to encourage partnerships among health, housing, and social support services (e.g., we can do better by working together; the outcome is worth the effort).


Comprehensive Agenda: Policy and Implementation Challenges

• Lack of targeted, sustainable funding for health, housing, and social support partnerships (e.g., funding for administrative functions).

• Need for streamlined funding sources to address duplication from multiple funders (e.g., multiple applications and reports).

• Data sharing barriers due to privacy concerns/HIPAA and information technology incompatibilities.

• Barriers to funding diverse types of case managers, including those who may be competent but unlicensed.


References• AARP (2015) Livability Index. http://livabilityindex.aarp.org/ Accessed August 29, 2015. • AARP (2012). AARP’s network of age-friendly communities. Washington, DC. Retrieved on August 20, 2012 from

http://www.aarpinternational.org/File%20Library/Resources/AARPNetworkofAgeFriendlyCommunitiesBooklet.pdf • Administration for Community Living (2015), Center for Integrated Programs, Office of Consumer Access and Self-Determination,

Aging & Disability Resources Centers, Program, No Wrong Door System, http://www.acl.gov/Programs/CIP/OCASD/ADRC/index.aspx. Accessed August 29, 2015.

• Administration on Aging (2014). A Profile of Older Americans. http://www.aoa.acl.gov/Aging_Statistics/Profile/index.aspx Accessed August 29, 2015.

• Castle, N., & Resnick, N. (2014). Service-enriched housing: The staying at home program. Journal of Applied Gerontology, 0733464814540049.

• Altarum Institute (2015) Center for Elder Care and Advanced Illness. MediCaring communities. A call to action: Making it safe to grow old. http://altarum.org/sites/default/files/uploaded-related-files/MedicaringCommunities_042815.pdf

Accessed August 29, 2015. • Association of State and Territorial Health Officers, Health aging and public health position statement.

http://www.astho.org/Policy-and-Position-Statements/Healthy-Aging-and-Public-Health-Position-Statement/ • Ellenbecker, C. H., Byrne, K., O’Brien, E., and Rogosta, C. (2002). Nursing Clinics in Elder Housing: Providing Access and Improving

Health Care Outcomes. Journal of Community Health Nursing, 19: 7–15.• Generations, Vol. 37, No. 4. Winter 2013–2014. Aging in Community. • Golant, S. M., Pynoos, J., Cicero, C., Lawler, K., Berger, C., & Blechman, A. D. (2012). Livable and Sustainable Communities. Public Policy and Aging Report, 19(1).• Golant, S. M., Parsons, P., & Boling, P. A. (2010). Assessing the quality of care found in affordable clustered housing-care

arrangements: Key to informing public policy. Cityscape, 5-28.• Grantmakers in Aging (2013). Age-friendly communities. The movement to create great places to grow up and grow old in America.

Retrieved on April 12, 2014 from http://www.giaging.org/documents/130402_GIA_AFC_Primer.pdf • Institute for Healthcare Improvement (IHI). IHI Triple Aim Initiative.

http://www.ihi.org/engage/initiatives/tripleaim/pages/default.aspx . Accessed August 29, 2015.• Journal of Aging & Social Policy (2014). Special Issue: Age-friendly cities and communities around the world. Vol. 26, Issue 1-2.


http://livabilityindex.aarp.org/

http://www.aarpinternational.org/File%20Library/Resources/AARPNetworkofAgeFriendlyCommunitiesBooklet.pdf

http://www.acl.gov/Programs/CIP/OCASD/ADRC/index.aspx

http://www.aoa.acl.gov/Aging_Statistics/Profile/index.aspx

http://altarum.org/sites/default/files/uploaded-related-files/MedicaringCommunities_042815.pdf.%20Accessed%20August%2029

http://www.giaging.org/documents/130402_GIA_AFC_Primer.pdf

http://www.ihi.org/engage/initiatives/tripleaim/pages/default.aspx%20.%20Accessed%20August%2029

References• Keenan, T. A. Home and community preferences of the 45+ population. (Washington, D.C.: AARP, 2010), 4. Available at:

http://assets.aarp.org/rgcenter/general/home-community-services-10.pdf • LeadingAge Center for Housing Plus Services (2014). Study documents higher health costs among HUD-assisted seniors.

http://www.leadingage.org/Study_Documents_Higher_Health_Costs_Among_HUD_Assisted_Seniors.aspx Accessed August 29, 2015. • LeadingAge Center for Housing Plus Services (2014) Housing and Health Care : Partners in Healthy Aging.

http://www.leadingage.org/housinghealth/. Accessed August 29, 2015.• LeadingAge Center for Housing Plus Services (2012). Why housing plus services. Retrieved on March 23, 2014 from

http://www.leadingage.org/Housing_Plus_Services_Rationale.aspx• Mollica, R., and Morris, M. 2005. Massachusetts Supportive Housing Program. New Brunswick, NJ: Rutgers Center for State

Health Policy.• National Association of Area Agencies on Aging, “Making your community livable for all ages: What’s working!” (2015).

http://www.n4a.org/files/n4aMakingYourCommunityLivable1.pdf • National Center for Health in Public Housing (2015), Health Center and Public Housing National Symposium,

http://www.nchph.org/wp-content/uploads/2015/07/2015-Health-Center-and-Public-Housing-Plenary-Descriptions.pdf• Public Policy and Aging Report (2015). Making a home in the city: The age-friendly community movement. Vol. 25 (1) Winter. • Rabins, P. V., Black, B.S., Roca, R., German, P.S., McGuire, M., Robbins, B., Rye, R., and Brant, L. (2000). Effectiveness of a nurse-

based outreach program for identifying and treating psychiatric Illness in the elderly. Journal of the American Medical Association, 283: 2802–2809.

• Reinhard, S., Feinberg, L. F., Choula, R., and Houser, A. (2015). Valuing the invaluable: 2015 update. AARP Public Policy Institute, Washington, D.C. Source: http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-new.pdf

• Robbins, B., Rye, R., German, P.S., Tlasek-Wolfson, M., Penrod, J., Rabins, P. V., Black, B.S.. (2000). The Psychogeriatric Assessment and Treatment in City Housing (PATCH) Program for elders with mental illness in public housing: Getting through the crack in the door. Archives of Psychiatric Nursing, 14: 163–172.


http://assets.aarp.org/rgcenter/general/home-community-services-10.pdf

http://www.leadingage.org/Study_Documents_Higher_Health_Costs_Among_HUD_Assisted_Seniors.aspx


http://www.leadingage.org/Housing_Plus_Services_Rationale.aspx

http://www.n4a.org/files/n4aMakingYourCommunityLivable1.pdf

http://www.aarp.org/content/dam/aarp/ppi/2015/valuing-the-invaluable-2015-update-new.pdf

References• Siu, C. (2009). Impacts of nutrition and human services interventions on the health of elderly and disabled persons in public

housing. Washington, DC: Congressional Hunger Center.• The Gerontologist (2015). Toward the 2015 White House Conference on Aging: Creating an aging policy vision for the decade

ahead. Vol. 55(2), 179-182.• U.S. Census Bureau. (2010). U.S. Population Projections. Available at:

www.census.gov/population/www/projections/summarytables.html• U.S. Census Bureau. (2013). American Community Survey. Retrieved from http://www.census.gov/acs/www/• U.S. Department of Health and Human Services (2014). Picture of housing and health: Medicare and Medicaid use among older

adults in HUD-assisted housing. Available at: http://aspe.hhs.gov/basic-report/picture-housing-and-health-medicare-and-medicaid-use-among-older-adults-hud-assisted-housing

• U.S. Department of Health and Human Services (2014a). Support And Services at Home (SASH) evaluation: first annual report. Retrieved from http://aspe.hhs.gov/daltcp/reports/2014/sash1.pdf

• U.S. Department of Health and Human Services. (2015). Who needs care? Available at: http://longtermcare.gov/the-basics/who-needs-care/• US Department of Health and Human Services, Heath Resources and Services Administration, Bureau of Primary Care, Public

Housing and Primary Care Health Centers. http://bphc.hrsa.gov/qualityimprovement/supportnetworks/specialpopulations/ Accessed August 29, 2015.• U.S. Government Accountability Office. (2015). Older adults: Federal strategy needed to help ensure efficient and effective

delivery of home and community-based services and supports. Available at: http://www.gao.gov/products/GAO-15-190 • World Health Organization (WHO) (2007). Global age-friendly cities: A guide. Geneva, Switzerland. Retrieved August 16, 2012

from http://whqlibdoc.who.int/publications/2007/9789241547307_eng.pdf


http://longtermcare.gov/the-basics/who-needs-care/


http://www.gao.gov/products/GAO-15-190

For additional information about today’s webinar, please contact:

Lori Simon-Rusinowitzemail: [email protected]


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