Design of a Demonstration of Coordinated Housing, Health and Long-Term Care Services and Supports for Low-Income Older Adults. IV. Rationale for a New Affordable Housing with Services Demonstration


Several converging factors might influence policymakers, housing providers, service and support providers and older adults themselves to carefully examine integrating services into an affordable housing platform. Numerous publicly assisted housing properties offer:

  1. A concentration of older adults, many of whom experience multiple chronic illnesses and functional impairment, creating potential economies of scale for preventive, primary and long-term services and support providers.

  2. Existing infrastructure that facilitates offering care coordination and onsite health services, such as physically accessible properties, common space available for the co-location of health services, and the presence of a service coordinator.

For a demonstration to succeed and sustain itself, each of the major stakeholders must find value in the model.

  • Federal and state health policy officials increasingly focus on care patterns of high-cost patients who experience repeat ER visits and hospital stays as a potential avenue to battle rising health care costs. Introducing evidenced-based interventions to residents of subsidized housing may improve the health of community residents and lower health care costs.

  • Anticipated Medicare payment reforms and Medicaid revenue opportunities will incentivize preventive, primary, acute, and long-term services and supports providers to combine forces to improve the care provided to individuals with high health care spending as a result of the current system fragmentation.

  • An aging resident base and the accompanying increase in chronic illness and disability of resident may compel sponsors and managers of publicly assisted housing to consider greater service integration. From the perspective of the property owner or manager, partnering with health and socials service providers may assist in reducing accidents, injuries and resident calls to 911; make it easier for the property to comply with fair housing rules and Olmstead requirements; improve resident transitions between the property and hospital and rehabilitation settings; improve resident and family security and satisfaction while maximizing resident autonomy; improve safety for all residents and reduce complaints about individuals “too sick” to live there; reduce housekeeping and maintenance costs; reduce turnover and evictions; and enhance the properties image in the community and, as a consequence, become an effective marketing tool.

  • Affordable and accessible senior rental complexes, purposely organized to provided health and long-term care services and supports, may enable low-income seniors to retain the autonomy their desire in an independent living setting with care available as needed.

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