Wilden, Robert, and Donald L. Redfoot. Added Assisted Living Services To Subsidized Housing: Serving Frail Older Persons With Low Incomes. Washington, DC: Public Policy Institute, AARP, 2002.
The purpose of this study is two-fold, the first being an examination of research on the potential demand for assisted living services in federally subsidized housing and the ability to provide such services, and the second, a discussion of findings from case studies of subsidized housing projects that have developed assisted living services.
This study first examines the existing research on the issues related to assisted living services among older residents in subsidized housing, including a summary of the research on supportive services provided in subsidized housing, specifically the service coordinator program and the federal Congregate Housing Services Program (CHSP). The second approach uses a case study method to examine policy and management issues. Interviews were conducted with 17 sponsors of subsidized housing for the elderly in nine states. Sponsors were chosen in states that provide Medicaid funding for assisted living services, such as New Jersey and North Carolina, and states that do not provide such funding, such as Connecticut. Other states, such as Maryland and New Hampshire, were chosen because of their substantial experience with state or federal Congregate Housing Services Programs. In-person interviews with sponsors in seven states (CT, KY, MD, NJ, NH, NC, and VA) were conducted between October 1999 and January 2000. Six interviews with sponsors were conducted by telephone or mail. Sponsors were mailed a project interview schedule before the interviews to obtain relevant data. The annotated review reports only the case study findings as the findings from the literature are covered in other sections of this review.
The findings from the case studies of 17 projects that provide assisted living services to the elderly cover financial issues, service delivery issues, state efforts and housing types, management, and other issues. Funding sources vary among subsidized housing sponsors, and are often an array of public and private sources. Among the 17 projects, 16 have funding from residents, nine from Medicaid, and six have private funding. Other funding includes other federal, state, and county sources. Funding limitations often result in low staff pay and high staff turnover.
Most projects have assisted living residents scattered throughout the building rather than concentrated in one location. Sponsors for grouping assisted living residents in one location argue that clustering creates economies of scale and saves staff time. Others feel that assisted living residents should not feel stigmatized or isolated from other residents, allowing residents to obtain services without having to move. All of the 11 sponsors visited on-site have managed to incorporate assisted living services while retaining a residential environment. Although most sponsors contract out some of their assisted living services, some owners find that providing services directly can save money. Other owners feel they lack the necessary skills to administer such programs and contracting out services may provide some liability protection. Most sponsors provide individual "a la carte" services rather than bundled services. Sponsors who provide "a la carte" services feel this allows residents to maintain decision-making power and focus on their individual needs. Other sponsors find it easier to structure a system of bundled services, however, those tend to be the larger projects that provide services directly through project staff. Section 202 policy changes have prevented newer housing projects built in the 1980s from establishing mandatory meals, thus, these projects and smaller sponsors, who often lack a commercial kitchen or central dining room, and have more difficulty developing meals programs for assisted living residents
Findings from case studies show that assisted living services can be successfully integrated with subsidized housing for seniors with funding, training, and coordination of housing and service staff major obstacles for implementation. States that have funded such services have also played a key role in development of assisted living services in subsidized housing. But, state efforts to regulate and monitor specific assisted living services will become more common as they begin to address the issue of developing way to monitor and enforce quality. Further research is needed to develop models and strategies for continued expansion and improved quality of assisted living services in subsidized housing for elderly.
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