The literature mentioned several policy barriers to the expansion of housing with services programs, including:
Restrictions in the Medicaid and Medicare programs, including lack of coverage of mental health care and occupational therapy. Another barrier mentioned was eligibility requirements that restrict the program to people who are impaired in ADLs, excluding people who need IADL assistance only. Lack of funding for registered nurse (RN) coordination was another noted barrier (Rantz et al., 2008).
Section 8 rules that do not permit tenants to be out of their units for more than 60 days was a noted barrier in the HOPE IV demonstration presented a challenge in some cases (e.g., returning from a nursing home within 60 days).
Lack of coordination between financing and regulation/licensing in housing and services, or a disconnect between housing and services programs, was mentioned as a challenge in some studies (Castle, 2008; Washko et al., 2007; Bolda et al., 2000). In their review of rural housing with services programs, Bolda et al. (2000) found that the some states housing development agency and human service agency were run out of different departments. This created the disconnect between the programs, making it more difficult to coordinate housing and services.