Housing Plus Services:
Promoting Independent Living for the Elderly & People with Disabilities
March 24, 2010 8:30 a.m. to noon
By creating more housing plus services, the state can help the elderly and individuals with disabilities live more independently and successfully. Investing in resident services coordinators, rental assistance, Money-Follows-The-Person and other strategies would not only provide a cost savings but is also the humane thing to do.
For example, a large percentage of elderly and disabled Medicaid recipients now in nursing homes and could live less expensively in their own homes.
Policy Recommendations
Download the policy ideas that came out of the forum here. Join in the discussion on our LinkedIn group!
Briefing Memo
Download the Housing Plus Services briefing memo here.
Materials
Public Housing and Supportive Services for the Frail Elderly:
A Guide for Housing Authorities and Their Collaborators
The Milbank Memorial Fund and the Council of Large Public Housing Authorities
Linking Housing and Services: Obstacles, Options, and Opportunities
Presentation at the Annual Meeting of the CT Coalition on Aging by Nancy W. Sheehan, PhD
Housing Barriers and Opportunities for Persons with Disabilities
Nancy W. Sheehan, PhD
The Aging of the Homeless Population: Fourteen-Year Trends in San Francisco
Judith A. Hahn, PhD et. al.
Presentations
Housing Plus Services: Texas
John Rio, Advocates for Human Potential
Housing Plus Services Across the United States
Lisa Sloane, The Technical Assistance Collaborative
Media Coverage
Program Focuses on In-Home Services
New Haven Register
Summary
Experts in housing plus services for the elderly and disabled told a forum at The Lyceum Resource and Conference Center March 24 that Connecticut can save hundreds of millions of dollars, and provide more humane services, by housing and serving clients in their communities rather than in institutions.
“Housing Plus Services: Promoting Independent Living for the Elderly and Disabled,” was the third forum in The 2010 Housing Policy Services co-sponsored by The Partnership for Strong Communities, the state Department of Economic and Community Development and the Connecticut Housing Finance Authority (CHFA.)
Peter Gioia, the chief economist for the Connecticut Business and Industry Association, said the potential state budget savings from moving elderly and disabled people from nursing home care to home care was as much as $600 million annually.
"We have to make it as easy to access home care as we do nursing home care," said Gioia, citing a recent BlumShapiro study done for the Connecticut Regional Institute for the 21st Century that found that home care was, on average, $34,000 per year compared to $73,000 for institutional care. Gioia said Connecticut is 3rd in the nation in per capita use of nursing home care, a level that needs to be lowered.
But the economists, lawmakers, Medicaid specialists and others cautioned that a wholesale shift of clients from nursing homes and hospitals to supportive housing and home care is complicated, requiring many services and significant case-by-case management and flexibility. Despite the challenge, CHFA’s Tim Bannon noted that the “financial hurricane” Connecticut is entering may catalyze policymakers and the public to reassess the fundamental structure of government, in order to find efficiencies and ensure better outcomes with scarce public dollars. He said that housing can be critical in providing services more efficiently. “If services are like spokes in a wheel, housing is the hub that holds these services together, without which we have a bunch of spokes that go nowhere.”
Richard Cho, Director of Innovations for the Corporation for Supportive Housing, said that effective service-enriched housing must include: 1) deep housing affordability, which requires housing subsidy, 2) flexible services, and 3) permanency of housing and services. Without addressing these three components simultaneously, efforts will fall short. Cho noted that Connecticut has done strong work in creating supportive housing for the chronically homeless with intensive needs, and “light-touch” housing with individuals and families with less intense needs, but there is significant need for improvement in medium-intensive service enriched housing.
National experts pointed out standards that many states use to ensure easy access to services:
- keeping eligibility simple.
- marketing a wide array of services.
- coordinating with housing authorities.
- making eligibility voluntary.
- ensuring that housing choice is a priority.
- being able to measure results.
And here's a caution," said John Rio, senior program associate at Advocates for Human Potential in Texas. "Residents in permanent supportive housing don't want their case managers to be their therapists. They want their homes to be their homes."
Dawn Lambert, Money Follows the Person Project Director at the Dept. of Social Services (DSS) noted that Connecticut has a higher percentage of its elderly citizens institutionalized than any other state – at sizable cost to Connecticut. But Lambert had several ideas for increasing housing plus services in Connecticut:
- Encourage Public Housing authorities to apply for federal services funds.
- Take advantage of the new federal health reform bill which will make resources available to CT’s disabled and elderly.
- Focus on home- and community-based services that help people sooner than hospitalization, keeping small problems from becoming big, expensive problems.
- Do better data collection and analysis to quantify needs, monitor outcomes and find efficiencies.
- Partner with private investors and philanthropy.
Mark Pellegrini, Director of Planning and Economic Development for the Town of Manchester, said that because the biggest obstacle to getting service-enriched housing built is local opposition based on misperceptions, public outreach and communication is critical. He also noted that housing developers routinely have to seek many approvals in a complex permitting process – one that sometimes has additional regulations related to providing services. Streamlining these systems can allow more development to occur.
Barbara Geller, Statewide Services Division Director for the Dept. of Mental Health and Addiction Services (DMHAS), offered hope for future success, since the state’s interagency collaboration on chronic homelessness – including DMHAS, DSS, DCF, DECD, CHFA and OPM – has shown that agencies can work well together on common goals. This type of collaboration will be critical as Connecticut fosters policies that better merge housing and services.
A focus on tying policies and funding together is critical. Lisa Sloane, a senior associate with the Technical Assistance Collaborative, said Louisiana learned in the aftermath of Hurricane Katrina that it lacked the infrastructure to provide housing plus services. So it embarked on an effort to use Shelter Plus Care, project-based vouchers and Low Income Housing Tax Credits to create 3,000 units of housing and then employing Community Development Block Grants (CDBG) and Medicaid to target clients and provide services.
"You must have a local lead agency and a housing support team to help people stay in housing and remain stable," Sloane said. Ohio, she said, employed an Interagency Council on Homelessness and Affordable Housing to create a plan for 6,000 units, using such tools as the Section 811 program for housing people with disabilities, Housing Choice Vouchers (the former Section 8 program), and Medicaid for the services.
"The main takeaway is that you need state involvement and local partners," Sloane said.
2009 Forum
Read a summary of last year's event here.