Financial challenges of housing-with-health-services models for low-income older adults

Reviewed by Megan Craig, M.Sc.Oct 31 2023

A groundbreaking study published in the journal Research in Aging sheds light on the financial challenges of housing-with-health-services models for low-income older adults. The report explores strategies for ensuring the sustainability of these beneficial efforts.

The study was conducted in partnership with Hebrew SeniorLife, a Harvard Medical School-affiliated nonprofit organization serving older adults in the Greater Boston area. It drew on insights from 31 key informational interviews and three focus groups with payers, housing providers, and community partners.

The Right Care, Right Place, Right Time (R3) Program deploys wellness teams in affordable housing sites. These teams include coordinators and nurses who adopt an "eyes-on" approach, training all housing staff to observe and contribute to care coordination for residents. The teams bridge housing and healthcare efforts, supporting residents where they live and aiming for better health outcomes and prolonged independence.

Despite the recognized potential of these programs to enhance the lives of low-income older adults, finding reliable funding sources is a significant hurdle.

Key findings from the study, "Promoting Sustainability in Housing with Services: Insights from the Right Care, Right Place Right Time Program," include the following:

• Recognized Value: Participants unanimously recognized the value of housing-with-services programs in improving the well-being of older adults.
• Funding Need: There was little consensus on how to secure ongoing funding for these programs. The responsibility for individuals in housing sites is distributed across health insurers, hospitals, and community service providers, making it challenging to incentivize investment.
• Government's Role: The study suggests that governmental mechanisms, possibly at the federal level, are needed to channel funding toward supportive services. Without reliable funding sources, replicating these housing models for low-income older people will be difficult.

The study emphasizes the need for innovative solutions to secure funding for supportive services. Sustaining and financing these models has proven to be a complex issue, given the separate systems of publicly-funded housing and healthcare."

Marc A. Cohen, co-author, co-director, LeadingAge LTSS Center, Department of Gerontology, University of Massachusetts

Housing models that integrate supportive services have proven popular among better-off individuals who can afford private-pay environments. Yet options for older people with fewer resources have remained limited due to scarce public financing. The Section 202 low-income housing program, established by the U.S. Department of Housing and Urban Development, has been one option for affordable housing for people aged 62 and older. Service coordinators were added to the program in 1990; yet it has remained limited in scope and poorly funded over the years, leaving many older adults without access to supportive housing environments.

"We expect these findings to contribute to a broader understanding of how housing-with-services models can be developed and maintained to benefit low-income older adults," said Kim Brooks, chief operating officer, senior living, Hebrew SeniorLife.

The study examined the experiences and perspectives of individuals involved in the Boston-area Right Care, Right Place, Right Time Program, which enrolled 400 older adults across seven intervention sites. Four sites were operated by Hebrew SeniorLife and three were operated by partner providers, including Milton Residences for the Elderly and WinnCompanies.

Lead author of the study was Pamela Nadash, PhD, associate professor, Gerontology Department, University of Massachusetts. Co-authors include Edward Alan Miller, professor and chair, Department of Gerontology, University of Massachusetts; Elizabeth J. Simpson, MPH, Department of Gerontology, University of Massachusetts; Molly Wylie, Department of Gerontology, University of Massachusetts; Natalie Shellito, Department of Gerontology, University of Massachusetts; Yan Lin, Department of Gerontology, University of Massachusetts; Taylor Jansen, PhD, Department of Gerontology, University of Massachusetts; and Marc A. Cohen, co-director, LeadingAge LTSS Center, Department of Gerontology, University of Massachusetts and Center for Consumer Engagement and Health System Transformation, Community Catalyst.

This work was supported by Hebrew SeniorLife, which designed and piloted the R3 program and secured additional funding for the evaluation and intervention. Funders include the Commonwealth of Massachusetts Health Policy Commission Health Care Innovation Investment Program; Beacon Communities LLC; Boston Scientific Foundation; Coverys Community Healthcare Foundation; Enterprise Community Partners; Massachusetts Department of Housing and Community Development; Mass Housing; and The Pioneer Institute.