U.S. Department of Health and Human Services

A Synthesis of Findings from the Study of Affordable Housing Plus Services for Low and Modest-Income Older Adults

Executive Summary

Mary F. Harahan, Alisha Sanders, M.P.Aff., and Robyn Stone, Dr.P.H.

Institute for the Future of Aging Services, American Association of Homes and Services for the Aging

August 2006

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This report was prepared under contract #HHS-100-03-0009 between the U.S. Department of Health and Human Services (HHS), Office of Disability, Aging and Long-Term Care Policy (DALTCP) and the Lewin Group. Additional funding was provided by the U.S. Department of Housing and Urban Development. For additional information about this subject, you can visit the DALTCP home page at http://aspe.hhs.gov/_/office_specific/daltcp.cfm or contact the ASPE Project Officer, Gavin Kennedy, at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. His e-mail address is: Gavin.Kennedy@hhs.gov.

The opinions and views expressed in this report are those of the authors. They do not necessarily reflect the views of the U.S. Department of Health and Human Services, the U.S. Department of Housing and Urban Development, the contractor or any other funding organization.

With the relationship between increasing age, chronic illness and disability, and growing long-term care needs well documented, new models of delivering health-related and supportive services are being sought that are attractive and affordable to low and modest-income older adults. One promising but under explored strategy, affordable housing plus services (AHPS), links older residents of subsidized multi-unit housing to health and supportive services so that they can “age in place.” The U.S. Departments of Health and Human Services (HHS) and Housing and Urban Development and the A.M. McGregor Home in Cleveland, Ohio, funded the Institute for the Future of Aging Services (IFAS), the policy and applied research arm of the American Association of Homes and Services for the Aging, to examine the potential of AHPS strategies to meet some of the long-term care needs of low and modest-income seniors. IFAS defines AHPS as having three elements:

• Independent, unlicensed, primarily subsidized, multi-unit housing where large numbers of low and modest-income older adults live in close proximity.
• Health-related and supportive services, funded separately from the housing, and available to at least some older residents (e.g., personal care, housekeeping, meals, transportation, health and wellness services, etc.).
• A purposeful linkage mechanism connecting residents to needed health-related and supportive services so that they are able to “age in place” in the face of declining health and increasing disability.

The study examined the literature on integrating affordable housing and health and supportive services for older adults, developed an inventory of promising AHPS strategies and programs, and brought together several hundred stakeholders from the fields of affordable housing and aging services in four workshops convened in four regions of the country. The study found a wide variety of AHPS programs in operation, typically at the initiative of individual housing providers. Hard evidence on the impact of these programs is lacking. Stakeholders at the workshops generally agreed that AHPS strategies could be effective in helping some publicly subsidized housing residents maintain independent living, even in the face of declining health and increasing disability. Programs they deemed most successful: (1) bridged the different worlds of housing and aging services; (2) involved housing providers committed to a broader role; (3) possessed the skills to develop collaborative relationships with community partners; and (4) pro-actively sought out funders and overcame regulatory barriers. The study concluded that wider replication and dissemination of AHPS programs will require additional numbers of committed housing providers, increased provider capacity, and concrete demonstration and evaluation of the impact of AHPS programs.