Tag Archives: Department of Housing and Urban Development

Housing is the Platform to Improve Health

29 Oct

For several years our firm has advocated providing support services at home to ensure improved well-being and cost savings. In doing so we have run into the silo mentality that exists in most government organizations. The US Department of Housing and Urban-Development (USHUD) insisted until recently that housing was just a roof, whatever happened under that roof was not an issue for them. In 2003, with several successful projects under our belt, we approached both USHUD and the Department of Health and Human Services (HHS) to collaborate so that appropriate services could be combined with housing. It took several years for them to accept that this concept was vital to serving the very individuals for whom they existed. A recent article published by USHUD speaks of housing as the platform to improve health and that stable housing was essential in addressing the health needs of chronically homeless individuals. What a novel idea!

The article highlights several programs undertaken in Boston, New York and Chicago. In Boston it was revealed that health issues impeded the ability of residents to obtain and retain housing. New York Common Ground organization found that in order to meet the needs of the homeless population a partnership between health and services was essential. The Chicago project demonstrated that a strategy to marry healthcare and stable housing was successful and cost-effective by reducing unnecessary hospitalizations and emergency calls.

All of the collaborating institutions, however, realize the difficulty of establishing collaboration and integration among disparate systems, programs and organizations. They call for a focus on individual needs, system reforms and elimination of existing barriers to collaboration and integration. All is well you may say. However, in our experience there is a chasm between identifying the issues and doing something about them. Time will tell if we can do it right.


Stop Forcing Low Income Seniors into Nursing Homes!

8 Jun

This has been our battle cry for over twenty years. The benefits of keeping seniors at home with needed services has proven to be cost-effective, beneficial to the health of these clients and responsive to seniors’ desires. And yet, change has come slowly particularly in southern states. Under the pressure of skyrocketing Medicaid budgets fueled by the increasing numbers of low-income seniors our policymakers have had to shift toward funding more community instead of institutional care (nursing homes), what is called in the industry: “rebalancing long-term care.”

One state that has been successful in doing so is Oregon that rebalanced their budget back in the early 1980’s. Many other states have followed, including Washington and Colorado. The number of people receiving Medicaid-funded nursing facility care in these states grew at a much slower rate than in the rest of the nation from the inception of Medicaid home and community-based waiver programs in the early 19080s to 1994. The number of people in nursing homes as a proportion of the population age 75 and above in these states decreased faster than the average for the rest of the nation. Total annual Medicaid spending on nursing facilities also increased at a slower rate in the study states than nationally after controlling for growth of the age 75-and-older population.

Today only a handful of states remain committed to forcing seniors into nursing homes when no longer able to live independently – Kentucky, Virginia, Alabama and West Virginia do not pay for assisted living services. Although an increasing number of states have created Medicaid waivers to pay for assisted living services, the funding always falls short of the need which creates long waiting lists. clients in need of assisted living services cannot wait the two or three years it takes to receive an allocation. So seniors and disabled adults are still forced into nursing homes and we continue to pay for poor quality and undesirable care.

In 2003 our firm started the conversation with the Department of Housing and Urban Development urging them to join forces with the Department of Health and Human Services (federal Medicaid program) to properly fund community care at least for those living in public/subsidized housing. Seven years later, it happened and both departments partnered to create the Community Living Initiative that funds housing and services for low-income disabled adults. Seniors, however, have to wait longer and as of today no initiatives have been taken to address the issues of the seniors.

Apparently financial crisis alone will not prompt the federal government to act. I firmly believe the issue of low-income seniors ending up in nursing homes prematurely must arouse public opinion. Those most affected, the seniors, the families, the advocates, need to demand this change. Rather than being remembered as the “silent minority” we must be remembered as the generation that changed the way we care for seniors in this country.