Affordable Housing Plus Services for Seniors

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As America’s senior population continues to grow, the need for new models of delivering health-related and supportive services that are both attractive and affordable to low- and modest-income older adults is increasingly clear. Although assisted living is a relatively popular alternative to nursing homes, it remains too expensive for many seniors with limited incomes. Aware that an established relationship exists among age, chronic illness and disability, and long-term health care needs, policymakers are seeking additional options for seniors.

One promising strategy, affordable housing plus services (AHPS), links older residents of subsidized multiunit housing with health and supportive services that allow them to age in place. The U.S. Department of Health and Human Services (HUD), and the A.M.

Affordable housing plus services enables older residents of subsidized multiunit properties to age in place rather than moving into a nursing home.

McGregor Home in Cleveland, Ohio jointly commissioned the Institute for the Future of Aging Services (IFAS) to explore the potential of AHPS to meet the long-term care needs of low- and modest-income seniors. This was a unique policy study, in that four regional workshops brought together representatives of housing and services, many of whom had never met before, to think through the implications of the AHPS model in their areas. IFAS, the nonprofit applied research arm of the American Association of Homes and Services for the Aging, was able to identify models, strategies, and programs that are currently integrating affordable housing with health and supportive services for seniors.

Research indicates that 1.8 million older adults live in federally subsidized rental housing. Unknown numbers of low-income seniors receive rent subsidies from municipalities and states, and still others living in privately owned housing receive no subsidies at all. Many of these adults have disabilities and limited mobility, and others require help with meal preparation or personal care. IFAS cited evidence that residents of subsidized senior housing who lack access to supportive services are more likely to be forced to transfer to a nursing home as they age. The problem stems from a disconnect between housing providers and community service agencies, according to IFAS, because they view their missions differently and have little experience working together. One solution may lie with AHPS initiatives existing in various forms around the country.

AHPS Initiatives at Work

The Institute found two types of AHPS initiatives: privately financed and publicly subsidized. Initiators of privately financed AHPS programs typically are individual providers of housing co-ops, shared housing, senior mobile home parks, and single-room occupancy hotels. In one example, Penn South Cooperative in New York City established the nonprofit Penn South Program for Seniors to support its aging residents. IFAS reports that this nonprofit...

“...offers case management; group recreation; educational, cultural and artistic programs; home-care coordination and non-acute nursing care; social daycare for those with dementia; health education and preventive services; money management; and advocacy. The program is staffed by social workers, nurses, and home-care coordinators. Penn South...[is] a training site for geropsychiatric fellows and receives free psychiatric consultations. In addition, two medical centers have opened geriatric practices onsite, and the Visiting Nurse Service of New York is contributing a half-time nurse to perform non-reimbursable services.”

The co-op also recently opened an onsite physical therapy office to serve all ages, with a special focus on preventing falls among elderly residents.

IFAS found an array of publicly subsidized AHPS strategies in use around the country, including co-location of services with subsidized housing; housing management staff who either coordinated or provided services; property managers, residents, and providers collaborating to arrange services for residents of naturally occurring retirement communities; and partnerships among state housing agencies, housing properties, and state aging and health agencies. In one example of a co-location model, IFAS describes what Koinonia Apartments, a Section 202 property sponsored by the First Presbyterian Church of Lenoir, North Carolina, is doing:

“The administrator functions as a property manger, service coordinator, and case manager. Koinonia Apartments has identified multiple community agencies that can provide services onsite at little or no cost to residents. The property serves as the site for an OAA Title III nutrition program, which [provides] a noon meal five days per week to residents and community members. Green Thumb, which operates a federally funded training program for older workers, supplies housekeepers in training at no charge to provide light housework, such as laundry, making beds, and sweeping. The property administrator also maintains a list of individuals in the community who provide reasonably priced housekeeping services. Personal care is available from the Caldwell County Home Health Agency and from the local Community Action Program. Both agencies provide a limited amount of personal care at no charge to residents. The property also provides a variety of activities for its residents, including exercise, blood pressure checks, craft activities, entertainment, and transportation.”

Next Steps

IFAS concluded that, although AHPS programs have not been carefully evaluated, they do have two clear advantages. First, seniors like having a level of support that allows them to remain in their own homes as their health declines. Second, AHPS initiatives can be extremely cost effective, because they often employ existing community resources. Policymakers need to know how well AHPS strategies work before formally committing resources to the model, however. More evidence is needed on what an effective strategy looks like, which services are critical, the prerequisites of a successful strategy, the obstacles, and the funding opportunities. Ultimately, the use of AHPS models, although successfully demonstrated in some communities, would require far greater numbers of housing providers to be committed to the concept, greater capacity building among providers, objective evaluations of AHPS models and practices, and adequate funding.

The results of IFAS’ exploration, A Synthesis of Findings from the Study of Affordable Housing Plus Services for Low- and Modest-Income Older Adults, is available at www.huduser.org/publications/affhsg/synthesis.html. This report and supplemental documents, Inventory of Affordable Housing Plus Services Initiatives for Low- and Modest-Income Seniors (www.huduser.org/Publications/pdf/inventory.pdf) and Lessons from the Workshops on Affordable Housing Plus Services Strategies for Low- and Modest-Income Seniors (www.huduser.org/Publications/pdf/workshop_report.pdf), are all available as free downloads from HUD USER.