1. Aging Gracefully: An Anticipated Future in Housing First Presented by Patrick J. O’Dwyer & Erica Alexander M.A.

2. Services Offered in Our Permanent Supportive Housing Model  Mental Health Services  Chemical Dependency  Supported Employment Services  Payee Services  24/7 on site support  Some meal provision/ shopping  Emergency call systems in apts.  Meaningful Activities  On site RN (some sites)

3. Long Term Services and Supports (LTSS)  Home and Community Based Services  Assisted Living Facilities  Home Health Agencies  Skilled Nursing Facilities  Hospices

5. What’s So Great About HCBS?  Vital services are brought to residents who need them, allowing them to age in place.  Has the potential to substantially raise residents quality of life  Way, way cheaper to provide than institutional care (national average for institutional LTSS care $42,800 annually per person)

6. Home and Community Based Services Non-Medical  Housekeeping  Bathing/Hygiene  Dressing  Laundry  Cooking  Shopping  Some Transportation  Meaningful Activities Medical  Physical Therapy  Occupational Therapy  Medication Management  Outreach Nursing

7. ...Not So Great? Practical Issues  Not designed to serve our population  Assessment Issues  Keeping scheduled appointments  Not 24/7 service  Accountability/Turnover  Resource allocation Relational Issues  Interpersonal Challenges (alliance necessary)  HR/HF/TIC values lacking  Flexibility  Substance use  Escalated behaviors

8. All this to say?  Don’t assume that just because a service connection has been made between HCBS and a resident that it will be effective or long lasting.  In the name of resident dignity and for the sake of their quality of life, be prepared to flex and assist residents while solutions are sought.  Our folks deserve better

9. Current/ Projected Age Demographics Nationally  Number of people utilizing LTSS expected to nearly double in the next 35 years from 15 million currently to 27 million  Overall U.S. population 65+ projected to “boom” from 40.2 million to 88.5 million during the same period Organizationally  DESC housed 1006 residents in 2013  DESC’s resident populations average age is 51 years old  57% of residents housed by DESC in 2013 were 50+ yrs. old

10. What’s the Point?  As the general population ages and the demand for HCBS increases it will be even more difficult to connect the population that we house with these critical services.  Organizations should anticipate these difficulties and cultivate partnerships with service providers who can effectively bring these services to our population in their homes or, depending on your own demographics, consider forming a HCBS program to meet the needs yourself.

11. On the Ground at DESC’s Canaday House

12. My Immediate Concern…  Average age of 82 Canaday House residents is 56 years old  66% are 50 or older (55/82)  27% are 60 years or older (21/82)  22% are enrolled in chore services that they pay for (19/82)  Only 4% are enrolled in HCBS (3/82)

13. Supportive Housing Model The model is designed to assist individuals in achieving their highest level of self-determination using a housing first harm- reduction based practice. The design of the facility, staffing patterns, program values and ways of interacting with residents all combine to create a program that helps people succeed over the long term. Service delivery roles: Project Manger Residential Counselors Clinical Support Specialists Case Managers/CD Counselors On site nursing care/coordination

14. How Can We Assist You?  Jane was a 59 year old African-American woman who was living in supportive housing when she was diagnosed with terminal cancer. Jane also suffered from gout, hepatitis C, vascular ulcers in her legs and memory loss. In addition to the medical conditions Jane also struggled with major depression, severe crack cocaine addiction with occasional alcohol use and she regularly smoked tobacco.  Jane wished to stay in her home and refused to consider an Adult Family Home due to income restrictions, not knowing the staff and being away from family and losing her sense of independence.

15. Issues and Interventions Challenges  Residents right and choice to be ill in their own home when they are beyond our scope of care  Staff lack medical training/knowledge  Facilities are not equipped to work with substance addictions and behavioral issues related to mental health  Rapport and sense of community Interventions  Housing staff  Home and Community Services (COPES)  Primary care and Hospice  Neighbor Care partnership  Case Management  Family  Skill Building  Flexible nursing facility

16. What we have learned…  Our population is aging and there are not enough resources to meet the needs of the residents we serve  Higher level of care facilities are not equipped to treat/care for individuals with severe mental health and/or addiction issues and the associated behavioral issues that may accompany major disorders  Services need to be brought to the individual so they can remain in their homes

17. Please feel free to contact us via email Patrick can be reached at podwyer@desc.orgpodwyer@desc.org Erica can be reached at ealexander@desc.org