2. Session Objectives Learn about the national need for services in Affordable housing Learn about innovative approaches to services Explore potential service delivery options in a housing environment. Learn about the role of the Service Coordinator in the delivery of those services

3. A Change in the National Mindset By 2050, 88 million people will be over the age of 65 in the US – 1/5 th of the total population, 19 million 85+ -Atlantic Monthly. Medicaid will not be able to house the growing number of low-income frail older adults in nursing homes and assisted living center. Most people will want to remain at home whenever possible. Economics and a focus on self-directed care are changing the drive from institutionalization to home.

4. Lewin Group Study Medicare and Medicaid Use in Affordable Housing HUD-assisted residents had more chronic conditions 55% of HUD-assisted MME’s (dual eligible) residents 5 or more compared to 43% of unassisted MME’s.

5. Medicare payments and utilization: HUD-assisted MME beneficiaries' average Medicare FFS per member per month (PMPM) payment was 16% higher than unassisted MMEs in the community ($1,222 compared to $1,054). Higher utilization by HUD-assisted MMEs for home health visits (31% higher), ambulatory surgery center visits (45% higher), physician office visits (26%), and emergency department visits (13%) drove the higher payments. Medicaid payments and utilization HUD-assisted MMEs Medicaid FFS PMPM payment was 32% higher than unassisted MMEs ($1,180 vs. $895). HUD-assisted MMEs used over 100% more Personal Care services, 80% more "other HCBS", and over 67% more durable medical equipment services

6. Medicaid payments and utilization HUD-assisted MMEs Medicaid FFS PMPM payment was 32% higher than unassisted MMEs ($1,180 vs. $895). HUD-assisted MMEs used over 100% more Personal Care services, 80% more "other HCBS", and over 67% more durable medical equipment services Medicare Service Utilization per 1000 Member Months HUD-Assisted MMEs with Medicaid FFS (N=106,764) Unassisted MMEs with Medicaid FFS (N=227,186) Ratio of HUD-Assisted vs. Unassisted MMEs Mean Personal Care services 4,512.42,149.12.09** Residential care 38.963.70.61** DME 380.0227.71.67** Other HCBS 2 3,309.81,840.61.79**

7. LeadingAge Center for Housing Plus Services 12 housing providers across the country Associated Catholic Charities in Baltimore, MD, Associated Catholic Charities Cedar Sinai Park in Portland, OR Cedar Sinai Park Cathedral Square Corporation in Burlington, VT, Cathedral Square Corporation Evangelical Lutheran Good Samaritan Society in Sioux Falls, SD, Evangelical Lutheran Good Samaritan Society Housing Authority of Milwaukee in Wisconsin, Housing Authority of Milwaukee Mercy Housing California in San Francisco. Mercy Housing California National Church Residences in Columbus, OH, National Church Residences NewCourtland in Philadelphia, PA. NewCourtland Peter Sanborn Place in Reading, MA, Peter Sanborn Place Presbyterian Senior Living in Dillsburg, PA, Presbyterian Senior Living Presbyterian Villages of Michigan in Southfield, MI, Presbyterian Villages of Michigan Selfhelp Community Services in New York, NY, Selfhelp Community Services

8. Learning Collaborative Each is working with a service provider either internal or external Came together to: Identify the essential elements and practices of promising Housing Plus Services Develop indicators and mechanisms to measure whether these models can improve health outcomes for seniors while creating cost savings for the health care system. Explore how regulatory and financing models could help bring these models to scale so they can serve the large and rapidly growing population of older Americans.

9. Gateway Collaborative Currently under development with Oasis taking the lead Hope to work with Accountable Care Organizations, ACOs Aftercare Evidence based wellness programs Network of care providers

10. Support and Services at Home SASH: A Collaborative Partnership Based in Vermont Over 50 housing, home health, hospital and social service agency partners Funded by state Medicaid and other resources Preventative health care and services coordination Self-management education and coaching, particularly relating to chronic health conditions such as diabetes and arthritis Transitions support after a hospital, nursing home or short- term rehab facility stay

11. Housing Service Provider Types Collaboratives/partnerships Multiply service providers Shared responsibilities Shared risk Single entity All housing and services provided in house

12. Benefits to SASH Participants Comprehensive health and wellness assessment Individualized Healthy Living Plan Money savings through preventative health care Check-ins and health coaching Convenient access to a wellness nurse Planning for successful transitions A trusted guide to help navigate long-term care An informed team to help in a crisis Access to prevention and wellness programs Medication management assistance

13. Self-Provided Services Larger organizations and companies Typically multi-divisional including Home and Community Based Services Licensure and regulatory responsibilities lie outside of housing provider Consultation and support services available in-house Legal and Risk Management Fundraising Accounting Medicare and Medicaid billing where applicable

14. Lutheran Senior Services Continuing Care Retirement Communities Independent Assisted/residential care Skilled Nursing/short stay rehab Home and Community Based Services Home Health Hospice Private Duty Outreach Social Service Affordable Housing

15. 10 locations -756 units HUD 202 PRAC HUD 202/8 Low Income Housing Tax Credits Moderate market rate Service Coordinators Chaplaincy Limited services

16. Project Wellness Pilot Enterprise Community Partner grant 2012 Telehealth Kiosk Wellness Nurse Partnership with Oasis for wellness programming Village at Mackenzie Place 90 units (at time of grant) Rose Hill House (control group) 97 units

17. Project Wellness Pilot Project demonstrated Decrease in hospitalizations Decrease in readmissions More health self awareness in residency Expanded to Rose Hill House in 2014

18. Lutheran Foundation Grant Overview Funded innovative approach to housing with wellness services Outreach to seniors in surrounding community Technology $384,000 over 3 years, awarded in March, 2015

19. Funded Under the Grant Telehealth Kiosk for the remaining communities in Metro St. Louis area Free access to residents and participants Bump in Service Coordinator salary Wellness Nurses Administrative financial assistance

20. The TeleHealth Kiosk Blood pressure, weight, pulse, blood glucose Alerts when any results are out of acceptable parameters Health Questions Hospitalization questions Isolation and depression related questions Lifestyle questions

21. Role of the Service Coordinator to Increase Wellness Participation Identifying residents who have had falls, hospitalizations, and heart health problems. Marketing Phone calls and flier reminders Incentive programs Monitoring and follow-up on kiosk alerts Partner with Wellness Nurses

22. Role of the Wellness Nurse Monitoring and follow-up on kiosk alerts Information and referral Encouragement Promote lifestyles Partner with Service Coordinator

23. Future Expansion Chore worker services LSS HCBS Private Duty Subsidized fee scale Expanded responsibilities of Service Coordinator Care Coordinator More in-depth care plans

24. Wrap Up Housing with Services will be the norm Strong collaboration and partnerships necessary to provide services Start building your network now Reliable funding streams needed

25. Questions?

26. Contact Information Susan Hutchinson Executive Director of Affordable Housing Lutheran Senior Services 1150 Hanley Industrial Court St. Louis, MO 63144 (314) 446-2558 Susan.Hutchinson@LSSLiving.org www.LSSLIVING.org

27. Resources Lewin Group Study: http://aspe.hhs.gov/daltcp/reports/2014/HUDpic.shtmlhttp://aspe.hhs.gov/daltcp/reports/2014/HUDpic.shtml LeadingAge Center for Housing with Services: http://www.leadingage.org/Center_for_Housing_Plus_Services.aspx http://www.leadingage.org/Center_for_Housing_Plus_Services.aspx LeadingAge Strategies and Tools: http://www.leadingage.org/Housing_Plus_Services_Strategies_and_Tools.aspx http://www.leadingage.org/Housing_Plus_Services_Strategies_and_Tools.aspx Support and Services at Home (SASH): http://www.sashvt.org/http://www.sashvt.org/ Atlantic Monthly article: http://www.theatlantic.com/business/archive/2015/05/living-and-dying-at- home/391871/ http://www.theatlantic.com/business/archive/2015/05/living-and-dying-at- home/391871/