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The AARP Public Policy Institute highlights three state programs that it says proactively connect long-term community services and support recipients with both housing and services. Two of these states have adapted their home care regulations to do so.
The report is part of the organization’s LTSS Choices initiative, which seeks ideas for “common sense” programs with this goal and presents models that are
ready for widespread scaling or with potential for success.
Although most states and managed care plans help individuals find affordable housing when transitioning from nursing homes to the community. But Massachusetts, New Jersey and Connecticut have gone further by finding a way to bolster their LTSS support by designing subsidized housing platforms that address the lack of affordable and accessible housing and labor shortages, according to the authors.
Subsidized housing creates economies of scale by consolidating service delivery and “effectively reaching concentrations of older adults using home and community services”, they said. This helps stretch limited labor and financial resources while improving the quality of care, to keep people in their communities, they added.
The authors noted that, among other things, two states changed their assisted living regulations to “adapt to the realities” of existing physical property designs, current housing regulations, and the potential volume of participating people on a property. “Some have also added categories to their assisted living regulations to specifically include assisted living in subsidized housing communities,” they said.
The Connecticut and New Jersey programs, for example, hire licensed assisted living service agencies to provide on-site services. In Connecticut, this includes residents of affordable senior housing (independent living) communities, including properties in the state’s Congregate Housing for the Elderly Program, administered by the Connecticut Home Care Program for the Elderly funded by the federal government.
In New Jersey, assisted living program staff must provide the same services available at licensed assisted living residences and must provide or arrange for those services.
In both states, residents pay monthly rent and can receive a housing and urban development subsidy that limits their rent costs to 30% of their income. Additionally, Connecticut residents eligible for a state-funded component are responsible for 9% of the cost of services.
These plans have reduced the number of aids needed to serve the same number of people, helping to alleviate an “explosive demand” for home aids and existing aid shortages, according to the report. On-site staff also provide greater continuity of care, allowing them to detect issues such as potential health issues or accidents earlier that can lead to emergency room visits, hospital stays and further decline. , the authors said.
The Massachusetts program, meanwhile, is for people living in publicly funded public housing for seniors and people with disabilities. The state contracts with private non-profit service providers at no cost to residents. The program is open to all residents who live in a property that operates the program.
The success of these programs may depend in part on the number of individuals needed to make them financially viable. In some cases, this may be limited by residents who are ineligible to receive assisted living services through Medicaid or may be dispersed among multiple providers through a Medicaid waiver program.
“This can cause providers to discontinue programs or be reluctant to start new ones,” the authors noted.
Although the state’s strategies do not produce new housing units, “they offer a promising approach to delivering LTSS that can provide more flexible and responsive supports to residents than the traditional model of individual home care,” they said. said the authors.
Providing integrated and community-based care options to LTSS recipients in affordable housing platforms “could strengthen the case for increased public and private investment in new affordable housing stock,” they concluded.