A new report from the Bipartisan Policy Center (BPC) makes a strong case for integrating health and supportive services into housing as a way to improve health outcomes for older adults and reduce health care costs.
Healthy Aging Begins at Home was released in late May by BPC’s Senior Health and Housing Task Force.
Robyn Stone, executive director of the LeadingAge Center for Applied Research (CFAR), serves on the task force’s Advisory Council.
CFAR has been working for more than a decade to research and promote models that use housing as a platform for delivering needed health and supportive services to vulnerable older adults.
“We are truly gratified that BPC has recognized these models as a key to ensuring that low-income elders can enjoy health and independence as they age in community,” says Stone. “The BPC report is important because it highlights the bipartisan nature of this issue. Now, it’s up to the provider community to reinforce the report’s messages and call for policy action.”
In its effort to promote healthy aging, BPC’s Senior Health and Housing Task Force makes recommendations in 4 broad areas. Those areas include:
- Increasing the supply of affordable homes for the nation’s oldest citizens
- Transforming homes and communities so older adults can “age with options” and have their needs prioritized in community decision-making.
- Integrating housing and health care.
- Deploying technologies to help all Americans age successfully.
7 Ways to Better Integrate Housing and Services
The BPC task force report devotes an entire chapter -- and 7 recommendations -- to the role that housing can play in helping older adults access health and wellness services, and manage their chronic conditions.
Those recommendations address how home-based care coordination, primary care, falls prevention, and health risk assessments, as well as Medicaid rebalancing, data collection, and hospital discharge planning can help older adults age healthfully in their homes and communities.
1. Expand care coordination in housing settings.
The BPC task force calls on the Centers for Medicare and Medicaid Services (CMS) to “incentivize the home as a place of clinical care” by launching an initiative to coordinate health care and long-term services and supports for Medicare beneficiaries living in publicly assisted housing.
The report cites research conducted by CFAR and the Lewin Group showing that HUD-assisted older adults who are eligible for both Medicare and Medicaid have more chronic conditions and higher health care utilization than unassisted beneficiaries.
The task force also refers to an evaluation of the Support and Services at Home (SASH) program in Vermont, which was conducted by CFAR and RTI International. SASH relies on a team consisting of an onsite service coordinator and part-time wellness nurse who connect program participants with needed services and supports.
“Initial data demonstrate positive impacts on resident health, health care utilization, and a slowing of the growth in Medicare expenditures relative to 2 control groups,” says the report.
2. Expand the Independence at Home Demonstration.
The Independence at Home Demonstration is testing whether home-based primary care teams can improve health outcomes and reduce expenditures for Medicare beneficiaries with multiple chronic conditions. The demonstration met quality-of-care performance standards and saved more than $25 million during its first year.
The BPC task force recommends that Independence at Home be expanded nationwide after CMS confirms that its cost savings can be sustained, determines who benefits most from the program, and identifies best practices.
A 2008 publication from CFAR, entitled Doctor at Your Door: The Senior Housing Community's Guide to Medical House Call Programs, outlines how housing providers can partner with the type of home-based primary care teams working in the Independence at Home Demonstration.
“Housing providers and primary care teams can both benefit from working together as the Independence at Home program begins to expand across the country,” says Stone. “These partnerships help housing settings gain access to critically needed services while, at the same time, helping primary care teams find groups of older adults who could benefit from home-based care.”
3. Prioritize falls prevention.
Annual falls by older adults are associated with approximately 2.5 million emergency department visits, 700,000 hospitalizations, and $34 billion in health care costs.
To reduce these numbers, the BCP task force recommends that Medicare’s Annual Wellness Visit include a falls risk assessment and a referral to a falls prevention program, when appropriate. In addition, falls prevention quality measures should be embedded in all CMS quality-measurement programs.
4. Incorporate housing into Health Risk Assessments.
Providers, insurers, and employers use health risk assessments (HRA) to collect data for individual and population health improvement. The BPC report recommends that HRAs include assessments of an individual’s frailty and falls risk, living situation, and home safety/accessibility.
5. Expand Money Follows the Person.
As of December 2014, the Money Follows the Person (MFP) Rebalancing Demonstration Grant helped states transition almost 52,000 institutionalized Medicaid beneficiaries to community settings.
The BPC task force recommends extending the MFP program, and encourages states to “think creatively about how to expand affordable housing options for beneficiaries ready to be transitioned from institutionalized settings.”
6. Collect data on housing-related Medicaid services.
The federal Medicaid program offers a limited number of opportunities for states to be reimbursed for providing housing-related services.
The BPC task force recommends that Medicaid begin tracking how each state is currently using these opportunities, the extent to which older beneficiaries are using these services, and how these services affect health outcomes and costs.
7. Pay attention to housing during hospital discharge planning.
Hospitals should ask questions about housing stability and falls risks during the discharge planning process, says the report. In addition, hospitals should work in partnership with housing providers to facilitate care transitions from hospital to home.
Task Force Conclusion
Linking housing and health care could allow millions of older adults to age more successfully while reducing medical costs, concludes the BPC Senior Health and Housing Task Force.
“Fortunately, there are several important opportunities available today to test these propositions through Medicare, Medicaid, and the nation’s hospital system,” says the task force report. “Seizing these opportunities is a critical step to realizing the full benefits of a more integrated approach that can transform homes into centers of senior health and well-being.”