A Service-Enriched Supportive Housing Model

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Home for Good

• A Service-Enriched Supportive Housing Model

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May Shields RN, MSNDirector of Health Services
Who We Are

• Deborah Cutler MSW, LICSW
• Director of Behavioral Health

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Who Is Hearth

• Hearth, formerly known as The Committee to End
  Elder Homelessness, was founded in 1991
• Hearths founders provided leadership for a
  coalition of public and private agencies working
  collaboratively to eliminate homelessness in
  Boston
• Hearths mission is to create permanent housing
  with supportive services
• 2005 Hearth Home for Good

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Mission Statement
Hearth is a non-profit organization dedicated to
the elimination of homelessness among the
elderly. This mission is accomplished through a
blend of prevention, placement, and housing
programs all designed to help elders find,
succeed, and age in homes of their own. To this
end, all housing operated by Hearth provides a
creative array of supportive services that assist
residents to age with dignity, regardless of
special medical, mental health, or social needs.
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2005 BostonHomeless Census

• On the evening of 12/19/05 there were 5,819
  homeless men, women and children counted in
  Boston
• 299 individuals were on the street 30 increase
  from 2004
• 77 were homeless elders on the street, making up
  26 of the street count

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Additional Statistics

• There are 20,000 elders in Boston who live below
  the poverty level
• The homeless portion of this population is over
  1,000 and growing at 17 a year
• One in 5 Boston elders age 65 and older live
  below the poverty level
• More than 4,000 elders were served last year in
  the states homeless shelters
• 3 of MA Medicaid elders reside in nursing homes
  and use 20 of the Medicaid budget

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Who Hearth Serves

• Men and women ages 50 and over
• Diverse racial and ethnic population
• Physically disabled
• Chronically mentally ill

• Homeless veterans
• Substance abusers
• Long term care residents
• Trauma victims

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How Does an Elder Become Homeless?

• Many do not have long histories of homelessness
• Significant illness or health event
• Death of a spouse, significant other or relative
  theyve been living with
• Loss of a job and income to pay rent
• Reduced affordable housing stock in Boston

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Tour Our HomesBishop Street
Our first residence, opened in 1992, is a
congregate living community in a charming
Victorian house with a yard full of flowers and
trees. Located on a peaceful residential street
in Jamaica Plain, Bishop Street House is home to
nine formerly homeless women, some of who have
lived there since it first opened. With each
resident occupying a single bedroom, every effort
is made to create a feeling of community through
the sharing of a kitchen, living room, baths,
porches, decks, garden and social
activities. For its work at Bishop Street House,
Hearth was honored to receive the 1994 Fannie Mae
Foundation Maxwell Award of Excellence for
Innovative Housing. In the spring of 2005,
Bishop Street was chosen to receive an Extreme
Makeover Boston Edition from Channel 5 ABC,
allowing us to complete needed renovations.
Hearths first residence No. 4 Bishop Street
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Tour Our HomesAnna Bissonnette House
Located in Bostons South End, the Anna
Bissonnette House (ABH) opened in 1997 to provide
permanent supportive housing to forty formerly
homeless elders. The building, once a bread
factory, was being used by Boston University as a
warehouse before the school generously donated it
for housing. The site was beautifully renovated
and decorated to provide 22 studio and 18
one-bedroom apartments. Common area kitchens and
community spaces are available on each floor, in
addition to the large Shapiro Community Room in
the lobby, a patio with benches and tables, and a
roof-top deck.
"The thoughtful remodeling of this handsome brick
bread factory into housing for the elderly
homeless is a model of preservation and
continuity. -- Ada Louise Huxtable, Pulitzer
Prize Winning Architecture Critic of The Wall
Street Journal
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Tour Our HomesRuth Cowin House
Opened in 2000, Ruth Cowin House was our first
site situated outside Boston. The beautifully
renovated brownstone, located on Beacon Street in
Brookline, is now home to nine formerly homeless
elder men and women. Each resident lives in a
fully furnished studio apartment with
kitchenette In 2000, Hearth was honored to
receive the Brookline Preservation Award for
dedication to historic preservation of the Ruth
Cowin House through the efforts of repairing,
restoring and maintaining the integrity of the
properties of the Town of Brookline.
Many of the residents at the Ruth Cowin House
welcomed the opportunity to return to their home
town.
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Tour Our HomesRuggles Assisted Living Facility

• Ruggles Affordable Assisted Living Community,
  opened in October of 2002, is the first assisted
  living facility in Boston exclusively targeted to
  low-income and frail elders.
• The site is comprised of 43 studio apartments.
  Common areas of Ruggles include
• a living room with piano,
• main dining hall,
• activities room with complete kitchen facilities,
• and sunroom overlooking a community garden.

25 Ruggles Street was a originally a school which
some of Hearths residents attended as children.
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Tour Our HomesUphams Corner ElderHouse
Opened in March 2002, the fourteen apartments
known as ElderHouse provide fully furnished
studio apartments for formerly homeless men and
women, some with special needs. Part of a
mixed-use development known as Uphams Corner
Market, it is comprised of retail and residential
units.
Uphams Corner is listed on the National Register
of Historic Places for its historic importance
the worlds first supermarket was located here.
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Service Delivery Model
Hearths model integrates housing, mental health,
medical and social services supports in a manner
that permits even very frail elders to live with
considerable independence in their own
apartments. The cost of Hearth housing is at
most one-half the cost of institutional
alternatives such as long term care. Hearths
team is comprised of MSWs, RNs, Site Directors,
Property Manager, Resident Assistants, Personal
Care Homemakers and Activity staff. Students,
interns and volunteers provide countless hours of
service to our residents.
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Student Interns Volunteers

• Collaboration with area MSW programs
• Collaboration with allied health programs
• 4 - 6 interns per academic year
• Intern activities include individual and group
  counseling, case management, program development,
  grant writing, exercise programs, health fairs,
  dental screening, smoking cessation
• Large number of volunteers involved in all
  aspects of resident life

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Major Issues

• Untreated/undiagnosed mental illness
• Substance abuse
• Difficult families
• Hoarding
• Medical frailty
• Lack of needed resources (ex. home visiting
  psychiatry, reliable medical transportation)

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Services Provided

• Behavioral health management
• Medical management including physician
  collaboration, medication assistance, health
  education and health screening
• Crisis intervention

• Substance abuse and brief mental health
  counseling
• Personal care and homemaking
• Socialization
• External referrals
• Close collaboration with property manager

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Interdisciplinary Service Planning

• Starts with pre-admission screening
• Annual comprehensive bio-psychosocial resident
  assessment
• Individual service plans
• Individual behavior plans when necessary
• Case conferences and consultations
• Service provision across the continuum

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Financing of the Model
Public/Private Programs that Support Hearth

• HUD Section 8
• SSIG - Supplemental Security Income-G
• Mass Health GAFC - Group Adult Foster Care
• DMH - Department of Mental Health
• EOEA - Executive Office Of Elder Affairs
• SCO - Senior Care Option
• Grants/Private Philanthropy

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Outreach Model

• Case managers work with individuals who fall
  anywhere on the continuum of housing readiness
• Often work with individuals who have no income,
  or any support or health services
• May have a multitude of housing barriers such as
  poor credit histories, criminal histories, and
  poor or no housing histories
• Outreach serves approximately 200 clients at any
  given time

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Outreach Model, continued

• Collaborate with numerous systems and providers,
  including legal aid, DMH, medical providers, the
  courts, elder service providers, landlords,
  management companies, shelters and clients
  families
• Strong advocacy and stabilization services for
  one year
• Fresh Start Program
• Funded primarily by a federal grant from HUD

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Public Policy, Advocacy, Research

• MA Health Systems Change Transformation
  Initiative
• Unified Behavioral Health Initiative
• CHAPA Citizens Housing and Planning Association
• Elder Economic Security Standard
• Three Nation Study Examining Causes of
  Homelessness

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Vignettes

• Mr. B is a 75 year old single man with a history
  of HTN, PVD, bilateral AKA, ESRD on HD, COPD and
  history of ETOH abuse
• Ms. C is a 63 year old woman with physical and
  mental health disabilities, the later undiagnosed
  and untreated and a 4 year history of homelessness

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Contact Information

• May Shields mshields_at_hearth-home.org
• Deborah Cutler dcutler_at_hearth-home.org

Hearth 1640 Washington Street Boston, MA 02118
T 617-369-1550 W www.hearth-home.org