Aging Gracefully: An Anticipated Future in Housing First

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Aging GracefullyAn Anticipated Future in
Housing First

• Presented
• by
• Patrick J. ODwyer
• Erica Alexander M.A.

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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)

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Long Term Services and Supports (LTSS)

• Home and Community Based Services
• Assisted Living Facilities
• Home Health Agencies
• Skilled Nursing Facilities
• Hospices

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Whats 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)

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Home and Community Based Services

• Non-Medical

• Medical

• Housekeeping
• Bathing/Hygiene
• Dressing
• Laundry
• Cooking
• Shopping
• Some Transportation
• Meaningful Activities

• Physical Therapy
• Occupational Therapy
• Medication Management
• Outreach Nursing

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...Not So Great?

• Relational Issues

• Practical Issues

• Not designed to serve our population
• Assessment Issues
• Keeping scheduled appointments
• Not 24/7 service
• Accountability/Turnover
• Resource allocation

• Interpersonal Challenges (alliance necessary)
• HR/HF/TIC values lacking
• Flexibility
• Substance use
• Escalated behaviors

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All this to say?

• Dont 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

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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
• DESCs resident populations average age is 51
  years old
• 57 of residents housed by DESC in 2013 were 50
  yrs. old

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Whats 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.

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On the Ground at DESCs Canaday House
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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)

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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

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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.

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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

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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

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Please feel free to contact us via email

• Patrick can be reached at podwyer_at_desc.org
• Erica can be reached at ealexander_at_desc.org