Housing Plus Services: What's Not to Like?

A half century ago, journalist Dorothy Kilgallen unwittingly changed the American lexicon when she reviewed a 1963 film called Charade:

"It has Audrey Hepburn, Cary Grant, Paris in living color, and a beautiful score by Henry Mancini," she wrote. "So what's not to like?"

Kilgallen's simple, 5-word question sums up my own feelings about the new Housing Plus Services models that are emerging in the field of long-term care services.

The LeadingAge Center for Applied Research has found plenty to like about these new models, which use affordable senior housing properties as platforms for the delivery of health and supportive services to older adults, many of whom have low incomes and complex medical conditions.

We know what we're talking about.

As you'll learn by reading the Center's newly released 2014 Annual Report , our researchers have done a great deal of work over the past several years studying this new model. And each year, we collect more evidence that Housing Plus Services models can help older people remain healthy and independent for longer, all while saving health care dollars.

So what's not to like about that?

A Growing Evidence Base

Our research to date convinces me that delivering health and supportive services in affordable senior housing settings can reduce the likelihood that residents will need to move to higher levels of care, or use expensive health care services like the emergency room.

We know from our visits to housing properties around the country that onsite supportive service programs can create a valuable sense of community among residents and make housing properties better places to live and work.

And now, we have some strong evidence that Housing Plus Services programs may also have the potential to slow the growth of Medicare spending for participating residents. For more on this, check out a report about the first-year findings of our 3-year evaluation of the Support and Services at Home program in Vermont .

For all of these reasons, the Housing Plus Services idea is catching on around the country. I met recently with state officials in Washington who are showing an interest in pursuing this model as a way to manage health care costs and meet the preferences of older people to age in place.

And it's not just state officials who are drawn to this model. At a recent affordable housing conference in California, I met a behavioral health professional from Oregon who feels this model represents a great way to get needed mental health services to older people. That sentiment is shared by SET Ministry, Inc. in Milwaukee, WI, and Senior Housing Assistance Group in Seattle, WA. Both of these organizations will use Innovations Fund Grants to bring behavioral health programs to senior housing communities over the next few years.

So, again, I ask, "What's not to like?"

Still Some Concerns Around Housing Plus Services

Don't get me wrong. Making a convincing argument for Housing Plus Services models is not a slam-dunk, by any means. Since this is a new model, there are lots of questions to answer, and concerns to assuage, before everyone can feel comfortable going down this new path.

One of those concerns comes from consumers who worry that Housing Plus Services models might become unregulated assisted living if we're not careful.

I understand the concerns -- but I don't share them.

I see assisted living and Housing Plus Services programs as very different options for older people.

Assisted living communities are residential buildings dedicated to serving individuals who are very frail and might otherwise be living in a nursing home. All of the residents in an assisted living community need a high level of support. That's why they live there.

Housing Plus Services models, on the other hand, serve people who are living independently in their own apartments. The services delivered at a housing property aren't targeted to the very frail individuals who assisted living communities typically serve.

Some residents of a housing property won't need any services at all to remain independent. Others may need only a few services. Still others may require a variety of services to remain in their own apartments. And participation in any service is always voluntary.

This diversity means that housing-based service programs can potentially serve everyone in an affordable senior housing property--from well elders who might benefit from education and exercise programs, to more vulnerable individuals who require more help.

It's also important to understand that few housing properties actually deliver the services they make available to residents. Instead, they work in partnership with respected community-based service providers to help residents manage their health.

Licensed providers deliver appropriate services. Government agencies regulate those service providers and exercise quality oversight over the work they do.

A Role for Assisted Living

The growing support for Housing Plus Services models doesn't negate the great work that assisted living communities do. We need assisted living communities to serve older people with high levels of frailty who need to receive personal care services in a residential setting.

However, not all seniors need that level of service. And not all seniors can afford it.

I'd love to see assisted living providers become partners in Housing Plus Services programs in their local communities. These providers could really make a difference by delivering onsite services to residents of affordable senior housing properties through an affordable assisted-living-at-home model. This is already happening in states like Minnesota and Connecticut.

This affordable model would strengthen Housing Plus Services programs while, at the same time, helping assisted living providers expand into the growing home and community-based services arena.

What a positive development that would be for assisted living communities and housing properties.

Most important, it would help to improve the lives of low-income seniors. And they, after all, are who we are here to serve.