Integrating Long-Term Supports with Affordable Housing (HOUSE)

VERMONT

Target Population

Elders who need long-term supports coordinated with affordable and accessible housing; elders who live in nursing homes but who could remain in the community if supportive housing were available; and persons who are dually eligible for Medicare and Medicaid.

Geographic Focus

Statewide

Primary Focus

Provide elders with real choices in supportive housing by (1) preserving, developing, and enhancing supportive housing projects (improving access); (2) establishing medication-assistance suggested practices to support critical early aging in place in unlicensed congregate housing; and (3) planning for the colocation of two Program for All-Inclusive Care for the Elderly (PACE) sites with affordable housing.

Goals, Objectives, and Activities

Goal: Improve access to housing by preserving, developing, and enhancing supportive housing projects.

Objectives/Activities

  • Provide key early or workout consultation through the Cathedral Square Corporation (CSC) to at least 14 supportive housing projects.
  • Build the knowledge base of CSC regarding issues that challenge the development or operation of the affordable supportive housing settings.
  • Provide early planning and service development support to an affordable assisted living demonstration sponsored by a public housing authority.
  • Provide early planning support for development of an assisted living demonstration by distributing grant funds to either developers or community leaders from areas where projects are needed and have been difficult to develop.

Goal: Establish medication-assistance suggested practices to support critical early aging in place in unlicensed congregate housing.

Objectives/Activities

  • Establish suggested medication-assistance practices for unlicensed supportive housing.
  • Implement pilot studies of suggested medication practices.
  • Provide housing, service, and care providers with the information and skills they need to implement suggested medication-assistance practices.
  • Transfer enduring knowledge and resources of this goal to programs and partnerships that will sustain the work after the life of this grant.

Goal: Determine the viability and complete planning to colocate two PACE sites with affordable housing.

Objectives/Activities

  • Conduct planning activities, including a feasibility study, to coordinate PACE sites within affordable and accessible housing in Rutland and Burlington.
  • Collaborate with the Religious Hospitallers of Saint Joseph–Vermont (RHSJ) to determine the feasibility of colocating the PACE site at its convent, and if feasible, convert the existing convent into affordable housing.

Key Activities and Products

  • Compile a resource book of documented sources that describe known effective means of coordinating efforts at the local project level between the Medicaid agency, housing entities, Area Agency on Aging, other service agencies, and the Medicaid/medically needy (MMN) consumer.
  • Provide consultation services through CSC to at least 14 supportive housing projects that can or will serve a significant number of Medicaid beneficiaries and medically needy persons.
  • Provide critical learning opportunities to CSC to build its capacity as a resource to elders.
  • Provide early planning and service development to support an affordable assisted living demonstration sponsored by a public housing authority.
  • Endorse medication practices that are scientifically supported and reflect the roles of housing-based service coordinators, case managers, nurses, and prescribing physicians.
  • Implement pilot studies of suggested medication practices and conduct an evaluation.
  • Refine the suggested practices and training materials before sponsoring a phase II dissemination and implementation followed by a phase II evaluation.
  • Transfer the knowledge base to the state-funded Housing with Supportive Services Program and other such partners.
  • Conduct feasibility studies and planning activities in Rutland and Burlington to support the development of two PACE sites with affordable housing.
  • Work with the PACE project coordinator to plan for project funding after feasibility studies are completed.

Consumer Partners and their Involvement in Implementation Activities

A workgroup for each of the three goals will be established, and each will include consumers, partners, and other stakeholders to review grant progress for each goal. Consumers will be involved in startup activities, problem analysis, planning, implementation, and evaluation.

Public and Private Partners and their Involvement in Implementation Activities

  • The Department of Aging & Independent Living (DAIL) is the lead public agency for the grant and will hire the project director and provide interim management until the permanent director is hired. The Office of Vermont Health Access (OVHA), the Medicaid agency, will liaise with the PACE advisory group until a PACE consultant is hired. OVHA will also be represented on the Access and Medication advisory groups.
  • The Vermont Department of Housing and Community Affairs (DHCA) will be represented on the Access Advisory Group.
  • Cathedral Square Corporation, a faith-affiliated nonprofit provider of affordable housing and services, will deliver consultation assistance to groups that need startup help, preservation, or workout services (when a property no longer operates to its budget or mission). CSC will provide services to at least 14 projects or groups in three categories: (1) preservation of existing supportive housing, (2) enhancement of supportive services, and (3) new construction or substantial rehabilitation. To build CSC's capacity as a resource to elders, DAIL plans to make an annual grant for critical learning.
  • The Vermonters Coming Home partnership and other housing community partners will provide perspective and resources to the Access workgroup in the areas of planning, problem analysis, implementation, and monitoring and evaluation activities.
  • DAIL will draw on the partnerships that surround the existing service coordinators at the state-funded Housing with Supportive Services (HASS) Program and other housing sites, including resident service coordinators and property managers, Vermont Housing Finance Authority, and the experience of Community of Vermont Elders in its Mental Health and Aging project for the Administration on Aging, among others.
  • The project will retain the services of a qualified consultant to (1) study the medication assistance problem from all stakeholder and consumer perspectives, (2) support the Medication Assistance workgroup in identifying and adopting suggested practices, (3) support the workgroup in identifying and selecting curricula and educational materials, (4) provide training, and (5) conduct two phases of evaluation.
  • RHSJ–Vermont will work with the PACE workgroup to develop ideas about the potential use of space at the convent for a PACE site.
  • PACE Vermont, Inc., will work with focus groups of seniors to evaluate PACE proposals.
  • Vermont's activities have been supported by NCB Development Corporation, a technical assistance provider to the Robert Wood Johnson Foundation's Coming Home grantees, and the National PACE Association.

Advisory Body, Committee, or Task Force

The three goal-oriented workgroups will benefit from consumer, partner, and stakeholder guidance within the DAIL advisory board. The grant project director will make quarterly progress and status reports to the advisory board and obtain feedback and advice.

Formative/Process Evaluation Activities

  • Organizations that sponsor or plan for supportive housing projects and that receive services funded by this grant will agree to document their coordination strategies at the appropriate time in their work with this project. If the appropriate time will occur after the term of this grant project, the organization will state its intent to document its coordination strategies.
  • Limited scholarship assistance will be available to subsidize the cost of attending training and of filing documentation to support evaluation of pilot medication assistance sites. Initial experience will be evaluated from consumers' and providers' perspectives. The consultant will conduct a paper survey, sample interviews, and record reviews, and a report will be presented for consideration and public comment.

Summative/Outcome Evaluation Activities

  • The number of sites that preserve, enhance, or establish long-term supports in affordable, accessible housing will be documented, together with the number of Medicare/Medicaid beneficiaries who benefit. The successful strategies will be catalogued. The effectiveness of consultation supports will be evaluated annually.
  • The effectiveness of medication supports will be evaluated from provider and consumer points of view, and from system efficiency and efficacy points of view, at the conclusion of two phases of implementation.
  • PACE Vermont, Inc., will reconvene focus groups with seniors to evaluate the proposals developed by the consultants, and a third focus group of clinical professionals will be added to evaluate the feasibility of proposed PACE sites.

Strategies to Ensure Sustainability

  • Each of the initiatives is grounded in strong, existing partnerships that are not dependent upon the activities of this grant, increasing the likelihood that change and knowledge gained will continue after this grant.
  • The State hopes to create capacity in its budget to continue funds to CSC and demonstration projects after the life of the grant. If this does not occur, basing knowledge in CSC, a statewide organization, assures that the knowledge will be sustained.
  • The permanent HASS program is at minimum a repository for enduring knowledge about medication assistance. The State anticipates that several organizations will be interested in playing a role to assure that trainings are replicated beyond the life of the grant, including service coordinator groups, a case management trainer under contract to DAIL, and senior wellness initiatives sponsored by health organizations.
  • The PACE sites will be able to deliver all needed medical and supportive services, providing the entire continuum of care and services to seniors with chronic care needs while maintaining their independence in their homes for as long as possible.