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.