What Hospitals Need to Understand About Housing

Blog_Sutton_GrantThere was a post in today’s HealthAffairs Blog  (see links at the end of this post) with some helpful insights on the importance of affordable housing as a key element of being able promote and sustain healthy aging. I have written rather extensively over the years in this space on this topic, and I have long been an advocate for Affordable Housing Plus Services.

I don’t recall if I’ve shared this here before or not, but I once had the opportunity to ask directly a former Secretary of Health & Human Services why there wasn’t more effective communication and coordination of policy initiatives between HHS and HUD. The response was unflattering: that was a great idea without a plausible explanation for why it had not been actively pursued. Thus be to bureaucracy.

If I could build upon the major policy themes pointed out in the HA post, something I have learned over the past five years is that a primary reason acute care providers struggle to understand post-acute care is because post-acute care is a lot more complicated than I understood. And, of course, I make that observation somewhat tongue-in-cheek because that’s all I’ve done for the past two decades.

But this article reminded me again how complex post-acute/long-term care can be. And that’s because it’s not just about providing good healthcare. It’s very much about where that healthcare is going to be provided (in what structure does the patient live). It’s about what support services are available to assist the patient with activities of daily living (in what community does the patient live). It’s about hospitality and entertainment (who wants the sole focus of their life to be an illness?) And it’s about insurance because most often care providers and/or insurers are underwriting extended care for which it is often difficult to predict duration, complexity and cost.

The same fundamental attributes that make it a complex delivery model make it a complex policy issue. Acute care providers are being more intimately connected with post-acute care providers every day through healthcare public policy initiatives. My counsel is they would do well to begin understanding the root causes of what makes post-acute and long-term care more complex than they may have realized.

Cheers,
  ~ Sparky


Read Health Affairs article here:

Integrating Health Care And Housing To Promote Healthy Aging
Read more about the authors here:
Allyson Schwartz and Anand Parekh

America’s Housing Crisis

Warning-Challenges-aheadLast week the Joint Center for Housing Studies of Harvard University released a new report, Housing America’s Older Adults: Meeting the Needs of An Aging Population. Funded primarily from a grant provided by the AARP Foundation, it concisely and comprehensively depicts the fissure of disconnect characterizing the burgeoning need for affordable senior housing as contrasted against the nation’s ability to accommodate that need.

As reported on there, a myriad of overlapping demographic and socioeconomic components are advancing unabated to create a perfect storm in the form of a national housing crisis that represents one of the most vexing domestic policy issues we will face over the next two decades.  Despite the growing enthusiasm for home and community-based services as a more preferable and lower cost alternative to institutionally-based care, the stark reality is that individuals in need of services and support, as well as long-term care, need a physical location at which they receive that assistance – and a place to sleep to boot.

With all of the media attention that has been given to healthcare reform it’s not surprising that housing, services and support and long-term care for the elderly and disabled is characterized by those intimately familiar as a social time bomb, ticking away without the attention it needs or deserves. In good part this deference is also due to the political reality that it’s a minefield of tough choices, which upon further survey frightens even the most stalwart politician into a stasis of self-preservation (yes, more so than usual).

Friend and colleague, Rob Hilton, President & CEO of the A M McGregor Group in East Cleveland, Ohio has long held a personal and professional passion for addressing the affordability of housing, services and care for seniors. In June of 2012 I interviewed Rob for a Pub Chat: Affordable Housing Key to Long-Term Care. Rob was originally responsible for my getting interested in the concept of Affordable Housing Plus Services. LeadingAge’s Center of Applied Research headed by Dr. Robyn Stone has some very good resources on the background and research surrounding AHPS.

That interest spurred my thinking about how taking a holistic approach to the development process could result in more affordable product offerings. Real estate development is by its nature both a risky and capitally intensive endeavor. Being able to use a process that effectively manages that risk while reducing unproductive expenditures can – in the aggregate – have a major impact on affordability. The graphic below is one that we use at Artower to help explain key concepts of this approach.

chart_061914

I also wrote about this approach a few years back in a white paper on Mission-Driven Development that further describes some of the key concepts.

Depicted below is a strategic development planning matrix that was developed collaboratively by me and Rob Hilton over the past decade (i.e., many iterations reflecting our learning). In some fashion this represents the holistic, circular process shown above being flattened into a linear representation that can better accommodate process tracking and accountability. I realize this image is too small to read, but please contact me if you are interested learning more.


Visio-Affordable Housing101013-page-0

So while I don’t claim to have all of the answers to the housing crisis that is facing us, I have spent considerable time undaunted by the aforementioned policy minefield thinking about solutions. I would be more than happy to share what I have learned with others who are interested in tackling this challenge head on – while there is still time.

Cheers,
  ~ Sparky

Blog picture credit: Power By Choice, Colorado Springs, CO 80904

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