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Health and Housing: Empowering Older Adults

September 2017

Nancy Rockett Eldridge, CEO, National Well Home Network
Amanda Reddy, Executive Director, National Center for Healthy Housing
Nancy Zweibel, PhD, Senior Program Officer, The Retirement Research Foundation

What does health and housing mean to you? Does it mean reducing lead in our homes? Does it mean bringing support to us older adults so we can remain at home? The good news is that health and housing is a vast umbrella providing an opportunity for philanthropy to make a positive difference.

How Funders are Responding

As growing evidence shows how profoundly our health is shaped by upstream factors, numerous foundations have focused their attention on the links between health and housing. Funders such as the Kresge Foundation, W.K. Kellogg Foundation, Conrad N. Hilton Foundation, Health Foundation of Central Massachusetts, HealthSpark Foundation, and The Boston Foundation have supported a range of efforts related to housing affordability, housing instability, homelessness, and community development.

Funders are investing in strategies such as financing permanent supportive housing, advancing policy and research, leveraging Medicaid dollars for housing services, and partnering with community development financial institutions.

Forming the National Well Home Network

The Retirement Research Foundation (RRF) has recognized the importance of addressing the relationship between health and housing through their grantmaking, with a special focus on our needs as we grow older. RRF has been instrumental in the development of the National Well Home Network (NWHN). Building on the early leadership of the John D. and Catherine T. MacArthur Foundation and others, RRF invested $100,000 in the National Center for Healthy Housing’s (NCHH) goal of developing a national strategy to assure the independence we all want later in life. RRF recognized that there are millions of low-income older adults living in publicly subsidized housing, many of whom would like to remain in their homes despite growing frailties, and will need to remain at home because there are not enough Medicaid funded nursing home beds to meet all our needs.

The Wells Fargo Housing Foundation has funded initiatives across the entire spectrum—from supporting organizations such as NCHH to address substandard housing conditions to funding the replication of housing-based service models through NCHH’s newly formed NWHN.

While effective housing-based service models exist, we need a national infrastructure in place to replicate these models and bring them to scale. NWHN aims to build the necessary infrastructure to deepen the impact of existing models and realize the full potential of using affordable housing as a platform for improving our health, containing costs, and empowering all of us to transform our lives and communities as we age.

Housing as a Platform for Health Services

Picture this: a 150-unit, high-quality rental property, home to older adults with incomes under $10,000 per year whose primary languages are Spanish, Mandarin Chinese, and Haitian Creole. The building has common spaces perfectly suited for Tai Chi classes, seated yoga, and nutrition classes. The property has Wi-Fi, making virtual telemedicine visits with our physicians possible. No more bus rides to the doctor to confirm that it’s the flu—the diagnosis can be made in the comfort of home. Rather than sending older adults to high-cost institutional settings, let’s use housing as a platform to keep our older neighbors home resulting in better care, improved health, and reduced spending.

Housing as a Hub

An all too common scenario is unfolding across this country. You get the call. Your mother had a stroke. She will recover—partially. Her four children live in four different states. The panicked emails and texts start. Where do we begin to help mom meet her goals? For over 5,000 Vermonters, the answer is a statewide program called Support and Services at Home (SASH). The goal of SASH is to put the individual in the driver’s seat. SASH is one example of a housing-based service model brought to scale at 140 hubs across the state.

When Housing is a Hazard

When housing-based service models enroll an older person living in a single-family home, the teams often find hazards such as lead-based paint and conditions in the home that exacerbate asthma among young and old. A true system of long-term services and supports to promote independence at home requires a comprehensive approach to home visits. Housing-based service models should include a home assessment, an evaluation of eligibility for services, and empowering older adults through advance directives.

How Funders Can Engage in Health and Housing

The need for philanthropic support in health and housing initiatives is urgent and the results are proven. For example, every dollar invested in lead hazard control results in health, educational, and other savings between $17 to $221 (Gould 2009), a return slightly better than vaccines. Funders can play a critical role in bringing evidence-based models to scale and can also support innovative new solutions that bridge health and housing.

Grantmakers can invest in housing remediation to address environmental and health hazards and support efforts to combine affordable housing with co-located services. Beyond traditional grantmaking dollars, funders can lead evaluation and data collection efforts to build the evidence base for effective strategies, foster collaboration between the health and housing sectors, and increase the capacity of health providers to work with housing organizations.

In addition, foundations can also help develop public-private partnerships. Federal initiatives can benefit from the expertise, influence, and convening power of foundations. For example, the U.S. Department of Housing and Urban Development (HUD) is about to kick off the Supportive Services Demonstration for Elderly Households in HUD-Assisted Multifamily Housing. This project will fund resident wellness directors and wellness nurses at 40 HUD-assisted senior housing communities in seven states.

Conclusion

As funders seek strategies to move upstream, there are increasing opportunities to improve health through housing. Philanthropy can continue to expand and scale proven solutions and pilot innovative new strategies. By addressing the intersections of health and housing, grantmakers can help build healthy and safe communities for people of all ages.