San Francisco Bay Area, California
A supportive service program helps older residents in federally-subsidized housing stay healthy in their affordable homes.
Identifying the Issue:
Research has found that older people living in subsidized housing:
- Have more chronic conditions than their peers in the community who do not receive assistance;
- Are highly likely to be eligible for Medicaid, in addition to Medicare;
- Run a higher risk of being hospitalized or using the emergency department than their peers in the community who do not receive assistance; and
- Have higher health care costs than the average older person -- and even higher costs than community-dwelling elders not receiving housing assistance who are also eligible for both Medicare and Medicaid.
Despite health conditions that make living independently more difficult, many older residents still prefer to stay in their affordable homes. The need for a supportive program to make this choice a viable option was identified by residents in the affordable housing communities. Based on community input, the Northern California Presbyterian Homes and Services (NCPHS), an affordable housing provider, developed the WellElder program. WellElder provides service coordination, wellness education, and health monitoring to older adults in federally-subsidized housing complexes.
Applying Innovative Solutions:
The WellElder program operates in four federally subsidized multifamily properties in the San Francisco Bay area. At each building, there is one on-site service coordinator and one nurse health educator. These staff members offer numerous services including communicating with health care providers, assisting with understanding medical and insurance programs, monitoring residents recently discharged from hospital and rehab stays, giving instructions on self-care, and helping reconcile medical bills. Property residents must enroll in the program (free of charge) to receive all benefits, but non-members are allowed to participate in group activities like wellness education seminars.
The service coordinator and nurse educators work closely with each other to evaluate member needs and tailor the program offerings accordingly. The WellElder staff also meet with the affordable housing property managers on a quarterly basis to share and resolve resident issues, such as hoarding or late rent payments.
On-site service coordinators are paid by NCPHS and Bethany Center Senior Housing (the affordable housing operator of one of the four sites). The nurse educators are paid by the Institute on Aging, a regional nonprofit health and social service agency.
An assessment conducted by the National Housing Conference found:
- While the residents in the program have complex health situations, a smaller number of participants experienced 911 calls, trips to the emergency room, or hospital stays than expected.
- The program has reduced turnover in the properties because it keeps residents functioning independently, and has more effectively dealt with residents struggling with issues like hoarding and mental illness. While a number of residents might be eligible for nursing home level care, only a small number of residents moved out of the property during NHC’s study period.
- A large portion of residents were able to stay in their apartment until their death. Less than half of residents who moved out transferred to a higher level of care.
- Nearly 95% of WellElder members thought the program was helpful to them.
- Over 60% of WellElder members believed the WellElder program helped them access services faster than they could have on their own.
- Over half of WellElder members believed the program would help them stay in their apartment longer than they would have been able to otherwise.
- Many non-member residents report a great sense of security from knowing there is someone on-site to help them if needed.
- Locate supportive staff on-site: When staff are located on-site they are able to most effectively engage residents and monitor their well-being.
Director of Community Services
Northern California Presbyterian Homes and Services