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• 1. [Article] The Health and Housing Specialist: An Emerging Job Classification to Support Aging in Place in Subsidized Housing

  As the U.S. population ages, the availability of workers with a basic understanding of aging and health-related services has not kept pace. This is true in traditional health care organizations such as ...

  Citation × Citation Citation Abstract Copy Title: The Health and Housing Specialist: An Emerging Job Classification to Support Aging in Place in Subsidized Housing Author: Carder, Paula C., Weinstein, Jenny, Kohon, Jacklyn Nicole Year: 2012 As the U.S. population ages, the availability of workers with a basic understanding of aging and health-related services has not kept pace. This is true in traditional health care organizations such as hospitals and primary care clinics as well as in long-term care settings and senior housing, including subsidized housing, the focus of this report. Nearly 1.8 million older persons receive some form of publicly-subsidized rental assistance. Some subsidized housing providers, including those that operate buildings designated for older persons, are developing new systems of service delivery that would either coordinate or provide health screenings, physical activity programs, nutrition programs, health monitoring, adult day health, and home care. Such efforts are intended to deliver health related services that allow older adults to remain in their apartment for as long as possible while also reducing their use of hospital emergency departments or nursing facility placement. However, because housing providers have not traditionally hired or contracted with health and social services workers, neither the specific job tasks, nor the qualities of workers, have been studied. This report describes the findings from a study designed to identify the characteristics of subsidized housing employees who work primarily with older residents. The study took place during 2011- 2012 and included interviews with housing providers, health and social services professionals who have clients in subsidized housing, current residents, and resident service coordinators who work in subsidized housing. A systematic job analysis, including a national survey with 87 service coordinators from 23 states, was conducted in order to identify the specific job tasks and the knowledge, skills, and abilities required of subsidized housing employees whose job would entail supporting aging in place for older residents. Based on this study, it is clear that significant numbers of older residents of subsidized housing have a variety of unmet needs that place them at risk of eviction, hospitalization, and premature nursing home admissions. Four broad categories of supports identified by study participants include information and referral, health, social and personal care services, case management and care coordination, and building-specific supports. While most residents are independent and want to remain so, many need assistance on a short-term basis, such as during an acute illness or after a hospitalization. Others need on-going supports such as personal care, medication management, and health monitoring. Currently, few housing providers have a means of assessing or monitoring the health status or needs of residents. Most study participants believed that a designated staff person who could assess and monitor resident health would be beneficial, though some cautioned against creating an institutional environment or forcing services onto residents who do not want such assistance. Title: The Health and Housing Specialist: An Emerging Job Classification to Support Aging in Place in Subsidized Housing Author: Carder, Paula C., Weinstein, Jenny, Kohon, Jacklyn Nicole Year: 2012 As the U.S. population ages, the availability of workers with a basic understanding of aging and health-related services has not kept pace. This is true in traditional health care organizations such as hospitals and primary care clinics as well as in long-term care settings and senior housing, including subsidized housing, the focus of this report. Nearly 1.8 million older persons receive some form of publicly-subsidized rental assistance. Some subsidized housing providers, including those that operate buildings designated for older persons, are developing new systems of service delivery that would either coordinate or provide health screenings, physical activity programs, nutrition programs, health monitoring, adult day health, and home care. Such efforts are intended to deliver health related services that allow older adults to remain in their apartment for as long as possible while also reducing their use of hospital emergency departments or nursing facility placement. However, because housing providers have not traditionally hired or contracted with health and social services workers, neither the specific job tasks, nor the qualities of workers, have been studied. This report describes the findings from a study designed to identify the characteristics of subsidized housing employees who work primarily with older residents. The study took place during 2011- 2012 and included interviews with housing providers, health and social services professionals who have clients in subsidized housing, current residents, and resident service coordinators who work in subsidized housing. A systematic job analysis, including a national survey with 87 service coordinators from 23 states, was conducted in order to identify the specific job tasks and the knowledge, skills, and abilities required of subsidized housing employees whose job would entail supporting aging in place for older residents. Based on this study, it is clear that significant numbers of older residents of subsidized housing have a variety of unmet needs that place them at risk of eviction, hospitalization, and premature nursing home admissions. Four broad categories of supports identified by study participants include information and referral, health, social and personal care services, case management and care coordination, and building-specific supports. While most residents are independent and want to remain so, many need assistance on a short-term basis, such as during an acute illness or after a hospitalization. Others need on-going supports such as personal care, medication management, and health monitoring. Currently, few housing providers have a means of assessing or monitoring the health status or needs of residents. Most study participants believed that a designated staff person who could assess and monitor resident health would be beneficial, though some cautioned against creating an institutional environment or forcing services onto residents who do not want such assistance. Close

• 2. [Article] Putting Regulatory Data to Work at the Service of Public Health: Utilizing Data Collected Under the Clean Water Act

  Under the Clean Water Act, the US Environmental Protection Agency (EPA) collects information from states on intended use and impairment of each water body. We explore the feasibility of using these data, ...

  Citation × Citation Citation Abstract Copy Title: Putting Regulatory Data to Work at the Service of Public Health: Utilizing Data Collected Under the Clean Water Act Author: Jagai, Jyotsna S., Rosenbaum, Barbara J., Pierson, Suzanne M., Messer, Lynne C., Rappazzo, Kristen M., Naumova, Elena N., Lobdell, Danelle T. Year: 2013 Under the Clean Water Act, the US Environmental Protection Agency (EPA) collects information from states on intended use and impairment of each water body. We explore the feasibility of using these data, collected for regulatory purposes, for public health analyses. Combining EPA impairment data and stream hydrology information we estimated the percent of stream length impaired for any use, recreational use, or drinking water use per county in the US as exposure variables. For health outcomes we abstracted county-level hospitalization rates of gastrointestinal infections, GI (ICD-9CM 001-009 excluding 008.45) and gastrointestinal symptoms, GS (ICD-9CM 558.9, 787) among US adults aged 65 years and older from the Center for Medicare and Medicaid Services (1991–2004). Linear mixed-effects models were used to assess county-level associations between percent impaired waters and hospitalization rates adjusted for population density, a proxy for person-to-person transmission. Contrary to expectation, both GI and GS were negatively associated with any water impairment in adjusted models (GI: −0.052, 95 % CI: −0.077, −0.028; GS: −0.438, 95 % CI: −0.702, −0.174). GI was also negatively associated with recreational water impairment (−0.079, 95 % CI: −0.123, −0.036 after adjustment). Neither outcome was associated with drinking water impairment. Limited state data were reported to the EPA for specific recreational (27 states) and drinking (13 states) water impairment, thus limiting the power of the study. Though limited, this analysis demonstrates the feasibility of utilizing regulatory data for public health analyses. Title: Putting Regulatory Data to Work at the Service of Public Health: Utilizing Data Collected Under the Clean Water Act Author: Jagai, Jyotsna S., Rosenbaum, Barbara J., Pierson, Suzanne M., Messer, Lynne C., Rappazzo, Kristen M., Naumova, Elena N., Lobdell, Danelle T. Year: 2013 Under the Clean Water Act, the US Environmental Protection Agency (EPA) collects information from states on intended use and impairment of each water body. We explore the feasibility of using these data, collected for regulatory purposes, for public health analyses. Combining EPA impairment data and stream hydrology information we estimated the percent of stream length impaired for any use, recreational use, or drinking water use per county in the US as exposure variables. For health outcomes we abstracted county-level hospitalization rates of gastrointestinal infections, GI (ICD-9CM 001-009 excluding 008.45) and gastrointestinal symptoms, GS (ICD-9CM 558.9, 787) among US adults aged 65 years and older from the Center for Medicare and Medicaid Services (1991–2004). Linear mixed-effects models were used to assess county-level associations between percent impaired waters and hospitalization rates adjusted for population density, a proxy for person-to-person transmission. Contrary to expectation, both GI and GS were negatively associated with any water impairment in adjusted models (GI: −0.052, 95 % CI: −0.077, −0.028; GS: −0.438, 95 % CI: −0.702, −0.174). GI was also negatively associated with recreational water impairment (−0.079, 95 % CI: −0.123, −0.036 after adjustment). Neither outcome was associated with drinking water impairment. Limited state data were reported to the EPA for specific recreational (27 states) and drinking (13 states) water impairment, thus limiting the power of the study. Though limited, this analysis demonstrates the feasibility of utilizing regulatory data for public health analyses. Close

• 3. [Article] State Experiences with Affordable Housing Plus Services: Report to Seniors and Persons with Disabilities, On The Move

  Housing developers, providers, policy makers, and advocates, increasingly recognize that for some groups of individuals, access to affordable housing alone is "not enough." That is, some individuals require ...

  Citation × Citation Citation Abstract Copy Title: State Experiences with Affordable Housing Plus Services: Report to Seniors and Persons with Disabilities, On The Move Author: Carder, Paula C., Zoller, Erika Year: 2009 Housing developers, providers, policy makers, and advocates, increasingly recognize that for some groups of individuals, access to affordable housing alone is "not enough." That is, some individuals require more than shelter. Examples include individuals who have chronic health conditions (e.g., HIV/AIDS), those with physical or cognitive limitations (e.g., persons with developmental disabilities, adults with physical disabilities), and those who have a combination of health conditions or who cannot thrive in traditional housing (e.g., persons who have been homeless, individuals with chronic mental illness). Increasingly, housing providers, social service agencies, advocates, states, and federal agencies have recognized the need to combine housing with supportive services designed to address the health and social needs of such groups and individuals. Older adults want to remain in their homes as long as possible (Bayer & Harper, 2000), and providing supportive services to them in their homes is one approach to preventing or delaying unnecessary institutionalization in an acute or long-term care facility (Gibson et. al., 2003). Increasingly, policy makers and advocates recognize that "homes" includes subsidized rental units occupied by older persons and adults with disabilities. There are a variety of affordable housing and service models across the United States, and they fall under a range of categories and terms (e.g., permanent supportive housing, enriched housing, affordable housing plus services). Whether or not some combination of housing and services can meet the needs of individuals transitioning out of nursing homes remains a question of interest to current nursing home residents, advocates, and policy makers. The purpose of this report is to describe examples of affordable housing plus services (AHPS) that might serve as models for Oregon’s On the Move demonstration project (a Centers for Medicare and Medicaid Services Money Follows the Person project). For this analysis, we reviewed existing reports and articles and collected information about policies and programs in several states in order to learn whether older adults and persons with disabilities, including those discharged from nursing homes, might be served by AHPS programs. Given that Oregon has a long history of providing home and community-based services, we focused primarily on unlicensed housing models rather than licensed residential settings such as assisted living and adult foster care. It is important to note that other states do not have as well-developed a home-and community based care network as does Oregon. Thus, for some states, assisted living is being promoted as a relatively new, and less expensive, alternative to institutionalization. In Oregon, one goal of creating nursing home alternatives is to expand individuals' choices to include affordable housing plus service options. Title: State Experiences with Affordable Housing Plus Services: Report to Seniors and Persons with Disabilities, On The Move Author: Carder, Paula C., Zoller, Erika Year: 2009 Housing developers, providers, policy makers, and advocates, increasingly recognize that for some groups of individuals, access to affordable housing alone is "not enough." That is, some individuals require more than shelter. Examples include individuals who have chronic health conditions (e.g., HIV/AIDS), those with physical or cognitive limitations (e.g., persons with developmental disabilities, adults with physical disabilities), and those who have a combination of health conditions or who cannot thrive in traditional housing (e.g., persons who have been homeless, individuals with chronic mental illness). Increasingly, housing providers, social service agencies, advocates, states, and federal agencies have recognized the need to combine housing with supportive services designed to address the health and social needs of such groups and individuals. Older adults want to remain in their homes as long as possible (Bayer & Harper, 2000), and providing supportive services to them in their homes is one approach to preventing or delaying unnecessary institutionalization in an acute or long-term care facility (Gibson et. al., 2003). Increasingly, policy makers and advocates recognize that "homes" includes subsidized rental units occupied by older persons and adults with disabilities. There are a variety of affordable housing and service models across the United States, and they fall under a range of categories and terms (e.g., permanent supportive housing, enriched housing, affordable housing plus services). Whether or not some combination of housing and services can meet the needs of individuals transitioning out of nursing homes remains a question of interest to current nursing home residents, advocates, and policy makers. The purpose of this report is to describe examples of affordable housing plus services (AHPS) that might serve as models for Oregon’s On the Move demonstration project (a Centers for Medicare and Medicaid Services Money Follows the Person project). For this analysis, we reviewed existing reports and articles and collected information about policies and programs in several states in order to learn whether older adults and persons with disabilities, including those discharged from nursing homes, might be served by AHPS programs. Given that Oregon has a long history of providing home and community-based services, we focused primarily on unlicensed housing models rather than licensed residential settings such as assisted living and adult foster care. It is important to note that other states do not have as well-developed a home-and community based care network as does Oregon. Thus, for some states, assisted living is being promoted as a relatively new, and less expensive, alternative to institutionalization. In Oregon, one goal of creating nursing home alternatives is to expand individuals' choices to include affordable housing plus service options. Close