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• 1. [Article] Sustainable, Affordable Housing for Older Adults: A Case Study of Factors that Affect Development in Portland, Oregon

  Portland, Oregon, is considered to be a leader in sustainable development. Government agencies, nonprofit organizations, and businesses have been innovators in policymaking and practice that is aimed at ...

  Citation × Citation Citation Abstract Copy Title: Sustainable, Affordable Housing for Older Adults: A Case Study of Factors that Affect Development in Portland, Oregon Author: DeLaTorre, Alan Kenneth Year: 2013 Portland, Oregon, is considered to be a leader in sustainable development. Government agencies, nonprofit organizations, and businesses have been innovators in policymaking and practice that is aimed at creating a more sustainable city. Despite population aging, little is known about how or whether planners and developers consider older persons in terms of sustainable development. Thus, this study examined the case of sustainable, affordable housing developed for low-income adults aged 55 and older. Interviews with 31 key informants were conducted in order to answer three research questions: What is the meaning of sustainable development in Portland, Oregon, as it pertains to affordable housing for an aging society? How and why has sustainable, affordable housing for older adults been developed in Portland? What are the policies that affect the availability and appropriateness of sustainable, affordable housing for older adults in Portland? The sample included individuals who influenced the creation of senior housing (e.g., urban planners, architects, nonprofit directors) and who were identified either because of their roles within local housing development or through snowball sampling. Six Portland-area developments provided the context for studying how and why sustainable, affordable housing for older adults was planned and created in the city. The findings suggested that introducing the topic of aging into the discourse of sustainable development will lead to a more robust meaning of the concept, which can aid future research, policy, and practice. Five elements characterizing sustainable housing for older adults were identified: physical accessibility; proximity to community services; infrastructure that connects housing with services; healthy living environments; and high-quality social spaces in and near housing developments. The findings also pointed to the need for sustainable development practices to pay attention to social equity and the equitable distribution of affordable housing, including housing for older adults. Several insights into how sustainable, affordable housing for older adults developed in Portland were gained (e.g., using government subsidies; involving aging experts in integrated design processes; intersectoral partnerships that led to the city becoming an early adopter in greening its affordable housing), as well as why such housing was completed (e.g., there was a collective public-sector response to meet the need for creating sustainable, affordable housing; an emerging culture of sustainable development in Portland; urban and regional planning efforts have begun to address population aging). However, the amount of sustainable, affordable housing remains insufficient to meet Portland's aging population. Reasons identified include: the absence of specific housing policy attuned to the needs of older adults in Portland; disconnects between housing and health care and supportive services; and lack of integration of older adults in the planning, design, and development processes. Room for innovation and improvement exists in regard to healthy, accessible, green, and affordable housing policies and the development of new models of housing for an aging population. Based on this research, 10 guiding principles of sustainable development for an aging society were proposed to inform future research, as well as planning and development efforts. Title: Sustainable, Affordable Housing for Older Adults: A Case Study of Factors that Affect Development in Portland, Oregon Author: DeLaTorre, Alan Kenneth Year: 2013 Portland, Oregon, is considered to be a leader in sustainable development. Government agencies, nonprofit organizations, and businesses have been innovators in policymaking and practice that is aimed at creating a more sustainable city. Despite population aging, little is known about how or whether planners and developers consider older persons in terms of sustainable development. Thus, this study examined the case of sustainable, affordable housing developed for low-income adults aged 55 and older. Interviews with 31 key informants were conducted in order to answer three research questions: What is the meaning of sustainable development in Portland, Oregon, as it pertains to affordable housing for an aging society? How and why has sustainable, affordable housing for older adults been developed in Portland? What are the policies that affect the availability and appropriateness of sustainable, affordable housing for older adults in Portland? The sample included individuals who influenced the creation of senior housing (e.g., urban planners, architects, nonprofit directors) and who were identified either because of their roles within local housing development or through snowball sampling. Six Portland-area developments provided the context for studying how and why sustainable, affordable housing for older adults was planned and created in the city. The findings suggested that introducing the topic of aging into the discourse of sustainable development will lead to a more robust meaning of the concept, which can aid future research, policy, and practice. Five elements characterizing sustainable housing for older adults were identified: physical accessibility; proximity to community services; infrastructure that connects housing with services; healthy living environments; and high-quality social spaces in and near housing developments. The findings also pointed to the need for sustainable development practices to pay attention to social equity and the equitable distribution of affordable housing, including housing for older adults. Several insights into how sustainable, affordable housing for older adults developed in Portland were gained (e.g., using government subsidies; involving aging experts in integrated design processes; intersectoral partnerships that led to the city becoming an early adopter in greening its affordable housing), as well as why such housing was completed (e.g., there was a collective public-sector response to meet the need for creating sustainable, affordable housing; an emerging culture of sustainable development in Portland; urban and regional planning efforts have begun to address population aging). However, the amount of sustainable, affordable housing remains insufficient to meet Portland's aging population. Reasons identified include: the absence of specific housing policy attuned to the needs of older adults in Portland; disconnects between housing and health care and supportive services; and lack of integration of older adults in the planning, design, and development processes. Room for innovation and improvement exists in regard to healthy, accessible, green, and affordable housing policies and the development of new models of housing for an aging population. Based on this research, 10 guiding principles of sustainable development for an aging society were proposed to inform future research, as well as planning and development efforts. Close

• 2. [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

• 3. [Article] Differential Health and Social Needs of Older Adults Waitlisted for Public Housing or Housing Choice Vouchers

  Affordable housing is an important form of income security for low-income older persons. This article describes characteristics of older persons waitlisted for either public housing or a housing choice ...

  Citation × Citation Citation Abstract Copy Title: Differential Health and Social Needs of Older Adults Waitlisted for Public Housing or Housing Choice Vouchers Author: Carder, Paula C., Luhr, Gretchen, Kohon, Jacklyn Nicole Year: 2016 Affordable housing is an important form of income security for low-income older persons. This article describes characteristics of older persons waitlisted for either public housing or a housing choice voucher (HCV) (previously Section 8) in Portland, Oregon. 358 persons (32% response rate) completed a mailed survey with questions about demographics, health and housing status, food insecurity, and preference for housing with services. Findings indicate that many waitlisted older persons experienced homelessness or housing instability, poor health, high hospital use, and food insecurity. Public housing applicants were significantly more likely to report lower incomes, homelessness, and food insecurity than HCV applicants. We conclude with policy implications for housing and health agencies that serve low-income older persons. Title: Differential Health and Social Needs of Older Adults Waitlisted for Public Housing or Housing Choice Vouchers Author: Carder, Paula C., Luhr, Gretchen, Kohon, Jacklyn Nicole Year: 2016 Affordable housing is an important form of income security for low-income older persons. This article describes characteristics of older persons waitlisted for either public housing or a housing choice voucher (HCV) (previously Section 8) in Portland, Oregon. 358 persons (32% response rate) completed a mailed survey with questions about demographics, health and housing status, food insecurity, and preference for housing with services. Findings indicate that many waitlisted older persons experienced homelessness or housing instability, poor health, high hospital use, and food insecurity. Public housing applicants were significantly more likely to report lower incomes, homelessness, and food insecurity than HCV applicants. We conclude with policy implications for housing and health agencies that serve low-income older persons. Close

• 4. [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