MEMORANDUM
TO:
Housing and Long-Term Care Workgroup
FROM:
Christal Stone, AcademyHealth Staff Contact
SUBJECT:
Summary of Kick-Off Conference Call May 17, 2006, 1:00 p.m. – 2:00 p.m EDT
DATE:
May 22, 2006
This was the first call of the LTC Housing Workgroup. The purpose was to discuss issues related
to LTC housing, establish where members interest lay to narrow down the topic, and begin
developing an activity for the group.
Participants:
Annette Totten (WG leader), Center for the Study on Aging, Boise State University;
Mary Marita, Benjamin Rose Institute
Courtney Burke, Rockefeller Institute
Paula Carder, University of Maryland-Baltimore County
Steve Golant, University of Florida
Sandra Hughes, SEIU
AcademyHealth Staff:
Kristine Metter
Christal Stone
Meredith Davis
Introductions
This workgroup was initiated from Steve Golant’s presentation at the 2005 LTC Colloquium.
AcademyHealth’s role is to staff the workgroup, provide outreach, and help disseminate
potential products. The goals of the LTC workgroups are to discuss relevant LTC issues, form
working relationships, and work together to create a useful product. The workgroup breakfast at
the 2006 Colloquium on June 24 in Seattle will be an opportunity to meet, talk, and determine
the direction of the group.
Housing is a huge topic and there are different interpretations on what is meant by LTC and
housing—from paying for housing to using housing to finance LTC, to how to design housing.
The margins are vague which makes it difficult to define the parameters of the issue.
Each member of the group introduced themselves and spoke on their specific background and
interests in the topic.
Mary Marita: New to the field from the housing perspective. Benjamin Rose recently closed their
nursing facility to focus on developing senior housing and service delivery.
Courtney Burke: Studies issues on Medicaid at the Rockefellar Institute and sees housing as a
key issue. Interested in learning about new innovations states are using to finance housing.
Sandra Hughes: SEIU represents 500,000 workers in nursing homes, homecare, CCRC’s, and
assisted living settings. Focused on assisted living and broader LTC housing policy issues.
Paula Carder: Finished a report on affordability of assisted living. Noted the disconnect between
housing and service providers. Looking at Medicaid, subsidy programs and private lenders.
Negotiated risk in assisted living. Interested in environmentally-friendly senior living options
(specifically geared toward Baby Boomers).
Steve Golant: Focused on affordability. Certain groups of elderly are more at risk which has
implications for the promotion of aging in place. Important to find affordable and appropriate
housing settings. How a program is packaged needs to be careful thought out in order for it to
meet multiple needs. Pros and cons to providing services onsite as opposed to outsourcing
services. Interested in linking services with assisted living, service coordinator approach.
Annette Totten: Involved with community and regional planners, which are not always talking
about housing, aging, and long-term care.
Beyond the Colloquium
Golant discussed next steps for his background paper. Most health related journals consider
housing-care linkages on the periphery. Need to convince the healthcare sector that providing
services at lower levels of impairment can be argued as preventative/controlling/delaying of
more serious responses. This argument opens up housing issues to a broader community.
Discussion on goals
AT: Medicaid budgets per state are generally key issues.
SH: ALFs and CCRCs, housing with supports. Interested in homecare and Medicaid. Very
interested in states that are rebalancing their LTC programs. State models. How can we get
housing into the LTC discussion?
CB: Medicaid plays a role in the focus on the medical aspect since it’s a way to pay. Have any
states take innovations in paying for non-medical services? Look to disability models for lessons
for the elderly and the elderly with disabilities.
PC: Also interested in looking to disability community for lessons. How to assess people’s needs
at the correct level.
SG: Medicaid program gives priority to different groups for recipients. HCBS, ALFs, nursing
homes, Medicaid waiver for HUD properties, rent subsidies. How can states examine why and
how. In what ways are states changing priorities within their rebalancing efforts.
PC: The home and community-based programs are very broad and mean very different things.
Many worried about the cost of the woodwork effect without looking at specifics. Clarifying the
range involved may help guide policymakers.
Future Activities
Potentially focus on the following questions:
Where are major efforts currently underway in states? We could examine initiatives taken by
states to rebalance ltc and see if they consider housing issues within their LTC framework. Then
we could work to take the rebalancing question further.
What are the most important unanswered questions? What needs to be known in the field?
Once we have this information, how do we get that information out? Can we stir-up interest
with information on the big questions? Another approach is to support researchers early in
their career by telling them what needs to be focused on
Next Steps
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Prioritize topic areas
Frame an agenda around selected subtopics
Find and summarize literature available on state rebalancing and housing-related
initiatives
Start producing a list for where efforts have already been made in this field and identify
how group efforts will feed into these
Produce something that solicits policymakers and/or researchers. Who to target?
Suggested Background:
Stephen Golant, “Affordable clustered housing care for older americans: A promising but still
immature long-term care strategy,” Prepared for Building Bridges LTC Colloquium, June 25,
2005. DRAFT.
Shirk. C, “Rebalancing Long-Term Care: The Role of the Medicaid HCBS Waiver Program,”
National Health Policy Forum, March 3, 2006.
See: http://www.nhpf.org/pdfs_bp/BP_HCBS.Waivers_03-03-06.pdf
Suzanne Crisp et al., “Money Follows the Person and Balancing Long-Term Care Systems:
State Examples,” Medstat, prepared for CMS, September 29, 2003.
See: www.cms.hhs.gov/PromisingPractices/Downloads/mfp92903.pdf
Green House Project. See: http://thegreenhouseproject.com