Building Innovative Partnerships to End Elder Homelessness

Presented by: Laila Bernstein, City of BostonElizabeth Bradley, MassHealth & OLTSSEmily Cooper, Executive Office of Elder AffairsGail Livingston, Boston Housing AuthorityMari Pérez-Alers & Nancy Roach, Upham’s Elder Service Plan

Agenda WHO WE ARE

INFORMATION ON HOMELESSNESS

BUILDING INNOVATIVE PARTNERSHIPS

CASE STUDIES

QUESTIONS

WHO WE ARE

Boston Housing Authority (BHA)

12,000 public housing units in many building types housing 26,000 residents

14,300 Section 8 participants

40,000 individuals on the BHA waiting list.

City of Boston Mayor’s Initiative to End Chronic and Veteran Homelessness

Chronic homelessness* =Must have a disabling condition + either: 1 continuous episode of homelessness of 1 year or more 4 episodes over three years totaling 12+ months

City designated by U.S. Department of Housing and Urban Development as “Continuum of Care” charged with ending homelessness. Every community in U.S. has a Continuum of Care. Find your local

CoC.**

*https://www.hudexchange.info/resources/documents/Defining-Chronically-Homeless-Final-Rule.pdf**https://www.hudexchange.info/grantees/#/byProgram

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MassHealth - Office of Long Term Services and Supports

Massachusetts PACE

8 PACE Organizations as of August 2017 Operating in 25 PACE Centers in 7 Counties More than one Program in some service areas Serving approximately 4367 Participants Over 98% of Participants have Medicaid

MassHealth and PACE Mass Health has 3 state staff dedicated to PACE Manager Clinical Operations

PACE Organization annual presentation of past year accomplishments

Program Evaluations PACE enrollment defers nursing facility entry by 20 months

Nursing facility cohort study- JEN Associates July 2014 and August 2015

PACE enrollment defers death by 18 Months- JEN Associates PACE Evaluation Nursing Home Residency and Mortality Summary Report August 2015

Executive Office of Elder Affairs Executive Office of Elder Affairs promotes the

independence, empowerment and well- being of older adults, individuals with disabilities and their caregivers.

Chief Housing Operator responsible for preserving and expanding affordable housing options through policy development and partnership building.

Upham’s Elder Service Plan (UESP)

Operated & Managed by Upham’s Corner Health Center Census: 282 Serves core neighborhoods of Boston 1st PACE Center in Dorchester Opened March 1996

2nd PACE Center in Roxbury Opened April 2008

3rd PACE Center in Jamaica Plain/Roxbury line Opened March 2013 BHA campus 12-unit PACE housing wing

Participant Demographics

Average Age of UESP PACE Participant : 75Youngest Participant: 56Oldest Participant: 97Average Age of Chronic Homeless

Participant: 62Youngest Participant: 56Oldest Participant: 77

Information on Homelessness

National Blueprint Homelessness among older adults is increasing across

the nation- adults over 50 currently make up 31 % of the nation’s homeless population.

The experience of homelessness ages people more quickly – the prevalence of geriatric conditions is higher among older homeless adults than housed adults 20 years older.

Homelessness in Boston

612 chronically homeless individuals in January 2016

About 1/3 of all homeless individuals on a given night are chronically homeless

Over 50% of chronically homeless individuals are 50 years old or older

376 chronically homeless individuals housed since January 2016 – represents 2,300 years of homelessness ended

Chronic homelessness = long term homelessness among people with disabilities

BUILDING INNOVATIVE PARTNERSHIPS

Successful Partnering Who Needs to be at the Table? Governmental and Institutional Entities: Impartial institutional

player Department of Neighborhood Development - City Executive Office of Elder Affairs – Commonwealth

Service provider: Ability to stabilize tenancies Uphams Elder Service Plan- PACE

Housers: Affordable units for the most vulnerable residents Boston Housing Authority

Shelter Providers: Identify and prepare prospective participants Pine Street Inn and others

Key Elements to Innovative Partnerships

Identify common goals House the homeless in a manner that creates stable tenancies

Identify reasons for commitment Mission Political Improve work outcomes

Disregard “turf” concerns Overlapping missions Be willing to reassess the way your organization works

“It’s nothing personal” – let go of defensiveness Listen to suggestions/critiques of others We can always work better and smarter Different initiatives require different processes

Make everyone’s job easier Recognizing common problems and solving them

AND…

Cultivating Existing Partnerships Upham’s Elder Service Plan and BHA Created Day Center and Supportive Housing Units at Amory

Street location Department of Neighborhood Development and BHA Years of collaboration on affordable housing development Recent cooperation on Mayor’s plan to end individual

homelessness Department of Neighborhood Development reaches out to

Executive Office of Elder Affairs to leverage service providers Executive Office of Elder Affairs invites PACE and other service

providers to end individual homelessness initiative Upham’s Elder Service Plan steps forward

Key Elements (continued)

TIME It takes times build the relationship It takes time to build trust

Sometimes it works to start small and give your group an opportunity for early success

Other times you just go for it!

How did the elder “ Housing Surge” arise?

“Housing surge” goal: attendees leave with an address and enrolled in the services they need to move into and maintain housing

City & State both very committed to goal of ending chronic homelessness

Boston Housing Authority offered units, but we still needed services

Boston approached MA Executive Office of Elder Affairs’ Chief of Housing

Elder Affairs looked at all available resources and suggested PACE among other Medicaid funded programs

Elder Affairs engaged PACE and Medicaid programs to learn about “housing surge” model

Worked together to do business differently

MassHealth/Elder Affairs Role in Surges

Before the Surge: Organized planning meetings with PACE to

brainstorm and get input on design and implementation Determined MassHealth coverage status for

invited homeless guests Ran claims data to help assess clinical eligibility

and identify providers. MassHealth Nurses conducted clinical eligibility review prior to event to identify PACE “possibles”.

MassHealth/Elder Affairs Role in SurgesAt the Surge:

Mass Health Enrollment Center Staff (MEC) available at surge for review of eligibility/issues

MassHealth Clinical team available at surge for immediate review of Pre-admission screening by PACE teams

Troubleshot issues that arose Provided information to all potential individuals

interested in PACE Ensured Social Security representatives were on

site. Provided proof of identify on location.

CASE STUDIES

Case Study: Adjusting to PACE 60 year old male who enrolled in PACE after the 1stSurge

event in July 2016. He has adjusted to the PACE program and uses services appropriately. He attends the center weekly and is participatory in his plan of care. Programmatic Considerations & Lessons Learned. Focused attention during the first center visit positively impacted

the engagement process. The readiness preparation by the case manager at shelter directly

impacted the participant’s ability to adjust to the program. A volunteer and participant ambassador program is being

considered, as well as expanding and exploring partnerships that may be able to enhance the resources the City has made available.

Case Study: It Takes a Village

70 year old male who enrolled into PACE after the most recent Surge in June 2017. He had previously been homeless for 12 years, and was well connected throughout the shelter system. Our partnership with him started prematurely when after signing his housing lease he declined returning to the shelter. This literally mobilized all the agencies—housing, the shelter, PACE—to ensure a successful transition. Programmatic Changes & Lessons Learned. This case reinforces that the success of the PACE model is directly

related to the ability to care for the individual as a whole and having the flexibility to streamline service/care plans.

The case also exemplifies the importance of having trusted relationships with key stake holders.

Case Study: Housing and PACE work together

56 year old male who enrolled in PACE after the 2nd Surge. He has a history of ETOH use. Prior to enrollment, he visited the ER weekly. Although he has not been ready to accept referrals to manage his alcohol dependency, he has only visited the ER once since enrollment. Programmatic Changes & Lessons Learned. This case demonstrates how a housing stabilization program and

access to comprehensive medical and social services can provide community support resources more easily which may help to decrease ER utilization.

Case Study: End of Life 67 year old male participant who enrolled in

December 2016 and died in March 2017 from complications from his HIV dx. Programmatic Considerations & Lessons Learned. The implementation of a Post-Surge Shelter Visit before

the pre-Center visit positively influenced the engagement process and the ability to better achieve regulatory compliance. Staff reaction is important. The engagement process is more inclusive when current

community providers and service agencies are involved.

Case Study: Is PACE the Right Fit

66 year old male who enrolled into PACE after the 1st surge event in July 2016. He successfully reintegrated into the community at large and seldom uses PACE services. Programmatic Changes & Lessons Learned.o The case highlights the importance of post surge discussions

with enrollee, housing agencies and service providers.

Conclusion• PACE can be an integral part of ending elder

homelessness across the U.S.• PACE demographics are changing• PACE needs to move forward in developing expertise in

the areas of homelessness, behavioral health, and substance use disorders

• Serving chronically homeless older adults and transitioning them to stable community settings are consistent with the PACE mission

Questions & Contact Information Laila Bernstein, Department of

Neighborhood Development, Advisor to the Mayor for the Initiative to End Chronic Homelessness, laila.bernstein@boston.gov

Elizabeth Bradley, Office of Long Term Services and Supports, Pace Program Manager, elizabeth.bradley@state.ma.us

Emily Cooper, Executive Office of Elder Affairs, Chief Housing Officer, emily.cooper@state.ma.us

Gail Livingston, Boston Housing Authority, Deputy Administrator For Housing Programs, Gail.Livingston@bostonhousing.org

Mari Perez-Alers, Upham’s Elder Service Plan, Senior Project Manager, MPerezAlers@uphams.org

Nancy Roach, Upham’s Elder Service Plan, Operations Director, nroach@uphams.org