Building Innovative Partnerships to End Elder Homelessness · Boston Housing Authority offered...
Transcript of Building Innovative Partnerships to End Elder Homelessness · Boston Housing Authority offered...
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, [email protected]
Elizabeth Bradley, Office of Long Term Services and Supports, Pace Program Manager, [email protected]
Emily Cooper, Executive Office of Elder Affairs, Chief Housing Officer, [email protected]
Gail Livingston, Boston Housing Authority, Deputy Administrator For Housing Programs, [email protected]
Mari Perez-Alers, Upham’s Elder Service Plan, Senior Project Manager, [email protected]
Nancy Roach, Upham’s Elder Service Plan, Operations Director, [email protected]