By Geralyn Magan
Alisha Sanders of the LTSS Center and Linda Couch of LeadingAge’s Policy Team are working together to translate research into action on Capitol Hill.
Collaboration between the LeadingAge LTSS Center @UMass Boston and the LeadingAge Policy Team recently resulted in a small victory on Capitol Hill for financing of housing plus services models.
The victory came in the form of a sentence, inserted in the “explanatory statement” that accompanied the FY20 Appropriations Bill. The sentence directs the Office of Policy Development and Research at the U.S. Department of Housing and Urban Development (HUD) to collaborate with the Centers for Medicare and Medicaid Services (CMS).
The required collaboration will focus on a subject that is dear to the hearts of both Alisha Sanders, director of housing and services policy research at the LTSS Center, and Linda Couch, vice president of housing policy at LeadingAge.
HUD is directed to collaborate with CMS to explore how Medicare and Medicaid funds can be used to support programs that use affordable senior housing as a platform for coordinating health, wellness, and supportive services and programs. Research by the LTSS Center and others shows that these models help older adults remain healthy, age in their community, and reduce their use of costly health care services.
Sanders and her colleagues at the LTSS Center have spent the past decade studying the housing plus services model, and documenting its positive outcomes. In 2018, that work led to a yearlong exploration, funded by the Gordon and Betty Moore Foundation, of potential financing options to support housing plus services models. A report on the financing exploration was released in April 2019.
“We know that more and more members are interested in bringing services to their affordable housing residents,” says Sanders. “But they’re struggling, in part, because they don’t have the resources to do it. This need is really what helped inform and drive our research around the financing paper last year.”
THE ADVOCACY AGENDA
Financing for housing-based services has also been on LeadingAge’s advocacy agenda, says Couch. That shared interest brought Sanders and Couch together in spring 2019 after Couch learned that Selfhelp Community Services, a LeadingAge member in New York, had recently piqued the interest of the office of Rep. Nita M. Lowey (D-NY), chair of the House Appropriations Committee, during a recent visit.
The Selfhelp representatives had described their organization’s housing plus services initiatives, shared their own research about the program’s effectiveness, and asked for Chair Lowey’s help so they could sustain and expand the program. When Lowey asked a staff member to help her address Selfhelp’s concerns, the staff member recalled a conversation about housing plus services that she’d had with Couch, and asked for Couch’s help in moving the issue forward.
Couch’s first instinct was to reach out to Sanders.
“When I hear people on the Hill, say ‘I want to do something real about housing plus services,’ my automatic response is, ‘Okay, I’m going to bring in Alisha Sanders and we will talk to you about it together.’ That’s because I want to bring all of her research knowledge to the conversation.”
That’s exactly what happened over the next few months as Couch and Sanders worked closely with the HUD appropriations subcommittee staff to fashion a workable strategy for initiating a conversation about housing plus services financing at the federal level.
“We explained that what (Selfhelp) did in New York City was made possible because of unique funding sources the organization had to cobble together, and that Selfhelp and other affordable housing organizations are struggling to enhance and build up those services because there’s no good financing mechanism for that,” says Sanders. “Our end goal is to have national policy that helps pay for those services. Because research shows that benefits are accruing to Medicare, we really need to bring CMS to the table to figure out how to make this happen.”
CONTINUING THE COLLABORATION
Couch and Sanders, who worked together with Hill staff to draft language for the explanatory statement, are hopeful that the collaboration between HUD and CMS could result in some real progress on the financing side. And, they say, LeadingAge and the LTSS Center will continue lending their support to the effort.
“(HUD and CMS) are going to need the LTSS Center to help them” as they explore financing options, says Couch. “The work that the Center has done on the financing issue will speed up any thinking that HUD’s Policy Development and Research office does on its own. A lot of the work, a lot of the thinking on this, has been done.”
While their ongoing collaboration helped Sanders and Couch score a win for housing plus services financing, both attribute much of their success to timing—and to the role of a LeadingAge member.
“Selfhelp is interested in scaling up these solutions, not just for themselves, but for the field,” says Sanders. “So, it was fortunate timing that the Hill staffers knew that this member had solid research and good outcomes. Then we were able to come along and say, ‘There’s no way to spread this or scale this or sustain this. We need Medicare at the table.’”