National Church Residences Home for Life HUD Pilot Innovates
We attended LeadingAge 2016, the annual industry meeting of aging services non-profits. We went in search of best practices, trends, and innovators. The results inform what we’re looking for in our own retirement and the advice we provide others. One of the best nuggets of innovation came from National Church Residences (NCR).
National Church Residences, based in Columbus, Ohio is one of the largest nonprofit operators. (ranking in both affordable housing units for seniors and market rate housing units for seniors.) It operates 340 communities in 28 states. NCR primarily operates communities on both coasts and across the Sunbelt. They are missing the upper plains states and much of the mountain west. National Church Residences also operates many aging support services outside of their communities.
Home for Life: Independence, Respect, Honor
National Church Residences (NCR) emphasizes integrated care. NCR operates beyond the limits of the brick and mortar. Corporately, they have a track record of continuous improvement. By systemizing innovation in the support technologies they’ve extended learned best practice experiences systemwide. This means learning from frontline caregivers. It also means helping frontline caregivers with clear expectations and accountability.
Improve medical outcomes through nonmedical interventions. Intended benefits included both better lives, less burdened by disease, and lower public spending for the associated entitlement programs.
National Church Residences won a Department of Housing and Urban Development (HUD) grant. This pilot grant was to improve affordable housing residents’ health through improved social supports. HUD’s Section 8 subsidized housing has a high concentration of elderly or disabled residents. Many of these individuals are dual eligibles. They receive benefits under both Medicare (elderly and disabled beneficiaries) and Medicaid (low-income beneficiaries). Stated another way, the grant was to improve medical outcomes through nonmedical interventions. Intended benefits included better lives, less burdened by disease. Intended benefits also included lower public spending for the associated entitlement programs. HUD would benefit from increased tenant stability through reduced unit turnover.
The pilot program was named “Home For Life“. Below is a video summary of how the program works:
If your first reaction is, “Surely, investing in a new medicine would be more effective.” You’d be wrong. Home for Life practically eliminated unplanned hospitalizations among high-risk patients in the program. This led to better health and life outcomes. And it produced Medicaid savings of 40% compared to the same population’s health costs before the intervention. How is this possible?
Shared Savings is where Medicare and Medicaid are both going, we have to be part of the future. — Teresa Allton
Medicaid savings of 40% – how is this possible?
First : This was effort at a population level. The coordinators assessed the health status of all the covered residents. They used a standardized health status assessment tool. No need to reinvent this wheel. Just apply it consistently. High risk was highly predictive of a major health crisis (high-cost morbidity) or death (mortality) in the next six months.
Second : NCR applied the Pareto Principle (aka the 80/20 Rule). Coordinators previously spread their time equally. Or worse, on the comparatively healthy, but squeaky wheels. The grant program focused coordinators time and effort on the 20% of the population with the worst health status. That is those that produced the highest burdens and health costs.
“National Church Residences’ Home for Life program is an outcomes-focused service model, using evidence-based assessments and evaluation tools to identify an individual’s needs and risk factors. By engaging those we serve where they live, Home for Life can identify and overcome social determinant factors that impact an individual’s ability to best manage their chronic diseases, leading to higher satisfaction and engagement, better health and cost savings.” National Church Residences
Coordinators then used grant resources and a patchwork of existing programs to help residents. These resources were used to better manage the resident’s health and use medical resources.
Diet and exercise can make a difference, even if someone is seriously ill. Seeing the doctor proactively can and did reduce emergency room visits. Also unscheduled hospitalizations due to chronic conditions progressing to a crisis reduced. Medical providers complain about patient non-compliance.
When it’s your parent in crisis, the support of professional caregivers like Home for Life is indispensable. We can choose the venue of our aging and death. We can enhance the quality of life & reduce traumatic care. Programs like National Church Residence “Home for Life” will make it possible.