Aging Gracefully in Safer and Healthier Homes

The National Center for Healthy Housing (NCHH) is seeking partners for our project titled “Aging Gracefully in Safer and Healthier Homes,” which will improve the quality of life for low-income older adults so that they may safely remain in their homes. Click here to respond to the request for partners. Responses are due by 5:00 p.m. on Monday, June 23, 2014.

By the year 2030, it is estimated that the older adult population (age 65-plus) in the U.S. will double to more than 70 million individuals. Policymakers and practitioners are beginning to grapple with the need for housing that matches this important demographic, which will constitute approximately 20 percent of the U.S. population. NCHH has just completed its next three-to-five-year strategic plan, which identifies a number of strategies around improving the quality and appropriateness of housing for older adults. We propose a multisite demonstration project to deliver improvements to the homes of low-income older adults with the goal of improving their health, safety, and quality of life.

*Funding for this project is still pending.


1. Will local groups be responsible for establishing the relationship with payers?

A: NCHH will be responsible for working directly with payers. However, we would like the applicants to identify in their proposals the names of the payers they think would be the best local data partners (hospital, ACO, health care system). In other words, we don’t expect local groups to have established the relationship prior to submitting their proposals but we would like them to help identify the likely prospects for the health care utilization/cost evaluation and any previous relationships they have with these partners. Those with prior relationships will likely score a little higher.

2. Can we work in multifamily housing?

A: Our original vision was single family low-income housing. Multifamily housing properties are okay as long as they are not long-term care facilities or nursing homes. Also, the applicant should be confident that they can carry out the interventions without encountering barriers (e.g., landlord won’t allow, interventions infeasible due to building type, et cetera).

3. Will we pay for the clinical organization’s time?

A: Our original vision was that the clinical home-based care was already being provided and therefore we are only adding the home repair component. As such, we have not budgeted time for the clinical staff. Applicants should comment on whether this assumption is realistic in the context of their proposal.

4. Regarding the definition of low income, in the grants we typically work on with HUD we use their definition: “A household whose income does not exceed 80 percent of the median income for the area, as determined by HUD, with adjustments for smaller or larger families. HUD may establish income ceilings higher or lower than 80 percent of the median for the area median on the basis of HUD's findings that such variations are necessary because of prevailing levels of construction costs or fair market rents, or unusually high or low family incomes.” Is this true in this case as well?

A: Yes.

5. How many pages should the application be?

A: No more than 5. Please see the last page of the RFP.

6. How did you arrive at the age of 60. As you know Low Income Housing Tax Credits and Fair Housing laws define “seniors” as 55-plus years old, while Medicare begins at 65, and HUD Section 202 age eligibility starts at 62. For example, we have found that it can be controversial in a rehab project if we provide different levels of rehab to different resident groups. So if we were to provide rehab assistance to a 60-year-old in one of our communities, but not to the 55-year-old neighbor, this might be unsettling to the residents. Related to this, many of our housing sites have younger disabled individuals who are at particular risk for isolation/mental health issues. I am wondering if you would be open to considering an age cut off of 55-plus, with flexibility to serve person’s with a disability residing in the same building?

A: Yes we are flexible. Note that we are trying to demonstrate the efficacy of home-based interventions. If you have a healthy population of 55-year-olds you will be unlikely to see an effect. This is one of the reasons we opted for a slightly older population. However, we are flexible if the age specification creates equity issues within the property. With regard to younger disabled individuals, since this demonstration is focused on older adults we wouldn’t want to go younger than 55.

7. We collect over 220 data elements on each of our participants including falls, mental health (depression and cognition), hypertension, et cetera. This data goes into our state’s Central Clinical Registry – an integrated health record available to physicians, community health workers and special programs such as tobacco cessation. We are able to pull dashboard reports (see attached) on all of this data, by housing site (we have 115 affordable housing communities participating at this point). Separate from this web based Electronic Health Record, our state has an all payer database that includes Medicare and Medicaid claims data with each participant flagged. My question is – if we were selected as your partner would you use our clinical and claims data – or would your evaluators utilize other data sets?

A: This sounds like a very rich data set. We have no need to collect additional data if the data sets you have access to would already enable us to track health care utilization and health care expenses.

8. We have developed what we call the “Evidence Based Practices Directory,” organized by the following categories: falls, chronic conditions (COPD, arthritis, asthma, et cetera), healthy lifestyles (nutritional status, exercise), medication management, and mental health. We are wondering if you are aware of a similar directory that cross walks the conditions you list in your proposal with physical plant improvements? We do about 82 reasonable accommodation requests per year, but they generally relate to avoiding home injuries and accessibility. So we are curious what physical changes you see as reducing the morbidity or mortality of a person with COPD or hypertension. We are working on several research projects including one with the Centers for Disease control on reducing hypertension – the most important practice we have found is to supply blood pressure cuffs at every one of our SASH communities. This is proving to increase the percentage of our low- income population who have controlled their high blood pressure.

A: We plan to work with the funded sites to establish and validate the intervention strategies that have not already been well documented. Preliminary work has been done on COPD (these interventions tend to look similar to asthma trigger management but also include items that make it easier for an individual to live and get around their home without getting out of breath. For hypertension, particulate matter and temperature of the home are the key evidence-based interventions. Again, we will refine the intervention protocol in partnership with the sites.

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