Our Job Is to Enable Well-Being

We're literally taking a page out of Gawande's book by recognizing that our real job is not just to put a roof over the heads of our older citizens.
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In 2012, noted author and surgeon Atul Gawande went on a mission to find community-based service models that could help older people live successfully "all the way to the end of their lives."

He found one such model at Peter Sanborn Place, a 73-unit affordable housing property and LeadingAge member in Reading, MA.

Sanborn Place isn't your typical affordable housing community. But each day I grow more hopeful that the services it offers to its residents -- services that range from help with meals and shopping to 24-hour personal care -- will soon become standard features in affordable senior housing communities around the country.

The fact that Sanborn Place figures prominently in Gawande's new book -- Being Mortal: Medicine and What Happens in the End -- is sure to help make that dream a reality.

Peter Sanborn Place: A Better Life

In a chapter entitled "A Better Life," Gawande reports that all but 13 of the 70+ residents of Sanborn Place receive some kind of supportive service from their housing property.

Sanborn Place provides nursing-home-level-care for some its residents. But Gawande is quick to point out that it is not a nursing home or an assisted living community.

"Officially, it's still just a low-income apartment complex," he clarifies, adding that CEO Jacqueline Carson may be Sanborn's most distinguishing feature.

Gawande describes Carson as "a manager who is determined to enable people to live in their own homes, in their own way, right to the end, no matter what happens."

Others are Catching On

Sanborn Place and other models featured in Gawande's book have convinced him that we're entering a new era of care for aging Americans. He gives credit for that change to the increasing number of professionals, like Carson, who "believe their job is not to confine people's choices, in the name of safety, but to expand them, in the name of living a worthwhile life."

My own travels to a variety of professional meetings over the past month have convinced me that this is absolutely true.

Each of those national meetings devoted an impressive -- and unprecedented -- amount of attention to Housing Plus Services models.

At a housing conference sponsored by the Urban Land Institute and the MacArthur Foundation, for example, we focused on how Housing Plus Services models could help lower income older adults remain independent, healthy and engaged in their communities.

At the annual conference of Grantmakers in Aging, we concentrated on the potentially powerful role that foundations and other philanthropic groups could play in advancing Housing Plus Services models.

At the annual scientific meeting of the Gerontological Society of America, we explored the nuts and bolts of implementing 4 projects that are currently providing services within affordable senior housing communities.

Happy to be Down in the Weeds

When LeadingAge established its Center for Housing Plus Services in early 2013, our staff traveled the country describing this fledgling model and explaining why it made so much sense, particularly in light of national efforts to reduce health care utilization and spending among our most vulnerable population groups.

Almost two years later, we're moving beyond our original awareness-raising agenda. Now, we're working "in the weeds" to determine, once and for all, what it will take to embed Housing Plus Services programs within affordable senior housing communities nationwide.

We're exploring how housing and health care providers can work together to bring services to housing properties and, in the process, decrease residents' high-cost hospitalizations and emergency room use.

We're figuring out how best to organize, implement and pay for these service programs.

We're conducting research to measure the impact that existing Housing Plus Services programs are having on residents, housing properties, health care professionals and payers like Medicare and Medicaid.

Asking the Right Questions -- And Moving Forward

We don't yet have all the answers we need to make Housing Plus Services models the norm. But the willingness of gerontologists, housing experts, health care clinicians, policy makers, and researchers to seriously explore these questions is a very hopeful sign.

Even more hopeful is the "can-do" attitude I'm observing on a variety of fronts. In this era of across-the-board budget cuts, no one knows if or when the federal government will make new and significant investments in Housing Plus Services models. LeadingAge and its partners continue to work hard to ensure that new investment is forthcoming.

In the meantime, however, Housing Plus Services advocates and developers aren't waiting around. We're designing strategic and mutually beneficial partnerships and innovative financing schemes. We're adopting a creative "let's figure this out" mindset to move our agenda forward.

We're not closing the door on government funding, by any means. In fact, we're hoping that our research and creative thinking will spur policy makers at the federal and state levels to see that investments in Housing Plus Services models can actually save public funds in other areas.

In short, we are laying the groundwork to make Housing Plus Services models a respected and sustainable way to ensure that Atul Gawande's vision for old age becomes a reality: that older adults won't have to sacrifice their autonomy just because they need help as they age.

We're literally taking a page out of Gawande's book by recognizing that our real job is not just to put a roof over the heads of our older citizens.

Instead, our job is to "enable well-being" among older adults so, in Gawande's words, they have the freedom to shape their own lives and write their own stories.

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