Supportive Services Demonstration for Elderly Households in HUD-Assisted Multifamily Housing

Department of Housing and Urban Development (HUD) 

DEADLINE: April 18, 2016. 

AWARD: HUD is making available through this NOFA $15,000,000 for a three year project period. Individual grant amounts vary. 

NUMBER OF AWARDS: HUD expects to make approximately 80 awards. 

ELIGIBILITY: Applicants must be owners of existing eligible federally assisted multifamily properties:

1.    Eligible Multifamily Property:

a.    Must be a HUD-assisted development with at least 50 assisted housing units – Unit count may be a combined count of total number in a campus setting. The development must be occupied by one or more person at least one of whom is 62 years of age or more at the time of initial occupancy.

b.    HUD-Assisted housing types are limited to:

  • Housing that is assisted under section 202 of the Housing Act of 1959;

  • Housing for which project-based assistance is provided under section 8 of the US Housing Act of 1937, including section 515 rural housing projects, receiving Section 8 rental assistance;

  • Housing financed by a loan or mortgage insured under section 221(d)(3) of the National Housing Act that bears interest at a rate determined under section 221(d)(5) of such act; or

  • Housing insured, assisted, or held by the Secretary, a State, or a state agency under section 236 of the National Housing Act;

c.     Properties meeting the requirements of 1.a. and 1.b. of this subsection with an existing service coordinator on staff may apply for funding in order to hire the Wellness Nurse and implement this enhanced supportive service model.

TARGET POPULATION: Low-income older adults in HUD-assisted housing. 

SUMMARY: Funding made available under this NOFA must be used to fund supportive services in eligible existing HUD-assisted multifamily developments targeted to elderly households. 

HUD’s investment under this Demonstration is intended to produce evidence about the impact of a supportive services model in existing assisted senior developments on:

  • Aging in place;
  • Transitions to institutional care; and
  • Housing stability, well-being, health outcomes, and health care utilization (e.g. hospitalizations, emergency room visits) associated with nursing home placement and high health care costs.

Supportive Services Model: Properties that apply to this NOFA and are selected for the Treatment Group of the Demonstration will be required to implement the core components of the supportive services model. The core components include an on-site full-time Enhanced Service Coordinator and an on-site part-time Wellness Nurse who will work as a team to conduct need assessments and coordinate and connect residents to supportive services. The Enhanced Service Coordinator and Wellness Nurse team must be available to serve the entire resident population, addressing social resource and support needs, providing preventive health services and education, and acting as a liaison with primary care and service providers. Resident participation must be voluntary. 

The Demonstration has identified key components that selected properties will be required to incorporate. These components are considered critical to the Demonstration design because of their potential to demonstrate the impact of targeted, coordinated housing, and health and long-term care services and supports on the outcomes of interest for low-income older adults in HUD-assisted housing. The core components include:

1.    Enhanced Service Coordinator role. One full-time Enhanced Service Coordinator should be able to serve between 50-100 elderly residents.

2.    Wellness Nurse presence.

3.    Coordination and support of transitions from a hospital or nursing home back to the property.

4.    Assistance with medication self-management. Another major focus of the model will be on improving resident skills and capacity for medication adherence. The Wellness Nurse will assess the medication self-management skills of residents and identify potential issues such as cognitive and physical ability to self-administer medications. Wellness Nurses must not administer medication.

5.    Falls prevention programs. The model will include one-on-one assessments and evidence-based education and interventions to improve balance, increase recognition of or identify fall threats, and prevent falls.

6.    Mental health programs. The model will include assessment of mental health needs and referrals to local resources to address some common issues that have been found among this population, such as depression, anxiety, and in some cases, serious mental illness.

7.    Engagement with health care providers. To the extent possible, the model will promote residents’ engagement with health care providers, with medical home teams, and/or with other health care providers. Beyond the on-site nursing presence, the model is expected to promote direct engagement with health providers and/or medical home team. The model is expected to take advantage of initiatives under the Affordable Care Act (ACA) and other health reform activities targeted to the high-risk and high-cost elderly population.

8.    Partnership between housing, health care, and service providers or provider agencies. At each site, the model will foster the collaboration between the housing provider and key partners for the Demonstration, such as Area Agencies on Aging (AAA)/Aging and Disability Resource Center (ADRC), the local home health agency, the local mental health services agency, and other local health and/or service provider agencies. It is expected that these agencies will enter into a partnership agreement with the property and designate a representative who will meet monthly with the Enhanced Service Coordinator and the Wellness Nurse to coordinate the services and supports to residents. All provider organizations will be a Medicaid and/or Medicare certified provider, have the capacity to bill Medicaid and Medicare or be affiliated with an AAA/ADRC, and be willing to serve residents regardless of income level by establishing a sliding scale linked to residents’ income. As with all Medicaid and Medicare services, beneficiaries will have a choice of providers and receipt of services is not a requirement for tenancy.

To generate rigorous evidence of the effectiveness of this supportive services model for elderly households, the Demonstration will be coupled with an experimental research design. There are three significant features of the research design that are shaping this Demonstration and will affect the Demonstration implementation: (a) the creation of two Treatment and two Control Groups of enrolled properties, (b) the use of a lottery – also known as random assignment – to place eligible properties in these groups, and (c) the requirement to implement the core components of the demonstration, to follow quality assurance and control requirements, and to cooperate with the formal independent evaluation of the Demonstration. The experimental design involves randomly selecting two Treatment and two Control Groups from the eligible properties that apply to this Demonstration. Pool 1 will include properties that currently have a service coordinator but do not have a nurse and Pool 2 will include properties that do not have a service coordinator or nurse. Properties in Pool 1 and 2 will be randomly assigned to the Treatment and Control Groups.

  1. Pool 1 – Treatment Group comprises eligible properties that have a service coordinator but do not have a nurse. These properties will receive a grant to hire a Wellness Nurse and augment their existing service coordinator program if necessary, implement the Demonstration in their property, enroll residents in the supportive service model, and assist in the evaluation;
  2. Pool 1- Control Group comprises eligible properties that have a service coordinator but do not have a nurse. These properties will not receive a grant to implement the Demonstration in their property, but will receive a financial incentive to collaborate with researchers and assist in the evaluation;
  3. Pool 2 – Treatment Group comprises eligible properties that do not currently have a service coordinator or a nurse. These properties will receive a grant to hire an Enhanced Service Coordinator and a Wellness Nurse, implement the Demonstration in their property, enroll residents in the supportive services model, and assist in the evaluation;
  4. Pool 2 – Control Group comprises eligible properties that do not currently have a service coordinator or a Wellness Nurse, These properties will not receive a grant to implement the Demonstration in their property, but will receive a financial incentive to collaborate with researchers and assist in the evaluation.

To support this research design, HUD expects to randomly assign eligible applicants to the Treatment and Control Groups through a state-level lottery process. 

LINK to RFP: http://portal.hud.gov/hudportal/documents/huddoc?id=2015ssdemo-nofa.pdf