Research confirms what many experts have long suspected: that good health and access to safe, affordable housing are inextricably linked. The problem is that housing and health care providers have been operating in their own “silos” and haven’t formulated long-term strategies for collaboration and sharing of information to provide these basic needs to the populations they serve.
With the goal of initiating a dialogue between interested parties, the Affordable Housing Conference of Montgomery County, partnering with Montgomery County’s Department of Housing and Community Affairs and the Department of Health and Human Services, held a roundtable last week to encourage each sector to brainstorm ways to better work together. According to Della Stolsworth, AHCMC director, “Our goal is not to target any one population but to hold a very general get-together and have an audience evenly mixed between health care providers and the folks in housing which caters to seniors, the disabled and the homeless.”
In introducing the first of two panels Barbara Goldberg Goldman, the founder and co-chairwoman of the AHCMC, gave two quick examples of the synergy between good housing and good health. “Imagine a woman in subsidized housing,” she said, “who needs a mammogram. It is incumbent on us to educate her about the need for the mammogram, if not provide the service.”
She provided another example: “Children need to be vaccinated. The parents need to be informed on the value of the vaccination to be able to make that decision for their child.”
The first panel, moderated by Clarence Suggs of the Montgomery County DHCA, had participants who introduced existing models of subsidized housing that already offer safe and healthy environments for its tenants.
Stephany de Scisciola of Enterprise Community Partners, an affordable housing nonprofit in Columbia, Md., that works with partners nationwide, said that its builders have long been committed to all aspects of good housing, helping not just the homeless but those who are burdened by the high cost of housing. The group is also a pioneer in green housing.
Because funding is always a consideration of developers, they are reaching out to health care payers and providers to see how they might offer capital into building affordable housing. They also have research projects and a health advisory council “working to help us chart our course forward,” de Scisciola said.
Elizabeth Pierce, a lawyer with Fannie Mae, said the housing finance agency has an indirect way of helping to ensure healthy living for low-income renters by helping borrowers of a multi-family affordable housing complex find cheaper financing. This allows for more affordable rents so tenants will have money for medicine, clothing and other necessities. Now Fannie Mae wants to find a more direct way to promote healthy living, so it is offering financing incentives — including interest rate breaks and investment opportunities in resident services — to encourage borrowers to incorporate healthy design tenets.
Andrew Fenelon, an assistant professor in the Department of Health Services Administration at the University of Maryland’s School of Public Health, mentioned that he is starting a multi-year project there to examine how giving families access to affordable housing through the Department of Housing and Urban Development’s housing assistance program improves health and wellbeing. The study of offering healthy housing environments for children might demonstrate how benefits accrue over the course of children’s lives, he said.
Capt. Jamie Baltrotsky of the Montgomery County Fire and Rescue offered a perspective on how responders are trying to break the cycle of frequent calls to 911 by the same people. Fire and Rescue has started a new mobile health program, MCNICCC (Montgomery County non-emergency intervention and community care coordination), which will work with first responders and the county’s social service agencies, five of the county’s six hospitals, and the providers of homeless outreach and behavioral health, on how to best serve the area’s EMS “super-users” who make these repeated 911 calls.
When fire and rescue personnel encounter such a vulnerable person they will decide if that patient should get assistance from an existing county support system. They will work to follow up so these people don’t continue dialing 911.
“Follow up is the key,” she said. A social worker will be added to a home visit team as well.
“People didn’t realize what our fire and rescue services deliver: basically health care delivery,” said Montgomery County Councilmember Nancy Floreen (D).
“There is a pressure on council members to fund the schools but we know that the environment kids grow up in is as important to their success as anything else,” she said. Tension between budgetary decisions and public policy exist over funding these needs.
“The real issue for all of us is deciding what we want the future to be,” Floreen said. “I don’t think we’re there yet.”
One audience member suggested that “we need a social awareness campaign to convince people of the benefits of affordable housing to the community.”
The second group of panelists focused on what was working for their housing properties, including forming personal relationships to see what their residents really need.
Joe Podson of Residential One recounted that when he was the executive director of Homecrest House, a not-for-profit, non-denominational community of apartment buildings in Silver Spring, he decided to partner with others to start a team approach to help tenants. Now there are three aides who stay in the building at Homecrest to care for the people in those in the 277 units. They work independently and rely on calling physical therapists.
Additional caregivers, if needed, are paid for by Medicare, Medicaid and private insurance. If residents are in the hospital the visiting nurses association will bring newsletters or get-well cards to patients to keep the connection with their home.
The emphasis must be on the personal, the panelists agreed. Ben Peck, representing Wellness and Independence for Seniors at Home, said his organization is all about creating glue between all the disparate parts in the health care system.
His employees visit people residing in buildings ranging from low-income to high-end, all trying to help them age effectively in place. They work with communities such as Homecrest where the building leadership and staff also want to keep their aging residents in their homes.
Nexus Montgomery is a collaborative effort among the six hospitals operating in the county and other non-profits, such as the WISH program, to implement or expand initiatives to improve the health of those most at risk. Its mandate is large; it works with the mentally ill population in the county by partnering with Cornerstone Montgomery to help 100 people to maintain their independence. It also worked with Cornerstone to develop a third crisis house in the county. In addition, Nexus is working to develop a respite care center consisting of 15 beds where the homeless can receive home health services they need after leaving the hospital. The hope is that these people will be able to move from that facility to independence.
The Montgomery Housing Partnership owns about 1,700 apartment buildings throughout the county. Its mission is to buy older apartment buildings, do major renovations and work to keep the apartments affordable. The group builds new buildings as well and recently constructed a 149-unit senior housing project on county-owned land in Silver Spring, The Bonifant. It also utilizes Enterprise green standards and create space for community centers.
“As a housing provider, we’re not experts and need a more deliberate way, but it’s all about place-based services,” said Rob Goldman of the housing partnership. “Residents know us and trust us.”
Dr. Uma Adhluwalia, director of Montgomery County’s Health and Human Services, emphasized that any conversation of health and housing is not just about aiding seniors but also children and families.
“It is the health of the community that will determine how healthy and well-adjusted our young people are as they grow up,” she said.