Service-enriched supportive housing, outreach, advocacy: a model approach to ending elder homelessness

1. Home for Good Service-enriched supportive housing, outreach, advocacy: a model approach to ending elder homelessness

2. Mark Hinderlie President & Chief Executive Officer

3. Who Is Hearth • Not just addressing a need, but solving a problem • A small agency with a big mission: to end the shame of elder homelessness

4. Three strategic initiatives: • The Boston Leadership Initiative: • Grow and nurture current operation including extensive collaborations • Develop Hearth at Olmsted Green • Seize the right new opportunities as they arise • Increase focus on prevention and outreach

5. Boston Leadership Initiative: Hearth at Olmsted Green

6. Boston Leadership Initiative: Hearth at Olmsted Green Hearth at Olmsted Green, situated on the former site of the Boston State Hospital,will provide a mix of up to 80 cost-effective supported and assisted living units designed to serve the needs of Boston’s most vulnerable residents. 100% of the units will be available for lease to very, very low income elders. Services will be provided as required to enable each resident to maintain a healthy, independent lifestyle.

7. Three strategic initiatives: • The Massachusetts Leadership Initiative: • Create research-based public policy in Massachusetts that supports the elimination of elder homelessness. • Create and support public commitment to prevention of elder homelessness

8. Three strategic initiatives: • The National Leadership Initiative: • Consider project elsewhere which has the right elements in place for the Hearth model • Proceed to develop and to operate project • Learn from our experience to inform future growth and to strengthen our capacity to provide leadership in this mission

9. Facts about Elders & Homelessness • 1 in 5 people over 65 in MA live beneath the poverty line • Hearth identified 1,700 elders in need of housing in the Boston area alone • In the US, there are at least 9 seniors waiting for every occupied unit of affordable housing • The cost of providing health care for an older American is 3 to 5 times greater than the cost for someone under 65 • By 2030, the cost of providing health care to older Americans will increase by 25% beyond inflation unless addressed • Good News: in 2002, 775 homeless elders were counted in the Boston area in one night; in 2006 there were under 100 • Aging population = aging homeless population

10. Additional Statistics • There are 20,000 elders in Boston who live below the poverty level • The homeless portion of this population is over 1,000 and growing at 17% a year • One in 5 Boston elders age 65 and older live below the poverty level • More than 4,000 elders were served last year in the state’s homeless shelters • 3% of MA Medicaid elders reside in nursing homes and use 20% of the Medicaid budget

11. Men and women ages 50 and over Diverse racial and ethnic population Physically disabled Chronically mentally ill Homeless veterans Substance abusers Long term care residents Trauma victims Who Hearth Serves

12. How Does an ElderBecome Homeless? • Many do not have long histories of homelessness • Significant illness or health event • Death of a spouse, significant other or relative they’ve been living with • Loss of a job and income to pay rent • Reduced affordable housing stock in Boston

13. What is the Hearth Model? The Hearth Model… • Permanent well-managed housing for formerly homeless elders, plus … • The right services for each resident, plus … • Outreach to the whole population of homeless elders, plus … • Research demonstrating our value linked to advocacy for the right public policy, plus … • Collaboration with public, private and philanthropic partners, plus … • Confidence we can truly end the shame of elder homelessness

14. What is the Hearth Model?

15. Tour Our Homes:Bishop Street Our first residence, opened in 1992, is a congregate living community in a charming Victorian house with a yard full of flowers and trees. Located on a peaceful residential street in Jamaica Plain, Bishop Street House is home to nine formerly homeless women, some of who have lived there since it first opened. With each resident occupying a single bedroom, every effort is made to create a feeling of community through the sharing of a kitchen, living room, baths, porches, decks, garden and social activities. For its work at Bishop Street House, Hearth was honored to receive the 1994 Fannie Mae Foundation Maxwell Award of Excellence for Innovative Housing. In the spring of 2005, Bishop Street was chosen to receive an Extreme Makeover: Boston Edition from Channel 5 ABC, allowing us to complete needed renovations. Hearth’s first residence: No. 4 Bishop Street

16. Tour Our Homes:Anna Bissonnette House Located in Boston’s South End, the Anna Bissonnette House (ABH) opened in 1997 to provide permanent supportive housing to forty formerly homeless elders. The building, once a bread factory, was being used by Boston University as a warehouse before the school generously donated it for housing. The site was beautifully renovated and decorated to provide 22 studio and 18 one-bedroom apartments. Common area kitchens and community spaces are available on each floor, in addition to the large Shapiro Community Room in the lobby, a patio with benches and tables, and a roof-top deck. "The thoughtful remodeling of this handsome brick bread factory into housing for the elderly homeless is a model of preservation and continuity.“ -- Ada Louise Huxtable, Pulitzer Prize Winning Architecture Critic of The Wall Street Journal

17. Tour Our Homes:Ruth Cowin House Opened in 2000, Ruth Cowin House was our first site situated outside Boston. The beautifully renovated brownstone, located on Beacon Street in Brookline, is now home to nine formerly homeless elder men and women. Each resident lives in a fully furnished studio apartment with kitchenette In 2000, Hearth was honored to receive the Brookline Preservation Award for dedication to historic preservation of the Ruth Cowin House through the efforts of repairing, restoring and maintaining the integrity of the properties of the Town of Brookline. Many of the residents at the Ruth Cowin House welcomed the opportunity to return to their home town.

18. Tour Our Homes:Ruggles Assisted Living Facility • Ruggles Affordable Assisted Living Community, opened in October of 2002, is the first assisted living facility in Boston exclusively targeted to low-income and frail elders. • The site is comprised of 43 studio apartments. Common areas of Ruggles include: • a living room with piano, • main dining hall, • activities room with complete kitchen facilities, • and sunroom overlooking a community garden. 25 Ruggles Street was a originally a school which some of Hearth’s residents attended as children.

19. Tour Our Homes:Uphams Corner ElderHouse Opened in March 2002, the fourteen apartments known as ElderHouse provide fully furnished studio apartments for formerly homeless men and women, some with special needs. Part of a mixed-use development known as Uphams Corner Market, it is comprised of retail and residential units. Uphams Corner is listed on the National Register of Historic Places for its historic importance: the world’s first supermarket was located here.

20. Tour Our Homes:27 Burroughs Street Opened in December 2006, Hearth at Burroughs is Hearth’s second residence in the historic neighborhood of Jamaica Plain. The Victorian home provides congregate-style residences, with fourteen bedrooms and five and ½ baths, along with communal kitchen and dining facilities, and a sitting room. The home is only steps away from scenic Jamaica Pond Park.

21. Service Delivery Model Hearth’s model integrates housing, mental health, medical and social services supports in a manner that permits even very frail elders to live with considerable independence in their own apartments. The cost of Hearth housing is at most one-half the cost of institutional alternatives such as long term care or shelter beds. Hearth’s team is comprised of MSW’s, RN’s, Site Directors, Property Manager, Resident Assistants, Personal Care Homemakers and Activity staff. Students, interns and volunteers provide countless hours of service to our residents.

22. Student Interns& Volunteers • Collaboration with area MSW programs • Collaboration with allied health programs • 4 - 6 interns per academic year • Intern activities include: individual and group counseling, case management, program development, grant writing, exercise programs, health fairs, dental screening, smoking cessation • Large number of volunteers involved in all aspects of resident life

23. Major Issues • Untreated/undiagnosed mental illness • Substance abuse • Difficult families • Hoarding • Medical frailty • Lack of needed resources (ex. home visiting psychiatry, reliable medical transportation)

24. Behavioral health management Medical management including physician collaboration, medication assistance, health education and health screening Crisis intervention Substance abuse and brief mental health counseling Personal care and homemaking Socialization External referrals Close collaboration with property manager Services Provided

25. InterdisciplinaryService Planning • Starts with pre-admission screening • Annual comprehensive bio-psychosocial resident assessment • Individual service plans • Individual behavior plans when necessary • Case conferences and consultations • Service provision across the continuum

26. Financing of the Model Public/Private Programs that Support Hearth: • HUD Section 8 • SSIG - Supplemental Security Income-G • Mass Health: GAFC- Group Adult Foster Care • DMH - Department of Mental Health • EOEA - Executive Office Of Elder Affairs • SCO - Senior Care Option • Grants/Private Philanthropy

27. Outreach Model • Case managers work with individuals who fall anywhere on the continuum of “housing readiness” • Often work with individuals who have no income, or any support or health services • May have a multitude of housing barriers such as poor credit histories, criminal histories, and poor or no housing histories • Outreach serves approximately 200 clients at any given time

28. Outreach Model,continued • Collaborate with numerous systems and providers, including legal aid, DMH, medical providers, the courts, elder service providers, landlords, management companies, shelters and client’s families • Strong advocacy and stabilization services for one year • Fresh Start Program • Funded primarily by a federal grant from HUD

29. Public Policy, Advocacy,& Research • Research beginning to evaluate public costs of Hearth residents compared to costs in other public systems for similar populations linked to policy advocacy • MA Health Systems Change Transformation Initiative • Unified Behavioral Health Initiative • CHAPA: Citizens’ Housing and Planning Association • Elder Economic Security Standard • Three Nation Study Examining Causes of Homelessness

30. Vignettes • Mr. B is a 75 year old single man with a history of HTN, PVD, bilateral AKA, ESRD on HD, COPD and history of ETOH abuse • Ms. C is a 63 year old woman with physical and mental health disabilities, the latter undiagnosed and untreated and a 4 year history of homelessness

31. Contact Information May Shields: mshields@hearth-home.org Mark Hinderlie: mhinderlie@hearth-home.org Hearth 1640 Washington Street Boston, MA 02118 T: 617.369.1550 W:www.hearth-home.org