A Service-Enriched Supportive Housing Model

1. Home for Good A Service-Enriched Supportive Housing Model

2. Who We Are May Shields RN, MSNDirector of Health Services Deborah Cutler MSW, LICSW Director of Behavioral Health

3. Who Is Hearth • Hearth, formerly known as The Committee to End Elder Homelessness, was founded in 1991 • Hearth’s founders provided leadership for a coalition of public and private agencies working collaboratively to eliminate homelessness in Boston • Hearth’s mission is to create permanent housing with supportive services • 2005 Hearth – Home for Good

4. Mission Statement Hearth is a non-profit organization dedicated to the elimination of homelessness among the elderly. This mission is accomplished through a blend of prevention, placement, and housing programs all designed to help elders find, succeed, and age in homes of their own. To this end, all housing operated by Hearth provides a creative array of supportive services that assist residents to age with dignity, regardless of special medical, mental health, or social needs.

5. 2005 BostonHomeless Census • On the evening of 12/19/05 there were 5,819 homeless men, women and children counted in Boston • 299 individuals were on the street – 30% increase from 2004 • 77 were homeless elders on the street, making up 26% of the street count

6. 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

7. 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

8. How Does an Elder Become 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

9. 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

10. 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

11. 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.

12. 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.

13. 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.

14. 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. 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.

15. 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

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

17. 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

18. Interdisciplinary Service 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

19. 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

20. 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

21. 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

22. Public Policy, Advocacy,& Research • 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

23. 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 later undiagnosed and untreated and a 4 year history of homelessness

24. Contact Information • May Shields – mshields@hearth-home.org • Deborah Cutler – dcutler@hearth-home.org Hearth 1640 Washington Street Boston, MA 02118 T: 617-369-1550 W:www.hearth-home.org