Congregate Housing

From Housing to Housing Plus Services

The U.S. Department of Housing and Urban Development (HUD) developed several congregate housing programs in the 1970s. The agency's discontinuation in 1995 of new Congregate Housing Services Program (CHSP) grants was in part due to HUD's identity as a housing agency rather than a service organization. Since that time, at least four factors have swung the momentum toward a more formal merger between housing and supportive services. First, residents have aged in place, and additional subpopulations with service needs have increased. Second, research has indicated that service-enriched housing positively affects residents’ housing success, quality of life, and the prevention of institutionalization. Third, policies resulting from the Supreme Court's Olmstead decision (1999), Fair Housing Act Amendment, the 2009 Obama administration's “Year of Community Living” for persons with disabilities, and recent collaboration among the Centers for Medicare & Medicaid Services (CMS) and HUD have emphasized community living options for all persons with disabilities. Fourth, community-based housing options are often less expensive than nursing homes and thus represent a cost saving for public agencies. For example, a CMS initiative titled Money Follows the Person was designed in part to provide noninstitutional alternatives to low-income persons residing in nursing homes who prefer to move to a community living setting. Publicly subsidized congregate housing, especially programs with services, was identified as a suitable option for some persons transitioning out of nursing homes.

Affordable Housing Plus Services (AHPS), one of several related terms to arise in the early 2000s, describes the array of strategies used by housing and service agencies to respond to the needs of residents who have health and social service needs that hinder their ability to reside in independent housing. There is no single federal model; instead, states and organizations have experimented to create housing with services to meet the needs of various populations, including older persons and adults with disabilities. Commonalities among AHPS include the economies of scale permitted by bringing services to a building or campus of units where large numbers of persons live, a formal process to assess resident needs, and partnerships between housing providers and health and social service agencies. Examples of AHPS include partnerships between public housing authorities and assisted living providers, nursing homes, and other health service providers, as well as arrangements that offer on-site health services. Goals of AHPS include reducing the use of higher cost medical services, such as emergency room visits, hospital stays, and nursing home admissions; increasing participation in health promotion and preventative health programs; improving mental and physical health; and improving social outcomes for vulnerable persons. To date, no large-scale outcome studies have been published that test whether AHPS programs meet such goals, possibly because programs tend to be unique to specific populations and geographic areas. However, empirical research would lend support to the development of new congregate housing policies and programs.

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