White House Reflections: Part Three — Where do we go from here?
As described in my last post, our data confirms our instincts: JCHE’s model of senior housing improves the quality of life of our seniors while saving government. The question is how do we sustain and expand it? The two greatest challenges are:
- Governmental structure—while we know that housing and community-based services save the government vast dollars by diverting people from expensive, Medicaid-funded nursing home care, there is the reality that to expand, the dollars saved and the dollars spent come from different buckets. By increasing HUD budgets to build more affordable senior housing, we can save a more significant amount of public resources in the Medicaid line item. This Administration has worked on cross-agency collaborations and joint planning—to their credit—but crossing silos to this degree is a huge barrier.
- Supply within the timeframe we’ll need it. We all know the demographic tsunami’s coming and our current supply of housing is inadequate (JCHE has 1000 households on our waiting list alone). But we also know the barriers to creating more housing and community-based services are great.
These are big challenges, but as Americans we share the optimism and can-do spirit of our country—a belief that with focus and commitment, we can solve our common problems. And we appreciate that this Administration is a partner in our work.
So let’s look ahead. The facts suggest that we can all agree to some basics:
- We will need to expand every piece of the continuum of care—from day programs, home-care services, supportive housing and nursing homes.
- The non-profit, mission-driven agencies combine the service-orientation of the public with the entrepreneurship of the private sectors—and have the ability to draw in philanthropy. Non profits can leverage private dollars to stretch scarce public ones. We recently built Shillman House on the Weinberg Campus. Because of our non-profit status, we were able to leverage federal dollars thrice during the development of Shillman House:HUD’s $7.6M capital advance, matched with a promise of long-term subsidies for 50 units, drew in $6.5M in private equity in the form of tax credit proceeds, more than $5M in state money and $4.7M in philanthropic dollars. Plus, the fact that we have private investors shifts a good deal of the monitoring burden to the private sector—the discipline of investors is a powerful check on our operations. We are seeing this same drive for ongoing measurement and monitoring from our philanthropic investors as well.
- We can and must achieve efficiencies in service delivery. For example, at congregate housing developments, in-home services can be clustered. Rather than a spending two to three hours each day traveling from house to house, home care workers can spend their entire 8 hours/day with clients who live down the hall from one another. And think of the avoided carbon footprint!
JCHE and our colleagues around the country have created structures that give true peace of mind for seniors, for the children of those seniors, and for those seniors without children. The challenge and opportunity in front of us is to approach this holistically across the silos. Regardless of program definitions, if we can understand the impact each piece of the puzzle can add up to a different whole when combined right—we can do it!