Beacon Communities & National Church Residences

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Commonalities of for-profit and non-profit

As the fields of health maintenance and affordable senior housing move ever closer together, a great deal of effort is being expended on both sides to figure out and shape the best and most cost-effective ways to support that trend. Two prominent and respected affordable housing organizations – one nonprofit and the other for-profit – offer two related and successful models.

In both domains, the fact that wellness looms so large in their vocabularies tells us a lot about the new priorities. And one of the key factors they have in common is a commitment to staying ahead of potential issues rather than being merely reactive. This approach has measurable results both in the health and happiness of residents and the financial resources expended for their care.

Home for Life
National Church Residences, based in Columbus, Ohio, is a leader in providing affordable housing to seniors and others who need help in their daily lives. Its professed mission is to integrate residence and supportive services to people regardless of faith.  Discussions with personnel frequently involve some reference to improving the lives of their residents, as in the Statement of Values: “Our vision is to advance better living for all seniors so that they may remain home for life.” The organization currently owns and manages 328 communities around the United States with most concentrated in the East and Midwest.

National Church Residences communities offer a range of medically related services, including skilled nursing, home healthcare, hospice, personal care services and transitional assistance from long-term care facilities back to residential living. But the emphasis on wellness care and services for independent senior living represent the crest of the wave of considering affordable housing and health as a unitary concept.

“As an organization, we are in a unique position to bring healthcare to seniors,” states Teresa “Terry” Allton, Senior Vice President of Home and Community Services. “We recognized the opportunity for residents to continue living independently if they had greater access to vital services as they were aging.”

Utilizing a HUD supportive services grant program, National Church Residences employs 360 service coordinators to assist residents and keep track of their needs. “We enhanced the previous model to become more proactive,” she comments. “We created a tool that allowed us to provide assessments and to stratify our residents’ needs. Previously, we didn’t have a way to know who needed what without intruding on privacy or violating HIPPA.” What the team developed is their Care Guide, an online assessment tool that allows a service coordinator to work with the individual and create a health profile for each resident and the facility as a whole.

“Affordable housing residents often represent high-need, high utilizers of the healthcare system. About ten percent of our residents are frail and severely vulnerable.”

Allton calls this approach a “pre-acute model. We’re trying to identify needs before they become acute through providing this new level of support. Our nurse liaisons and care coordinators become patient advocate partners and help navigate doctors, pharmacies and the entire system.”

Living Well by Design
“They do an amazing job,” says Brenda Limone, Assistant Vice President for Resident Services and Wellness Programs at Beacon Communities, LLC in Boston, which owns and manages 62 market-rate, affordable and senior care communities in eight eastern states. The same sort of testimonial Limone gives to her nonprofit colleagues is often applied to Beacon, one of whose operating mantras is “Living Well By Design,” regardless of the income level or status of the residents in its diverse facilities.

Beacon has tried a number of strategies in its quest to have its residents, in Limone’s words, “age in place in a safe environment of independent living, and keep that status as long as possible.” In the process, “We have really discovered that healthcare coordination is the way to go.

“One model we tried was to have a primary care facility on-site. We agreed to a yearlong contract with a large primary care provider, but it didn’t work for a variety of reasons. We didn’t always have the volume to have it pay off, and residents didn’t want to change from their own primary care doctors.”

The best model for Beacon turned out to be providing an on-site wellness nurse who could determine the seriousness of each issue. Emergency visits went way down as a result. The number of hours the nurse spends at each site depends on the budget for that particular property, with Beacon providing space for an exam room and office. Some of the properties have fitness centers with equipment specifically tailored to seniors. Eleven sites have wellness nurses on-site for varied hours. They work closely with the full-time Resident Service Coordinator and property staff.

Controlling Expenses
Like National Church Residences’ service coordinators, Beacon’s resident service coordinators (RSC) represent the point where housing, healthcare and control of expenses intersect. “The RSC is a payroll line item and the wellness nurse is payed as a contractor through a staffing agency. The wellness nurse does not perform billable services,” Limone explains. “But the benefit of these ‘coordination’ services – education, medication explanation and monitoring, stress reduction, fall prevention initiatives, advocacy – these benefits far outweigh the costs. A lot of services are out there, and one of the things our service coordinators do is figure out how to access them for our residents. Having a wellness professional available really pays for itself.”

There has been an ongoing effort among leading and pioneering affordable housing owners and operators to quantify these benefits. “Several of us are really trying to capture the data,” Limone states.

“We can show anecdotal evidence all day long that we’re getting better outcomes with lower costs,” says Allton. “But now we’re being methodical and generating financial data to show the impact we’re having on the total Medicare spend.”

Part of this impact comes from the way National Church Residences is dealing with “dual eligibles”: those who qualify for both Medicare and Medicaid. “We’ve set up a joint venture with Aetna in a shared savings model, where we’re working directly with primary care physicians. We want to demonstrate that this is saving money for Medicare and Medicaid.”

A second model is a hospital partnership involving 100 residents with COPD in an attempt to lower the Medicare cost per patient. “We’re trying to move toward having funding mechanisms coming from cost savings.”

As Limone puts it, “We’re saying to the government: ‘Hey, we just saved you X amount of dollars. Now put it back into the community!’”

Ties with Hospitals
In Richmond, Virginia, for example, Beacon has a relationship with Virginia Commonwealth University’s medical school and hospital. “We have a high-rise building with a poor population,” says Limone. “Our Richmond Health and Wellness Program provides care coordination that includes social work, behavioral therapy, nursing and pharmacy services. Seventy-five percent of the residents in the building are using these services.”

Beacon’s recent research and statistical analysis has calculated a 36% decrease in ambulance visits through having supportive healthcare services on-site. Even such secondary factors as greater socialization and improved personal hygiene contribute to this calculus.

So the evidence is growing ever more compelling that the combination of resident coordinators – who act as both monitors of residents’ health and advocates for them throughout the government and health systems – and the creation of partnerships with a variety of local healthcare providers, represents an optimum model for combining best outcomes with cost savings for residents in affordable senior housing.

Limone notes, “HUD is finally saying, ‘We realize now that housing and health go together,’ and CMS and HUD are finally sharing data.”

This realization and increasing acceptance of the integral relationship between these two spheres have major implications for the future of affordable housing and the health and welfare of its senior residents.

“The leadership of our organization is always asking, ‘What’s it going to be like five and ten years ahead?’” says Allton. “Looking forward, how are we best able to serve our residents?”

“More and more, affordable housing operators are seeing the value of the relationship,” Limone comments. “There has been more communication, but there is still a way to go. It’s still a struggle to figure out how to pay for it, but there are ways.”