1. HOUSING WITH SERVICES
David Fuks, CEO, Cedar Sinai Park
Housing With Services Summit
Salem, Oregon / 28 November 2011

2. Boomers vs. Available Resources
72m
63.9m
Boomers, 65+ 54.8m
46.8m
40.3m
Available
resources
2010 2015 2020 2020 2030
www.cedarsinaipark.org 2

3. Necessity Is the Mother of Invention
• Increase in population needing services
• Low rate of saving for retirement among
boomers
• Consistently high demand for affordable
housing
• Impact of current downturn on capacity to save
www.cedarsinaipark.org 3

4. Necessity Is the Mother of Invention
• People in affordable housing are 4x more
likely to need healthcare assistance and help
with (Instrumental) Activities of Daily Living than
people in their own homes
• Need to manage health care costs (Affordable
Care Accounts/CCOs)
www.cedarsinaipark.org 4

5. Housing With Services and
Berwick’s Triple Aim
1. Improve the Experience of Care
2. Improve the health of populations
3. Reduce per capita costs of healthcare
www.cedarsinaipark.org 5

6. Improving the Experience of Care
• Possible pilot strategies:
– Coordination among providers
– Collocation of some services on site
– Increased transportation
– Increased case management
– Developing services with tenant community
involvement
www.cedarsinaipark.org 6

7. Improving the Health of Populations
• Possible pilot strategies:
– Focus on residents in subsidized housing
– On-site wellness education
– Coordination with on-site home care
– Coordination with nutritional assistance
www.cedarsinaipark.org 7

8. Reducing per Capita Costs of
Healthcare
• Possible pilot strategies:
– On-site rather than emergency room treatment
– Increased compliance with medication prescriptions
and medical follow-up
– Access to case management, hospice, home health,
etc.
www.cedarsinaipark.org 8

9. Berwick’s Triple Aim: Preconditions
• Partnerships with individuals and families
– Possible pilot strategies:
• Tenant Council
• Community organizations
• Redesign of care
– Possible pilot strategies:
• On-site collaboration
• Population health management
– Possible pilot strategies:
• Focus on subsidized housing
www.cedarsinaipark.org 9

10. Berwick’s Triple Aim: Preconditions
• Financial management
– Possible pilot strategies:
• Consortium
• Integrator
– Possible pilot strategies:
• Case management
• Service coordinators
www.cedarsinaipark.org 10

11. Housing With Services Target
Outcomes: Aging in Place
• Reduce nursing home and assisted living facility
utilization
• Reduce emergency room utilization and
hospital stays
• Reduce criminal justice intervention due to
substance abuse and mental health problems
www.cedarsinaipark.org 11

12. Housing With Services Meta-Strategies
• Collaboration between Cedar Sinai Park,
Seniors and People with Disabilities, Multnomah
County Aging and Disability Services, and
Portland State University to assure sustainable
funding sources and measurable outcomes
• Develop a replicable model
www.cedarsinaipark.org 12

13. Housing With Services Macro-Strategies
• Coordinate development of sustainable
consortium of providers committed to defined
target outcomes
www.cedarsinaipark.org 13

14. Housing With Services Mezzo-Strategies
• Increased case management.
• Increased access to mental health and
substance abuse treatment.
• Onsite health care and education.
• Onsite staff culture change to support aging in
place.
www.cedarsinaipark.org 14

15. Housing With Services Mezzo-Strategies
• Empower family caregivers’ competency
regarding resident support and care team
interactions
• Increase resident access to health information
and education regarding health decisions
• Increased sense of community within the
buildings
www.cedarsinaipark.org 15

16. Housing With Services Micro-Strategies
• Increased home care services
• Health education classes
• Expanded transportation
• Onsite nursing
• Alcohol and drug treatment
www.cedarsinaipark.org 16

17. Housing With Services Micro-Strategies
• Mental health services
• Geriatric assessment
• Alternative medicine (e.g. acupuncture,
massage, etc.)
• Tenant council(s) – Individual buildings &
Residents
www.cedarsinaipark.org 17

18. Housing With Services
www.cedarsinaipark.org 18

19. Housing With Services Timeline
1 2 3 4
Consortium Program Pilot project Program
development development sustainability
www.cedarsinaipark.org 19

20. Consortium Development
• Initial planning meeting
• Identify finance, point staff, prospects
• Find healthcare partner
www.cedarsinaipark.org 20

21. Program Development
• In all levels of planning engage
– Residents
– Outside providers
– Tenant families
– Community volunteers/resources
• Conduct needs and demand assessments
• Define scope of services
www.cedarsinaipark.org 21

22. Program Development
• Build sustainable funding model
– Budget
– Funding sources and methods
• Clarify roles and agreements
• Hire service coordinator
www.cedarsinaipark.org 22

23. Pilot Project
• Determine staffing
• Orient residents
• Contract with state for funding
www.cedarsinaipark.org 23

24. Program Sustainability
• Build structure to maintain partnerships
• Program quality control and maintenance
• Evaluate outcomes and satisfaction
www.cedarsinaipark.org 24

25. THANK YOU!
Contact: David Fuks
503.535.4307
david.fuks@cedarsinaipark.org
Visit: www.cedarsinaipark.org