Seize This Opportunity, Dr. Carson

Retired neurosurgeon Dr. Ben Carson was recently confirmed as Secretary of the Department of Housing and Urban Development (HUD). Dr. Carson is stepping into his new role at a critical time for the more than 1.5 million older adults who qualify for federal rental subsidies and whose health care and other supportive needs are covered through the Centers for Medicare and Medicaid Services (CMS). At the same time, Dr. Carson is facing potential cuts to his agency of $6 billion.

Seniors who live in subsidized housing face many health risks, and generate a disproportionate amount of Medicare cost resulting from ill-health, visits to the emergency department, and hospitalizations — yet there has been little coordination to date between HUD and CMS, which together represent nearly 40% of the federal budget.

Dr. Carson could change that. With his understanding of the complexities that drive health care costs, he brings a unique background and knowledge base to lead the creation, for the first time, of an effective partnership between the federal housing and health care agencies.

The needs of low-income seniors are significant, and they span a wide range of physical, behavioral, and social issues. A large majority have serious and/or chronic medical conditions, including a high incidence of Alzheimer’s and other dementias. Mobility issues alone put seniors at increased risk for falls, which is a primary reason for emergency transports to hospitals and emergency rooms, costing the national Medicare program more than $5.2 billion on 16.6 million ambulance transports annually.

Faced with these challenges, low-income seniors are often unable to perform activities of daily living, such as shopping, cleaning, bathing, and cooking. Without enough access to coordinated care and support services, many have no choice but to enter nursing homes to ensure their safety – costing our health care system a significant and potentially avoidable expense.

In sum, these seniors have complex and interconnected needs, underscoring the significant potential for improved outcomes and savings if care from housing staff, payers, and community based providers was better coordinated.

I urge Dr. Carson to take a close look at a program that HSL is piloting called The Right Care, Right Place, Right Time: Effectively Integrating Senior Care and Housing initiative (R3 Project), which is funded by a $421,742 grant from the Massachusetts Health Policy Commission through the Health Care Innovation Investment (HCII) Program, and additional funding of $480,000 in combined funding from MassHousing, Mass Department of Housing and Community Development, Enterprise, Beacon Communities, and WinnCompanies. This model could be scaled regionally and nationally across congregate senior housing sites to meet the “silver tsunami” need for supportive housing. And, with more than $1,800 of expected savings per member annually, using this model, the projected system savings for seniors in affordable housing nationally could reach over $3.6 billion, which could help offset suggested cuts to current HUD programs.

In addition I urge him to continue and expand current HUD demonstration projects designed to help low-income seniors age in place, including the Supportive Services Demonstration for Elderly Households in HUD-Assisted Multifamily Housing. These programs that provide supportive services, hold promise to improve the health and quality of life of millions of low-income seniors, reduce emergency department visits, hospitalizations, and nursing home use, and potentially free up considerable government resources.

Dr. Carson, please seize this opportunity. You can lead this initiative toward integrating health care and housing services. Such an initiative holds promise for dramatic cost savings while vastly improving quality of life for low-income seniors.