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BY: BOBBY ARTIS

Mr. Artis is director, HUD Housing Development, Catholic Healthcare Partners, Cincinnati.

A Cincinnati-based Health Care System Develops Housing for the Low-Income Elderly

As surely as genetic makeup and our own choices determine health, so too, in thousands of ways, do our daily environment and the place we call "home." "In our organization, the concept of housing—particularly for low-income elderly—represents a very important element in an integrated approach to caring for people in need," says Jane D. Crowley, executive vice president, Catholic Healthcare Partners (CHP), Cincinnati. "Housing and supportive services are a natural extension of our continuum of care to address seniors' physical, social, spiritual, and psychological needs in a variety of settings. We're not in it for the four walls alone."

At CHP, a commitment to ensure the availability of safe, affordable housing is deeply embedded in our mission and values, which emphasize human dignity as well as caring for the poor and vulnerable. Because of that emphasis, how we carry out our commitment to housing embraces much more than bricks and mortar.

CHP creates senior housing developments designed to enrich residents' experience with a vibrant community life and to provide them with supportive services and activities that will enhance their well-being.

An Expression of Charitable Purpose
CHP is the continuation of the health ministries started more than 150 years ago by our cosponsoring congregations, the Sisters of Mercy, Regional Communities of Cincinnati and Dallas, PA; the Sisters of the Humility of Mary, Villa Maria, PA; the Franciscan Sisters of the Poor, Brooklyn, NY; and Covenant Health Systems, Lexington, MA. In Ohio, Kentucky, Pennsylvania, and Tennessee, our system of regional health care providers focuses on improving the health of our communities by providing locally responsive, integrated health services. Our continuum of care ranges from outreach services and wellness centers to acute care hospitals and hospice programs. Within that continuum is a wide range of residential options, including assisted living and affordable, independent housing.

As we have done for decades, we provide extensive services to the broader community, with emphasis on services for the poor and underserved. CHP's ministry in affordable housing is one vital expression of our charitable purpose. "As the government seeks to reduce its spending allocation for affordable housing, we continue to see a growing, demonstrated need and want to do more," says James Makos, CHP's vice president of long-term care and housing. "Doing more" means assessing and addressing the local needs for safe, affordable senior housing in each CHP region. Our responses are as unique as the communities we serve. Yet, underlying every housing initiative within CHP is the drive to create a fulfilling and enriching community experience.

Sacred Heart Village
CHP's Sacred Heart Village, Louisville, KY, is a community that integrates six levels of service to the elderly on one campus. Founded in 1892 by two Sisters of Mercy as a home for elderly women, Sacred Heart Village today provides a safe, professional, warm, and nurturing environment for aging members of the community, both men and women, who require differing levels of assistance.

Congregate-living housing (independent living with meal service) was added to Sacred Heart Village in 1981. Between 1996 and 2002, U.S. Department of Housing and Urban Development (HUD) "202 grants" enabled substantial growth. The campus now offers a full spectrum of residential options:

• HUD 202 independent living apartments
• Congregate living
• Personal care (assisted living)
• Intermediate nursing care
• Skilled nursing facility
• Adult day care as an alternative to in-home or nursing-facility care

"We applied for HUD grants because there was a demonstrated need for elderly housing for the poor in this area," says Makos. "The location integrated well with our continuum of care, and the site was close to community and public facilities, such as shopping, doctors' offices, churches, and senior centers." Sacred Heart Village was designed to encourage the involvement of residents who, in another setting, might become isolated and withdrawn. Residents have access to a wide range of services and amenities, such as resident activities, a beautician and barber shop, an exercise room, and religious services in the chapel.

Sacred Heart Village I, a building containing independent-living apartments, was completed in 1996. The first of the campus' HUD 202 grant projects, it was constructed as an annex to Sacred Heart Nursing Home. In approving the addition of a new facility to an existing structure, the local HUD office broke a precedent. "Sacred Heart Village I is fortunate that our building is physically attached to Sacred Heart Nursing Home," says Sr. Johnette Wiedmar, RSM, the addition's manager. "Our residents can utilize services and participate in programs simply by opening a door from our lounge and entering Sacred Heart Nursing Home."

Sacred Heart Village I proved to be so popular that a waiting list developed for it. We therefore decided to build two other sets of independent-living apartments: Sacred Heart Village II, on campus, and Sacred Heart Village III, our first off-campus site, located in southwest Louisville. Catholic Charities of the Archdiocese of Louisville collaborates to provide support services to Sacred Heart Village III residents.

A deep spirituality and caring permeates Sacred Heart Village. Formal spiritual care services include daily Mass or Communion services, a weekly Growth in Faith educational series, ecumenical services, and seasonal devotionals. A holistic care ministry offers residents therapies intended to enhance physical, emotional, and spiritual well-being and to assist in pain management.

This singularly integrated community enables seniors to age in place (remain in their own homes) and, at the same time, have the support services and programs they need to measure, monitor, and positively influence their health. For this combination of services, Kentucky in 2003 named Sacred Heart Village I the best elderly housing facility in the state.

Reaching Out to Our Communities
Our commitment to create a supportive, nurturing environment for the seniors we serve extends beyond the residences we sponsor. Among these projects are:

• Personal Health Partner In 2002, CHP's Laurel Lake Retirement Community, Hudson, OH,* launched what it calls its "Personal Health Partner" program. The Personal Health Partner is a nurse who serves low-income residents in a public housing complex near Laurel Lake. The nurse acts for these residents as a clinician, confidant, educator, social director, advocate, and resource. She provides blood pressure screenings; publishes a monthly newsletter; conducts health classes; involves residents in social activities (both on- and off-site); and, when necessary, refers them to other community resources. Seed money for the project was provided by the Salmon Memorial Fund of the Sisters of the Humility of Mary. CHP's Mercy ElderReach Fund provides ongoing support.

  *For more on Laurel Lake Retirement Community, see Marie Ruegg, Victoria Schirm, and Barbara Boyce, "Making 'Caring Connections,'" Health Progress, January-February 2004.

  Laurel Lake Retirement Community is also involved in the construction of a Habitat for Humanity project. Laurel Lake will fund the project-a "senior-friendly" home-and Laurel Lake staff and residents (with the help of residents' family members) will perform the actual construction work. It will be the first Habitat for Humanity home in Ohio to be designed and built by seniors for seniors. The project is an important part of Laurel Lake's community outreach program.
  
  
• Samaritan Place Recognizing that the need for housing is sometimes temporary, St. Mary's Health Partners, Knoxville, TN, has created a short-stay shelter for seniors who must leave their homes because of abuse, neglect, financial crisis, or unsafe conditions. Samaritan Place, operated in collaboration with Catholic Charities of the Diocese of Knoxville, is one of only a handful of such shelters in the nation.
  

  Many other programs have received financial support from two CHP grant programs. The Mercy ElderReach Fund provides grants to programs that minister specifically to the elderly poor. The Community Initiatives Fund provides grants for research and development for a wide variety of services that promote community health. Both funds have contributed to an array of local services designed to maximize seniors' health and the quality of their lives. For example, CHP grants support:

  • Healthy Link Living at Home/Block Nurse Program, sponsored by Humility of Mary Health Partners, Youngstown, OH. This program links elderly people who have a limited capacity to care for themselves with services addressing their health, housing, social, and personal needs.
  • Mercy Lifeline, sponsored by Mercy Hospital, Tiffin, OH. This emergency response system helps low-income seniors remain independent in their own homes.
  • Adult Day Services of Lourdes Hospital, Paducah, KY. This program offers cognitive and coordination-building therapy that promotes independence in elderly clients, thereby preventing or delaying their institutionalization.
  • Status Alert, Scranton, PA. This program enables low-income seniors who live in high-rise apartment buildings to check on each other daily, thereby helping them ensure their health and safety.

Mercy St. Theresa Village
CHP's senior housing ministry constantly seeks to improve the way it addresses the complexities involved in providing community and well-being for seniors in need. At Mercy St. Theresa Village, an independent-living community in Cincinnati, we are embarking on a pilot project involving one of the most perplexing challenges facing managers of senior housing—ensuring residents' safety even as their health or functional status begins to fail.

As seniors age, their health inevitably begins to decline. An unsteady gait or a memory lapse can pose serious risks both for the person with the condition and for his or her neighbors. Even so, a senior may fail to report such problems for fear of losing his or her independence and home. Family members who are aware of the problem also may delay seeking help, for fear that the senior will be required to move to a residence with a higher—and unaffordable—level of supervision.

The pilot project at Mercy St. Theresa Village is designed to provide free safety assessments for its residents. Upon request, trained CHP personnel evaluate an apartment and make safety recommendations to the resident and his or her family. When, as the resident grows older, additional assistance is required, that too is recommended. Because our senior housing and supportive services constitute a natural extension of our continuum of care, we can help guide the family to appropriate resources within our system. Our goal is to maximize seniors' function and independence while ensuring their safety and the safety of their neighbors.

Addressing Chronic Conditions
Chronic conditions, such as heart disease, cancer, high blood pressure, diabetes, and asthma, are now the leading causes of illness, disability, and death in the United States.1 Accounting for seven of every 10 deaths, these illnesses affect the quality of life of 90 million Americans, many of whom are elderly. CHP's senior residential communities therefore offer an ideal setting for the development of new and more effective methods for helping residents with chronic diseases better manage their illnesses and live better lives.

Although our senior residences currently offer regular health assessments and screenings to help prevent or manage developing health problems, we will this year embark on a focused, measurable pilot program to improve the health of residents with chronic conditions. "We are designing a program to incorporate baseline assessments and a variety of health and quality-of-life metrics to better understand the health status of our residents who are living with chronic illness," says Crowley. "That knowledge will be applied to develop and provide very specific services to improve their health. Our focus on measurable data will allow us to demonstrate their progress and the effectiveness of this approach."

Creative Funding Yields Creative Solutions
As CHP continues to develop its housing ministry—particularly for seniors in need—it has employed a wide variety of funding mechanisms to meet the requirements of each situation.

CHP has actively pursued grants from HUD for the development and construction of safe, affordable housing for low-income seniors. Five of CHP's 10 regions together offer more than 800 units of housing constructed either in conjunction with HUD grants or through the low-income housing tax-credit program (see Box). In either case, the size and scope of the developments reflect identified community needs.

Yet HUD and tax-credit funding are not always the answer. When a feasibility study showed the need for a retirement community within CHP's Tennessee region, St. Mary's Health Partners designed a 65-acre mixed neighborhood and recruited investors for it. Income from the market-rate single family homes—some specifically designed for seniors—condominiums for independent elderly, and assisted living facilities enabled St. Mary's to bankroll assisted living and nursing home beds for low-income elderly.

Partnerships further leverage our resources and allow us to extend our housing ministry to seniors in need on an even larger scale. Since 1998, CHP has maintained a formal strategic alliance with six other Catholic health care systems to support Mercy Housing and increase the availability of safe, affordable housing for those who are poor.* Through CHP's Investment Management Program, we provided Mercy Housing with a $5 million interest-free loan to develop new affordable housing and rehabilitate old housing stock. This collaboration has enabled Mercy Housing to develop new properties in cities across the country, attract new sources of funding for affordable housing, and strengthen its infrastructure.

*See, in this issue, Lillian Murphy, "Allying Health Care and Housing," and Chuck Wehrwein and Melinda Pollack, "Health, Housing, and Public Policy," p. 21.

Other collaborations, while smaller in scope, are equally powerful. When CHP sought to expand its continuum of care with low-income tax-credit housing for seniors in Dayton, OH, we partnered with a local developer and an apartment manager to secure funding. This group assembled $6 million through 15 different funds from nine different sources, including the county, the local housing commission, the state government, and private banks. That effort marked the first not-for-profit development in the Dayton area to be built with such an array of funding sources.

Strategic Planning for Tomorrow
As our nation's population ages, the need for safe, affordable housing for the elderly continues to grow. CHP has begun to create a systemwide strategic plan for its housing ministry. We seek to tap our own system synergy and collaborative partnerships as we redefine both what we do and how we do it, and, by doing so, to better meet seniors' physical, social, spiritual, and psychological needs through our housing ministry.

NOTE

1. Centers for Disease Control and Prevention, The State of Aging and Health in America 2004, Washington, DC, 2004, p. 1, available at www.cdc.gov/aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf.