Measuring Resident Outcomes
By Mark Fogarty
Affordable housing is more than building pretty buildings
Property managers in the affordable housing sector aren’t there just to collect the rent and keep steam in the radiators. Usually they are quite concerned about their residents’ quality of life. And the outcomes they are looking for aren’t trivial. Keeping seniors out of nursing homes or locked up in memory care centers. Permanent housing for the formerly homeless. College scholarships for kids who don’t come from college-track families. Homeownership for the first time ever for a family.
A survey of some representative affordable housing operators shows a lot of advocacy on behalf of residents. Faith-based or not, there is a lot of similarity among their outreaches, and a lot of similar passion to help people in their affordable multifamily properties. And there is a conscious effort to measure outcomes, either formally or informally.
Take a woman we’ll call Julia, a resident at a property run by the Schuett Companies of Minneapolis. Julia, who is about 80, took a fall and suffered a subdural hematoma (a brain bruise that can cause temporary memory loss). She went to a nursing home for rehab but when the hematoma was healed, the nursing home advised her family that she should either remain at the nursing home or go into a memory care center.
Seeking advice, the family sought out CompassionCare, a home care provider started by Tom Schuett, now the chief executive of the Schuett Companies and operating in six of their properties. Patti Peppel, director of nursing, looked into the case and felt Julia didn’t need nursing home care. She thought Julia would be better off staying independent. Julia’s been in a Schuett property for a couple of months now and is responding well.
“She’s doing wonderfully,” says Peppel. “If she went to memory care it would have been sad. She would have felt like a prisoner. She’s living in a nice apartment she can decorate and have personal belongings.”
Peppel says CompassionCare, started in 2011, isn’t assisted living but rather aide care supervised by a nurse.
“First and foremost we’re affordable housing,” she asserts. “People that need assistance to live independently, we provide that help.”
She continues, “A nurse is always on call. Aides provide day-to-day care.” There are about 25 home care aides, four registered nurses and two licensed practical nurses working in the six properties. They provide personal care to assist daily living, helping with things, like bathing, dressing, hygiene, grooming and some delegated nursing tasks, like changing dressings, monitoring blood pressure and blood sugar, if an aide is able to be trained to do these correctly.
“Compassionate care is the heart of what we strive to deliver to each and every client,” according to the company, though, not every resident is a client. Many of the clients are insured by Medicare or Medicaid, but there are also private payers.
Schuett has a total of 16 properties with 1,100 units throughout Minnesota. Is CompassionCare planning to expand to more of Schuett’s properties? “We talk about it all the time,” says Peppel.
When it comes to measuring outcomes, Geoff Brown, president and chief executive of USA Properties, Roseville, CA can tell you exactly how many residents have graduated thanks to a $1 million fund it was set up to grant scholarships for college. Ten residents now have degrees.
“We’re trying to give residents opportunities. Some haven’t been as fortunate as others. It’s been a real successful program. We’ve started to change the mindset in our communities. We’re getting more and more applications,” says Brown.
The fund has also been used to encourage sports participation by paying fees resident families might not be able to afford, Brown says. Between 200 and 300 resident kids have used this program.
“We’re not just building pretty buildings,” he says, although they have built quite a few (11,000 units in 85 properties, mostly in California with a few in Nevada).
In 1996, USA teamed up with Riverside Charitable to offer social services to residents through the LifeSTEPS program. Over the past 20 years, it has set up quite a few, augmented by the J.B. Brown Fund started by Geoff Brown and named after his father, the founder of USA Properties.
Brown’s father had a special feeling for the needs of elderly residents that Brown is carrying on and extending. “I continue what he started. He was very connected to the elderly. He was very passionate about seniors. We have tried to evolve what his passion was for the elderly.”
One way is by a pilot program for the frail elderly. This has placed a nurse in three senior communities. “We’ll see if we can help people age in place because they can’t afford assisted living,” says Brown.
After school activities are also on the menu, since the typical family in USA Properties is a single mom with two kids.
“We’re having an impact on people’s lives,” he concludes.
Tools to Assess Need
Faith-based groups, like the Volunteers of America, also pride themselves on having positive outcomes on people’s lives. The group’s Chesapeake unit (VOAC), based in Arlington, VA, maintains a 44-bed homeless shelter but is also committed to helping homeless people to obtain and maintain permanent housing. Besides housing, it also provides supportive services for substance abuse and mental health.
Nationwide (VOA operates in 46 states, the District of Columbia and Puerto Rico) about 60 percent of its housing stock (500 properties, 20,000 units) is devoted to senior housing, according to Vice President of Resident Services Donna Thurmond.
“Aging in place allows our residents to live independently in the home as long as possible,” she says.
VOA has 133 service coordinators in 158 properties, serving 8,000 residents, Thurmond says. The program is voluntary so not all residents use it, but VOA has measured about 80 percent usage. The service coordinators enroll residents in benefits and entitlement programs and link them to outside and property-based services.
They use four evidence-based tools to assess need. The four are the Vulnerable Elders Survey 13 (to detect health problems and assess residents for frailness), the Patient Health Questionnaire 9 (to detect symptoms of depression), the Lubben Social Network Scale (to detect social isolation) and the General Practitioner Assessment of Cognition (to detect symptoms of dementia).
After the assessments, an action plan is devised by the resident and the coordinator if any further action is needed.
VOA is very interested in tracking outcomes, Thurmond says, and has been implementing a database system (ServicePoint) to track them. Already it tracks things like how many unplanned hospital visits residents make (ER visits are down, she says), avoiding premature admissions to nursing homes, how active residents are in the community, how many residents have a primary care provider (that’s up to 90 percent, says Thurmond), and how good they are at keeping appointments.
The nonprofit also is tracking a pilot program it has going in two of its communities for improved outcomes. This service combines a full-time services coordinator with a part-time (20 hours) wellness nurse.
Doing projects in partnership with healthcare providers can also bring good results, she says. One VOA project in Tennessee invited some nursing students to a health fair, and the visit went so well the nursing school now has students doing two eight-week rotations at the property.
One company in Boston is so focused on outcomes it has just put out a detailed report on results in the HUD Family Self-Sufficiency (FSS) program it participates in.
POAH (Preservation of Affordable Housing), partnering with Compass Working Capital, also in Boston, has implemented the program in projects in Rhode Island and Massachusetts and touts it as a great way to improve economic mobility.
It gives a success story achieved by a resident named Tanya Febrillet of Lynn, MA. “Tanya enrolled in a FSS program operated through a partnership between her housing authority and Compass. The FSS program gave her the opportunity to work one-on-one with a financial coach at Compass, while also building savings through a mechanism that ties savings to increased income and rental payments.
“Over the course of five years in the program, Tanya paid down her debt, increased her annual income by nearly $8,000, improved her credit score by more than 140 points, and built over $3,000 in savings. She graduated from the FSS program in 2015 and achieved her dream of becoming a homeowner– the first in her family ever to do so.”
HUD made a study of the Compass FSS programs and found the following:
- Average increase of $6,305 in annual earnings.
- Average decrease of $496 in annual welfare income.
- Average increase in credit score of 23 points, compared to an average increase of 3.9 points in a comparison group.
- Average decrease in derogatory debt of $764, compared to an average increase of $554 in a comparison group.
- Average decrease in credit card debt of $655, compared to no change in a comparison group. One quarter of Compass participants experienced a decrease in credit card debt of $1,000 or more.
- An increased likelihood of establishing credit, if entering the program with no credit history.
Those sound like pretty good outcomes.