The Department of Housing and Urban Development (HUD) recently released finalized guidance clarifying its position on the role of housing in accomplishing the goals of Olmstead, the landmark Supreme Court decision giving people with disabilities the right to have multiple housing options.
Olmstead‘s objective is to help people with disabilities lead normal, integrated and independent lives. For some, this may mean living in a community setting where they can also receive supportive services if necessary, rather than a nursing home or some other institutional setting.
There has been a lot of cross-agency collaboration between the Department of Justice, the Department of Health & Human Services, and HUD to clarify and implement Olmstead, notes Michelle Norris, senior vice president of acquisitions and development at National Church Residences (NCR), which provides affordable housing to a variety of populations including the elderly and disabled.
The ruling has implications for senior housing, especially for providers of HUD-assisted supportive housing. A significant number of disabled people are also elderly, Norris says, and because of the aging in place trend, that’s not expected to change.
“People are living in [their homes] longer and living longer,” she says, adding that the average age of people living in NCR housing is now 75. “As people head into their 80s, they generally have more limitations, chronic illness, and disabilities. We are going to see both sets, the elderly and those with disabilities, in our buildings.”
While there have been increased efforts across the country to give more choices to disabled individuals who are institutionalized or housed in settings that are considered segregated, there has still be a lot of confusion about how housing providers should follow Olmstead, according to the HUD guidance.
“[T]here is a great need for affordable, integrated housing opportunities where individuals with disabilities are able to live and interact with individuals without disabilities, while receiving the health care and long-term services and supports they need,” HUD says.
NCR’s action plan is to continue providing supportive housing for populations including seniors, the disabled, and the homeless, and to keep working with states that are providing funding for supportive housing and make sure they understand Olmstead policy.
The agency is exploring how it can fund additional integrated housing units with long-term healthcare and supportive services along with the funding it already provides for single-site supportive housing that already houses and supports individuals with disabilities.
“HUD is taking this opportunity to advise housing providers, as they manage their portfolios of housing and develop new housing to meet the needs of individuals with disabilities, to consider the particular housing needs in their individual communities and in their state,” the guidance reads.
Through the finalized guidance, HUD is trying to help states understand their position from both a housing and supportive services perspective.
“HUD and HHS have been going state by state educating people on the parameters [of Olmstead],” Norris says. “There’s room within this guidance; it’s not very, very strict, saying ‘you must do this, you can’t do that.’ It’s more balanced.”
Some independent living providers see opportunity in Olmstead and how it is enforced.
“We believe ILCs [independent living centers] can play a crucial role in the implementation of managed care,” said Liz Pazdral, California’s Independent Living Council Executive Director, in a statement. “ILCs have established and effective relationships with community-based organizations and can help managed care plans contain costs by assisting individuals living with disabilities to live independently in their homes rather than in institutions.”
California is transitioning to a managed care model for its dual eligible population, with an emphasis on home- and community-based services. Through the state’s Coordinated Care Initiative and Medicaid system, independent living centers can work with managed care plans to expand access to HCBS services. This is accomplished by including those services in a benefit package for dual eligibles, says the California State Independent Living Council, and contracting with managed care organizations to deliver the services in a community setting.
“In the past, ILCs have never had to demonstrate to health plans the benefit of the services we provide and how those services can effect positive outcomes such as reducing re-hospitalization or providing in-home support services that keep individuals out of emergency rooms,” said Todd Teixeira, Silicon Valley Independent Living Center’s director of programs. “Given the role we can play in keeping costs down while providing quality services, it will be critical for ILCs to collect data and track outcomes that demonstrate our value to the managed care plans.”
Access the finalized HUD guidance.
Written by Alyssa Gerace