Recognizing that Federal policy (Olmstead Act, Medicaid waivers), state regulatory practices, and consumer preferences have begun to redefine the levels of frailty that can be maintained in settings such as residential care, assisted living and other forms of licensed and unlicensed supportive housing;1 and
Concerned that between 800,000 and 1 million aged persons live in licensed supportive housing with an equal number thought to live in unlicensed supportive housing,2 and that this population is not explicitly sampled, much less over sampled, in national surveys; and
Recognizing that governmental studies of supportive housing have raised concern about resident safety, and the adequacy of care in settings that are less well staffed and funded than nursing homes;3-5 and
Recognizing that existing national housing and health status monitoring systems (e.g., the National Health Interview Survey and the Medical Expenditure Panel Survey) use sample frames and living quarters classifications designed to exclude persons in supportive housing and noninstitutional group quarters, including those of residential care and assisted living;6 and
Recognizing that residents of skilled nursing facilities and recipients of home health care and hospice care are surveyed by special national surveys, leaving residents of supportive housing as the only major long-term care service recipient group excluded from national service recipient statistics;6 and
Acknowledging that at least six national surveys (e.g., American Housing Survey, Health & Retirement Survey, National Health Interview Survey, National Long Term Care Survey, Medical Expenditure Panel Survey, and Medicare Current Beneficiary Survey) have the potential to be adapted to explicitly include supportive housing settings and their residents as a recognizable living arrangement, and to explicitly sample or oversample this population;7 and
Noting that the American Public Health Association’s Executive Committee Task Force on Aging has been established to (a) raise awareness and promote education about aging within APHA, (b) recommend ways to improve the public health infrastructure in the context of aging, and (c) to develop and advocate public policies that will improve the health and well being of the aging population.
Therefore, APHA urges the Congress and President to authorize and appropriate the resources necessary for the Agency for Healthcare Research and Quality, National Center for Health Statistics, Assistant Secretary for Planning and Evaluation, Centers for Disease Control and Prevention, Centers for Medicare & Medicaid Services, Department of Housing and Urban Development, Health Resources and Services Administration, and U.S. Census Bureau, to:
- Modify national population surveys such as the National Health Interview Survey and American Housing Survey so they can provide national estimates on resident and facility characteristics among the population living in supportive housing. Specific modifications needed include:
- expanding the sample design used by these surveys to expressly include and/or to over-sample persons living in licensed housing and selected supportive living quarters when not licensed;
- modifying living quarters classifications to identify and distinguish assisted living, residential care, and other specific types of licensed housing;
- having data tabulations and public use data files from these surveys distinguish between the population and facility characteristics of community housing (e.g., single family homes, apartments, flats) and those of supportive housing (e.g., licensed facilities, facilities with services if unlicensed);
- standardizing living quarters classifications used among the various surveys, and to be consistent with the living quarters classification used in the panel surveys (e.g., Medicare Current Beneficiary Survey, Health and Retirement Survey, and the National Long Term Care Survey) that track individuals over time, regardless of changes in housing;
- These panel surveys will need to modified to oversample the population in supportive housing.
- Develop and test a pilot program adapting state licensing and certification processes for supportive housing and quality assurance programs for home and community-based service programs to provide a community level information system on supportive housing. Such information can be used to monitor community trends, inter-community variation, and it can be aggregated to provide statewide profiles. This information can be incorporated into a national data set such as the Area Resource File to permit inter-state comparisons.
References
- Mollica, R. (2002). State Assisted Living Policy 2002. Portland, ME: National Academy for State Health Policy.
- U.S. House of Representatives, Select Committee on Aging. (1989). Board and Care Homes in America: A National of Tragedy. (A Report by the Chairman of the Subcommittee on Health and Long-Term Care, pub. no. 101-711). Washington, DC: Government Printing Office.
- U.S. General Accounting Office (US GAO). (1989) Board & Care: Limited Assurance That Residents Needs Are Being Met. Washington, DC: US General Accounting Office (GAO/HRD 89-50).
- U.S. General Accounting Office (US GAO). (1997) Long Term Care: Consumer Protection and Quality-of-Care Issues in Assisted Living. Washington, DC: US General Accounting Office (GAO/HEHS 97-593).
- U.S. General Accounting Office, (1999) Assisted Living: Quality-of-Care and Consumer Protection Issues for Four States. April. GAO HEHS-99-27.
- Newcomer R, Maynard R. Thoughts on National and Community-Level Supportive Housing Data Systems. Seniors Housing & Care Journal, 10(1):55-54.
- Newcomer R, Benjamin AE. (1997). Community-Level Indicators for Chronic Health Care Services. In Newcomer R, Benjamin AE (Eds.), Indicators of Chronic Health Conditions: Monitoring Community-Level Delivery Systems. Baltimore, MD: The Johns Hopkins University Press.
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