# Presentation: 787920

## HOLGATE HOUSE

**HOLGATE HOUSE**

**Holgate House**
**4601 SE 39****th**** Street**
**Portland, Oregon 97202**

_**Partners**_**:**
** ****U.S. Department of Housing and Urban Development**
** ****Housing Authority of Portland (HAP)**
** ****Portland Area Agency on Aging**
** ****Oregon Department of Human Services**

**- One of four high-rise**
**  ****buildings where**
**  ****Congregate Housing**
**  ****Program operates**
**- 120 Total CHSP Slots**

## BACKGROUND

**BACKGROUND**

**HOLGATE HOUSE**

**PORTLAND, OR**

** ****1981 HAP initiated the Congregate Housing Services Program (CHSP)**
** ****Thirty slots in one building**
** ****Provided support services to the frailest elderly and disabled individuals**
** ****HUD  funded the program except resident’s paid a sliding scale portion of the fee**
** ****CHSP funds managed by HUD Office of Housing**
** ****1993 HAP requested from HUD  received ninety additional slots**
** ****A total of one-hundred twenty slots in four buildings; 3PH, one mixed population**
** ****1993 HUD initiated a 60% matching requirement **

## DESIGN / STAFFING

**DESIGN / STAFFING**

**HOLGATE HOUSE**

**PORTLAND, OR**

** ****HAP manages the buildings and the CHSP**
** ****Management, service coordinators and kitchen staff are HAP employees**
** ****Personal care, housekeeping, transportation, nursing, podiatry and senior companion services are contracted out**

## PROCESS

**PROCESS**

**HOLGATE HOUSE**

**PORTLAND, OR**

** ****1993 HAP obtained 50% of required 60% matching funds via the Oregon State Home and Community Based Care (HCBC) Medicaid Waiver program.**
** ****10% of matching funds from participant fees **
** ****HCFA provided the funds and the Oregon State Department of Aging administered the fund**
** ****CHSP participants continued to pay their rent  **
** ****HCBC provides HAP with a monthly capitated rate per CHSP program participant regardless of the level of service required by each individual**
** ****CHSP  participants must meet Medicaid income level requirements **(income of $500.00 dollars per month, assets under $2,000)

## PROCESS (Continued)

**PROCESS ****(Continued)**

**HOLGATE HOUSE**

**PORTLAND, OR**

| FUNDING SOURCES (averages) |  |  |  |
| --- | --- | --- | --- |
|  | MONTH | ANNUAL |  |
| Medicaid Community Based Care Waiver Program | $302 | $3,624 | Contributes toward cost of 1 meal per day, housekeeping, personal care, transportation, basic nursing, case management, senior companion services |
| HUD Congregate Housing Services Program funds, administered by the Housing Department | $242 | $2,904 |  |
| Participant | $60 | $720 |  |
| Total: | $604 | $7,248 |  |
|  |  |  |  |
| ALF | $2,938 | $35,256 |  |
| Nursing Home | $3,500 | $42,000 |  |

## MANAGEMENT / MARKETING

**MANAGEMENT / MARKETING**

**HOLGATE HOUSE**

**PORTLAND, OR**

** ****CHSP not regulated in Oregon **
** ****HAP Administrator and Service Coordinators provide onsite program monitoring **
** ****No formal marketing necessary**
** ****Referrals from Area Agency on Aging and “word of mouth” within the housing authority and outside communities **

## CHALLENGES/FAILURES/LESSONS LEARNED

**CHALLENGES/FAILURES/LESSONS LEARNED**

**HOLGATE HOUSE**

**PORTLAND, OR**

** ****February 2003 state budget cuts have drastically affected the level of Medicaid funding**
** ****Now more difficulty meeting level of care standard. **
** ****Further state budget cuts anticipated 4/03.  Likely result  will be less funding per individual recipient**
** ****There are no alternative sources of matching funding once Medicaid funds are decreased**
** ****Recognizing time to pursue a higher level of care placement. **
** ****Ability to secure alternative placement in an expeditious manner**
** ****HAP would consider developing an Assisted Living program and thereby access ALF Medicaid funds**
** ****Obstacle--there are no HUD or other funds to retrofit the buildings**

## ACCOMPLISHMENTS/SUCCESSES/HIGHLIGHTS

**ACCOMPLISHMENTS/SUCCESSES/HIGHLIGHTS**

**HOLGATE HOUSE**

**PORTLAND, OR**

** ****Enables low income individuals to reside independently much longer than would otherwise be the case**
** ****Enables some program participants to completely avoid institutionalization**
** ****The program has improved the quality of the lives of participants**
** ****The program has assisted to preserve participants’ health, actually increasing life spans**
** ****To date the program has met the budgetary challenges and managed to provide an adequate level of care to the program participants**
** ****Provides the services at an incredibly reasonable price**
** ****The program has been able to meet the needs of an increasingly frail population**

## SUMMATION

**SUMMATION**

**HOLGATE HOUSE**

**PORTLAND, OR**

** ****Currently, only HA’s that received CHSP funding as of 1995 are eligible to apply for this program **
** ****HUD should consider allowing additional HA’s to apply**
** ****HUD should consider a more reasonable CHSP funding match (currently 60%), so that current HA’s can remain in the program **
** ****HUD should consider increasing CHSP funding because alternatives are more costly**
** ****CHSP, combined with community resources, can adequately maintain many frail elderly residents until nursing home placement is necessary or until natural death occurs**

## SUMMATION (Continued)

**SUMMATION ****(Continued)**

**HOLGATE HOUSE**

**PORTLAND, OR**

** ****A continuum of care, i.e. CHSP and if needed, ALF, is an economical alternative to nursing home care **
** ****Many elderly individuals experience physical and/or mental deterioration due to inability to take meds as prescribed causing otherwise unnecessary NH placement **
** ****CHSP regulations should contain a mandatory provision for medication management**
** ****HUD should consider ways that HA’s could access funds to modify buildings/apartments to comply with state ALF requirements**
** ****Retrofitting costs cannot be absorbed within most HA’s current  budgets**

**Notes:**
Providing a continuum of care, i.e. CHSP and if needed, ALF, is an economical alternative to nursing home care for meeting the needs of PH frail, elderly residents
 CHSP should contain a mandatory provision for medication management for those who require the service.  Many program participants’ physical and/or mental deterioration is due to lack of ability to properly take their medications
 HUD should consider ways that HA’s could access funds in order to modify buildings/apartments to comply with state ALF requirements.  These costs cannot be absorbed within most HA’s current  budgets.  Some participating HOPE VI HA’s have been able to provide for ALF requirements within their buildings
 CHSP funds are managed by the HUD Office of Housing.  The funds are available to previous providers which are either PHA’s, 202, Section 8, Section 236 or 221 D-3 properties