BAY AGING PARTNERSHIPS BRING 

HELP AND HOPE 

TO PEOPLE EXPERIENCING HOMELESSNESS 

Mr. Spriggs, a 68-year-old veteran, contacted Bay Aging when he could no longer aford to pay 

$400 for the shed where he lived. Ten days later, he moved into a service-enriched apartment 

developed and managed by Bay Aging, an Area Agency on Aging (AAA) in Urbanna, Virginia. Te move 

gave Mr. Spriggs access to supports that would allow him to bathe, cook and eat nutritious meals. He 

now is thriving both mentally and physically. He can be seen walking around town getting his steps in, 

smiling, waving, and making new friends. 

His change in living situation was made 

possible by a contractual relationship between 

Bay Aging and the local U.S. Department of 

Housing and Urban Development (HUD) 

ofce. Trough this relationship, Bay Aging 

provides subsidized housing with ready 

access to transportation, community living 

services, and health programs that help older 

adults and others live independently in their 

communities. Other partnerships between Bay 

Aging and local community organizations are 

helping to improve the availability of afordable 

and accessible housing, promote housing 

stability, and reduce homelessness. 

Starting with a general overview of 

homelessness and the need for partnerships in 

housing and services, this case study describes 

Bay Aging’s housing partnerships and programs 

that helped the AAA address homelessness and 

promote housing stability. Bay Aging has also 

had an impact in the greater community as a 

founding member and leader of the Northern 

Neck Middle Peninsula Housing Coalition. Tis 

case study features the award-winning results 

of these collaborations as well as suggestions 

that organizations can use to form housing and 

supportive services partnerships of their own. 

HOMELESSNESS PARTNERSHIPS LINK HOUSING AND SERVICES 

In any single night in January 2020, 

about 580,000 people were experiencing 

homelessness.1

 In the United States, 

homelessness is disproportionately high among 

those identifying as Black or African American; 

American Indian, Alaska Native, Pacifc Islander 

and Native Hawaiian; or Hispanic/Latino.2 People 

with disabilities are also more likely to experience 

homelessness. Nearly half (48.5 percent) of 

single adults and heads of households who 

used homeless shelters over the course of a year 

report living with a disability, according to HUD’s 

Annual Homeless Assessment Report.3 

Since 2016, homelessness has been increasing, 

and the COVID-19 pandemic made fnding and 

retaining stable housing more difcult.4

 Also 

notable is the rise in the number of people 

age 50 years and older who are experiencing 
2 

homelessness.5

 Tis population is more likely 

to have chronic medical conditions and to 

experience severe illness due to COVID-19.6 

To become housed, many people who are 

experiencing homelessness need a combination 

of afordable and accessible housing and a 

range of services, including nutrition, health 

care, tenancy support, transportation, benefts 

enrollment, behavioral health, and assistance 

with everyday activities.7 Across the nation, 

HUD funds Continuums of Care (CoCs) 

to serve as networks of governmental and 

nonproft organizations that provide housing and 

support for people experiencing homelessness. 

Partnerships between CoCs and AAAs help 

ensure people at risk of homelessness or 

experiencing homelessness have access to the 

mix of supports they need to (re)gain stability. 

To these partnerships, AAAs bring not only 

a local network of service providers, but also 

deep expertise from decades of serving older 

adults and caregivers (see What Is an Area 

Agency on Aging on the next page). 
3 

WHAT IS AN AREA AGENCY 

ON AGING (AAA)? 

Created by the Older Americans Act in 

1973, AAAs are part of the national Aging 

Network. AAAs are the local leaders that 

develop, coordinate, and deliver a wide 

range of home and community-based 

services. Tese services include information 

and referral/assistance, case management, 

home-delivered meals and meals in 

congregate settings, in-home services, 

caregiver supports, transportation, evidencebased health and wellness programs, 

long-term care ombudsman programs, 

and more. People who receive services 

provided by AAAs have improved health 

and well-being, helping them remain in 

their homes and thrive in the community. 

BAY AGING LINKS HOUSING AND 

SERVICES 

As both the AAA for a 10-county region and 

a Community Action Agencya

 for eight counties, Bay Aging has diverse funding streams it 

can draw upon to serve older adults and other populations. Federal Older Americans Act 

funding is allocated to AAAs by State Units on 

Aging, and the U.S. Administration for Children 

& Families funds Community Action Agencies 

through Community Services Block Grants. 

Tese and other funding sources enable Bay 

Aging to ofer a wide array of services through 

its specialized divisions for housing, health, 

and transit. Bay Aging has developed internal 

systems to integrate these supports seamlessly 

for its clients (see Bay Aging Housing-Related 

Services During the Pandemic on the next page). 

To provide afordable, accessible housing, Bay 

Aging developed, owns, and manages 10 communities funded through the HUD Section 202 

Supportive Housing for the Elderly Program. Te 

federal program provided the initial capital for 

the development of units designated for people age 62 and older. All Bay Aging apartments 

have universal design features, so they can 

be accessed by anyone, including people with 

mobility challenges, older adults, and people 

with disabilities. Te AAA also maintains a HUD 

Project Rental Assistance Contract, which helps 

support operating expenses in Section 202 properties to allow rents to remain low; residents pay 

only 30 percent of their adjusted gross income 

each month. 

Living in a Bay Aging apartment enables 

residents to have the beneft of ready access 

to an array of services, including on-site care 

coordination. Te AAA’s care coordinators work 

in partnership with residents to help organize 

and manage clinical and/or supportive services. 

Care coordinators can be essential to stabilizing 

a housing situation, averting crises, and 

improving health and well-being. 

In 2020, 367 older adults lived in 317 safe 

and afordable Bay Aging apartments. Yet 

unmet needs in this rural region remained 

signifcant. In 2021 Bay Aging had more 

than 1,000 older adults on its waiting list for 

housing. For this reason, Bay Aging secured 

Low-Income Housing Tax Credits to construct 

its eleventh property. In 2022, this 40-

unit property, which includes one-and-two 

bedroom units, will provide up to 136 older 

adults with a place to live and supportive 

services that can both help stabilize their 

housing situation and their health. 

a Community Action Agencies are designated by state or local governments to work with community partners to reduce poverty among extremely poor populations. 
4 

 

 

INNOVATIVE HUD PARTNERSHIP 

REDUCES HOMELESSNESS 

Bay Aging’s ongoing relationship with HUD 

provided the foundation for the AAA to expand 

eforts to reduce homelessness. Over several 

years, with HUD’s approval, Bay Aging established criteria for prioritizing housing applications from populations with higher needs. 

Tese criteria give preference to applicants 

from two populations: 

. Veterans Preference: 

In 2010, Bay Aging became the 

frst age- and income-restricted 

housing provider in Virginia to 

receive HUD approval to ofer a 

veterans preference for housing. 

As a result, veterans who were 

eligible for Bay Aging apartments 

and had an honorable discharge 

received priority to move up the 

waitlist. In 2015, Virginia became 

the frst state to functionally end 

veteran homelessness, meaning 

that Virginia can house all veterans experiencing homelessness in 

an average month.8 

. Homeless Preference: 

In 2018, Bay Aging began partnering with its local CoC to provide 

supportive housing for older adults 

who were transitioning out of 

homelessness. Bay Aging became 

the frst in Virginia to implement 

a homeless preference under 

the HUD Section 202 Supportive 

Housing for the Elderly program. 

After many years of adaptation, Bay Aging 

eventually created a unique way to rotate 

through preferences to create a diverse community. Te process entails using multiple lists 

for multiple properties and exhausting the 

preference waitlist before moving to 

another list.b 

BAY AGING SERVICES DURING THE PANDEMIC 

During the pandemic, Bay Aging ofered services across its full service area, including to 

older adults who have low incomes, chronic health conditions, and/or barriers to remaining 

stably housed. Because many of these individuals also have elevated risk for COVID-19 

complications, Bay Aging coordinated vaccines for people who live in age-restricted rental 

housing. Bay Transit, a Bay Aging program, ofered free rides to all community members on 

retroftted buses, with free hand sanitizer and masks available. Te AAA also partnered with 

local restaurants to provide meal delivery services. Te provision of these services helped 

community members stay in their homes. 

b For example: Unit A becomes available, and it is ofered to veteran applicant 1. If they decline, it is ofered to veteran applicant 2... and so on. When Unit B becomes 

available, it is ofered to homeless applicant 1. If they decline, are no longer homeless, etc., it is ofered to homeless applicant 2. If there are no more verifed 

homeless individuals, the unit will then be ofered to a general applicant. When Unit C becomes available, it is ofered to general applicant 1. If they decline, it is 

ofered to general applicant 2. When Unit D becomes available, it is ofered to veteran applicant 3. 
5 

 

[P]artnerships between Bay Aging 

and local community organizations 

improve the availability of afordable 

and accessible housing, promote housing 

stability, and reduce homelessness. 

BAY AGING PROGRAMS TO REDUCE HOMELESSNESS 

Bay Aging brings together a variety of programs 

to address homelessness using federal, state, 

and philanthropic funding, including federal 

COVID-19-relief funds. 

. Housing crisis hotline: Individuals 

in the region who are experiencing a housing crisis can call to be 

assessed for, referred to, and connected to housing and assistance 

based on their strengths and needs. 

Te hotline connects to the regional 

CoC’s coordinated entry process 

that ensures all people experiencing 

a housing crisis have fair and equal 

access and are quickly connected 

to services.9

 Bay Aging operates the 

coordinated entry process. 

. Financial assistance: Bay Aging 

administers rapid rehousing and 

emergency services, which provides a subsidy and security deposit to quickly stabilize a household 

in a housing crisis. 

. Emergency housing vouchers: 

To prevent homelessness, in 

addition to and separate from 

the HUD 202 Program, Bay Aging 

also administers HUD Emergency 

Housing Vouchers through the 

department’s Housing Choice 

Voucher Program. 

. Housing navigation: To help 

people fnd housing, Bay Aging 

coordinates with landlords to 

identify an inventory of afordable 

and accessible rental units to 

match incoming clients to housing 

that has the supportive services 

clients need, in the areas where 

clients prefer to live. 

. Supportive services: Bay Aging 

supports residents through case 

management that assesses needs, 

plans and monitors services, 

and evaluates. Te agency also 

provides credit counseling, landlord 

negotiation and legal advocacy, 

increased access to benefts, 
6 

modifcations to rental units for 

accessibility, tenancy support, 

and much more. Anyone in the 

Bay Aging service area can receive 

options counseling, which provides 

unbiased information on the available 

programs, services, and options to 

help people make informed choices 

about housing and other services. 

. Technology to track housing 

data: Te Homeless Management 

Information System stores data, 

referrals, and outcomes, and can 

communicate with other systems 

that AAAs and other organizations 

in the feld may already use. 

While Bay Aging operates the above programs in 

its service area, these programs may have diferent administrators in other communities. Where 

they exist, these programs may represent potential partners for homelessness services and organizations in the aging and disability networks. 

Where they do not, they represent potential gaps 

that community partnerships could fll. 

[C]oalition members and Bay Aging have 

a shared mission to serve the people who 

are at high levels of disadvantage. 

HOUSING COALITION PARTNERSHIPS SERVE THOSE WHO ARE HOMELESS 

Bay Aging works with community partners to 

reduce homelessness. Bay Aging is a founding 

member of the Northern Neck Middle Peninsula 

Housing Coalition and was ofcially recognized 

by the Virginia Department of Housing and 

Community Development as the local coalition’s 

Lead Agency in 2018. 

Te coalition serves the same 10-county area 

as Bay Aging. Te coalition has a community 

services board and includes organizations 

addressing domestic violence, departments of 

social services, emergency shelters, the faith 

community, homelessness prevention, housing 

providers, legal aid, street outreach, Virginia 

Housing (state housing fnance agency), Virginia 

Department of Housing and Community 

Development, Virginia Department of Veteran 

Services, and HUD. 

Coalition members communicate daily, sharing 

knowledge and skills and working collectively 

to break down silos in housing, health care, 

transportation, and more. Tey are part of the 

CoC’s coordinated entry process, the referral 

system that involves the community in helping 

people fnd housing. Bay Aging also receives 

referrals from health care providers and has its 

own options counseling service. 

Bay Aging fnds that the coalition aligns well 

with the services Bay Aging provides as a AAA. 

Furthermore, coalition members and Bay Aging 

have a shared mission to serve the people who 

have a high level of need. 
7 

 

BAY AGING’S AWARD-WINNING OUTCOMES 

Bay Aging’s eforts have been recognized by several awards programs, including the 2022 

and 2021 USAging Aging Innovations and Achievement Awards program and the Virginia 

Commonwealth Council on Aging award. In March 2021, the Virginia Trust Fund awarded Bay 

Aging a $300,000 Older Adults Innovation Project grant. Tese awards recognize cutting-edge 

models that others should consider replicating. 

REPLICATION 

Bay Aging’s accomplishments are impressive— 

and replicable. Bay Aging’s Senior Vice President 

of Housing Joshua Gemerek encouraged AAAs 

and other community-based organizations that 

wish to model similar eforts to look at needs, 

funding sources, and opportunities to form partnerships with organizations that address housing needs and homelessness. As AAAs identify 

housing issues, they often can fnd easy, quick 

wins, he said. For example, Gemerek encouraged 

AAAs to speak with their local HUD ofces to 

identify local Section 202 properties to learn 

which services their residents need. Or, in areas 

with a high number of people for whom English 

is a second language, AAAs also could ofer language translation services. 

Building business relationships that leverage 

and beneft from shared expertise and resources 

are key to better delivering coordinated services 

and supports to individuals in the community. Bay Aging urges AAAs and CoCs to create 

partnerships with other networks that stabilize 

housing situations for older adults and people with disabilities. Formal partnerships also 

enable AAAs to receive funding through homeless services programs to carry out specialized 

support. Developers can implement homeless 

preference policies similar to Bay Aging’s, which 

could lead to revenue from programs that provide incentives to reduce homelessness, according to Bay Aging. 

“Partnerships that bridge Continuums of Care 

and AAAs are critical for every community to 

have and should be tailored to each unique 

community,” said Gemerek. “At a minimum, 

information and referrals should take place in 

networking spaces, such as AAA’s Aging and 

Disability Resource Center engagements.” 

ENDNOTES 

1 US Interagency Council on Homelessness. 2021. 

Key Findings of 2020 Point-in-Time Count. 

https://www.usich.gov/tools-for-action/2020-

point-in-time-count/. 

2 Ibid. 

3 Department of Housing and Urban Development. 

2021. Te 2020 Annual Homelessness Assessment 

Report to Congress. https://www.huduser.gov/ 

portal/sites/default/fles/pdf/2020-AHAR-Part-1. 

pdf 

4 Cho R. 2021. What Will It Take to House America? 

National Alliance to End Homelessness. 

https://endhomelessness.org/what-will-it-take-tohouse-america. 

5 Culhane D, Byrne T, Metraux S, et al. 2019. Te 

Emerging Crisis of Aged Homelessness: Could 

Housing Solutions Be Funded by Avoidance 

of Excess Shelter, Hospital, and Nursing 

Home Costs? https://www.aisp.upenn.edu/ 

wp-content/uploads/2019/01/Emerging-Crisis-of-Aged-Homelessness-1.pdf. 

6 Cha S, Henry A, et al. 2021. Morbidity and Mortality Among Adults Experiencing Homelessness 

Hospitalized With COVID-19. Te Journal of 

Infectious Diseases, 224(3): 425–430. https://academic.oup.com/jid/article/224/3/425/6276529. 

7 Department of Health and Human Services, 

Department of Housing and Urban Development. 

2021. Advancing Community Living Trough 

Coordination Between Housing and Voluntary 

Community Services. https://acl.gov/sites/default/ 

fles/ada/HHS-HUD_HousingFactSheetpdf.pdf. 

8 National Alliance to End Homelessness. 2018. 

Ending Veteran Homelessness in Virginia: A 

Statewide Collaboration. https://endhomelessness. 

org/resource/ending-veteran-homelessness-virginia-statewide-collaboration. 

9 HUD Exchange. Coordinated Entry and Homeless 

Management Information Systems (HMIS) FAQs. 

https://fles.hudexchange.info/resources/documents/Coordinated-Entry-and-HMIS-FAQs.pdf. 
AUGUST 2022 

Tis publication was supported by the U.S. Administration for Community Living through a contract with Mission Analytics Group, Inc. 

(Contract number HHSP233201500060I) which subcontracted the work to USAging. Te views expressed do not necessarily 

represent the positions or policies of the Administration for Community Living/Department of Health and Human Services.