The Coming Home Demonstration Program: A Model for Development of Affordable Assisted Living

By Jenkens, Robert | Generations, Winter 2005 | Go to article overview

The Coming Home Demonstration Program: A Model for Development of Affordable Assisted Living


Jenkens, Robert, Generations


The challenge of blending housing programs with services for older people on Medicaid.

It has always been a challenge to create financially viable community-based housing with services for people with low incomes. This challenge has substantially limited the development and availability of alternatives to nursing home care for people with low incomes, especially when the option requires joining purpose-built affordable housing with comprehensive services. Blending affordable housing programs with Medicaid-reimbursed and state-regulated services (i.e., an array of scmces with a mechanism for regulatory oversight) requires developers, providers, and policy makers to marry subsidy programs that were not designed to work together and often have conflicting rules, goals, and incentives. As Hernandez notes elsewhere in this issue, many have tried, but with the notable exception of a handful of states such as Oregon, few have had much success on a large scale. The Coming Home Demonstration Program serves to reaffirm that it is possible to create successful projects.

DEVELOPMENT OF COMING HOME

In the early nineties, the National Cooperafive Bank Development Corporation (NCBDC), a nonprofit community development finance organization, with funding assistance from the Robert Wood Johnson Foundation, embarked upon creation of the Coming Home Demonstration Program, which would turn out to be an intensive thirteen-year effort to encourage development of affordable assisted living. The first phase of the program (1992-98) focused on identifying organizations that recognized the need for affordable assisted living in their communities and were willing to explore the prospect of creating and operating affordable assisted-living projects.

This phase provided significant insight into how difficult developing affordable assisted living could be without a supportive state policy and program environment. After six years, five projects with 210 units in four states had been built. Six additional projects with 214 units in two states had been started, and a Medicaid assisted-living services demonstration program in one state had been initiated.

With the difficulty of creating affordable assisted living in mind, NCBDC and the Robert Wood Johnson Foundation acted as partners to create phase two (1999-2005) of the Coming Home Program. This phase focused on identifying specific barriers to creation of affordable assisted living within states and fostering development of policies and programs designed to overcome these barriers and lead to successful operations. As of December 2005, Coming Home phase two had supported the development and opening of twenty affordable assistedliving projects with 780 units in the nine Coming Home demonstration site states. Another seventy-three affordable assisted-living projects with approximately 2,500 units are in some stage of development now, with the potential of coming online within the next several years.

In short, something bigger and more permanent than reports and training occurred, but these efforts are still substantially short of a sustained movement that might result in significant increases in affordable assisted living. What were the key elements in this effort?

KEY ELEMENTS

For such an ambitious effort, a well-formulated plan of action is necessary. Based on the Coming Home demonstration, NCBDC identified the following key elements for successful development of affordable assisted living.

Goal consensus. While it is not unusual for those seeking to develop a project to coalesce around a "dream," many times this dream is not the result of an inclusive consensus-building process. The first step is to determine with clarity what the program's goals are for a new or adapted model: Why is the organization pursuing the development or implementation of a new model? An assessment of the goals and models should identify the pros and cons of the model for all stakeholders. …

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