Media Mentions

Crain’s: Keeping elderly supportive-housing residents healthier and out of the emergency room

A supportive-housing nonprofit has found that when elderly residents have care plans that are tailored to their specific health needs, the number of days these patients spent in the emergency department was cut by 72%.

Breaking Ground, which describes itself as the city's largest provider of supportive housing, conducted a two-year pilot program that followed 41 residents, age 62 or older, who received regular visits from health care providers. They also participated in wellness activities such as trips to farmers' markets to promote healthy eating and diabetes management workshops.

Breaking Ground has 3,530 supportive housing units at 19 properties. Health care services were delivered by Janian Medical Care, the health care arm of the Manhattan nonprofit Center for Urban Community Services, a housing and social services nonprofit.

The 41 residents lived in three Breaking Ground properties—two in Manhattan, one in Brooklyn—and spent 109 days in the emergency room or hospital in 2012. But by 2015, those same residents spent only 31 days in those settings, which Breaking Ground estimates saved taxpayers $177,000.

Providing health care services to poor elderly New Yorkers could take on increasing importance with the graying of the city's population. A front-page article in The New York Times earlier this week examined the challenges that an older homeless population will pose for the nonprofits and government agencies that provide services to them.

Breaking Ground has been working on the project since 2013. The nonprofit believes sharing the lessons it learned, compiled in a report published Thursday, could help more people stay at home rather than receive services in a skilled-nursing facility.

"It really began as, 'What can we do because we want people to continue to live in our housing with dignity for as long as they can?'" said Brenda Rosen, Breaking Ground's chief executive. "They've finally found a
place where they have a de facto family, and all of a sudden, you can't stay there anymore."

The initiative, called the Elder Care Health Outreach program, was funded through $560,000 in contributions from five foundations. One doctor from Janian saw patients one day a week, with two nurse practitioners working half-time to oversee the program. Another full-time staff member supervised the wellness portion of the initiative.

Beyond the 41 seniors who were tracked, 155 adults received medical services and 357 accessed such tenant services as instructions on preventing injuries and falls that can often land older adults in the emergency department or hospital.

Rosen said the pilot cost less than $2,000 a person, a figure low enough to demonstrate to other organizations its usefulness as a cost-effective care model.

"Immediately, the return on investment was very good," she said.

The pilot wasn't exactly scientific, though. Residents weren't selected randomly; Breaking Ground targeted individuals with complex medical issues who were frequent visitors to the emergency department and were less likely to access services on their own. It might be easier to reduce days spent in the hospital for those types of patients. But Rosen believes Breaking Ground's program is a step in the right direction.

"It's not a panacea. The hope is to use this to spur further conversations and expand these services and look at these results over a longer period of time and for more people," she said. "It's the beginning, not the end."