This past December, the CDC did something remarkable. When considering which long-term care community types to recommend states include in its Pharmacy Partnership for Long-Term Care Program, the CDC included a portion of affordable, HUD-subsidized senior housing communities.
“Long term care” is often used to talk about nursing homes, assisted living communities, insurance and home- and community-based services. Including affordable housing into long term care discussions too often becomes a footnote, reading something like, “No real long term care system is possible without an adequate supply of affordable housing.”
This makes the CDC’s December 2020 recommendation that states include certain federally subsidized affordable senior housing in the same vaccine distribution tranche as nursing homes and assisted living communities quite groundbreaking.
During the pandemic, LeadingAge, an association of more than 5,000 nonprofit aging services providers and other mission-minded organizations in long-term care, has worked with the Department of Housing and Urban Development. HUD serves more than 1.6 million older adults, the majority in HUD-subsidized apartment buildings.
We also work with Treasury’s Low Income Housing Tax Credit-financed buildings, which serve another 800,000 older adults, and with the USDA’s Rural Housing Service, which subsidizes senior apartments across the United States. These communities all need help to protect residents and staff from the ravages of COVID-19. In a survey of our affordable housing members, we learned that 60 percent are aware of COVID-19 cases in their communities.
Advocacy efforts on Capitol Hill to get these federally subsidized communities the relief they need has provided some help, but significant needs remain for services and staffing, for never-before needed services like meals and laundry and 24-hour front desk staff, for more service coordinators and for funds for wireless Internet to connect residents to telehealth and combat social isolation.
‘Getting onsite vaccine clinics would be better than winning the lottery: it’d be saving lives.’
In addition to HUD and Congress, LeadingAge works with the CDC on a variety of issues, including the Pharmacy Partnership. The CDC was preparing recommendations to states on which types of communities are to be considered a “long-term care facility.” In addition to nursing homes and assisted living communities, where 40 percent of COVID-19 deaths have occurred, what other settings would be included in “long-term care”? On the affordable housing side, LeadingAge urged the CDC to classify affordable senior housing within its definition of “long-term care facility” for the purposes of the Pharmacy Partnership.
Depending on where you sit, who you serve, where your mother lives, where your brother works, there are dozens of types of communities that can be considered long-term care settings. It was clear the CDC wanted to start with a narrow definition and expand it as the vaccine supply expands, and that states would be the ultimate decision drivers.
The Pharmacy Partnership Benefits
The Pharmacy Partnership was extremely attractive to affordable seniors housing providers. Being in the Pharmacy Partnership would mean the community would receive “end to end” vaccine administration—staffing, vaccines, reporting—all facilitated by the Pharmacy Partners. For affordable housing providers, where all residents are ages 62 and older and 39 percent are older than age 80, getting onsite vaccine clinics would be better than winning the lottery: it’d be saving lives.
Service coordinators in Section 202 (HUD Housing for the Elderly program) communities help residents connect to assistance for activities of residents' daily living, such as eating, dressing, bathing, grooming, transferring and home management. Among HUD Section 202 residents, 38 percent are frail or near-frail. Section 202 residents are not only older, they are more likely to be Black than non-HUD assisted residents, and more likely than their non-HUD-assisted peers to have chronic health conditions—a recipe for a particularly high-risk demographic.
Ultimately, for health equity reasons, the CDC included one affordable senior housing program, HUD’s Section 202 program, in its recommended initial vaccine distribution of the Pharmacy Partnership program. For purposes of the Pharmacy Partnership program, the CDC understood that many Section 202 residents, who have average annual household incomes below $14,000, would live in assisted living communities if there was more affordable assisted living, and many Section 202 residents would live in nursing homes if not for the Section 202 program.
Ideally, the vaccine supply would have been robust enough to include all federally subsidized senior housing in the Pharmacy Partnership program. But not all states followed the CDC’s recommendation and included even Section 202 communities in their Pharmacy Partnership programs. LeadingAge is committed to getting vaccines to all aging services providers so older adults and the staff who serve them are protected from the deadly virus and lives can begin to take on some of the normalcy lost almost a year ago.
In the midst of all the hurdles behind us and in front of us, we must take a moment to remind ourselves, as the CDC has, how housing and health are so intimately interconnected.
Linda Couch is the vice president of Housing Policy at LeadingAge in Washington, DC.