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In your experience, what are some good examples of health and housing working together in ways that have promoted positive outcomes for seniors? What has made these programs successful? View the full forum.

By Loren Colman

Several years ago, staff working in the elderly high rises in St. Paul, Minnesota realized that many longtime residents of the buildings were becoming frailer and in need of long-term services and supports to remain in their apartments. All residents were low-income because you had to be income eligible to reside in the buildings; residents paid only 30 percent of their income for the rent. Most were also eligible for Medicaid because of their low incomes and assets. Typically, residents with increasing service needs would have moved to a nursing home where the cost of their care through Medicaid would greatly increase.

Anxious to help seniors age in place and find more affordable ways to provide services, the staff approached the Amherst H. Wilder Foundation in St. Paul with the idea of putting together a package of services for the residents. The Wilder Foundation is unique in Minnesota as a foundation that uses its assets to directly operate programs needed in the community. The foundation was intrigued by the opportunity to develop a new model for individuals in need.

The Wilder model of assisted living that evolved was a package of services delivered in a community-based, affordable housing setting that enabled residents who are frail, mentally ill or with disabilities to retain a high level of independence despite being at risk of and eligible for nursing home placement. Wilder Assisted Living participants collaborate with their case managers in development of service plans based on their needs, strengths and preferences. The program is staffed 24 hours a day, seven days a week with a full-time site coordinator, nurses, social workers and program aides. The program includes service coordination, two meals served 365 days per year, transportation, housekeeping and laundry, medication management, social and community activities.

Many of the program participants were hospitalized repeatedly before moving to the program because they were unable to manage multiple medications. The program provides extremely flexible medication management, which greatly reduces hospital or mental health crisis placements. Consumers receive 24-hour support while maintaining their private living quarters.

Because the program operates in partnership with public housing, residents contract separately for their housing. As a result of the public housing subsidy, the participants enjoy two to three times as much disposable income for personal needs ($150 – $175 per month) as assisted living clients in nonsubsidized housing, who can retain only $80 per month. Residents contribute toward the cost of services by paying 10 to 20 percent of their adjusted monthly income. The Department of Housing and Urban Development and matching local resources, including Alternative Care, Elderly Waiver and Community Alternatives for Disability Inclusion, cover the remainder of program costs.

The program has attracted state and national attention because of its success in maintaining residents with very challenging issues in an independent living situation.

Loren Colman is assistant commissioner of Continuing Care for Older Adults.


Welcome to the BPC Health and Housing Expert Forum. Each month contributors from different parts of the health and housing sectors will be invited to respond to a discussion topic. Have a question you’d like us to consider? Please leave it in the comments.

Any views expressed on this forum do not necessarily represent the views of the Health and Housing Task Force, its co-chairs, or the Bipartisan Policy Center.