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					          Home for Good

Service-enriched supportive housing,
    outreach, advocacy: a model
      approach to ending elder
    Mark Hinderlie

      President &
Chief Executive Officer
                   Who Is Hearth

• Not just addressing a need, but solving a

• A small agency with a big mission: to end
  the shame of elder homelessness
           Three strategic initiatives:

The Boston Leadership Initiative:
  •Grow and nurture current operation including
  extensive collaborations

  •Develop Hearth at Olmsted Green

  •Seize the right new opportunities as they arise

  •Increase focus on prevention and outreach
Boston Leadership Initiative:
 Hearth at Olmsted Green
           Boston Leadership Initiative:
            Hearth at Olmsted Green
Hearth at Olmsted Green, situated on the
former site of the Boston State Hospital, will
provide a mix of up to 80 cost-effective supported
and assisted living units designed to serve the
needs of Boston’s most vulnerable residents.
100% of the units will be available for lease to
very, very low income elders. Services will be
provided as required to enable each resident to
maintain a healthy, independent lifestyle.
           Three strategic initiatives:

The Massachusetts Leadership Initiative:

  •Create research-based public policy in
  Massachusetts that supports the elimination of
  elder homelessness.

  •Create and support public commitment to
  prevention of elder homelessness
           Three strategic initiatives:

The National Leadership Initiative:
  •Consider project elsewhere which has the right
  elements in place for the Hearth model

  •Proceed to develop and to operate project

  •Learn from our experience to inform future
  growth and to strengthen our capacity to
  provide leadership in this mission
                        Facts about Elders &
• 1 in 5 people over 65 in MA live beneath the poverty line
• Hearth identified 1,700 elders in need of housing in the Boston area
• In the US, there are at least 9 seniors waiting for every occupied unit
  of affordable housing
• The cost of providing health care for an older American is 3 to 5
  times greater than the cost for someone under 65
• By 2030, the cost of providing health care to older Americans will
  increase by 25% beyond inflation unless addressed
• Good News: in 2002, 775 homeless elders were counted in the Boston
  area in one night; in 2006 there were under 100
• Aging population = aging homeless population
                 Additional Statistics
• There are 20,000 elders in Boston who live below
  the poverty level
• The homeless portion of this population is over
  1,000 and growing at 17% a year
• One in 5 Boston elders age 65 and older live below
  the poverty level
• More than 4,000 elders were served last year in the
  state’s homeless shelters
• 3% of MA Medicaid elders reside in nursing homes
  and use 20% of the Medicaid budget
                   Who Hearth Serves

• Men and women ages 50       • Homeless veterans
  and over
                              • Substance abusers
• Diverse racial and ethnic
  population                  • Long term care residents

• Physically disabled         • Trauma victims

• Chronically mentally ill
                  How Does an Elder
                  Become Homeless?

• Many do not have long histories of homelessness
• Significant illness or health event
• Death of a spouse, significant other or relative
  they’ve been living with
• Loss of a job and income to pay rent
• Reduced affordable housing stock in Boston
                What is the Hearth Model?

The Hearth Model…
  • Permanent well-managed housing for formerly homeless elders,
    plus …

  • The right services for each resident, plus …

  • Outreach to the whole population of homeless elders, plus …

  • Research demonstrating our value linked to advocacy for the right
    public policy, plus …

  • Collaboration with public, private and philanthropic partners,
    plus …

  • Confidence we can truly end the shame of elder homelessness
What is the Hearth Model?
                               Tour Our Homes:
                                        Bishop Street
Our first residence, opened in 1992, is a congregate living
community in a charming Victorian house with a yard full of
flowers and trees. Located on a peaceful residential street in
Jamaica Plain, Bishop Street House is home to nine formerly
homeless women, some of who have lived there since it first
opened. With each resident occupying a single bedroom, every
effort is made to create a feeling of community through the        Hearth’s first residence:
sharing of a kitchen, living room, baths, porches, decks, garden   No. 4 Bishop Street
and social activities.

For its work at Bishop Street House, Hearth was honored to
receive the 1994 Fannie Mae Foundation Maxwell Award of
Excellence for Innovative Housing.

In the spring of 2005, Bishop Street was chosen to receive an
Extreme Makeover: Boston Edition from Channel 5 ABC,
allowing us to complete needed renovations.
                               Tour Our Homes:
                           Anna Bissonnette House
Located in Boston’s South End, the Anna Bissonnette House
(ABH) opened in 1997 to provide permanent supportive
housing to forty formerly homeless elders. The building, once
a bread factory, was being used by Boston University as a
warehouse before the school generously donated it for housing.
The site was beautifully renovated and decorated to provide 22
                                                                 "The thoughtful remodeling
studio and 18 one-bedroom apartments. Common area                of this handsome brick bread
kitchens and community spaces are available on each floor, in    factory into housing for the
addition to the large Shapiro Community Room in the lobby, a     elderly homeless is a model
                                                                 of preservation and
patio with benches and tables, and a roof-top deck.              continuity.“
                                                                 -- Ada Louise Huxtable,
                                                                 Pulitzer Prize Winning
                                                                 Architecture Critic of The
                                                                 Wall Street Journal
                             Tour Our Homes:
                               Ruth Cowin House

Opened in 2000, Ruth Cowin House was our first site situated
outside Boston. The beautifully renovated brownstone, located
on Beacon Street in Brookline, is now home to nine formerly
homeless elder men and women. Each resident lives in a fully
furnished studio apartment with kitchenette

In 2000, Hearth was honored to receive the Brookline
Preservation Award for dedication to historic preservation of the
Ruth Cowin House through the efforts of repairing, restoring        Many of the residents
and maintaining the integrity of the properties of the Town of      at the Ruth Cowin
Brookline.                                                          House welcomed the
                                                                    opportunity to return
                                                                    to their home town.
                            Tour Our Homes:
                Ruggles Assisted Living Facility

Ruggles Affordable Assisted Living Community, opened
in October of 2002, is the first assisted living facility in
Boston exclusively targeted to low-income and frail

The site is comprised of 43 studio apartments. Common          25 Ruggles Street was a
areas of Ruggles include:                                      originally a school
                                                               which some of Hearth’s
                                                               residents attended as
     •a living room with piano,                                children.
     •main dining hall,
     •activities room with complete kitchen facilities,
     •and sunroom overlooking a community garden.
                         Tour Our Homes:
                 Uphams Corner ElderHouse

Opened in March 2002, the fourteen apartments
known as ElderHouse provide fully furnished
studio apartments for formerly homeless men and
women, some with special needs.
Part of a mixed-use development known as
Uphams Corner Market, it is comprised of retail
and residential units.                            Uphams Corner is listed on
                                                  the National Register of
                                                  Historic Places for its
                                                  historic importance: the
                                                  world’s first supermarket
                                                  was located here.
                              Tour Our Homes:
                               27 Burroughs Street

Opened in December 2006, Hearth at Burroughs
is Hearth’s second residence in the historic
neighborhood of Jamaica Plain. The Victorian
home provides congregate-style residences, with
fourteen bedrooms and five and ½ baths, along
with communal kitchen and dining facilities, and
a sitting room.

                                                   The home is only steps away from
                                                   scenic Jamaica Pond Park.
               Service Delivery Model

Hearth’s model integrates housing, mental health, medical
and social services supports in a manner that permits even
very frail elders to live with considerable independence in
their own apartments. The cost of Hearth housing is at most
one-half the cost of institutional alternatives such as long
term care or shelter beds.

Hearth’s team is comprised of MSW’s, RN’s, Site Directors,
Property Manager, Resident Assistants, Personal Care
Homemakers and Activity staff. Students, interns and
volunteers provide countless hours of service to our
                     Student Interns
                      & Volunteers
• Collaboration with area MSW programs
• Collaboration with allied health programs
• 4 - 6 interns per academic year
• Intern activities include: individual and group
  counseling, case management, program
  development, grant writing, exercise programs,
  health fairs, dental screening, smoking cessation
• Large number of volunteers involved in all aspects
  of resident life
                       Major Issues

• Untreated/undiagnosed mental illness
• Substance abuse
• Difficult families
• Hoarding
• Medical frailty
• Lack of needed resources (ex. home visiting
  psychiatry, reliable medical transportation)
                        Services Provided

• Behavioral health           • Substance abuse and brief
  management                    mental health counseling
• Medical management          • Personal care and
  including physician
  collaboration, medication
  assistance, health
  education and health        • Socialization
                              • External referrals
• Crisis intervention
                              • Close collaboration with
                                property manager
                    Service Planning
• Starts with pre-admission screening
• Annual comprehensive bio-psychosocial resident
• Individual service plans
• Individual behavior plans when necessary
• Case conferences and consultations
• Service provision across the continuum
                 Financing of the Model

Public/Private Programs that Support Hearth:
  • HUD Section 8
  • SSIG - Supplemental Security Income-G

  • Mass Health: GAFC - Group Adult Foster Care
  • DMH - Department of Mental Health
  • EOEA - Executive Office Of Elder Affairs
  • SCO - Senior Care Option
  • Grants/Private Philanthropy
                     Outreach Model

• Case managers work with individuals who fall
  anywhere on the continuum of “housing readiness”
• Often work with individuals who have no income,
  or any support or health services
• May have a multitude of housing barriers such as
  poor credit histories, criminal histories, and poor or
  no housing histories
• Outreach serves approximately 200 clients at any
  given time
              Outreach Model, continued

• Collaborate with numerous systems and providers,
  including legal aid, DMH, medical providers, the
  courts, elder service providers, landlords,
  management companies, shelters and client’s
• Strong advocacy and stabilization services for one
• Fresh Start Program
• Funded primarily by a federal grant from HUD
               Public Policy, Advocacy,
                     & Research

• Research beginning to evaluate public costs of Hearth
  residents compared to costs in other public systems for
  similar populations linked to policy advocacy
• MA Health Systems Change Transformation Initiative
• Unified Behavioral Health Initiative
• CHAPA: Citizens’ Housing and Planning Association
• Elder Economic Security Standard
• Three Nation Study Examining Causes of

• Mr. B is a 75 year old single man with a history of
  HTN, PVD, bilateral AKA, ESRD on HD, COPD
  and history of ETOH abuse

• Ms. C is a 63 year old woman with physical and
  mental health disabilities, the latter undiagnosed
  and untreated and a 4 year history of homelessness
                  Contact Information

   May Shields:
   Mark Hinderlie:

1640 Washington Street   T: 617.369.1550
Boston, MA 02118         W:

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