More Than Just a Home

10 min read

The Comprehensive Services of Jewish Community Housing for Elderly

If we had to pick a single word that best characterizes the approach to senior living exemplified by Jewish Community Housing for the Elderly of Boston, Massachusetts, we would find that word right in the name: Community. While the term “Aging in Place” is bandied about to represent numerous concepts and situations, “Aging in Community” has a very specific meaning as applied to JCHE’s 1,200 apartment units spread over eight buildings. Altogether, they house about 1,500 senior residents.

“Community really is the defining feature of our work,” declares Jessica Boatright, the Associate Director of Real Estate Development. “We start from the premise that housing is not the end goal, but a building block upon which community is built. We have a strategic plan to rally around aging in community. We offer an antidote to isolation and a place of engagement.”

The community that JCHE, now in its 50th year of operation, has established is nonsectarian and specifically designed to provide peace of mind for its diverse residents, 90 percent of whom are deeply subsidized. This is achieved through a total approach to living that involves housing, services, classes, activities and other initiatives, all geared to “aging with dignity through opportunities that foster connection, purpose and growth.”

The Boston-Brighton campus contains around 700 units in three buildings. The other facilities have about 150 units each.

“We open our doors, our hearts and our minds wide for everyone,” says President and CEO Amy Schectman. “We celebrate all the holidays and many cultures and everything is open to everyone. For example, our community Passover Seder is conducted in English, Hebrew, Russian and Chinese – both Mandarin and Cantonese!”

Measurable Results
Schectman and her staff’s philosophy is that “Old age is part of a continuum, and everyone wants opportunities at every stage of life.”

Adds Boatright: “Our interests are just as varied when we’re older, so we want to explore their interests. Our strategic thinking is about helping people to live as well as they can, and all of the staff members see themselves as carrying out the working of supporting that goal.” That is why programs include a wide variety of artistic and cultural options, computer classes, fitness and wellness, intergenerational programs, and transportation services, among many others.

One program, called Generations Together, joins residents with younger people – from preschoolers through college age. “It’s about building relationships and having fun through exercise, talking and other activities,” says Schectman. A popular activity is two or more generations working together to trace their roots. “It’s beneficial to both groups, because they come to realize that exercise and fun and learning are all life-long.”

Core programming is aimed at residents “staying fit, staying connected and staying engaged.”

Many of the activities are run by residents, such as a tai-chi group and chess club. A van takes residents, both, shopping and to cultural events.

The results of this approach to community involvement are not only impressive, they are measurable. The Department of Health and Human Services has determined that chronic loneliness is one of the greatest threats to health of older people, and seniors who live in supportive communities live, on average, five years longer than their peers who live in more isolating circumstances. Moreover, according to HUD statistics, the average age of seniors who enter nursing homes is 79. In JCHE housing, the average age at the end of occupancy is 88.2, meaning that its residents manage to stay active and healthy more than nine years longer. Another way of presenting this is that only three percent of the JCHE population goes into assisted living facilities each year.

“One of the key pieces to our approach is our resident services coordinators,” Schectman explains. “They are the linchpins of our service model. They deeply know who lives here and how their needs and interests are working.”

The 14 resident services coordinators – RSCs – perform a multitude of functions, all directed toward keeping residents healthy, engaged and contributing to the community. They can be advocates within the JCHE system or with government agencies such as Social Security, liaisons between departments, mediators, information providers, companions and good listeners. They can comfort residents who are grieving the loss of a spouse or loved one, protect them from potential scam letters and emails, communicate with personal physicians, secure a home health aide when a resident returns from surgery or other hospitalization, and keep families up-to-date and involved with a parent’s physical, mental and social well- being. Many of the RSCs speak several languages and have advanced degrees.

“Our resident services coordinators can help you get services from otherwise nameless and faceless bureaucracies,” says Schectman. “Also, they can advocate individually and for groups as a whole. By having them perform an array of services, we try to make sure that everyone has an entry point.”

JCHE also maintains 24-hour emergency services and relationships with area hospitals.

All staff members, even those not directly connected to resident services, are trained, encouraged and empowered to take action whenever it seems appropriate. “The idea for each staff member is, ‘How can I be most helpful?’” says Schectman. Since most calls are answered by maintenance people, they are likely to be the first to recognize a potential problem or issue simply by seeing the inside of an apartment and evaluating the environment.

“If anyone on the staff sees someone fall or stumble in the hall, he or she can recommend that the fitness staff looks into it,” Boatright notes. “We have a fall prevention program that tracks every fall and keeps a record so the fitness staff can work with the individual, in the gym and even in apartments.”

The community approach extends through Alzheimer’s and memory care. Through a program called Habilitation Therapy, staff members are trained with the goal of enabling residents with Alzheimer’s disease or related forms of dementia to remain in senior housing and independent living longer by coordinating care with specialized memory support teams. It is not rehabilitation, but habilitation to the new reality for the individual, accomplished through drawing out cognitive, social and coping skills throughout the course of the disease. Key aspects include understanding how the resident deals with the immediate physical environment, how he or she communicates and defining purposeful engagement for that individual. The objective is not only to keep that person out of extended nursing care longer, but to make him or her happier and more content in the meantime. Clearly, it also has a huge effect on the peace of mind of children and loved ones, who are also brought into the program.

All of the JCHE programs are aimed at aging in place, in this embracing community, rather than having to leave for more extended care facilities. Caring Choices, an initiative that varies slightly from building to building, offers elements like a nutritious Kosher lunch, medical escorting to doctors’ appointments house calls, personal care and light housekeeping assistance, including medication reminders, preparation for bed, reassurance checks, toileting, warming up meals, washing dishes and taking out the trash, all for modest fees. While each item might not seem determinative by itself, collectively they allow increasingly frail seniors, or ones who have temporary postoperative or rehabilitative needs, to stay where they are rather than have to move out.

The Challenge
In any program of JCHE’s scope, funding is always a critical issue and challenge. Income derives from a variety of sources, including rent and tenant fees, home delivered meals, government funding programs, foundation grants and donations.

About $17 million is covered by federal government rent subsidies, another $5.5 million from tenant rent and direct government grants, and another $1.5 million from private philanthropy.

“Fundraising is extraordinarily time consuming,” Schectman admits. “And raising money for seniors is really hard. In this youth-oriented culture, people don’t want to think that it will ever happen to them. And yes, we are dependent on the federal government for heat and water and the basics. But each of our programs are not just sweet little additions to peoples’ lives. They determine core outcomes.”

While tax credits are significant to building such a low income housing enterprise, Boatright notes that most of the current portfolio was built under the 202 program. “It’s unfortunate that such an efficient, wonderful program is not there anymore. I don’t think we’ve totally cracked the building model under tax credits. Our average annual income per resident is $14,000, and we can’t serve our population that way. We both have to make this model work under complex mixed financing, and we need to raise more philanthropy.”

JCHE is realistic about the challenges. Boatright says, “This is not a sustainable or growable model and we are looking to expand our portfolio. So we are focused on policy work that looks at creating a financing model that recognizes services are the core of what we’re doing.”

That model takes a big picture approach to evaluate the various costs of providing these services and contextualizes them in a total care model.

The Big Picture
“We know how much money is involved in healthcare,” states Boatright. “But what factors actually impact health?”

The answer to that question is key to JCHE’s strategy going forward.

With a seed grant from the Tufts Foundation, Schectman and her senior staff are building their case through hard data, applying sophisticated analyses to study the impact of supportive services on health outcomes; that is, to quantify the savings from JCHE’s wraparound approach to low-income and affordable senior living. The idea is to show that by keeping residents healthier, happier and independent for longer periods, government and private funding sources can actually save significant amounts of money.

For instance, by demonstrating the savings to Medicare of having an individual senior remain in an independent living environment like JCHE over a nursing home for a period of years, the total costs of services begin to look like a huge bargain. The same is true with Caring Choices, which offers just the degree of assistance necessary to keep an individual resident on the right side of the tipping point of extended care.

Boatright says, “We all have to recognize the reality of the expenses of aging. In an approach like ours, there are so many more opportunities for economies of scale. The typical home care worker in a private home will spend about five and a half hours a day in direct services delivery, once you account for transportation to and from each site. Here, they spend all eight hours with residents.”

As Schectman puts it, “There is a duality. It’s a real challenge we face, and a real opportunity. You tell me in your ‘logical person hat’ if resident services coordination visits, meals, medicine, fitness, intergenerational programs, computer classes, all don’t add up to a tremendous investment opportunity for healthy and happy senior living.”

“We think we have a social impact model that many others could benefit from,” says Boatright. “And we are looking for engagement at the national level.”