Older Adult Housing: Future Collaborations on Housing and Health Services Should Include Relevant Agencies and Define Outcomes

Highlights

What GAO Found

The Departments of Housing and Urban Development (HUD) and Health and Human Services (HHS) have collaborated on older adult housing and health issues, but these efforts did not fully demonstrate leading practices GAO identified for effective collaboration.

The HUD-HHS efforts demonstrated some leading practices. For example, the agencies have written agreements for data-sharing projects and have leveraged resources to conduct research on older adults.

The Department of Agriculture (USDA) was not included in the efforts although it provides housing assistance to older rural households. GAO identified the inclusion of all relevant participants as a leading practice. According to HUD, the efforts were intended to explore the health of HUD-assisted households. However, by not including USDA in future collaborations, HUD and HHS may miss opportunities to leverage expertise and USDA may not be able to benefit from any resulting insights and improvements.

The HUD-HHS collaborative efforts also did not define common outcomes, another leading practice GAO identified, likely because their collaboration is relatively new. Without common outcomes (for instance, focused on recipient impact or cost savings), the agencies lack measures against which to monitor, evaluate, and report the results of any collaborations.

Future collaborations would benefit from consistent USDA involvement. And by defining common outcomes, the agencies would help inform Congress and stakeholders of results achieved and strategies or areas on which to focus.

Historical and Projected Population 65 and Older as a Proportion of Total Population, 1900-2050

Why GAO Did This Study

According to the Census Bureau, by 2030, about 1 in 5 Americans will be 65 and older. This aging of the population presents challenges and opportunities for policymakers and service providers in helping ensure that the older population's needs—including housing and health services—are met. Federal agencies with programs that provide housing assistance to low-income older households include HUD and USDA. Several HHS programs provide those households with health services.

This report assesses the extent to which the three agencies collaborated to address the housing and health service needs of older adults living in federally assisted housing.

GAO compared agency efforts to leading collaboration practices it has identified (including written agreements; roles and responsibilities; leveraged resources; relevant participants; and defined outcomes) and interviewed HUD, HHS, and USDA officials.

Recommendations

GAO is making three recommendations (one each to HUD, HHS, and USDA). They focus on including USDA in collaborations on older adult housing and health services and defining outcomes for the efforts. The three agencies concurred with GAO's recommendations. HUD stated that it had begun examining challenges relating to services for low-income rural older adults.

Recommendations for Executive Action

Agency Affected	Recommendation	Status
Department of Housing and Urban Development	The Secretary of Housing and Urban Development should work with HHS and USDA's Rural Development to define common outcomes and identify opportunities to include USDA in future collaborative efforts on older adult housing and health services. (Recommendation 1)	Closed – Implemented As of August 2020, the departments had taken a number of actions to address the recommendation, including new projects and initiatives that include USDA. More specifically, in October 2018, HHS announced it would fund a three-year home modification project through a cooperative agreement with the University of Southern California. Among other things, the project aims to develop a knowledge base of local, state, and national programs; and address barriers to access and use of home modifications by identifying consumer needs and delivering targeted information to them. The university convened a steering committee, including HHS, HUD, and USDA, to set priorities; identify the best use of funds; and improve coordination among the housing, health, and disability sectors. According to HHS officials, an outcome of this effort has been the development of the Home Modification Information Network, a web-based state-by-state inventory of home modification policies, funding sources, and programs. In August 2020, HHS, HUD, and USDA issued a joint informational bulletin on federal resources and programs to improve home safety and accessibility for older adults and individuals with disabilities in rural areas. The bulletin provides state and local agencies with information that may help older and disabled individuals living in rural America remain in their homes and communities. By working on common outcomes and identifying opportunities to include USDA in collaborative efforts on older adult housing and health services with HUD and HHS, the departments have demonstrated actions responsive to our recommendation.
Department of Health and Human Services	The Secretary of Health and Human Services should work with HUD and USDA's Rural Development to define common outcomes and identify opportunities to include USDA in future collaborative efforts on older adult housing and health services. (Recommendation 2)	Closed – Implemented As of August 2020, the departments had taken a number of actions to address the recommendation, including new projects and initiatives that include USDA. More specifically, in October 2018, HHS announced it would fund a three-year home modification project through a cooperative agreement with the University of Southern California. Among other things, the project aims to develop a knowledge base of local, state, and national programs; and address barriers to access and use of home modifications by identifying consumer needs and delivering targeted information to them. The university convened a steering committee, including HHS, HUD, and USDA, to set priorities; identify the best use of funds; and improve coordination among the housing, health, and disability sectors. According to HHS officials, an outcome of this effort has been the development of the Home Modification Information Network, a web-based state-by-state inventory of home modification policies, funding sources, and programs. In August 2020, HHS, HUD, and USDA issued a joint informational bulletin on federal resources and programs to improve home safety and accessibility for older adults and individuals with disabilities in rural areas. The bulletin provides state and local agencies with information that may help older and disabled individuals living in rural America remain in their homes and communities. HHS and USDA also collaborated on two other efforts. In December 2018-February 2019, the departments began coordinating on an initiative to replicate the homecare worker cooperative model nationally in response to a shortage of workers, with the goal of increasing the number of worker-owned homecare agencies. The initiative aims to improve working conditions for paid caregivers as demand for their services increases. Consistent with the leading collaborative practices identified in our report, the initiative could benefit from USDA's expertise serving rural communities, which may face unique challenges meeting the demand for homecare. In September 2019, HHS and USDA conducted a joint presentation at the national Village to Village Network Conference, an annual event focused on sharing innovative ideas on aging in place and highlighting effective practices within the older adult "village" model. By working on common outcomes and identifying opportunities to include USDA in collaborative efforts on older adult housing and health service s with HUD and HHS, the departments have demonstrated actions responsive to our recommendation.
Department of Agriculture	The Assistant to the Secretary for Rural Development should work with HUD and HHS to define common outcomes and identify opportunities to include USDA in future collaborative efforts on older adult housing and health services. (Recommendation 3)	Closed – Implemented As of August 2020, the departments had taken a number of actions to address the recommendation, including new projects and initiatives that include USDA. More specifically, in October 2018, HHS announced it would fund a three-year home modification project through a cooperative agreement with the University of Southern California. Among other things, the project aims to develop a knowledge base of local, state, and national programs; and address barriers to access and use of home modifications by identifying consumer needs and delivering targeted information to them. The university convened a steering committee, including HHS, HUD, and USDA, to set priorities; identify the best use of funds; and improve coordination among the housing, health, and disability sectors. According to HHS officials, an outcome of this effort has been the development of the Home Modification Information Network, a web-based state-by-state inventory of home modification policies, funding sources, and programs. In August 2020, HHS, HUD, and USDA issued a joint informational bulletin on federal resources and programs to improve home safety and accessibility for older adults and individuals with disabilities in rural areas. The bulletin provides state and local agencies with information that may help older and disabled individuals living in rural America remain in their homes and communities. HHS and USDA also collaborated on two other efforts. In December 2018-February 2019, the departments began coordinating on an initiative to replicate the homecare worker cooperative model nationally in response to a shortage of workers, with the goal of increasing the number of worker-owned homecare agencies. The initiative aims to improve working conditions for paid caregivers as demand for their services increases. Consistent with the leading collaborative practices identified in our report, the initiative could benefit from USDA's expertise serving rural communities, which may face unique challenges meeting the demand for homecare. In September 2019, HHS and USDA conducted a joint presentation at the national Village to Village Network Conference, an annual event focused on sharing innovative ideas on aging in place and highlighting effective practices within the older adult "village" model. By working on common outcomes and identifying opportunities to include USDA in collaborative efforts on older adult housing and health services with HUD and HHS, the departments have demonstrated actions responsive to our recommendation.