LeadingAge Magazine · September/October 2014 • Volume 04 • Number 05

Building a Culture of Wellness in Affordable Housing

August 23, 2014 | by Diana Delgado

This affordable housing and assisted living provider brings services to residents, with a strong emphasis on wellness and proactive problem-solving, by partnering with many other service providers.

Older adult consumers seek active communities that provide a variety of supportive services to facilitate aging in place. As an affordable housing provider since 1980, Eaton Senior Communities (ESC) has been purposeful in its mission “to provide affordable housing in a service-rich environment that enables all to live to their fullest potential.” Creating that service-rich environment, offering wellness and supportive services in affordable housing, is challenging due to limited financial resources. Over the years, a culture of wellness has grown through perseverance and creative partnerships, leading to an array of wellness options for its residents.

Located in Lakewood, the fifth largest city in Colorado, ESC’s campus comprises two communities: 161 HUD-subsidized senior apartments with a dining program and 66 assisted living market-rate and Medicaid-subsidized apartments. ESC has a total of 60 employees at the two communities; most work in assisted living. Building a culture of wellness depends on a staff that embodies the passion for creating wellness opportunities and supportive services for residents, and ESC’s staff is dedicated to making it happen.

Since its inception, ESC has focused on providing onsite supportive services. Rev. Jim Elland, retired ESC director of mission and ministry and pastor of ESC’s founder, West Alameda Community Baptist Church, was with ESC almost from the beginning. Elland states, “The church always had a vision to serve the community. In the late 1960s, the city determined the number one community need was ‘decent, affordable housing for old people.’ The church gave up its land to build ESC and church members were purposeful in designing a community where seniors could age in place, with common areas to enable socialization and a meal program to serve their nutritional needs.” Early on, ESC staff and the church partnered to hire a social worker and create a case management team that involved a visiting nurse from a local nursing home. According to Elland, “It allowed us to identify resident issues early and advocate for the residents so they could receive the supports and services they needed.”

In 2010, the organization created a strategic initiative “to achieve demonstrated change to a culture and philosophy of wellness for the organization and those we serve.” According to David Smart, president/CEO, “We emphasize to staff and the greater community that our goal at ESC is to offer everything you would find in a high-end CCRC but to make those amenities and services accessible and affordable for our income-challenged residents.”

Smart says we have been able to do that by creating win-win partnerships with service providers. “When we discuss wellness we are including eight dimensions: physical, social, emotional, spiritual, nutritional, intellectual, environmental and community. Our goal is to serve the whole person and to create an environment where individuals have choices in how they live their lives and live as independently as possible for as long as possible.”

We continue to seek out and develop relationships with community resources to provide supportive services. Our HUD Service Coordinator, Gwen Million, has been with ESC since 1997. She works in conjunction with Health Services Coordinator Sarah Schoeder to connect residents with onsite wellness services and community resources. Director of Life Enrichment Marie Quinn coordinates with Schoeder to program a wide variety of events and find volunteers that tap into the eight dimensions of wellness. Residents and staff also come together at the monthly wellness committee meetings to plan activities and services that enhance the program.

Because transportation can be a great challenge for many of our residents ESC strives to bring as many services onsite as possible. Tai Chi, acupuncture, massage, blood pressure clinics, and health services such as dental, audiology, dermatology, optometry and laboratory services are examples. Resident Mary Roll, 98, states, “I love the massage and the acupuncture is great. It really helps me achieve immediate relief when I need it most, better than taking any pill.” Schoeder has even arranged for a local veterinary clinic to visit once a month to ensure pet wellness at ESC.

Spiritual enrichment is also an important component and continues the founders' vision. The church and pastor along with the “Caring Connection” volunteers promote being present with residents, no matter where they are. These community and resident volunteers provide spiritual support to current and former residents at ESC, in hospitals, rehab centers or in long-term care communities.

There are challenges to managing a culture of wellness with limited resources. Schoeder’s part-time position is partially grant-funded through private foundation grants, and Million’s full-time position is funded through HUD’s service coordinator grant program. ESC’s part-time foundation administrator, Liz Grieser, works tirelessly to find grant funding and creative ways to continue staffing Schoeder’s position. Grant funding with a focus on seniors is scarce, though there are many foundations that have a focus on health and wellness. Grieser states, "After the economic downturn, many funders re-evaluated their funding goals and the impact of their grants. Organizations serving low-income seniors have taken a hit by not being able to easily measure outcomes or report that their clients are moving toward economic self-sustainability. While we see the benefits of our supportive services every day, we find it challenging to translate what we see into statistics."

Knowing that grant funding is not a dependable source of income long-term, ESC’s foundation has created other fundraising opportunities for supporting services, such as the annual autumn balcony garden party and the spring dinner and auction. This year, the proceeds from both fundraisers will support Schoeder’s position, which primarily develops partnerships and coordinates with service providers.

Another challenge is offering services residents can afford. Finding service providers who understand ESC’s mission and want to participate is key. Service provider partners understand they are serving a population in need but also have the benefit of a strong customer base where they can serve several clients in one place or at the same time. Schoeder has worked with the onsite health providers to ensure insurance coverage or discounted rates for services, improving resident participation. For example, the massage therapist offers discounted pricing and massage in increments of 15 minutes so residents can receive the physical benefits at an affordable rate. According to Schoeder, “The wellness partners have become part of the community and residents are willing to take a chance on something new. They are proud of what is offered here and so they have bought into the culture of wellness, which makes it successful. It’s great to see people you never expected to see attending these activities.”

One of ESC’s wellness partners, Legacy Healthcare Services, provides onsite physical, occupational and speech therapy services to ESC’s residents. Legacy offers its services within ESC’s fitness center, allowing the therapists to provide training and oversight of residents’ use of the equipment at no extra expense. Legacy’s therapists have become part of ESC’s community, offering weekly exercise classes and health-related classes for the residents. Anne Shimek, Legacy’s regional vice president, states, “ESC was the first affordable housing community where we provided therapy services. We were successful in providing an environment in which the resident would have health care services when they returned from a hospitalization. We have replicated this model in several other affordable housing communities.”

ESC’s use of the COLLAGE© lifestyle survey and health and social check-up tools has enabled the community to tailor wellness services directly to the residents’ needs. Million uses these tools with residents when they first move in and assists them in creating a “healthy aging plan” with goals for the coming year.

To effectively provide ongoing wellness coaching to residents, ESC formed a partnership with Metropolitan State University of Denver to offer wellness coach internships for health occupation students. ESC benefits from the additional coaches and students gain a valuable learning experience. Kate West, ESC’s 2014 intern, is an integrative health management student. She says, “A fellow student at MSU Denver had an incredibly positive experience with her internship at ESC and highly recommended it to me. My experience has furthered my hands-on learning with integrative health by utilizing holistic health and wellness concepts in a real-world environment. I have initiated several programs and it has been a wonderful experience to see resident health supported in every way.”

MSU Denver's Integrative Therapeutic Practice (ITP) program offers a club for students to have practical experiences in the real world and ESC is a beneficiary of this club. According to Dr. Emily Matuszewicz, faculty advisor for the ITP Club, “Our students tend to enter our program because they have a strong desire to make a difference and they have found that they get as much back from working with seniors as they are contributing. With our students interested in volunteering their time through the ITP Club, it gives us additional avenues through which we can build a relationship with ESC.”

Another important partnership is with HealthSET, a health promotion clinic sponsored by Centura Health. HealthSET’s nurses, client advocates and trained volunteers provide free and essential health clinics and substantial follow-up care, acting as a bridge to the complex health care and social service systems. An additional partnership is with Senior Reach, a community program that identifies older adults who may need emotional or physical support and/or connection to community services. Teresa Legault, senior reach program manager, states, “By providing wellness classes that have a behavioral health focus at senior residences we have been able to open a new entry door for seniors into support services like Senior Reach and HealthSET. Senior Reach has proven outcomes which include reduction in depression and in social isolation.”

“As you age, you need the discipline to keep everything moving, making sure you do things regularly,” says ESC resident Eloise Olson. “I keep moving by participating in Tai Chi which helps my joints. Massage helped me as I healed from my broken collar bone and made it much more comfortable for me. HealthSET’s classes on diabetes and fall prevention have been very helpful and allowed an exchange of ideas with other class members.” Affordable housing with a variety of onsite services adds quality to residents’ lives and enables residents to easily access services.

Exploring community resources and reaching out to providers who might already be serving housing or long-term care communities in unique ways takes initiative and dedication from housing staff, no matter how large or small the staff size. Taking into consideration the financial challenge of offering affordable housing with services, providers need to explore options such as alternate funding sources, discounted rates, insurance-covered services and benevolent organizations that will enable the creation of a culture of wellness in your community.