Aging in Place: A Cross-Sector Partnership of Housing and Health Care

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Abstract/Project Summary Many older adults prefer to remain in their homes as they age. The ability to age in place is a balance between the amount of cognitive and physical function, the physical environment, and the social environment available to stay in their homes. Black older adults and the poor experience greater physical impairment and a higher prevalence of Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRDs) than their counterparts resulting in greater challenges to aging in place. Bold ideas to facilitate aging in place, particularly among vulnerable populations, are needed. To promote aging in place, we present the Unite care model, a community-initiated, academic supported, dual- sector initiative that combines two sectors: housing and health care. The Unite care model co-locates a Federally Qualified Health Center (FQHC) clinic on an older adult affordable housing campus, home to over 700 predominately Black older adults in Flint, Michigan. The Unite care model will promote aging in place by optimizing: 1) medical care including onsite clinic and home visits; 2) the physical environment through referrals for home safety evaluations and facilitating environmental modifications and; 3) the social environment by community health worker led health behavior and social interventions. Overall, the Unite care model will flip the paradigm that asks the most vulnerable older adults to seek out the medical safety net. Instead, the Unite care model will bring the safety net to older adults to support aging in place. The objective of this proposal is to assess how well the Unite care model is implemented, identify which older adults utilize it, with particular emphasis on older adults with activity limitations or AD/ADRD, and whether the model promotes aging in place. In aim 1, through a concurrent exploratory mixed methods design guided by the Proctor implementation outcomes framework, we seek to determine how much and for whom (i.e., penetration) and how well (i.e., adoption and acceptability) the Unite care model is implemented. In aim 2, we will determine which older adults utilize the Unite care model and assess whether the Unite care model promotes aging in place through blood pressure reduction, a measure of medical care and an important predictor of disability, and changes to the physical and social environment. We have worked in partnership with the Flint community for over a decade and have specifically worked on this project with our housing and healthcare partners for two years. This proposal will inform other communities contemplating new models of care to promote aging in place among older adults living in poverty and older Black Americans and suggest whether larger-scale testing of this model of care is warranted. .