Document Type

Technical Report

Publication Date



Low-income tenants -- Medical care -- Oregon, Older people -- Housing -- Oregon -- Portland, Housing policy -- Oregon -- Portland, City planning -- Oregon -- Portland


Housing developers, providers, policy makers, and advocates, increasingly recognize that for some groups of individuals, access to affordable housing alone is "not enough." That is, some individuals require more than shelter. Examples include individuals who have chronic health conditions (e.g., HIV/AIDS), those with physical or cognitive limitations (e.g., persons with developmental disabilities, adults with physical disabilities), and those who have a combination of health conditions or who cannot thrive in traditional housing (e.g., persons who have been homeless, individuals with chronic mental illness). Increasingly, housing providers, social service agencies, advocates, states, and federal agencies have recognized the need to combine housing with supportive services designed to address the health and social needs of such groups and individuals.

Older adults want to remain in their homes as long as possible (Bayer & Harper, 2000), and providing supportive services to them in their homes is one approach to preventing or delaying unnecessary institutionalization in an acute or long-term care facility (Gibson et. al., 2003). Increasingly, policy makers and advocates recognize that "homes" includes subsidized rental units occupied by older persons and adults with disabilities.

There are a variety of affordable housing and service models across the United States, and they fall under a range of categories and terms (e.g., permanent supportive housing, enriched housing, affordable housing plus services). Whether or not some combination of housing and services can meet the needs of individuals transitioning out of nursing homes remains a question of interest to current nursing home residents, advocates, and policy makers. The purpose of this report is to describe examples of affordable housing plus services (AHPS) that might serve as models for Oregon’s On the Move demonstration project (a Centers for Medicare and Medicaid Services Money Follows the Person project).

For this analysis, we reviewed existing reports and articles and collected information about policies and programs in several states in order to learn whether older adults and persons with disabilities, including those discharged from nursing homes, might be served by AHPS programs. Given that Oregon has a long history of providing home and community-based services, we focused primarily on unlicensed housing models rather than licensed residential settings such as assisted living and adult foster care. It is important to note that other states do not have as well-developed a home-and community based care network as does Oregon. Thus, for some states, assisted living is being promoted as a relatively new, and less expensive, alternative to institutionalization. In Oregon, one goal of creating nursing home alternatives is to expand individuals' choices to include affordable housing plus service options.


Additional support provided by: Sheryl Elliot, Miuh Tin Sng, Jennifer Svoboda, Lakshmi Tata, Andree Tremoulet & Jenny Weinstein

Published by the Institute on Aging Portland State University

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