HOPE IV Improves Quality of Care for Frail Elderly

HUD designed the HOPE for Elderly Independence Demonstration (HOPE IV) to help low-income, frail elderly persons live independently in nonrestrictive environments. The program combines Section 8 rental assistance with case management and support services for people age 62 and older who have limitations in three or more life activities such as bathing, dressing, and housekeeping.

According to a new report on HOPE IV's effectiveness, the program has improved both the quality of life and the quality of care for its participants. Elderly people served by HOPE IV have "received a significantly higher level of supportive services than the comparison group," states Evaluation of the HOPE for Elderly Independence Demonstration -- Final Report. Recently released by HUD's Office of Policy Development and Research, the evaluation also found that HOPE IV filled a gap in the service system for the frail elderly in all 16 communities studied. For example, five grantees stated that their communities had no real housing alternatives for the frail elderly except nursing homes when HOPE IV was implemented. From the perspective of community service providers, HOPE IV represented the first chance to link human and support service delivery for the low-income, frail elderly population in a far more systematic and coordinated fashion.

The requirement that participating housing authorities hire service coordinators to design and carry out an integrated system of case management, personal care, and home management for the elderly participants is key to HOPE IV's success. A professional assessment committee that includes members with medical and social service backgrounds screens applicants and documents their service needs.

Although the Section 8 programs at most participating public housing authorities initially experienced difficulties meeting the new demands imposed by HOPE IV, the report found that they responded by making changes in their organization and orientation. For example, one public housing authority reduced the number of frail elderly clients seen by its Section 8 staff by 50 percent by using the resources of a local university. Another provided formal training for Section 8 staff on the needs of the frail elderly.

The evaluation found no statistically significant differences between HOPE IV participants and the comparison group members in rates of nursing home placement and mortality. HOPE IV participants are much more frail than noninstitutionalized elderly persons in the general population but they are considerably less frail than elderly persons in nursing homes or persons receiving home nursing.

As required by HUD, all grantees collaborated with local agencies in developing their winning HOPE IV applications and these partner agencies provided the primary source of matching funds as either in-kind services or dollars donated for services. As a consequence, few grantees found generating the required matching funds a serious barrier to implementing the HOPE IV program.

HUD USER offers the Evaluation of the HOPE for Elderly Independence Demonstration -- Final Report for $5. Use the order form.

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