Geriatric Care Coordination and Palliative Support for Aging Supportive Housing Residents

The Silver Tsunami of Aging in Supportive Housing

Across the United States, permanent supportive housing (PSH) ecosystems are confronting a profound demographic transformation: the rapid, unprecedented aging of their residential populations. Over the past decade, the proportion of supportive housing residents aged fifty and older has surged dramatically, now comprising more than fifty percent of the total national PSH population. This demographic shift, widely recognized among social gerontologists and housing leaders as the Silver Tsunami of supportive housing, is driven by the aging of the baby boomer cohort alongside significant improvements in permanent housing retention that have allowed formerly chronically unhoused individuals to survive into advanced age.

However, the permanent supportive housing model was originally developed and architected around younger, more physically autonomous adults. Standard PSH developments feature multi-story apartment buildings, independent private units, and case management models that emphasize workforce reintegration, behavioral health stability, and independent tenancy maintenance. Today, these exact same buildings are populated by frail, elderly residents navigating severe physical disability, mobility loss, sensory decline, complex multiple chronic diseases, and early-stage dementia. Without proactive systems adaptation, housing providers face an alarming crisis: watching beloved long-term residents experience preventable catastrophic falls, severe self-neglect, and premature expulsion into high-cost institutional nursing homes.

Compounding this challenge is the biological phenomenon of Accelerated Geriatric Aging. Decades of surviving on cold concrete sidewalks, enduring severe nutritional deprivation, suffering untreated chronic illnesses, and navigating chronic trauma cause physiological wear-and-tear that ages an unhoused individual body fifteen to twenty years ahead of chronological age. Consequently, a supportive housing resident who is fifty-two years old exhibits the identical geriatric vulnerability profile, fall frequency, functional limitations, and cognitive impairment rates of a seventy-five-year-old in the general housed population. According to research curated by the National Institute on Aging (NIA), addressing this vulnerability demands integrating comprehensive Geriatric Care Coordination, Medicaid Home and Community-Based Services (HCBS), and In-Home Palliative Care directly into the physical housing environment.

This master clinical and housing policy guide delivers an exhaustive architectural roadmap for geriatric care coordination and palliative support in supportive housing. Examining the physiological benchmarks of accelerated aging, dementia wandering mitigation, Program of All-Inclusive Care for the Elderly (PACE) integration, trauma-informed advance directives, universal environmental modifications, and dignified end-of-life hospice care, this document provides an authoritative blueprint for housing executives, geriatricians, palliative care nurses, and public health officials committed to guaranteeing that every aging resident can grow old and pass away with peace, autonomy, and human dignity in their own home.

Accelerated Biological Aging: The Premature Geriatric Phenomenon

To design clinically appropriate interventions for aging supportive housing residents, healthcare practitioners and housing staff must understand the biological reality of Accelerated Aging. In conventional American social policy and healthcare administration, geriatric benchmarks are tied rigidly to chronological age thresholds: age sixty-two for public housing senior preferences, and age sixty-five for Medicare eligibility and social security retirement. In populations with extensive histories of chronic homelessness, relying on these chronological thresholds is catastrophic, systematically excluding thousands of profoundly frail individuals from essential geriatric supports.

The molecular pathophysiology of accelerated aging is driven by Allostatic Load: the cumulative biological wear-and-tear on the human body resulting from chronic exposure to severe, unrelenting environmental and psychological stress. Decades of chronic survival hyper-vigilance flood the cardiovascular, neuroendocrine, and immune systems with continuous bursts of catecholamines and glucocorticoids. This chronic allostatic overload triggers telomere shortening, accelerated cellular senescence, mitochondrial DNA damage, and chronic systemic low-grade neuroinflammation. The vascular endothelium stiffens prematurely, bone mineral density declines rapidly, and cerebral white matter loses structural integrity.

Consequently, geriatric medicine and housing researchers establish fifty years of age as the official Geriatric Benchmark for formerly unhoused populations. Landmark clinical trials published by the National Institutes of Health (NIH National Library of Medicine) confirm that individuals aged fifty to fifty-nine who have experienced chronic homelessness suffer from rates of cognitive impairment, urinary incontinence, visual impairment, functional immobility, and traumatic falls that are statistically indistinguishable from those observed in domiciled senior citizens in their late seventies and eighties.

Failing to recognize the age-fifty benchmark creates severe institutional policy failures. When a fifty-four-year-old resident with advanced vascular dementia and severe mobility impairment requires personal home care aides, commercial insurers and state agencies routinely reject coverage, declaring the individual too young for senior programs. Progressive Continuums of Care and state Medicaid programs are actively reforming statutory eligibility, establishing specialized Vulnerability Equivalency Statutes that grant residents aged fifty and older full access to geriatric care coordination, senior day centers, and Medicaid home-care waivers as championed by the American Geriatrics Society.

Epidemiology of Geriatric Conditions: Falls, Cognitive Decline, and Multimorbidity

The epidemiological landscape of aging in supportive housing is defined by high rates of Complex Multimorbidity: the concurrent coexistence of three, four, or more severe chronic medical, psychiatric, and cognitive conditions. Unlike affluent seniors who typically manage chronic conditions under the care of coordinated outpatient specialists, supportive housing residents enter older adulthood with decades of untreated, compounding physiological damage.

Traumatic Falls represent the leading cause of accidental injury, emergency department transport, and functional loss among aging PSH residents. The risk factors for falls are ubiquitous in this population: peripheral neuropathy resulting from poorly controlled diabetes and chronic alcohol consumption; muscle wasting (sarcopenia) from chronic protein malnutrition; vestibular and cerebellar damage; visual impairment from untreated cataracts and diabetic retinopathy; and psychotropic polypharmacy. When an elderly resident falls in their private apartment, the consequences are devastating: hip fractures, traumatic subdural hematomas, and prolonged floor times where the resident lies helpless for hours, precipitating rhabdomyolysis and acute renal failure.

Cognitive Decline and Mild Cognitive Impairment (MCI) exhibit extraordinarily high prevalence. Extensive clinical evaluations indicate that between thirty and forty-five percent of PSH residents over age fifty-five meet clinical criteria for cognitive impairment, driven by a convergence of traumatic brain injury (TBI) sustained during street violence, vascular dementia secondary to uncontrolled hypertension and strokes, alcohol-related brain damage (Korsakoff syndrome), and early-onset Alzheimer disease. Cognitive decline severely degrades executive functioning, leaving residents unable to calculate correct insulin doses, track utility bills, recognize expired food, or manage apartment locks.

Compounding cognitive decline is the widespread prevalence of Chronic Sensory Loss, specifically bilateral hearing loss and visual impairment. Because low-income and Medicaid health plans historically excluded comprehensive adult dental, vision, and audiology coverage, thousands of elderly residents live in near-total sensory isolation. The inability to hear hallway alarms or read prescription labels significantly accelerates cognitive decline, triggers persecutory paranoia, and drives intense social withdrawal as documented by researchers at the Urban Institute Health Policy Center.

Structural Architecture of Geriatric Care Coordination in PSH

Managing the complex, multidisciplinary needs of aging residents requires transforming the traditional supportive housing case management model. Standard PSH case management, with ratios of one case manager to twenty-five or thirty residents (1:25), was engineered for general tenancy navigation, not for managing complex geriatric syndromes. High-fidelity supportive housing communities establish specialized Geriatric Care Coordination Units that integrate clinical nursing, social work, and occupational therapy into daily building operations.

At the center of this structural architecture is the Geriatric Care Coordinator (GCC), typically a registered nurse or master-level licensed clinical social worker with advanced certification in social gerontology. The care coordinator maintains a reduced caseload of fifteen to eighteen aging residents, conducting Comprehensive Geriatric Assessments (CGAs) upon move-in and every six months thereafter. The CGA systematically evaluates seven core clinical domains: Cognitive Status (utilizing the Montreal Cognitive Assessment, MoCA), Functional Independence in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), Fall Risk (utilizing the Timed Up and Go, TUG, test), Nutritional Vulnerability, Depression and Loneliness Indices, Pain Staging, and Medication Polypharmacy.

The care coordinator formulates an individualized, person-centered Aging-in-Place Stabilization Plan. The coordinator serves as the single, accountable liaison connecting the resident with primary care geriatricians, physical therapists, home health nursing agencies, Medicaid personal care aides, and specialty memory care clinics. The coordinator organizes multidisciplinary case conferences, ensuring that all clinical providers, property managers, and supportive staff are aligned around the resident functional goals and safety parameters.

Furthermore, geriatric coordination units establish structured Daily Wellness Check Protocols. For residents identified as high-fall-risk or experiencing early cognitive impairment, supportive housing staff execute scheduled, non-intrusive daily morning check-ins: knocking gently on the resident door, exchanging friendly morning greetings, confirming that the resident is awake, dressed, and mobile, and observing unit conditions. This simple, consistent touchpoint catches emergent medical crises early, prevents prolonged fall floor times, and provides the resident with deep emotional security as curated by the Center for Health Care Strategies (CHCS).

Cognitive Impairment, Dementia, and Wandering Mitigation Protocols

Among all clinical challenges confronting aging supportive housing communities, none is more delicate or operationally complex than managing progressive Cognitive Impairment, Alzheimer Disease, and Related Dementias. When a resident experiences advancing cognitive decline, the behaviors that emerge, domestic hoarding, leaving cooking appliances on, accusing neighbors of stealing possessions, and wandering out into freezing nighttime weather, are frequently misinterpreted by property managers as intentional lease violations, prompting rapid legal eviction actions that expel confused elders into life-threatening street homelessness.

Wandering Mitigation and Environmental Wayfinding represent core life-safety operations. Aging residents with memory impairment frequently experience severe disorientation upon leaving their apartments, becoming unable to identify their own doors in long, identical hallways. Facilities deploy Environmental Wayfinding Interventions: painting corridor walls on each floor with distinct, vibrant colors, installing large, high-contrast door numbering, and mounting personalized memory shadow boxes beside each apartment door displaying familiar photographs, military memorabilia, or personal mementos that trigger instant recognition for the resident.

To prevent dangerous off-site wandering into traffic or extreme weather, buildings install Discreet Electronic Life-Safety Systems. Exit doors are equipped with delayed-egress magnetic locks compliant with NFPA life-safety codes, which sound an immediate soft chime at the front desk when opened. Front desk staff are trained in gentle, respectful re-direction techniques: rather than physically restraining or confronting a wandering elder, staff approach calmly, offering a warm cup of coffee and engaging the resident in pleasant conversation while guiding them gently back to the community lounge. Furthermore, residents are enrolled in voluntary wearable smart locator programs (such as Project Lifesaver or cellular GPS wristbands), ensuring that if an elder does become lost, community search teams can locate them safely in minutes as documented by the National Institute on Aging (NIA Dementia Guidelines).

Managing Activities of Daily Living: Personal Care Aides and Medicaid HCBS

When an aging supportive housing resident loses the functional capacity to perform basic Activities of Daily Living (ADLs, including bathing, dressing, toileting, transferring, and eating) or Instrumental Activities of Daily Living (IADLs, such as grocery shopping, cooking, laundry, and medication management), supportive housing case managers cannot provide this intensive hands-on physical care. Case managers are licensed for social work, not personal care. Maintaining tenancy stability requires mobilizing Medicaid Home and Community-Based Services (HCBS) and certified Personal Care Aides (PCAs).

Medicaid HCBS Waivers, authorized under Section 1915(c) and Section 1915(i) of the Social Security Act, represent the primary statutory funding mechanism for in-home care in the United States. HCBS waivers permit state Medicaid programs to provide comprehensive personal care, homemaker chore services, adult day health care, and respite services directly inside an individual private home, specifically to prevent institutionalization in a Medicaid-funded nursing facility. Geriatric care coordinators specialize in navigating the complex state HCBS assessment and enrollment processes, securing authorizations for ten, twenty, or thirty hours per week of dedicated personal care aide support for frail residents.

Under a clustered care model, aides operate throughout the facility from 7:00 AM to 10:00 PM. Aides provide flexible, micro-bursts of personal assistance: helping Resident A with a morning shower and dressing at 8:00 AM; assisting Resident B with meal preparation at 9:00 AM; helping Resident C with medication reminders and walking exercise at 10:00 AM; and returning to assist Resident A with evening dinner. Stationing aides directly on-site provides immense operational efficiency, eliminates travel downtime, and fosters deep, loving familial bonds between aides and aging residents as analyzed by researchers at the Center for Health Care Strategies (CHCS).

Palliative Care and In-Home Hospice Integration: Dignified End-of-Life Planning

For formerly chronically unhoused individuals who have survived decades of severe societal exclusion, the end of life represents a sacred clinical and moral moment. Historically, unhoused elders died cold, lonely, and traumatic deaths: collapsing on sidewalks, enduring futile and painful resuscitations in emergency room resuscitation bays, or passing away in sterile, anonymous hospital intensive care units surrounded by machines rather than loving human faces. Permanent supportive housing transforms this tragedy by establishing comprehensive In-Home Palliative Care and Hospice Integration.

Palliative Care is specialized medical care for people living with a serious, life-limiting illness (such as metastatic cancer, end-stage heart failure, advanced COPD, or end-stage liver disease). Unlike hospice care, which is reserved for individuals with a prognosis of six months or less who have chosen to forgo curative treatment, palliative care is appropriate at any age and at any stage of a serious illness, and can be delivered concurrently with curative therapies. Palliative care focuses on expert symptom management: relieving intractable pain, dyspnea, nausea, fatigue, and severe anxiety, while aligning medical treatments with the patient personal life values.

When an aging resident reaches the terminal stage of disease, the supportive housing team partners with licensed community hospice agencies to deliver In-Home Hospice Care directly inside the resident apartment. Under the Medicare Hospice Benefit and Medicaid hospice authorities, a specialized multidisciplinary hospice team, comprising a palliative physician, hospice nurse, spiritual chaplain, social worker, and hospice volunteer, provides twenty-four-hour clinical coverage. The team manages pain through scheduled and PRN subcutaneous or sublingual opioids, provides hospital-grade pressure-relieving air mattresses, and delivers compassionate emotional and spiritual support.

Crucially, supportive housing staff and fellow residents function as the dying elder chosen family. In supportive housing communities, bonds between neighbors run deep: residents have survived the streets together and shared meals for years. Housing communities create dignified Sacred Vigil Spaces inside the resident home. Fellow residents and staff take shifts sitting beside the bed, holding the dying resident hand, playing their favorite music, and ensuring that no human being ever dies alone. When the resident passes peacefully, the community gathers to hold an in-house memorial service, honoring their life, validating their memory, and mourning collectively with profound community dignity as championed by the Urban Institute Centers on Social Policy.

Advance Care Directives, Healthcare Proxies, and Trauma-Informed Guardianship

Facilitating the appointment of a Durable Power of Attorney for Healthcare (Healthcare Proxy) is an urgent priority. Because many residents lack contact with biological kin, they often nominate a trusted friend, a fellow resident, or a trusted community pastor as their healthcare proxy. Coordinators ensure that legal proxy documents are properly drafted, notarized, and uploaded directly into the resident hospital electronic health record and regional health information exchange (HIE). If a medical emergency occurs, hospital emergency physicians can instantly verify the legal healthcare proxy, preventing estranged relatives who have not seen the resident in thirty years from swooping in to make decisions that violate the resident explicit wishes.

In cases of advanced cognitive impairment where an elder lacks legal capacity and possesses zero surrogate decision-makers, programs navigate Trauma-Informed Public Guardianship as an absolute last resort. coordinators work with specialized non-profit public guardianship agencies that practice supported decision-making, ensuring that the appointed guardian respects the elder prior expressed values and advocates fiercely to keep the resident stably housed in their supportive housing apartment rather than defaulting to nursing home institutionalization as documented by the American Geriatrics Society Legal Standards.

Combating Senior Social Isolation: Intergenerational Circles and Pet Therapy

While physical healthcare and universal design modifications are essential for bodily survival, emotional health and human connection are the true determinants of human flourishing in older adulthood. Aging supportive housing residents suffer from extraordinarily high rates of Chronic Loneliness and Severe Social Isolation. Over decades of street homelessness, many unhoused elders lost their entire natural social networks to premature mortality, incarceration, or estrangement. Living alone in an apartment, physical disability and mobility loss can trap an elder within four walls, inducing severe clinical depression, cognitive deterioration, and failure to thrive.

Supportive housing communities actively combat social isolation through structured Intergenerational Circles of Support. Housing providers partner with local public school districts, community colleges, and university social work programs to establish intergenerational mentorship initiatives. High school and college students visit the supportive housing building weekly, pairing with senior residents for oral history storytelling projects, technology tutoring (teaching seniors how to use smartphones and video-call loved ones), and community gardening. These intergenerational friendships bring boundless youthful vitality into the facility, restoring a sense of social utility and elder pride to senior residents.

In addition, community lounges host daily congregate Senior Meal Programs and communal recreational circles: chair yoga classes, bingo tournaments, watercolor art therapy, and music circles. Gathering daily to share a hot, nutritious meal and laugh with friends transforms an isolated residential building into a vibrant, loving village where every elder is known, valued, and celebrated as highlighted by research curated by the Urban Institute Policy Centers.

Financing Geriatric PSH: Dual-Eligible Special Needs Plans and PACE Models

Building and sustaining high-capacity geriatric care infrastructure within supportive housing requires advanced, integrated healthcare financing. The vast majority of aging supportive housing residents are Dual-Eligible Beneficiaries: individuals enrolled simultaneously in federal Medicare (due to age or permanent Social Security disability) and state Medicaid (due to extreme poverty). Historically, Medicare and Medicaid operated in complete administrative conflict: Medicare paid for acute hospitalizations and physician visits while actively avoiding long-term care costs, while Medicaid paid for nursing home institutionalization while lacking control over hospital services. This financing divide created perverse economic incentives that fragmented care and drove high-cost institutionalization.

The modern financing revolution is anchored by Integrated Dual-Eligible Special Needs Plans (D-SNPs) and Fully Integrated Dual-Eligible (FIDE) SNPs. Under these specialized Medicare Advantage models, a single managed care organization receives combined, capitated funding from both CMS and state Medicaid. Because the health plan is financially accountable for the patient entire care continuum, from acute hospital stays down to in-home personal care aides, the plan possesses a powerful financial incentive to invest in supportive housing services that keep elderly residents safely housed, healthy, and out of high-cost hospitals and nursing facilities.

An even more powerful clinical and financial vehicle is the Program of All-Inclusive Care for the Elderly (PACE). PACE is a fully capitated, comprehensive Medicare and Medicaid benefit model that provides all primary, acute, and long-term care services to nursing-home-eligible individuals aged fifty-five and older, enabling ninety-five percent of participants to remain safely in the community. PACE operates through an Interdisciplinary Team (physicians, nurses, physical therapists, occupational therapists, social workers, dietitians, recreational therapists, and personal care drivers) based out of a centralized PACE Adult Day Health Center.

Preventing Premature Nursing Home Placements: Economic and Systemic Analysis

From a public finance, health economics, and human rights perspective, preventing premature nursing home institutionalization among aging supportive housing residents is a municipal imperative of the highest order. When a supportive housing resident experiences functional decline and is placed into a Medicaid-funded nursing home (Skilled Nursing Facility, SNF), the financial costs to state taxpayers skyrocket, while the individual personal autonomy and quality of life are decimated.

Consider the stark actuarial comparison between institutional nursing home confinement and geriatric supportive housing. In major metropolitan markets, a semi-private bed in a Medicaid-certified nursing home costs between $8,000 and $12,000 per month ($96,000 to $144,000 annually) in direct Medicaid operating expenditures. In stark contrast, maintaining that same individual in permanent supportive housing, combining a project-based rental voucher ($1,500/month), intensive geriatric care coordination ($500/month), and twenty hours per week of Medicaid personal care aide support ($2,000/month), totals approximately $4,000 per month ($48,000 annually). Maintaining an aging resident in supportive housing cuts total public expenditure by more than fifty to sixty percent, generating direct annual taxpayer savings of $48,000 to $96,000 per resident.

Comparative Typology of Senior Living and Supportive Housing Frameworks

To design an optimal, comprehensive aging continuum for vulnerable populations, municipal housing officials, health plan leaders, and Continuum of Care executives must systematically evaluate the operational parameters, clinical scopes, funding mechanisms, and admission barriers across available senior residential models. Treating senior living options as interchangeable leads to severe systemic gridlock: attempting to place a formerly unhoused elder with active behavioral symptoms into private commercial assisted living results in immediate eviction, while consigning independent seniors to institutional nursing facilities squanders astronomical public capital.

The comparative matrix below provides an authoritative technical breakdown of the four primary residential care models operating in modern elder care: Geriatric Permanent Supportive Housing (PSH), Traditional HUD Section 202 Senior Housing, Commercial Assisted Living Facilities (ALFs), and Medicaid Skilled Nursing Facilities (SNFs). By comparing clinical acuity capacity, physical housing models, average monthly public cost, Medicaid HCBS integration, and low-barrier admission adaptability, this matrix equips leadership teams with the strategic clarity required to govern high-impact senior care.

Synthesizing these comparative findings demonstrates that Geriatric Permanent Supportive Housing provides an irreplaceable bridge within the elder care ecosystem. Traditional Section 202 housing is inaccessible to individuals under sixty-two and rejects active behavioral symptoms; commercial assisted living is financially prohibitive and quick to evict; and skilled nursing is an astronomically expensive, restrictive institution of last resort. By establishing specialized geriatric supportive housing equipped with universal design, clustered personal care aides, and integrated palliative care, communities provide vulnerable elders with the optimal, cost-effective balance of clinical safety and lasting residential independence.

Frequently Asked Questions About Geriatric Care in Supportive Housing

What is the Silver Tsunami in permanent supportive housing?

The Silver Tsunami refers to the rapid demographic aging of supportive housing residents, where individuals aged 50 and older now comprise over 50 percent of the national PSH population, demanding a fundamental transition from workforce-focused case management to geriatric care coordination.

Why is age 50 considered the geriatric benchmark for formerly unhoused adults?

Due to accelerated biological aging and chronic allostatic load from decades of street survival, an unhoused individual body ages 15 to 20 years prematurely. A 50-year-old formerly unhoused resident exhibits the cognitive, physical, and fall vulnerabilities of a 70-to-75-year-old in the general population.

What universal design features are essential for aging residents in supportive housing?

Essential modifications include zero-threshold roll-in showers, reinforced wall grab bars, ADA comfort-height toilets, 36-inch wide doorways for wheelchairs, non-slip luxury vinyl flooring, induction cooktops with 15-minute auto-shutoff timers, and high-illumination non-glare LED lighting.

How do supportive housing teams manage dementia and wandering behaviors?

Programs deploy non-punitive trauma-informed protocols: utilizing distinct floor colors and door shadow boxes for wayfinding, installing delayed-egress exit doors with front-desk chimes, training desk staff in gentle verbal re-direction, and utilizing voluntary wearable GPS locator bands.

What are Medicaid Home and Community-Based Services (HCBS) waivers?

Medicaid HCBS waivers (Section 1915c/i) allow state Medicaid programs to pay for in-home personal care aides, homemaker chore services, and adult day care directly inside a resident apartment, enabling frail elders to remain housed rather than entering a costly nursing home.

What is the difference between palliative care and hospice care?

Palliative care provides expert symptom and pain relief for serious, life-limiting illnesses at any stage of disease, concurrently with curative medical treatments. Hospice care is specialized end-of-life care for individuals with a life expectancy of six months or less who have chosen to forgo curative therapy.

How does the Program of All-Inclusive Care for the Elderly (PACE) partner with PSH?

PACE provides comprehensive, capitated medical, therapy, and social day-center care. Progressive developers co-locate PACE adult health centers directly on the ground floor of senior supportive housing buildings, enabling frail residents to take an elevator to receive comprehensive clinical care.

What is the Five Wishes document in advance care planning?

Five Wishes is a trauma-informed, conversational advance directive document that allows an individual to specify their chosen healthcare proxy, desired medical treatments, comfort preferences, personal treatment by caregivers, and wishes for how they want to be remembered.

What are the public financial savings of keeping an elder in supportive housing vs a nursing home?

A Medicaid skilled nursing facility costs $8,000 to $12,000 per month. In contrast, geriatric supportive housing with intensive in-home personal care averages $3,500 to $4,500 per month, saving taxpayers between $48,000 and $96,000 per resident annually.

Future Horizons: Architecting a Compassionate Aging-in-Place Ecosystem in Social Housing

Realizing this compassionate future requires bold statutory and fiscal reforms across federal and state governments. Congress must enact statutory amendments to federal housing and healthcare laws formally codifying age fifty as the legal geriatric eligibility threshold for individuals with verified histories of chronic homelessness, unlocking senior housing preferences, Medicare enrollment flexibility, and Older Americans Act supportive services. Simultaneously, state Medicaid directors must dramatically expand HCBS waiver funding, mandating that managed care health plans contract with supportive housing providers to finance clustered on-site personal care teams in every affordable senior property.