S4 E5 - Shallow Rental Subsidy Pilot Program

Katie White [: 00:00:00

Welcome to Pretend I Know Nothing About. I'm Katie White, your host, administrator of COAAA. On today's episode, we will learn from Dr. Katie Calhoun and director Marisa Sheldon with Ohio State College of Social Work, Age Friendly Innovation center, all about the COAAA Shallow Subsidy pilot program. Well, good morning and welcome to the podcast. I'm joined by two special guests today. I'm just going to go ahead and let you introduce yourself.

Katie White [: 00:00:38

Katie, you want to go first? Yeah.

Dr. Katie Calhoun [: 00:00:39

Happy to be here. Katie Calhoun. I'm an assistant professor at the College of Social Work at Ohio State University.

Katie White [: 00:00:44

Thank you. And Marisa.

Marisa Sheldon [: 00:00:46

Hi, I'm Marisa Sheldon. I'm the director of Age Friendly Columbus and Franklin county and the Age Friendly Innovation center at the Ohio State University College of Social Work.

Katie White [: 00:00:53

Thank you for being here. I'm so excited to talk about another one of our collaborative projects with the Age Friendly Innovation Center. Today is all about our Shallow Subsidy pilot program. So before we get all the way into what that is, Katie, can you talk about your background in Denver, what brought you to Columbus, and kind of how that helped shape the foundation of this work?

Dr. Katie Calhoun [: 00:01:17

Yeah, happy to. So I moved to Columbus from Denver, Colorado. I was out in Denver doing my PhD studies. My area of research really centers around housing and stability and homelessness. And while I was in Denver, I had the amazing opportunity to work with a program called the Denver Basic Income Project. And what it was was providing a guaranteed income for folks who are unhoused and a guaranteed income. It's a recurring unrestricted cash assistance. And so the idea was knowing that one of the main drivers for homelessness is this combination of lack of affordable housing and low incomes.

Dr. Katie Calhoun [: 00:01:59

The idea behind the Denver Basic Income Project was trying to get at the income side of things. If we can provide folks with a baseline, it's not meant to replace other benefits or it's not meant to replace work, but an income floor. Could that improve housing outcomes? My work has really centered around income supports as a way to both prevent and address homelessness. I was again, very lucky to be hired at the College of Social Work at osu, and that's what brought me to Columbus. And since we've, since I've moved here, I've had more opportunities to explore this again, income assistance to prevent and homelessness. And one of the current projects is looking at shallow subsidies as one way to provide some income supports for folks.

Katie White [: 00:02:52

Wonderful. And how far along is the Denver guaranteed income?

Dr. Katie Calhoun [: 00:02:56

The whole project has run its course. So it was one year of that unconditional cash assistance A randomized control trial. So there are different levels of income that folks were provided. One group got $1,000 a month for 12 months. One group got $6,500 the first month, and then $500 a month for the next 11 months. And then the third group, which was meant to be kind of a comparison group, received $50 a month for 12 months. Okay. So I was trying to see, like, these different income levels.

Dr. Katie Calhoun [: 00:03:26

The $6,500 group especially, like, does that lump sum at the beginning provide access to housing by addressing, you know, paying for deposits and those expenses to get into housing. And so the full project has been completed. We're disseminating, We've been disseminating findings. There was definitely movement in a lot of areas and not in others.

Marisa Sheldon [: 00:03:49

Yeah.

Dr. Katie Calhoun [: 00:03:49

And so I think one of the big findings of that is we had a very diverse sample of folks who were unhoused. So we had folks who are literally unsheltered, living on the streets, as well as folks who are in transitional housing or living in motels with families. And so trying to kind of understand the unique experiences of homelessness and how cash, you know, infused cash can impact those unique experiences rather than like the whole very diverse sample of folks who are experiencing homelessness.

Katie White [: 00:04:19

Okay, and so those were folks of all ages, not necessarily older adults.

Dr. Katie Calhoun [: 00:04:22

Okay, correct.

Katie White [: 00:04:23

So a couple of things were converging at the same time. So you came here with your expertise. Age Friendly Innovation center had a doctoral student who also had a background and interest in homelessness and older adults. And then also there was the Central Ohio Regional Assessment on Aging that really was pointing us towards these trends of increased housing instability with older adults. So, Marisa, can you ground us a little bit in the Central Ohio data?

Marisa Sheldon [: 00:04:49

Yeah, absolutely. We'll be happy to. And to add a little more context on the age friendly side, the age friendly framework looks at eight domains of livability for older adults when we talk about our communities and improving them. And one of those is housing. And over the years, since the work started Here Locally in 2016, we have embarked in lots of projects around home sharing, around property taxes. But with that Central Ohio regional assessment in 2021 and seeing that data, it was an increased recognition that we needed to be focusing our work in a different way around housing and more on folks who were more low income, extremely housing cost burden, not just homeowners, which primarily our projects had been working on, and our pilots. And so this was a move towards that. So around 2021, we had now Dr.

Marisa Sheldon [: 00:05:36

Anthony Traver join us as a PhD student working under our director of research, Dr. Holly Debilkoshoni. And his interest was on older adults experiencing homelessness. So he spent time out in the community interviewing older adults who were currently or had previously experienced homelessness here in central Ohio, as well as service providers. It was about a little over 20 individuals that he interviewed who had experienced it and I think about 10 service providers. To really understand what that experience looked like here in central Ohio, that's not something that had been done before with just older adults. And between those findings, as well as one particular finding in the CORA data around housing cost burden, which told us that well over half of the folks 50 plus in central Ohio were considered extremely housing cost burden. The stat is that less than half were under the housing cost burden metric, which is 30%.

Marisa Sheldon [: 00:06:32

Another almost 40% were between that 30 and 50%. And then we had almost 20% that were in the 50 or more, which is really high. So anything over 30% is considered housing cost burden. So we had quite a lot were in those categories and then even more that were in that extremely housing cost burden. So 50% or more. And so we had the opportunity to think about potential solutions and one that was raised was a shallow subsidy, so providing that smaller monthly payment towards your housing costs to support you long term.

Katie White [: 00:07:04

So Katie comes, Dr. Katie Calhoun comes to central Ohio. Dr. Anthony Traver comes to central Ohio. The CORA data comes out showing the problem. And then a couple other things happen around this time too. So I participated along with some of the age friendly folks in the community Shelter Board's annual count where we went out into the community. You get out in the community around like 5am and you're literally kind of trudging through, around the train tracks, in the woods, along the sides of the road and talking with folks that are living on the land.

Katie White [: 00:07:39

You provide them with some resources. Every continuum of care has to do this annual count. So you're literally taking a head count of folks. So that was a really eye opening experience in and of itself. Anthony starts having these deeper conversations with homeless older adults. And then at coaa we started having conversations with staff around what are your biggest challenges as case managers? What are things that dealing with? And one area was housing and homelessness. So kind of swirled all this together and there were some ARPA funds that we were able to utilize and say, you know what, this is a big concern. We know the data is showing us that it's a serious issue.

Katie White [: 00:08:21

Let's try something new. And so we started learning more about your Work, Katie. And then we also took a look at what was going on in San Diego. Can someone give me an overview of that project? Because what we were trying to see is has anyone done this with older adults yet?

Dr. Katie Calhoun [: 00:08:37

Yeah. So the project in San Diego was the first one to look at child subsidies specifically for older adults. In 2023, San Diego, their Department of Homeless Solutions and Equitable Communities launched a shallow subsidy program for renters over the age of 55 whose incomes were below 50% of the area median income. In San Diego, there's another element to that and who spent more than 50% of their income on housing costs. So where they in that extremely severely rent cost burden category? We don't have findings from that project yet. They haven't released findings yet, but they were kind of the ones who started like went into the space of shell subsidies for older adults.

Katie White [: 00:09:20

Okay, so we take all of this into consideration and then we have a couple of conversations with the housing staff at coaa, with Age Friendly Innovation center and we come up with our shallow subsidy pilot project here. So there is already an episode on our housing assistance program. So if somebody needs a background on that, they can listen to it. But for today's conversation, can someone walk me through what that process looked like? So from kind of start to finish irb, who are we recruiting from? How did all of that get started? Marisa, you want to do that?

Marisa Sheldon [: 00:09:55

Sure, I'll start it and you please fill in. So it started just with a lot of conversations, particularly with your housing team. They are a phenomenal resource and incredibly knowledgeable. Continued to hear from them. There are emergency funds for folks that need them, but for renters that need that long term stability while they're on wait lists for what is considered a housing choice voucher, we need something long term. So one of the considerations in crafting the program was that it was not a one time payment. It would be a 12 month payment. Dr.

Marisa Sheldon [: 00:10:27

Anthony Traver did lots of great math for us to help us figure out what the right amount would be. Looking at the average cost of, of housing and what would get folks to that 30%. And so each individual got $330 a month directly to their landlord. There were a few caveats, of course. Because this was a program, they had to be enrolled in a current COAA program. They had to be spending at least 50% of their income on rent. They had to have a lease in place with a landlord. So there was that documentation and then their lease had to agree to accept this payment.

Marisa Sheldon [: 00:11:02

What sometimes folks don't know is that our municipalities across central Ohio have passed legislation that you cannot discriminate based on where payments come from. So that allows renters to get those subsidies. But not all of our municipal partners have done that yet. That's kind of a newer thing. I think that Worthington was the first a couple years ago to pass that and some other communities have stepped up to do the same. And so at the same time, through your leadership, Katie, you have been a big driver of ensuring that we are building evidence for the things that are happening here in central Ohio, particularly through the area agency model, so that you have more options to serve communities. And so not just helping to craft the program, but then to take a step back and say, while you're running this program, we'd love to do an evaluation of it. And I'll let you talk about that part.

Dr. Katie Calhoun [: 00:11:49

Yeah, happy to. So with the evaluation, we decided we wanted to, and this is again through conversation with the team here and the age friendly team as well, we wanted to do what's called a randomized control trial. We wanted to kind of understand what happens when you receive this intervention and what happens when you don't receive the intervention. Intervention. And so that was, I'll admit, like a tricky part of the evaluation, but an important part. So folks were randomly assigned to either receive the shallow subsidy or to be part of what we've called the treatment as usual group. So they're still receiving all the other services they receive, of course, through CO aaa, just not the shallow subsidy. That really gave us the ability to again see and compare outcomes between these two groups so that we can understand at the end of the year where people ended those outcomes, are they attributed to the intervention or were they attributed to some other thing that was happening in central Ohio that, you know, didn't have anything to do with the shallow subsidy.

Katie White [: 00:12:51

So how many folks ended up enrolling and how many were in each group?

Dr. Katie Calhoun [: 00:12:56

Yep, so we had 40 people enroll. So 20 people in the shallow subsidy group and 20 people in the treatment as usual group.

Katie White [: 00:13:02

And as a reminder, every person that was enrolled was being case managed by someone at coaa. So that came with its own benefit. But definitely a challenge too. When you talk about a randomized control trial. That means some of our case managers here knew that the folks they were working with were extremely housing cost burden, that they were referring them and that there was a chance that they wouldn't be getting the payment. And so that was something that we had a lot of conversations with internally processing it, grabbing grappling with it. It's a tough pill to swallow though. It is part of science.

Katie White [: 00:13:40

So we did a lot of comparisons of if you were in a clinical trial in a medical center for something around Alzheimer's, folks are opting in knowing they might be getting the placebo. Right. So that was one of the most difficult parts. And I think we'll talk a little bit about the evaluation that you did with staff too, because you did two right alongside each other. But I also think because of this small number, quote unquote small, 40 still feels like a lot. That also helped with the rigor.

Marisa Sheldon [: 00:14:10

Right.

Katie White [: 00:14:10

Because if we didn't have the randomized control portion of it, it's even harder to pull out any real findings from it. Right?

Dr. Katie Calhoun [: 00:14:17

Yep, yep. It'd be very descriptive. It's still, of course, telling an important information. It's not always an option to do a randomized controlled trial. And like you just said, it improves the rigor for sure. And just again trying to get at, okay, was this due to the shallow subsidy or did overall well being and improve in central Ohio and that's why there was this change?

Katie White [: 00:14:41

Yes. So this was offered across all eight counties. Of course, just like our housing assistance programs are really looking at the region. And so we just wrapped this up not that long ago. So we are through the one year process, which I was not very patient all along the way. I'm like, what are you hearing? What are you hearing? Like this is science, we can't tell you. And I respected that though. When you're in something like that, you're so anxious to hear any outcomes.

Katie White [: 00:15:10

And I also want to make sure to say that piloting something doesn't mean it's going to work. It's going to meet your hypothesis that it's going to be gangbusters all the way. Right. And that's okay. But we still have to be trying these things, learning what we learn and then iterate. So saying all of that, talk about some of the findings, what were the trends, what did we see?

Marisa Sheldon [: 00:15:33

Do you mind if I add just. I think it would be helpful too to talk about how we talked with folks and what that looked like. Oh, please.

Katie White [: 00:15:40

Yes.

Marisa Sheldon [: 00:15:41

So everyone in both groups went through a baseline survey and consent process. So they knew that they were walking into this randomized control trial. They consented to that and we filled out, we walked through surveys with them. They did most of those over the phone, but did offer to come to folks if they needed that. And then at the six month mark, we did another survey with folks with the same question to track what that change looked like between the six month mark and the 11 month mark. We offered opportunities for in depth interviews where we talked with each individual as long as they would chat with us about their experience and then did a final interview at the end of the time between that 11 and 12 month window. So that really gave us multiple points in time. Every individual received a gift card for those experiences, whether they were in the treatment group or in the shallow subsidy group.

Marisa Sheldon [: 00:16:36

So really honoring that time that they were putting in and investing to give us that information.

Katie White [: 00:16:40

That's great. And the consent process is really prescriptive and built and rooted in science because this went through the IRB process. Real quick, Katie, what's the IRB process?

Dr. Katie Calhoun [: 00:16:51

So the irb, it's the Institutional Review board. All institutions can have an institutional review board. Of course, Ohio State University has its own irb. And it's really a check and balance to make sure that the, the research that we're doing is ethical. And so we submit all the details of the research to the irb, they review it and like I said, just make sure that the consenting process is ethical, that the compensation that Marisa was just talking about, all folks received a gift card for their time for the surveys and interviews. So making sure that that aspect of the research was ethical. So again, it's just a check and balance to make sure that, that we're not doing harm to the community.

Katie White [: 00:17:31

Yes, the converging needs and ideas, we come together, we come up with the concept, we go through irb, we roll this out. There are specific measures that you're looking at along the way. Now walk us through some of the trends and things that you heard.

Dr. Katie Calhoun [: 00:17:46

Yes, so we are looking at the outcomes in three different buckets. And so of course we're looking at housing. It's a housing intervention. So housing is a primary outcome. And we know that there's different aspects and elements to having secure housing, including health and well being. So we also looked at physical health, mental health and financial health. And so starting with some of the housing outcomes, Housing is an interesting thing to measure because we like to say, like, did housing stability improve or did it get worse? But then when you dig into it, it's like, well, what is housing stability? Is it how often you move? Is it being able to afford your housing? Is it feeling safe in your housing? Is it, you know, accessibility of your housing? And so we tried to kind of tease that out a little bit. We looked at affordability, that rent to income Ratio.

Dr. Katie Calhoun [: 00:18:37

We looked at number of moves that folks had during the period of the study. And then we used a standardized measure from HUD that looked at housing insecurity in those different elements across the board. We did see improvement across all of these different elements of housing. I will say one of the caveats to that. Because of that small sample size that you referenced earlier, we didn't have statistical power to identify significance. What that means is we don't have a level of confidence. We can't say for sure that it's due to the housing, the shallow subsidy. However, the trends are really, really promising.

Dr. Katie Calhoun [: 00:19:19

And so again, we did see improvement in housing affordability for the shallow subsidy group.

Marisa Sheldon [: 00:19:25

Yeah, I'd love to just add too, from like the practice side of things, what that means is it could be due to the shallow subsidy. And we still hope it is. We just can't definitively say that with proof, which I think is that distinction that is kind of a step above with that scientific process where it's like we need to every ounce of proof. We need that statistical power. When, when you're in practice, it doesn't always feel that way. Like, oh, this person said that this helped. We're good. And so it's not to say it didn't.

Marisa Sheldon [: 00:19:54

Just like you said, the trends are moving the right direction. It just doesn't quite have enough to say it for that scientific method yet.

Katie White [: 00:20:00

And I think some of the tools that we're measuring on were not or have not necessarily been specifically built to evaluate older adult needs. So while moving on one scale might seem like that was a negative outcome, potentially moving was a good thing in our case.

Marisa Sheldon [: 00:20:17

We've talked for a long time in the aging network about aging in place, and that is a goal for most older adults. And there's emerging language in the last few years around aging in the right place. And so maybe that move actually was a really positive thing that got them more stable to a more accessible place. And it was the right move and they felt good about it. But the measures don't really include that piece.

Dr. Katie Calhoun [: 00:20:38

And even, you know, housing cost burden is a tricky one with this population. Because of fixed incomes, you know, folks don't necessarily have the opportunity to increase their income. And we're in a community with rising, rapidly rising costs of housing. And so that again, it's so nuanced, it's really hard to pinpoint with this quantitative data what the impact or how strong the impact maybe I should say is. Is on housing.

Katie White [: 00:21:05

And we're just starting, I think that's another important point.

Marisa Sheldon [: 00:21:08

Right.

Katie White [: 00:21:08

Like we're not trying to justify anything, but we're laying the foundation of what we're learning, we need and what works in central Ohio. So. So we've got some good trends. What else did we find?

Dr. Katie Calhoun [: 00:21:18

Yeah. And so we have some good trends. And because we did this mixed methods evaluation, we also have really strong qualitative findings around housing. And so some of the themes that we're seeing from the shallow subsidy group, but specifically about housing, was that shell subsidies increased choice for how and where participants were living. They were feeling more empowered to be being able to stay in their current place and being able to access their immediate community, being able to go out and grab coffee with a friend, really enhancing not just their actual living situation, their home, but also the immediate community around their home.

Katie White [: 00:21:59

And protecting choice and having choice as we age is a huge goal. It's something that I think we've talked quite a bit about in age friendly. Like there's all kinds of different nuances but as long as we can try to make sure that people get that choice, that autonomy, that efficacy. Right.

Marisa Sheldon [: 00:22:15

That age with dignity, isn't that what we all want?

Katie White [: 00:22:17

Yes. What else?

Dr. Katie Calhoun [: 00:22:19

I would say very exciting finding from the shell subsidy group. We also interviewed the folks in the treatment as usual group about their experience with high quality cost of housing and we heard things like the current housing situation simply is not affordable and a lot of concern and worry about additional and future rent increases. Just feeling like they know that's on the horizon and there's no way to meet that coming need.

Katie White [: 00:22:42

Yes. So oftentimes individuals, if they've been through a one year lease, then they are on a month to month essentially which then takes away any protections from the renter around increases. So if you're on a month to month lease, the landlord can increase your rent without having to give you some sort of notice.

Dr. Katie Calhoun [: 00:23:00

Yep.

Marisa Sheldon [: 00:23:01

Yeah. Usually about 30 days. Yeah. Is all they have to do.

Dr. Katie Calhoun [: 00:23:03

And we heard from, I mean folks had been in their current housing for quite a while. I think it was like five years on average. And we heard people, even if it was a, you know, a year long lease, they're like, yep. And I know in June it's going to go up at least $50 or at least $30. Like they just because that's their experience over the, you know, previous several years. So moving to financial well being, that was another primary outcome that we are looking at. On the quantitative side, pro one of the most promising, the largest change that we saw looking at the difference between the two groups, we used a standardized measure again from the Consumer Financial Protection Bureau called the Financial well Being Scale. So it really looks at both the tangible like I can pay my rent kind of questions, but also the perceived feelings of control and yet just power over one's financial situation.

Dr. Katie Calhoun [: 00:23:56

So it kind of mirrors those two pieces together. And we saw pretty strong improvements for the shallow subsidy group, while the treatment as usual group stayed pretty neutral over the course of the study. Then our qualitative findings really support those quantitative findings, which we always like to see in mixed methods research. The shallow subsidy group shared that continued that most of their income still goes toward rent, but they were able to purchase what they were calling extras or non essentials. And some of those extras are non essentials. That's how they were categorizing them were things like a haircut, things like a mattress, clothing that they hadn't been able to afford. And so while they were considering those things as extras, I think we can all agree those are not extras and they're really included in those basic needs.

Marisa Sheldon [: 00:24:46

And I'll add a couple of the ones that stood out to me was folks who had previously, whenever they were asked to go out to lunch or to coffee with a friend, saying no because they couldn't afford it, and now being able to say yes, or someone who talked about being able to buy their granddaughter a gift for Christmas and isn't that what every grandparent would want to be able to do? And then some of the really stark basic needs that folks had been sacrificing prior to this, someone who particularly talked about when I went to the store before this being a part of this program, I was deciding between soap and toilet paper. And you simply have to have toilet paper and you can forego the soap, but now I can buy both. And those are the quotes that have really stuck with me.

Katie White [: 00:25:27

Yeah, yeah. I imagine those conversations were probably very emotional to have.

Marisa Sheldon [: 00:25:34

Yeah, and a lot of conversation too. And I think with the health, we'll talk about this, but being able to meet their medical needs that were basic needs, people talking about their diabetes medication and having previously foregone their that, or paying back medical debt or being able to fill all of their prescriptions for the first time in a long time.

Katie White [: 00:25:53

And so obviously the folks that are in this study, again, if COAAA is case managing them in their home, they are likely meeting a nursing home level of care or something close to that. And so again, it's not perfect science because we obviously pulled from a group that is Already a subset anyway. But knowing that the mixed methods allow us to see both the quantitative and then here the qualitative is so important.

Dr. Katie Calhoun [: 00:26:18

It's so important. Quantitative, I think, is what we tend to go toward or trust. Like these numbers. We want to see what the numbers say. And one of the things I am so passionate about is the qualitative is just as real, it's just as valid as those quantitative numbers. And when we pull them together, we get to see see such a more complete story. The quantitative only tells one part of the story. The qualitative only tells one part of the story.

Dr. Katie Calhoun [: 00:26:44

So it's really powerful and we can do both.

Katie White [: 00:26:46

Definitely.

Marisa Sheldon [: 00:26:47

And I think that translates to all parts of our life beyond. And that's why it's an important part of the science communication to have both. Because when I think about how I learn, it is not just with numbers, but it's with those stories and those personal anecdotes that stick with you. And we know that that's true and been shown for policy change and lots of different things. And so that's another real part of why we need both. Yeah.

Katie White [: 00:27:08

And so did you hear similar things in the health category?

Dr. Katie Calhoun [: 00:27:11

We did, yeah. So we looked at both physical and mental health, again, used a standardized measure on the quantitative side. It's called the PROMIS scale. It's the Patient Reported Outcome Measurement Information system. It's a 10 item global health scale. So looking at both again those mental health and physical health, we saw movement on both of those subcategories. Improvement, I should say, on both of those subcategories, less so in physical health, which I think is to be expected. Right.

Dr. Katie Calhoun [: 00:27:42

Aging population, it makes sense for health either to kind of be the same or even decline a little bit. We did see more improvement on the mental health side of things. The shell subsidy group improved much more than the the treatment as usual group did. Again, the qualitative supports that quantitative. It was really interesting with the qualitative side for the child subsidy group. While the participants did share that their physical health issues persisted, they did identify that connection between mental health and physical health. So they said things like, I'm less stressed and so I don't feel the aches and pains quite as much as I used to.

Katie White [: 00:28:20

Wow. Talk about the social drivers of health. Right. I mean, oh my gosh. And talk to me a little bit about the ED visits.

Dr. Katie Calhoun [: 00:28:27

Yeah. So it's actually one that I'm not sure if we were looking for specifically. And so it was kind of one of those. I don't want to say surprise because we asked about number of ED visits, but it was one that we were excited to see. So we asked folks the number of times that they went to the emergency department in the previous six months. So at baseline, we asked for looking back six months before receiving the shuttle subsidy for folks who were receiving it. How many times did you visit the emergency department? And then that same question of the subsequent surveys, we saw quite a dramatic decline in the number of ED visits for folks in the Shallow subsidy. At the beginning of the study.

Dr. Katie Calhoun [: 00:29:09

At baseline, for the folks in the Shiloh subsidy group, close to 70% of people said that they had been to the emergency department at some point six months before receiving the shawl subsidy. By our last time point, it was down to 20%. So only 20% of participants reported being visiting the emergency department in the previous six months.

Marisa Sheldon [: 00:29:32

Wow.

Katie White [: 00:29:33

And that's a huge stat for all kinds of reasons, but in general, thinking about health care payers and all the conversations going on there, that is a huge cost savings.

Dr. Katie Calhoun [: 00:29:45

Sure. Yeah. Just think about the policy implications. Yeah. Yes.

Marisa Sheldon [: 00:29:48

And you think about most of us have older adults in our life who we have seen. What happens when you go to the er, if it's for a fall, if it's for some sort of medical well, always for a medical emergency, there is often a cascading effect after that of many life changes. A move into a skilled nursing facility. Some folks never return home after an ER visit. And so if we can reduce those, we know that that's impacting our housing stability.

Katie White [: 00:30:12

And individuals that are on fixed incomes, generally speaking, you know, we talk about their one medical crisis. They're one large medical bill away from everything, you know, being at risk. And depending on how much it costs for an ED visit, that could be the medical bill.

Dr. Katie Calhoun [: 00:30:29

Absolutely.

Katie White [: 00:30:30

Interesting. So what, any other sort of big takeaways before we turn our attention to the parallel evaluations that we did together?

Marisa Sheldon [: 00:30:38

One I'd love to talk about is something that surprised our team. We talked about the eligibility for the program being folks who had to be spending at least 50% of their income on housing costs. And for the vast majority of folks in the program, they were Nowhere near the 50% we were looking at. 70, 80, 90, over 100% of their income was going towards housing costs.

Katie White [: 00:31:00

So every single month spending 70, 80, 90 more money than you have.

Marisa Sheldon [: 00:31:05

Yes. Living off savings in that way. And that was a really powerful learning for our team. And when I talked about that housing cost burden question, that's on the 20, 21 Central Ohio Regional Assessment on Aging. We're gearing up for that next one in 2026. And we were really intentional with the learning from this project that we needed to add another category that that 50 and above was too broad, that that doesn't show us enough. So we're adding that next section of 50 to 80 and then 80 to 100. And kind of how Katie mentioned earlier, we don't really know what an acceptable level for housing cost burden is specific to older adults because they're lumped into the same category as families that are paying those housing costs and childcare or paying for lots of other things.

Marisa Sheldon [: 00:31:52

And we've never measured that as a community, as a scientific community for what it means specific for older adults. And we don't know if 30% is a realistic baseline for someone on a fixed income in a community like Central Ohio. We want to get there, but we don't really know if that's realistic.

Katie White [: 00:32:09

And the opportunities for people that aren't on fixed income. You might be able to pick up another job. You might be able to move neighborhoods. You might be able to take a apartment that doesn't have an exterior balcony or whatever that is. Right. But for an older adult, there's less and less and less of those options to even explore trying to, you know, earn more income or move to a different building.

Marisa Sheldon [: 00:32:32

There was a quote from a person in one of the interviews who said to the person interviewing them who was of a different generation, and said something to the effect of like, I know, you know, moving is hard because you've done it, but moving is way harder for me because I'm an older adult.

Dr. Katie Calhoun [: 00:32:46

And we heard, too, about frustrations about just access to those housing resources, not feeling like they were designed for them as older adults, you know, I don't have kids, and so I don't qualify for these services and programs. Yeah, I can get on a housing wait list, but it's. The wait list itself is five years, you know, five years before I could get into some place.

Katie White [: 00:33:06

And that's an absolutely real, you know, two, three, four, five years. Individuals waiting for the voucher or a specific housing complex that they can afford. Yeah. In addition to creating and running and doing the shallow subsidy for the past year, you also ran a parallel study which evaluated how the program worked. And so again, utilizing and engaging COAAA staff to understand what worked, what didn't. So talk to me a little bit about that.

Marisa Sheldon [: 00:33:39

We knew that while we were doing the evaluation of the program itself, it would be really important in Continuing to build the evidence, should this program show promising results and want to be continued about how the program was being implemented. We got support from the Ohio State University's Office of Outreach and Engagement to do the implementation analysis concurrently with the evaluation. We're grateful for that support and it allowed us to really understand in the context of this specific agency how this worked. Because like we said earlier, not only have shallow subsidies not been tested with older adults, broadly they have not been tested with inside of an area agency on aging.

Dr. Katie Calhoun [: 00:34:16

So what we conducted, it's called considered an implementation assessment for folks who are interested in evaluations. It's kind of similar to a process evaluation. So just kind of seeing how was the program implemented, what were the barriers and facilities facilitators to implementing this new program? And like Marisa said, especially in the setting or context where it hasn't been done before. So we want to make sure that we are learning from this first iteration. And so if there are subsequent iterations, we can improve them along the way. So through this implementation assessment, we used a framework to kind of look at these different areas where we, you might see facilitators and barriers. So we used, it's called the cfir. It's the consolidated framework for implementation research.

Dr. Katie Calhoun [: 00:35:03

What it does is it breaks down different settings. And so we really zeroed in on what's considered the inner setting. So what's going on in the agency that allowed that helped or maybe slowed down the process of implementing the new project?

Marisa Sheldon [: 00:35:21

And I'll just add, if that's okay. It's not an easy thing to welcome an implementation analysis to say, okay, we did this. We know we weren't perfect. Where were we not perfect? Where could we have done better? And so I just give the agency and all the staff that participated a lot of credit for being willing to own that and being open to that process. Not everyone's willing to do that. Yeah.

Katie White [: 00:35:41

And I think we have to be dedicated to that.

Marisa Sheldon [: 00:35:43

Right.

Katie White [: 00:35:44

We need to be okay asking the questions that we don't know the answers to, asking how we can get it better. I mean, times are changing, whether it's payers or housing or needs or whatever it is. And so that commitment to asking the questions and being okay with what we learn.

Dr. Katie Calhoun [: 00:36:00

Yeah, yeah. And it's a really important part of evidence based practice too. And just building that evidence base. So what we did was we attended one of the all staff meetings here at COAAA and introduced what we were doing. And at the end of that meeting, we invited all staff, regardless of role to complete a survey that started to get at some of those elements of the CFIR. We had 85 staff complete that survey, which was exciting. And then the last question on the survey was, would you be willing to participate in a focus group? So the survey was completely anonymous unless they said, yes, I want to participate in a focus group. We needed their email so we could follow up with them.

Dr. Katie Calhoun [: 00:36:38

We were able to conduct two focus groups with general staff. It was 12 participants in total of those focus groups. And then we did a third focus group. Knowing that the housing team had a very unique and important perspective on the implementation of this project, we invited the housing Assistance program staff as well for a third focus group. So we did those three focus groups along with the survey to kind of again understand what the implementation looked like.

Katie White [: 00:37:08

So alongside obviously the outcomes and the learnings that you're going to share, I just think it's so important to again highlight the amazing COAAA staff. Right. Not only their day to day dedication to what they're doing, the most incredible, passionate people you've ever met, but also identifying what other challenges we should be working on, chipping in and working on those challenges, participating in the feedback, to work here and to engage with the folks here. I just feel like, is to continue to be so impressed with the impact that the 407 staff members of CRAA are having on our region.

Dr. Katie Calhoun [: 00:37:44

Absolutely. Yeah. And just the passion that we heard in the focus groups especially was really, it was really impactful. And we talked about the issue of housing affordability for older adults and they were fired up about it. They were really important conversations that we were able to have through those focus groups.

Katie White [: 00:38:05

I bet. Yeah. I mean, these are the folks going to the houses, sitting in the homes, having the conversations with Mrs. Jones on her couch. Right. And so, yeah, that passion and that fury is palpable, I'm sure. So what kinds of things did we learn through this?

Dr. Katie Calhoun [: 00:38:21

Yeah, so we learned a lot. One of the things kind of along those same lines, one of the constructs within the CFIR is tension for change. So it's kind of looking at like, was there even a need for this intervention? Were there areas where, you know, it was already being met and so did we really need this new thing? And there was overwhelming support from the survey and from the focus group that it's just getting more expensive and we're not able to meet those needs. And it is really frustrating to be talking to a client and all I can do is hand them a list of resources and just feeling like my hands are tied and I don't know what else to do. So there was definitely that tension for change that was a facilitator that helps helped implement this new project. Because there was a very overwhelming understanding that this is something that we need, we need to be doing something in addition to what we're already doing. One of the other really strong facilitators was the existence of the Housing Assistance program. The knowledge that that team had of housing resources, housing needs in the area was really important and the flexibility that they were able to provide.

Dr. Katie Calhoun [: 00:39:31

They were able to really jump in when case managers just didn't have the capacity to do eligibility screenings for potential participants. The Housing Assistance team was able to fill that need for the implementation.

Marisa Sheldon [: 00:39:45

So Katie mentioned as a part of the evaluation process that some of the participants talked about how overwhelming the housing systems and resources are. And not only that they didn't feel like they understood them, but that they weren't designed for them as an older adult. And what we really heard in this focus group with folks was language that was coined, called the COAAA way, and really saying we were going to make sure that these folks that were eligible, we would get them across the finish line of that eligibility no matter what. We weren't going to say, can you email me your lease? They were going to show up to their house and did show up to their house, help them find their lease, make copies of it for them, walk through all those steps that many other providers would say, please send me this and that would be the end. And just really that dedication and that passion to flexibility and stepping up was a huge facilitator to this program actually happening.

Katie White [: 00:40:37

Yeah. And we had folks from all over the agency chipping in to volunteer for that. Right. Whether, you know, I dropped some applications off or we had folks from the senior executive team making phone calls, it really was kind of an all hands on deck situation.

Dr. Katie Calhoun [: 00:40:55

Kind of along those same lines. It was also one of the unique parts of the implementation was it was constricted by a timeline, right?

Katie White [: 00:41:04

Yes.

Dr. Katie Calhoun [: 00:41:05

And so that was kind of on the barrier side. That's what we heard.

Katie White [: 00:41:09

Definitely.

Dr. Katie Calhoun [: 00:41:09

It was hard to fit into my, you know, I see my clients once a month and I needed to be able to see them and, you know, do their eligibility screenings in two weeks. And that just. Which just wasn't possible. And so that's one of those. The learnings. Hopefully in future iterations there won't be that restricted timeline. And so it can be a slower. Yeah, I guess a slower, more intentional process moving forward.

Katie White [: 00:41:35

Yeah, that's definitely a huge learning point for us. And we had a debrief group of COAAA folks when you guys came in and presented all this information and. Absolutely. I think one of the reasons why our housing assistance program is so well written, received and so successful is because it's an anytime option. And so finding a way to fund the shallow subsidies so that it is also an ongoing, I think would be really huge for us.

Dr. Katie Calhoun [: 00:42:01

Yeah. And be able to meet those crisis situations too, which I know the shallow subsidy is meant, is an ongoing support, but it might be from a single crisis that spurs the need for the shallow subsidy. So.

Katie White [: 00:42:13

Yeah. Yes, yes. So any other big outcomes for that?

Dr. Katie Calhoun [: 00:42:16

Yeah, so one of the things kind of similar to that tension for change is mission alignment. So does this program align with the agency's mission? And that was one where 100% of staff who completed the survey agreed that yes, this is something that aligns with the mission, not just because it's caring for our clients, but it's innovative. Which was kind of, it was really fun to see in the focus groups. Like, yeah, we're supposed to do things to kind of push forward and meet the changing needs of our clients. And this fit into that.

Marisa Sheldon [: 00:42:47

And I also think that's powerful not only because again, 100% of people never agree on anything in our communities, but because in some conversations, providing direct assistance in the format of money is controversial and is something people feel a little wiggly about and aren't sure it's a newer emerging way to support our communities. And again, having this, having the fact that this has not been done within an area agency model before, it was really exciting to see that the staff overwhelmingly agreed that yeah, this fits within our mission and this aligns with the way our organization runs.

Katie White [: 00:43:25

And I'm hoping that one, we continue to do all kinds of collaborative evaluations together, but two, that they continue to come from the community and the community means the copper and those that we serve. So I think that's one of the reasons why this ended up feeling and being perceived as so mission critical is because the process of identifying that housing is an issue and we wanted to try something new was started, you know, six months before we even rolled out the shallow subsidy.

Marisa Sheldon [: 00:43:54

Right.

Katie White [: 00:43:55

And so continuing to. It's like that community based participatory research. Right. Like it just should continue to keep feeding back in what's the problem? Let's co create a solution, let's evaluate the solution, let's learn from it and try again. Yeah.

Marisa Sheldon [: 00:44:08

I love that. And we talk at the Age Innovation center all the time about our older adult residents being those experience experts. But the service providers are also those experience experts. And this was a beautiful way where we got to talk to the folks in the program, those older adults being impacted, but then also the folks at the agency leading the work, talking with those older adults every day and be able to put pair those together.

Katie White [: 00:44:30

Definitely. Well, thank you both so much for being here. Thank you for your incredible leadership on this work. And congratulations on the end. But also, we're definitely not done together.

Marisa Sheldon [: 00:44:41

So.

Katie White [: 00:44:46

I hope now you know something about the Shallow subsidy program.