Strategies

Revise health care processes and provider roles to integrate mental health and substance abuse treatment into primary care; continue to refer patients with severe conditions to specialty care

Use a case management model for frail elderly patients living independently, coordinating aspects of long-term care (LTC) such as status assessment, monitoring, advocacy, care planning, etc.

Implement multi-component efforts that include coordination of health services by multidisciplinary teams of health care professionals, patient self-management, and patient education

Provide grants to states and localities to fund activities that build, buy, or rehabilitate affordable housing for rent or homeownership, or provide direct rental assistance to households with low incomes

Support funds that help create or maintain affordable housing, subsidize rental housing, and assist homebuyers with low incomes and non-profit housing developers

Support a collaborative approach by a multidisciplinary team of professionals working to meet the full range of long-term care (LTC) needs for frail elderly patients living in community settings

Provide funds to households with low incomes to meet home energy needs, especially for households with children, older adults, or individuals with disabilities

Provide continuous, comprehensive, whole person primary care that uses a coordinated team of medical providers across the health care system

Engage practice coaches or facilitators to work with primary care clinic staff to redesign clinical practices, organize quality improvement efforts, improve communication, share best practices, etc.

Establish tenant protections via regulations to the housing rental market such as limits on rent increases and eviction protections for tenants with low incomes; typically via rent stabilization