USDA, HUD, and HHS Collaborated on Some Housing and Health Service Efforts That Did Not Focus on Older Adults

USDA has collaborated with HUD on two efforts related to housing, and  with HUD and HHS on one effort that addressed both housing and health  services, although these efforts were not focused specifically on older  adults. Select Collaborations Did Not Include USDA or Define Common Outcomes

We found that the collaborative efforts between HUD and HHS (pilot  programs and data sharing related to older adults) demonstrated some  but not all relevant leading practices we previously identified for effective  interagency collaboration. As we reported in 2012, interagency  collaborative mechanisms can be enhanced by leading practices,  including written guidance and documenting agreements on how the  participating agencies will be collaborating, clarifying roles and  responsibilities, leveraging resources (such as funding and staffing),  including all relevant participants, and clearly defining outcomes. HUD officials stated that  USDA was not included because these collaborative efforts were pilots  originally intended to better understand the health of households assisted  by HUD. As these collaborative efforts mature, USDA, which provides assistance  to low-income older adults in rural areas, may benefit from inclusion. By not including USDA in future  collaborative efforts on older adult housing and health services, HUD and  HHS may miss opportunities to identify and respond to the changing  needs of some older adults living in federally assisted housing—such as  by drawing on the experience and resources of the Rural Housing Service  in serving rural populations. For example, while  some of these efforts were expected to explore the housing and health  relationship and inform more evidence-based program decisions, the  agencies have not defined common outcomes for their interagency efforts  as a whole. In contrast, HUD and HHS have developed broader goals that  relate to how they serve older adults.However, without defined common  outcomes to help guide ongoing and future efforts, HUD and HHS (and  potentially USDA) lack measures against which to monitor, evaluate, and  report the results of their collaborative efforts. But  collaborative federal efforts to address the housing needs of older adults  and tie into health services would benefit from consistent USDA  involvement and from defining common outcomes. Outcome information would help the agencies  articulate to stakeholders and Congress the results the collaborations  achieved; activities, strategies, or areas on which to focus in the future;  and how scarce federal resources were leveraged and managed. Recommendations for Executive Action

We are making a total of three recommendations (one recommendation  each to HUD, HHS, and USDA):  The Secretary of Housing and Urban Development should work with HHS  and USDA’s Rural Development to define common outcomes and identify  opportunities to include USDA in future collaborative efforts on older adult  housing and health services. All three agencies  concurred with our recommendations.
Why GAO Did This Study

According to the Census Bureau, by 2030, about 1 in 5 Americans will be 65 and older. This aging of the population presents challenges and opportunities for policymakers and service providers in helping ensure that the older population's needs—including housing and health services—are met. Federal agencies with programs that provide housing assistance to low-income older households include HUD and USDA. Several HHS programs provide those households with health services.
This report assesses the extent to which the three agencies collaborated to address the housing and health service needs of older adults living in federally assisted housing.
GAO compared agency efforts to leading collaboration practices it has identified (including written agreements; roles and responsibilities; leveraged resources; relevant participants; and defined outcomes) and interviewed HUD, HHS, and USDA officials.

What GAO Found

The Departments of Housing and Urban Development (HUD) and Health and Human Services (HHS) have collaborated on older adult housing and health issues, but these efforts did not fully demonstrate leading practices GAO identified for effective collaboration.
The HUD-HHS efforts demonstrated some leading practices. For example, the agencies have written agreements for data-sharing projects and have leveraged resources to conduct research on older adults.
The Department of Agriculture (USDA) was not included in the efforts although it provides housing assistance to older rural households. GAO identified the inclusion of all relevant participants as a leading practice. According to HUD, the efforts were intended to explore the health of HUD-assisted households. However, by not including USDA in future collaborations, HUD and HHS may miss opportunities to leverage expertise and USDA may not be able to benefit from any resulting insights and improvements.
The HUD-HHS collaborative efforts also did not define common outcomes, another leading practice GAO identified, likely because their collaboration is relatively new. Without common outcomes (for instance, focused on recipient impact or cost savings), the agencies lack measures against which to monitor, evaluate, and report the results of any collaborations.
Future collaborations would benefit from consistent USDA involvement. And by defining common outcomes, the agencies would help inform Congress and stakeholders of results achieved and strategies or areas on which to focus.

What GAO Recommends

GAO is making three recommendations (one each to HUD, HHS, and USDA). They focus on including USDA in collaborations on older adult housing and health services and defining outcomes for the efforts. The three agencies concurred with GAO's recommendations. HUD stated that it had begun examining challenges relating to services for low-income rural older adults.