Coming Home Program

NOTE: This program is no longer in operation.

The Coming Home Program - no longer in operation - was designed to bring the benefits of assisted living to low-income, frail seniors living in rural areas.

The rural elderly make up 25 percent of the population in some areas and often need services not available in their communities. As a result, many are forced to relocate or are unnecessarily institutionalized in nursing homes. Assisted living can provide frail seniors with an alternative to such institutions as well as a missing piece in the continuum of care.  Currently, the more than 30,000 assisted living residences that have sprung up around the country charge $100 or more a night for their services, pricing them out of reach for the majority of older Americans.

The Coming Home Program created models of assisted living that serve low-income seniors. It focused on smaller communities where there are fewer options for frail seniors, particularly those with modest incomes. To be successful, the Program had to reach Medicaid-eligible seniors, for they are the most "at risk" for premature institutionalization. States have some discretion in determining the financial criteria for Medicaid eligibility.

To be eligible for federal funds, states are required to provide Medicaid coverage for most individuals who receive federally assisted income maintenance programs like Supplemental Security Income (SSI). Though some states supplement the SSI payment, the standard national payment is $484 per month. It is an industry standard that frail seniors will pay up to 80% of their income for a combination of rent and services. With that in mind, the goal of Coming Home projects was to reduce the shelter payment to about $350-$400 per month, with services funded through Medicaid. This may increase in states that have a higher SSI payment.

A major barrier to bringing affordable assisted living to rural communities has been a lack of technical assistance and availability of capital. The Coming Home Program solved for this by providing technical assistance and grants to both providers and states, including access to an $8 million revolving loan fund. Funded by a $6.5 million grant from The Robert Wood Johnson Foundation (RWJF), the program awarded $300,000 grants to grantee states willing to make regulatory changes needed to foster assisted living for low-income, frail seniors.

This website contains a number of tools and resources to assist those interested in affordable assisted living and the former Coming Home Program, including a backgrounder — an introduction to the concept of assisted living, application guidelines, articles, reports and publications, case studies of completed Coming Home projects, two short videos introducing successful Coming Home projects, and helpful industry links.