Living with Dignity – Aging in Place

July 2010

Colleen BloomAmerican Association of Homes

& Services for the Agingcbloom@aahsa.org

(202) 508-9483

Housing and Supportive Services

• Public preference for aging in place is overwhelming, but has major challenges:– Fragmentation of services available– Issues of financing and coordination on local

level– Lack of affordable supportive housing options – Nursing Homes often only option for very low

income elderly

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Need for Supportive Services in HUD-Subsidized Housing

• Average age is about 80 years(Section 202/ Public Housing – Many 90+)

• 90% of residents are older women who live alone; less than $10,000 income

• Estimate 20-30% need supportive services to remain in existing home

Current Housing-Provider Concerns/Opportunities

• Facilitating Successful Aging in Place

• Retrofitting for Accessibility

• Reasonable Accommodations

• Insurance and Liability

• Dementia and Related Issues

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Relevant Fair Housing Laws

• Fair Housing Amendments Act– 42 U.S.C. § 3604(f), et. seq.

• Americans with Disabilities Act– 42 U.S.C. § 12101, et. seq.

• Section 504 of the Rehabilitation Act of 1973– 42 U.S.C. § 794

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Creating Successful Models and Exploring Options

• Housing + Services Options

• Key Factors to Consider

• What Happens When Housing and Services Cannot Meet the Resident’s Needs

• Successful Models

Models of Housing with Services

• Housing & Program of All Inclusive Care for the Elderly (P.A.C.E.)

• HUD Assisted Living Conversion Program (A.L.C.P.)

• Housing and Contracted Services: HCBS

• Housing-preference for Olmstead

Assisted Living Conversion Program

• Grant funds the physical costs of converting some or all of the units into an ALF

• Funding for supportive services paid for by residents, foundations, Medicaid, SSI, State or Area Agency on Aging, etc.

Housing Linked to Services

• Connect with local area agencies on aging

• Partner with home and community-based services providers

• Co-location

• Partnering with State to give priority to Olmstead-related policies

In the Future

• “Housers” unlikely to be the licensed provider until the public funding is sufficient to support the service mandate (partnerships with HCBS providers)

• The amount of service provided will expand and decrease with the availability of public funding sources

• Service programs will be geared towards an aging-in-place philosophy

Financing Structure

Goal: To admit tenants that meet income guidelines for Section 8 and can afford to either pay for services through private pay or meet asset guidelines for Medicaid and HCBS

• Debt on Physical structure paid for through guaranteed revenue stream in the form of Project Based Section 8 Vouchers

• Services paid for through Medicaid/HCBS or Private Pay

Financial Structure• Project based Section 8 Vouchers• 4% Tax Credits• Tax Exempt Bonds• Bridge Loan• Soft Funds/Gap Funding (Federal Home Loan Bank)• Predevelopment Funds from Housing Authority/Non Profit

 

Assisted living Services• Housing and Community Based Services• Medicaid Waiver• Private Pay

Talent/Workforce Availability

• New talent needed from the boardroom to the bedside

• Workforce will become more diverse; more immigration

• Management of new workforce will require new skills and greater racial/ethnic diversity

• Workers will need to adapt to technology • Family caregivers will need training to

keep people at home

Resources• HUD/DOJ Joint Statement on Reasonable

Accommodation/Modification

– http://www.hud.gov/offices/fheo/library/huddojstatement.pdf

– http://www.hud.gov/offices/fheo/disabilities/reasonable_modifications_mar08.pdf

• AAHSA Website

– http://www.aahsa.org/Housing/

• Seniors Commission

– http://govinfo.library.unt.edu/seniorscommission/pages/final_report/keydemo.html

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Resources• AAHSA/IFAS Expanding Housing Plus Services

Publications- http://aahsa.org/article_ifas.aspx?id=1572 IFAS

• Health Care Reform and CLASS – AAHSA Health Care HUB- http://www.aahsa.org/HealthReformHub.aspx

• ElderCare Locator (800 677-1116) or -http://www.eldercare.gov/Eldercare/Public/Home.asp

• For long-distance caregivers- http://www.hhs.gov/aging/- http://www.benefitscheckup.org/