An Analysis of Legislation Passed to Date on the State & Federal Level Moderator: George Littlejohn, Novogradac & Company Inc. Panelists: JP Delmore, NAHB Crystal Ford, Locke Lord, LLP Todd Kercheval, Government Affairs Consultant Michelle Norris, National Church Residences Test Notes Page

28 SITES 1620 UNITS If you know us, you know us as a housing owner and also a third party mgmt. company. You may also know us as an org that runs a very extensive service coordination program in our building and in other peoples buildings. The importance if this has become more significant over the last decade and I’ll share more about why that is.

330 senior housing communities 9 Permanent Supportive Housing Communities Continuing Care Retirement Communities Assisted Living Communities Market Rate Senior Independent Communities Hospice agencies Home Health agencies Home Care agencies Adult Day Centers

National Church Residences vision? To Advance Better Living For All Seniors Enabling Them to Remain Home for Life!! 2016 adapted this vision for our team Endorsed by board Filter for our initiatives

We have heard much talk about the greying of society is real certainly in most developed countries. The issue is really really big and it is really complicated and it is really personal. (graphic… begin with world that zooms all the way from global to Atlanta…) The Perfect Storm

56% of Americans Have Less Than $10,000 Saved for Retirement The GoBankingRates survey was conducted as three Google Consumer Surveys, each targeted at one of three age groups: millennials, Generation Xers, and baby boomers and seniors. Each age group was asked the same question, “By your best estimate, how much money do you have saved for retirement?” Respondents could select one of the options as displayed below: Less than $10K $10K to $49K $50K to $99K $100K to $199K $200 to $299K $300K or more I don’t have retirement savings. GoBankingRates analyzed the survey results to reveal key insights into how Americans of all ages are saving for retirement. Whether due to various economic factors or not correctly prioritizing finances, many people are not on track to have enough money to cover their expenses during retirement.

WHO CARES ABOUT AFFORDABLE SENIOR HOUSING & SERVICES? Seniors Care Providers Employers Families National Church Residences desires to partner with all the interest groups… #1 – seniors – treat with dignity and respect, advocate for them #2 – families – when they are in crisis #3 – employers – partnership for employees quality and balance of life #4 – gov – don’t need to kick down road – better solutions if plan Government

COMMONS AT LIVINGSTON – THE INTERSECTION OF DEVELOPMENT & PUBLIC POLICY

ADVOCACY ADVISE INVEST TIME RESPECT THE STAFF KEEP IT SIMPLE MAKE IT REAL

Michelle Norris mnorris@nationalchurchresidences.org

STAY UA (Services To Age in Your Upper Arlington) Started in 2009 - First formalized program of its kind in the country Now funded by City of Upper Arlington Program bridges gaps between services offered by the Fire Division's emergency medical service by connecting residents with the appropriate support services that could help prevent future emergency situations. Assisted over 800 residents and families. 11% reduction in 911 calls for program participants last year Contributing factor in selecting Upper Arlington Fire Division as the recipient of the State of Ohio EMS Agency of the Year Award for 2016.

Enhanced Community Living (ECL) WHAT IS ECL? In response to an identified need for a new long term care service options for individuals at the greatest risk of institutionalization, in 2010, the Enhanced Community Living (ECL) service became available in Ohio under the PASSPORT Medicaid Waiver program. Intended to promote aging in place by offering tenants of multi-family, affordable housing communities on-site access to a range of interventions that help meet established health goals and proactively manage chronic health conditions. WHY ECL? Seniors in affordable housing have more chronic conditions, run a higher risk of hospitalization, and have higher health care costs than the average older person.* Desired outcomes: Residents remain healthy and stable at home longer Reduced nursing home admissions Decreased hospitalizations & ER visits More efficient business model for home care providers *Picture of Housing and Health: Medicare and Medicaid Use Among Older Adults in HUD-Assisted Housing, The Lewin Group, March 2014.

Enhanced Community Living (ECL) How is ECL different from other Medicaid waiver services? Utilizes a flexible service delivery approach to provide services, such as personal care, daily wellness checks and chronic disease education and maintenance in smaller amounts of time, and on an intermittent or unplanned basis throughout the day. ECL at work: personal care aide is stationed at a affordable apartment building and on call as needed in 15 minute increments throughout the day, rather than pre-scheduling longer (often unnecessary) blocks of time with clients all over town. Lessons Learned in Ohio: Regulatory Roadblocks Regulation requires that ECL providers must be both Medicare and Medicaid certified. However, the agencies that actually provide ECL services are typically only “PASSPORT-certified.” Certification standards cause a myriad of unintended consequences, and has proven to be too unduly burdensome to be sustainable. Currently working on regulatory fix with Ohio Dept. of Aging.