HOLGATE HOUSE Holgate House 4601 SE 39 th Street Portland, Oregon Partners: U.S. Department of Housing and Urban Development Housing Authority of Portland (HAP) Portland Area Agency on Aging Oregon Department of Human Services - One of four high-rise buildings where Congregate Housing Program operates Total CHSP Slots

Assisted Living Facilities Models in Public Housing 2 BACKGROUND HOLGATE HOUSEPORTLAND, OR 1981 HAP initiated the Congregate Housing Services Program (CHSP) Thirty slots in one building Provided support services to the frailest elderly and disabled individuals HUD funded the program except resident’s paid a sliding scale portion of the fee CHSP funds managed by HUD Office of Housing 1993 HAP requested from HUD received ninety additional slots A total of one-hundred twenty slots in four buildings; 3PH, one mixed population 1993 HUD initiated a 60% matching requirement

Assisted Living Facilities Models in Public Housing 3 DESIGN / STAFFING HOLGATE HOUSEPORTLAND, OR HAP manages the buildings and the CHSP Management, service coordinators and kitchen staff are HAP employees Personal care, housekeeping, transportation, nursing, podiatry and senior companion services are contracted out

Assisted Living Facilities Models in Public Housing 4 PROCESS HOLGATE HOUSEPORTLAND, OR 1993 HAP obtained 50% of required 60% matching funds via the Oregon State Home and Community Based Care (HCBC) Medicaid Waiver program. 10% of matching funds from participant fees HCFA provided the funds and the Oregon State Department of Aging administered the fund CHSP participants continued to pay their rent HCBC provides HAP with a monthly capitated rate per CHSP program participant regardless of the level of service required by each individual CHSP participants must meet Medicaid income level requirements (income of $ dollars per month, assets under $2,000)

Assisted Living Facilities Models in Public Housing 5 PROCESS (Continued) HOLGATE HOUSEPORTLAND, OR FUNDING SOURCES (averages) MONTHANNUAL Medicaid Community Based Care Waiver Program $302$3,624 Contributes toward cost of 1 meal per day, housekeeping, personal care, transportation, basic nursing, case management, senior companion services HUD Congregate Housing Services Program funds, administered by the Housing Department $242$2,904 Participant$60$720 Total:$604$7,248 ALF$2,938$35,256 Nursing Home$3,500$42,000

Assisted Living Facilities Models in Public Housing 6 MANAGEMENT / MARKETING HOLGATE HOUSEPORTLAND, OR CHSP not regulated in Oregon HAP Administrator and Service Coordinators provide onsite program monitoring No formal marketing necessary Referrals from Area Agency on Aging and “word of mouth” within the housing authority and outside communities

Assisted Living Facilities Models in Public Housing 7 CHALLENGES/FAILURES/LESSONS LEARNED HOLGATE HOUSEPORTLAND, OR February 2003 state budget cuts have drastically affected the level of Medicaid funding Now more difficulty meeting level of care standard. Further state budget cuts anticipated 4/03. Likely result will be less funding per individual recipient There are no alternative sources of matching funding once Medicaid funds are decreased Recognizing time to pursue a higher level of care placement. Ability to secure alternative placement in an expeditious manner HAP would consider developing an Assisted Living program and thereby access ALF Medicaid funds Obstacle--there are no HUD or other funds to retrofit the buildings

Assisted Living Facilities Models in Public Housing 8 ACCOMPLISHMENTS/SUCCESSES/HIGHLIGHTS HOLGATE HOUSEPORTLAND, OR Enables low income individuals to reside independently much longer than would otherwise be the case Enables some program participants to completely avoid institutionalization The program has improved the quality of the lives of participants The program has assisted to preserve participants’ health, actually increasing life spans To date the program has met the budgetary challenges and managed to provide an adequate level of care to the program participants Provides the services at an incredibly reasonable price The program has been able to meet the needs of an increasingly frail population

Assisted Living Facilities Models in Public Housing 9 SUMMATION HOLGATE HOUSEPORTLAND, OR Currently, only HA’s that received CHSP funding as of 1995 are eligible to apply for this program HUD should consider allowing additional HA’s to apply HUD should consider a more reasonable CHSP funding match (currently 60%), so that current HA’s can remain in the program HUD should consider increasing CHSP funding because alternatives are more costly CHSP, combined with community resources, can adequately maintain many frail elderly residents until nursing home placement is necessary or until natural death occurs

Assisted Living Facilities Models in Public Housing 10 SUMMATION (Continued) HOLGATE HOUSEPORTLAND, OR A continuum of care, i.e. CHSP and if needed, ALF, is an economical alternative to nursing home care Many elderly individuals experience physical and/or mental deterioration due to inability to take meds as prescribed causing otherwise unnecessary NH placement CHSP regulations should contain a mandatory provision for medication management HUD should consider ways that HA’s could access funds to modify buildings/apartments to comply with state ALF requirements Retrofitting costs cannot be absorbed within most HA’s current budgets