Living with Dignity – Aging in Place July 2010 Colleen Bloom American Association of Homes & Services for the Aging (202)

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 3

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 4

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 2

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 – ement.pdfhttp:// ement.pdf – able_modifications_mar08.pdfhttp:// able_modifications_mar08.pdf AAHSA Website – Seniors Commission – ages/final_report/keydemo.htmlhttp://govinfo.library.unt.edu/seniorscommission/p ages/final_report/keydemo.html 39

Resources AAHSA/IFAS Expanding Housing Plus Services Publications - IFAS Health Care Reform and CLASS – AAHSA Health Care HUB - ElderCare Locator ( ) or - For long-distance caregivers