1. HELEN SAWYER PLAZA Helen Sawyer Plaza 1150 N.W. 11 th Street Miami, FL 33136 U.S. Department of Housing and Urban Development Miami-Dade Housing Agency (Florida) State of Florida Department of Elderly Affairs - 104 Units - Partners: * The Nation’s First Licensed Assisted Living Facility Within Public Housing (1999)

2. Assisted Living Facilities Models in Public Housing 2 Service Providers: Miami Dade Housing Agency (MDHA) retains ownership and operational control of Helen Sawyer Plaza Provides day-to-day management of the facility and hands- on care for the residents – annual contract cost of $100,000 per year HELEN SAWYER PLAZA BACKGROUND MIAMI, FL Public sector funding along with private sector expertise provide the structure for Helen Sawyer Plaza

3. Assisted Living Facilities Models in Public Housing 3 BACKGROUND (Continued) PHAs - turning to Assisted Living Facility (ALF) models as a vehicle to enable seniors to age in place Avoid premature transfers to more intrusive and costly housing and service options such as nursing home facilities 1976 - Provided elderly public housing - Group meals only 1995 - No longer provided congregate meal service = Hardship 1995 - No meal service combined with poor transportation, no services, and a declining neighborhood = 30% occupancy rate HELEN SAWYER PLAZAMIAMI, FL

4. Assisted Living Facilities Models in Public Housing 4 Envisioned by MDHA - Meet physical and emotional needs of elderly public housing residents Evolved from a lack of affordable housing alternatives to meet the demand for senior housing Need for new funding sources to satisfy the problem of long-term care MDHA - converted an underutilized independent living facility into a multi-service center for elderly residents 1999 - MDHA opened the “Helen Sawyer Plaza Assisted Living Facility” BACKGROUND (Continued) HELEN SAWYER PLAZAMIAMI, FL

5. Assisted Living Facilities Models in Public Housing 5 Conversion to a Public Housing Assisted Living Facility: Step 1: Contracted with a consultant who is an expert in the Assisted Living Facility field Step 2: HUD funding to rehabilitate the building according to Housing Quality Standards Step 3: Obtained an Assisted Living Facility license from the state of Florida Step 4: Coordinated work efforts with Miami and Dade Counties to revitalize abandoned buildings in HSP neighborhood - expanded transportation Step 5: Petitioned the State of Florida Department of Elderly Affairs - grant a Medicaid waiver -Helen Sawyer Plaza elderly services eligible for Medicaid funding reimbursement BACKGROUND (Continued) HELEN SAWYER PLAZAMIAMI, FL

6. Assisted Living Facilities Models in Public Housing 6 DESIGN / STAFFING 104 Units 0 BR83 1 BR21 Amenities: Lobby, public restrooms, full kitchen with resident dining room, community room, administrative offices and maintenance staff areas Additional Building Features: Electronic security system with 24-Hour security guards Staffing Needs: Staffing includes an Administrator, Receptionist, Accountant, Maintenance Staff, Cook and Cook Assistants, Housekeepers, Certified Nursing Assistants, Activity Coordinator and a Social Worker HELEN SAWYER PLAZAMIAMI, FL

7. Assisted Living Facilities Models in Public Housing 7 DESIGN / STAFFING (Continued) CONSULTANT ADMINISTRATOR ACCOUNTING AR/AP MAINTENANCEACTIVITIES DIRECTOR NURSERESIDENT CARE FOOD SERVICE HELEN SAWYER PLAZAMIAMI, FL

8. Assisted Living Facilities Models in Public Housing 8 PROCESS Resident Eligibility Requirements: Must be low-income individuals Able to perform activities of daily living with supervision or assistance Be at risk of placement in a nursing home Medicaid eligible Must be at least 62 years old Do not require 24-hour nursing supervision Do not require licensed, professional mental health treatment Program Demographics: (104 residents) Average age is 85 Average length of stay is 35 months 40% of residents are former residents of nursing homes HELEN SAWYER PLAZAMIAMI, FL

9. Assisted Living Facilities Models in Public Housing 9 PROCESS (Continued) Benefits and Features: Married couples can continue to live together Helen Sawyer Plaza provides: Services including bathing, grooming and feeding 30 hours of activities per week - dancing, exercise, shopping and cultural events 24-hour supervision by trained staff Assistance with Medications Physical Therapy Transportation services Cafeteria Meals (three hot meals - two snacks per day) HELEN SAWYER PLAZAMIAMI, FL

10. Assisted Living Facilities Models in Public Housing 10 PROCESS (Continued) HELEN SAWYER PLAZA IS 100% SUPPORTED BY Optional State Supplement (OSS) to SSI$945,00041% State Sponsored Medicaid Waivers for Services$655,20029% HUD Operating Subsidy$424,20018% HUD Utility Subsidy$138,1686% Private Pay Residents$134,4006% Total:$2,296,968 REHABILITATION FUNDING SOURCES HUD Modernization$350,000 Borrowed Start-up$150,000 Total:$500,000 - Miami Dade Housing Agency subsidizes rent for all units - 65 residents receive Medicaid waivers that reimburse up to $28 per day for services $4,808 per unit HELEN SAWYER PLAZAMIAMI, FL $22,000 per unit subsidy vs. Nursing Home subsidy rate that is 5-6 times higher!

11. Assisted Living Facilities Models in Public Housing 11 PROCESS (Continued) Assessment of Service Fees: Residents are assessed $685 per month for services. The cost is subsidized through the Optional State Supplement (OSS), which is a State supplement to Social Security Income Cost Comparison: Nursing home facility vs. Assisted Living Facility - nursing home facility will cost 68% more Nursing Home = $38,000 per year Assisted Living Facility = $12,000 per year HELEN SAWYER PLAZAMIAMI, FL

12. Assisted Living Facilities Models in Public Housing 12 PROCESS (Continued) Helen Sawyer Plaza has an Extended Congregate Care License - required to access the Medicaid Waiver Result of petitioning - State legislature enacted a demonstration project Medicaid Waiver for $1.3 million First time a Medicaid Waiver and case management was allocated to public housing 100% of the units are affordable to 50% of area median income Residents pay rent set at 30% of adjusted gross income HELEN SAWYER PLAZAMIAMI, FL

13. Assisted Living Facilities Models in Public Housing 13 MANAGEMENT / MARKETING Management: Participatory management Constant training and communication among staff Residents are treated with respect, care and devotion Monthly training for social service staff Marketing: Outreach through resident services Sells concept that MDHA is a Medicaid provider and case management agency Clients come through word of mouth from publicity, newspaper articles, radio, T.V. and Community Groups 30% of residents come from Community Group referrals The residential waiting list averages 20-30 persons On average, MDHA loses 20 elder residents per month to death/nursing home/private assisted living facilities HELEN SAWYER PLAZAMIAMI, FL

14. Assisted Living Facilities Models in Public Housing 14 CHALLENGES/FAILURES/LESSONS LEARNED State and Federal Government requires excessive documentation Government Catch 22: Obtaining an ALF license –- Cannot be obtained until development is complete Lender Loans are difficult to obtain without a guarantee of Medicaid Funding Impossible to underwrite the Medicaid Waiver as a source of revenue because waivers cannot be committed before the facility is operational Petition the State of Florida Department of Elder Affairs to grant a Medicaid waiver is a hit and miss process What Helen Sawyer Plaza may have done differently: Opened the facility 6 months earlier Admitted more residents into the Medicaid Waiver Program Spent more time talking to key staff and residents for support HELEN SAWYER PLAZAMIAMI, FL

15. Assisted Living Facilities Models in Public Housing 15 ACCOMPLISHMENTS/SUCCESSES/HIGHLIGHTS Resident Successes: Based on Florida International University Center of Aging study: Health and mental condition of residents have significantly improved Residents have a high level of satisfaction with services Residents have a renewed desire to engage in life Helen Sawyer Plaza Successes: Achieved 100% lease-up within one year Achieved the lowest attrition rate among residents and staff Has saved the Florida Medicaid budget over $8 million Received recognition from legislatures and policy makers Awards: HUD Best Practices Award NAHRO Human Services Award National Association of Counties Achievement Award Florida Housing Coalition Success Stories Award HELEN SAWYER PLAZAMIAMI, FL