1. 1 The Rising Tide of Elder Homelessness and the Aging of the At-Risk Population Mark Hinderlie, Hearth, Inc. Leading Age Annual Meeting and Conference Washington, D.C. October 18, 2011

2. 2 U.S. Population is Growing … and Growing Older Source: U.S Census Bureau - Census projections as of 8/2008 Slide thanks to Rodney Harrell, AARP Public Policy Institute YEAR65+ POPULATIONTOTAL POPULATION 65%+ SHARE OF TOTAL POPULATION 200034,991,753281,421,90612% 201040,229,000310,233,00013% 203072,092,000373,504,00019% 205088,547,000439,010,00020%

3. 3 Poverty and the Lack of Affordable Housing Two critical issues FROM US CENSUS ANNUAL MEDIAN HOUSING COSTS ANNUAL MEDIAN INCOME FOR ELDERS 65+ DIFFERENCE US$11,000$19,000+$8,000 Boston$16,000$13,000-$3,000 Sources: US Census, American Community Survey, Employee Benefit Research Institute, & Russell, Lifelines for Elders Living on the Edge ●Housing costs make a large portion of elders’ budgets. ●Rise in rents, utility costs, housing prices and property taxes. ●Loss of stock of affordable rooming houses. ●Annual cost of living for an elder individual renting a one bedroom apartment in Massachusetts was $24,496 in 2008.

4. 4 Poverty and the Lack of Affordable Housing Two critical issues ●Most homeless elders lack any safety net of income, pensions or savings. ●Living below the federal poverty line, they struggle to meet basic needs with meager benefits from Social Security or Supplemental Security Income (SSI). ●Nationally, the average SSI monthly payment check to a person 65 and older (Hearth residents’ most common source of income) for August 2011 was $401.90.

5. 5 Supplemental Poverty Estimates Show Greater Prevalence of Poverty Among Older Adults FROM US CENSUS OFFICIAL POVERTY RATE FOR 2009 (circa 1960) SUPPLEMENTAL POVERTY RATE FOR 2009 (MSI-GA- CE)* DIFFERENCE All ages14.3%15.7%+1.4% points 65+ years 8.9%16.8%+7.9% points Source: US Census, Alternative Poverty Estimates Based on NAS Recommendations (2009) from Current Population Survey 2010 ●3.6 million American seniors (8.9%) live below the official federal poverty line (uses budget = 3x food costs), but millions more are not making ends meet. ●Using National Academy of Science (NAS) recommendations, the Census Bureau’s supplemental poverty estimate for ages 65+ nearly doubles to 16.8%, due to higher medical costs and updated spending patterns.* Supplemental Poverty Measure nearly doubles elder poverty *Medical out of pocket expenses subtracted from income (MSI), with geographic adjustment (GA), thresholds based on Consumer Expenditure Survey (CE).

6. 6 2009 Elder Standard for Single Elder in Boston Area vs. MA SSI Payments & Federal Poverty Levels Source: Russell, Lifelines for Elders Living on the Edge, 2009 Today’s high living costs exceed many elders’ incomes

7. 7 Older Adult Homelessness is Growing Source: HUD’s 2009 Annual Homeless Assessment Report to Congress, July 2010 Of the nation’s sheltered homeless population in the year 2007-08, 68% (1,092,600) were individuals and 32% (516,700) were persons in families. Nationally, older adults 62+ were 2.8% of those in shelters, and 51+ were 17.2% of sheltered homeless individuals in 2009. Older adults age 51+ increased from 34.9% of long-stayers (over 180 days) in emergency shelter in 2007 to 40.5% in 2009

8. 8 Age Distribution for Four Male Prevalence Cohorts in NYC Single Adult Shelters 1998-2005 Source: Culhane, Metraux and Bainbridge, The Age Structure of Contemporary Homelessness, 2010 Second-Half Boomers in the Shelters: 30-year-olds in 1988 are 55 in 2013, and 62 in 2020 14% 12% 10% 8% 6% 4% 2% 0% 18 - 21 22 - 24 25 - 27 31 - 33 34 - 36 37 - 39 40 - 42 43 - 45 46 - 48 49 - 51 52 - 54 55 - 57 58 - 59 60 - 61 62 - 64 65 - 72 75 & up 28 - 30

9. 9 Aging of the Homeless Population: Selected Cities Numerous studies confirm aging of the homeless population. ●Of San Francisco’s street homeless population, adults 50+ increased from 11.2% to 32.3% between1990–1994 and 2000–2002. ●In New York City, the median age of the homeless population rose from 28 to 42 between 1987 and 2005. ●In Massachusetts, adults 55+ increased from 8% of the homeless population in 1999 to 14% in 2003. ●In Chicago, homelessness is increasing among adults between the ages of 50 and 64. Source: NAEH, Demographics of Homelessness Series: The Rising Elderly Population, April 2010.

10. 10 Many Problems Lead to Older Adult Homelessness Financial Problems Fixed incomes, rising rents and health care costs => downward spiral Job Loss Job loss, prolonged unemployment drain resources Loss of spouse’s income or pension Physical Health Issues Serious health problems Physical disability and/or frailty Memory loss Mental Health Issues Sensory problems, i.e. hearing loss, reduced vision; paranoia and/or isolation Estrangement Absence of family/helpful family connections Lack of networks, informal supports Other Life Crises Death of spouse or family caregiver Divorce, domestic violence, addiction Scams and financial abuse

11. 11 Traditional Solutions Do Not Work for the Elderly Homeless Founded in 1991, Hearth partners with many organizations serving the homeless with a targeted approach for older adults age 50 and over. Hearth Housing & Services 7 sites, 137 units (additional 59 units under construction) Hearth Outreach 1,100 elders placed 3,000 served (capacity to help 350 elders annually)

12. 12 Hearth Outreach Program Helping those who Hearth can’t house The demand for Hearth housing is high and availability is limited. The Hearth Outreach Program enables Hearth to assist homeless elders in locating alternative affordable housing opportunities and the social services critical to their long term housing success.

13. 13 ●Hearth’s model integrates housing, mental health, medical and social services supports in a manner that permits even very frail elders to live with considerable independence in their own apartments. ●Hearth’s team is comprised of a Property Manager, MSW’s, RN’s, Site Directors, Resident Assistants, Personal Care Homemakers, Activity staff and a Representative Payee. ●Students, interns and volunteers provide countless hours of service to our residents. Partnerships include: Hearth’s Service Delivery Model ●Harvard Geriatrics Fellowship Program ●Northeastern University Physical Therapy Program ●Art Therapy Interns from Lesley University ●Social Work Interns from Boston College, Boston University, and Simmons College

14. 14 Boston Area Elder Living & Long Term Care Costs Sources: MetLife Survey of Long-Term Care Costs 2009, UMass Boston Gerontology Institute, Massachusetts Elder Economic Security Standard Index 2009 Supportive housing costs less than home & nursing home care

15. 15 ●The cost of Hearth housing is at most one-half the cost of institutional alternatives such as long term care or shelter beds. ●There are high costs associated with leaving elders in shelter or on the street which include costs such as increased use of emergency medical care for routine care. ●At over $58,000 a year on average in Massachusetts for assisted living and $107,000 for nursing home care, assisted living is generally unavailable to most poor and minority elders. ●At Ruggles, Hearth is able to provide access to this high level of care for Boston’s very low income, frail elders who otherwise would be living in nursing homes on Medicaid’s tab. Supportive Housing Makes Sense

16. 16 New Funding Strategy: Social Impact Bonds & Risk Adjustment for Homelessness Brings private investment into social service/prevention work Global payment in new health care law allows for risk adjustment for homelessness Current administration doing pilots now