Living with Dignity – Aging in Place

July 2010

Colleen BloomAmerican Association of Homes

& Services for the Agingcbloom@aahsa.org

(202) 508-9483

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

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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

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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

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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 StructureGoal: 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– http://www.hud.gov/offices/fheo/library/huddojstate

ment.pdf– http://www.hud.gov/offices/fheo/disabilities/reason

able_modifications_mar08.pdf

• AAHSA Website– http://www.aahsa.org/Housing/

• Seniors Commission– http://govinfo.library.unt.edu/seniorscommission/p

ages/final_report/keydemo.html

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Resources• AAHSA/IFAS Expanding Housing Plus Services

Publications- http://aahsa.org/article_ifas.aspx?id=1572 IFAS

• Health Care Reform and CLASS – AAHSA Health Care HUB- http://www.aahsa.org/HealthReformHub.aspx

• ElderCare Locator (800 677-1116) or -http://www.eldercare.gov/Eldercare/Public/Home.asp

• For long-distance caregivers- http://www.hhs.gov/aging/- http://www.benefitscheckup.org/