KnowledgePlex News Feature
July 15, 2002

Connect Housing and Health Care, Seniors Commission Recommends

Unmet housing and health care needs will, in the next few years, reach crisis proportions for the growing population of older Americans, according to the Commission on Affordable Housing and Health Facility Needs for Seniors in the 21st Century. The congressionally chartered commission submitted its report to Congress, "A Quiet Crisis in America," on June 28, and the report is now available on the commission's Web site. Highlighting the dual housing and health care needs of aging Baby Boomers, the report calls for increased attention to seniors' needs and creation of a national policy for affordable senior housing that is coordinated with health and supportive services.

"The nation can no longer afford the inefficiency of the current disconnect between housing and health service systems for seniors," the report said. "Coordination should begin in the halls and committee chambers of Congress and should spread through all branches of government and society…A first step…is to develop a common vocabulary, common age for eligibility, common definition of poverty, and common standards for programs."

Congress established the Commission to: recommend policy and legislative actions to increase the availability of affordable housing and health-related services, estimate the future demand, identify areas for private sector participation and public-private partnerships, explore how seniors can "age in place," propose methods for streamlining the delivery of housing and human services, and examine how to establish intergenerational learning and care centers and living arrangements.

"It was not an easy task dealing with this population and their needs," said Commission Co-Chair Nancy Hooks, northeast regional vice president of the Washington, DC-based American Association of Homes and Services for the Aging. Hooks stressed that the report should be viewed as a framework for future policy and legislative action. "This study can be used as a foundation for the future to start addressing the issue."

Independent living, a secure environment, the accessibility of health care and supportive services, vastly improved coordination of housing and health care with better access to home and community-based services, and the preservation of affordable housing stock are key themes of the report's recommendations. "Now, the system cannot address the vast number of people. This will be a key challenge to how we serve them," Hooks said. "If we can serve them at home, it is more dignified and cost effective than institutionalization."

Recommendations include:

• Preserve affordable seniors' housing stock: Preserve, renovate, retrofit, and refinance existing affordable and public housing, particularly Section 202 supportive housing for the elderly and disabled; utilize HOPE VI public housing modernization funds to build independent and assisted-living facilities and retrofit existing stock. Also, recognize manufactured housing as an affordable housing option and develop better financing products.
• Enhance seniors' housing programs: Expand successful housing production and rental assistance programs, home- and community-based services, and supportive housing models. Modify rural housing programs to better serve seniors and ensure that home- and community-based services and supportive senior housing are available in rural areas.
• Link shelter and services to encourage aging in place: Coordinate services in federally funded housing with senior populations. Have the General Accounting Office evaluate interdepartmental operations between the U.S. Departments of Housing and Urban Development (HUD) and Health and Human Services (HHS) and make recommendations regarding the effective delivery of programs.
• Reform federal financing programs: Call on the government-sponsored housing finance enterprises-Freddie Mac and Fannie Mae-to develop financing products that encourage private-sector participation in seniors' housing. Modernize Federal Housing Administration programs. Ask Congress to increase Medicaid funding for home- and community-based services.
• Create new housing and service program models: Encourage innovative approaches by supporting pilot programs and demonstrations. Create in incentive for the purchase of long-term care insurance.

The Commission projected that, by 2020, retiring Baby Boomers will represent a vastly different consumer market and they will have lived a different lifestyle than their parents, posing new demands for housing and service delivery. Other findings:

• The number of Americans ages 65 is expected to increase from 12.4 percent of the population today to 20 percent by 2020.
• More than 80 percent of senior householders will be homeowners.
• The number of seniors with disabilities will increase to 7.9 from 6.2 million.
• Because seniors want to age in place, the need for home- and community-based services will increase.

Five of the 13 commission members signed a minority report, arguing that the recommendations adopted by the commission by majority vote do not go far enough in making specific requests for federal action. The Minority Report's recommendations include calling on Congress to: immediately authorize and fund the supply of 60,000 units of subsidized elderly housing and supportive services annually; allocate at least $200 million to the Affordable Housing Preservation Act to preserve and improve elderly subsidized housing; and cover the cost of home- and community-based services as an entitlement under both Medicare and Medicaid.

Resources

The American Seniors Housing Association (ASHA) provides leadership for the seniors housing industry on legislative and regulatory matters, and promotes research and the exchange of information among the developers, operators, and financiers of all types of seniors housing. Go to www.seniorshousing.org/books/whitepapers/default.html to find reports and testimony on seniors housing, including:

"Assisted Living Quality Coalition Outcome Measurement Summit Proceedings" summarizes presentations and group discussions from a summit on performance measurement in assisted living, held June 1999 in Washington, DC.

"The Hallmarks of Assisted Living: Consumer Choice and Education," testimony of Philip J. Downey, vice president of Planning, Development and Regulatory Affairs, Marriott Senior Living Services, before the Senate Special Committee on Aging, April 26, 1999.

"Solving America's Long-Term Care Crisis" provides an up-to-date, thorough discussion of the dichotomy between Medicaid long-term care benefits and private-pay seniors housing.

"Assisted Living Quality Initiative: Building a Structure That Promotes Quality" describes the framework for a quality initiative for assisted living and guidelines for states on minimum standards.

AARP's Research Center provides information on a variety of topics related to aging, including "independent living" and "health and long-term care." The resources on independent living include:

"Serving the Affordable Housing Needs of Older Low-Income Renters: A Survey of Low-Income Housing Tax Credit Properties" presents the results of a survey of nearly 1,600 owners of Low-Income Housing Tax Credit rental properties.

"Accessibility and Visitability Features in Single-family Homes: A Review of State and Local Activity," reviews the methods state and local jurisdictions are using to promote the inclusion of accessibility features in new single-family homes.

"Falls Among Older Persons and the Role of the Home: An Analysis of Cost, Incidence, and Potential Savings from Home Modification" reviews the research literature on fall prevention through home modification and uses sensitivity analysis to explore the financial challenges such programs need to address.

"Adding Assisted Living Services To Subsidized Housing: Serving Frail Older Persons With Low Incomes," by Robert Wilden and Donald L. Redfoot, reports on 17 housing projects that offer assisted living services for older persons.

The U.S. Department of Housing and Urban Development (HUD) provides extensive housing-related resources for seniors or those with aging parents, relatives, or friends. The senior citizens section of the HUD site, , groups information under the following helpful categories: stay in your home, find an apartment, housing plus help, protect yourself, and stay active. The site also provides links to other private and federal sources of information on and assistance with housing for seniors.

The mission of Rebuilding Together with Christmas in April is to preserve and revitalize houses and communities, assuring that low-income homeowners, particularly those who are elderly and disabled and families with children, live in warmth, safety, and independence. To locate a program, go to www.rebuildingtogether.org/find_program_near_you/index.shtml.

KnowledgePlex Resources

A checklist provided by Rebuilding Together can help to assess the safety of a home for its elderly residents and develop modification strategies. A "Toolbox" provides tips for volunteer groups to perform home modifications for the elderly.

"Aging in Place: Coordinating Housing and Health Care Provision for America's Growing Elderly Population," written by Kathryn Lawler and published by the Neighborhood Reinvestment Corporation and the Joint Center for Housing Studies of Harvard University, states that "the most desirable and most cost-efficient method of aging-aging in place-is difficult, even under the most ideal conditions." The report explores how to create both health care and housing options that provide support at the margin of need as defined by an individual's personal desire and efforts to live independently.

On KnowledgePlex Partners Sites

The Funder's Network for Smart Growth and Livable Communities' paper "Aging and Smart Growth: Building Aging-Sensitive Communities" underscores the importance of transforming our sprawling, automobile-dominated communities so that they are aging-sensitive, making it possible for people to maintain their health and independence even as needs change.

The Housing Assistance Council conducted case studies on how federal and other funds have been used in rural areas to help meet the housing needs of low-income elderly homeowners and renters in selected counties. "Federal Programs and Local Organizations: Meeting the Housing Needs of Rural Seniors" reports on these often innovative and collaborative programs.

The Joint Center for Housing Studies of Harvard University recognizes seniors housing as a critical emerging and expanding area of research and policy development. The center's research in this area has covered important trends such as aging in place, home modifications, and housing and health care for seniors. Following are descriptions of the center's recent reports in this area:

According to "Housing America's Seniors," by Robert Schafer, concerns over the graying of America seem overblown. Schafer finds that while the population age 65 and over will indeed grow dramatically after 2010, the balance between working-age adults and the dependent population will not exceed its historical peak.

"Housing America's Elderly Population," by Robert Schafer, explores the housing choices of America's elderly households.

"Determinants of the Living Arrangements of the Elderly," by Robert Schafer, looks at the reasons that elderly persons choose different types of housing arrangements.

"America's Elderly Population and Their Need for Supportive Services," by Robert Schafer, examines the characteristics of America's elderly population, and estimates their need for supportive housing.