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Living with Dignity – Aging in Place

Living with Dignity – Aging in Place. July 2010 Colleen Bloom American Association of Homes & Services for the Aging cbloom@aahsa.org (202) 508-9483. Housing and Supportive Services . Public preference for aging in place is overwhelming, but has major challenges :

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Living with Dignity – Aging in Place

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  1. Living with Dignity – Aging in Place July 2010 Colleen Bloom American Association of Homes & Services for the Aging cbloom@aahsa.org (202) 508-9483

  2. 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

  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

  4. Current Housing-Provider Concerns/Opportunities • Facilitating Successful Aging in Place • Retrofitting for Accessibility • Reasonable Accommodations • Insurance and Liability • Dementia and Related Issues 4

  5. 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

  6. 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

  7. 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

  8. 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.

  9. 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

  10. 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

  11. 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

  12. 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

  13. Resources • HUD/DOJ Joint Statement on Reasonable Accommodation/Modification • http://www.hud.gov/offices/fheo/library/huddojstatement.pdf • http://www.hud.gov/offices/fheo/disabilities/reasonable_modifications_mar08.pdf • AAHSA Website • http://www.aahsa.org/Housing/ • Seniors Commission • http://govinfo.library.unt.edu/seniorscommission/pages/final_report/keydemo.html 39

  14. 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/

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