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[107 Senate Hearings]
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S. Hrg. 107- 985
THE PRELIMINARY FINDINGS OF THE
COMMISSION ON AFFORDABLE HOUSING AND
HEALTH FACILITY NEEDS FOR SENIORS
IN THE 21ST CENTURY
=======================================================================
HEARING
before the
COMMITTEE ON
BANKING,HOUSING,AND URBAN AFFAIRS
UNITED STATES SENATE
ONE HUNDRED SEVENTH CONGRESS
SECOND SESSION
ON
HOW WE CAN WORK BETTER TO MEET THE NEEDS OF A GROWING SENIOR POPULATION
IN THIS COUNTRY
__________
JUNE 27, 2002
__________
Printed for the use of the Committee on Banking, Housing, and Urban
Affairs
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WASHINGTON : 2003
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COMMITTEE ON BANKING, HOUSING, AND URBAN AFFAIRS
PAUL S. SARBANES, Maryland, Chairman
CHRISTOPHER J. DODD, Connecticut PHIL GRAMM, Texas
TIM JOHNSON, South Dakota RICHARD C. SHELBY, Alabama
JACK REED, Rhode Island ROBERT F. BENNETT, Utah
CHARLES E. SCHUMER, New York WAYNE ALLARD, Colorado
EVAN BAYH, Indiana MICHAEL B. ENZI, Wyoming
ZELL MILLER, Georgia CHUCK HAGEL, Nebraska
THOMAS R. CARPER, Delaware RICK SANTORUM, Pennsylvania
DEBBIE STABENOW, Michigan JIM BUNNING, Kentucky
JON S. CORZINE, New Jersey MIKE CRAPO, Idaho
DANIEL K. AKAKA, Hawaii JOHN ENSIGN, Nevada
Steven B. Harris, Staff Director and Chief Counsel
Wayne A. Abernathy, Republican Staff Director
Martin J. Gruenberg, Senior Counsel
Jennifer Fogel-Bublick, Counsel
Jonathan Miller, Professional Staff Member
Mark A. Calabria, Republican Economist
Sherry E. Little, Republican Legislative Assistant
Joseph R. Kolinski, Chief Clerk and Computer Systems Administrator
George E. Whittle, Editor
(ii)
C O N T E N T S
----------
THURSDAY, JUNE 27, 2002
Page
Opening statement of Chairman Sarbanes........................... 1
Opening statements, comments, or prepared statements of:
Senator Allard............................................... 2
Prepared statement....................................... 18
Senator Reed................................................. 2
Prepared statement....................................... 18
Senator Corzine.............................................. 18
WITNESSES
Ellen Feingold, Co-Chair, The Commission on Affordable Housing
and Health Facility Needs for Seniors in the 21st Century...... 4
Prepared statement........................................... 19
John Erickson, Commissioner, The Commission on Affordable Housing
and Health Facility Needs for Seniors in the 21st Century; on
behalf of Nancy Hooks, Co-Chair................................ 4
Prepared statement of Nancy Hooks............................ 22
(iii)
THE PRELIMINARY FINDINGS OF THE
COMMISSION ON AFFORDABLE HOUSING
AND HEALTH FACILITY NEEDS FOR
SENIORS IN THE 21ST CENTURY
----------
THURSDAY, JUNE 27, 2002
U.S. Senate,
Committee on Banking, Housing, and Urban Affairs,
Washington, DC.
The Committee met at 10:18 a.m. in room SD-538 of the
Dirksen Senate Office Building, Senator Paul S. Sarbanes
(Chairman of the Committee) presiding.
STATEMENT OF CHAIRMAN PAUL S. SARBANES
Chairman Sarbanes. The hearing will come to order.
I want to thank our witnesses, Ellen Feingold, who is the
Co-Chair of the Commission on Affordable Housing and Health
Facility Needs for Seniors in the 21st Century, and John
Erickson, who is a Commissioner, for appearing before us this
morning.
Nancy Hooks, who is the Co-Chair with Ellen Feingold, was
scheduled to be here, but she had a family emergency and was
not able to be present.
John, we are most appreciative to you for your willingness
to step in on very short notice.
We are very much looking forward to hearing our witnesses
on how we can work better to meet the needs of a growing senior
population in this country. In fact, as I understand it, by
2030, less than three decades from now, the elderly population
in America will double to 70 million people, and it will then
comprise 20 percent of our population.
Currently, the figure is 12\1/2\ percent. So in 30 years,
we will go from 12\1/2\ percent to 20 percent of our population
being elderly.
In our work on this Committee, it has become apparent that
there is an affordable housing crisis, one that touches every
part of the country, every segment of society. In hearings that
were held earlier this year, we heard that the need for
affordable housing continues to grow with almost 13 million
American families paying over half their income toward rent.
Working people are finding it more and more difficult to afford
a decent home for their families.
We have reviewed the general housing problems of Americans,
but we have not fully focused on the housing needs of this
fast-growing segment of our population, the elderly. For too
many seniors, especially those who rent their homes or those
living on fixed incomes, decent and safe housing is not within
reach.
There are currently six needy seniors for every available
unit of affordable senior housing. There are over 300,000 units
of affordable senior housing at risk of being lost, and it is
estimated that 35 percent of all seniors pay more than they can
afford for housing.
As the Seniors Commission finds in its Report, the housing
shortage will become worse in the coming years. The Commission
referred to this as a ``quiet crisis,'' a crisis that has not
yet come to the public's attention, but one that we cannot deny
or ignore, and of course, one purpose of this hearing is to
help to bring it to the public's attention.
As we look ahead, as I indicated, in the not too distant
future, one out of every five Americans will be a senior
citizen and we need to begin to address new programs and
services to meet their needs. The Commission outlined the
housing and health care needs they would face, and given the
current shortage of housing, it is clear we must start
preparing now to meet these needs.
I want to make this observation.
When we talk about the housing needs of elderly people, we
are not only discussing bricks and mortar, the physical
structure, we also need to address the necessary supportive
services. Housing and services are interrelated. In fact, the
ability of an elderly person to remain in their home is
frequently dependent upon the availability of adequate
services. Too often, the only options available to seniors are
to remain in their homes, which are lacking the necessary
services, or move to restrictive institutionalized settings.
Not everyone is fortunate enough to have the kind of
imaginative and responsive lifestyle that John Erickson has
developed with great success in meeting this challenge.
When the Congress established the Commission on Affordable
Housing and Health Facility Needs for Seniors in the 21st
Century, that was established in the 2000 HUD/VA Appropriations
Act. We charged the Commission with conducting a study, and
submitting a report to Congress outlining the housing and
health facility needs of the elderly and making recommendations
for how to best meet these needs.
Originally, there was a deadline of this past December 31.
This was extended to June 30 of this year. In fact, we are
almost there.
Mr. Erickson. To the edge.
Chairman Sarbanes. With the data compiled by the
Commission, we will have a better understanding of just how
large a problem we face. I understand that the Commission will
have both the Majority and Minority Report, which, as I
understand it, differ in the extent of their recommendations.
But there is much common ground in the two statements. Both
ask us to continue pushing for greater funding of housing
programs, to ensure that we maintain the housing supply and
that we have and expand the stock of affordable housing. Both
seek better coordination of Federal housing and health care
programs. And the Report will obviously reinforce the work that
this Committee has been doing on the affordable housing issue.
I look forward to hearing from our witnesses this morning
on the findings of the Commission and the ways that the
Congress might address their recommendations to make sure that
our senior citizens can live a life of dignity.
These, after all, are the men and the women who have built
the strength of this country and it is only appropriate and, in
fact, meeting an important responsibility that in their senior
years, they be able to live in dignity.
I think these Reports will help us to counter this coming
crisis.
Senator Reed and Senator Allard, who are the Chairman and
Ranking Member of the Subcommittee on Housing, have been
conducting a series of hearings on this important question.
Both have had a very keen interest in the issue and I am
delighted that both are here with us this morning.
Since I go in this direction first, I will yield to Senator
Allard, and then to Senator Reed.
Senator Allard.
COMMENTS OF SENATOR WAYNE ALLARD
Senator Allard. Mr. Chairman, I understand we have a vote
about 10:50. Is that correct?
Chairman Sarbanes. It is sometime shortly.
Senator Allard. Yes. So, I would just like to put my
statement in the record, so we can move forward and hear from
the panel.
But I would also express appreciation for Rita Poundstone,
who works with the Colorado Housing and Finance Authority,
serving on this Commission. I have worked closely with the
Colorado Housing and Finance Authority and think it is a great
organization.
Chairman Sarbanes. Thank you. Your full statement will be
included in the record.
I say to the witnesses, that was a very gracious gesture on
Senator Allard's part.
[Laughter.]
Given the way things work around here.
Senator Reed.
COMMENTS OF SENATOR JACK REED
Senator Reed. Thank you, Mr. Chairman. I will also
graciously ask that my statement be placed in the record.
[Laughter.]
Let me just quickly welcome Commissioner Feingold and
Commissioner Erickson and thank them for their work and the
fellow Commissioners for their great work.
Our challenge is to preserve senior housing. It is to
expand senior housing through increased production programs.
And it is also to ensure that the services are available. This
is a particularly vital issue in my home State of Rhode Island.
We rank sixth in population of people age 65 years and older.
So these are critical issues for all of us, but
particularly for my home State. I look forward to working with
Chairman Sarbanes and Senator Allard, my colleague on the
Subcommittee.
Thank you, Mr. Chairman.
Chairman Sarbanes. Very good. Thank you, Senator Reed.
Now, we are ready to hear from the witnesses. And Ellen, as
the Co-Chair, I think we will turn to you first. If you want to
take a moment or two to introduce your fellow Commissioners
that are here with you today, we invite you to do that as well.
STATEMENT OF ELLEN FEINGOLD
CO-CHAIR, THE COMMISSION ON AFFORDABLE HOUSING
AND HEALTH FACILITY NEEDS FOR SENIORS
IN THE 21ST CENTURY
Ms. Feingold. Thank you, Mr. Chairman. I would be very glad
to do that. And then after I have made the introductions, I
would like, with your consent, to ask Mr. John Erickson to
present the Majority Report.
It seems to me appropriate that the Majority Report come
before the Minority. But I will accept your invitation to
introduce our Commissioners.
Chairman Sarbanes. Fine.
Ms. Feingold. We have with us, starting at the end,
Commissioner Baumgarten from----
Chairman Sarbanes. Why don't each of you stand as you are
introduced?
Ms. Feingold. --the State of Oregon. We have Commissioner
Poundstone, whom Senator Allard introduced, from the State of
Colorado. We have Commissioner Sykes from Madison, Wisconsin.
We have Commissioner Thomas from Seattle, Washington. We have
Commissioner Protulis, who I think at the moment is from
Florida. Is that correct?
Mr. Protulis. Maryland. Maryland.
[Laughter.]
Ms. Feingold. Maryland. Maryland.
[Laughter.]
Yes.
Mr. Protulis. And everybody else behind me is from
Maryland.
[Laughter.]
Chairman Sarbanes. Yes.
Ms. Feingold. We have our Executive Director Gerard Holder
and our Associate Director Dina Elani. And I am very pleased to
introduce you to our principal consultant on the demographics
of this problem. This is Dr. Stephen Golant, from the
University of Florida.
We asked him to join us at the very last minute because we
thought you would probably have more serious questions about
the numbers than either John or I are expert about. Steve
Golant is here to be of help to all of you.
Now, with your consent, may I turn this over to
Commissioner John Erickson?
Chairman Sarbanes. We would be very happy to hear from you,
Commissioner.
STATEMENT OF JOHN ERICKSON
COMMISSIONER, THE COMMISSION ON AFFORDABLE
HOUSING AND HEALTH FACILITY NEEDS FOR
SENIORS IN THE 21ST CENTURY
ON BEHALF OF NANCY HOOKS, CO-CHAIR
Mr. Erickson. Thank you very much, Chairman Sarbanes, and
Senators. I appreciate the opportunity to be here today, and
for holding this hearing.
As you said, I am John Erickson, and for the record,
Chairman of Erickson Retirement Communities, a Baltimore-based
company that is a national provider of senior housing.
As 14 Commissioners, with vastly different backgrounds and
life experiences, we brought a great deal of diversity of
opinion to this responsibility--and that diversity is a
strength that has led us to an array of thoughtful
recommendations. Our Report offers over 40 specific
recommendations and a wealth of new data to lay the groundwork
for the changes that are needed if we are to provide Americans
with the assurance that they will not be abandoned in their
later years.
Our Congressional mandate laid out extensive expectations,
and I am pleased to report on the vigorous effort that has been
undertaken to meet them. Serving the seniors to come is a task
requiring considerable preparatory work--it cannot be handled
overnight and ``more money'' is an oversimplified and
inadequate solution.
The Seniors Commission has launched a nationwide dialogue
on senior housing, health care, and supportive service issues.
We organized and conducted a series of coast-to-coast field
hearings that
resulted in our exposure to an array of innovative thinking and
best practices.
At each of the five field hearings, we allocated time to
allow seniors to address the Commission and we listened closely
and were moved deeply as seniors and their loved ones told us
about their own difficulties in housing and health challenges
that they faced every day.
As a result, the Commission learned that the needs of
seniors are quite diverse and that the ways in which these
needs need to be met are equally diverse. What works in some
cities does not necessarily work in others or in rural or
suburban communities. What works for some seniors doesn't for
others, or is even unavailable altogether. We learned that many
Government programs do not function collaboratively, and that
their failure to do so imposes added burdens on the very people
that they hope to try and serve.
The Seniors Commission has highlighted America's ``quiet
crisis''--the senior housing and health care challenges we will
face as the Baby Boomer generation reaches retirement age.
Today, as we summarize our key findings, we call upon the
Congress, the Administration, State and local governments, the
private sector, nonprofits and faith-based organizations to
recognize that senior housing and health services must become a
national priority. President Bush recently announced his
progressive housing initiative to promote homeownership and to
increase the supply of affordable homes, and has demonstrated
his leadership by identifying housing as a national imperative.
The Commission's Report contains data reflecting the
present needs of seniors, and allows us to predict the range of
the future need. Fortunately, all of the people that will be
seniors using up our health services are currently alive today,
so we have a lot of information about what to expect.
Right now, more than 80 percent of seniors own their own
homes. And of those, above the age of 50, almost 60 percent
have their homes free and clear. This pattern is likely to
prevail, and in the future, it might even extend to a greater
condition. So, aware of this, the Commission took a serious
look at health policy, especially with regard to long-term care
affordability, availability, and accessibility. It is apparent
that health policy, especially long-term care, compels people
to leave their homes in order to receive care, favors an
institutional settings and is often prohibitively expensive.
Therefore, the Commission recommends encouraging the provision
of Home- and Community-Based Services wherever possible.
In general, we expected Baby Boomers to begin their
retirement years in better financial position than their
parents. They will, nevertheless, test the limits of our
housing and health system. Even if increasing incomes are
assumed, large numbers of low-income seniors will continue to
require significant assistance, and many middle-income seniors
will find themselves on the precipice of hardship due to
unforeseen health or housing expenses that may not be addressed
by present policy.
The Commission heard one, consistent message--seniors wish
to age as best as they can in place, which may mean in a
private home, a congregate community environment, or another
location of their choosing. If it can be done safely and
efficiently, it should be done. Smart policy, providing the
appropriate level of care and securing effective assistance in
the home can avoid premature placement in institutional
settings and save scarce resources for those who truly need
these extensive and costly levels of care.
The Senate Aging Committee has recently conducted 13
hearings, and if you extrapolate the current usage for long-
term care costs, it would ultimately absorb 75 percent of the
total budget in the year 2030.
So, obviously, we have to make some changes.
Modest assistance for home modifications or repairs can
allow seniors to remain in their homes, thereby reducing the
need to build additional, affordable rental housing.
Furthermore, service-related assistance for seniors, once
again, in the home, will allow them to remain in the community,
reducing the overall cost to taxpayers. In an institutional
setting, for many seniors receiving Government assistance, the
Government is not only paying for their health services, but
also for their housing. By subsidizing health services in the
home setting, substantial savings could be realized. So
providing home-based assistance allows seniors to maintain
their independence and their dignity, and we certainly
encourage you to make it available at every possible
intersection.
Enactment of a shelter deduction will help the Home- and
Community-Based Services gain parity with institutional
settings, just by changing the home from a liability in terms
of qualifying for
assistance to an asset that reduces the overall cost of
providing services by removing the costs associated with this
institutional component. Currently, it works against seniors to
stay home and is qualified as income. But if it allowed them to
have services, we could take that as a deduction.
The Commission strongly recommends private-sector
solutions. We encourage Congress to provide incentives to
purchase long-term care insurance, to reduce the overwhelming
out-of-pocket burden on seniors, and the pressure on the public
support systems. Deductibility of long-term care insurance
should be a part of any tax planning in the future.
I focused on our health recommendations since, as we delved
into these issues, the levels of frailty and the fragmentation
of services combined with a large number of senior homeowners
of all incomes indicates to us that perhaps health and health-
related services are an even wider problem than the lack of
affordable housing. Clearly, however, there are shortages of
affordable housing and there is a need for more of it. There is
no doubt about that.
There is a need for such housing to be modified and
constructed with the needs of seniors in mind. Although the
American Housing Survey is, perhaps, the best data set
available on housing, several Commissioners identified serious
flaws with that housing index, and additional research using
other data sets, especially on income, serve to reinforce their
concerns.
These, coupled with the Harvard Joint Center for Housing
Studies' projections of greatly increased senior homeownership
and an awareness that, in some communities, subsidized housing
units remain vacant, raises a cautionary flag about proceeding
too vigorously with housing production. What is clear is that
shortages exist, and in some communities, they are extremely
serious.
Some key recommendations in our Report: The preservation,
modernization, and retrofitting of existing affordable senior
housing--very important; expansion of all types of assisted
housing programs in order to meet market demand; expansion of
the role of Government Sponsored Enterprises, GSE's, in
supporting senior housing needs; encouragement of service-
enriched, senior housing developments by streamlining
regulatory processes and by coordinating agencies that
interface in the provision of housing and services at the
Federal, State, and local levels; and finally, the redesign of
programs to reflect the real needs of individual seniors, while
providing enough flexibility to ensure that localities have the
most appropriate tools to meet local needs, rather than
imposing a ``one-size-fits-all'' type of solution.
By moving in these directions, the needs of the growing
senior population can be met. To reiterate, our Report has more
than 40 recommendations; it is a tool for change, a document
that looks to the future in a realistic manner. I encourage you
to examine the recommendations closely and to explore their
implications and their impacts.
On behalf of Nancy Hooks, I thank you for this experience
and the opportunity to participate in developing a
comprehensive, bipartisan, and national policy statement on
issues that we all care so deeply about.
Thank you, Senator Sarbanes.
Chairman Sarbanes. Thank you very much, John.
Those lights up there on the clock indicate that we are now
more than halfway through the time for the vote. That is why my
colleagues have been leaving. So, I have to recess the hearing
for a few minutes while we go and vote, and then we will return
and will hear Ms. Feingold's statement and have a question
period.
The hearing stands in recess.
[Recess.]
Chairman Sarbanes. The hearing will now resume and we will
hear from Ms. Feingold.
Ms. Feingold. Thank you, Mr. Chairman.
For the record, I am Ellen Feingold. I am the Co-Chair of
the Commission on Affordable Housing and Health Facility Needs
for Seniors in the 21st Century. I am also the President of
Jewish Community Housing for the Elderly in Boston, which is a
nonprofit nonsectarian developer, owner, and manager of over
1,000 units of Government-funded housing for low-income
elderly.
It is relevant for this Commission that I am also a founder
of an organization called the Committee to End Elder
Homelessness.
Every year in Boston, we do a census of elder homelessness.
And this year, there were over 400 seniors who were homeless in
the month of January in Boston. If you want to see the problem
of lack of housing for seniors writ large, look at seniors who
have become homeless.
I want to thank the Committee and especially thank Chairman
Sarbanes for inviting me and the rest of the Commission to
testify before you.
I also want to thank Congressman Barney Frank for the
privilege of appointing me in concert with Senators Kerry and
Mikulski, and Congressman Mollohan.
This has been a rare opportunity for me, I appreciate it
deeply.
When we were doing introductions before, I did not
introduce you to the people who represent those whose problems
we have solved. I would like to introduce you to about 60
seniors in this room who are residents of Government-supported
senior housing. Will you all stand up?
[Applause.]
They are residents of housing which has been developed by
the Elderly Housing and Development Corporation of which
Commissioner Protulis is the Director. Commissioner Protulis
has made sure that there have been seniors at every single one
of our public hearings. Some of them have testified before us,
but many have sat and listened and they have applauded our
efforts because there is nobody who understands the problems,
and also the value of the solutions, the way these people do.
I am thrilled that you are all here. Thank you so much.
I come before the Committee as someone who has dealt with
the problem of providing decent, supportive housing for elderly
persons for over 20 years. The average age of residents in my
housing is over 80, and their incomes average $10,000 a year or
less. They are very old. They are very poor. And they are
increasingly frail. I know first-hand how valuable the programs
are that the Federal Government provides for helping people to
live decent lives.
In the Commission's Report, you will find examples of how
these programs are used creatively, how they are blended
together, how we make a great stew out of some very disparate
Government products that were never designed to work together.
But we also know the inadequacy of the quantity of the
resources we have.
My organization has 1,050 apartments. They are all occupied
all the time. We have no vacancy rate. And there are 1,800
people on our waiting list.
The Section 202 program allocates around 150 to 175
apartments per year to Massachusetts. I could use all of it for
10 years and I still wouldn't house my waiting list. We need
resources desperately.
Every day, people call me and my staff pleading, desperate,
looking for housing. They probably call your staff, Mr.
Chairman, and your staff probably calls me or people like me,
saying, what can you do for my boss' constituent? My answer is
nothing, for 6 years. They have to get on the waiting list. And
I wind up telling people who are 80 that they have to wait 6
years for housing.
Now, Mr. Erickson referred to some places in the country
that have vacancies in subsidized housing. That is true. But it
is the rare exception, it is not the rule. The rule is massive
waiting lists. The rule is people who are desperate. And we
come before you to ask the Congress to really address this
problem.
The question is, how much more do we need?
Dr. Stephen Golant prepared for the Commission a piece of
groundbreaking research which is in the Appendix to our Report,
which quantifies and puts together in one place the issues of
need, the issues of affordability, and the issues of housing
condition and accessibility.
Let me say at this point that the Minority of the
Commission supports wholeheartedly almost the entirety of the
Majority Report. The specifics that Mr. Erickson laid out
before are all specifics that are important. Where we depart
from the Majority is in quantifying for you the dimension of
the need, the crisis of the need and to plead with you to
change priorities so that we can begin to meet the need.
The Minority Report differs from the Majority Report in
four crucial areas. Number one, increased housing production
goals. Number two, using our resources first to meet the needs
of the poorest and the frailest. Number three, begin to make
major changes in the funding system for services to seniors.
And number four, to deal with the issue of the resources that
solving this problem will take.
We have to start now. We were asked to look at the crisis
in 20 years. We have to start now because the crisis is now.
Right now, there are 1.2 million Government-subsidized
rental units that house 1.3 million people. But there are 6.1
million very low- and extremely low-income seniors who have
priority housing problems, who are not now living in assisted
housing. That is 6.1 million. That, in a sense, is the gap.
Not all of those 6 million want to live in rent-assisted
housing. But if you figured that a quarter to a half of them
do, then we are looking at a gap of 1\1/2\ to 3 million badly
housed, very poor old people today. Not 20 years from now.
Today.
Now if you project that to 2020, Dr. Golant tells us there
will be 9.5 million very low-income and extremely low-income
persons with priority housing needs. That is 9.5 million. If
you figure a quarter to a half of them would move into rent-
assisted housing, that means we would need 2.4 million units
over the next 17 years, which translates to 140,000 units a
year, if we are going to catch up in 2020.
Supposing we looked just at renters. The largest number of
seniors at all income levels are homeowners, but look at
renters. There are 2.4 million senior renters who are very low-
income or extremely low-income who are not in rent-assisted
housing. Figure half of them--because they are renters--might
be willing to move, would be overjoyed to move into rent-
assisted housing. So today, that number is 1.2 million. In
2020, if you look just at renters, the very poor, very needy
renters, there will be 3.2 million. If we were going to house
half of them, we would need to produce 94,000 units a year.
It is in the context of those numbers that the Minority
recommends strongly to you that the Congress begin now to
authorize 60,000 units a year of housing for low-income
seniors, either through the Section 202 program or the Rural
Housing Services Section 515 program, or public housing
programs, or the low-income units in tax credit properties.
We also recommend to you, to prevent falling back even
further, $200 million now for the Affordable Housing
Preservation Act, to prevent the loss of some 300,000 senior
units that are at risk today.
There is no cheap way to do it. If you do it by tax
credits, you are spending tax money. If you do it by budget
outlays, you are spending appropriated money. But the wood and
bricks and steel and plumbers and electricians cost the same.
There is no way of getting around that building housing costs
money.
With respect to supportive services, we echo virtually all
of the recommendations of the Majority. There are some
additional recommendations in the Minority Report which are
worth mentioning.
One of the problems one faces trying to put housing and
services programs together is they do not even talk the same
language. If you ask what is the eligibility for housing, it is
calculated according to Area Median Income. So it is very
sensitive to regional variations, local variations.
If you ask if someone is eligible for Medicaid, that is
based on a national poverty figure. There are some parts of the
country where those numbers are similar and there are some
parts of the country where there are wide disparities.
In Massachusetts, you can have an income of twice the
Medicaid income ceiling and be eligible for assisted housing.
This means that we have many people living in subsidized
housing who cannot access the services that they need.
We cannot even understand that problem until we start
talking the same language.
So one of our recommendations, a small one, is to change
the language, change the terminology, and use the Area Median
Income for both health programs and housing programs.
The two most dramatic recommendations that we make to you
have to do with Medicaid and Medicare. Both of those programs
have done a terrific job at some of what they do.
Medicare, which dates from 1965, originally cover hospital
costs--what in 1965 we knew to be the normal, extraordinary
health needs of older people. We now acknowledge that today's
normal, extraordinary needs include prescription drugs. So,
Congress is preparing to add that coverage, which the entire
Commission supports.
The Commission's Minority urges you to think seriously of
adding long-term care service benefits to the Medicare program.
It will cost both the users and the Government additional money
in the short run, but Medicare has to become the long-term care
insurance program for most Americans. We cannot pretend that
only hospitals and doctors are what elders need. These changes
will reduce costlier and often unnecessary
institutionalization.
The second major change we recommend to you is a change in
the Medicaid program, which at this time entitles poor people
to go to nursing homes.
When Mr. Erickson mentioned someone who lives in his or her
own home, but for lack of services, has to go to an
institution, the missing link there is that if that low-income
person was eligible for services under Medicaid, they wouldn't
have to go to a nursing home where Medicaid will pay their
bill.
There is a Medicaid Home- and Community-Based Waiver
Program now. It has been very successful. Different States use
it in different ways. We recommend strongly to the Congress
that the days of waiver and special demonstrations are over,
that the Home- and Community-Based Services be rolled into the
Medicaid program as a central part of that program.
Finally, I would say to you that we recognize the costs of
what we are asking for. That the costs are huge. But this
country has resources. The question is, how are we going to
allocate our resources? We allocate them in many ways that are
beautiful and we accomplish great things.
One of the things we have been enormously successful at is
stimulating homeownership for people at all income levels. We
have the highest proportion of homeownership in the world in
the United States. And that costs us. There is a tax cost to
the stimulation of homeownership of $60 to $80 billion a year.
We would like to see Congress think of what $60 to $80
billion a year would do for the housing needs of low-income
renters. We would like to see parity. We would like to see poor
people's housing supported at a level like that. We would like
to see services for low- and moderate-income seniors supported
at a level like that.
The program has succeeded. But it has left people behind.
And we would urge you strongly to think about how to raise
funding for low-income assisted housing up to a level that
begins to meet today's and tomorrow's needs. We shouldn't have
our mothers and our fathers and our grandparents risking
homelessness and risking institutionalization.
We urge you strongly to look at our recommendations and to
do what needs to be done so that seniors live in health and
dignity and safety.
Thank you.
Chairman Sarbanes. Good. Thank you very much.
One of the things the Commission did was some very
important new research, and we very much appreciate a lot of
this additional material. I think it is going to be very
helpful to us.
As I understand it, there are about 325,000 units of senior
housing that are at risk of being lost to the affordable
housing stock.
Ms. Feingold. Correct.
Chairman Sarbanes. Through the problem of opt-outs.
Correct?
Ms. Feingold. That is correct.
Chairman Sarbanes. I was curious. Is this housing that was
originally designated for seniors, or are these units that now
house elderly families through the process of aging in place?
Do you know?
Ms. Feingold. I do not know. I can guess, but I do not
know. I would guess that it is mostly age-segregated housing.
But I do not know the answer.
Chairman Sarbanes. Does Dr. Golant know?
[Pause.]
Ms. Feingold. It includes everything. But my guess is that
it is largely senior housing. We will get you the answer. You
will have the answer shortly.
Michael Bodaken, who researched preservation issues for the
Commission, included all HUD-subsidized elderly housing and all
other assisted multifamily housing in which 50 percent or more
of the households are age 62 and over. See Appendix G3, page
13, in the Commission's Report.
Chairman Sarbanes. I would be interested in that figure.
Ms. Feingold. Yes.
Chairman Sarbanes. You said a tiny change to equalize where
you have to be financially to qualify for affordable housing
and where you are in order to qualify for Medicaid. As I
understand your recommendation, it was to move the Medicaid
qualification standard up to the Area Median Income, which
would correspond with the housing.
Ms. Feingold. Correct.
Chairman Sarbanes. Do you have any idea how much additional
that would cost in terms of Medicaid benefits?
Ms. Feingold. We are not reaching that point. What we are
saying to you is, if Medicaid eligibility were calculated using
the standard of Area Median Income, we would be able to see
what that means. Right now, we label the eligibilities by two
totally different standards and we only know when the human
being comes in and says, I am eligible for this, but I am not
eligible for that.
We do not know what it means.
We do know that in Boston, you are eligible for housing
when you are not eligible for services. There are other places
where you are eligible for services and not eligible for
housing. So until we are talking the same language, it becomes
very difficult to deal with.
Chairman Sarbanes. But we need some factual basis if you
are going to----
Ms. Feingold. We are not changing the eligibility yet.
Using the same standards will provide you with the factual
basis.
Chairman Sarbanes. The same language.
Ms. Feingold. That comes later.
Chairman Sarbanes. Pardon?
Ms. Feingold. That comes later. Let me put it this way. If
the Area Median Income, say, is $50,000, so 50 percent of the
Area Median Income is $25,000, that is the HUD eligibility
ceiling. Perhaps the Medicaid eligibility ceiling is $10,000.
There is a huge gap. We are not saying yet, fill the gap. We
are just saying, at least talk the same language so that
people----
Chairman Sarbanes. I am just trying to find out some figure
as to the cost if you were to talk the same language. That is
all.
You are advocating talking the same language. And an
important factor in judging that, presumably, amongst other
things, is what the cost would be.
Ms. Feingold. Only if you then changed the eligibility.
Right?
Chairman Sarbanes. That is the only way you could talk the
same language.
Ms. Feingold. No, no. Right now, if you have decided in
your State that the Medicaid eligibility threshold is $10,000,
and you define it as 100 percent of poverty, you could also
describe it as 20 percent of the Area Median Income. The same
number of dollars could be described as 20 percent of Area
Median Income or 100 percent of poverty.
Chairman Sarbanes. So, then, what follows from that?
Ms. Feingold. What would follow is one would look at it and
say, well, what makes sense? And you could then decide that it
doesn't make sense to go much above that, or one could decide
it should go up 10 or 20 percent, and then one could cost it
out. Just changing the vocabulary doesn't change the money.
Chairman Sarbanes. What is the purpose of changing the
vocabulary if it is not going to change the money?
Ms. Feingold. So that the person who works for me and has
to recertify the housing eligibility of our tenants every year,
also knows without calling somebody else up in another agency
who is eligible for what.
HUD housing uses Area Median Income as a standard. And if
people's eligibility for services were based on Area Median
Income, we would know who in our buildings was eligible for
what. We would not have to have them certified for eligibility
by another agency.
Chairman Sarbanes. So, you all talk about predatory
lending. Abusive lending practices I think is the phrase that
is used in the Report, targeting seniors. This is an issue in
which this Committee has taken a keen interest. And we found in
a series of hearings that elderly homeowners are particular
targets of predatory lending, often because they have
accumulated a lot of equity in the course of their lifetime.
What did the Commission find in its hearings and research
regarding abusive lending practices?
Ms. Feingold. John, do you want to take that?
Mr. Erickson. We found that the large entities like Fannie
Mae and the rest have actually developed very comprehensive
programs and they have been pretty good at policing to see that
there are no predatory practices.
Certainly in the small, less national policies, you could
still have some abuse. But the reverse mortgage program is much
more detailed and spelled out so that seniors know what they
are getting into if they are using mortgages at a late time in
life to finance their health costs or some of their ability to
stay at home.
So the disclosure policies have gotten much stronger. It is
an area that we did not find widespread abuse, but it was one
of the areas that did come up and we said that we should be
particularly cautious about making sure seniors are not
targeted because they do not have any earnings capacity if they
do make a bad mistake.
Chairman Sarbanes. Well, the AARP, of course, has taken a
keen interest in this issue and we have been trying to work
closely with them on it.
We have found evidence of repeated exploitation of the
elderly, which results in the equity being literally stripped
away from them through excessive fees, repeated refinancing,
single-premium credit insurance that is built in, things of
that sort. In fact, some of the more responsible lenders in the
field have now ruled out some of these practices, which is a
real step forward and an encouraging development. We have some
legislation in that we want to take a look at.
But there are some very sharp and fast operators who just
really make victims out of the elderly, and the elderly seem to
be one of their target groups for exploiting. We are quite
concerned about that issue.
How much work did you do on the question of senior housing
in public housing?
Ms. Feingold. The largest number of low-income people
living in Government-assisted housing live in public housing.
And we are very concerned about that group.
The Minority Report stresses the need for moving services
into public housing, for the ability to renovate and retrofit
public housing so that it can do a better job of housing
seniors.
I do not believe we heard a great deal of testimony, but it
was very clear in looking at the data that we saw. We also have
among our Commissioners Mr. Thomas, who is the Director of the
Seattle, Washington, public housing authority and very active
nationally in housing authority organizations. He brought us a
lot of the information about this.
It is a serious problem and our recommendations are that we
reestablish public housing production programs for seniors. We
recommend that, contingent on a large increase in Section 202
authorization, public housing authorities be made eligible to
use those funds. We do not recommend this change if funding
remains at today's limited levels because there is a large
community of developers, nonprofit sponsors who make very good
use of the Section 202 program.
But this is a program that really works, and when we get
enough of it out on the street, we think that public housing
authorities who exist in some 3,400 communities around the
country are well-placed to become developers of senior housing
using that program.
Chairman Sarbanes. Does the Commission have a view on
whether housing for the elderly should be, to what extent it
should be for the elderly and to what extent the elderly should
be in an affordable housing complex which embraces the
nonelderly as well?
Ms. Feingold. I think the watchword of the Commission was
choice. These are not mutually exclusive. There are some
elderly who want to live in seniors-only housing. There are
some elders who love living in a mixed-age community or a
mixed-income community. The need is enormous. We should meet it
in every way we possibly can.
Chairman Sarbanes. In the public housing reform bill we did
just a couple of years ago, there was an effort to move toward
greater diversity of income of the tenants.
Now this runs counter to the proposition that you should
take care of the poorest first because it means you would have
people in the affordable housing context who were not at the
very bottom of the income scale.
The argument that was made on its behalf was that a better
mix community in income terms--we are still talking about low-
income people. It is a question of whether you are talking
about just the very lowest or whether it is a mix in a somewhat
broader context.
The argument was that that more diversified community would
be more stable, that you would have leadership models that
would be present in the community and that would therefore have
an impact on a more stable housing environment.
There are good arguments in both directions, I think. But
does the same issue arise with respect to senior housing, as
you see it?
Ms. Feingold. Most of my buildings are 100 percent low
income. I have one building that is 15 percent market.
Chairman Sarbanes. Let's not go there. I mean, let's not go
to market.
Ms. Feingold. Market is pretty low. It is just not as low
as low.
Chairman Sarbanes. When you say low income, do you take the
lowest income first?
Ms. Feingold. We are required to take a certain proportion
of our tenants with 30 percent of median income.
Chairman Sarbanes. Right.
Ms. Feingold. We have the same----
Chairman Sarbanes. Presumably, all of your tenants could be
at 30 percent of median income.
Ms. Feingold. Absolutely.
Chairman Sarbanes. All right. Well, why don't you do that?
Why don't you take the very poorest first?
Ms. Feingold. Well, if you are asking me literally, because
I am governed by rules that say that I have to take people in
chronological order that they get on my waiting list. In fact--
--
Chairman Sarbanes. Do you think that you should take----
Ms. Feingold. --most of our tenants are at 30 percent. I
mean, that is why we have tenants whose median income is
$10,000 a year. Most of our tenants are extremely low income.
Chairman Sarbanes. Do you think that in some way weakens
the ability to have a stable housing environment as opposed to
having more of a mix of income?
Ms. Feingold. In senior housing, I do not think that this
is as much of a problem as it is in family housing.
Again, this is an area where I do not see a need to choose.
I do not see a need to say, it all must be mixed income or it
all must be very low income. My experience is that both work.
The bottom line is an issue of need and how vast the need
is. Whatever way we go about meeting the need is what we need
to do. And to get hung up on which is the best way when both
are good, I think is not productive.
Chairman Sarbanes. I don't really quarrel with that, and I
am one who is strongly committed to trying to get more
resources into affordable housing.
Ms. Feingold. Good.
Chairman Sarbanes. But as long as the resources fall well
short of the need, the kind of questions I have just been
putting are going to continue to come to the fore.
Ms. Feingold. I know.
Chairman Sarbanes. And that is why I was really trying to
explore your thinking on that part.
How are we going to coordinate the housing needs and the
health care needs? What are the prime recommendations you would
make in order to accomplish that objective?
Ms. Feingold. Well, we come down very strongly, both the
Majority and the Minority Report come down very strongly on the
value of service coordination. Service coordinators are people
who are staff in senior housing who know the resources in the
community. For years, I have been hiring them, calling them
brokers. They link users with resources. That works on the
ground.
We would like to create programs that work, so that it is
not constantly an exercise in creativity to make it work.
In the State of Massachusetts, we have a number of both
State-funded and Federally-funded service programs which
service coordinators link. In some cases, we can run an entire
program in a housing building. But in many cases, you have to
do it person-by-person-by-person.
In our Report, as I say, we come down strongly on the need
for service coordinators who become expert in what is available
in their areas and how to assess people for their needs and
link them with services.
We are also recommending in the Minority Report a program
that would enable housing sponsors to access both service money
and HUD housing money in one application.
We are suggesting to you that an allocation from HHS, from
DOT, from the Administration on Aging--that there be funds
appropriated to those agencies and then provided to HUD, so
that if I come in applying for funding to build a supportive
housing development, I go to HUD and I say, I need X-number of
dollars to build it. I need Y-number of dollars to subsidize
the rents. I need Z-number of dollars to run transportation. I
need V-number of dollars to run a meal site.
These are all pieces of funding money that currently come
from different agencies. If a piece of money was coming from
the agency to HUD so that a single application from a sponsor
could access those funds, you would go a long way to making it
easy for housers to see that their residents are getting the
services that they need.
Look, the bottom line is we have a Government structure
that separates functions. The silo term has become old hat.
When I was first appointed to this Commission, I thought,
great, we are going to figure out a way to punch holes in the
silos. I had to give up on that.
What we are looking for now are the small ways in which we
can make the silos work for us rather than creating constant
barriers. And one way is to have these pots of money that all
go to a coherent program that is administered through HUD,
using the same standards each program establishes. For example,
the recipients of services would still have to qualify for
Medicaid.
The housing sponsor who is getting this piece of Medicaid
funding which is coming from HHS to HUD to the housing sponsor
will still have to follow the rules that govern that money. But
the money will come to one place in one application. You will
make it immensely easier to carry out the coordination of
housing and services that you are interested in. So, we are
recommending that you do a demonstration program of this kind.
Mr. Erickson. Senator.
Chairman Sarbanes. Yes, John.
Mr. Erickson. This is even more important for the 96
percent of seniors that are not in public housing that are
either in private rental, or whatever.
If you look at the vast majority, that 96 percent that are
in other forms of housing, the ability to begin demonstration
programs that would capitate Medicare payments and do earlier
interventions would have a huge impact. The ability to have
primary care at an early point instead of urgent care in
hospitals, would shift dollars and make seniors have a much
higher quality of life.
Currently, capitation rules are limited under Medicare by
an entire county instead of by groups.
And so, we recommended being able to break that down into
much smaller entities, even a thousand seniors at a time, to
say, you put in a full-service program under capitation and try
and cost this and see if you can do a better delivery service
and move from acute care and institutional care to home and
community care.
Chairman Sarbanes. Well, this has been an extremely helpful
panel and we very much appreciate the Commission's work and the
Report, which is about to be published, I guess.
When will it be published?
Mr. Erickson. We submit tomorrow and it should be printed
over the weekend.
Chairman Sarbanes. I thank not only the two of you, but
also all of the Commissioners and the staff for the
contributions they have made. I think that it is going to
contribute significantly to the dialogue as we try to meet this
challenge, which I think is an extremely important one.
Ms. Feingold. Thank you so much, Chairman Sarbanes. I would
like to offer to the Committee staff who are here the time of
Dr. Golant, who is here for a little while longer. And those of
you who have questions about the research, he is available to
you now.
Chairman Sarbanes. Yes. We appreciate that very much.
Mr. Erickson. Thank you, Senator Sarbanes.
Chairman Sarbanes. The hearing stands adjourned.
[Whereupon, at 11:50 a.m., the hearing was adjourned.]
[Prepared statements supplied for the record follow:]
PREPARED STATEMENT OF SENATOR WAYNE ALLARD
I want to thank the Chairman for holding this hearing. I appreciate
the opportunity to hear a preview of the Commission's Report today.
In 1999, Congress created the Commission on Affordable Housing and
Health Facility Needs for Seniors in the 21st Century. I was pleased to
be able to help select some of the Commissioners. I was particularly
pleased to nominate Rita Poundstone to serve as a Commissioner. Rita
works at the Colorado Housing and Finance Authority, an organization I
have worked with closely over the years.
Over the past 2 years, the Commission has held hearings and public
forums all over the country, commissioned the collection of data and
compiled data on housing and services for seniors, and created a set of
recommendations for Congress. We are here today to hear these
recommendations which will help Congress address the needs of this
increasing population of seniors in our country over the next decades.
Over the years, the Congress has enacted some very strong and
effective housing programs, such as the Low-Income Housing Tax Credit
and Section 8 Voucher programs. These, and other programs, meet the
housing needs of many Americans, including seniors. I am interested to
hear from the Commissioners and to read in the final Commission Report
suggestions for continuing to met the needs of seniors in our country.
Thank you, Mr. Chairman.
----------
PREPARED STATEMENT OF SENATOR JACK REED
Mr. Chairman, thank you for holding this hearing today.
We are happy that Co-Chairman Feingold and Commissioner Erickson of
the Seniors Commission are here today to talk about such an important
issue--the housing and health facility needs of our Nation's elderly.
We are looking forward to hearing your recommendations about how to
address these needs.
This is an issue near and dear to my heart. In my own State of
Rhode Island, almost one-fifth of our residents are over the age of 60.
Approximately 10 percent of Rhode Island's seniors are currently living
in subsidized housing and many more are currently on the waiting lists
for such housing.
About 31 percent of Rhode Island's seniors are paying more than 40
percent of their income toward their housing. For those over the age of
75, 36 percent are paying over 40 percent for their housing.
As the Commissioners are going to testify today, not only do we
need to start building more units of affordable housing for the Baby
Boomers that are beginning to enter their senior years, but we also
need to work together to preserve existing affordable housing for
seniors.
I believe this is one of the most important issues before the
Congress at the moment--how we can preserve our existing senior housing
stock without losing more of it to market forces. In my own State,
approximately 11 percent of Rhode Island's affordable senior housing is
currently in danger of being lost to the market.
In addition to struggling with the affordable housing issues, many
seniors are struggling to obtain health care services. As our seniors
live longer, they are having a harder time meeting their long-term
health care needs, even when they are Medicare eligible.
We clearly have a problem. I look forward to the Commission's
advice and recommendations regarding how the Government can help
promote, encourage, and if necessary, create elderly housing with
services for some of our Nation's most vulnerable citizens.
Most seniors want to remain in their own homes as long as possible.
This is not only the best choice for them, it is also the best choice
for the American taxpayer.
----------
PREPARED STATEMENT OF SENATOR JON S. CORZINE
Mr. Chairman, I am very pleased that the Committee is holding this
important and timely hearing today to discuss what is a growing crisis
in our country--the crisis in long-term care. As we will hear from the
Commission's Co-Chairs, our country not only faces a long-term health
care crisis, but also a long-term housing crisis. Indeed, as the
Commission's preliminary findings show, housing and health needs for
our Nation's seniors are inextricably linked. We cannot adequately
address the health needs of our Nation's growing elderly population
without providing them
access to affordable housing.
In the next 30 years, the senior population will grow to more than
20 percent of the U.S. population. Currently, 20 percent of seniors
have significant long-term care needs, and as our population lives
longer this number will only increase. Low-income families nationwide
face severe housing problems, particularly in New Jersey where rental
costs are among the highest in the Nation. But, seniors, particularly
elderly women who generally outlive their spouses and are more likely
to live alone, face especially complex housing problems. Fifty-seven
percent of seniors who rent pay more than 30 percent of their income
for housing and are likely to have significant health care needs.
Eighteen percent of seniors need assistance with at least one daily
activity, such as bathing or cooking. Too many of these seniors,
however, lack access to the
support services they need to help them ``age in place.'' As a result
of a shortage of supportive housing and limited access to community-
based services, too many of our seniors have been institutionalized, a
measure that is both costly and sometimes unnecessary.
While most States provide access to certain home-based care
services for elderly Medicaid recipients, these services are not
guaranteed and are only available to very low-income seniors. Forty
percent of our senior population has an income below 50 percent of the
Area Median Income. Yet many of these seniors are not Medicaid
eligible, and are too poor to pay for home care services or assisted
living. And, for those who are eligible for Federally-subsidized
supportive housing, there is too often a long waiting list.
Nationally, for every one senior living in subsidized housing,
there are an additional six seniors on waiting lists for such housing.
In New Jersey, there are nine applicants for every one available
Section 202 unit. According to the Commission's preliminary findings,
in order to keep pace with this 6 to 1 ratio, we will need to create an
additional 730,000 additional rent-assisted units by 2020. And that is
what we need just to maintain the status quo. The need for affordable
housing production cannot be understated. There are currently 1.4
million elderly households that are currently eligible for Federally-
subsidized housing but are not receiving it.
Mr. Chairman, we have a crisis in this country today that will only
continue to worsen. As the Commission's findings demonstrate, the
puzzle of meeting seniors' housing and health care needs requires not
only creative solutions, but will also require a significant investment
in the production of affordable and supportive housing that will enable
our seniors to age with dignity.
Thank you, Mr. Chairman. I look forward to hearing from our panel.
----------
PREPARED STATEMENT OF ELLEN FEINGOLD
Co-Chair, Commission on Affordable Housing and Health Facility Needs
for Seniors in the 21st Century
June 27, 2002
I am Ellen Feingold, Co-Chair of the Commission on Affordable
Housing and Health Facility Needs for Seniors in the 21st Century and
also President of Jewish Community Housing for the Elderly, a nonprofit
nonsectarian developer, owner, and manager of over 1,000 units of
Government-funded housing for low-income elders in the Boston area.
I want to thank the Committee and especially Chairman Sarbanes for
inviting me and my Co-Chair Nancy Hooks to testify before you today. I
also want to take this opportunity to thank Congressman Barney Frank
who, together with Senators John Kerry and Barbara Mikulski and
Congressman Alan Mollohan gave me the great honor of serving on this
Commission and the opportunity to work with my fellow Commissioners
toward ensuring that our Nation's elders are well-housed and have the
health and supportive services they need as we move through the 21st
century.
I come before you as someone who has dealt with the problem of
providing decent supportive housing for elderly persons every day for
over 20 years. JCHE's residents' average age is over 80, and their
incomes average around $10,000 a year. They are very old, very poor,
and increasingly frail. I know first-hand how valuable the tools are
that the Federal Government has given us to work with, and in the
Commission's Report we describe the ways these tools are being used
innovatively to create housing environments in which people can grow
old safely, with dignity, and with the supports they need to be as
independent as possible.
But we also know how inadequate the quantity of resources we have
are NOW. My organization has 1,050 apartments, all occupied all the
time, and 1,800 people on our waiting list at any one time. Every day,
people call me and my staff, pleading for housing for themselves or
their family members. Often, your staff call me and my colleagues in
your States on behalf of your constituents who are frantic with worry
and need. The Commission Report has numbers and statistics describing
what has become a crisis; but I hear the need from desperate seniors
first-hand, as do you. What do you tell them? I have to tell them it
will take years before there will be a JCHE apartment for them. Can you
imagine telling an 80-year-old that they will have to wait 6 years for
an apartment? This need for decent, supportive, affordable housing is
not an abstract issue. These are real people, our own parents and
grandparents, and their need is critical and urgent.
The Commission heard this story over and over--and we heard how
very grateful seniors who live in Government-assisted housing are for
their quality affordable housing, and we heard over and over that what
is needed is MORE.
The Commission is presenting to you a piece of groundbreaking
research, in which Dr. Stephen Golant of the University of Florida
quantified today's housing need, and projected this need in 2020. In
Part III of the Commission Report, Key Findings and Projections, you
will find a summary of his work, and his analysis of the need and the
full report is in the Appendix. Dr. Golant found that, for every rent-
assisted unit currently occupied by a senior, there are almost six
seniors with housing problems--either due to affordability, or poor
conditions, or other problems--who cannot access decent, affordable
housing.
The Commission's Minority supports most of the Commission Report--
its findings and many of its recommendations.
This Minority Report goes beyond the Majority Report in calling for
greatly increased housing production goals, for using our resources
first to meet the needs of the poorest and frailest seniors, for major
changes in the systems for providing and funding services to seniors,
and for a commitment to providing the major increase in funding that
these changes will require. We believe that the only way that our
Nation can meet the anticipated crisis in supply is by starting NOW to
meet today's huge need.
Just how great is the need? Looking at Dr. Golant's Exhibit I (Part
III, page 3), you will see that there are currently 1.2 million
Government-subsidized rental units housing 1.3 million seniors. Exhibit
8 (Part III, page 9) shows that there are currently 6.1 million very
low- and extremely low-income seniors with priority housing problems
who are NOT living in those 1.2 million units. In other words, today's
gap is 6.1 million units. Even assuming that only one-half or one-third
or even one-quarter of those 6.1 million urgently needy very poor
seniors want to live in decent rent-assisted housing, you can see we
are looking at a current deficit of 1.5 million to 3 million units.
Projecting to 2020, and such projections are, of course, very
approximate and subject to all kinds of caveats, Dr. Golant estimates
there will be 9.5 million very low- and extremely low-income seniors
with priority housing problems. Again, assuming that only one-quarter
of those seniors want to live in rent-assisted housing, this means we
should produce 2.4 million units over the next 17 years, or 140,000
units a year, if we want to be able to provide decent affordable
supportive housing to the country's seniors in 2020.
Those numbers are huge! Suppose we do the same set of calculations
just looking at very low- and extremely low-income renters with
priority housing problems. Today, there are 2.4 million seniors in that
category, NOT living in rent-assisted housing. Since they are renters,
one could predict that a higher proportion of them would live in rent-
assisted housing if it was available. If half of them would do so, this
means today's deficit for renters is 1.2 million units.
Dr. Golant estimates that in 2020 there will be 3.2 million very
low- and extremely low-income renters with priority housing problems.
To provide decent affordable supportive housing to half of them, we
should produce 94,000 units a year between now and 2020.
It is in the context of these numbers that the Commission Minority
recommends to Congress that it authorize and fund an immediate
production goal for subsidized elderly housing with supportive services
of at least 60,000 units a year for the foreseeable future. This
housing could be developed through the highly successful Section 202
program, the Rural Housing Service's Section 515 program, public
housing programs, and the low-income units in tax credit developments.
You might then ask the question: If we assume that it might take
94,000 units a year to house those very poor senior renters with unmet
priority housing needs, and as many as an additional 46,000 units for
very poor home owners with priority housing problems who might want to
move to such housing, why recommend only 60,000 units a year? It is the
Minority's view that it will take time and effort to gear up at all
levels--administration, producer capacity, regulatory, etc.--to be able
to utilize an authorization of even 60,000 units. This is a big jump in
Federal commitment--for example, this year's Section 202 authorization
was for only 5,800 units, just a few hundred for Section 515, and no
additional public housing units. The 60,000 units will be a serious
start to meeting both today's and tomorrow's needs. But less than that
would indicate an avoidance, a failure of will in heading off the
crisis.
The Minority also recommends major funding of at least $200 million
for the Affordable Housing Preservation Act to stem the potential loss
of any of the 324,000 affordable elderly housing units at risk.
With respect to the health and supportive services that seniors
need to enable them to age well in place, the Minority recommends a
number of short-term and long-term steps.
First, we make a series of recommendations that are similar to
those in the Majority Report to strengthen the highly successful
Service Coordination Program in senior housing: That the HUD Service
Coordinator grant program be expanded to all Federally-assisted low-
income housing and its funding increased to a realistic level; that
public housing authorities be funded to enable them to contract for
services to their elderly residents; that Medicaid Home- and Community-
Based Services waiver funds be guaranteed for supportive services in
all Federally-assisted senior housing, including those projects
utilizing the Assisted Living Conversion Program; and a number of
others.
More basic, it is obvious that the current Federal agency
structure, in which housing and the various services seniors need are
provided separately by separate Government departments which are
governed by separate Congressional Committees and separate OMB
sections, does not lend itself to well-integrated and coordinated
housing and service programs. When the Commission began its work, I
thought this would be the single most important focus of our work.
However, the Commission's limited time-frame and mandate militated
against in-depth consideration of structural reorganization proposals.
Instead, the Minority proposes a number of concrete steps that will
begin the process of creating a coordinated system.
For example, the Minority recommends a simple change that will make
eligibility determinations in HUD-funded and HHS-funded programs easier
to coordinate. Currently, HUD determines program eligibility according
to the regionally sensitive Area Median Income standard. HHS programs
use a national standard--either the Federal Poverty Level or the
Supplemental Security Income level. The Minority recommends that HHS
program eligibility be based on the Area Median Income to facilitate
the linking of HUD and HHS programs.
Similarly, the Minority recommends that HUD and HHS jointly develop
a uniform definition of assisted living and assisted living services
for seniors.
In another more ground-breaking example, the Minority recommends a
new Aging in Place demonstration program that links funds provided
through the HHS Home- and Community-Based Service waivers and other
Federal senior supportive service programs (through AoA and DOT, for
example), with HUD and RHS rent subsidies to support aging-in-place
strategies for frail residents.
These are small steps that can perhaps lead to far greater linkages
among the programs that help support successful aging.
And finally, recognizing that the principal payment systems for
services and health care for seniors are the Medicare and Medicaid
programs, the Minority offers two recommendations that will begin the
transformation of these programs for the 21st Century.
First, we join the call for a Medicare Prescription Drug Benefit.
The new wonder drugs available today have made possible declining
hospital utilization rates as more and more serious conditions can be
treated out of the hospital. But seniors often cannot afford these
drugs and therefore wind up requiring the far more expensive hospital
care. The Prescription Drug Benefit has become an essential prong of a
comprehensive and cost-effective health policy. Likewise, the success
of today's health care measures is evident in keeping seniors alive and
relatively well-functioning for many years longer, but brings with it a
need for home care for the resulting chronic conditions and
disabilities. Again, without necessary home care, seniors will wind up
in much more expensive hospital care. The Minority, therefore,
recommends an expansion of Medicare coverage to include chronic and
long-term care and prescription drugs.
Similarly, the relatively complete coverage that Medicaid provides
to low-income seniors does not require that Home- and Community-Based
Services be provided on an equal basis with institutional care and
other Medicaid entitlements. Since Medicaid is a joint Federal-State
program within which States have wide latitude in designing their
program, there has been a reluctance to impose a new entitlement on
States. The Minority believes that putting Home- and Community-Based
Services on an equal footing with institutional care will, in the long
run, save money, as it will avoid the far more expensive institutional
care. More important, it will respect the dignity and choice of seniors
who wish to remain in their own homes as long as possible. It will also
enable States to respond positively to the mandate of the Supreme
Court's Olmstead decision that individuals have the right to choose to
live in the least restrictive environment that will meet their needs.
The Minority also stresses the importance of adequate training and
pay scales for the workers who provide services to seniors and we
provide a series of recommendations to improve their working
conditions.
In closing, you gave the Commission an enormous mandate, to look
ahead at a problem that is clearly and dramatically growing in scope.
The Minority believes that denial and wishful thinking have no place in
trying to solve a problem. We believe that Members of Congress asked to
know the scope of the problem and the hard realities of its solution.
The country's unprecedented success that makes possible many more years
of life for the elderly of our country than were even dreamed about
just a generation ago has created an unprecedented demand for housing
and health and supportive services. The hard reality is that there are
unprecedented costs involved in meeting this demand.
This country has the resources to pay these costs. The country uses
them according to our priorities and our commitments. We have used our
resources with extraordinary success to create the highest rate of
homeownership in the developed world by permitting the interest we pay
on home mortgages to be tax deductible--a subsidy amounting to $60 to
$90 billion in 1999. We must now begin to bring parity in resource
allocation to the housing and service needs of low-income elders that
we brought to stimulating homeownership.
The Minority urges Congress to commit the Nation once again to
assuring a good old age for its seniors who have contributed so much.
The effort of this Commission, both Majority and Minority members,
has been to provide Congress with information and with new tools to
address the crisis ahead. We have participated in a nationwide dialogue
which we have reported to you. It is our hope that the outcome will
result in better health and greater independence for the huge numbers
of elderly people who will surely need both.
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PREPARED STATEMENT OF NANCY HOOKS
Co-Chair, Commission on Affordable Housing and Health Facility Needs
for Seniors in the 21st Century
June 27, 2002
Please note: Since Ms. Nancy Hooks was not able to be present at
the hearing, her testimony was presented by Mr. John Erickson,
Commissioner, Commission on Affordable Housing and Health Facility
Needs for Seniors in the 21st Century.
Chairman Sarbanes, Senator Gramm, Members of the Committee--thank
you for holding this hearing to receive testimony regarding the
impending Report of the Commission on Affordable Housing and Health
Facility Needs for Seniors in the 21st Century--the Seniors Commission.
I am Nancy Hooks of Albany, New York, and for the past 18 months I
have Co-Chaired the Seniors Commission. It is a great honor to have
been selected for this important mission and to be invited to share our
key findings with you.
Like many of my colleagues on the Commission, I have dedicated my
professional life to helping seniors live with a sense of fulfillment
and of dignity. As fourteen Commissioners, with vastly different
backgrounds, occupations, and life experiences, from 11 different
States, we brought a great deal of diversity of opinion to this
responsibility--and that diversity is a strength that has led us to an
array of thoughtful recommendations. Our Report reflects a wide range
of perspectives and solutions to some extraordinarily pressing
problems. We offer over 40 specific recommendations and a wealth of new
data to lay the groundwork for the changes that are
needed if we are to provide Americans with the assurance that they will
not be abandoned in their later years.
Mr. Chairman, our Congressional mandate laid out extensive
expectations, and I am pleased to report on the vigorous effort that
has been undertaken to meet them. I would like to begin by explaining
how we have evolved. Created in the fall of 1999 by bipartisan
legislation sponsored by former Congressman Rick Lazio, the Seniors
Commission was not formally appointed until January 2, 2001. And we
recognized
our creation as a rare opportunity to be proactive--to be creative.
Serving the
overwhelming and diverse population to come is a task requiring
considerable
preparatory work--it cannot be handled overnight and ``more money'' is
an oversimplified and inadequate solution. Rather, the task will
necessitate substantial changes in Federal, State, and local policies,
service delivery and funding.
Throughout 2001, the Seniors Commission launched a nationwide
dialogue on senior housing, health care, and supportive service issues.
We organized and we conducted a series of coast-to-coast field hearings
that resulted in our exposure to some of the most innovative thinking
and best practices impacting the lives of seniors today.
In Syracuse, NY, Columbus, OH, San Diego, CA, Miami, FL, and
Baltimore, MD, we listened not just to policy experts, researchers,
demographers, Government officials, civic leaders, professionals and
care providers, but to seniors themselves. At each of our five, day-
long field hearings we allocated time in the program to allow every
concerned senior present to address the Commission. We listened closely
and were moved deeply as seniors and their loved ones told us, in their
own compelling words, about the housing and health challenges they face
each and every day.
As a result, the Commission learned that the needs of seniors are
quite diverse and that the ways in which those needs may be met are
equally diverse. We learned that there are policies that work for many,
but not necessarily for all. What works in some cities does not
necessarily work in others or in rural or suburban areas. What works
for some seniors doesn't for others, or is unavailable altogether. We
learned that many Government programs do not function collaboratively,
and that their failure to do so imposes added burdens on the very
individuals they are intended to help. We learned that Government, the
private sector, nonprofits, and faith-based organizations can and must
do more today to address the existing and future needs of our growing
senior population.
The Seniors Commission's national dialogue highlighted what we
consider to be America's ``quiet crisis''--the senior housing and
health care challenges we will face as the Baby Boomer generation
reaches retirement age. Today, as we summarize our key findings, the
Seniors Commission urges broad acknowledgement of this crisis. The
legacy of this panel, and that for which each Commissioner hopes, is
for Congress, the Administration, State and local government, the
private sector, nonprofits and faith-based organizations to recognize
that responding to the senior housing and health concerns we have
identified must be a national priority. President Bush, in his recently
announced, progressive housing initiative to promote homeownership and
to increase the supply of affordable homes, has demonstrated his
leadership by identifying housing as a national imperative.
The Commission's Report contains data reflecting the present needs
of seniors and how they are met, and allows us to predict the range of
future need. Today, nearly 68 percent of Americans own their own home,
and that figure is over 80 percent among those aged 50 and above.
Further, of those aged 50+ homeowners, 58 percent own their home free
and clear.\1\ This pattern is likely to prevail in the future, perhaps
to an even greater extent if our projections hold true. Aware of this,
the Commission took a serious look at health policy, especially with
regard to long-term care affordability, availability, and
accessibility. It is apparent that health policy, especially long-term
care, compels individuals to leave their homes to receive care, favors
institutional settings and is often prohibitively expensive. Therefore,
the Commission strongly recommends encouraging the provision of the
Home- and Community-Based Services (HCBS).
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\1\ United States Census, Housing Vacancy Survey, First Quarter,
April 2002, Graph of Homeownership Rates.
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The senior population is expected to grow dramatically over the
next 30 years due to the aging Baby Boomer generation. In 2011, this
generation will begin to retire. By 2020, they will number close to 54
million and by 2030, they are expected to number 70 million. One in
five Americans will be a senior.\2\ America's future seniors are now in
their 30's, 40's, and 50's. In 9 short years, the first wave of this
generation will reach age 65, and begin to test our Nation's senior
resources.
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\2\ Older Americans 2000: Key Indicators of Well-Being, Federal
Agency Forum on Aging-
Related Statistics (August 2000): Indicator I. http://
www.agingstats.gov/chartbook2000/
population.html
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The prime focus of our mandate is housing and health facility
needs. Housing and health-related needs data is vital to producing a
picture of the future needs of senior Americans. Information on income
and Federal investment is also important to a thorough analysis. Both
factors give context to the scope of need demonstrated by existing
housing and health data. The income of seniors is an essential factor
in predicting their ability to cope with the challenges of aging.
A key trend is the gradual percentage reduction in the low-income
and poverty level population. In general, we expect the Baby Boomers to
begin their retirement years in a better financial position than that
of their parents. They will be a generation of consumers who are
accustomed to personal independence, financial planning, and consumer
choice--their needs and expectations will differ greatly from those of
our current seniors, as will their health, wealth, and social
attributes. While this trend is expected to continue, the large volume
of Baby Boomers moving through the various age cohorts during the
period beyond 2010 will, nevertheless, test the limits of our housing
and health system. Even if increasing incomes are assumed, large
numbers of low-income seniors will continue to require significant
assistance, and many middle-income seniors will find themselves on the
precipice of hardship due to some unforeseen health or housing expenses
that may not be addressed by present policy.
The different forms of assistance, the different benefits offered
in each Government application, and the different income qualifications
impact numerous seniors. Rent-assisted housing often has the broadest
eligibility of the means-tested programs because of the Department of
Housing and Urban Development's use of Area Median Income (AMI) as a
guide. Medicaid, on the other hand, uses variations of Supplemental
Security Income eligibility that relate to the Federal Poverty Level
(FPL).\3\ In many areas of the Nation, the differing standards do not
make a great difference. However, in high-cost areas, they are very
important, because the HUD standard tends to be more lenient, creating
a disparity between eligibility for housing and eligibility for the
types of health or health-related benefits many need, and that are only
subsidized effectively under Medicaid.\4\ In contrast, in other areas,
individuals are eligible for Medicaid, but not for subsidized housing.
The Commission addresses these complex issues in its recommendations.
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\3\ One hundred percent SSI is approximately 74 percent FPL; both
are national standards, with minor exceptions.
\4\ Robert Mollica, Personal Care Services: A Comparison of Four
States, AARP (March 2001).
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The Commission heard one, consistent message: Seniors wish to age
in place, which may mean in a private home, a congregate community, or
another location of their choosing. If it can be done safely and
efficiently, it should be done. We have always been a Nation that puts
a high value on liberty and choices. Smart policy, providing the
appropriate level of care and securing effective assistance in the home
can avoid premature placement in institutional settings and save scarce
resources for those who truly need the extensive and the very costly
level of care provided by those settings.
The Senate Aging Committee has recently conducted 13 hearings, and
has reported that Government program spending on long-term care will
absorb nearly 75 percent of all Federal revenues by the year 2030.\5\
Already, in 2001, State Medicaid programs paid about 62 percent of the
$137 billion spent nationally on long-term care.\6\ Key witnesses at
the June 20, 2002, Senate hearing suggested that our Government could
realize savings if Medicare and Medicaid funds could be blended to
evade service duplication and if States could utilize Medicare and
Medicaid funding to reimburse preventive care, thereby allowing seniors
to remain at home, as opposed to moving to more costly institutional
settings.\7\
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\5\ McKnight's Online Daily Update (June 24, 2002).
\6\ Lewin Group Report to the U.S. Department of Health and Human
Services, as reported in McKnight's Online Daily Update (June 24,
2002).
\7\ Senate Aging Committee Report, ``Aging Committee: Hearing
Finding Summary,'' as reported in McKnight's Online Daily Update (June
24, 2002).
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Modest assistance for home modifications or repairs can allow
seniors to remain in their homes, thereby reducing the need to build
additional, affordable rental housing properties. Furthermore, service-
related assistance for seniors, once again, in the home, allows them to
remain in the community, reducing the overall cost to taxpayers. In an
institutional setting, for many seniors receiving Government
assistance, the Government is paying for their housing and their health
services. By subsidizing health services in the home setting,
substantial savings are realized. Only in the most desperate of health
situations, does an institutional setting achieve real cost benefits.
Providing home-based assistance allows seniors to maintain their
independence and dignity, and it should be encouraged.
While there will always be a need for the skilled nursing facility
level of care, Home- and Community-Based Services offer an alternative
that is appropriate for most, except the very frail or seriously ill,
who do not have the benefit of informal caregivers and, therefore,
require intensive and extensive support. The Federal Government's
involvement in the funding of such services under the Medicaid program
largely began with the use of Medicaid waivers.\8\ Many State-funded
programs have also recognized HCBS.\9\ Although the greatest use of
HCBS has been to support the de-institutionalization and expansion of
community services for individuals with developmental disabilities, the
waivers have become increasingly useful as a means to finance services
for low-income seniors. States may also provide personal care services
through the ``Personal Care Option'' under Medicaid, though personal
care tends to be limited to nonmedical types of care.\10\
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\8\ Valerie Lewis, Medicaid Waivers: California's Use of a Federal
Option, Medi-Cal Policy Institute (March 2000): 5-6. http://
admin.chcf.org/documents/mcpi/medicaidwaivers.pdf
\9\ Enid Kassner, Loretta Williams, ``Taking Care of Their Own:
State-Funded Home- and Community-Based Care Programs for Older Persons,
AARP (1997). http://research.aarp.org/health/9704Xfunded.html
\10\ Robert Mollica, Enid Kassner, Personal Care Services: A
Comparison of Four States, AARP (2001), 1-2. http://research.aarp.org/
health/2001X04Xcare.pdf
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Commission research projects that, in 2020, 4.2 million seniors
will need personal care, including 2.4 million seniors with incomes
under 250 percent of the poverty level. Another 3.2 million will
require skilled home care with 2.3 million under 250 percent of
poverty. Coverage for such services under Federal and State programs
becomes more limited as income increases, since Medicare is far more
restrictive in its coverage of such services.\11\ Given the
unprecedented growth in need for these services and the present limited
levels of access to such services, the Commission has developed several
recommendations to improve the availability of services to seniors,
regardless of their residential setting.
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\11\ Mollica, 4.
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The Commission recommends that Congress encourage the States to
continue to develop Home- and Community-Based Services as the
preferable and cost-effective alternative to facility-based skilled
nursing care under the Medicaid Program. For example, enacting a
``shelter deduction'' will help HCBS gain parity with institutional
settings by changing the home from a liability in terms of qualifying
for assistance, to an asset that reduces the overall cost of providing
services by removing the costs associated with the institutional
component.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
The Commission also recommends that Congress examine ways in which
Home- and Community-Based Services can be modified to more efficiently
and effectively support services to seniors with chronic disabilities
or illnesses. The Commission believes that it is the reform, rather
than the reduction of Medicare spending, that has the potential for
savings.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
In addition, the Commission recommends private sector solutions. We
encourage Congress to provide incentives to purchase long-term care
insurance to reduce both the overwhelming out-of-pocket burden on
seniors and the pressure on the public support systems.
For many seniors, greater availability of, and investment in, long-
term care insurance will provide them with a more secure future and
allow them to save their
financial resources. It is important that diverse, quality products be
developed and promoted. Deductibility for long-term care insurance
should be a part of any future tax proposals.
I opened my remarks with a discussion of our health recommendations
since, as we delved into the issues, the level of frailties and the
fragmentation of services combined with the large number of senior
homeowners of all incomes indicated to us that perhaps health and
health-related services are a wider problem than the lack of affordable
housing. Clearly, however, there are shortages of affordable housing
and there is a need for more of it. There is also a need for such
housing to be modified or constructed with the needs of seniors in
mind.
To accommodate those seniors who cannot afford market rate housing,
there is clearly a need for more affordable housing production.
Although the American Housing Survey is, perhaps, the best data set
available on housing, several Commissioners identified serious flaws in
it, and additional research using other data sets, especially on
income, served to reinforce their concerns.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
These, coupled with the Harvard Joint Center for Housing Studies'
projections of greatly increased senior homeownership and an awareness
that, in some communities, subsidized housing units remain vacant,
raises a cautionary flag about proceeding too vigorously with housing
production.\12\
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\12\ State of the Nation's Housing 2001, Harvard Joint Center for
Housing Studies (2002), 29.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
What is clear is that shortages do exist, and in some communities
they are very serious. They are likely to continue unless relieved by
significant increases in production. Some of the key recommendations in
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our Report are:
f Preservation, modernization, and retrofitting of existing affordable
senior housing.
f Expansion of all types of assisted housing in order to meet market
demand.
f Expansion of the role of Government Sponsored Enterprises in
supporting senior housing needs.
f Encouragement of service-enriched, senior housing development by
streamlining regulatory processes and coordinating agencies that
interface in the provision of housing and services at the Federal,
State, and local levels.
f Redesign of programs to reflect the real needs of individual seniors,
while providing enough flexibility to ensure that localities have
the most appropriate tools to meet local needs, rather than
imposing ``one-size-fits-all'' solutions.
By moving in these directions, the needs of the growing senior
population can be met. To reiterate, our Report has more than forty
recommendations; it is our tool for change--a document that looks to
the future in a realistic manner. I encourage you to examine the
recommendations very closely and to explore their implications and
impacts.
Will Rogers once said, ``Even if you are on the right track, you
are gonna get run over if you just sit there.'' The members of the
Seniors Commission did not just sit there. And we believe our
recommendations will take the Nation farther down the track toward
ensuring affordable housing and addressing health facility needs for
seniors in the 21st Century.
Co-Chairing the Seniors Commission has been a valuable experience
and opportunity for me to participate in developing a comprehensive,
bipartisan and national policy statement on the issues I care about so
deeply, and I have enjoyed serving you and working to find solutions to
improve the lives of American seniors.
I thank you for this valuable opportunity.