<DOC>
[109 Senate Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:30792.wais]
S. Hrg. 109-670
MEETING THE HOUSING
AND SERVICE NEEDS OF SENIORS
=======================================================================
HEARING
before the
COMMITTEE ON
BANKING,HOUSING,AND URBAN AFFAIRS
UNITED STATES SENATE
ONE HUNDRED NINTH CONGRESS
FIRST SESSION
ON
EXAMINATION OF S. 705, TO ESTABLISH THE INTERAGENCY COUNCIL ON MEETING
THE HOUSING AND SERVICE NEEDS OF SENIORS
__________
JUNE 16, 2005
__________
Printed for the use of the Committee on Banking, Housing, and Urban
Affairs
Available at: http: //www.access.gpo.gov /congress /senate/
senate05sh.html
_____
U.S. GOVERNMENT PRINTING OFFICE
30-792 PDF WASHINGTON : 2006
_________________________________________________________________
For sale by the Superintendent of Documents, U.S. Government
Printing Office Internet: bookstore.gpo.gov Phone: toll free
(866) 512-1800; DC area (202) 512-1800 Fax: (202) 512-2250 Mail:
Stop SSOP, Washington, DC 20402-0001
COMMITTEE ON BANKING, HOUSING, AND URBAN AFFAIRS
RICHARD C. SHELBY, Alabama, Chairman
ROBERT F. BENNETT, Utah PAUL S. SARBANES, Maryland
WAYNE ALLARD, Colorado CHRISTOPHER J. DODD, Connecticut
MICHAEL B. ENZI, Wyoming TIM JOHNSON, South Dakota
CHUCK HAGEL, Nebraska JACK REED, Rhode Island
RICK SANTORUM, Pennsylvania CHARLES E. SCHUMER, New York
JIM BUNNING, Kentucky EVAN BAYH, Indiana
MIKE CRAPO, Idaho THOMAS R. CARPER, Delaware
JOHN E. SUNUNU, New Hampshire DEBBIE STABENOW, Michigan
ELIZABETH DOLE, North Carolina ROBERT MENENDEZ, New Jersey
MEL MARTINEZ, Florida
Kathleen L. Casey, Staff Director and Counsel
Steven B. Harris, Democratic Staff Director and Chief Counsel
Mark A. Calabria, Senior Professional Staff Member
Tewana Wilkerson, Legislative Assistant
Jonathan Miller, Democratic Professional Staff
Jennifer Fogel-Bublick, Democratic Counsel
Sarah Garrett, Democratic Legislative Assistant
Kara Stein, Democratic Legal Counsel
Joseph R. Kolinski, Chief Clerk and Computer Systems Administrator
George E. Whittle, Editor
(ii)
C O N T E N T S
----------
THURSDAY, JUNE 16, 2005
Page
Opening statement of Chairman Shelby............................. 1
Opening statements, comments, or prepared statements of:
Senator Sarbanes............................................. 2
Senator Allard............................................... 4
Senator Santorum............................................. 5
Senator Martinez............................................. 6
Senator Stabenow............................................. 13
Prepared statement....................................... 35
Senator Reed................................................. 17
WITNESSES
Alphonso Jackson, Secretary, U.S. Department of Housing and Urban
Development.................................................... 8
Prepared statement........................................... 35
Response to a written question of Senator Stabenow........... 73
Nelda Barnett, Member, Board of Directors, AARP.................. 19
Prepared statement........................................... 38
Dana Olson, Executive Director, Volunteers of America's Laurel
Manor Senior Residence, Colorado Springs, Colorado............. 21
Prepared statement........................................... 40
Stephen Proctor, President and CEO, PHI Retirement and Senior
Care Services, Camp Hill, PA................................... 23
Prepared statement........................................... 42
William T. Smith, Ph.D., Chair of the Board, American Association
of Homes and Services for the Aging (AAHSA).................... 24
Prepared statement........................................... 44
Terry Allton, Vice President of Support Services, National Church
Residences..................................................... 26
Prepared statement........................................... 46
Steve Protulis, Executive Director and Vice President, Elderly
Housing Development and Operations Corporation (EHDOC)......... 28
Prepared statement........................................... 49
David G. Wood, Director, Financial Markets and Community
Investment, U.S. Government Accountabilty Office............... 30
Prepared statement........................................... 54
Additional Material Supplied for the Record
Various letters submitted by Senator Paul S. Sarbanes............ 74
(iii)
MEETING THE HOUSING
AND SERVICE NEEDS OF SENIORS
----------
THURSDAY, JUNE 16, 2005
U.S. Senate,
Committee on Banking, Housing, and Urban Affairs,
Washington, DC.
The Committee met at 10:07 a.m., in room SD-538, Dirksen
Senate Office Building, Senator Richard C. Shelby (Chairman of
the Committee) presiding.
OPENING STATEMENT OF CHAIRMAN RICHARD C. SHELBY
Chairman Shelby. The hearing will come to order.
This morning, the Committee meets to hold a hearing
examining the coordination of the housing and service needs of
our Nation's seniors. While there are a variety of Federal
housing programs either targeted to seniors, or containing
special features for the elderly, few of these programs are
linked with other services, such as health care or
transportation, that are vital to the well-being of the
elderly. It is all too often left up to the elderly themselves
to make the connection across the various Federal, State, and
local programs designed to assist them.
My colleague, Senator Sarbanes, has introduced legislation,
S. 705, to address this very issue. Today, over 80 percent of
elderly families own their own homes. Almost three-fourths of
homeowners own their home free and clear of any mortgage. Many
seniors have a strong desire to age in place, and I believe
greater coordination of the programs can facilitate their
ability to do so.
In addition, many seniors are heavily dependent upon public
transportation in order to perform essential activities, such
as going to the supermarket or making a doctor's appointment.
However, over a third of elderly households report having no
access to public transportation. This lack of access is
particularly acute in many rural and suburban areas.
I want to note that the public transportation title of the
transportation bill which is pending now in the Senate as
reported out of this Committee and passed by overwhelming
support by the Senate, included significant increases, Mr.
Secretary, in Elderly and Disabled Program administered by the
Federal Transit Administration.
Once again, I want to commend my colleague, Senator
Sarbanes for his leadership on this issue. I also want to
recognize Senator Santorum's interest in this issue. We are
also fortunate to have a very distinguished group of witnesses
this morning.
Our first witness this morning will be someone who is no
stranger here; the Secretary of Housing and Urban Development,
Secretary Alphonso Jackson. The Committee, Mr. Secretary,
greatly appreciates your willingness to appear this morning and
your attention to this very important issue.
Our second panel will consist of Ms. Nelda Barnett, Board
Member, AARP, and former Director of the Maplebrook Village
Christian Homes of Kentucky, where she continues to serve on as
a Board Member; Ms. Dana Jo Olson, Executive Director, Laurel
Manor Senior Residence, appearing today on behalf of the
Volunteers of America; Mr. Steve Proctor, President,
Presbyterian Homes, and appearing on behalf of the Pennsylvania
Non Profit Housing Association; Dr. William T. Smith, President
of the American Association of Homes and Services for the
Aging; Ms. Terry Allton, Vice President of Support Services,
National Church Residences; Mr. Steve Protulis, Executive
Director, Elderly Housing Development and Operations
Corporation; and Mr. David G. Wood, Director for Financial
Markets and Community Investment, GAO.
I want to thank all of you for appearing here today, and we
all look forward to your testimony and having a dialogue with
you.
Senator Sarbanes.
STATEMENT OF SENATOR PAUL S. SARBANES
Senator Sarbanes. Thank you very much, Chairman Shelby. I
want to express my appreciation to you for holding this hearing
on S. 705, Meeting the Housing and Service Needs of Seniors
Act. I also want to recognize a group of seniors who have come
to the hearing from Marlow Heights, Maryland. We are pleased to
have them with us this morning. I want to thank all the
witnesses for the work they do every day to better the lives of
American seniors, and we look forward to hearing from them.
Unfortunately, much more needs to be done to ensure that our
elderly population has easy access to the housing and service
needs they require, particularly to allow them to age in place,
which is an important focus of this legislation.
The elderly population of this country is rapidly growing,
far outpacing the growth of any other age group. In 2000, the
population over 65 years of age was close to 35 million. The
number is expected to grow to over 50 million by 2020, and by
the year 2030, nearly one-fifth of the U.S. population will be
above the age of 65. We obviously need to start preparing to
meet the needs of this growing population so that seniors and
their families have real choices about where and how to age.
And that is exactly what the legislation we are considering
this morning will do. This legislation is designed to address
the fragmented government bureaucracy of programs for the
elderly so that seniors and their families can more easily
access needed support and remain in their homes.
We cannot put this off any longer. Each of us in the room
will be affected in one way or another. Every segment of our
society is affected. It is not just a problem of affordability,
although there is certainly an affordability problem. But the
problem is lack of availability and access that is increasingly
experienced by large segments of our elderly population.
Every survey has shown that seniors overwhelmingly want to
remain in their homes. They want to age in place, as they put
it, or age in noninstitutional settings. But in order to do
this, we have to better connect services to where seniors live.
Over 18 percent of senior citizens who do not reside in nursing
homes have difficulty performing their daily activities without
assistance. Over 1 million of these seniors are severely
impaired, requiring assistance with many basic tasks. Many
others, those who can perform their daily functions, still
require access to health care, transportation, and other
services. And the Congressionally established Seniors
Commission found in its 2000 report, ``the most striking
characteristic of seniors' housing and health care in this
country is the disconnection of one field from another.''
A recent AARP report also found this disconnect. According
to that report, ``today's subsidized rental housing is a
patchwork of disparate programs, which creates problems in
coordinating housing policy for diverse needs. For instance,
many properties that serve older persons are experiencing a
growing need for supportive services as the residents' age, but
delivery of these services vary from program to program.''
While there are numerous Federal programs that assist
seniors and their families in meeting these needs, they are
fragmented across many government agencies with little or no
coordination. We have a diagram that illustrates this
fragmentation. If this chart looks confusing, that is because
it is. That is exactly the state of play. Housing and services
are provided through different and often unconnected programs,
many with their own requirements and eligibilities.
This fragmentation has real consequences. The disconnect of
housing from services places an enormous burden on seniors and
their families in making decisions about long-term care.
Families must not only worry about the affordability of
housing, but they must also piece together health care,
transportation, physical assistance, and other services.
Without enhanced housing opportunities, seniors find it
increasingly difficult to remain outside of nursing homes or
other institutional settings. In fact, the Seniors Commission,
the Congressionally mandated study that I mentioned earlier,
found that, ``many seniors across the income spectrum are at a
risk of institutionalization or neglect due to declining health
and the loss or absence of support and timely interventions.''
Now, for some of the elderly, nursing homes are a
necessity. They are the appropriate choice. But for many
others, options such as assisted living, service-enriched
housing, retrofitting a home, linking services to a current
home are the best way for seniors to age, as well as the most
cost-effective. Seniors and their families should not find it
easier to enter a nursing home than to remain at home with
necessary supports. When faced with difficult decisions about
long-term care, seniors and their families should not have to
navigate a confusing maze of programs and services, and work
through multiple bureaucracies. We must streamline these
choices. I think an Interagency Council on Meeting the Housing
and Service Needs of Seniors will help to make options more
widely available.
The Council will be a high level executive office, which
the Federal Government can work to consolidate and streamline
the various programs that exist to help our elderly. It will be
composed of the Secretaries or designees of the agencies which
operate these various programs: HUD, HHS, DOT, Agriculture,
Treasury, Labor, Veterans Affairs, as well as the Commissioner
of the Social Security Administration, the Administrator of the
Centers for Medicare and Medicaid Services, and the
Administrator of the Administration on Aging. It will review
all Federal programs designed to assist seniors, identify gaps
in services, recommend on how to reduce duplication, identify
best practices, and work to improve the availability of housing
linked with services. The Council will be charged with
monitoring, evaluating, and recommending improvements in
existing programs and services to make sure that the Federal
Government in concert with States, localities, and private
sector partners, is doing all they can to help seniors age in
place or find alternative, suitable living arrangements.
Mr. Chairman, I think this legislation could be an
important first step. This is an effort to get a process
working by which we can enhance the services, coordinate them,
remove duplication, fill in the gaps, put some focus on what I
think is a pressing problem now and will, obviously,
increasingly become a pressing problem.I look forward to
hearing from Secretary Jackson. We are pleased to have him back
before the Committee and the panel to follow.
Mr. Chairman, I have a number of letters here from various
organizations: The AARP, which, of course, we have had a lot of
dealings with; the Elderly Housing Development Operations
Corporation; the Elderly Housing Coalition, made up of a number
of groups; the American Association of Homes and Services for
the Aging; American Association of Service Coordinators; the
National PACE Association; National Housing Conference; United
Jewish Communities; the Housing Assistance Council; NARO,
which, of course, has been before our Committee on a number of
occasions; the Council of Large Public Housing Agencies; the
National Affordable Housing Management Association; the
Enterprise Foundation; and the National Leased Housing
Association; and the National Low Income Housing Coalition, and
I ask that all of these letters in support of this legislation
be included in the record.
Chairman Shelby. Without objection, it is so ordered
Chairman Shelby. Senator Allard.
STATEMENT OF SENATOR WAYNE ALLARD
Senator Allard. I would like to thank you, Mr. Chairman,
for holding this hearing. Nearly all of us have to address the
needs of aging parents or aging grandparents or other family
members, so we understand the challenges present to today's
seniors, and I appreciate this opportunity to more closely
examine one way to help meet those challenges.
I would also like to commend Senator Sarbanes for
introducing S. 705, ``Meeting the Housing and Service Needs of
Seniors Act of 2005.'' He and I worked together previously on
creation of the Congressionally chartered Seniors Commission,
and this bill will help implement their recommendations to
promote better coordination.
Quite simply, coordination makes sense. It makes sense for
the Government, taxpayers, and it makes sense for the people
served by the programs. Utilizing a similar model, we have seen
improvements to the programs and services for homeless
individuals under the Interagency Council on Homelessness. I am
hopeful that we can find similar benefits under the Seniors
Commission. As the baby boomers age, it is increasingly
important that we ensure that they have the information
necessary to make the most appropriate decisions regarding
housing, services, and other needs.
I firmly believe that seniors want to live in their own
homes. I think that our challenge is to do whatever we can to
help facilitate their desire to live in their homes. That means
making home care services more available; it means making it
possible for them to stay in their homes. I think in this age
of high technology that we certainly have an opportunity,
perhaps, to even extend long range type medical services into
the home. You connect it in for an EKG on the chest, for
example, or they can plug in periodically to perhaps have an
evaluation. And I think there are other opportunities to get a
high tech solution into homes that will facilitate those senior
and elderly parents and grandparents and other family members
to stay in that home with a minimum of support from family
members.
At one time, family members were always present, but now,
they are not. They are spread all over the United States, and
it is not always convenient for that level of care to happen.
So, I think that Senator Sarbanes is addressing a real issue
that we have here in our society, and I commend him for that.
And in particular, I support S. 705 to identify and help
eliminate inefficiency and duplication. This will ensure that
all taxpayer dollars invested in housing and services for
seniors are maximized.
I would like to also welcome today's witnesses to the
hearing. Your perspectives will be important as we consider
this bill, and you bring first hand knowledge of the importance
of giving seniors the option to age in place. I would like to
extend a special welcome to Dana Olson, who is testifying on
behalf of Volunteers of America. Dana is from Colorado Springs
and does excellent work at the Laurel Manor Senior Residence to
assist seniors. Dana, I am glad that you are here.
I also look forward to your testimony, Mr. Secretary, and I
know that you bring a special perspective also. And I look
forward to working st Senator Shelby, Senator Sarbanes, and
Senator Santorum. Now, we have a run of Ses there, do we not?
Chairman Shelby. We do.
[Laughter.]
Senator Allard. To move this bill forward to help meet the
housing and service needs of our Nation's seniors.
Thank you, Mr. Chairman.
Chairman Shelby. Thank you.
Senator Santorum.
STATEMENT OF SENATOR RICK SANTORUM
Senator Santorum. Thank you, Mr. Chairman, and thank you
very much for holding this hearing, and I appreciate the work
that you have done; Senator Allard, I appreciate the work that
you have done; and in particular, I appreciate the work,
obviously, of Senator Sarbanes, who introduced Senate Bill 705,
and I am honored to be a cosponsor of that legislation. And I
do not want to reiterate what everyone said. Everyone has
covered the legislation and certainly the reasons for it, and I
share with everybody the importance of this issue.
We have a very large senior population in Pennsylvania. The
average in the country is about 12 percent of our population is
seniors. We have a third more. We have a 16 percent population
of seniors in Pennsylvania. We are second to the State
represented by the gentleman on my left in the percentage of
seniors in our population, but I believe his number is going
down, and our number is going up.
It is a big concern for us in Pennsylvania, and we can
continue to build senior housing facilities and all sorts of
other things to do really what this legislation and this
hearing is intended to do, which is instead of building new
facilities, to try to integrate these services to try to
provide them at home so people can age in place, as Senator
Sarbanes said.
And that, to me, is the ideal. That is the one that I think
most seniors would like to have happen. I know it is one that
my people are going through at this time, and my in-laws are
going through at this time in their lives. So it is very
personal, and it is very important to the people in my State,
and I appreciate the attention that the Committee is directing
at it, and I look forward to working together on a bipartisan
basis to make some progress in this area.
Thank you very much, Mr. Chairman.
Chairman Shelby. Thank you.
Senator Santorum. And I apologize; I have to leave. We have
a markup in the Finance Committee on the energy tax title, so
if you will excuse me----
Chairman Shelby. That is important, too.
Senator Santorum. Thank you, Mr. Chairman.
Chairman Shelby. Senator Martinez. You know, it is not
often that we get the former Secretary of HUD together with the
current Secretary of HUD.
[Laughter.]
Chairman Shelby. Senator Martinez.
STATEMENT OF SENATOR MEL MARTINEZ
Senator Martinez. Thank you, Mr. Chairman.
I am very proud to be here today for this hearing and with
my colleague and former partner at HUD. But Senator Shelby and
Senator Sarbanes, I appreciate your holding this hearing on
this important subject, and Senator Sarbanes, I commend you for
taking the initiative to identify the growing needs of our
elderly population, and I am very supportive of Senate Bill
705, which would create an interagency council to oversee the
housing and service needs of the seniors.
But I am also pleased to welcome here today my good friend
Secretary Jackson. I also want to make a special note: Today is
the first time that I have had occasion to see our new
Assistant Secretary for Housing and Housing Commissioner, Brian
Montgomery, a good friend and a wonderful person who I know is
going to do a great job in this very important position, and
Mr. Secretary, first time I can call you that; wish you all the
best, and I hope you will call if I can be of any help to you
in your new responsibilities.
But I have an additional special pleasure today, Mr.
Chairman, which is also to introduce one of today's witnesses
to the Committee. It is Mr. Steve Protulis. He is here from
Fort Lauderdale, testifying on behalf of the Elderly Housing
Development and Operations Corporation, where he serves as the
Executive Director and Executive Vice President.
His agency is considered the premier provider of quality,
affordable housing for seniors in the United States. It manages
42 properties in 14 States, offering affordable living options
for low-income seniors. Mr. Protulis was formerly the Assistant
to the President of the AFL-CIO and Executive Director of the
National Council of Senior Citizens, one of the Nation's
strongest voices for older Americans and families. He also
served on the U.S. Commission on Affordable Housing and Health
Facility Needs for Seniors in the Twenty-First Century, a
committee appointed by the U.S. Congress.
The Elderly Housing Development and Operations Corporation
is dedicated to promoting quality, affordable housing for
seniors. It is committed to the principle of aging in place,
ensuring opportunities for elderly citizens to live
independently with dignity and self-determination with their
peers. The State of Florida is home to more than 2.8 million
residents over the age of 65, and while my distinguished
colleague from Pennsylvania was right in terms of percentage of
population the fact is that it is a growing population.
Over the next two decades, more than 3.6 million Floridians
will reach retirement age. According to the 2000 Census, 51.2
percent of Floridians over the age of 65 are considered low
income, and 43.8 percent are considered very low income. As
health care and housing costs continue to rise, and in Florida,
housing costs rise dramatically each and every day, Florida
residents will grow increasingly dependent upon the types of
services Mr. Protulis and others like him are providing.
In Miami-Dade County alone, the Elderly Housing Development
and Operations Corporation manages five low-income housing
projects, which currently serve 750 residents with more than
1,300 eligible residents on waiting lists. In addition to
offering basic health services such as blood pressure
screening, and dental hygiene, the corporation contributes to
the overall wellness through its prescription monitoring
programs and educational classes on nutrition, exercise, and
computer training.
I thank Mr. Protulis for being here today and look forward
to his testimony. But I want, in further evidence of Senator
Sarbanes' proposal and the things that he has been speaking of;
you are talking about 1,300 eligible residents of Florida on
the waiting list just for these facilities in Dade County
alone. That just goes to show, Mr. Chairman, what a tremendous
need there is in this area for more avenues of coordination and
more opportunities for seniors to be provided decent, safe, and
affordable housing.
Thank you, Mr. Chairman, and I look forward to the
testimony.
Chairman Shelby. Thank you, Senator Martinez.
Secretary Jackson, your written statement will be made part
of the hearing record in its entirety. You proceed as you wish.
Welcome again.
STATEMENT OF ALPHONSO JACKSON, SECRETARY
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
Secretary Jackson. Thank you very much, Chairman Shelby,
Ranking Member Sarbanes and distinguished Members of this
Committee. Thank you for inviting the Department to testify on
the Meeting the Housing and Service Needs Act of 2005. I
commend Senator Sarbanes for bringing this matter to the
attention of the Committee. Mr. Chairman, in order to reserve
as much time as possible for questions, I will ask that I be
allowed to summarize the statement.
This Administration is strongly committed to meeting the
needs of America's senior citizens. That commitment will be
very publicly displayed this afternoon when President Bush
visits the Department of Health and Human Services to roll out
the Nation's Medicare prescription drug benefit for seniors.
The senior population, those aged 65 and over, continues to
grow. In the last decade, the elderly population has increased
by 10 percent, and this trend is certain to accelerate. Over
the next 5 years, the children of the World War II generation
will turn 65, followed by the baby boom generations, which I am
a member of. Within that horizon, we have every reason to
believe that the number of seniors will double by 2030. By
then, the Census Bureau estimates that 20 percent of Americans
will be older than the retirement age.
As the senior population grows, so do challenges we face in
meeting seniors' housing needs. First, we must find ways to
maximize housing resources in order to serve a growing number
of seniors. Second, we must provide for very low-income seniors
while allowing for aging in place. Third, we must improve the
data collection methods and improve dissemination of that
information to the end user. Fourth, we must better coordinate
all Federal levels, working agencies to provide the seniors the
best service. And fifth, we must create a better linkage
between needed assessments, evaluation, and research.
Clearly, this Nation will need to address the senior
housing issues from a different perspective than we have in the
past. As the Committee knows, HUD has a long history of
providing housing, delivering related services to the Nation's
low and very low-income elderly. Specifically, Section 202
programs provide important resources to address the housing
needs of the elderly. More than 375,000 units have been funded
since the inception of the 202 program, which was established
in 1959. More than 6,000 new units have been funded under the
Section 202 program annually.
These housing programs are sponsored by nonprofit
organizations. Many of them are faith-based. These
organizations have a history of serving the elderly and are
committed to meeting the needs of a very vulnerable population
in our society. The Administration is dedicated to the ongoing
viability of the Section 202 program. We are committed to
working with Congress, with nonprofit organizations that
sponsor these important projects, and with the elderly persons
who are eligible to reside within them.
HUD's commitment to the Section 202 program goes beyond
building housing for the elderly. We also want to ensure that
the seniors have the services they need in order to live
comfortably. Seniors tell us they want to live independently as
long as possible. The Administration has recognized the
importance of addressing both the housing and servicing needs
of the elderly and has made these issues a top priority.
The Department agrees with the Committee that seniors
require a wide array of housing options with access to
services, including meals, transportation, health care, and
other assistance. We also agree that there are numerous Federal
programs that assist seniors and their families in meeting
these needs. Many government agencies exist at the State and
local level, but we need coordination. The Department has made
an effort to coordinate to the greatest extent possible with
other agencies in its program, but there can always be
improvement in communications, coordination to ensure that
seniors have access to decent, safe, and sanitary housing and
can obtain the necessary supportive services.
As I understand it, the legislation before this Committee
proposes an interagency council to promote a more cost-
effective Federal response to meeting the needs of housing for
the seniors. If we are able to inspire an effective cooperation
among the Federal agencies that address housing needs of
seniors, the effort will yield long-term savings that could pay
for home-based amenities.
We believe the legislation before you today is a good idea.
The concept creates the Interagency Coordinating Council for
the Federal Government. This is very important for the
uniqueness of the operation. There are some technical aspects
that the Administration would like to work with Congress to
address. In closing, let me say that the Administration and the
Department are committed to working with Congress and the
industry partners to address the growing needs of affordable
elderly housing and the necessary supported services. This
proposed legislation will provide the opportunity for us to
work with government agencies and stakeholders and coordinate
more effectively a basis for requiring us to address these
needs.
And in closing, which is not part of my testimony, I would
just like to say that again, I would like to commend Senator
Sarbanes and this Committee. I was in a very unique position in
the sense that I had a very great debate with my brothers and
sisters, as Senator Martinez knows, about my mother, and I made
the decision that my mother would not go into a home. It was
very difficult financially for me, but my mother lived in her
home until her death, because I thought it was important for
her to have that comfort, and so, I am very much committed to
working with you on this specific issue.
Chairman Shelby. Thank you, Mr. Secretary.
You have had a lot of experiences, Mr. Secretary, dealing
with various agencies here, and it is difficult at times to get
different agencies to work toward the same objective, even when
they share the same goal.
Secretary Jackson. Right.
Chairman Shelby. One attempt at this in which you have been
involved is the Interagency Council on Homelessness. Could you
share briefly with the Committee how well you believe that
council has worked and whether that experience for you can
offer us any lessons in designing S. 705?
Secretary Jackson. Yes, Mr. Chairman. I will say this: As
you know, Senator Martinez at that time was Secretary Martinez,
who was the first chair, and I worked with him closely. I think
that President Bush has insisted and continues to insist that
the agencies work together. What has occurred before President
Bush is that we had very simple domains where people did not
want to interact with one another. The Interagency Council on
Homelessness has made great strides, because we have talked
with each other. We have come together to make sure that the
needs of the homeless are addressed from a holistic
perspective, not from a piecemeal perspective.
I think the same thing can occur here with this
legislation, because it forces us to talk and address the needs
of the seniors not again in a piecemeal fashion.
Chairman Shelby. Sure.
Secretary Jackson. But in a very whole fashion.
Chairman Shelby. Mr. Secretary, under the terms of S. 705,
the Council would be chaired on an alternating annual basis
between the HUD Secretary, in your case now, you, and the HHS
Secretary. Do you believe that one year is enough time for a
chairman to be effective, or should we consider expanding this
to a longer term? And in addition, should we be limiting the
chairman to just the HUD and HHS Secretaries? I realize they
are high profile cabinet members.
Secretary Jackson. Sure.
Chairman Shelby. Or should other Council members also be
eligible to serve as the chair? I do not know. I can see the
point of both Secretaries, because you are the Secretaries.
Secretary Jackson. Right.
Chairman Shelby. You are Cabinet members, and that lends a
lot of not only power but also prestige to what you are doing.
Secretary Jackson. I would say, Mr. Chairman, I do not
disagree with the chairmanship rotating between Housing and
Human Services, because I think we have a direct effect on the
lives of many seniors in this country.
Chairman Shelby. You do.
Secretary Jackson. There are some ancillary effects that
the others have. So if we are going to try to do the very best
we can to give the best service, I think those who are directly
related on a day-to-day basis will be the best persons to
chair.
Second, I believe, having served on a number of boards, a
number of university boards, that a two-year rotation is
usually the best, because you are able at that point in time to
get many of the programs started. And then, there is a
continuity of about 6 months between you and the next chairman
to discuss and make sure.
Chairman Shelby. But you are still on the board, even
though you rotate, right?
Secretary Jackson. Yes, yes, you are still on the board,
but I think that a one year service is fine, but I just think
you have better coordination and continuity if you have a 2
year period.
Chairman Shelby. Senator Sarbanes.
Senator Sarbanes. Thank you very much, Mr. Chairman.
First of all, Secretary Jackson, could we assume that if
this legislation becomes law, this allows for the Secretary or
a designee of the Secretary, and I am interested in how much
you would expect to be personally involved yourself in
providing leadership to the council as opposed to turning the
responsibilities over to a designee. Now, I know you are a busy
man. The Secretary has a range of responsibilities. On the
other hand, I do think to get this moving, certainly, and to
get it up and going with the kind of authority behind it that I
think it requires, we need the top people to take interest and
not immediately turn it over to a designee, and I am just
looking for some assurances out of you, at least, with respect
to that issue.
Secretary Jackson. Not only will I assure you, but I will
also promise you that I will give this my utmost attention. I
am extremely fond of seniors. I have always made sure that
seniors live well. I am committed, and I have to tell you in
many ways it did not come to my mind, but I am elated by this
legislation, because I think it is going to do a very important
job for seniors in this country, where we have not done it
before.
Senator Sarbanes. We have been in the process of converting
some of the 202 senior housing into assisted living type
facilities. I know HUD has taken an interest in doing that. I
wonder how much cooperation you are getting from other
Departments and Agencies in achieving that and particularly
from HHS, which, of course, as you just pointed out, is the
other Department that has a range of programs that are highly
relevant to what we are concerned about here.
Secretary Jackson. We have had good coordination, but I
think with this legislation, if it passes, it will force us to
have much better coordination than we have had before. But I
cannot say that it has been a negative effect on us. It has
been very, very supportive.
Senator Sarbanes. One of the things the Council might do in
the process of coordination is really develop a master strategy
for coordination and implementation of these provisions, so
there is actually a framework set up to accomplish this rather
than it being done more on an ad hoc basis as we move along
from month to month.
And that has been one of the things we are seeking to do.
It would seem to me that the Interagency Council, we set up the
Trade Promotion Coordination Committee, and out of that, they
now develop a trade promotion coordinating strategy every year.
They keep updating it. They bring all the agencies and
departments together to try to have a concerted strategy, and
it seems to me we need to do something similar with respect to
the housing and service needs of seniors.
Secretary Jackson. I think, Senator Sarbanes, that the more
structured it is, the better it is, because I think we can then
focus in on addressing the needs of seniors from a very whole
perspective. I do not like that term holistic but from a very
whole perspective. And as I said at the end of my speech, one
of the problems that I faced with my mother was that her needs
were many, and you were at one specific agency to another
agency trying to get those needs addressed. I think if we can
structure it, the better off we are.
Senator Sarbanes. Thank you very much, Mr. Secretary.
Thank you very much, Mr. Chairman.
Chairman Shelby. Senator Allard.
Senator Allard. Yes, Mr. Secretary. You have to find a home
for this commission. Are you comfortable having it in HUD? I
would assume that you are.
Secretary Jackson. Senator, Mr. Chairman, and Ranking
Member, if you are comfortable, I am comfortable.
[Laughter.]
Senator Allard. Do you feel that you could adequately serve
the needs of this commission in your agency?
Secretary Jackson. Yes, I do, and if you choose to put it
there, let me say this to you: I cannot reiterate again;
Senator Martinez is here. I was very committed to my mother
staying in her house, and I am very committed to elderly. And I
will do whatever. As I just said to Senator Sarbanes, I will
specifically take great pleasure in making sure this works if
that is your desire.
Senator Allard. Now, I notice that we have a number of
reports being called on from the various agencies. I am
assuming with this commission, all these various agencies also
submit reports for the Government Procedures and Results Act.
Are we duplicating it? Does the Government Procedures and
Results Act already have enough reporting there that all you
have to do is make sure a copy of that gets to maybe a
different set of people? Or do we need a whole different set of
reports?
Secretary Jackson. That is a difficult question to answer.
I think we do an awful lot of reporting, and I think if we can
streamline it, it is all for the best. But in the process of
streamlining, I think there still must be accountability.
Senator Allard. Well, that is the reason I pulled up the
Government Procedures and Results Act.
Secretary Jackson. Right.
Senator Allard. Because the whole idea of that is to have
accountability. You measure performance. You put out specific
goals and objectives, and then, you do it in a measurable way.
Secretary Jackson. Sure.
Senator Allard. And so that whoever is overseeing these
programs, including the Congress, gets a feel of whether they
are meeting certain parameters and what not.
Secretary Jackson. I think that is very important, and let
me say this: That is what President Bush has done with the
President's Management Agenda. There has been a number of hue
and cries about us having to report and live up to it, but I
think it has been the catalyst to make us more effective in
managing. And that is why I said if we can streamline the
accountability, yes, I think it is important to have it.
Otherwise, there is no measurement tool.
Senator Allard. I want to also just bring up this issue of
how do you plan on cooperating with State and local agencies?
There are a lot of them involved, and I think a lot of States
have taken a different perspective here, and is there a way
that we can facilitate the State and local involvement and not
get too meddlesome? Maybe you could comment on that and how we
could evaluate in a way or put together a program that takes
those concerns.
Secretary Jackson. Since this is such a universal problem
that we are all going to face, and there is no question that we
will all face it quicker than we think, I think the more
persuasion of all members of this interagency committee,
whether it be HUD, whether it be Health and Human Services,
Labor, will use our moral persuasion to discuss this issue with
governors, with county administrators, with mayors to show them
how important it is that we address this need from a whole
perspective. And from my interaction with both governors,
county administrators, mayors, it has not been a very difficult
process to get them to understand vital issues that are
necessary to be addressed in their respective jurisdictions.
Senator Allard. Thank you, Mr. Chairman.
Chairman Shelby. Senator Stabenow.
STATEMENT OF SENATOR DEBBIE STABENOW
Senator Stabenow. Thank you, Mr. Chairman, and first, I
would ask that my opening statement included in the record.
Chairman Shelby. Without objection, it is so ordered.
Thank you for calling this hearing, and thank you to
Senator Sarbanes for your leadership on this very important
issue, and Secretary Jackson, it is nice to see you again.
Welcome.
Secretary Jackson. Thank you so much.
Senator Stabenow. I do have a specific question, but I did
want to make a couple of comments first. And that is that I
think we all come together in support of certainly seniors, our
parents, older adults, but there are a lot of big things in
front of us right now that will determine whether or not we put
those words into actions. I am a believer that it is about
action, and just a more general statement for my colleagues, I
mean, we look at the fact that over 60 percent of older
Americans rely primarily on Social Security to live, the debate
about privatizing part of Social Security is a big deal; it is
a big part of this, and I am greatly concerned about that;
Medicare and what we are doing there has a huge impact.
This Congress just passed a $10 billion cut in Medicaid,
which is my State, the majority of those are low-income seniors
in nursing homes. What is a $10 billion cut going to mean for
them? We are hearing States debate optional services, and when
we go down the list of optional services for low-income health
care, it is things like being able to see--eyeglasses--being
able to hear--hearing aids--being able to chew your food--
dentures. Certainly, I do not consider that optional for me, in
my family, and so I just raise that. That is certainly beyond
what we are talking about today, but it is a lot of very
serious things affecting older adults today and decisions that
are being made, including things like home health care and
whether or not we are going to see a long scheduled cut
actually happen in home health care.
I just want to bring to your attention, this is not
something directly for you, but there are some simple things we
can do as well for older adults: The Commodities Supplemental
Food Program right now does not allow seniors to deduct their
medicine in order to qualify for supplemental food payments.
Some of us have been trying to change that for some time, and
it seems to me that we could come together and help change that
so that medicine does not count when meeting low-income
standards, because for low income seniors in the commodities
programs, they are literally choosing between food and medicine
right now. So there are a number of things we can do.
But on to my question: You and I had an opportunity to
speak before you were confirmed, and I supported your
confirmation, about the growing number of grandparents that are
raising their grandchildren, and in fact, we were successful,
and I appreciate the support of Members of the Committee and
the Senate, we were successful in the American Dream Act of
2003 in adding a provision to create demonstration projects,
from two to four demonstration projects in Section 202 housing
for grandparents raising grandchildren, to be able to allow
both accommodations in terms of play equipment and other
things, to be able to look at the impact in Section 202
housing.
And there were two other provisions. One was a HUD Census
study to be done as it relates to Section 202 housing, and the
other was that this instructed how to train employees in the
rights of grandparents raising grandchildren. I would like to
know the status on that provision.
Secretary Jackson. I cannot tell you details today, but I
will get back to you specifically with the details. I know that
we have set it up, but I have to be very honest with you: I am
not prepared to tell you the end results today, but I would be
happy to get it to you immediately.
Senator Stabenow. I would appreciate that. This is a
provision supported by the House, Senate, and the White House.
It is in law. We have a lot of older adults now taking on the
responsibilities, again, of being parents, and we want to make
sure that they are not inadvertently discriminated against in
their housing needs. And I think it is very important that we
move forward in implementing those provisions.
Secretary Jackson. I know we have started. I just want to
give you the best details now, and I cannot do that right now,
but I will get it to you immediately.
Senator Stabenow. Thank you.
Thank you, Mr. Chairman.
Chairman Shelby. Thank you. Senator Martinez.
Senator Martinez. Thank you, Mr. Chairman.
Secretary Jackson, a couple of questions on this issue. I
know that the Interagency Council on Homelessness really, when
we revitalized it, worked I think extremely well, and I hope it
continues to be a help to the homeless population like we hope
this will be to the elderly population. I wondered if one of
the things that had occurred is it had just fallen off and even
though still statutorily authorized, it was not happening. And
we took up the mantle and have revitalized it, and it is off
and going again. I guess what I would want to make sure, Mr.
Chairman, in the course of this legislation is we do not let
that happen. If we put it in the books, we want it to be
something that has to be accountable enough to where it
continues to happen.
I also believe that Senator Sarbanes asked a very pertinent
question, which is about your participation. I am delighted
with your commitment. I know it will be there, but I also
believe, Mr. Chairman, one of the essential keys to the success
of the Interagency Task Force on Homelessness was not only was
I participating and vitally interested but that it also made
the commitment of the Secretary of HHS at the time to also be
involved. Secretary Thompson and I worked together, and the
fact that we would both show up at meetings, and we both
delivered on the agenda that was set for the meetings made it
happen.
I am concerned about the designee portion of this, and I
know that I, of all people, should understand how busy Cabinet
secretaries are, and I know that for many of these secretaries,
it is going to be impossible for them to attend: The Secretary
of Treasury, for instance, a designee would be fine. But I
think as to the Secretaries of HHS and HUD, particularly if
they are going to be chairing the commission, that their
commitment and their personal involvement is going to be vital
to the success of it. And I would want to find some vehicle by
which we could ensure that that took place.
Do you not think, Mr. Secretary, that that part of the
commitment has to be there, at least in those two key
departments, to make sure that it works? Because if it gets
designated down the road, sometimes, the bureaucracy does not
get the message if the designee is too far down the road.
Secretary Jackson. I agree with you, Senator, I agree. And
that is why when Senator Sarbanes asked me if I would
personally commit as long as I am Secretary to being involved,
I said yes. Because this, to me, is a very critical issue that
we are going to face.
Senator Martinez. And I think also a two-year chairmanship
would probably add to that same continuity of getting it done.
But one other thing that was very successful in the
Homelessness Task Force was the fact that we had a local tie-in
as part of our strategy; in other words, the Interagency
Council came together, but then, the work of the Interagency
Council with our strategy then being picked up by mayors
throughout the country really has given it life.
It is not only what we are doing here in Washington but
also what is happening in Dallas, Orlando, Miami, wherever it
may be around the country. And I believe that part of the
charge should be that we somehow develop a strategy of how
local governments can also participate in an interagency or
intercouncil task force to make sure that the work that is
being done here federally has a counterpart at the local level,
where the rubber meets the road, really.
Secretary Jackson. Right.
Senator Martinez. And so, I would think that maybe not
formally in the statute but certainly as part of the charge
that some local tie to the deliverers of local services in
local government, that they be also, through our grant programs
or however, that they might also be encouraged and directed to
cooperate, because the same divisions and the same
fragmentation that happens here also happens at the local
level.
Secretary Jackson. I think two things, Senator. First of
all, I think that if it is passed, the first thing we must do
is meet frequently for the first 2 to 3 years to establish the
importance of the Commission and what its objectives and goals
are. Second, I think within those first 2 or 3 years, from my
perspective, it would be well to go out two to three times a
year into the respective States or communities to let them have
a voice in the say of this Commission and how they think it
affects their States.
I felt, when I was Deputy Secretary under Secretary
Martinez, that having the executive management meetings in the
field within our 10 regional offices was one of the most
effective things that occurred, because he and I learned an
awful lot about HUD that most secretaries never knew. Because
once we were there in the field, they gave us great advice of
how they felt we were not running very well, and we were able
to benefit from that.
I think the same thing could be said for how we address the
needs of seniors. Because the needs of seniors in Florida are
quite different from the needs of the seniors in Alabama,
because we know that a number of the seniors in Florida have
worked most of their lives, and they do not need Social
Security as well as some of the seniors in Florida or in Texas.
So if we listen to the States, I think we will be better
equipped to address the issues.
Senator Martinez. One last issue, Mr. Secretary, is the
issue of reverse mortgages, and I know you probably would not
be prepared to answer that for me today. But the question I
have, and perhaps our newly minted and capable Housing
Commissioner can help us with this. The issue of reverse
mortgages is a vehicle by which seniors can obtain equity out
of their homes to allow them to defray other expenses, whether
it might be property taxes, whether it might be just living
expenses, home improvements, whatever.
I know there is a desire to see the FHA current cap be
removed so that there is no ceiling on the number of reverse
mortgages that can take place. I am also very interested in the
fact that it has a requirement for financial counseling prior
to any of these mortgages taking place.
Secretary Jackson. That is right.
Senator Martinez. I would just like to know from FHA what
the experience has been. What has been the track record in
terms of the impact on elderly homeowners who engage in this
practice and I know that there are many good stories of how to
solve problems for them; the infusion of equity cash can be a
tremendous opportunity to get this equity that is latent there
but get this capital to use in their later years.
Secretary Jackson. Sure.
Senator Martinez. And the issue of the cap and whether it
should be removed or not. Another issue I know that is of
concern that industry is the issue of the local FHA limits and
whether they operate unfairly in neighboring communities just
by the mere fact of geography and not home prices. So, I would
appreciate an update from Mr. Montgomery, who I am sure has a
his hands full with a whole lot of other things, on this whole
issue of reverse mortgages and where we should go with it in
terms of future caps or no caps, and just a good experience on
where we have been and where we should go.
Secretary Jackson. I can assure you that Assistant
Secretary Montgomery will get on that immediately.
[Laughter.]
Senator Martinez. Yes. It would be a good chance to see
him. And thank you very much, sir.
Chairman Shelby. Senator Reed.
STATEMENT OF SENATOR JACK REED
Senator Reed. Thank you very much, Mr. Chairman.
I certainly want to commend Senator Sarbanes for this
legislative proposal. It makes great sense, and in one very
real sense, it is overdue. I mean, we recognize we have to
coordinate better. And Mr. Secretary, thank you for your
testimony and your service.
One of the aspects of the seniors who want to stay in place
is that to stay in place, they need more assistive services. I
know we have the 202 Senior Housing program. There has been
some effort to try to incorporate more services so it becomes
more of an assisted living arrangement rather than simply a
rental unit. Can you comment on what you and HHS and others are
doing to try to help this transformation?
Secretary Jackson. I think as the Chairman said, at one
time, we were basically somewhat obstinate about getting into
the assisted living area. We realize today more and more, that
is needed; that many of the people can live, but some of them
cannot live directly independent of each other. And that is why
I said to you that Health and Human Services and us have been
working well. But if we have a structure in place that says
this is the best way to address it, I think it will be much
better.
And I, in reading the legislation Senator Sarbanes has
proposed to us, I think that that begins to give us a
structure, and we will be, in essence, forced to work much
closer than we have in the past. And that is not to say that it
has been negative. it has been very positive. I will tell you
that.
Senator Reed. I appreciate that, Mr. Secretary, and we all
recognize that this is a growing demand, that this is a growth
industry for seniors. I point out in my notes that by the year
2030, nearly one-fifth of the U.S. population will be over 65.
Secretary Jackson. That is correct.
Senator Reed. I will be 85, with any luck.
[Laughter.]
I take some solace in knowing that Rhode Island is the
fifth-largest State with a population over 85 years old, so I
have lots of company back home. But we are addressing these
issues of increased growth and demand with relatively flat
budgets. The 202 budget has been declining slightly; in fact,
doing reasonably well given the huge pressure on the budget,
but if this was a situation of a constant demand, we would feel
pretty good about it.
And essentially, at the heart of the interagency effort are
efforts by HHS to give support, which is typically Medicaid; as
you understand there is a $10 billion cut hanging out there in
Medicaid funding. And I would also point to transit funding,
which is also so critical to seniors so that they can maintain
their independence.
Secretary Jackson. True.
Senator Reed. Particularly the innovative programs, the
small jitneys that move around and take people to programs and
not traditional bus service.
So my sense is your great challenge would not be just
talking to each other but finding the resources to meet this
effort. Any ideas that you have in that regard?
Secretary Jackson. It is always a challenge for the
resources. There is no question, Senator Reed. But I do believe
this, that if we are able to put in place the legislation that
we proposed for the flexible voucher program, we will level off
the Section 8 program, which will help us tremendously look at
other programs that I feel are very critical to the needs of
HUD and the elderly, the handicapped, and others.
And I think that once we do that, stop the growth of the
program as exponentially as it has been, I think we can address
many of the issues you just said.
Senator Reed. Well, Mr. Secretary, I hope we do not just
get in a situation of shifting the burden to another
population. One of the reasons, I think, for the growth in the
Section 8 subsidies is because the housing market has been
accelerating dramatically. Those costs go up. And if you want
to compensate a private landlord for putting people in his
unit, you have to give him a subsidy that is at least remotely
related to what he could get by going out in the market and
putting people in.
Secretary Jackson. I agree with you, but let me say this to
you, because we are talking about regional areas. If you are
talking about the East Coast or the West Coast, yes, that is
the case. But if you are talking about the Southwest, the
Midwest, the Southeast, the affordable housing rates in many of
the markets have gone down substantially. And I think clearly,
we understand that, and we compensate for the East and West
Coasts.
Senator Reed. I am particularly interested in compensating
for the East and West Coasts. The East Coast.
[Laughter.]
The West Coast has their own people here, but from my
perception, you can find Mr. Secretary, areas where the housing
is rather stable, and the prices have been reasonable, but I
have seen up in, the Minneapolis area, where it is very
expensive there, and that is smack dab in the middle of the
country, so I do not think it is entirely the East Coast.
And as you know, there are some of us who are trying to do
some things with affordable housing in this GSE bill, and we
will get a chance to talk about that later.
Secretary Jackson. All right.
Senator Reed. Thank you, Mr. Secretary.
Secretary Jackson. Thank you.
Chairman Shelby. Mr. Secretary, we thank you for your
appearance, and I know you will be back. Thank you very much.
Senator Sarbanes. Could I ask the Secretary a question
before he leaves?
Chairman Shelby. Sure.
Senator Sarbanes. Are you all keeping an eye on this marked
increase in interest-free mortgages where they pay only
interest and are not paying down the principal at all?
Secretary Jackson. Yes, we are.
Senator Sarbanes. All right; because I think the potential
implications of that could be very far reaching if the economy
takes something of a dip.
Secretary Jackson. I think you are absolutely correct. And
we are very much so, and I have had a number of discussions
with Secretary Snow. That is a very critical issue.
Chairman Shelby. Thank you, Mr. Secretary.
Secretary Jackson. Thank you.
Chairman Shelby. Our second panel will be Ms. Nelda
Barnett, Board Member, AARP. Senator Bunning wanted to
introduce Ms. Barnett, and he has a statement for the record.
He is in a markup now, and he cannot be there, in another
Committee, but I want to put his statement on his behalf into
the record.
Ms. Dana Jo Olson, Executive Director, Laurel Manor Senior
Residence; Mr. Steve Proctor, President and CEO, Presbyterian
Homes, Inc., Pennsylvania Nonprofit Housing Association; Dr.
William T. Smith, President, American Association of Homes and
Services for the Aging; Ms. Terry Allton, Vice President for
Support Services, National Church Residences; Mr. Steve
Protulis, Executive Director, Elderly Housing Development and
Operations Corporation; Mr. David G. Wood, Director, Financial
Markets and Community Investment, U.S. Government
Accountability Office.
I have introduced you earlier, but I wanted to do it again
for the panel. Thank you very much. All of your written
testimony will be made part of the record. We are probably
going to have a vote on the floor and have to cut loose but not
yet, and we will start with you, Ms. Barnett, if you will sum
up your testimony in 5 minutes or less.
Ms. Barnett. I will do the best I can.
Chairman Shelby. Thank you so much. Welcome all of you.
Ms. Barnett. Thank you very much. Thank you and welcome for
your note on Senator Bunning. His staff had contacted me.
Chairman Shelby. Yes. Senator Bunning is a very important
Member of this Committee. He is on the Finance Committee, and
he is tied up, and he better be where he is right at the
moment.
Ms. Barnett. Thank you very much.
Chairman Shelby. But he did want me to mention that.
STATEMENT OF NELDA BARNETT
MEMBER, BOARD OF DIRECTORS, AARP
Ms. Barnett. I appreciate it. And I thank you for this
opportunity to testify this morning. I am Nelda Barnett and I
am from Owensboro, Kentucky. I am also a Member of AARP's Board
of
Directors.
My remarks this morning will focus on the need to improve
coordination among the various agencies, levels of government,
and providers of housing and related supportive services that
older Americans require in order to age with dignity in our own
homes. It goes without saying that housing is a critical factor
in determining our quality of life.
During the 1990's, Americans on the average improved the
quality of their housing, but despite the progress of the
1990's, many low-income and moderate income, older Americans
continue to experience serious housing problems, and their
numbers are growing.
Already, what we call the ``old old population,'' those
aged 85 and older, represents the fastest growing segment among
older persons in our Nation. This group is disproportionately
frail and among the most vulnerable to excessive housing cost
burdens. To be more specific, there are about 4.6 million
Americans aged 85 and older in 2002. That number is projected
to increase by more than 70 percent, to approximately 7.3
million, by 2020.
Clearly, powerful demographic forces are at work. By 2030,
the number of persons age 65 and older will increase to 20
percent of the population, and much of this growth will be
driven by large increases in the number of persons age 75 and
older. AARP supports enactment of S. 705, Meeting the Housing
and Service Needs of Seniors Act of 2005. The need for greater
coordination is particularly apparent when trying to put
together the housing, health, and social service programs at
all levels of government that are critical to successfully
serving people with disabilities of all ages.
Research has shown that Federal housing programs have very
efficiently, if inadvertently, identified those who are at high
risk of needing supportive services in order to remain
independent. Analysis by AARP's Public Policy Institute of data
from the 2002 American Community Survey found that compared to
older homeowners, older renters in subsidized housing were much
older. Half of the renters in subsidized housing were 75 or
older, compared to just over one-third of older homeowners.
It found it twice as likely as older homeowners to
experience physical and cognitive limitations that threaten
their ability to live independently, and it found it more than
three times as likely as older homeowners to live and have weak
informal supports from family and roughly three times as likely
as older homeowners to be at high risk of needing Medicaid
assistance due to low incomes and high levels of disability.
Better coordination of housing, health, and social service
programs would serve a variety of purposes, but the most
compelling case for better coordination comes from the lives of
our older people who need assistance. The older woman who is
clinging to independent living in her apartment but has no one
to help her bathe or just get out of the tub; the older man who
is told he has to move to a nursing home to get housekeeping
services; or an older disabled resident in a nursing home who
might have been able to leave if suitable housing and services
were available.
AARP research consistently documents that as Americans pass
through mid-life, regardless of whether they own or rent their
housing, we, by and large, prefer to remain in our own homes.
But the adaptability of housing to the processes of aging in
place presents different challenges for housing facilities that
have not often been designed with these life changes in mind.
Mr. Chairman, if we continue to accept poor coordination
among providers of housing and housing related services, we
will see an America with an even greater number of underhoused,
underserved older citizens and a corresponding substantial
increase in costly and premature institutionalization of older
people. S. 705 is a worthy first step as we begin to address
these problems. We urge its speedy enactment.
Thank you again for this opportunity to testify, and we
would be very happy to answer any questions.
Chairman Shelby. Thank you.
Ms. Olson.
STATEMENT OF DANA OLSON
EXECUTIVE DIRECTOR, VOLUNTEERS OF
AMERICA'S LAUREL MANOR SENIOR RESIDENCE,
COLORADO SPRINGS, COLORADO
Ms. Olson. Chairman Shelby, Senator Sarbanes, and Members
of the Committee, I am Dana Olson, Executive Director of
Volunteers of America Laurel Manor Care Center in Colorado
Springs, Colorado, and Regional Health Care Manager of 11
Volunteers of America senior residences in Colorado, Nevada,
and California.
In that capacity, I also supervise the opening and initial
operations of our senior residence in Senator Allard's home
town of Fort Collins, Colorado. I have worked for 34 years in
long-term care, about 15 years of those years as Director of
Nursing and the rest as a Nursing Home Administrator.
Volunteers of America is one of the Nation's largest and most
comprehensive charitable, nonprofit, spiritually based human
service organizations. In 2004, Volunteers of America's
services across the country sought to empower over 135,000
seniors to maintain a healthy, engaged quality of life through
senior centers and day programs, home repair and homemaker
services, information and referral services, Meals on Wheels
and group meal programs, transportation, companion services,
elder abuse protection, case management, and coordination of
other community services.
On behalf of our organization, I want to express our
sincere appreciation for your interest in Senate Bill 705, the
Meeting the Housing and Service Needs of Seniors Act and
concern for the needed coordination between housing, health
care, and supportive services for the growing population of
seniors in the United States. In a recent study, the State of
the Nation's Housing 2001, the Joint Center for Housing Studies
of Harvard University reported that heads of household over the
age of 75 are expected to increase by roughly 1.3 million over
the decade. They go on to say that this growth implies rising
demand for housing that allows seniors to age safely in place
and for specialized facilities such as assisted living and
continuing care communities.
Clearly, as a Nation, we have a problem of extraordinary
scale and urgency, as the housing and social service programs
and funding we have in place today will not keep pace with this
situation. As people grow older in residences designed only for
independent living, they are at high risk of being forced into
institutional nursing home care or alternatively having their
needs unmet.
Much of this problem is due to the fact that the delivery
of services to many persons is fragmented because of multiple
policymaking authorities and funding streams, conflicting
regulations, and poorly coordinated overlapping Federal and
State government agencies. This fragmentation is not only
costly; but it also oftentimes leads to serious gaps in
providing what is needed.
It is because of this existing fragmentation that passage
of Senate Bill 705, the Meeting the Housing and Service Needs
of Seniors Act, is so important as a step in the right
direction to better coordinate our housing programs and related
services, so seniors can age in place and have access to needed
services.
Let me tell you a little about my experience in Colorado.
As the administrator of a skilled long-term care center, I am
seeing older, more frail, acutely ill seniors coming to us for
care and rehabilitation to allow them to return home or to a
lesser level of care in the continuum. As the people we care
for come to us much more acutely ill, and the regulations under
which we operate become more and more stringent, the fragmented
system is more difficult to work with.
We never want to be in a position that limits the services
we need to provide to give our residents the highest quality of
service possible, but we need your help to do so. As the
Regional Housing Manager of five 202 senior housing complexes
in Colorado, we have a waiting list of over 200 seniors. That
means 200 seniors are out there in need of our services, and we
are not able to meet those needs at this time.
This only reinforces the need for more available services
for our seniors. The best way to meet this need is to have
adequate funding to build additional senior apartment
facilities with a service coordinator in each facility. The
person would have the capability of assisting our seniors
access the system to fill the need for food, medical care, and
other supportive services.
But even good service coordinators have difficulty
unraveling the myriad rules, regulations, agency sources, and
funding streams that are intended to serve senior citizens.
Passing this legislation and establishing a Federal Interagency
Council on meeting the housing and service needs of seniors
would provide a structure for a Federal agency to jointly
review housing and service programs, more effectively
coordinate Federal programs and services, and work with States
to coordinate programs and services at the State and local
level.
For the sake of our Nation and its deserving senior
citizens, we must find an efficient, well-coordinated means of
providing long-term care through integrated health care with
supportive services and housing, and that process has to start
at the top. That is why Volunteers of America believes that the
Meeting the Housing and Service Needs of Seniors Act must be
passed as a bipartisan testimony to the worth of our older
generations.
We appreciate the opportunity to bring you our ideas and
perspectives and want to ensure all of the Members of the
Committee that Volunteers of America is strongly committed to
helping resolve these issues before the growing demand for
elderly housing and supportive services spirals out of control.
We are confident that sound solutions can be found and
implemented in a way that is fiscally responsible and fair to
all parties.
Thank you.
Chairman Shelby. Mr. Proctor, I just wanted to mention, as
you well know, Senator Santorum was here earlier. He is a
Member of the Finance Committee. They are having a markup, and
he wanted me again to reiterate if he could be here, he would
like to acknowledge your presence.
Thank you.
STATEMENT OF STEPHEN PROCTOR
PRESIDENT AND CEO, PRESBYTERIAN HOMES, INC.
RETIREMENT AND SENIOR CARE SERVICES,
CAMP HILL, PENNSYLVANIA
Mr. Proctor. Thank you.
Chairman Shelby. Go ahead.
Mr. Proctor. Good morning, Mr. Chairman and distinguished
Members of the Committee. I am Steve Proctor, President and CEO
of Presbyterian Homes, headquartered in Camp Hill,
Pennsylvania, and I am honored to be able to provide you with
some testimony today on behalf of Presbyterian Homes and the
Pennsylvania Not for Profit Homes Association, the principal
association that provides representation for faith-based
providers of senior services.
As was mentioned earlier, the population we serve in
Pennsylvania is among the Nation's oldest and, in many areas of
the State, requires a significant amount of care. We have 15
facilities in Pennsylvania, but we also have facilities in
Maryland, Delaware, and Southeastern Ohio. Some are located in
urban areas; others are located in some of the most rural
places you can imagine.
We provide a full continuum of care for Pennsylvanians in
need of chronic care. Seniors in some of our locations are
younger individuals with disabilities. Our staff, about 2,600
individuals, provides housing and services to more than 3,000
residents Statewide, and we are very proud of the history of 80
years of service or providing this kind of care.
When I was first told about the intent of S. 705 and asked
to testify, I was a little skeptical. Historically, proposals
to initiate this type of council have been many, and the
solutions coming from them have not always lived up to their
original billing. But when I read Senator Sarbanes' bill and
comments during the introduction of this piece of legislation,
we discovered that it was very consistent with PANPHA's
Strategic Initiative on Consumer Choice. That is, housing and
services alignment driven by consumer need, not the wishes of
often well-intentioned bureaucrats and funding agencies.
We strive toward this goal because it is how consumers wish
to, and deserve to, receive the services they need and want. In
short, this bill makes sense. The coordination proposed in S.
705 is not only necessary; it is long overdue and will provide
real enhancements in the delivery of housing and services to
the people we serve.
As a provider of housing and services, I thought my time
before you would best be focused on some specific examples of
how things work in terms of the statutory regulatory and
funding maze that is out there. PHI is a sponsor of Stadium
Place, a model for senior housing located on the site of
Memorial Stadium in Baltimore. The site currently contains HUD
housing, tax credit housing for seniors, market rate and
homeownership developments to follow. It shares a site
containing a full service YMCA and has developed to provide
seniors with limited incomes many of the same options available
only to more affluent seniors of continuing care retirement
communities.
A recent editorial in the Baltimore Sun identified Stadium
Place as the right model for senior housing. More importantly,
many of the residents of Stadium Place describe it as the best
place they have ever lived, and if you have not seen this
project, I would encourage you to visit this site.
But the key to really realizing the dream of Stadium Place
Memorial Stadium and other senior housing projects of similar
scope is the delivery of supportive services in an environment
that can best and most charitably be described as fragmented.
The combination of case management, coordination of existing
services, and flexible delivery service systems will enable
this group of seniors to live more healthy and active lives.
The timely intervention of health and social services will
ultimately save money by helping residents of Stadium Place to
age in place. Aging in place is obviously what people desire if
their needs can be met, and that is if their needs can be met.
PHI has a person in one of our facilities who has been in that
particular project since being admitted with her disabled
husband in 1970, so she has really aged in place. We are able
to meet her needs, and that is becoming more increasingly
difficult as she is in her mid- to upper 1990's. Without better
coordination among and across the agencies that deliver
services to her, it is doubtful that we can provide a continued
opportunity for her to age in place as she would prefer.
There are many examples of the housing and service needs of
seniors not matching up with inflexible regulations and program
requirements. There are a couple of examples of this that are
listed in my printed testimony. They are very obvious in terms
of not providing the ability for services to follow people to
the place they are moving to. You will see examples of people
not having services follow them. Their needs have changed;
their income has not changed, but where they live has changed.
You will find that there is a tremendous amount of support
not only among service providers but among the people we serve
for this as they struggle to find their way through one
application process after another or struggle to find services
at all. They would be here with me today supporting and
seconding all of this.
I will not go over all the statistical evidence of
Pennsylvania and all of the seniors we have to serve. That is
well-documented and actually frightening, but I would like to
second my colleagues' opinions up here in terms of supporting
this bill. It is a wonderful bill. We hope it realizes the
promise that we all expect from a first rate effort.
Thank you.
Chairman Shelby. Thank you.
Dr. Smith.
STATEMENT OF WILLIAM T. SMITH, Ph.D.
CHAIR OF THE BOARD, AMERICAN ASSOCIATION OF HOMES
AND SERVICES FOR THE AGING (AAHSA)
Mr. Smith. Chairman Shelby, Ranking Member Sarbanes, and
Members of the Committee, I would like to thank you for
inviting me to appear before you today to discuss Senate Bill
705. I have submitted written testimony for the record, so for
my comments this morning, I would like to talk to you about the
real world experience of providers and seniors we serve as well
as the opportunities that this bill presents for making service
delivery and program administration less cumbersome and more
responsive.
My name is William Smith. I am the Chair of the Board of
the American Association of Homes and Services for the Aging,
AAHSA. AAHSA members serve 2 million people every day in 5,600
facilities throughout this country through mission-driven, not
for profit organizations dedicated to providing the services
people need when they need them in a place that they call home.
AAHSA members offer the continuum of aging services:
Assisted living residences, continuing care retirement
communities, nursing homes, home and community based services,
and senior housing. Our commitment is to create the future of
aging services through quality that people can trust. It is
this commitment that underlines our support for this
legislation, its goals, and increasing the effectiveness and
collaboration amongst Federal programs that serve our seniors.
In addition to my work with AAHSA, I serve as the President
and CEO of Aging in America, a community-based organization
that originated in 1852 with a mission of providing housing for
aged women and has evolved into a full service organization
employing over 550 staff that serve over 5,000 seniors
annually, primarily in the Bronx but also in the neighboring
areas of New York.
I know firsthand how complicated and difficult it can be to
work with a patch quilt of programs to create the range of
housing and services necessary to care for seniors with varying
degrees of frailty and need. In 1972, Aging in America
developed a skilled nursing facility for 386 residents and
later established a continuum of community-based services. In
1978, we converted a 90,000 square foot former high school into
our social service agency, including a number of community
based activities, intergenerational programs, Alzheimer's day
care center, case management, victims assistance, elder abuse,
and, frankly, support for grandparents raising grandchildren.
We opened our first senior center in 1979, and since then,
we have had two off-site senior centers and four satellite
programs providing recreation, education, information,
referral, wellness programs, et cetera, to over 1,500 older New
Yorkers weekly. We delivered hundreds of meals and last year
provided nearly 300 seniors with 3,465 trips to medical and
social service providers.
In order to help clients navigate the maze of Federal,
State, and local programs, we have developed a comprehensive
case management program that provides services for over 700
elderly New Yorkers conducting in-home assessments and
authorization of the delivery of in-home personal care,
housekeeping services, and home delivered meals. We have a 17-
bed temporary housing unit that provides respite, emergency,
and permanent living arrangements for people over 60.
Senate Bill 705 is integral to the goals and policy laid
out by the Commission on Affordable Housing and Health Facility
Needs for Seniors in the Twenty-First Century. The demographics
compiled by that Commission are staggering. Today's seniors
comprise 12.4 percent of our population. That is 35 million
people. By the year 2030, that number will have doubled: 70
million seniors, 20 percent of our population. I live in
Westchester County, and 20 percent of Westchester County is
already above the 65 year age group.
One of the Commission's primary recommendations was a call
for the coordination of housing and health care among
departments, stable, affordable housing settings. Those places
that seniors call home are the cornerstone of service delivery.
I cannot overstate the importance of bringing services to these
housing settings among all income levels. In 2020, those
seniors that will need some form of assistance will be 5.8
million homeowners, 1.5 million unsubsidized renters, and
almost 600,000 with some form of rental assistance. The Federal
and State governments did not set out to create a complicated,
contradictory, sometimes duplicative system of programs and
funding mechanisms for serving those who are most in need, but
unfortunately, that is what we have.
With over half of our senior population at 75 years of age
and older, we need to do a better job of making and
coordinating that array of services. Senate Bill 705 is a
significant step in that direction. It really is landmark
legislation, and we strongly support it and support in
particular the use of common vocabulary, common age for
eligibility, common definition of eligible populations and
standards for programs.
Chairman Shelby, Members of the Committee, I want to thank
you for your time this morning. I would certainly like to thank
Senator Sarbanes for introducing this legislation and taking
this important first step. And frankly, I would like to thank
the other Committee Members also for their support for this
very important legislation.
Thank you.
Chairman Shelby. Ms. Allton.
STATEMENT OF TERRY ALLTON
VICE PRESIDENT FOR SUPPORT SERVICES
NATIONAL CHURCH RESIDENCES
Ms. Allton. Good morning, Chairman Shelby, Ranking Member
Sarbanes, and other Members of the Committee. My name is Terry
Allton. I am Vice President of Support Services at National
Church Residences. We are a nonprofit housing and supportive
services and health care provider based out of Columbus, Ohio.
We employ 154 service coordinators throughout the United States
who provide services to our seniors. I am very excited to be
here today to talk about housing and supportive services and
especially the Senate Bill 705.
Congress' establishment of the service coordinator program
launched a profession with the sole purpose of addressing
quality of life issues for the elderly, offering possible
solutions to aging in place. The service coordinator program is
the Interagency Council in action. The goal of a service
coordinator is to link residents with services that exist in
the community, allowing them to remain independent, in their
own homes, and avoiding the premature institutionalization that
they so fear.
The primary function of a service coordinator is to work
with service delivery systems, provide resource information,
identify programs, and assist seniors through the labyrinth of
regulations attributable to a multitude of government agencies.
Our elderly residents typically do not know who supplies which
services or that some services even exist within their
community, and that is why the prospect of the Interagency
Council is so exciting.
National Church Residences is a founding organization of
the American Association of Service Coordinators. This is a
national, nonprofit organization representing more than 1,500
service coordinators who serve more than 400,000 low-income
elderly across the United States. Like others on this panel,
National Church Residences is an active member of AAHSA and its
State affiliate, the Association of Ohio Philanthropic Homes,
Housing, and Services for the Aging. I am here also
representing AASC, the American Association of Service
Coordinators, as the current Chair of their Board of Directors.
AASC has long urged that housing, health care, and other
Federal support programs serving the elderly join together to
better focus Federal policy and regulatory efforts in
conjunction with States and communities. Senate Bill 705 will
do exactly that.
Before I talk about our service coordinator program, I
would like to talk about NCR's commitment to the preservation
of affordable housing and serving residents as they age in
place. NCR has long advocated for Congress to recognize the
importance of preserving existing affordable housing and
helping residents at risk of losing their housing as providers
opt out of HUD programs and sell or convert their properties to
market rate.
We are losing more senior housing than we are currently
building. This means that seniors are and will be in a
precarious position to meet their housing and service needs
unless we are able to preserve affordable housing. Housing
services go hand-in-hand for seniors who are aging in place.
One without the other spells disaster for residents as they
become frailer, with limited options and fewer resources.
Service coordinators serve as a lifeline for seniors in all
manner of housing settings and have become an increasingly
important part of our older senior housing communities, where
people have lived 20-plus years aging in place.
For individual residents, service coordinators do, on the
local level, or at best try to do what this legislation would
do at the Federal level, by coordinating what is frequently
referred to as a crazy quilt of health, housing, and service
programs that are used by seniors, service coordinators, and
properties. They identify resident needs; they work within the
community to locate existing resources: And they provide
service management to organized health and wellness programs so
that residents who live in these communities who do not know
services exist, they broker those services and bring those
services to the residents.
They offer one-on-one help for residents by providing
intensive assistance, helping residents understand insurance,
Medicaid, Medicare, entitlement programs, and benefits that
they might not even know that they are eligible for. They act
as a broker for services that are difficult to obtain through
public resources and assist residents in securing the help that
they need to live safely and independently through community
agencies.
The first stage of providing a continuum of housing and
service choices for the elderly is in home supportive services.
Navigating through a system of segmented service providers and
benefits is often difficult for older persons and their
families. As I said, service coordinators are the Interagency
Council in action. Their lives and jobs will be made a lot
easier by Senate Bill 705, not to mention what it will mean to
seniors and family caregivers who might be unfamiliar with the
aging services field.
In addition to navigating services which should be made
easier by this legislation, service coordinators help elderly
residents take advantage of cost saving programs such as
prescription drug discounts so that the elderly are not
choosing between paying the rent, buying food, or getting their
prescription drugs. Service coordinators also provide a cost
saving benefit to subsidized housing communities, saving those
communities money by preventing unnecessary vacancies when
residents might go on to a long-term care or some type of
situation that they might not need.
So, I will end my comments at that point. I thank you very
much for letting me present today, and I will entertain
questions later.
Chairman Shelby. Thank you.
Mr. Protulis.
STATEMENT OF STEVE PROTULIS, EXECUTIVE DIRECTOR
AND VICE PRESIDENT, ELDERLY HOUSING
DEVELOPMENT AND OPERATIONS CORPORATION (EHDOC)
Mr. Protulis. Thank you, Mr. Chairman. I really appreciate
the opportunity to share with you some of my frustration of the
last few years.
First of all, I want to thank you, Mr. Chairman for having
a great staff on the basis that, in my opinion, Mark is one of
the greatest assets you have, and the Chairman is not hearing
you, Mark, I am sorry, but he will.
[Laughter.]
Mark is an outstanding young man you have working for you,
sir, and I want you to know that he needs a raise.
[Laughter.]
Chairman Shelby. I agree. He needs to be better paid.
[Laughter.]
Mr. Protulis. Yes, sir. That is exactly right.
Senator Sarbanes. There is a law against lobbying the
Congress on----
[Laughter.]
Mr. Protulis. Okay; I plead the Fifth.
The truth of the matter is I have gone through many notes,
and I have already submitted my written testimony, so I want to
be brief and just speak from my heart instead of my notes.
And I just wanted to share a couple of things. I wanted to
just bring quickly, in my opinion, an observation that is real
because it is in this room. There is a lady in a wheelchair
sitting in the back; Mary, would you please wave?
Chairman Shelby. Hold her hand and identify her. I see her.
Mr. Protulis. Thank you, Mr. Chairman.
Mary lives in our property in Maryland and she was very
depressed, because her doctor, on the basis of frailty, told
her that you need to go to a nursing home. Now, here is an
example: If you took the time to listen to her agonizing
personal feeling--no matter what the physician says--but an
individual being told that you have to move from your home,
from your place that you are comfortable, and go someplace that
is new and scary, it was something she did not want to deal
with, and the depression took over.
Our service coordinator, actually took time to find an
organization that will provide the means so she can age in
place, and today, she remains in her place, and through the
PACE program, we were able to provide for her needs so that she
was able to age in place and be happy. With that example, Mr.
Chairman, you can see there are thousands of other stories
where we can keep seniors living in the same area and be happy
because they are getting their needs met and the service they
need.
Prior to working on this bill, I was actually wearing a
different hat. I was appointed by this illustrious, great
Senator from Maryland, Senator Sarbanes, to a commission. And
when I took that job, I was probably the most ignorant person
among all the commissioners. And when we went through hearings
and listened to the testimony from all kinds of experts and
knowledgeable people like on this panel, I was mystified to the
lack of knowledge that I had myself and the fact that even in
our own commission, which we were given a very short window, 18
months, they cut us $800,000, so we could not get enough
witnesses to bring forward; we only had six hearings around the
country.
We managed to come out with recommendations, and Mr.
Chairman, I have this book here, and I want you to know it is
does not have all the answers in here, but there is plenty of
information. So having this agency, Mr. Chairman, and you
having the leadership to follow the wishes of a great Senator
like Sarbanes, where is the question--who can be opposed to
this? Who can be opposed to giving seniors a choice? And you
know, the only statistic we have in this country are the
provisions that we have when we provide services to poor
seniors, because it is an inadequate system, because it comes
with resources from the Federal Government.
But do you know that every single one of us in this room
sooner or later, if it already did not happen, will have to
face a reality like the Secretary of HUD mentioned earlier
about his mother's decision to stay in her home. And what is
available out there? There are some great stories where people
have been provided great benefits through the private sector,
government assistance, States doing great work, stories that we
do not even know exist today in trying to keep that senior
aging in place.
So, I just want you to know that the timing is almost too
late, but it is important that we are doing something
expeditiously and urgently. I just had the privilege yesterday
morning to attend an AARP conference where there were over 350
delegates from all over the world to discuss aging in place.
The Premier of British Columbia testified in front of all of
us. And one of the issues that was mentioned about the agencies
that are set up in his own province, how difficult it is to
tell bureaucrats from an agency you have to compare notes with
someone else, as it was addressed this morning, and it is a
major issue.
So the mandate to make this Interagency follow the rules
and learn the best stories out there, not just the resources
coming from the Federal Government but how we can make those
seniors feel there is a place where they can make choices and
compare notes. Thank you for the opportunity to testify.
Chairman Shelby. Thank you.
Mr. Wood.
Senator Sarbanes. Mr. Chairman.
Chairman Shelby. Yes, Senator Sarbanes first.
Senator Sarbanes. Mr. Chairman, I am going to have to leave
the hearing, because there is another group that has come from
my State that we had early on arranged to be here. I do want to
thank all the witnesses for their testimony and for the very
strong statements. I have looked through these statements, and
we very much appreciate the obvious care and effort that went
into preparing these statements. These are very valuable in
building a record in support of the legislation, and I am very
hopeful that we will be able to move ahead on this legislation
and provide the kind of support that it would give to the work
that you are doing.
And I do want to thank you once again for the work you are
doing. It is enormously important.
Chairman Shelby. Thank you, Senator Sarbanes.
Senator Sarbanes. Thank you.
Chairman Shelby. Mr. Wood.
STATEMENT OF DAVID G. WOOD, DIRECTOR,
FINANCIAL MARKETS AND COMMUNITY INVESTMENT
U.S. GOVERNMENT ACCOUNTABILITY OFFICE
Mr. Wood. Thank you, Mr. Chairman, and I thank you and the
Ranking Member for inviting me today.
My statement is based primarily on our recent report
concerning Federal housing assistance programs to benefit the
elderly. The report was requested by the Senate's Special
Committee on Aging, which was particularly interested in the
availability of supportive services for the elderly who reside
in federally assisted housing.
Federal programs aid the provision of housing in a variety
of ways, ranging from financing the construction and
rehabilitation of units to helping pay rents. With few
exceptions, the programs are not specifically directed at the
elderly, although many can and do benefit from them. We
identified a total of 23 Federal assistance programs whose
beneficiaries explicitly include the elderly; two that are
targeted exclusively to the elderly; three that are targeted
exclusively to the elderly or the disabled; 18 that have
special provisions for the elderly such as income adjustments
that make it easier for them to qualify.
These programs do not reach all eligible households, and
waiting lists are often long. Only 4 of the 23 housing
assistance programs require that participating property owners
ensure the availability of supportive services. For example,
HUD Section 202 programs subsidize the development and
operating cost of multifamily properties, exclusively for the
low-income elderly. Owners must ensure that residents have
access to transportation and other services.
The Agriculture Department's Congregate Housing Program
funds the development of independent living facilities, which
must provide meals, transportation, housekeeping, and personal
services. Neither HUD nor Agriculture provide funds under the
four programs for supportive services. However, HUD does offer
grants and other assistance that can be used to provide some
services to elderly residents of federally assisted housing.
Property owners typically obtain needed funds from a variety of
sources, including HUD's or other Federal programs or form
partnerships with local charities or nonprofits to provide
services.
For health care, a key source is the Department of Health
and Human Services. For example, the Department's Public
Housing Primary Care Program provides some elderly public
housing residents with primary and preventive health care
through on-site clinics, while the Medicaid Home and Community
Based Services Waiver program enables elderly residents to
receive needed health care in their current homes, including
federally assisted housing.
We do not have comprehensive data on exactly what services
are provided to the elderly or how they are funded at all
Federally assisted housing programs. However, given the range
of programs and funding sources, it is likely that they vary
considerably. As the Seniors Commission report illustrates,
many elderly Americans can be expected to need both housing and
health care services in the future. This is yet another case in
which achieving a Federal goal requires the concerted and
coordinated efforts of two or more agencies. However, GAO's
work has shown that a number of barriers inhibit coordination
among agencies. These include missions that are not mutually
reinforcing or that may even conflict, concerns about
protecting jurisdiction over missions and control over
resources, and incompatible procedures, processes, data, and
computer systems.
Addressing the potentially large service needs of a growing
elderly population will call for effectively overcoming these
or other barriers. That concludes my prepared statement. I will
be glad to answer any questions you have.
Chairman Shelby. I want to thank all of you, and I also
want to again thank Senator Sarbanes for his leadership in this
area. I have several questions, and I will ask, and then, I
will have some for the record.
It is very important here as far as the topic. S. 705 would
charge an interagency council with making recommendations for
streamlining Federal housing programs and services for seniors.
That is what we are trying to get at.
Mr. Wood, GAO's February 2005 report, which you have
alluded to, states that there is little available information
about the effectiveness of these housing programs serving the
elderly. We want them to be effective, though. What criteria,
Mr. Wood, do you believe that the council should use in making
its recommendations? In other words, your testimony refers to
existing program missions that are not mutually reinforcing and
sometimes conflicting.
Mr. Wood. Right.
Chairman Shelby. Should Congress require the Council to
establish goals, Federal goals for seniors' housing and
services, goals against which the performance of all of these
programs should be judged or would be judged?
Mr. Wood. I think we have in several, a couple of reports
in the past stressed a couple of things that have already been
mentioned at this hearing this morning. One was by Senator
Allard when he talked about the Government Procedures and
Results Act. We have testified and reported on many occasions
that that offers a good framework for both establishing goals
and for promoting coordination. It is actually a required
element of agencies' strategic plans, their annual plans, and
their annual reports to report on the extent of coordination
that they have engaged in with regard to cross-cutting----
Chairman Shelby. It makes a lot of sense, does it not?
Mr. Wood. Absolutely.
Chairman Shelby. Senator Allard is very involved in the
housing, and Ms. Olson and everybody else knows, and is a
senior Member of this Committee. He has done a lot of work in
this area.
Mr. Wood. Right; the other thing that I would mention,
again, that came up this morning is we have long said that it
requires--effective coordination requires a commitment at the
top, and by requiring the Secretaries themselves to be part of
this Council it addresses that.
Chairman Shelby. Be very involved.
This type coordination could be, as you know better than
anyone, the coordination of services to the elderly to let them
live in place could be one of the biggest cost savings for the
American people and also could be something that the elderly
want to do.
Mr. Protulis. Absolutely.
Chairman Shelby. I do not know myself of any of the elderly
that would not rather stay in their home, as you have pointed
out, where they are comfortable, something that they are used
to. This is just common sense, human nature, is it not, Mr.
Protulis?
Mr. Protulis. Not only that, Mr. Chairman, but also in
these days of cuts in Medicaid and Medicare, we prove over and
over by keeping them at their home and providing service, we
save money, which is something----
Chairman Shelby. Save billions and billions of dollars.
Mr. Protulis. And there have never been statistics shown,
and it is for real. It exists.
Chairman Shelby. I think you are absolutely right.
I am going to reference S. 705 again. We all have. It would
allow State and local representation on the Council. I believe
this is an important element to have the representation, have
the involvement. As many housing, health care, and
transportation programs as we all know are carried out by the
State and the local governments. S. 705 directs the council to
select these representatives.
To any of you, would you like to comment, would this be a
workable process? Should Congress specify a particular number
of State or local representatives? Should Congress also specify
a more detailed method of choosing which State and local
representatives should serve on the Council? Or should that be
left up to the Council?
Who wants to tackle that?
Mr. Protulis.
Mr. Protulis. I just personally think that my initial
reaction is that there has been such overwhelming need to have
community involvement so we can safeguard not only the policies
already established by the Government but also where the best
stories are, where the real good stories are taking place, and
they are on the local level. So how do we go about structuring
that? I would say that the more involvement in the community it
is, the better off it is going to be.
Chairman Shelby. Sure.
Mr. Protulis. And I also want to add one more: If you ask
those 30-some seniors sitting behind us which is the number one
issue outside of the health care needs, transportation is
critical. And I think that department of our agency of the
Government also can play a critical role in how we provide
transportation, because transportation, when they give up their
car, depression sets in; they sit in their room; they do not
want to leave. So just housing in place is important to aging
in place, but keep them involved in the community, and that
transportation is a critical element.
Ms. Barnett. Mr. Chairman, may I comment on this also?
Chairman Shelby. Yes, Ms. Barnett.
Ms. Barnett. I come from a rural area, and transportation
is very important. We do not have access to public
transportation in only two small areas there. But the cost of
transportation is so extremely high that our providers are
saying if we go bring a person in to a medical facility, we
have to have three of these people to bring in for it to be
cost-effective for us. So they cannot bring one in, delaying
health care at that point. So this is another reason that I
feel that this is so very important, that if we can provide
these services in facilities to keep them aging in place that
it is very important to do so.
Chairman Shelby. Thank you.
Ms. Barnett. I strongly support this bill.
Chairman Shelby. Dr. Smith.
Mr. Smith. You know, I get teased by the adage that all
politics are local.
Chairman Shelby. Well, there is a lot of truth in it.
Mr. Smith. I know, I know.
Chairman Shelby. A lot of us that run for public office
recognize that.
Mr. Smith. Know that law very well.
[Laughter.]
I think it is important that the Federal Government and
through this excellent bill really model how this can be done.
I think that clearly, the Secretaries of both major agencies
should be mandated to be in attendance for at least a period of
time of 2 or 3 years, something like that, and then, perhaps,
50 percent of the meetings going on from there if it is
necessary.
But I think the leadership at the top is key. I think for
the Commission to appoint--I mean, somehow, they have to
solicit recommendations from the local area and get some
endorsement from the key players in States or cities. I come
from New York that has not found a Federal law that it cannot
embrace and enhance, so I get nervous about more regulations
coming down the line.
I think where the Commission could clearly help us with
that leadership is also looking at common language, common
eligibility rules, age rules. I mean, I work with seniors that
as they age in place and get older, they fall out or fall
ineligible for different types of programs to let them still
age in place. So, I think we really have to insist upon common
definitions. And forcing these agencies to work together, be in
the same room once or twice a year, maybe even more than that,
would be a wonderful first start.
Chairman Shelby. Well, I really like the term coordination
more than regulation.
Mr. Smith. Yes.
Chairman Shelby. And if we can coordinate, it is more than
just common sense. I think you have all demonstrated it. You
are involved in it. And I think this is a worthy piece of
legislation if we can make it, pass it, and make it work, and
if we are able to pass this type of legislation, it will be
meaningful, but it will be a heck of a lot more meaningful if
it is coordinated and worked, implemented, executed, so to
speak.
Mr. Smith. And AAHSA would certainly stand ready to help
the Committee find additional sponsors around the country to
really get this legislation passed. So many people will benefit
by it.
Chairman Shelby. You make it bubble up locally.
Mr. Smith. Absolutely.
Chairman Shelby. We feel it here, as you know.
I want to thank you all for your appearance but more than
that for your involvement. You are committed to a worthy goal.
The hearing stands adjourned.
[Whereupon, at 11:55 a.m., the hearing was adjourned.]
[Prepared statements, response to written questions, and
additional material supplied for the record follow:]
PREPARED STATEMENT OF SENATOR DEBBIE STABENOW
Mr. Chairman, thank you for calling this hearing. And, thank you
Senator Sarbanes for championing this issue. I could not agree with you
more that better coordination of our Federal resources aimed at
assisting seniors is one that needs attention. With seniors comprising
more than 12 percent of the Nation's population and that number
increasing every year, we must begin putting in place the
infrastructure necessary to handle the broad array of services that
seniors draw upon each day.
My home State of Michigan has more than 1.2 million residents over
the age of 65 and they will all benefit from a more efficient
coordination of the services that assist with their housing and other
necessary services.
As we know, many of our seniors need assistance with their daily
activities. Other seniors need assistance with medication, meals,
transportation, health care, and other needs. And, right now, we do not
do a great job in matching up a person's housing needs with the way we
deliver these vital services.
There are so many ways we can improve our safety-net services to
make them more effective. As a Member of the Senate Agriculture
Committee, I have seen that also happen with our Federal nutrition
programs.
I have meet with food banks that are frustrated that many seniors
they would like to help are not eligible for USDA's important nutrition
program--the Commodity Supplemental Food Program (CSFP). That is
because seniors cannot deduct the cost of their medications when
seeking eligibility for food assistance. We have people who are
literally deciding between their food and their medicine. In a Nation
as great as ours, this is outrageous!
As Senator Sarbanes has pointed out, the current programs and
services that assist the elderly in meeting their needs are spread
across numerous Federal agencies, making it difficult for seniors to
understand and access needed services.
For instance, the Congressionally established Seniors Commission,
found in its 2002 report that the most striking characteristic of
seniors' housing and health care in this country is the disconnection
of one field from another.
Senator Sarbanes is moving us toward a solution. His bill, S. 705,
would create an executive level Interagency Council on Meeting the
Housing and Service Needs of Seniors to better coordinate housing
programs and related services so that senior citizens can age in place
and access needed services.
I support his efforts and look forward to the testimony of the
witnesses. Thank you.
----------
PREPARED STATEMENT OF ALPHONSO JACKSON
Secretary, U.S. Department of Housing and Urban Development
June 16, 2005
Chairman Shelby, Ranking Member Sarbanes, distinguished Members of
the Committee, thank you for inviting the Department to testify on the
``Meeting the Housing and Service Needs of Seniors Act of 2005,''
legislation intended to better coordinate housing programs and related
services so that senior citizens can age in place and access needed
services.
I commend the Ranking Member for bringing this matter to the
attention of the Committee.
The Committee has asked the Department to discuss the changing
senior population and its housing needs. This includes the ability of
seniors to access programs and services that will allow them to age in
place; the Federal role in better preparing to meet the needs of
seniors, particularly as it relates to our partnerships with State and
local governments and the private sector; and how an Interagency
Council on Meeting the Housing and Service Needs of Seniors could
assist and coordinate these efforts.
The Changing Senior Population and Its Housing Characteristics
The senior population--those aged 65 and over--continues to grow.
In the last decade, the elderly population has increased 10 percent.
That is an impressive figure considering that those turning 65 in the
last 10 years were born in the 1930's, and are the children of the
Great Depression, which was a ``baby bust'' generation.
The fact that the elderly population is growing at such a steady
rate reflects both immigration and advances in the Nation's
extraordinary health care system. We can be sure that the growth will
accelerate. Over the next 5 years, we will have the children of the
World War II generation turning 65, followed by the Baby Boom
generation. With that on the horizon, we have every reason to believe
that the number of seniors will double by the year 2030. By then, the
Census Bureau estimates that 20 percent of Americans will be older than
retirement age.
The elderly population is geographically and culturally diverse,
and this will present additional challenges in the coming years. For
instance, in many minority communities, the culture is to have the
grandparents live out a life of a dignity not in an institution, but
rather surrounded by family and friends at home. With the rapid growth
in the Nation's ethnic and minority communities, these dynamics will
become more profound in the future.
Clearly, this Nation will need to address the issue of senior
housing from a different perspective than we have in the past.
How HUD Programs Support the Senior Population
As the Committee knows, HUD has a long history of providing housing
and delivering related services to one of the Nation's most vulnerable
populations: The
low- and very low-income elderly. The overall aging of the population
and the corresponding need for elderly housing has prompted the
Department to make changes in a number of our programs to meet this
growing demand.
Specifically, the Section 202 program provides an important
resource to address the housing needs of the elderly. Along with Low
Income Housing Tax Credits, the HOME program, and Section 8/PRAC
Assistance, the Section 202 program contributes significant funding
toward providing affordable housing units, many with supportive
services. The elderly are well-served by HUD programs with
representation that is, in general, proportionally higher than the
elderly share of total eligible households. The Department has forged
successful partnerships with States, localities, and other interested
parties to provide additional resources to these projects. More than
375,000 units have been funded since the inception of the Section 202
program, which was established by the Housing Act of 1959.
The program has undergone at least two significant changes since
its inception. It began as a low-interest rate loan program without
rental subsidy in 1959. In 1974, it became a loan program with project-
based Section 8 rental assistance. Finally, in 1991, Section 202 became
a capital advance program with project rental assistance, and it
remains so to this day. Under the current program, the capital advance
is provided without interest and does not have to be paid back as long
as the housing remains available for the intended population for 40
years. Projects developed under the current program provide supportive
services dependent on the needs of the residents.
More than 6,000 new units have been funded under the Section 202
program annually. These housing units are sponsored by nonprofit
organizations, many of which are faith-based. These organizations have
a history of serving the elderly and are committed to meeting the needs
of this very vulnerable population for the 40-year term of the project
and beyond.
To make it easier to develop these projects, the Department has
initiated grants to cover certain predevelopment costs that are
incurred when constructing a Section 202 project. In the past, we found
that many project sponsors have spent valuable time to cover these
costs after they obtain a Section 202 commitment from the Department.
The Administration is dedicated to the ongoing viability of the
Section 202 program. We are committed to working with Congress, with
the nonprofit organizations that sponsor these important projects, and
with the elderly persons who are eligible to reside within them.
The Department has experienced an increase in requests to use our
multifamily mortgage insurance programs for elderly only housing. In
addressing this need, the Department amended the MAP guide to include
the Section 231 program; this should enable the Department to process
Section 231 applications in about half the time it currently takes.
Aging in Place
HUD's commitment to the Section 202 program goes beyond building
housing for the elderly; we also want to ensure that they have the
services they need in order to live comfortably. For that reason, the
Department continues to encourage and fund assisted-living conversion
and service coordinator grants to assist existing projects. These
programs recognize that residents in our facilities are ``aging in
place,'' a concept that HUD supports by encouraging independent living,
and helping individuals stay in their homes--keeping them in their
communities and close to family and friends.
This is exactly what seniors tell us they want; 95 percent of those
over the age of 75 say they want to live independently as long as
possible.
The Department has implemented the Assisted Living Conversion
Program for 5 years. Under it, HUD provides the funds to convert
existing affordable housing units into affordable assisted-living
units. HUD requires the sponsor to provide evidence that they have
commitments from other sources to fund the services required by
residents. We believe that this is the only national program dedicated
to the development of assisted-living facilities for very low-income
households. The program has successfully produced over 2,100 units;
based on our experience, however, we believe many more units could have
been developed if the Federal response had been better coordinated.
The Department commitment to providing the service component that
is unique to senior housing is demonstrated by our continued support of
the Service Coordinator program. It is so important to us that we have
an indicator in our Annual Performance Plan to assess HUD's ability to
increase by 10 percent the number of elderly households living in
private assisted-housing developments served by a service coordinator.
The Department continues to be committed to renewing expiring Section 8
contracts and Project Rental Assistance Contracts. We understand this
is a critical component in providing affordable housing to the elderly,
and we attempt to ensure the timeliness of the payments.
Another example of interagency coordination is our collaboration
with the DHHS on the implementation of the new Medicare prescription
drug coverage. We are joining forces with DHHS in educating people with
Medicare--America's seniors and people with disabilities--that they are
all eligible for this new prescription drug coverage and that there is
extra help for those with low income. To accomplish this, DHUD will
train our Rental Housing Integrity Improvement Program (RHIIP) help
desk officers so they can include this new coverage in their work with
the senior citizens residing in low-income housing. We will work
collaboratively and leverage our resources to ensure that we educate
America's seniors on this new benefit.
This Administration has recognized the importance of addressing
both the housing and servicing needs of the elderly, and has made these
issues a priority. The Department agrees with the Committee that
seniors require a wide array of housing options with access to
services, including meals, transportation, health care, and assistance
in daily activities. We also agree there are numerous Federal programs
that assist seniors and their families in meeting these needs, and that
these programs originate in many governmental agencies on the Federal,
State, and local levels.
Federal Partnerships Assist in Meeting Seniors' Needs
The Department has made efforts to coordinate to the greatest
extent possible with other agencies on its programs. But there can
always be improved communication and coordination among all the
stakeholders to ensure that seniors have access to decent, safe, and
sanitary housing and can obtain the necessary supportive services.
Examining the Legislation Before the Committee to Create an
Interagency Council, and How It Will Help to Meet the Housing
and Service Needs of Seniors
It is our understanding that the legislation proposes an
Interagency Council similar in structure to the Congressionally
mandated Interagency Council on Homelessness. The Department is a
member of the Interagency Council on Homelessness, and we have found it
to be an invaluable tool in promoting a more cost-effective Federal
response to homelessness. The proposed legislation is of significant
interest to the Department. If we are indeed able to inspire effective
cooperation among those Federal agencies that address the housing needs
of seniors, the effort may yield long-term care savings that could pay
for home-based alternatives. Such responses could, however, create
demand for or increased spending in other programs. The comprehensive
nature of interagency work on these issues should allow for
consideration of all such issues.
We believe the legislation before you today puts forth some good
ideas. Thus, the Administration supports the concept of creating an
Interagency Council to coordinate the Federal Government's efforts to
address the unique needs of this continually evolving population. There
are some technical aspects the Administration would like to work with
Congress to address. We question whether it is necessary to exempt
council staff from civil service provisions.
In summary, the Administration and the Department are committed to
working with Congress and our industry partners to address the growing
need for affordable elderly housing and the necessary supportive
services. The proposed legislation will provide an opportunity for us
to work with other governmental agencies and stakeholders, and
coordinate on a more comprehensive basis the resources required to
address this growing need.
PREPARED STATEMENT NELDA BARNETT
Member, Board of Directors, AARP
June 16, 2005
Good morning. Chairman Shelby, Ranking Member Sarbanes and Members
of the Committee, thank you for this opportunity to testify today, on
behalf of AARP, regarding the state of housing and housing-related
services for American seniors. My name is Nelda Barnett. I am from
Owensboro, KY, and I am a Member of AARP's Board of Directors. My
remarks this morning will focus on the need to improve coordination
among the various agencies, levels of government, and providers of
housing and related support services that older Americans require in
order to age with dignity in their own homes.
It goes without saying that housing is a critical factor in
determining our quality of life. During the 1990's, Americans, on
average, improved the quality of their housing. But despite the
progress of the 1990's, many low-income and moderate-income, older
Americans continue to experience serious housing problems--and their
numbers are growing. At the top of the list of problems are:
<bullet> Substandard conditions--there has been remarkable progress in
living conditions over the decades; however, the 2003 American
Housing Survey still indicates around 6 percent of older households
living in units with moderate or severe physical problems,
<bullet> a lack of affordability, and
<bullet> housing that is simply not appropriate for the changing needs
of older people.
AARP's views regarding housing policy reflect the public commitment
made over half a century ago by the Housing Act of 1949, that sets the
goals of ``a decent home and a suitable environment'' for every family
in America.
Our policy recommendations are framed by our concern for:
<bullet> The affordability, accessibility, and appropriateness of
housing for older persons,
<bullet> The impact of the supply and demand for elderly housing and
supportive services on older persons, and
<bullet> How the design and maintenance of an older person's home can
impact an older person.
AARP research consistently documents that as Americans pass through
midlife--regardless of whether they own or rent their housing--they by-
and-large prefer to remain in their homes. This fact has been
consistently documented by AARP research (Fixing to Stay, 2000; Beyond
50.05, 2005). But the adaptability of housing to the processes of
``aging in place'' presents difficult challenges for housing facilities
that have often not been designed with these life changes in mind.
Already, what we call our ``old-old'' population--those aged 85 and
over--represents the fastest growing segment among older persons in our
Nation. This group is disproportionately frail, and among the most
vulnerable to excessive housing cost burdens. To be more specific,
there were about 4.6 million Americans aged 85 and older in 2002. That
number is projected to increase by more than 70 percent--to
approximately 7.3 million--by 2020. Clearly, powerful demographic
forces are at work. By 2030, the number of persons aged 65 and older
will increase to 20 percent of the population and much of this growth
will be driven by large increases in the number of persons aged 75 and
older.
Today, the availability of and access to supportive services varies
widely. An important factor is the residential distribution patterns of
older Americans. According to AARP's analysis of the 2003 American
Housing Survey data, 74 percent of today's older households live
outside central cities. They are dispersed across suburbs, small towns,
and rural areas. Such dispersion presents formidable challenges to the
efficient delivery of supportive services such as transportation, in-
home health care, home-delivered meals, home care, and other necessary
services.
Mr. Chairman, there is a deficit of affordable and appropriate
housing for growing numbers of our older Americans. The housing and
healthcare services shortfall of today will turn into the housing and
healthcare services crisis of tomorrow if our policymakers fail to
anticipate and act on the arrival of baby boomers that are of modest
means.
Given the dwindling Federal resources available to address these
needs, the importance of improved coordination cannot be overstated. In
this light, AARP supports enactment of S. 705, the ``Meeting the
Housing and Service Needs of Seniors Act of 2005,'' is essential. As
proposed, S. 705 would establish an Interagency Council to not only
coordinate service delivery, but also monitor, evaluate, and recommend
improvements in existing programs and services that assist seniors in
meeting their housing and service needs at the Federal, State, and
local level. And, the Council would collect and disseminate information
about the needs of seniors along with these programs and services.
AARP strongly supports enactment of S. 705. At the same time, we
urge strengthened provisions to improve the extent to which Congress
and the public can evaluate any of the housing and housing-related
services information collected by the Interagency Council or that is
otherwise required to be provided to the relevant Committees and the
Council. We respectfully suggest that Congress may want to require that
this information be made available over the Internet and in a format
which facilitates comparative analysis and content searches. Improving
the accessibility of this data would also help improve overall public
confidence in these programs.
Better coordination of housing programs is needed for a variety of
reasons. In many instances, multiple program requirements and paperwork
may become duplicative and burdensome. Resident eligibility
requirements and means testing procedures may also be slightly
different across programs. And, different methods of
establishing rent levels and defining market areas for comparison are
used by different programs. Last, different housing sponsors and
agencies may have different waiting lists that can overlap for a
population at need.
The need for greater coordination is particularly apparent when
trying to put together the housing, health, and social services
programs at all levels of government that are critical to successfully
serving persons with disabilities of all ages. Research has shown that
Federal housing programs have very efficiently, if inadvertently,
identified those who are at high risk of needing supportive services to
remain independent. Analysis by AARP's Public Policy Institute of data
from the 2002 American Communities Survey found that, compared to older
homeowners, older renters in subsidized housing were: \1\
---------------------------------------------------------------------------
\1\ Redfoot, D., Kochera, A., (2004). Journal of Housing for the
Elderly, (Vol. 18 No. \3/4\, p. 137).
<bullet> Much older--half of the older renters in subsidized housing
were 75 or older compared to just over a third of older homeowners;
<bullet> Twice as likely as older homeowners to experience physical and
cognitive limitations that threaten their ability to live
independently;
<bullet> More than three times as likely as older homeowners to live
alone and have weak informal supports from family; and
<bullet> Roughly three times as likely as older homeowners to be at
high risk of needing Medicaid assistance due to low incomes and
high levels of disability.
Better coordination of housing, health, and social services
programs would serve a variety of purposes. Housing managers need
reliable partners from health and social services agencies to serve the
large and growing number of frail, older people in their buildings.
Social services agencies could benefit from the greater efficiencies of
serving concentrations of older people with supportive services needs.
But the most compelling case for better coordination comes from the
lives of the older people who need assistance--the older woman who is
desperately clinging to independence in her apartment but has no one to
help her bathe or just simply get out of the tub; the older man who is
told he must move to a nursing home to get basic housekeeping services;
or the older disabled resident in a nursing home who might have been
able to leave if suitable housing and services were available.
AARP actively participated in the Seniors Housing Commission whose
2002 report called attention to many of these issues. We have supported
efforts to expand the mission of housing programs and to provide the
needed tools for serving older persons with disabilities through
building features that accommodate service needs, staffing that
includes trained service coordinators, and retrofitting dollars to
convert buildings to assisted living. AARP is cochairing a process,
along with the National Cooperative Bank Development Corporation,
Fannie Mae, and the National Council of State Housing Agencies, to
develop recommendations on how housing finance programs could be better
structured to promote affordable assisted living. While these efforts
have been important, they do not yet approach the scale of what is
needed to serve the frail older people who need help. Only a concerted
effort by all agencies at all levels of government can adequately
address these needs.
Mr. Chairman, if we continue to accept poor coordination among
providers of housing and housing-related services, we will see an
America with an even greater number of underhoused, underserved older
citizens and a corresponding substantial increase in costly and
premature institutionalization of older people. S. 705 is a worthy
first step as we begin to address these problems. We urge its speedy
enactment.
Thank you again for the opportunity to testify. I would be happy to
answer any questions you may have at this time.
PREPARED STATEMENT OF DANA OLSON
Executive Director, Volunteers of America's Laurel Manor
Senior Residence, Colorado Springs, Colorado
June 16, 2005
Mr. Chairman, Members of the Committee, I am Dana Olson, Executive
Director of Volunteers of America's Laurel Manor Senior Residence in
Colorado Springs, Colorado and regional healthcare manager for 11
Volunteers of America senior residences in Colorado, Nevada, and
California. In that capacity, I also supervised the opening and initial
operations of our senior residence in Senator Allard's hometown of Ft.
Collins, Colorado. I have worked for 34 years in Long Term Care--about
15 of those years as a director of nursing and the rest as a nursing
home administrator. Ten years of my experience in Colorado was working
in a facility with a high population of mentally ill people.
Volunteers of America is one of the Nation's largest and most
comprehensive charitable, nonprofit, spiritually based human service
organizations. We provide services that are designed locally to address
specific community needs. Our common areas of focus include caring for
the elderly and people with disabilities by fostering their
independence, promoting self-sufficiency for the homeless and for
others overcoming personal crisis, and supporting troubled and at-risk
children and youth. In 2004, Volunteers of America services across the
country sshould empower over 135,000 seniors to maintain a healthy,
engaged quality of life through senior centers and day programs, home
repair and homemaker services, informational and referral services,
Meals-on-Wheels and group meal programs, transportation, companion
services, elder abuse protection, case management, and coordination of
other community services.
Also, Volunteers of America is one of the Nation's leading
nonprofit providers of quality affordable housing for individuals and
families in need, people with disabilities, and the elderly in over 225
communities across the country, and is a growing provider of assisted
living, skilled nursing and Alzheimer facilities for seniors with
limited resources. As a leading provider of housing and services for
the elderly, Volunteers of America is an active member of the
Leadership Council of Aging Organizations, the American Association of
Homes and Services for the Aging, the National Council on the Aging,
the Interfaith Coalition for Long Term Care, and the Elderly Housing
Coalition.
As a spiritually based organization we draw on more than a century
of experience and the reach of a nationwide movement that is:
<bullet> Bonded by a commitment to faith, human dignity, and social
justice;
<bullet> Dedicated to actively engaging volunteers in the community;
<bullet> Committed to the highest quality of service.
On behalf of our organization, I want to express our sincere
appreciation for your interest in S. 705, the Meeting the Housing and
Service Needs of Seniors Act, and concern for the needed coordinated
between housing, healthcare, and supportive services for the growing
population of seniors in the United States.
The problems we face as an nonprofit human service organization and
as a Nation in attempting to provide more and better facilities to
house and serve America's seniors, especially the frail elderly, will
be severely compounded by the expected rapid growth in the Nation's
aging population in the coming decades and the lack of adequate public
policy and resources to meet that growth.
In a recent study, ``The State of the Nation's Housing 2001,'' the
Joint Center for Housing Studies of Harvard University reported that
heads of households over the age of 75 ``are expected to increase by
roughly 1.3 million over the decade.'' They go on to say, ``This growth
implies rising demand for housing that allows seniors to age safely in
place and for specialized facilities such as assisted living and
continuing care communities.''
The Harvard report further indicates that, of the nearly 5 million
one-person households to be added over the next decade, ``almost one-
third will be over the age of 65.'' This growth is not going to take
place in the distant future, it is going to be taking place between now
and 2010, when the baby boomer generation begins to retire in ever
increasing numbers.
In their 2004 report, the Joint Center said the Nation's 35.6
million seniors face a ``quadruple threat.'' First, many have
inadequate incomes to pay for housing; second, increased healthcare
needs compete with other basic needs; third, most live in single-family
homes that require maintenance and are difficult for caregivers to
reach because of their geographic dispersion; and fourth, ``many have
physical limitations or cognitive impairments that must be addressed by
in-home care or structural modifications. In the 2000 Census, for
example, 9.5 million seniors reported a physical disability and 3.6
million reported a mental disability.''
All of this is corroborated by the U.S. Department of Housing and
Urban Development anticipating that today's senior population will
double in size by 2030, expanding at a rate of almost 3 percent a year
to almost 70 million people by that time, with the fastest growing
segment of that cohort being persons aged 85 and older. Commensurately,
the Census Bureau estimates that 20 percent of the population in the
United States will be beyond retirement age by 2030 compared with only
about 13 percent today.
Clearly, as a Nation we have a problem of extraordinary scale and
urgency as the housing and social services programs and funding we have
in place today will not keep pace with this situation. Therefore, it is
so important that the programs we have in place--like the excellent
Section 202 Elderly Housing Program--operate in an efficient and
expeditious manner. But its effectiveness for the future can only be
made complete by assuring the availability of coordinated healthcare
and supportive services.
Because of that need, Volunteers of America believes we are at a
time in our history that calls for serious debate that leads to the
creation of a national long term care policy that is inclusive of the
continuum of services issues of affordable senior housing, adult day
care, homecare, assisted living, and skilled nursing facilities. This
is vitally important to persons who are frail and elderly, especially
those who participate in federally assisted or subsidized housing, who
are among the most vulnerable. As they grow older in residences
designed for independent living, they are at high risk of being forced
into institutional nursing home care, or alternatively having their
needs unmet.
Much of this problem is due to the fact that the delivery of
services to many persons is fragmented because of multiple policymaking
authorities and funding streams; conflicting regulations; and poorly
coordinated, overlapping State and Federal Government agencies. This
fragmentation is not only costly, it often times leads to serious gaps
in providing what is needed. For instance: Providers of long-term
housing finance typically to not understand the terminology or analytic
framework of the health care community. Health care regulators are
unaware of the requirements of housing finance. The need to get
participation and approvals for transportation, social service, and
other regulatory bodies further complicates the discussion. Housing
sponsors often must spend inordinate amounts of time and energy as a
go-between because different disciplines give different meanings to
important words. Often terms like ``assisted living'' acquire precise
regulatory meanings that differ from State to State.
It is because of this existing fragmentation that passage of S.
705, the Meeting the Housing and Service Needs of Seniors Act, is so
important as a step in the right direction to better coordination of
housing programs and related services so seniors can age in place and
have access to needed services.
Let me tell you a little about my experiences in Colorado. As an
Administrator of a skilled, long-term care center, I am seeing older,
more frail, acutely ill seniors coming to us for care and
rehabilitation to allow them to return home or to a lesser level of
care in the continuum. As the people we care for come to us much more
acutely ill, and the regulations under which we operate become more and
more stringent, the fragmented system is more difficult to work with.
We never want to be in a position that limits the services we need to
provide to give our residents the highest quality of service possible,
but we need your help to do so.
As the Regional Housing Manager of five 202 Senior Housing
Complexes in Colorado, we have a waiting list of over 200 seniors. That
means 200 seniors are out there in need of our services and we are
unable to meet those needs at this time. This only reinforces the need
for more available housing with services for our seniors. The best way
to meet this need is to have adequate funding to build additional
senior residences with a service coordinator in each facility. The
coordinator would have the capability of assisting our seniors access
the system to fill the need for food, medical care, and other
supportive services. But even good service coordinators have difficulty
unraveling the myriad rules, regulations, agency sources, and funding
streams that are intended to serve senior citizens. Passing this
legislation and establishing a Federal Interagency Council on Meeting
the Housing and Service Needs of Seniors would provide a structure for
Federal agencies to jointly review housing and service programs, more
effectively coordinate Federal programs and services, and work with
States to coordinate programs and services at the State and local
level.
Adult children of middle and lower incomes, whose parents face
these housing and health care needs, are ill equipped both in terms of
care management skills and financial capacity to meet all of the needs
their parents face. Our Nation has evolved to a point where these
elders cannot look entirely to their adult children for financial and
care support, since most of our households have the adults working full
time to meet their own financial obligations and the needs of their
young children. Where once upon a time in our Nation, long-term care
meant providing for aging adults in their adult children's homes, we
now by necessity have our adult children working long days at jobs that
leave little time for adult care. Somehow and in some way the solution
to this senior housing and long-term care crisis must come from a
comprehensive policy that cost-effectively integrates housing,
healthcare, and supportive services for seniors into a reasonable
approach that meets the needs and affordability of the individual and
his/her family in partnership with State and national governments.
Some individuals might think that committed and competent providers
like Volunteers of America have access to sufficient resources to meet
the growing national need for elderly housing, healthcare, and
supportive services. Unfortunately, that is not the case, especially
with respect to the growing needs of frail seniors who are not
affluent. There has been a trend toward reduced funding for the
development of new federally assisted housing for seniors, the
devolution of Federal housing programs to State and local governments,
short-term renewals and funding for Section 8 contracts, the potential
loss of affordable housing units to market-rate housing through Mark To
Market, and, more recently, cutbacks in Medicaid funding and barely
level funding for the important Service Coordinator program.
For the sake of our Nation and its deserving senior citizens we
must find an efficient, well coordinated means of providing long-term
care through integrated healthcare with supportive services and
housing, and that process has to begin at the top. That is why
Volunteers of America believes that the Meeting the Housing and Service
Needs of Seniors Act must be passed as a bipartisan testimony to the
worth of our older generations.
We appreciate the opportunity to bring you our ideas and
perspectives and want to assure all the Members of the Committee that
Volunteers of America is strongly committed to helping resolve these
issues before the growing demand for elderly housing and supportive
services spirals out of control. We are confident that sound solutions
can be found and implemented in a way that is fiscally responsible and
fair to all parties.
Thank you.
----------
PREPARED STATEMENT OF STEPHEN PROCTOR
President and CEO, PHI Retirement and Senior Care Services, Camp Hill,
PA
June 16, 2005
Good morning Mr. Chairman and distinguished Members of the
Committee. I am Steve Proctor, President and CEO of Presbyterian Homes,
Inc., headquartered in Camp Hill, PA, and am honored to have been asked
to provide you with testimony today on behalf of Presbyterian Homes and
PANPHA--Pennsylvania's trade association representing nonprofit senior
services providers. The population we serve in Pennsylvania is among
the Nation's oldest, and in many areas of the State, requires more care
than average. We have 15 sites statewide. Some are located in the
State's largest urban/suburban areas. Others are located in regions
that are among its most rural.
We provide the full continuum of care for Pennsylvanians in need of
chronic care--seniors and, in some of our locations, younger residents
with disabilities. Our world class staff--2,600 strong--provide housing
and services to more than 3,000 residents statewide. We are extremely
proud of our dedicated service and care providers without whom,
providing the highest quality of care and services would not be
possible.
I will admit that when first told about the intent of S. 705 and
asked to testify, I reacted with a degree of skepticism. Historically,
proposals to initiate this type of council have been many--and
solutions coming from them few. Then I read Senator Sarbanes' bill, and
his comments during introduction of this piece of legislation. It is
consistent with PANPHA's strategic initiative on ``Consumer Choice''--
that is, housing and services alignment driven by consumer need, not
the wishes of often well-intentioned bureaucrats and funding agencies.
We strive toward this goal because it is the how consumers wish to and
deserve to receive their services.
In short, this bill makes sense. The coordination proposed in S.
705 is not only necessary--but it is also long overdue, and will
provide real enhancements in the delivery of housing and services to
the people we serve.
As a provider of housing and services, I thought that my time
before the distinguished Members of this Committee would be best spent
discussing the daily challenges that the maze of statutory, regulatory,
and funding requirements pose in
providing housing and services for that resident.
PHI is a sponsor of Stadium Place, a model for senior housing
located on the site of Memorial Stadium in Baltimore. This site
currently contains HUD housing Tax Credit housing for seniors, with
market rate and homeownership developments to follow. It also shares
the site with a full service YMCA. It was developed to provide seniors
with limited incomes many of the same options available to more
affluent seniors of continuing care retirement communities. A recent
editorial in the Baltimore Sun identified Stadium Place as the right
model for senior housing. More importantly, many of the residents of
Stadium Place describe it as the best place they have ever lived. If
you have not seen this project, I would encourage you to visit the
site.
The key to fully realizing the dream of Stadium Place and other
similar senior housing projects is the delivery of supportive services
in an environment that can best be described as fragmented. The
combination of case management, coordination of existing services, and
flexible service delivery systems will enable this group of seniors to
live more healthy and active lives. The timely intervention of health
and social services will ultimately save money by helping residents of
Stadium Place to age in place.
Aging in place is what people desire, if their needs can be met.
PHI has a person in one of our senior housing projects that was
admitted with her disabled husband in 1970. Her needs have changed--but
her desire to remain in her ``home''--since 1970--has not. We provide
her with the care and support services necessary in this setting, but
it has become increasingly difficult to do so given the maze of
regulatory requirements and prohibitions across programs and funding
streams. Without better coordination among and across the agencies
included on the proposed coordinating council in this bill--she may
soon be forced to leave her ``home'' with us.
There are many examples of the housing and service needs of seniors
not matching up with inflexible regulations and program requirements.
The following are two recent illustrations in Presbyterian Homes'
experience.
The first scenario was an 80+ year-old man who lived in the
community. He was receiving funding for services through the Office of
Aging's Medicaid waiver. He was receiving meals-on-wheels and was
having someone come in to assist him on occasion. PHI staff was called
by the Office on Aging to do an assessment on this man. When they got
there the following day, they discovered that he had fallen a day or
two before, but Aging did not have anyone to send out to see him, so
PHI staff were the only ones to help him. They found garbage up to
their shoulders with a path through the trailer. It was evident that
the personal care services he needed had not been provided in quite a
while. He was admitted to a PHI personal care facility.
In this case, the funding and oversight that he received through
the Medicaid waiver was obviously not enough to provide him with the
services that he needed to stay in his home in a dignified manner. We
frequently see families who are provided with the waiver money and then
have to make the choice between food, utilities, medication, and
assistance.
The problem in this situation is that, while this man could no
longer stay at home with the limited support systems available, when he
was admitted to a PHI personal care facility, his funding COULDN'T
follow him. He was not eligible for any waiver funds, he was a few
dollars over the limit to receive the $30/day personal care home
supplement which Pennsylvania pays, but he did not have nearly enough
the pay for the cost of care in personal care. In addition, in the
community, he was eligible for Medicaid health insurance (Access card),
but once he was admitted to personal care, he was no longer eligible
because the requirements were different. The only reason he was able to
be cared for adequately was because we provided him with benevolent
care.
The second situation was an elderly woman with mental health issues
(schizophrenia) who was evicted by a personal care home because she had
extremely limited income. In her case, she was eventually assisted by
an inpatient program. The irony of this situation is that had she been
admitted to a group home, another ``community'' setting or her own
home, she would have received funding for mental health services and
transportation. If she would have been admitted to personal care, she
would have lost that funding because it is considered a medical
facility and therefore the personal care facility is responsible for
those costs/services.
In both of these situations, the funding follows the setting, not
the person. The person's needs and income did not change, just where
they happened to live.
When placed in context by the challenges I just discussed as we
provide housing and services for, the activities of the council
proposed in S. 705 take on even greater importance. The timing could
not be better for this effort. In Pennsylvania, the 65+ population is
projected to grow by 195,981 between now and 2015--encompassing a full
17 percent of Pennsylvania's population.
You will hear many ``experts'' tell you we will not feel any impact
of the ``Baby Boom'' until the mid-2020's--that we have ample time to
project, plan, and coordinate housing and services. It is true that is
when the bulk of the ``Baby Boomers'' will begin hitting ``care age'',
but to say that we do not need solutions in place until then ignores
the realities. In many States, including ours, the sheer volume of
residents living past the age of 85 will fundamentally alter the need
for coordinated housing and services. Pennsylvania's 85+ population
will have more than doubled between 1990 and 2010, growing to 336,407
persons--almost 3 percent of Pennsylvania's total population. They are
the highest users of the long-term care continuum--and do not have the
luxury of waiting until 2020 for a solution to their immediate care
needs.
In Pennsylvania we are feeling the pinch now in a rather difficult
budget negotiation at the State level on Medicaid funding for
facilities. One of the major causes of that battle, happening right now
in many of your States as well, is a direct result of the fragmentation
of the programs and funding for long-term care. The provisions in this
bill that speak to developing best practices, identifying those
barriers--statutory, regulatory, and fiscal--to providing seamless
housing and services are our best hope to meet the needs of this
growing population.
Thank you again for the opportunity to provide this testimony. I
speak for PHI, PANPHA, and our national association AAHSA in applauding
your efforts in this bill. We look forward to help laying the
groundwork for a delivery system that makes more sense for providers
and consumers alike. I would be happy to answer any additional
questions you have at this time.
----------
PREPARED STATEMENT OF WILLIAM T. SMITH, Ph.D.
Chair of the Board
American Association of Homes and Services for the Aging (AAHSA)
June 16, 2005
Chairman Shelby, Ranking Member Sarbanes, Members of the Committee,
I would like to thank you for inviting me to appear before you today to
discuss S. 705, Meeting the Housing and Services Needs of Seniors Act.
I would like to talk to you about the real world experience of
providers and the seniors we serve, as well as the opportunities that
this bill presents for making service delivery and program
administration less cumbersome and more responsive.
My name is William Smith. I am Chair of the Board of the American
Association of Homes and Services for the Aging (AAHSA). The members of
the American Association of Homes and Services for the Aging serve two
million people every day, in 5,600 facilities across the country,
through mission-driven, not-for-profit organizations dedicated to
providing the services people need, when they need them, in the place
they call home.
AAHSA members offer the continuum of aging services: Assisted
living residences, continuing care retirement communities, nursing
homes, home and community-based service programs, and senior housing.
AAHSA's commitment is to create the future of aging services through
quality that people can trust. It is this commitment that underlies our
support of this legislation, its goals and increasing the effectiveness
and collaboration among Federal programs that serve our seniors.
In addition to my work with AAHSA, I serve as the President and CEO
of Aging in America, a community-based organization that originated in
1852 with a mission of providing housing for aged women, and has
evolved into a full service organization employing over 550 staff that
serves over 5,000 seniors annually throughout the Bronx, New York. I
know first hand how complicated and difficult it can be to work with a
patchwork of programs to create the range of housing and services
necessary to care for seniors with varying degrees of frailty and need.
In 1972, Aging in America developed a skilled nursing facility for
386 residents. Later, we established a continuum of community-based
services to undertake educational, research, and advocacy efforts
designed to further enhance the lives of seniors in our community. In
1978, Aging in America converted a 90,000 squarefoot high school into
our social service agency, including a number of community-based
activities, intergenerational programs, an Alzheimer's day care center,
case management, victim assistance, and elder abuse counseling.
When we opened our first senior center in 1979 we served 45 hot
lunches and provided recreational programming. Since then we have added
two off-site senior centers and four satellite programs providing
recreation, education, information and
referral, wellness programming and nutritional services to over 1,500
older New Yorkers weekly. We deliver hundreds of meals daily through
congregate lunches at our senior centers and satellite locations.
Furthermore, in order to help clients navigate the maze of Federal,
State, and local programs we have developed a comprehensive case
management program that provides services for over 700 elderly New
Yorkers, conducting in-home assessments, case management and
authorization for the delivery of in-home personal care, housekeeping
services, and home-delivered meals.
Aging in America also offers transportation services and last year
we provided nearly 300 seniors with 3,465 trips to medical and social
service providers through our program. Our telephone reassurance
program assisted 450 seniors over the last year. Our 17 bed temporary
housing program provides respite, emergency housing, and permanent
living accommodations for people over 60 in need of a semi-protective
environment. We are also opening a 120-unit rental community named
Hertlin House on Long Island, NY. This housing program is for
independent seniors who may require services over time. This property
will be targeted to seniors with incomes $25,000 to $30,000 annually.
The Congressionally established Commission on Affordable Housing
and Health Faculty Needs for Seniors in the 21st Century, comprised of
an expert panel of 13 of aging service professionals, looked carefully
at the demographics, existing programs, the current system of service
delivery and prepared recommendations for a Congress on a necessary and
thoughtful Federal aging policy. Senate Bill 705 is integral to that
policy.
The demographics compiled by the Commission are staggering and
highlight the importance of leadership at the Federal level to
coordinate programs and identify opportunities for improving programs
and service. Today, seniors comprise 12.4 percent of our population.
That is 35 million people. By 2030, that number will have doubled.
Seventy million seniors--20 percent of our population--may be accessing
Federal programs to help meet their housing and service needs. The
demand will be unprecedented. We are faced with a monumental task and a
remarkable opportunity. To delay working toward a solution will leave
us all--governments, providers, and families--in a state of crisis,
unprepared to meet the needs of our seniors. Such a scenario will
inevitably require extra resources, while leaving more and more of our
elderly citizens to fall through the cracks due to overwhelmed, dated,
financially strapped, divergent programs.
One of the Commission's primary recommendations was a call for the
coordination of housing and health care among departments. Frequently
it is during a time of crisis that seniors or their families are faced
with, not one, but a maze of programs in order to get the necessary
services and appropriate housing. Eighteen percent of seniors, 65 and
older, almost 6 million people, who are not living in nursing homes
have difficulty performing at least one activity of daily living
(ADL's)--such as mobility, bathing, dressing, walking, eating, going to
the bathroom, or one instrumental activity of daily living (IADLS)--
such as preparing meals, assistance with financial management, and
taking medications.
Stable, affordable housing settings are the cornerstone of service
delivery. Home and community-based providers, such as Aging in America,
serve seniors where they are. I cannot overstate the importance of
bringing services to all housing settings, among all income levels. In
2020, among those seniors that will need assistance with at least one
ADL or IADL will be 5.8 million homeowners, 1.5 million unsubsidized
renters and 595,000 with some form of rental assistance. Of those
seniors that own their homes, 44 percent have incomes of less than
$25,000 per year and a significant portion are facing excessive housing
costs and have homes that are not accessible and that require capital
repairs. In addition to family and informal support networks, these
seniors rely heavily on Federal programs. They face a multitude of
needs, with varying resources, and will be significantly helped by
Federal agencies that work together.
While the Federal and State governments did not set out to create a
complicated, contradictory, sometimes duplicative system of programs
and funding mechanisms for serving those that are the most in need,
that is, unfortunately, what we have. Over several decades Congress has
enacted various laws, establishing several programs, each with their
own eligibility criteria, funding mechanism and regulations. All of
these programs were created with the best intentions, to meet a real,
critical need. They addressed insular problems, with little awareness
or regard of other agencies and departments working with the same
population.
Today, over half of our senior population is over 75 years old.
We--the housing and service providers and Congress--have some
experience with how older, frail seniors utilize housing and services
programs. We know that the elderly do not experience their different
needs in isolation--rather they experience them in what is all too
often an overwhelming crisis that leaves them with unmet or underserved
housing, health, or service needs. Too often the result is premature,
publicly funded,
costly institutionalization. With a comprehensive, coordinated system
of Federal programs these seniors could be served in the most efficient
manner, with programs based on need and not driven by outdated delivery
mechanisms.
The Members of Congress are essentially problem solvers and so you
must be thinking what we in the field are thinking--knowing what we
know about existing programs, current problems, growing need, and
diminishing resources--there has to be a better way to make sure that
seniors can get the housing and services that they need. Senate Bill
705 is a significant step in that direction. This landmark legislation
is the necessary next step to the Commission recommendation of
coordinating programs by starting with a ``common vocabulary, common
age for eligibility, common definition of eligible populations, and
standards for programs.'' Most importantly it will make coordination a
Federal priority and give agencies an opportunity to identify barriers
and weaknesses and refine programs to make sure that housing and
service programs work together. Senate Bill 705 establishes the perfect
mechanism by which Federal programs can be streamlined with Federal
policy objectives in mind.
Across the country there have been State efforts to coordinate
programs with some success. However, it is clear that the Federal
dictates that govern the programs still need work. Successes at the
State level are limited because the authority to change, modify, update
regulations exists here in DC at the headquarters for HUD, CMS, VA,
Labor, Transportation, and others. Senate bill 705 will guarantee that
the Secretaries, or their designees, address and examine their programs
in a new light, with common goals of coordination, efficiency, and
service.
Chairman Shelby, Members of the Committee, I want to thank you for
your time this morning. I would like to thank Senator Sarbanes for
introducing legislation to take this first step in preparing for the
dramatic increase in the number of seniors that we will see win the
next two to three decades. As the head of an organization providing a
multitude of services for the elderly, I can assure you this
legislation is sorely needed to help our seniors, their families,
caregivers, and providers in making sure that departments work
collaboratively and purposefully toward a federally integrated system
of housing and services.
----------
PREPARED STATEMENT OF TERRY ALLTON
Vice President of Support Services, National Church Residences
June 16, 2005
Good Morning Chairman Shelby, Ranking Member Sarbanes, and Members
of the Committee. My name is Terry Allton and I am the Vice President
of Support Services at National Church Residences, a nonprofit housing,
services, and healthcare provider, based in Columbus, Ohio. National
Church Residences has been dedicated to providing quality housing and
supportive services at affordable prices to low and moderate-income
seniors since 1961. NCR has over 225 communities throughout the United
States and Puerto Rico, housing more than 15,000 low-income elderly,
families and persons with disabilities. As a member of the aging and
not-for-profit community we feel that it is our responsibility to share
our experiences and input in the formation of public policy affecting
those that we serve. I am excited to be here to talk to you about
housing, supportive services and the need for Senate Bill 705.
National Church Residence's Department of Support Services is
nationally recognized as a leader in the housing industry and our
Quality Assurance program has won national awards as the most
comprehensive program of its kind in the country. Our belief in the
benefits of community-based services and supportive housing is
demonstrated by our commitment to attempt to place service coordinators
in 100 percent of our facilities. In the early 1990's, Congress enacted
the Cranston-Gonzalez Act which authorized the service coordinator
program. There have been appropriations since 1991 through HUD. This
launched a profession with the sole purpose of addressing quality of
life issues for the elderly offering possible options to age in place.
Our goal is to link residents with services that will allow them to
remain independent, in their own homes and avoid premature
institutionalization. We use a variety of funding sources to pay for
service coordination, including HUD funding and private grants. The
primary function of a service coordinator is to work with service
delivery systems, provide resource information, identify programs, and
assist seniors through the labyrinth of regulations attributable to a
multitude of government agencies. Our elderly residents typically do
not know who supplies which services or that some services even exist.
National Church Residences is a founding organization of the
American Association of Service Coordinators (AASC), a national,
nonprofit organization representing more than 1,500 professional
service coordinators who serve more than 400,000 low-income older
persons and other special populations living in federally assisted and
public housing facilities nationwide. Like others on this panel, NCR is
an active member of AAHSA and its State affiliate, the Association of
Ohio Philanthropic Homes, Housing and Services for the Aging (AOPHA). I
am also here representing AASC as the current Chair of their Board of
Directors. AASC has long urged that housing, health care, and other
Federal support programs serving the elderly join together to better
focus Federal policy and regulatory efforts, in conjunction with States
and communities. Senate Bill 705 will do just that.
Before I talk about our service coordinator program, I would like
to talk to about NCR's commitment to the preservation of affordable
housing and serving residents as they age in place. NCR has long
advocated for Congress to recognize the importance of preserving
existing affordable housing and helping residents at risk of losing
their housing as providers ``opt-out'' of HUD programs and sell or
convert their properties to market rate. We are losing more senior
housing than we are building. To date, more than 15,000 units of
federally assisted senior units have been converted to market rents.
According to GAO 20 of the 41 older Section 202 properties that will
reach the end of their mortgage commitments by 2013, do not have rental
assistance. This means that those seniors will be in a precarious
position to meet their housing and service needs at a time when
Federal, State, and local communities will have experienced several
years of tight budgets and housing and services are so fragmented.
Housing and services go hand-in-hand for seniors aging in place.
One without the other spells disaster for residents as they become
frailer, with limited options and few resources. Service coordinators
serve as a lifeline for seniors in all manner of housing settings and
have become increasingly important part of our older senior housing
communities, where people have lived for over 20 years, aging in place.
For individual residents, service coordinators do on the local level,
or at best try to do what this legislation would do at the Federal
level by coordinating, what is frequently referred to as the ``crazy
quilt'' of health, housing, and service programs utilized by seniors.
Service coordinators identify resident needs, work within the
community to locate resources, provide limited case management, and
organize health and wellness programs. Service coordinators also
arrange homemaker services, transportation, and meals assistance. They
offer one-on-one help for residents by providing intensive assistance
with entitlement and benefit programs, insurance, Medicare, and
Medicaid. Service coordinators act as a broker for services that are
difficult to obtain through public resources and assist residents in
securing the help that they need to live safely and independently
through community agencies. Their role not only enhances quality of
life issues faced by elders and their families, but may also influence
the cost of caring for elders by keeping them in noninstitutional care
longer.
The first stage of providing a continuum of housing and service
choices for the elderly is in-home supportive services. Individuals
with ample resources, many times, have easier access and a greater
variety of choices in how and from whom services are acquired. Those
living on a fixed income are more reliant on publicly funded services,
governed by Federal departments and regulations that are frequently
overburdened, financially restrictive, and severely limited, and often
unable to meet the demands placed on the existing system. In addition,
navigating through a system of segmented service providers and benefits
is often difficult for older persons and their families. Service
coordinators are the interagency council in action. Their lives and
jobs will be made a lot easier by Senate Bill 705--not to mention what
it will mean to seniors and family caregivers who may be unfamiliar
with the aging services field.
NCR's Support Services Division has gone to great lengths to
quantify the benefits of service coordinators. We continually monitor
programs, offer training and track outcomes. We produce tools, such as
a monthly report, a semi-annual report, and resident and manager
surveys. NCR provides quality assurance to service coordinators working
at 249 communities providing services to approximately 21,875
residents. Each service coordinator serves an average 87.9 residents.
Over 28 percent of the residents are 80 years of age or older and over
38 percent are considered ``frail'' or ``at-risk'', meaning they need
assistance with 1-3 or more activities of daily living (ADL's) per day.
A recent study performed by NCR found that service coordinator time is
allocated accordingly:
<bullet> Advocacy to service agencies, management, and vendors on
behalf of the residents: 16 percent;
<bullet> Helping residents with Benefits and Entitlements: 13.7
percent;
<bullet> Case management: 9.5 percent;
<bullet> Monitoring services: 8.6 percent;
<bullet> Referrals to Health Care Services: 6.4 percent;
<bullet> Conducting Assessments: 5.5 percent.
It is a testament to the benefit of service coordinators in housing
settings that only 3.2 percent of their time is spent on crisis
intervention.
In addition to navigating services, service coordinators help
elderly residents take advantage of cost saving program opportunities,
such as prescription drug discounts, phone bills, utility bills,
supplemental insurance, medical equipment, and food. Seventy percent
(70 percent) of our residents received two or more interventions by our
service coordinators that resulted in cost savings of an average
$2,944.40 per year per resident. Imagine how difficult it is for a
senior living alone without access to a service coordinator.
Service coordinators also provide a cost saving benefit to our
subsidized housing communities, by preventing unnecessary vacancies.
The average cost for a vacancy in one of NCR's facilities is $1,732.
Service coordinators help residents avoid potential eviction, undesired
move-outs, and unnecessary placement at a higher, more costly level of
care. In one study, we were able to establish that service coordinators
in NCR facilities saved the properties an average of $2,393 per
property over a 4-month period by making it possible for residents to
remain in their homes, aging in place. One study shows that housing
with home health care services costs approximately $60.00/day, while
one day in assisted living costs $100/day, and a day in a skilled care
facility costs $180/day. The cost-savings of in-home supportive
services is staggering.
A preventative, expansive, affordable range of community-based
services is essential to making our communities, our staffs, and our
residents successful, but more can be done. The types of programs that
our seniors rely on often come from Federal departments and agencies or
state programs that are federally funded. From Transportation to HUD to
CMS, we work with a staggering number of regulations and eligibility
requirements. Under Senator Sarbanes' bill, the primary people
responsible for all of these programs will be brought to the table.
This bill will give leaders a chance to look at these programs with a
bird's eye view in the context of senior housing, services, and long-
term care. We in the industry have a number of ideas on how to make
programs work better together. It would be far more beneficial to bring
these issues to those that set and implement the policies that govern
the programs.
Too often we spend time going from agency to agency and writing
various headquarters offices, trying to make programs work together in
order to meet our resident's needs. We have made some headway and the
State and local agencies are eager to help, but the simple fact is that
it is unnecessarily time consuming for us, and for the agency and
department staff. I urge you to consider the benefits to establishing
an interagency council and to support Senate Bill 705. Federal, State,
and local governments are struggling with soaring costs related to
caring for our seniors. This legislation will give the Federal
Government and our policymakers an opportunity to create a workable
solution to cost effective, noninstitutionalized long-term care--
housing and services.
Chairman Shelby, Ranking Member Sarbanes, Members of the Committee,
thank you for your time and consideration of this important piece of
legislation. The Meeting the Housing and Services Needs Act is the
first step in maximizing program effectiveness, addressing the need for
Federal coordination of programs and most importantly, serving seniors
where they are--in their homes. I urge you to act on this legislation
before we face a system that is ill-prepared to serve the numbers of
seniors in the future. Our Federal programs serve a very real need, a
need that will continue to grow. Unfortunately, sometimes it seems that
change takes a while with complicated programs. We cannot afford to
wait. The commitment of the departments and agencies at the Federal
level can make this work. Again, on behalf of NCR, our staff and
residents, thank you for your time and work on important issue.
PREPARED STATEMENT OF STEVE PROTULIS
Executive Director and Vice President
Elderly Housing Development and Operations Corporation (EHDOC)
June 16, 2005
Mr. Chairman, and Members of the Senate Committee on Banking,
Housing, and Urban Affairs, my name is Steve Protulis, Executive
Director of the Elderly Housing Development and Operations Corporation
(EHDOC), a nonprofit development and management corporation based in
Ft. Lauderdale, FL devoted to providing the best suitable and
affordable housing for low and moderate income older persons. EHDOC
currently has 42 senior housing facilities in 14 States, DC, and Puerto
Rico for approximately 4,000 senior citizens; and has three additional
properties under development. Most of our senior housing facilities are
financed through the Section 202 program.
First of all, I would like to express my appreciation to you,
Senator Shelby, for your leadership in convening this very timely
hearing on S. 705, legislation to establish the Interagency Council on
Meeting the Housing and Service Needs of Seniors. I am pleased that my
State's Senator, Mel Martinez is a Member of this Committee. Not only
because he is a compassionate person with practical housing
experiences, but he also has a unique perspective of the need for
interagency collaboration as the former Secretary of HUD.
I would like to start my testimony by telling a story of Marie, a
frail, older resident who had lived for 14 years in one of our four
senior housing communities in southern Florida. She called our service
coordinator crying because she had no other family members or friends
to help her and she did not want to go to a nursing home as her doctor
indicated that she would. Her level of frailty and income qualified her
for Medicaid. The service coordinator linked her with a community
agency that specializes in a comprehensive health care program for
frail elderly--a Program of All-Inclusive Care for the Elderly (PACE).
As a result of the collaboration between the senior housing and the
Florida PACE Centers, the resident who was previously at-risk of going
to a nursing home, could continue to live in our senior housing
facility, attend the PACE healthcare center and receive needed
assistance 7 days a week, which achieved Marie's choice to remain in
her home with dignity and independence.
This is just one example of the mutual benefits of collaboration
between housing, services, and health care that enables an older person
to achieve their choice to age in place, while at the same time saving
public funds. There are countless other stories in EHDOC's properties,
and the other organizations testifying today, of frail older persons
struggling to age in place. My testimony today will focus on some of
EHDOC's experiences as well as my observations as one of the 14 members
of the Congressional appointed Seniors Commission on Affordable Housing
and Health Facility Needs for Seniors in the 21st Century. The final
report, ``A Quiet Crisis in America'', was presented to this Committee
on June 27, 2002.
Seniors Commission
I would like to publicly thank Senator Paul Sarbanes for the honor
of being his appointee to the Seniors Commission and for his leadership
with introducing S. 705, Meeting the Housing and Service Needs of
Seniors Act As may be evident by the attendance of many older residents
from Council House, an EHDOC community of 160 units in nearby Marlow
Heights, Maryland, Senator Sarbanes has earned much respect and
admiration for being a champion for senior citizens.
As we discuss today the issues outlined in Senator Shelby's
invitation letter regarding housing and service needs of seniors, and
how these programs can be better coordinated, we must always be mindful
of the faces behind the data, and involve older persons in our
deliberations. One of the most gratifying experiences of the Seniors
Commission was the opportunity to hear compelling testimony directly
from senior citizens at each of our field hearings held around the
country.
The one consistent message that was repeatedly heard by the Seniors
Commission from seniors, as well as from policymakers and other
professional experts, was the desire of seniors to age in place. It is
appropriate that one of the key objectives of the proposed Interagency
Council on Meeting the Housing and Service Needs of Seniors is to
facilitate the aging in place of seniors, as well as to improve
coordination between housing and services.
The findings and demographic information highlighted in Section 2
of the S. 705, and the fact sheet provided for these hearings provide
forceful data to justify the need to establish the Interagency Council.
These findings identified in the bill, are reinforced by the extensive
research and documentation by the Seniors Commission, including a
thorough analysis of projected housing and services needs provided in
the appendix. The Commission reported that 53 million Americans (one in
six) will be aged 65 and older in 2020, which will represent 20 percent
of the population (compared to 12.4 percent when the report was issued
in 2002). That significant increase and the need for Americans to
prepare for the changing demographics represent a ``Quiet Crisis is
America'' which is the apt title of the final report from the Senior
Commission.
A substantial number of older residents in federally assisted
housing are women living alone with some physical or cognitive
limitations. The Seniors Commission reported that about a third of
residents over the age of 65 require some assistance. For those aged 75
and older, this rose to 36 percent and 11 percent with mental
disability that seriously interfered with their everyday activities.
However, for the lowest income of the group, with income under 150
percent of poverty level, they are especially vulnerable with almost
214,000 or over 42 percent having at least one limitation with
activities of daily living. The average age nationally of low-income
residents of Section 202 elderly housing in 1999 was 75.
While these national figures may be helpful for public policy, for
operations it is vital that the data be considered at the community and
facility level where the data is far more meaningful. Nationally, the
average age of residents in EHDOC facilities is 79 and increasing
annually; we have facilities where the average age is 80 (Florida). The
desire of older persons to age in place is certainly reflective of the
number of years that they remain in federally assisted housing. Many of
EHDOC residents have lived at properties in many States including
Florida, Illinois, and Pennsylvania for over 20 years--from the time
the senior housing facility was first opened. A few months ago, one of
our residents in Ohio celebrated her 101st birthday--centurions are
becoming more frequent. She has a regular exercise routine and
participates in the weekly exercise class offered at our property--that
is aging in place. At one of our properties in New Hampshire, 50
percent of the residents are over the age of 85, including one 98 years
of age.
As documented by the Seniors Commission, the need for supportive
services is reflected by the number of persons who are considered frail
or at risk. In Florida, for example, of our 620 units in four
facilities, 37 percent of the residents are considered frail and 41
percent are at risk. This translates to approximately 78 percent of the
residents needing supportive services. In Pennsylvania, of the 348
units in five buildings, 22 percent of residents are rated as frail and
29 percent at risk; or over half of all residents needing services to
maintain their independent living.
When considering the types of services that older residents of
federally assisted senior housing need, (based on a survey of a small
sample of facilities in Florida), the Seniors Commission reported that
two of the top three most important services related to transportation.
The need to collaborate between senior housing and transportation might
be of interest to the Housing and Transportation Subcommittee. Seniors
stated that transportation to and from doctor's office (15 percent),
and for grocery shopping (14 percent) was a priority need. When asked
if they had a problem getting affordable transportation to places (not
within walking distance), over 25 percent of the elderly indicated that
they had a problem always or most of the time and 15 percent some of
the time. The number one service need reported was physical
modifications to the facility or their apartment, that is, hand-rails,
grab-bars in bathrooms. Over a third reported that they had no person
that they could rely upon for their health and disability-related
problems, and 16 percent said they only had someone they could rely
upon occasionally.
Dr. Stephen Golant, University of Florida, a senior issues
specialist who conducted for the Seniors Commission an extensive
research paper on demographics and future housing needs of older
americans (included in the Appendix of the final report), is presenting
a paper to the Commonwealth Fund and AcademyHealth Forum next month. As
he will be reporting on emerging relationships between senior housing
and long-term care, when informal care giving assistance becomes
inadequate, lower-income, older adults must turn to public sector
solutions. (This is when), they are likely to confront administrative
or organizational barriers that make it difficult for them to bundle
together the benefits and services they need to age in place
successfully.
Dr. Golant's report also advises that not having access or
knowledge of services, lack of funds, and the time and inconvenience it
takes to secure services are important drawbacks in getting seniors the
help they need. In addition, the qualifications/eligibility may be
different for each service. The paperwork alone can deter a person from
seeking the services they need.
Clearly, as often testified before the Seniors Commission, there
are a number of existing barriers that are making it very difficult for
some older persons, their caregivers, professional staff, and others to
assist older residents to access a range of supportive services. The
Seniors Commission identified a number of major barriers to linking
housing and services, including the traditional distinct roles of
various Federal departments, such as HUD, focusing on a safe, decent,
and affordable place to live, that is, to provide a roof over seniors
heads--but not to provide the types of services essential for enabling
aging in place and/or quality of life for older residents.
Some of these barriers are the types of actions that can be
addressed by the proposed Interagency Council on Housing and Service
Needs of Seniors. For example, the Commission identified a number of
administrative and organizational barriers caused by different
government programs, levels of government, different types of providers
(public, private, or nonprofit), different funding streams. As
characterized in the final report, . . . ``housing and service needs of
seniors traditionally have been addressed in different `worlds' that
often fail to recognize or communicate with each other . . . while
policymakers have struggled to be to be responsive to the needs of
seniors, the very structure of Congressional Committee and Federal
Agencies often makes it difficult to address complex needs in a
comprehensive and coordinated fashion. For example: Medical needs of
seniors are addressed by Medicare and Medicaid; social services needs
are address by Medicaid, the OAA (Older Americans Act), and other block
grant programs; housing programs are administered by HUD and the
Department of Agriculture's Rural Housing Services (RHS); and
transportation programs are administered by the U.S. Department of
Transportation.''
Future of the Interagency Council on Housing and Service Needs for
Seniors
I believe that the various functions identified in Section 5 of S.
705 for the Interagency Council will significantly contribute to
forging better communication and collaboration between the various
Federal agencies (as identified in Section 4c of the bill) involved
with housing, services and health care, as well as between the Federal
Government with State and local governments and with the private
sector. For example, the Council could examine ways to promote
increased collaboration by making more compatible the different income
eligibility to participate in some HUD and HHS programs. HUD and USDA/
RHS could collaborate with the Department of Health and Human Services/
Center for Medicare and Medicaid Services (HHS/CMS) in working with
States and local communities to ensure suitable and affordable housing
is available in communities seeking to develop Home and Community-Based
Services either in response to the Supreme Court, Olmstead Decision
requiring community options for persons with disabilities or as part of
the Administration's New Freedom Initiative. The Interagency Council
could facilitate a means to implement the various recommendations of
the Seniors Commission: To provide a means to streamline
counterproductive regulations; to compile and exchange data, research,
and technologies; or a ``one-stop-shop'' for best practices or to
foster the development of innovative or cross-cutting models. As the
Commission reported, ``the Nation can no longer afford the inefficiency
of the current disconnect between housing and health services systems
for seniors.'' The time has come for coordination among Federal, State
, and local agencies and administrators. The establishment of the
Interagency Council could help improve efficiency among the various
Federal agencies within the existing structure.
While some could argue that the benefit of the Interagency Council
is saving costs--and perhaps even could be self-financed by recycling
cost savings, I believe that the focus of this effort should not be
saving money, but rather on saving lives. Remember my first story of
Marie, the frail, older lady in Florida who was able to remain in her
home through effective collaboration between the housing provider and
the health care provider? The Interagency Council could help promote
the replication of models like this as a means to save the life of
another older person in another facility (or own home). The Program for
All-Inclusive Care for the Elderly (PACE) program is administered by
States and funded through Medicaid and Medicare for a wide range of
health care and services, but does not have HHS funds for the physical
structure to house a PACE center. Some federally assisted and public
housing may have a number of frail residents who could benefit from the
PACE program, but do not have HUD funds nor desire to operate the PACE
program. However, if there should be surplus space in or adjacent to
the housing facility to enable the colocation of a PACE center, it is a
win-win situation for the frail elderly, the housing provider, the PACE
provider and taxpayers. The Interagency Council could help expedite the
development of both the PACE and Center space as well as transportation
through uses of more flexibility with existing funds.
Service Coordinators
One of the key recommendations of the Seniors Commission for
forging increased collaboration between senior housing and services is
the staffing of service coordinators. I am pleased that Terry Allton is
here to testify on behalf of the American Association of Service
Coordinators (AASC) where I am honored to serve on the Board. I am
pleased that EHDOC has a service coordinator for nearly all of our 42
properties. In our website: www.ehdoc.org we include a copy of our
Newsletter, New Dimensions, that includes a Service Coordinator Page
with quarterly examples of
exemplary efforts of service coordinators assisting seniors to age in
place. The following are two examples where our service coordinators
have not only assisted vulnerable frail elderly to remain in their home
as they desired, but also saved public funds.
Council House, Marlow Heights, MD--One of our residents, Edna,
stopped socializing as much as she used to. She had such severe leg
pain that even using a walker was not possible. She seemed to be
slipping into a depression because she was confined to her apartment.
The Service Coordinator suggested that we get her a wheelchair, but she
said that she would not be able to push herself around because she is
too weak in her upper body.
The Service Coordinator told her about another option that could
work. We contacted a company that has motorized, compact scooters. We
ordered one and Medicare paid for it. Edna now ``drives'' herself
everywhere. She is much happier now that she can again go outside, come
down to bingo, come down to lunch where she plays cards with friends,
attend religious services, etc. Her fear was that she would become so
immobilized that she would have to move to a nursing home.
By keeping this resident mobile so she could live at home, we saved
Medicare over $10,000 the State of Maryland nearly $40,000 plus
additional savings with other Government programs and significantly
reduced costs to the low-income, older person. These estimates are
based on the average cost of nursing homes in Maryland over the 2 years
that Edna has been able to continue to live at Council House since
getting the scooter.
Mildred and Claude Pepper Towers, Miami, FL--Our service
coordinator has helped link our frail residents into the State's
Channeling program to enable them to continue to live independently in
their apartments. For example, the program has helped one of our
resident's, Fannie, by providing a visiting nurse and home health aide
to conduct daily cleaning activities, medications ands home delivered
meals, thus saving the government tens of thousands in the 2 years that
she has been in the program. Before Fannie was linked with this
program, she thought she would have to go into a nursing home.
Despite the ample documentation of the cost effectiveness of
service coordinators in enabling frail elderly to access community
services, it may require an investment in one department (HUD) to save
money in another (HHS). Unfortunately, funding for service coordinators
in Federally assisted senior housing, as well as with public housing,
is woefully inadequate to ensure that facilities providing affordable
housing for low and moderate income elderly have sufficient resources
to include service coordinators as part of the operating budget of
federally assisted and public housing. The Interagency Council could
facilitate actions that both agencies would find mutually beneficial,
including interagency training, access to timely information,
technologies, or best practices.
Private Sector Collaboration
One of the issues that Chairman Shelby asked us to address was the
role of the private sector with housing and services needs of seniors.
Rightfully so, considering that senior housing and services is big
business: Jobs, consumer products, taxes, etc. Senior housing and
services has a symbiotic partnership with the private sector. The
Seniors Commission examined a number of issues that need the active
involvement of the private sector with housing and services, including
increased role for Government Sponsored Enterprises (Fannie Mae,
Freddie Mac), bonds, and various tax incentives. With the present
rapidly escalating housing costs and tight local markets, many
federally funded facilities that could be used for affordable senior
housing are being lost through conversions to condos.
Given the demographics, the limited Federal funding for Section 202
and other affordable senior housing, and long waiting list for most
facilities (nationwide EHDOC has over 4,200 seniors waiting for
affordable housing--more than those who currently resident in our
facilities), we need to create additional means to finance the
development and preservation of affordable senior housing. Some
existing buildings could be acquired through public-private
partnership, rehabilitated, add enhanced services, and reposition in
the community as mixed-financed, mixed-use, and mixed-income senior
housing, as part of a community long-term care strategy. We clearly
need effective interagency collaboration with the GSE's, HUD, IRS,
State housing finance agencies, banks, State and local government, and
the private sector.
EHDOC could not function without partnering with the private
sector. For example, we have been successful in work with Homeward
Bound to provide 100 hours of free personal care aids to residents in
New York; Verizon Corporation, BellSouth, and SBC for donations in
excess of $100,000 in computers for seniors to be connected to today's
technology, and the Pequot Indians Prescription Drug Program which
provides prescription medication to EHDOC seniors at the lowest
possible costs.
In addition to the efforts of our service coordinators brokering
linkages between senior residents with a myriad of public and private
community agencies, EHDOC has established a program to promote
collaboration between our residents, our facility, and the local
community. Our Community Action Program (CAP) is designed to encourage
active participation between seniors and their community. We promote
volunteers both by our resident's involvement within the community, as
well as by community organizations and individuals to assist our
residents. Again, our website provides an on-gong listing of local
programs in our newsletter. One of the recent examples of CAP which we
take much pride, was action taken by our residents in response to the
devastation caused by the Tsunami. Our low-income, older residents
conducted bake sales and other fund raising activities (some with local
private sector matches), and were able to raise and donate $25,000 to
survivors. Not only would an Interagency Council be helpful with our
local, State, or national efforts by exchanging timely information
nationwide, but now also worldwide. I will be discussing our CAP
program in Norway next week as part of the International Association of
Homes and Services for the Aging (IAHSA).
One final comment on the private sector and S. 705 to establish the
Interagency Council on Meeting the Housing and Service Needs of
Seniors, I would like to suggest that we borrow a phrase by the Nike
Corporation . . . ``Just Do It!'' I believe that the establishment of
the Interagency Council is the next step building upon the wealth of
testimonies, research, data, best practices, and countless hours of
deliberations of the Seniors Commission. It was the wisdom of the
Congress in establishing the Seniors Commission to give us an 18-months
deadline. I believe that the final report provides ample justification
for the need to increase interagency and public and private
collaboration in meeting the housing and services needs of rapidly
increasing elderly population. While it was challenging, we met the
deadline, and delivered our final report and recommendations to this
Committee at hearings held on June 27, 2002 before Senator Sarbanes and
the Banking, Housing, and Urban Affairs Committee. I am pleased that
the Committee arranged for the final report, as well as the proceeding
of the hearings and related actions to be available at
www.seniorscommission.gov. I would like to request that the Committee
take additional actions to ensure the extensive demographic research
paper is also inserted into the website. I am pleased that the
Commission was identified as a contributing factor in the introduction
of this important and timely legislation. I am encouraged that the
establishment of the Interagency Council on Meeting the Housing and
Service Needs of Seniors will provide a means to address and implement
its comprehensive list of recommendations.
My final comment would be to think like Nike of the private sector:
``Just Do It! At EHDOC we have modified this phrase to: ``Feel It (in
your heart), Think it (do your homework), and Do it (take timely
actions). I would urge your quick passage of this bill to establish the
Interagency Council on Meeting the Housing and Service Needs for
Seniors; and urge your support to ensure its quick enactment during
this 109th Congress. Thank you.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
RESPONSE TO A WRITTEN QUESTION OF SENATOR STABENOW
FROM ALPHONSO JACKSON
Q.1. In the LEGACY Act of the American Dream Downpayment Act of
2003, what is the status of: The provision to create a
demonstration program to train employees in the rights of
intergenerational families in connection with the Section 202
Supportive Housing for the Elderly program; the provision that
Census study be done in relation to HUD Section 202 housing?
A.1. The LEGACY Act provisions of the American Dream
Downpayment Act authorized the Department to carry out a
demonstration program to provide assistance for
intergenerational dwelling units for intergenerational families
in connection with the Section 202 Supportive Housing for the
Elderly program. The Act was signed into law on December 16,
2003. However, the Consolidated Appropriations Act of 2004
(Public Law 108-199, approved on January 23, 2004) did not
provide an appropriated amount to carry out the demonstration
units. The fiscal year 2005 appropriations bill again did not
provide funds for this purpose. Although funds are not yet
available to carry out the demonstration, the Act also included
a provision that directed the Department and the Bureau of the
Census to conduct a study to determine an estimate of the
number of grandparent-headed and relative-headed families in
the United States and their affordable housing needs. The study
is expected to be completed this summer.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>