SENIOR HOUSING 101 & WHY YOU SHOULD PARTNER WITH A HOUSING AUTHORITY

Presented by Joseph Glucksman, MPA

DEFINING SENIOR HOUSING

• Age • Dwelling Type:

• SFH; Group Homes; Adult Family Care Facilities; Assisted Living; Nursing Home

• Level of Care:

• Independent; Assisted; Skilled

• Cost to Live There: • Affordable; Moderate; Market Rate; High End

AGE

• HUD definition:

– Near Elderly: 51-61 years old

– Senior: 62 years and older

DWELLING TYPE

• Single Family Homes are retrofitted to accommodate the needs of the elderly or infirm … usually for accessibility.

• Group Homes are congregate settings were independent seniors share meals and some activities. No personal care services are offered.

• Adult Family Care Homes (AFCH) are licensed for up to 5 unrelated adults, similar to group homes but where care services are provided.

DWELLING TYPE (con’t)

• Assisted Living Facilities (ALF) provide personal care services and usually medications management in a social setting. A wide range of services can be offered. Persons as young as 18 can reside in ALFs.

• Nursing Homes and residential rehab facilities provide 24 hour skilled nursing care in a medical setting.

DWELLING TYPE (con’t)

• Continuing Care Retirement Communities (CCRC) offer “step up” housing by providing Independent, Assisted Living and Skilled care all on one campus. Your care steps up as your needs dictate…and so do the fees. Usually very large and up scale communities with amenities such as golf courses, club houses, restaurants and even shopping.

LEVEL of CARE

• Independent Senior communities do not provide care services directly but can arrange for 3rd party medical care to be offered in most settings. Services can range from nothing to group meals, on site medical care and an active social calendar of events. Settings range from single room rentals and apartment buildings to planned senior communities.

LEVEL of CARE (con’t)

• Assisted Living provides personal care services and arrange for medical care. Personal care services include assistance with the activities of daily living and medications management. ALFs are social settings with a schedule of daily activities for residents to participate in. Adult Family Care Homes provide a similar level of care in a small “home-like” setting, usually converted single family homes.

LEVEL of CARE (con’t)

• Skilled Care is provided in nursing homes and residential rehab facilities. Similar to ALFs…personal care services are provided, but there is also 24 hour skilled nursing. Skilled care is a medical setting with an expectation of institutionalization. New skilled beds require a Certificate of Need (CON) to be issued by the State.

COST TO RESIDE

• Each dwelling type has its own cost to provide the housing and care services.

• The continuum of costs range from subsidized and affordable on the lower end, moderate or market rate in the middle, and high end as the most expensive & usually more opulent settings.

• Our focus is on subsidized affordable senior housing.

COST TO RESIDE (con’t)

There is usually a direct correlation between cost and the amenity package.

However, higher costs do not

necessarily equate to better care services.

CARE SERVICES

• Assistance with the Institutional ADLs: banking, laundry, shopping, traveling, etc.

• Assistance with ADLs: ambulating; bathing; dressing; eating; grooming; toileting.

• Medications Management • Skilled Nursing Care: 24 hour per day nurses

available. • Physician Care: needed in nursing homes.

SUPPORTIVE SERVICES

• Usually not required by Statute or Rule, but certainly adds to the quality of life for residents.

• Some Supportive Services are required by funders like the FHFC.

• Providing Supportive Services is “good business” to keep seniors healthy, happy and can reduce tenant turnover.

SUPPORTIVE SERVICES

• Transportation • Daily Activities • Religious Services • Physician Care • Home Health Care • Diagnostic Services • Adult Education

Courses

• Intergenerational programming

• Meals & Snacks • Pharmacy Services • Durable Medical Equipment • Therapy Services • Case Management • Etc.

BALANCING COMMUNITY NEEDS • Needs vs. Wants • Desires and Goals • Demographics • Community Profile • Shifts in the Community…trends

DECISIONS MADE SHOULD BE NEEDS BASED!

THE AGE FACTOR

• Care needs & resident choice rather than age should dictate the type of housing … Independent vs. ALF vs. Skilled.

• Strive to provide as much independence as possible.

• AFCHs, ALFs and Nursing Homes can house adults as young as 18 of age, but are heavily regulated.

AVERAGE AGES • Independent Senior Housing:

– Near elderly: 51-61 years old – Elderly/Senior: 62 years and older – Average being late 60’s- mid 70’s

• Assisted Living: 82 is the average

– Can house adults 18 years and older

• Nursing Homes: 80’s +. Age varies significantly dependent upon funding. Medicaid funding for disabled adults brings the average age way down.

FLORIDA: SENIOR INCOME

In 2009, the average income of all Floridians, 65 years and older was $33,818.

Source: US Census Bureau: FactFinder.census.gov

INCOME CATEGORIES

• Federal Poverty Level: 908/mo $10,890/yr

• Extremely Low Income (30%): 987/mo $11,850/yr

• Very Low Income (50%): 1,645/mo $19,750/yr

• Low Income (80%): 2,633/mo $31,600/yr

source: HUD 2011 guidelines: Florida

SOCIAL SECURITY

Social Security is the primary payer source for housing seniors.

As of December 2009, the average monthly Social Security check for Florida residents over the age of 65 is only…

$1,157.70 Therefore the average Floridian senior is

considered a very-low income household. Source: OASDI Annual Statistical Supplement, 2010

HOW MUCH DOES $1,157.70 BUY

NOT MUCH!

• Independent housing cost varies significantly based upon the type of dwelling and the supportive service package offered.

• Average ALF in Florida is about $1,850/month with ranges from just under $1,000 to over $5,000/month.

• Skilled care starts at about $5,000/month.

Other housing subsidies are needed.

AFFORDABILITY

• HUD defines affordable housing as the household not paying more than 30% of

their gross monthly income on housing expenses including rent & utilities.

• At $1,157.70, the average SS beneficiary

should not spend more than $347.31/month on housing.

FLORIDA: FAIR MARKET RENTS

• Fair Market Rents throughout Florida for a one-bedroom apartment range from a low of $536 to a high of $1,106 per month.

• Average FMR across Florida is $821/mo.

Source: HUD Fair Market Rents 2011

THE GAP

• Average Fair Market Rent: $821.00 • Average Senior SS Affordability: 347.31

• The Gap: $473.69

• Conclusion: SUBSIDIES NEEDED

FLORIDA AFFORDABILITY

• Of the 3,339,880 seniors 65 and older, 2,056,362 live in households that pay more than 30% of their adjusted gross monthly income on housing.

• A staggering 61.6% of all seniors in this age group.

• Represents 16.5 % of all Floridian households. Source: DOEA 2010 Florida County Profiles

FLORIDA DEMOGRAPHICS

• Total population 18,881,443 100.0% • Aged 60+ 4,454,625 23.6% • Aged 70+ 2,442,215 12.9% • Aged 80+ 1,073,865 5.7%

Source: Dept of Elder Affairs; 2010 Florida County Profiles

OF THOSE 60+ … • Race: White 4,006,806 89.9%

Non-White 447,819 10.1% • Gender: Male 1,996,280 44.8% Female 2,458,345 55.2% • Financial: Poverty 411,460 9.2%

125% 599,248 13.5% • Living Situation: Alone 1,042,357 23.4%

Rural Areas 456,039 10.2% w/grandchildren 197,273 4.4%

FLORIDA CURRENTLY HAS…

• 466 AFCH 8,721 Beds • 2,840 ALFs 81,032 Beds* • 710 Nursing Homes 82,415 Beds TOTAL 172,168 Beds There is no count maintained for independent

senior homes or beds. * Of the 81,032 ALF beds, only 15,717 are reserved

for the economically disadvantaged (OSS beds). Source: Agency for Health Care Administration/DOEA

FLORIDA’s GAP IN LONG TERM CARE FACILITIES

• For those 65 years and older, DOEA estimates that there are 800,348 persons declared Medically Underserved.

800,348 seniors in need 172,168 beds on line 628,180 the GAP • Many can be served in well planned independent

housing communities that offer supportive services.

SENIOR HOUSING SUBSIDIZES

• If the average Social Security payment is $1,157.70 per month; and

• The 30% affordability factor allows for $347.31 per month in total housing expenses;

• Then how can Florida seniors afford decent, independent housing without their being a subsidy?

DEVELOPING AFFORDABLE HOUSING

DEVELOPMENT FUNDS

For Affordable Senior Housing: • Tax Credits • S.A.I.L. • S.H.I.P. • HOME • CDBG • HUD Programs like 202 & 232 • Federal Home Loan Banks • Foundations

OPERATING FUNDS • Private Funds: Directly from the resident

and family such as Social Security or pensions.

• Medicaid: Care Service in AFCH/ALF/Skilled Homes • Medicare: Care Service for

Independent Housing • Section 8 Vouchers: Rental costs for Independent/ALF housing • HUD : Public Housing & other

monthly program subsidies

WHAT CAN A HOUSING AUTHORITY OFFER?

• Land…the use of it. You don’t need to sell or give the land. A long term lease will keep the Authority involved with some control. The land must be properly located to maximize funding applications.

• Vouchers… will provide investors with a “guarantee” for the rental portion during operation. HAP Contract.

• Marketing assistance.

• Support for the developers funding applications.

• Conduit to the City for local issues such as plan approval, rezoning or special exceptions that may be needed.

• Establish a customer friendly client approval process

INCENTIVES FROM THE CITY

• Density Bonus …will provide for additional beds/units to be constructed at no cost to the City and will enhance the Authority’s Assets.

• Expedited Plan Review and Permitting reduces the development period.

• Support and Expediting of the site plan approval.

• Cash contribution in the form of a grant or loan to demonstrate local support.

QUIET WATERS

An Affordable Senior Rental Community in Belle Glade

QUIET WATERS

• An example of an Independent Senior Community that provides full services.

• An Affordable Community. • A study in partnerships at all levels. • Designed to serve the local community of

Belle Glade…but a replicable model. • A demonstration project.

QUIET WATERS • 63,000 sq ft

• Solid Concrete Modular Construction

• 93 one bedroom apts. • 15,500 sq ft Community Service Center • 5.0 acres • Hurricane Resistant • 750 KW Generator with

3,500 gallons of fuel

• 430 sq ft Apartments • Individual HVAC Units • Fully Furnished • ADA Accessible • Multi-level Security • Computer Center • Physician Office • Adult Day Care Center • Dining Facilities • Library

RESIDENT PACKAGE

• Fully Furnished Apartment; • All Utilities Paid; • One Free Lunch Meal Every Day; • Case Management Services; • Activities Program; • Medical Care Coordination; • Privacy & Dignity.

SUPPORTIVE SERVICES

• On-site physician care • Home Health Care • Physical Therapy • Wound Care & other

nursing services • Senior Congregate Meal

Site • Full service restaurant

• Social Activities • Local Transportation • Adult Day Care • Tenant Clubs • On-site Management • Case Management • Resident Advocacy • Resident Garden

COST TO THE RESIDENT

• 30% of their adjusted monthly income!

• The Housing Authority pays the balance or 70% of the cost of housing.

• Monthly cost to resident of $372 for those receiving the average Palm Beach County Social Security of $1,241. Real average cost to residents is closer to $262.50.

HOUSING FUNDING

• RESIDENT: Private Funds from residents or their families pays for 30% of the cost of housing. The funding sources include social security, pension, interest income from assets.

• HOUSING AUTHORITY: Pays for 70% of the cost of housing (including utilities) through a project based section 8 voucher program.

SERVICE FUNDING

To pay for the cost of services to residents:

• 3rd party payer sources such as Medicare for health care.

• Congregate Meals program. • Grants to fund case managers and other direct

service staff. • Resident rent concessions. • Donations and Proceeds from the development.

QUESTIONS

Joseph Glucksman

306 SW 10th Street Belle Glade, FL 33430

(561) 996-7040 Joe.glucksmanqw@gmail.com