- Report Published -
|Report of the Department of Social Services Stuyding the Provision of Certain Services to Low-To-Moderate Income Persons Allowing Them to Remain In Independent Living Facilities|
|Department of Social Services|
|HJR 564 (Regular Session, 1995)|
|Concerns about residents of federal and state subsidized housing who are aging-in-place without the availability of essential services led the Virginia General Assembly to request this study. The study reviews congregate housing in Virginia, identifies the supportive services necessary to maintain older persons in the least restrictive home settings, reviews models for linking housing and services, reviews risk, examines current Virginia models which link services and housing, and identifies models for funding support services in assisted housing.|
Key findings resulted from analyses of data and information compiled by the Task Force.
National Phenomena Which Impacts Service Needs in Congregate Housing
• There is an unprecedented number of elders in the population and the trend toward an older population will continue into the 21st century.
• Aging-in-place is a phenomenon in senior housing.
• Chronic disability usually means greater reliance on others to provide help with daily living activities.
Supportive Services in Virginia's Congregate Housing
• Essential supportive services commonly include, but are not limited to, assistance with: transportation, personal care, housekeeping, shopping assistance, medication reminders, and meal preparation.
Other State-Sponsored Senior Housing Initiatives
• The Virginia Housing Partnership Fund was established by the Governor and the 1988 General Assembly to support and encourage improvement of housing resources and opportunities available to lower-income Virginians.
• The Virginia Housing Partnership Fund created the Congregate Housing Program to help people with special needs live independently. The program is designed to increase the supply and improve the quality of housing available to low-and-moderate income citizens with special needs.
• The Internal Revenue Code of 1986 provides tax credits to owners of residential rental projects providing low-income housing units. This program is called the Low-Income Housing Tax Credit Program.
• The purpose of the Rent Reduction State Tax Credit Program is to increase and preserve the supply of affordable housing for seniors and persons with disabilities while helping owners of rental properties fill vacant units and/or offer other affordable rent to current residents. Property owners agree to discount rents by at least 15 percent of the market rent and receive 50% of the discount back in the form of a state tax credit.
Risk Factors in Independent Living Facilities
• On average, low-income elders living in federally assisted housing are over age 80. Most people this age have experienced declining health, widowhood, and retirement. These events often result in the need for supportive services.
• A 1987 Brookings Institute report finds some 850,000 elders, nationally, with severe impairments residing in the community. "Severe impairments" is defined as having limitations in five or six activities of daily living.
• "Naturally occurring retirement communities" (NORCs) are described as the most dominant and overlooked form of senior housing. NORCs presenting the greatest challenge are those with a high rate of older people living alone or with very low incomes, and/or with deteriorating housing and in need of services to remain independent.
Linking Services to Housing for Elders and Persons with Disabilities
• With the increased number of frail elders in congregate housing, the support services needs of these residents has grown and become more complex.
• In some state and federal subsidized housing, housing managers assume no role in assuring that needed services are provided.
• For many elders and persons with disabilities whose needs can be met in independent living facilities, it is more cost effective to provide supportive services than to place the person in a nursing facility.
• Consideration should be given to (a) the residents' need for supportive services, (b) the property management's wish to promote safety and well-being of residents, and (c) state code regarding the types of facilities that are subject to licensure.
Models for Funding Support Services in Assisted Housing
• States fund a statewide service coordinator who directs housing managers to available service resources. No new services or housing are created (Minnesota, Connecticut).
• States provide tax exemption bond financing for construction of congregate housing facilities. Developers are responsible for providing supportive services under loose guidelines, and the states are not involved in service provision or subsidy (Arkansas, Idaho, Illinois, Pennsylvania, North Carolina, Ohio, and Oregon).
• States directly provide and/or subsidize the provision of new supportive services to frail elders in exiting senior housing or newly constructed congregate facilities (Connecticut, Maine, Maryland, Massachusetts, New Jersey, New Hampshire, New York, Vermont, and Oregon).
The following models of joint cooperation are identified:
• The federal government's contributing housing assistance and states' contributing the services to frail elders who occupy the units.
• Federal-state funding of supportive services from savings in Medicaid expenditures that accrue from delayed institutionalization of frail elders.
• Independent of any linkage created through Medicaid savings, federal-state-local funding of services for federal- and state-assisted housing units occupied by frail elders.
Current Virginia Programs Impacting Residents in Independent Living Facilities
• The Northern Virginia Cluster Care and Cost-Sharing Model, the Department of Medical Assistance Services' Personal Care Program Model, the Department of Rehabilitation's Personal Assistant Service Model, Alexandria's Route Companion Services Model, the Comprehensive Supportive Services Model,- Southeastern Virginia Areawide Model Program's (SEVAMP) Housing Service Coordination Program, and the League of Older Americans' Melrose Towers Program are some of the models used in Virginia facilities to efficiently and cost-effectively provide support services to facility residents.
The study presents the following recommendations:
• Recommendation 1
The Commonwealth should explore more extensive use of service coordination in housing for elders and persons with disabilities by taking the following actions:
* Explore public/private partnerships to develop service coordination programs modeled after the Congregate Housing Services program administered by the United States Department of Housing and Urban Development;
* Initiate discussions with the Department of Housing and Urban Development to
explore expanded funding under the Congregate Housing Programs to include the cost of service coordinations;
* Provide tax exemption bond financing for construction of congregate housing and allow the cost of service coordination to be included in the operating cost; and
* Explore the feasibility of implementing supportive services coordination in housing developments which target elders and persons with disabilities.
• Recommendation 2
The General Assembly should request that the Joint Commission on Health Care, as part of their current study under House Joint Resolution 639, address whether provisions of Chapter 9 of the Code of Virginia are relevant to independent living facilities and, if so, under what circumstances do those provisions become relevant.
• Recommendation 3
* The Commonwealth should support efforts that link services to senior housing developments, to include Medicaid waivered services;
* Virginia Housing Development Authority should be asked to explore the expansion of its housing training and staff development initiative to include non-VHDA senior housing developments; and
* The Commonwealth should explore how the Office of Volunteerism can work with senior housing management to promote volunteerism, such as the creation and use of resident volunteer cooperatives to compliment the delivery of more formal supportive services.
• Recommendation 4
The Commonwealth should provide guidelines to local service providers to develop a local fee schedule which reflects the uniqueness of the community. Guidelines should address:
* The definition of the target population and how eligibility will be determined;
* What specific supportive services will be delivered;
* A mutually agreed upon scale for all providers of in-home services within the community;
* Minimum income level at which a fee for services will be assessed (i.e., may elect to collect no fee for persons whose income is SSI or less);
* Whether a fee will be based on percent of unit cost or percent of gross income. (A percentage of gross income fee schedule would eliminate the added burden of revising fees based on change of need and authorized hours.);
* What specific deductions from gross income will be made before assessing the fee for services (i.e. , the cost of prescription medicines, the cost of rent or a percentage of the cost of rent, Adult Day Care costs, other regularly reoccurring cost of maintaining the person in the community, etc.);
* Under what circumstances will fees be wavered;
* Under what circumstances will services be suspended or terminated for nonpayment of fees; and
* To whom shall the consumer pay fees? to the provider? to the provider agency?
• Recommendation 5
To better plan for housing needs of the next 50 years, the Departments of Social Services and for the Aging should proceed with an analysis to identify the areas of the Commonwealth in which the shortage of assisted housing for elders and persons with disabilities is most acute now and project where shortages will be most acute in the next decades.