# Presentation: 085807

## Housing for Older Americans: Trends, Challenges, and Solutions 

- White House Conference on Aging
- July 20, 2005
- Jon Pynoos, Ph.D. and Christy M. Nishita, Ph.D.
- National Resource Center on Supportive Housing and Home Modification
- Fall Prevention Center of Excellence
- Andrus Gerontology Center
- University of Southern California
- Los Angeles, CA 90089-0191
*www.homemods.org*

## Why Housing is Important for Older Americans

## Housing Plays an Important Role for Older Adults

- A Costly Basic Necessity
- A Major Asset
- A Key To Aging In Place
- A Cost Saving Alternative To Nursing Homes
- An Important Element In Preventive Health Care

## Critical Housing Problems

- Affordability
- Accessibility and Usability
- Supportiveness

## Sub-Groups Requiring Special Attention:

- Minority Groups
- Persons with Low-incomes
- Frail Older Adults
- Women
- Persons Living Alone
- Those Living in Rural Areas

## Affordable Housing

## >30% Pay Too Much of Income for Housing

**>30% Pay Too Much of Income for Housing**

## Cost Burden Highest for Low Income

**Cost Burden Highest for Low Income**

## Most Severe Housing Costs for Women Living Alone

**Most Severe Housing Costs for Women Living Alone**

## Slide 10

## Government Subsidized Housing

- Section 202 Housing
- 350,000 older adults
- 3,500 facilities

- Section 8 rental subsidies
- 500,000 older adults

- Current Beneficiaries- 1.6 million older persons

- Other Programs: 221d3, Public Housing, Rural Housing Service programs

## Federally Subsidized Housing in Short Supply

**Only 1/3** of eligible older persons receive federal assistance
- Developers of subsidized housing paying off loans early and returning to market rents or opting not to renew their contracts
- 300,000 units lost between 1997-1999
- Production rate of 5-6,000 units per year of Section 202 far below the 20,000 units per year in the late 1970s
- In 1999, nine applicants waiting for each Section 202 unit

## Slide 13

## Preserve and Expand Affordable Housing

- Incentives for Developers to Retain Low-Income Residents or Transfer Complexes to Non-Profits
- Encourage Public/ Private Partnerships And Simplify Complex Financing To Expand Supply
- Create A National Housing Trust Fund To Provide A Steady Source Of Revolving Financing

## Reverse Mortgages

- Potential market: 3-5 million elderly households
- 560,000 households in 1991 would have been above the official poverty threshold if they obtained HUD’s Home Equity Conversion Mortgage (HECM)
- 119,000 HECMs originated since the program began
- Limitations: an option only for homeowners, uptake slow, high closing costs

## Accessible and Usable Housing: A Key to Aging in Place

## Unmet Need

- 1.14 Million Elderly Households With At Least One Functional Limitation Report Unmet Need For Home Modifications

- Peter Pan Housing

## Percent of Older Adults Who Prefer to Stay in their Own Home and Never Move

**Source: AARP (1996)- Understanding Senior Housing Into the Next Century. Percent of Respondents Who Agreed With the Statement “ I’d Like to Stay in My Home and Never Move”.**

## 3 Major Problem Areas Of The Home:

**Outside Steps To The Entrance**
**Inside Stairs To A Second Floor**
**Unsafe Bathrooms**

**Source: HUD (2001)**

## Risk for Falls

- Source: National Health Interview Survey, 1997-1998 (Kochera, 2002)

## Home Modifications

## Slide 23

## Slide 24

## Barriers to Obtaining Home Modifications

## Expand Home Modification Programs to Reduce Health And Long-term Care Costs

- Reconfigure Public/Private Sources:
- Medicaid, Medicaid Waivers
- Community Development Block Grants
- Older Americans Act
- Private Pay
- Social Marketing Campaign to Raise Awareness Among Builders, Remodelers, Consumers, Health Providers, etc.

## Supportive Housing:Accessible Settings and Services

## Source: Heumann, Winter-Nelson, & Anderson, 2001

## Subsidized Housing: A Valuable Resource

- The 20,000 federally assisted housing complexes are one of our best resources to meet the needs of low-income frail older persons in residential settings
- Contain concentrations of Medicaid eligible individuals at risk of moving to more expensive nursing homes
- Potential cost savings to Medicaid budget

## Improve Supportiveness of Subsidized Housing

- Expand the HUD service coordinator program
- Revise federal guidelines to permit additional service space in senior housing
- Greater coordination between HUD and HHS
- Retrofit complexes to better meet the needs of frail older persons

## Make Residential Assisted Living an Affordable Option

- Support Conversion Of Section 202 Housing Into Assisted Living
- Allow Housing Sponsors Flexibility In Providing An Enhanced Level Of Service Without Costly Regulations And Standards
- Simplify Ability To Use SSI, Medicaid, And HUD Vouchers

## Build Housing That
Maximizes Independence

**Maximizes Independence**

## Visitability

- A Small Set Of Accessibility Features That Enable Persons Of All Ages With Disabilities To Access The Main Level Of Single-Family Homes
- Can Benefit Residents, Friends And Relatives

## Key Visitability Features

- Zero Step Entrance To Home
- Wide Interior Doors
- A Wide, Level Route Though The Main Floor Of The Home
- Reinforced Bathroom Walls
- Raised Switches And Outlets

## Rise of Visitability Legislation

- As of 2003, at Least 5 States and 10 Cities and Counties Have Mandated Legislation
- H.R. 2532 Inclusive Home Design Act of 2003
- Requires visitability features in all newly-constructed, federally assisted, single-family homes and townhouses

## Universal Design

- Adaptable Housing and Neighborhoods Designed to be Useable by **All Persons** to the Greatest Extent Possible
- Different From Visitability Because It Applies To **Entire Home**

## Universal Design Features in Housing

- Wide and Level Entries
- Wide Interior Door Openings
- Lever Door Handles
- Variable Height Counters
- Supportive Bars in Shower and Bathroom
- Bathrooms and Kitchens Large Enough to Accommodate Walkers/Wheelchairs
- Stackable Closets for Elevators

## Approaches to Promote Visitability and Universal Design

- Social Marketing
-  Campaigns

- Consumer
- and
- Builder Tax
- Incentives

- CODE CHANGES

## Create New Models of Housing and Liveable Communities

- Mixed Use Housing
- Mixed Income Developments
- Intergenerational
- Second Units
- Co-location Of Programs And Services

## NORCs- Naturally Occurring Retirement Communities

- 27% of older people live in a building or neighborhood where more than 50% of the residents are over 60
- Economies of scale in the delivery of services

## Vision for the Future

- Affordable

- Accessible

- Supportive

## Housing is a Cross-Cutting Issue:

- Planning Along the Lifespan
- The Workplace of the Future
- Our Community
- Health and Long Term Living
- Social Engagement
- Marketplace

## Housing Strategies:

- Preserve and Expand Affordable Housing Supply
- Reduce Health And LTC Costs Through Programs That Promote HMs
- Improve Supportiveness of Subsidized Housing
- Make Assisted Living an Affordable Option
- Develop Liveable Communities by Adopting Principles of Visitability and Universal Design
- Create New Models of Housing and Communities That Maximize Independence and Provide Choice

## We shape our dwellings...

**      ****And later our dwellings shape us.**
- 					Winston Churchill