The State of Housing 

in America in the 

21st Century: 

A Disability Perspective 

National Council on Disability 

January 19, 2010
National Council on Disability 

1331 F Street, NW, Suite 850 

Washington, DC 20004 

The State of Housing in America in the 21st Century: A Disability Perspective 

This report is also available in alternative formats and on the National Council on 

Disability (NCD) Web site (www.ncd.gov). 

Publication date: January 19, 2010 

202-272-2004 Voice 

202-272-2074 TTY 

202-272-2022 Fax 

The views contained in this report do not necessarily represent those of the 

Administration, as this and all NCD documents are not subject to the A-19 Executive 

Branch review process. 
National Council on Disability 

An independent federal agency making recommendations to the President and Congress 

to enhance the quality of life for all Americans with disabilities and their families. 

1

Letter of Transmittal 

January 19, 2010 

The President 

The White House 

Washington, DC 20500 

Dear Mr. President: 

On behalf of the National Council on Disability (NCD), I am pleased to submit this report 

titled The State of Housing in America in the 21st Century: A Disability Perspective. This 

report looks at the state of housing for people with disabilities with the intent to provide 

recommendations that can improve housing opportunities. The research contained in 

this report provides a comprehensive overview of the state of housing in the 21st 

century and answers important questions about the current housing needs and options 

for people with disabilities living in the United States. 

The Council is deeply appreciative of your efforts on behalf of people with disabilities. 

We hope that the recommendations contained herein will aid the Administration in 

addressing the challenges facing people with disabilities in attaining affordable, 

accessible, and appropriate housing for people with disabilities. 

NCD undertook this study with three objectives in mind: (1) to evaluate public laws, 

policies, and program initiatives affecting the housing opportunities available to 

Americans with disabilities and others who have accessible housing needs for whatever 

reason, whether due to aging or a temporary disability; (2) to analyze what housing, 

supports, and other benefits are available through the public, nonprofit, and/or private 

sectors; and (3) to provide recommendations that can improve housing opportunities for 

people with disabilities in the United States. 

Affordable, accessible, and appropriate housing is critical and integral to making a 

community more livable for people with disabilities. In this report, NCD finds that there 

are unmet housing needs based solely on standard measures of housing affordability. 

This analysis also reveals a gap between current policy goals and outcomes—even with 

laws in place requiring a portion of units to be accessible, some developers and 

property owners do not comply. Whether this noncompliance is due to ignorance or 

intent, the evidence suggests we have missed opportunities to increase the supply of 

accessible, affordable housing. 

● ●

● ● ●

1331 F Street, NW Suite 850 Washington, DC 20004 

202-272-2004 Voice 202-272-2074 TTY 202-272-2022 Fax www.ncd.gov 
The findings and recommendations contained in this document are grounded in data 

and research gathered from federal agencies, either directly or via published reports, 

and from research completed by academics and disability advocates. This report also 

provides evidence of what can be effective in meeting the range of housing needs 

among a diverse group of consumers with disabilities. This includes best and promising 

practices drawn from real examples, and lessons learned from experts working on 

housing issues and policy. In reviewing best and promising practices, data were 

triangulated from different sources—interviews, published reports, and Internet 

research—to ensure a comprehensive assessment. To this end, the research has been 

reviewed and commented on by a diverse panel of experts and consumer groups that 

have all provided valuable insights and guidance. 

NCD stands ready to work with you, members of your Administration, and the 

leadership in Congress as you work toward improving our nation’s housing 

infrastructure. 

Sincerely, 

John R. Vaughn 

Chairperson 

(The same letter of transmittal was sent to the President Pro Tempore of the U.S. 

Senate and the Speaker of the House of Representatives.) 

2
National Council on Disability Members and Staff 

Members 

John R. Vaughn, Chairperson 

Patricia Pound, Vice Chairperson 

Victoria Ray Carlson 

Robert R. Davila, Ph.D. 

Graham Hill 

Marylyn Howe 

Lisa Mattheiss 

Heather McCallum 

Katherine O. McCary 

Lonnie Moore 

Anne M. Rader 

Linda Wetters 

Tony Williams 

Staff 

Michael C. Collins, Executive Director 

Martin Gould, Ed.D., Director of Research 

Mark S. Quigley, Director of External Affairs 

Julie Carroll, Senior Attorney Advisor 

Joan M. Durocher, Senior Attorney Advisor 

Lisa Grubb, Special Assistant, Coordinator of Administration 

Geraldine Drake Hawkins, Ph.D., Senior Program Analyst 

Anne C. Sommers, Legislative Affairs Specialist 

Stacey S. Brown, Staff Assistant 

Carla Nelson, Administrative Specialist 

3
Acknowledgments 

The National Council on Disability deeply appreciates the incisive policy research 

undertaken by Dr. Janet Smith, Co-Director, Nathalie P. Voorhees Center Associate 

Professor, Urban Planning and Policy, University of Illinois at Chicago, in the writing of 

this report. Special thanks goes to the primary authors of each of the topical briefs: Dr. 

Joy Hammel and Leonor Vanik of University of Illinois at Chicago, Alberto “Beto” 

Barrera and Michelle Robbins of Access Living (State Evaluation); Janet Smith (Federal 

Evaluation); Mary Lou Breslin and Tyler Zoanni of the Disability Rights Education and 

Defense Fund (DREDF) (Private and Nonprofit Sector Housing); Michele Magar, Esq. 

(Mental Health Issues—Housing for People with Psychiatric Disabilities); and Dr. 

Brenda Phillips of Oklahoma State University (Homeland Security and Emergency 

Housing Evaluation). 

4
Contents 

Executive Summary ...................................................................................................... 9

Introduction ................................................................................................................. 21

CHAPTER 1. Housing Need...................................................................................... 27

Affordability................................................................................................. 29

Accessibility................................................................................................ 32

CHAPTER 2. Federally Subsidized Housing ........................................................... 37

U.S. Department of Housing and Urban Development............................... 40

Public Housing................................................................................ 42

Housing Choice Vouchers .............................................................. 44

Multifamily Housing......................................................................... 47

HUD Formula-Based Housing Grant Programs.......................................... 49

Community Development Block Grant............................................ 49

HOME Investment Partnerships Program....................................... 50

Homeless Shelter and Housing Programs...................................... 51

Low Income Housing Tax Credit Program.................................................. 53

Rural Housing............................................................................................. 55

Single-Family Housing.................................................................... 56

Multifamily Housing......................................................................... 58

Looking Ahead ........................................................................................... 61

Section 811 Legislation................................................................... 61

New Funding for Affordable Housing via the National 

Affordable Housing Trust Fund ....................................................... 62

New Vouchers for Nonelderly People with Disabilities.................... 63

New Vouchers for Veterans ............................................................ 63

Inclusive Home Design Act (H.R. 1408).......................................... 64

Potential New HOPE VI Legislation ................................................ 64

Section 202 Supportive Housing for the Elderly Act of 2009 

(S. 18)............................................................................................. 64

HUD’s Real Estate Management System (REMS) ......................... 65

New Requirements for Low Income Housing Tax Credit 

Reporting ........................................................................................ 65

Green Efficient Public Housing ....................................................... 66

Promoting Livable Communities ..................................................... 66

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CHAPTER 3. Geographic Dispersion of Housing Programs and Expenditures .. 67

CHAPTER 4. Public Sector Initiatives to Increase the Housing Status of 

People with Disabilities .............................................................................................. 71

Movement to Coordinate Housing and Community Living Supports 

and Systems............................................................................................... 71

Key Issues Influencing “Real Choice”......................................................... 73

Differences in Definitions ................................................................ 73

Differences in Qualifying and Eligibility Criteria............................... 76

Differences in Funding and Parity of Supports and Services.......... 77

Differences in Information Access .................................................. 79

Differences in Coordination of Supports and Services Across 

Systems and Quality Control, Monitoring, and Enforcement........... 80

Housing and Community Living Promising Practices ................................. 81

Systems Change and Coordination ................................................ 81

Cross-System Navigation ............................................................... 83

Promoting Integrated and Least Restrictive Choice........................ 84

Increasing Information Access with Housing Locator Systems....... 85

Legislative Promising Practices ...................................................... 86

CHAPTER 5. Best and Promising Practices in Accessible and Affordable 

Housing........................................................................................................................ 89

Intensive Homeownership and Housing Support........................................ 90

United Cerebral Palsy of Texas, Austin, Texas............................... 90

Housing Initiatives Program, Institute for Disability Studies, 

University of Southern Mississippi, Hattiesburg, Jackson, and 

Gulf Park, Mississippi...................................................................... 92

The Lease-to-Own Model: The Arc of the Central 

Chesapeake Region (formerly The Arc of Anne Arundel 

County), Maryland .......................................................................... 95

Support for Independent Living .................................................................. 97

Neighbors, Inc., Franklin Park, New Jersey .................................... 97

Onondaga Community Living (OCL), Syracuse, New York............. 98

Options in Community Living, Madison, Wisconsin ........................ 99

LifeLong Supportive Housing Program (Alameda County 

Health, Housing, and Integrated Services Network), Oakland 

and Berkeley, California................................................................ 100

Supportive Housing Programs for People with Psychiatric Disabilities..... 101

Pathways to Housing .................................................................... 102

Mental Health Association of New Jersey: Residential 

Intensive Support Team (RIST) .................................................... 105

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Main Street Housing ..................................................................... 107

Affordable, Accessible, Integrated, Mixed-Use Housing Development..... 109

University Neighborhood Apartments, Berkeley, California .......... 109

Helios Corner, Berkeley, California............................................... 110

Housing Cooperatives (Co-ops) ............................................................... 111

Penn South Cooperative, New York, New York............................ 112

Aging in Place .......................................................................................... 113

Vladeck Cares/NORC Supportive Services Program, New 

York, New York............................................................................. 114

Increasing Very Low Income Housing Through the Low Income 

Housing Tax Credit (LIHTC) Program ...................................................... 114

North Carolina LIHTC Development ............................................. 115

Disability Organizations Advocate for Very Low Income 

Housing with LIHTCs .................................................................... 116

Increasing Accessible, Integrated, Supportive Housing Through 

Legal Advocacy ........................................................................................ 117

Laguna Honda Hospital Settlement, San Francisco, California .... 117

Fair Housing and Americans with Disabilities Act Housing 

Access Settlements ...................................................................... 118

Universal Design ...................................................................................... 119

6 North Apartments, St. Louis, Missouri........................................ 119

University Neighborhood Apartments, Berkeley, California .......... 119

Universal Design and Visitability: Mandatory and Voluntary Policy 

Models...................................................................................................... 120

Concrete Change and Habitat for Humanity, Atlanta, Georgia ..... 120

Minimum Universal Design Requirements for New 

Construction Using Affordable Housing Trust Funds from the 

City of St. Louis............................................................................. 121

Design for Life Montgomery, Montgomery County, Maryland....... 121

California Model Universal Design Ordinance .............................. 122

CHAPTER 6. Lessons Learned from National Emergencies Regarding the 

Provision of Accessible and Affordable Housing .................................................. 123

Key Issues................................................................................................ 123

The Emergency Housing Process ............................................................ 124

Emergency Shelter ....................................................................... 124

Temporary Shelter ........................................................................ 125

Transitioning into Temporary or Permanent Housing ................... 126

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Federal Programs for Temporary and Permanent Housing...................... 127

Federal Emergency Management Agency (FEMA) ...................... 127

Small Business Administration (SBA) ........................................... 128

U.S. Department of Housing and Urban Development (HUD) ...... 129

U.S. Department of Justice (DOJ) ................................................ 129

Rebuilding Permanent Housing................................................................ 129

Congregate Care and Group Locations.................................................... 132

Risk Mitigation .......................................................................................... 132

Promising Practices.................................................................................. 133

A Functional Model ....................................................................... 134

U.S. Department of Justice Guidance for Emergency Shelters .... 134

Search Tools................................................................................. 135

U.S. Department of Housing and Urban Development ................. 135

Mortgage and Rental Relief .......................................................... 136

FEMA Comprehensive Planning Guide ........................................ 137

National Disaster Housing Strategy .............................................. 137

Concerns About Federal Guidance............................................... 138

FEMA Disability Coordinator(s)..................................................... 138

Voluntary and Community Organizations and Advocates............. 139

CHAPTER 7. Recommendations ............................................................................ 141

Recommendations by Theme................................................................... 141

Crosswalk for Specific Recommendations ............................................... 149

NCD Topical Brief #1. Federal Evaluation............................................................... 159

NCD Topical Brief #2. Private and Nonprofit Sector Housing ............................... 243

NCD Topical Brief #3. Mental Health Issues— Housing for People with 

Psychiatric Disabilities ............................................................................................. 295

NCD Topical Brief #4. Homeland Security and Emergency Housing 

Evaluation .................................................................................................................. 325

NCD Topical Brief #5. State Evaluation................................................................... 385

APPENDIX A. Data Tables........................................................................................ 425

APPENDIX B. Mission of the National Council on Disability................................. 459

Endnotes.................................................................................................................... 463

8
Executive Summary 

While great strides have been made by the National Council on Disability (NCD) and 

others to advance the notion of livable communities for all, there are still gaps in the 

knowledge about what exactly is needed to transform our communities. Affordable, 

accessible, and appropriate housing is a critical and integral part of making any 

community more livable for people with disabilities. This report looks at the state of 

housing for people with disabilities with the intent to provide recommendations that can 

improve housing opportunities. The research contained in this report provides a 

comprehensive overview of the state of housing in the 21st century and answers to 

seven important questions about the current housing needs and options for people with 

disabilities living in the United States. 

1. What are the types and extent of housing needs of people with 

disabilities and what is currently available to meet those needs? 

● Total Households: Currently, about 35.1 million households have one or more 

people with a disability—nearly one-third of all U.S. households in 2007. In 

addition, about 1.6 million people live in nursing homes and another half million 

in group homes. 

● Affordability: The greatest need is the ability to afford housing. On average, 

the income level of people with disabilities is lower than that of people without 

disabilities. As a result, an estimated 14.4 million households with at least one 

person with a disability cannot afford their housing—this is 41 percent of all 

households with disabilities. 

● Worst-Case Need: A recent report, The Hidden Housing Crisis: Worst Case 

Housing Needs Among Adults with Disabilities, estimates that about 2.4 million 

households with nonelderly people with disabilities, including 1 million families 

with children, have worst-case housing needs—nearly 40 percent of all worstcase housing needs in the United States. In addition, another 1.3 million “elderly 

households” (age 62 years or older) have worst-case housing needs, with many 

9
likely also to have a disability. Most are very low income and paying more than 

half their monthly income for rent. 

● Homelessness: A recent government report estimated that at least 43 percent 

of the homeless adults that stayed in a shelter—about 421,000 people—had a 

self-reported disability. This does not include homeless children with disabilities 

in shelters or the estimated 282,000 people homeless each night who are living 

on the streets, in abandoned buildings, or elsewhere not intended for human 

habitation. While estimates vary, a large portion of this total is likely to include 

veterans. 

● Physical Accessibility: National housing survey data indicates that hundreds 

of thousands of people with disabilities need some form of modification to make 

their homes accessible. The majority need grab bars and ramps, which cost 

relatively little to greatly improve people’s lives. 

● Environmental Sensitivities: About 11 percent of the U.S. population has 

some level of chemical sensitivity (CS) that is likely to require housing that is 

free of disabling environmental triggers. Unless housing is universally designed 

to accommodate different sensitivities, it is better for some with CS to live in 

segregated housing that ensures control over potential exposures. 

● Mental Health Issues: More than 300,000 people with psychiatric disabilities 

currently living in segregated housing could benefit from more integrated and 

least restrictive housing options. 

● Public Housing: While Section 504 of the 1973 Rehabilitation Act requires a 

portion of public housing units to be accessible—5 percent for mobility 

impairments and 2 percent for hearing and visual disabilities—but we do not 

know if this is the case. If all public housing developments were compliant to 

this minimum, then about 68,000 could be accessible. There are potentially 

another 46,000 accessible units in rural multifamily developments if all were 

compliant. However, many of these units are likely to be in age-restricted 

developments (62 years and older), and therefore not available to all people 

with disabilities, even if accessible. 

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● Private Sector Housing: Similar patterns are found in federally subsidized 

housing operated by private sector nonprofit and for-profit groups. While about 

156,000 units of the U.S. Department of Housing and Urban Development 

(HUD) multifamily housing portfolio (11% of total) are accessible, less than half 

(73,000 units) are designated for people with disabilities. While there are about 

195,000 “year-round beds” in permanent supportive housing, which often 

targets people with disabilities, these can benefit only people who are homeless 

first. Furthermore, many of these programs link housing with services, which 

can restrict choice and independence. 

2. What are the profiles of users for housing program supports and 

what is the quality of life of people relying on housing-related 

programs and supports? 

Most people with disabilities in federally subsidized housing programs are without 

children and living alone. While there also may be children with disabilities, these 

families are not considered “disabled,” so they are not included in the numbers above. 

A key concern is that need far exceeds the supply of accessible units. In 2008, about 

211,000 nonelderly and 135,000 elderly (62 years and older) public housing households 

were identified as having disabilities. We know nothing about the type of disability or if 

the housing is appropriate for their needs. Similarly, we do not know how many of the 

households with disabilities using Housing Choice Vouchers—544,561 nonelderly 

families with disabilities and 374,265 elderly families—live in appropriate accessible 

units, or if they are integrated into the community. 

Relatively little is known about the quality of life of people living in federal housing other 

than statistics that generally show public housing residents tend to have poorer health 

(mental and physical) than the general population and experience higher-than-average 

rates of crime and violence. Still, research shows that not all public or federally 

subsidized housing is dangerous, though it is likely to be poor quality due to poor 

11
construction and deferred maintenance, which has led to the demolition of nearly 

150,000 units in the past 10 years. 

Finally, while the Section 811 program has produced about 27,000 housing units 

specifically for people with disabilities, most are segregated. Recent changes in the 

program, coupled with innovative strategies, such as buying condominiums in marketrate developments for people with disabilities, are encouraging. Still more is needed in 

terms of legislation, education, and capacity to scale up these ideas. 

3. What is the geographic dispersion of housing and related programs 

and expenditures? 

The federal resources needed for affordable accessible housing are not sufficient to 

meet the needs in most, if not all, communities. Most entitlement funding is based on 

formulas designed to reflect need on a per capita basis rather than relative need. 

The States with the largest estimated number of noninstitutionalized people with 

disabilities are California (4,279,000 people), Texas (3,050,000), Florida (2,610,000), 

New York (2,533,000), and Pennsylvania (1,865,000). These same States have the 

largest number of renters with mobility impairments and housing problems in the United 

States, and also the largest share of HOME and Community Development Block Grant 

dollars annually. In comparison, Puerto Rico has the highest disability prevalence rate 

at 27 percent of its population (963,000 people), followed by West Virginia (24%), 

Kentucky (21%), Arkansas (21%), and Mississippi (21%). 

Funding for subsidized housing units for people with disabilities—both public housing 

and multifamily housing—is not subject to formula but instead comes from direct grants 

and loans from the Federal Government. Looking across the States, we find the 

following: 

● New York—and particularly New York City—has long had the largest share of 

public housing (205,000 units) in the United States, with four times the number 

12
of units than in Pennsylvania (52,000), which is the next largest supplier. 

Furthermore, New York has the most public housing for people with disabilities, 

elderly people (ages 62 and older), and families, and the largest supply of 

federally funded multifamily housing (108,000 units), though only second and 

third, respectively, for units designated for people with disabilities and 

designated units for the elderly. The State ranks lower for Housing Choice 

Vouchers. 

● California, while home to nearly twice as many people with disabilities as New 

York, has relatively little public housing (less than 40,000 units). Instead, the 

State has the largest number of Housing Choice Vouchers (290,000), with 

78,000 being used by people with disabilities, 28,000 by elderly households, 

and 55,000 by households that are both elderly and with disabilities. California 

also has the largest number of federally subsidized multifamily housing units 

designated for elderly (39,000) and for people with disabilities (5,000). 

● States that rank consistently in the top 10 across all categories of housing 

based on the number of units developed include Illinois, Ohio, Pennsylvania, 

and Texas. 

● States ranking consistently in the bottom 10 across all categories of housing, 

based on the number of units, are Alaska, Idaho, Montana, North Dakota, South 

Dakota, and Wyoming, along with the District of Columbia. 

4. What barriers and gaps prevent people with disabilities from 

attaining accessible and affordable housing? 

Creating and sustaining safe, accessible, affordable, and integrated housing continues 

to involve challenging and complex barriers that arise from the interaction of poverty, 

inaccessibility, funding rules related to acquiring supportive services, and a disability 

policy system rooted in the outmoded model of segregating people with disabilities from 

the community mainstream. 

13
Affordability is a key challenge. For prospective buyers this includes securing financing, 

which is even more daunting with tighter rules guiding both conventional lending and 

affordable homebuyer programs. The single greatest barrier to rental housing in the 

private market may be the combination of too little subsidized housing and inadequate 

funding for Housing Choice Vouchers to close the gap between very low incomes and 

rental costs. Even if affordable, most market-rate housing lacks basic accessibility 

features. Some private building industry groups oppose additional mandatory 

accessibility requirements for new home construction, and bureaucratic complexities 

tied to funding supportive services add additional challenges and layers of difficulty. 

A key challenge to putting housing and community services together is the difference 

between systems and funding mechanisms, their differing groundings and philosophies, 

and the complexity of housing and community living choice at the legislative and policy 

levels. States face several challenges when trying to create “real choice” in accessing 

affordable, accessible, and integrated housing. This includes differences in: 

● Definitions related to housing and community living/integration, which make it 

hard to show need, coordinate services, and compare across States. 

● Qualification and eligibility criteria, which are set by funding sources that often 

use different thresholds to determine initial and continuing eligibility (e.g., HUD 

uses median income in relation to national poverty and income thresholds, 

while Medicaid uses income/asset thresholds determined by individual State 

statute). 

● System funding levels and disparities related to funding of housing and 

community living supports, as well as disparities between different disability and 

aging constituencies in accessing this funding. 

● Information access, quality, and coordination, especially for people with 

disabilities who may be trying to access information during times of housing or 

health crises or emergencies, or from within settings where information access 

is difficult, unavailable, or withheld. 

14
● Coordinated, consumer-directed system delivery, especially across housing and 

community services, but even within each. 

● Monitoring and enforcement across systems. 

5. What means are available to people with disabilities to enhance their 

capacity to choose and sustain accessible and affordable housing? 

Potential best practices and models that respond to current barriers almost always 

involve public policy that supports (or can be interpreted to support) a particular 

solution, multiple public and private funding sources, local ingenuity and community 

commitment, and, in some situations, the courts. We do see “promising practices” that 

have been or are being implemented by and within States in the areas of systems 

change, information access, legislation, monitoring and enforcement, and research 

related to housing and community living. These include: 

Systems Change and Coordination 

One of the most promising trends has been the increasing cross-coordination of 

housing with community living and support systems, funding, and service delivery. 

Referred to as Single Access Points, One Stop Shop, No Wrong Door, and 

Comprehensive Entry Point, these systems enable consumers to enter through many 

different “doors” in order to receive coordinated housing and community living supports 

and services. Many of these initiatives, which often require new policies to enable 

coordinated service delivery, are based on a Money Follows the Person (MFP) 

framework to offer cross system, consumer-directed choice. 

Cross-System Navigation 

Several of these systems change initiatives have formally incorporated coordination with 

regional Aging and Disability Resource Centers, Area Agencies on Aging, and Centers 

for Independent Living (CILs) to provide information, case management, peer 

mentoring, legal assistance, and connection to related community living, transportation, 

social participation, and employment opportunities. Several States are using CILs and 

15
peer mentors to support consumers in navigating complex housing and community 

living systems and programs. Coordination also involves continuous education of staff 

across systems and delivery programs. 

Promoting Integrated and Least Restrictive Choice 

Several States have targeted initiatives to create and expand integrated housing 

choices. For example, Washington is using federal demonstration grant funding to 

collaborate with local housing authorities throughout the State to develop more 

integrated and less restrictive (four or fewer beds/units) community living choice 

models. Oregon continues to expand community housing in small neighborhood homes, 

and is also developing individual apartment housing in which consumers can share 

support services with other consumers with developmental disabilities. Virginia is 

working to revise legislation and policies to enable people with developmental 

disabilities to share an apartment or single-family home with supports. 

Increasing Information Access with Housing Locator Systems 

A number of States have developed housing locator systems that allow online searches 

of affordable housing units. These systems range from minimal databases of Statefinanced developments to more sophisticated Web sites with multiple search options, 

detailed accessibility information, updated vacancy and occupancy status, and links to 

local service agencies and resources. Some States, such as Louisiana, have 

incorporated housing locators into housing developer contracts to make it easier for 

individuals to identify available housing options and to improve marketing of affordable 

and accessible units to consumers. 

Legislative Promising Practices 

As a result of disability advocacy, some States have enacted legislation to rebalance 

Medicaid monies toward community-based options. For example, Texas Rider 37 

enables the Texas Department of Human Services to allow money to follow the person 

from a nursing facility to the community, enabling the transfer of funds from nursing 

home appropriations. As of 2007, an estimated 13,300 people transitioned from nursing 

16
homes to the community via this initiative. Passed in 1996, Vermont Act 160 allows 

funds appropriated for nursing home care to be used for extensive home- and 

community-based services, and created a statewide system of Long-Term Care 

Community Coalitions to action plan methods to improve the infrastructure for Medicaid 

waiver and the long-term services and supports programs. 

6. What practices exist that improve the housing status of people with 

disabilities? 

In addition to the promising practices above, specific examples of effective housing 

solutions exist; however, they generally are not yet sufficiently scaled to meet the need. 

At a minimum, long-range solutions must include comprehensive changes in public 

policy. Such changes include substantially increasing funding for housing vouchers, 

creation of incentives for inclusion of housing units for very low income people with 

disabilities in all federal and State programs that support housing development and 

construction, and adoption of accessibility standards and universal design principles for 

all home construction by States, counties, and cities, as well as by the building and 

housing construction industry. 

Although serious problems remain, some notable successes suggest that momentum is 

building for broader reforms. For example, the movement for housing to be constructed 

according either to universal design or visitability principles appears to be gaining 

currency. Designers, architects, and homebuyers are growing increasingly interested in 

these principles. Thirty-seven cities across the nation have adopted either mandatory or 

voluntary policies that are beginning to generate results: because of such policies, 

roughly 30,000 homes have been constructed with some level of accessibility. These 

advances are serving as models for other locales, demonstrating that accessibility and 

visitability can be achieved without undue cost or administrative burden. 

For-profit and nonprofit developers are creating exemplary models of scattered, 

affordable, accessible mixed-income and mixed-use housing that set the bar for what 

can be accomplished. Other housing models are evolving that hold promise for people 

17
with disabilities, including Naturally Occurring Retirement Communities (NORCs) and 

Limited-Equity Cooperatives (LECs). Supportive living programs ensure that people with 

disabilities receive the help they want and need to live as independently as possible in 

their own homes. The evolution of these programs nationwide has helped significantly 

reduce the number of people who are forced to live in restrictive institutions. Much 

remains to be done, but these and other areas of progress reveal that an important shift 

is taking place that eventually will lead to an increase in and improvement of housing 

and supportive services options for people with disabilities. 

7. What lessons have been learned from national emergencies, such 

as Hurricane Katrina, regarding the provision of accessible and 

affordable housing in the wake of national disasters and 

emergencies? 

1. Hurricane Katrina revealed stark gaps in emergency housing for people 

with disabilities. Progress toward closing these gaps has come from 

community and organizational initiatives and post-Katrina legislation that have 

led to the creation of guidance and planning materials. To this end, several 

promising and best practices are emerging that follow three principles: 

2. Forethought and planning for disabilities and special needs should serve 

as the main strategy. This begins by taking a functional approach to special 

needs, which centers on communication, medical needs, independence, 

supervision, and transportation (C-MIST model). This approach is now 

supported through various guidance and planning materials, including the U.S. 

Department of Justice Guidance for Emergency Shelters: ADA Best Practices 

Toolkit for State and Local Governments, and the Federal Emergency 

Management Agency (FEMA) Comprehensive Planning Guide. 

3. Include and actively involve people with disabilities, disability 

organizations, and advocates to help planners and those involved in all 

aspects of emergency housing identify problems and address solutions.

In January 2009, FEMA approved a National Disaster Housing Strategy, which 

includes sections specifically on building partnerships to assist in the 

18
evaluation and identification of special needs. At a formal level, FEMA’s 

National Advisory Council has recommended the creation of Regional 

Disability Coordinator positions for each of the 10 FEMA regional offices to 

serve as liaisons between State and federal levels and to increase personnel 

available to coordinate and support outreach to victims with special needs. 

4. Ensure sufficient resources to support initiatives, including relocation 

and rebuilding. Internet-based search tools provide a resource for both 

individuals and case managers to search for suitable emergency housing. 

Also, HUD has developed programs to help people relocate relatively easily to 

other communities while maintaining their housing assistance. For 

homeowners, the Mortgage and Rental Assistance Act of 2007 can help lowand moderate-income families keep their homes after a disaster. An example 

for rebuilding, Louisiana plans to create 3,000 new supportive housing units for 

people with disabilities using multiple sources of funding. 

19
20
Introduction 

Communities in the United States are faced with increasingly difficult choices 

and decisions about how to grow, plan for change, and improve the quality of 

life for all citizens including children, youth, and adults with disabilities...we 

believe that for the promise of full integration into the community to become a 

reality, people with disabilities need: safe and affordable housing, access to 

transportation, access to the political process, and the right to enjoy whatever 

services, programs, and activities are offered to all members of the community 

by both public and private entities.1

This report looks at the state of housing for people with disabilities in America in the 

21st century. It has three objectives: (1) to evaluate public laws, policies, and program 

initiatives affecting the housing opportunities available to Americans with disabilities and 

others who have accessible housing needs for whatever reason, whether due to aging 

or a temporary disability; (2) to analyze what housing, supports, and other benefits are 

available through the public, nonprofit, and/or private sectors; and (3) to provide 

recommendations that can improve housing opportunities for people with disabilities in 

the United States. 

The first objective aims to produce information that can help stakeholders better 

understand the formal parameters—e.g., regulations, program guidelines, income 

restrictions, funding limits—that shape what housing exists now and is likely to be 

produced in the future for people with disabilities. This includes type, tenure, scale, 

design, features, and location, which are all important aspects for any person when 

searching for housing, but even more critical when considering the wide-ranging needs 

of people with disabilities. The second objective aims to take stock of what housing for 

people with disabilities is already being provided by the public and private sectors. The 

third objective provides evidence-based guidance for making improvement in existing 

systems, as well as considering new ideas for legislation, policy, and practice. 

The research builds on previous NCD reports on livable communities, including Livable 

Communities for Adults with Disabilities (2006) and Inclusive Livable Communities for 

People with Psychiatric Disabilities (2008). A livable community is one that: 

21
● Provides affordable, appropriate, accessible housing 

● Ensures accessible, affordable, reliable, safe transportation 

● Adjusts the physical environment for inclusiveness and accessibility 

● Provides work, volunteer, and education opportunities 

● Ensures access to key health and support services 

● Encourages participation in civic, cultural, social, and recreational activities 

Affordable, accessible, and appropriate housing is critical and integral to making a 

community more livable for people with disabilities; without it or when it is insufficient 

relative to need, the benefits of the other five elements are diminished and made less 

accessible. To this end, the degree to which any community has an adequate supply of 

affordable, accessible, and appropriate housing depends on a complex mix of federal, 

State, and local policies and practices that bring the public and private sectors together 

to facilitate development by both nonprofit and for-profit housing producers, and to 

provide services that respond to and reflect needs relative to housing. To better 

understand how these different entities work—or do not work—together, five specific 

research briefs were completed: 

● NCD Topical Brief #1: “Federal Evaluation.” A comprehensive evaluative study 

of public sector housing. 

● NCD Topical Brief #2: “Private and Nonprofit Sector Housing.” Promising 

practices in the nonprofit and private sector. 

● NCD Topical Brief #3: “Mental Health Issues—Housing for People with 

Psychiatric Disabilities.” An evaluation of housing issues related to people with 

psychiatric disabilities. 

● NCD Topical Brief #4: “Homeland Security and Emergency Housing 

Evaluation.” An evaluation of housing and disaster relief, especially provisions 

for mortgage, rental, and temporary housing assistance. 

22
● NCD Topical Brief #5: “State Evaluation.” An examination of States’ 

development of affordable, available, accessible, and integrated community 

housing options for people with disabilities. 

The potential uses and benefits of all this research are many. At a minimum, 

assembling in one place the basic information about the current supply of housing for 

people with disabilities helps policymakers see what is and is not available across the 

entire scope of programs and sources. Unfortunately, this report also reveals how 

limited and uneven the data is that is currently available. In general, we know some 

things about public sector housing, such as the basic demographics of residents, 

including “disability status,” but do not have any information about the accessibility of 

housing or if the unit is appropriate for the resident.2 From the private sector, we have 

no information on the accessibility features of unsubsidized units or developments for 

the simple reason that there is no requirement to report it to a public agency. Although 

this is changing with the growth of Internet-based data clearinghouses and housing 

locator systems that include information for people with disabilities, this data has its own 

limits and challenges, as most is self-reported, unverified, and not subject to compliance 

verification.3

 

Still, with the data available now, we know that there is unmet housing need based 

solely on standard measures of housing affordability. For the most part, this reflects a 

real shortage of affordable, appropriate, and accessible housing. However, the analysis 

also reveals a gap between current policy goals and outcomes—even with laws in place 

requiring a portion of units to be accessible, some developers and property owners do 

not comply. Whether noncompliance is due to ignorance or intent, evidence suggests 

we have missed opportunities to increase the supply of accessible affordable housing. 

Compounding matters is the lack of consistent compliance oversight and enforcement. 

The gap between need and supply is further exacerbated because not all federally 

subsidized accessible units are available to all segments of the disability population. For 

example, a majority of the accessible housing developed through different federal 

23
programs is age restricted (i.e., “seniors” or “elderly” only). As a result, thousands of 

affordable and accessible housing units built with public monies are not available to 

people with disabilities under the age of 62. Furthermore, most accessible housing that 

is built for people with disabilities is segregated by design and not integrated into 

communities. 

Policymakers and others need to keep in mind that the ability to accurately assess 

current and future fit between housing supply and need requires accurate and complete 

information—an especially salient concern given the cost of housing production and the 

time it takes to develop. The findings and recommendations contained in this document 

are grounded in data and research gathered from federal agencies, either directly or via 

published reports, and from research completed by academics and disability advocates. 

This report also provides evidence of what can be effective in meeting the range of 

housing needs among a diverse group of consumers with disabilities. This includes best 

and promising practices drawn from real examples, and lessons learned from experts 

working on housing issues and policy.4

 In reviewing best and promising practices, data 

was triangulated from different sources—interviews, published reports, and Internet 

research—to assure a comprehensive assessment. To this end, the research has been 

reviewed and commented on by a diverse panel of experts and consumer groups that 

have all provided valuable insights and guidance. 

Chapter 1 highlights housing needs among people with disabilities. Chapter 2 outlines 

what is currently available to people with disabilities through various federal housing 

programs and provides a profile of people using these programs. Chapter 3 provides an 

overview of the distribution of need across the States relative to the distribution of units 

produced by key federal housing programs. Chapter 4 discusses opportunities, gaps, 

and barriers created by existing policies and practices that limit the ability to produce 

integrated, affordable, and accessible housing, and it describes promising practices 

from different States that are currently surmounting these barriers. Chapter 5 provides 

promising practice examples from private and nonprofit efforts to improve choice and 

access to affordable, accessible, and integrated housing. Chapter 6 outlines lessons 

24
learned about the provision of accessible and affordable housing in the wake of national 

disasters and emergencies. Chapter 7 provides recommendations aimed at improving 

federal and State efforts to provide integrated, accessible, and affordable housing for 

people with disabilities. 

25
26
CHAPTER 1. Housing Need 

This section summarizes key national data to illustrate housing needs among people 

with disabilities. We begin with a general profile of individuals with disabilities and a 

comparison of households with and without someone with a disability to illustrate 

common issues and differences among housing needs, followed by specific data on 

need for affordable, accessible, and appropriate housing. 

Recent federal research estimates that 54.4 million people with disabilities live in the 

civilian population in the United States, representing approximately 19 percent of the 

noninstitutionalized population.5 At all ages, women (24%) have a higher prevalence of 

disability when compared with men (19%). For all, the prevalence of disability increases 

with age, from 11 percent for people 18 to 44 years of age to 52 percent for people 65 

years and older.6

An estimated 11 million people 6 years and older need personal assistance with 

activities of daily living (ADLs) such as bathing, eating, dressing, or getting around 

inside the home, or with instrumental activities of daily living (IADLs), which include 

household chores, doing necessary business, shopping, or getting around for other 

purposes.7 Approximately 35 million people 15 years and older have a severe 

disability.8 The number and percentage of people with a severe disability increases with 

age so that of those 65 and older with a disability, 37 percent had a severe disability. In 

addition to needing appropriate medical and public health services, this segment of 

people with disabilities is likely to need personal assistance as well as specific 

accessibility features within the home and in the community. 

National housing survey estimates suggest that about 35.1 million households have one 

or more person with a disability, which is about 32 percent of the households in the 

United States in 2007.9

 These households are:10

● Small in size with about three-fourths of households in one- and two-person 

households.

27
● More likely to headed by someone age 65 or older (60% of households with a 

disability are in this age group; in comparison, only 2% of households without a 

disability are age 65 or older).

● More likely to be low income (65% compared to 36% of households without a 

disability).

● Nearly 2.5 times more likely to be extremely low income—earning less than 

30 percent of the median, which is near the national poverty level (25% 

compared to 10% of households without a disability). 

● More likely to be paying more than 30 percent of income for housing costs (40% 

compared to 32% of households without a disability). 

● More likely to receive some form of government assistance with rent (9% 

compared to 2% for households without a disability). 

● Less likely to live in a central city (26%) or suburb (30%) and more likely to live 

in a rural area outside a metropolitan area (20%) than a household without a 

disability. 

● More likely to live in manufactured housing (8% compared to 5% of households 

without a disability). 

● More likely to live in a building with a no-step entrance (45%) and in an 

apartment on the same floor as the building entrance (38% compared with 34% 

of households without a disability). 

● More likely to live in a building/development that offers “impersonal” services 

(such as meals, transportation, housekeeping, financial management, 

telephone aid, and shopping) and personal services (assistance with bathing, 

eating, moving about, dressing, and toilet use). 

Also important to note is that among people below the age of 65, people with disabilities 

are more likely than people without disabilities to rent their home (37% compared to 

31%). However, nearly 15.1 million households with people with a disability between 65 

and 85 years old own their own home. This means that among homeowners in this age 

28
bracket, nearly 94 percent have a disability.11 Such high levels of ownership among this 

age group are likely due to the fact that many purchased their homes before acquiring a 

disability as they aged. Many of these homeowners are likely to face challenges if they 

want to remain independent in a home that often is not accommodating and may be 

costly to maintain. 

Finally, the data above does not include about 2.17 million people living in nursing 

homes or group homes.12 About 1.6 million live in nursing homes, including an 

estimated 125,000 people ages 22 to 64 with severe mental illness—a 41 percent 

increase since 2002.13 Estimates of people with a disability usually do not include this 

population because people in “group quarters” (i.e., nursing homes and group homes) 

are excluded from most federal reports on housing need. If current rates of growth 

continue without the development of new alternatives that allow people to remain in 

homes in their communities as they age, it is expected that there will be 3 million 

nursing home residents by 2030.14 

Affordability 

Poverty and low-income status of people with disabilities are key barriers to acquiring 

housing. The median monthly income earnings in 2005 for people with no disability 

($2,539) were significantly higher than for people with severe disabilities ($1,458). While 

people with nonsevere disabilities did better, their monthly median income was still 

lower ($2,250). Poverty is much higher among people ages 25 to 64 with severe 

disabilities (27%) when compared to people in the same age group with nonsevere 

disabilities (12%) and no disability (9%). For many, this is due to being unemployed. In 

2005, less than half (46%) of the population with a disability ages 21 to 64 was 

employed. In comparison, 84 percent of people in this age group who did not have a 

disability were employed. 

Since the 1970s, policymakers and housing researchers have come to understand 

housing need based on assumptions about precisely how much consumers should pay 

for housing. Current federal guidelines fix the relationship between income and housing 

29
cost at 30 percent. That is, housing is affordable if it costs a household no more than 

30 percent of its income. For renters, this includes monthly contract rent plus utilities. 

For owners, cost includes monthly mortgage payments, insurance, utilities, and taxes. 

For both, and regardless of income level, housing is not affordable if a household uses 

more than 30 percent of its income for it. There is a need for affordable housing when 

there are fewer units than people can afford to pay according to this threshold. 

Obvious evidence of need for affordable housing is homelessness. The most recent 

data from HUD suggests that at a minimum, 43 percent of homeless adults (about 

421,246 people) who stayed in a shelter have a self-reported disability.15 Missing from 

this account is the number of homeless children with disabilities and all people with 

disabilities not in a shelter that are literally homeless living on the streets, in abandoned 

buildings, or elsewhere not intended for human habitation. 

Another indicator of need for affordable housing is people at risk of becoming homeless 

because they live in precarious housing situations. This can include low-income people 

who are “cost burdened” (i.e., paying more than 30% of income for housing) and whose 

need is considered “worst-case.” HUD defines households with worst-case needs as 

“Unassisted renters with very low incomes who have one of two ‘priority problems’ 

either paying more than half of their income for housing (‘severe rent burden’) or living 

in severely substandard housing.”16 

A recent report determined that nearly 6 million households in the United States have 

worst-case housing needs. Of this total, between 1.3 million and 1.4 million are 

“nonelderly” (below 62 years of age) renter households with people with disabilities.17 In 

addition, nearly 1 million worst-case need families with children include nonelderly 

adults with disabilities.18 This means that as many as 2.4 million very low income 

households with disabilities may be worst-case—a rate of between 35 and 40 percent of 

the overall worst-case housing need in the United States. In addition, another million 

“elderly” households (ages 62 and above) were also found to be worst-case need, 

which is likely to include people with disabilities.19

30
The fastest-growing segment of need appears to be in rural areas.20 Less is known 

about the need for accessible housing in these areas, though data from the 2007 

American Housing Survey suggests that about 7 million households had at least one 

person with a disability in rural nonmetropolitan areas in the United States. Of this total, 

about 2.5 million are extremely low income but only about 10 percent are claiming any 

form of rental assistance from the government.21

A trend likely to be contributing to this problem is the continued increase in housing 

need among low-income people with disabilities living on Supplemental Security Income 

(SSI). According to Priced Out in 2008, a single person in the United States has an 

income that is five times greater than that of a person receiving SSI assistance, which 

on average is $668 a month.22 With such a low income, a person on SSI has limited 

housing options. No State in the United States has an average-priced one-bedroom or 

studio apartment that would be affordable to someone on SSI. In fact, the average 

rental payment in the United States for a studio would require spending 100 percent of 

the monthly SSI payment and renting the average one-bedroom unit would require 

112 percent of a monthly SSI payment. As a result, most of the 4.2 million people 

receiving SSI cannot afford housing in their community unless they receive some form 

of housing subsidy. 

For people with disabilities who work, the challenge is finding work that pays a sufficient 

wage to afford housing. The National Low Income Housing Coalition (NLIHC) examines 

housing costs annually to estimate the “housing wage” needed to afford housing, 

assuming a household pays no more than 30 percent of its income for monthly rent. 

NLIHC uses HUD’s Fair Market Rent, which is adjusted annually and by location to 

reflect regional variations. Nationally, a single person or household with one worker 

would need to earn at least $14.97 per hour (based on a 40-hour work week, working 

50 weeks a year) to be able to afford the average rent for a one-bedroom rental unit.23

This wage varies widely across the country, with a high of $24.15 per hour needed to 

afford to live in Hawaii and a low of $8.38 in North Dakota, which is still above the 

current national minimum wage of $7.25 an hour.24

31
Accessibility 

Many people with disabilities are able to live independently, although current research 

suggests that a growing number are unable to find appropriate housing to meet their 

needs relative to their disability. Reasons include housing location, quality, physical 

accessibility, affordability, and an unmet need for supportive services that some 

individuals require in order to live independently in the community. 

Based on the most recent national data available, thousands of people with disabilities 

need basic home modifications to make their homes accessible.25 The greatest need 

was for grab bars or handrails (an estimated 788,000 households) that, relatively 

speaking, are not expensive to install. In addition, many people needed basic features 

that make units “visitable,” including ramps to access the building or home (612,000 

households), elevator or lifts to access the unit once in the building (309,000 

households), widened doorways and halls in the unit (297,000 households), and 

accessible bathrooms (566,000). As might be expected, renters had proportionally 

greater unmet need for all features when compared to homeowners. 

In addition to modifications to make the physical environment more accessible, there is 

a need to consider the overall built environment, given the growing number of people 

affected by environmental exposures—a physical condition that is triggered by the 

environment.26 Symptoms include neurological, respiratory, muscular, cardiovascular, 

and/or gastrointestinal problems. Known triggers include the following: 

● Pesticides: weed killers, bug sprays, treated wood products 

● Solvents: paints, glues, gasoline, nail polish/remover 

● Indoor air Volatile Organic Compounds: new carpet, formaldehyde, 

plasticizers, chlorine, fragrances and fragranced products 

● Cleaners: bleach, ammonia, phenolic disinfectants, air fresheners 

● Combustion-related: auto and diesel exhaust, tobacco smoke, natural gas, 

tar/asphalt 

32
● Drugs/medical devices: anesthetics, antibiotics, implants, vaccines 

● Electrical devices: microwaves, transformers, high-tension wires, fluorescent 

lighting, cell towers, cell phones 

These triggers can be in the housing unit, elsewhere in the building if a multifamily unit, 

and/or outside it in the immediate community as well as in locations the person needs to 

or would like to visit in daily life. While some of these products are used in development 

of housing (and buildings in general), many are introduced by people through the care 

and maintenance of buildings as well as by people being in the building (e.g., someone 

wearing perfume). Current estimates suggest that 11 percent of the population has 

some sort of chemical sensitivity.27 For people with environmental sensitivities, 

accessible housing must be free of these environmental triggers. However, unless the 

housing is universally designed to accommodate all the different sensitivities, for some it 

is better to live in segregated housing that assures control over potential exposures. 

Assistance is another means to accommodate and/or remove environmental barriers in 

and around a home. Many people with disabilities need help with certain activities of 

daily living to make their housing accessible.28 Using this “functional” definition of 

disability, current estimates of the population in need of accessible housing and 

communities who are under age 65 range from between 3.5 million to 10 million.29 This 

population will grow as the population of aging baby boomers soon reaches an age 

where housing accessibility and livable communities will become one of their highest 

priorities. People with disabilities also are living longer and their housing and supportive 

requirements are changing; such trends directly affect these individuals’ community 

living options. The population of people over age 65 is expected to double by 2030. 

Currently, 20 percent of people ages 65 and over require assistance with at least one 

activity of daily living. This number is expected to increase to 50 percent by age 85. 

Over the next 30 years, disability rates for people 85 years and older are expected to 

rise as this population triples.30

33
For people with psychiatric disabilities, accessible housing is a relatively recent public 

policy concern that focuses on promoting integrated rather than segregated community 

living. Before the 1960s people diagnosed with serious mental illness were considered 

incapable of living outside institutions. The development of psychotropic medications, a 

desire to save public funds, and growing concern about conditions in institutions led to a 

nationwide movement to deinstitutionalize hospital residents. As a result, the number of 

people diagnosed with mental illness living in public institutions dropped from 559,000 in 

1956 to 154,000 people in 1980.31 People released from mental institutions were 

supposed to receive treatment and support services in the community, but the promise 

of community-based treatment proved illusory, and the lack of support services coupled 

with the dearth of affordable housing swelled the ranks of people with mental illness 

living without shelter. 

The need for community-based housing for people with psychiatric disabilities sparked 

the development of a new type of institution called the board and care home.32 Board 

and care homes, which provide food and 24-hour supervision to residents, range in size 

from 2 to more than 200 residents. The majority house more than 50 people. Currently, 

approximately 330,000 people with psychiatric disabilities live in board and care homes. 

Board and care homes were not designed to lead to recovery—they simply filled the 

housing gap created by deinstitutionalization. Today, most board and care homes 

function as mini-institutions within the community. They provide very little privacy, a 

limited scope of services, and little opportunity to interact with people without disabilities 

in the community. In most homes residents have no opportunity to exercise choice in 

their day to day lives over roommates, meals, bedtimes, or other daily functions. 

Virtually all resident income goes directly to the home, making it impossible for residents 

to save sufficient funds to consider moving to private housing.33 Also, there is little 

oversight and most homes are unlicensed, and as a result, there have been multiple 

press stories about abusive conditions in board and care homes.34 Finally, few board 

and care homes help residents develop independent living skills or move on to 

independent housing.35 

34
NCD’s 2008 report, Livable Communities for People with Psychiatric Disabilities, 

underscores the need for new and more options beyond this form of congregate living.36

While “different perspectives exist” on which is the best housing approach, consumers 

when given the choice are likely to choose independent, integrated living over some 

form of congregate arrangement. This also aligns with national surveys that consistently 

report that 80 to 95 percent of people with disabilities and seniors strongly prefer to 

remain in their own homes,37 and report higher quality of life when they are able to 

remain in the community.38 However, data also illustrate how community living is a 

constant fight to manage housing, finances, and transportation, all survival issues that 

directly affect people’s choice, and potentially their health and participation.39 Problems 

worsen when people do not have information to make informed decisions about least 

restrictive living.40 People with disabilities need information they can use to become 

informed on their choices, as do policymakers and other stakeholders that can help 

expand choice. As the next section illustrates, information on housing options is 

currently quite limited in the United States. 

35
36
CHAPTER 2. Federally Subsidized Housing 

The three main sources of federal funding that either target or benefit people with 

disabilities are (1) U.S. Department of Housing and Urban Development (HUD), (2) U.S. 

Department of Agriculture (USDA) rural housing, and (3) the Low Income Housing Tax 

Credit (LIHTC) via the Internal Revenue Service. In addition, the Department of 

Veterans Affairs offers a number of housing programs that help veterans with mental 

and physical disabilities, some in conjunction with HUD and others with State agencies. 

All housing built with federal funds and housing programs receiving federal funds are 

subject to the requirements of the 1973 Rehabilitation Act (Section 504), which provides 

for nondiscrimination in all programs, services, and activities receiving federal financial 

assistance; and in programs, services and activities conducted by executive agencies. 

Section 504 regulations require 5 percent but not less than one dwelling unit to be 

accessible to people with mobility disabilities, and at least 2 percent but not less than 

one dwelling unit to be accessible for people with visual and hearing disabilities. Section 

504 regulations require compliance with the Uniform Federal Accessibility Standards 

(UFAS), published in 1984 by HUD and three other federal agencies to provide uniform 

standards for the design, construction, and alteration of buildings in accordance with the 

Architectural Barriers Act (ABA), 42 U.S.C. 4151–4157. The ABA applies to buildings 

and facilities designed, constructed, altered, or leased with federal construction 

monies.41 While ABA covers only the facilities, Section 504 also covers programs, 

services, and activities, which must be accessible to people with disabilities. 

Federal housing is also subject to American with Disabilities Act (ADA) Title II regarding 

public access and Title III regarding places of public accommodation in private 

multifamily property. Finally, all housing is subject to State and local regulations, 

including zoning and building codes.42 

In addition, with few exceptions and regardless of funding source, all multifamily 

housing with four or more units in a single structure built after March 13, 1991, is subject 

to the design and construction requirements of the Fair Housing Act (1988). However, 

37
the law does not ensure that the majority of rental units will be accessible to people with 

disabilities, since more than 85 percent of the rental housing in the United States was 

built before 1991.43 For these units, there is the expectation that reasonable 

accommodations can be made to meet different accessibility needs of people with 

disabilities. This was recently reinforced through a jointly issued statement from HUD 

and the Department of Justice (DOJ) on June 17, 2004, which reminded that: 

One type of disability discrimination prohibited by the [Fair Housing] Act is the 

refusal to make reasonable accommodations in rules, policies, practices, or 

services when such accommodations may be necessary to afford a person 

with a disability the equal opportunity to use and enjoy a dwelling [42 U.S.C. 

§ 3604(f)(3)(B)]. HUD and DOJ frequently respond to complaints alleging that 

housing providers have violated the Act by refusing reasonable 

accommodations to persons with disabilities.44 

The statement aims to help housing providers better understand the rights of people 

with disabilities and the obligations of housing providers under the act. While 

determining what is a reasonable accommodation is dependent on the individual with 

the disability, the statement provides some examples that are likely common 

accommodation requests, including assigning a parking space close to an entrance for 

a person with a mobility limitation, allowing different means for paying rent (e.g., via mail 

instead of in person), and waiving “no pet” policies to allow assistance animals in the 

unit. Also, the statement reminds that housing providers cannot charge a fee for 

providing a reasonable accommodation. 

Of course, people with disabilities need to first find housing in the market before they 

can seek accommodations. A recent study of the Chicago metropolitan area, 

Discrimination Against Persons with Disabilities: Barriers at Every Step, completed for 

HUD provides evidence that discrimination based on disability still occurs.45 As part of a 

larger nationwide study, the Chicago area served as a pilot study, which focused on the 

treatment of people who are deaf using the TTY system—a device that allows 

individuals to make and receive text phone calls—to inquire about advertised rental 

housing and the treatment of people using wheelchairs visiting rental properties to 

inquire about available units. The findings indicate that “adverse treatment against 

38
people with disabilities occurs even more often than adverse treatment of African 

Americans or Hispanic renters in the Chicago-area market.”46 This was evident in the 

lower rates of service, information provided, and units available, and in higher denial 

rates when requesting opportunity to inspect units for home seekers with a disability 

than for comparable home seekers without disabilities.47 

Compounding the problem of discrimination, HUD continues to be behind in handling 

fair housing complaints, the majority of which are filed by people with disabilities.48

Assuming someone knows if he or she has been discriminated against—which may not 

always be the case—a fair housing complaint can be filed up to 1 year after the alleged 

discrimination (180 days if filing under 504). Once filed, HUD is expected to take action. 

Currently, HUD outlines the process on its Web site.49 Up front, HUD states it will “notify 

you if it cannot complete an investigation within 100 days of receiving your complaint” 

and then: “If, after investigating your complaint, HUD finds reasonable cause to believe 

that discrimination occurred, it will inform you. Your case will be heard in an 

administrative hearing within 120 days, unless you or the respondent wants the case to 

be heard in Federal district court.”50 

While the speed of the process is subject to many factors, including the cooperation of 

the person filing the complaint, there is concern that despite these commitments to 

timeliness, people with disabilities wait a very long time for resolution. A 2001 National 

Council on Disability report revealed that cases were open on average nearly 500 days 

in 2000. Based on a recent review by the National Fair Housing Alliance (NFHA), things 

do not appear to have changed all that much. NFHA found in its review of cases in 

which a charge was issued between January 2004 and October 21, 2008, that “the 

average age of cases in which a determination of reasonable cause was made and a 

charge issued was 502 days. The shortest time period between filing the complaint and 

the issuance of a charge was 143 days, while the longest was 1,254 days.”51

39
U.S. Department of Housing and Urban Development 

The U.S. Department of Housing and Urban Development (HUD) is the primary federal 

agency responsible for affordable housing programs. HUD administers all funding for 

public housing and Tenant-Based Rental Assistance programs, which are then 

implemented by the 3,300 Public Housing Agencies (PHAs) across the country. HUD 

also administers two competitive programs in which developers apply directly to HUD: 

Section 202 housing for “elderly” (ages 62 years and older) and Section 811 housing for 

people with disabilities. HUD also has oversight responsibility for a portfolio of 

developments created through now-inactive programs (project-based Section 8, Section 

236 Interest Reduction program). Finally, HUD administers several formula-based grant 

programs under which funds are allocated to local agencies that are given fairly broad 

discretion on spending on housing. This includes the HOME program, Community 

Development Block Grant (CDBG), and the Continuum of Care (Homeless) program 

that produces permanent and transitional housing as well as emergency shelters for 

homeless people, including people with disabilities and with AIDS/HIV. HUD is also 

responsible for approving all Consolidated Plans (State and local) that establish specific 

priorities for allocating federal funds for housing and community development.52

Eligibility for HUD housing programs is determined by income limits using annual 

“family” Area Median Income (AMI), which is adjusted for family size.53 HUD further 

distinguishes “extremely low income” households (income below 30% of AMI), “very low 

income” (income below 50% of AMI), and “low-income” (income below 80% of AMI). 

Table 1 below illustrates the variation in median income and the income limits 

associated with each HUD income category based on a family of four, which is the 

standard usually cited when public officials talk about median income. In this sample of 

11 cities, the median income ranges from a high of $102,700 in Washington, D.C., to a 

low of $61,100 in Houston, Texas. Using HUD’s calculations, an extremely low income 

family in Washington, D.C., has an annual income of no more than $30,800, while in 

Houston it would be $18,350. However, since many people with disabilities live alone, it 

is important to see how these income categories vary depending on family size. For 

example, in Washington, D.C., a one-person household would be extremely low income 

40
Table 1. HUD Income Limits for a Four-Person Family 

in Selected Cities, FY 200955

Extremely low 

income 

30% of median

Very low 

income 

50% of median

Low-income 

80% of median Median 

New York City $23,050 $38,400 $61,450 $61,600 

Los Angeles 23,800 39,650 63,450 62,100

Chicago 22,600 37,700 60,300 74,900 

Houston 18,350 30,550 48,900 61,100 

Philadelphia 23,350 38,900 62,250 77,800 

Phoenix 19,750 32,950 52,700 65,900 

Jacksonville 19,550 32,550 52,100 65,100 

Washington, D.C. 30,800 51,350 64,000 102,700 

Denver 22,800 38,000 60,800 76,000 

Atlanta 21,500 35,850 57,350 71,700 

Seattle 25,300 42,150 64,000 84,300 

earning $21,550 annually, while an eight-person family would go up to $40,650. In 

Houston, the range would be from $13,400 to $25,300.54

Beyond income, HUD also identifies tenants as one of the following: elderly family, 

disabled family, or both elderly and disabled. 

A disabled family, according to HUD, means a family whose head, spouse, or sole 

member is a person with a disability. It may include two or more people with disabilities 

living together, or one or more people with disabilities living with one or more live-in 

aides. By definition, a family with a child with a disability but no other adult with one is 

not a disabled family. HUD uses several means to determine disability status for 

purposes of qualifying for housing: Section 223 of the Social Security Act (42 U.S.C. 

423), Section 102 of the Developmental Disabilities Assistance and Bill of Rights Act 

(42 U.S.C. 6001[5]), or 

determined by HUD regulations to have a physical, mental or emotional 

impairment that: a) is expected to be of long, continued, and indefinite duration; 

41
b) substantially impedes his or her ability to live independently; and c) is of 

such a nature that such ability could be improved by more suitable housing 

conditions....The definition of a person with disabilities does not exclude 

persons who have the disease acquired immunodeficiency syndrome (AIDS) or 

any conditions arising from the etiologic agent for acquired immunodeficiency 

syndrome (HIV). However, for the purpose of qualifying for low income 

housing, the definition does not include a person whose disability is based 

solely on any drug or alcohol dependence. (Note: The definition of a person 

with disabilities as defined in 24 CFR 8.3 must be used for purposes of 

reasonable accommodations and program accessibility for persons with 

disabilities.)56

Elderly family means a family whose head, spouse, or sole member is 62 years of age 

or older. The term family includes a single elderly person, two or more elderly people 

living together, and one or more elderly people living with one or more people who are 

determined to be essential to the care or well-being of the elderly person(s). An elderly 

family may include people with disabilities and other family members who are not 

elderly. To be classified as both elderly and disabled, the head, spouse, or sole member 

must be a person with a disability and 62 years of age or older. 

HUD organizes its many housing programs into three broad categories: public housing, 

privately owned subsidized multifamily housing, and Housing Choice Vouchers (tenantbased housing assistance). We also include a fourth category: formula-based grant 

programs. 

Public Housing 

Most public housing was built between 1937 and the mid-1980s to provide low-income 

families affordable housing. Depending on the time period, public housing may be lowrise townhouses, mid-rise multifamily developments, or high-rise apartment buildings. 

Potential tenants have to be qualified based on their income, which cannot exceed the 

low-income limit for their area and family size; however, this does not guarantee that a 

household will be able to lease a unit, since this depends on availability. In many larger 

urban areas, applicants are on waiting lists for many years. Often PHAs open up waiting 

lists only periodically (e.g., every few years) and fill up after being open for only a short 

time. PHAs can set “local preferences” to move a household with greater housing needs 

42
up on the waiting the list as long as these preferences are approved by HUD. This can 

include people with disabilities. 

Once in a unit, tenants are required to pay either a minimum of $50 or 30 percent of 

income (as determined by HUD’s eligibility criteria) for rent, depending on which is 

higher. The remaining rent—the actual cost of operating and maintaining the unit—is 

paid to the PHA through a contract with HUD. Rent usually includes some utility 

assistance or allowance. Each household is reviewed annually to verify income and 

adjust rent payments if income has changed. 

Currently there are about 976,000 occupied public housing units in the United States.57

This is less than 1 percent of all housing in the United States, and substantially lower 

than the 1.28 million public housing units that existed throughout the United States and 

Puerto Rico in 2000.58 The 24 percent reduction in units is mainly due to the demolition 

of 150,000 public housing units under the HOPE IV program in order to develop new 

mixed-income housing developments, which, when completed, will have less than 

50,000 replacement public housing units.59 This lower number also reflects the loss of 

units that have been declared uninhabitable and other units permanently eliminated 

through demolition. 

According to HUD’s data, there were 210,760 “disabled families” (22%) and 307,782 

“elderly families” (32%; of which 135,218 had a disability) living in public housing as of 

December 2008.60 The remaining 457,182 were families (47%) in which the adult head 

of household was neither elderly nor with a disability. 

There is no current information on how many public housing units are accessible. 

Section 504 requires PHAs to do a self-evaluation of all their programs, housing, and 

facilities to determine if they are in compliance and to develop transition plans to deal 

with conditions that are not in compliance. While these documents are considered 

public and should be available upon request from a PHA, there is no publicly available 

master list of all evaluation results that could help determine what proportion and 

number of units in public housing are up to UFAS standards. However, assuming the 

43
minimum of 5 percent for mobility and 2 percent for vision/hearing impaired required by 

504, we estimate there should be at least 68,300 units of accessible public housing in 

the United States based on current inventory.61 Since this estimate is not based on 

actual data, the real number may be higher or lower. 

Recent compliance reviews of several large PHAs suggest that the number is lower. 

Based on Voluntary Compliance Agreements with HUD, we know that at least nine 

PHAs were not meeting the minimum threshold (Atlanta, Boston, Chicago, Lafayette 

(LA), Las Vegas, Miami-Dade, Pittsburgh, Puerto Rico, and Seattle), and one State 

financing agency (Alaska).62 With the exception of Chicago, all were given the mandate 

to make at least 5 percent of their units UFAS accessible. The Chicago Housing 

Authority was given a minimum of 5.3 percent for mobility impairments and 2.1 percent 

for sensory impairments.63 Some PHAs were also required to complete a needs 

assessment to determine more precisely what is needed. Given the number of disabled 

families plus the number of elderly families that have someone with a disability, the 

minimum number of accessible units required under Section 504 appears to be 

significantly smaller than the need. 

Finally, a further limitation to consider is that many accessible public housing units are 

in age-restricted “elderly only” developments (i.e., for people who are 62 years or older) 

and therefore are not available to all people with disabilities. Beginning in 1992, HUD 

allowed PHAs to designate public housing developments as elderly only. As of 2009, 

about 65,000 units had been added to this category, with the majority being onebedroom units (40,900 units).64 In addition, the designation of another 35,000 units had 

expired, while 60 requests from PHAs were denied designation status and another 50 

requests had been withdrawn.65

Housing Choice Vouchers 

Also known as tenant-based housing assistance, a Housing Choice Voucher (HCV) 

allows the household the same benefits as HUD’s public housing program, but in the 

private rental market. To qualify for an HCV, the household must be very low income (at 

44
50% of the Area Median Income), which is a lower income threshold than required for 

public housing. A household with a voucher pays 30 percent of its income for rent 

(though it can choose to pay more if it wants). With a grant from HUD, the PHA pays the 

difference up to the Fair Market Rent, which is near the median rent for the area.66

Housing units are required to meet HUD-specified quality standards verified through an 

inspection, and are subject to annual reviews to make sure they remain in compliance. 

As with public housing, there is likely to be a waiting list and PHAs can establish HUDapproved local preferences. 

Currently, about 1.97 million households are using Housing Choice Vouchers in the 

United States. These figures include households that receive assistance through special 

voucher allocations that Congress has provided for the exclusive use of nonelderly 

disabled households. An estimated 64,000 vouchers are included in two programs: the 

Designated Voucher Program and the Mainstream Housing Opportunities for Persons 

with Disabilities program. The Designated Voucher Program began in 1997 as an effort 

by Congress to provide new vouchers for nonelderly people with disabilities who would 

have qualified for studio and one-bedroom units in federal public and assisted housing 

properties designated elderly only. An estimated 50,000 designated vouchers for 

nonelderly people with disabilities were appropriated between 1997 and 2001. 

Congress requires PHAs upon turnover of these vouchers to make them available only 

to people with disabilities. The Mainstream Housing Opportunities for Persons with 

Disabilities program is administered as the Housing Choice Voucher program, but is 

funded through the Section 811 Supportive Housing for Persons with Disabilities 

program. Congress has appropriated an estimated 14,000 Mainstream Vouchers, which 

must also continue to be used solely by people with disabilities if they turn over. 

Of the total number of HCV holders, HUD data identifies 544,561 as disabled families 

(28%) and 374,265 as elderly families (19%), of which 150,499 also include someone 

with a disability. As with public housing, most voucher holders are nonelderly families 

with no person with a disability as head of household (1,052,906 households; 53% of 

total), and we do not know if there are children or other adults with disabilities in these 

45
families, since HUD does not identify them. Based on the number of disabled families in 

the HCV program, it appears that the majority did not gain access to federal housing 

assistance through the Designated or Mainstream programs. As a result, the majority of 

vouchers currently benefiting people with disabilities are not guaranteed to continue to 

do so if returned, since there is no requirement for turnover to another disabled family. 

Regardless of the type of voucher, there is no record of what, if any, accessibility 

features are in the units that tenants with disabilities occupy. While some public housing 

authorities and disability advocates keep a list of landlords with accessible rental units, 

there is no systematic recordkeeping for HUD on the number of voucher holders with 

disabilities renting accessible and/or adaptable units. Even if all vouchers in both of 

these programs were being used by people with disabilities, we cannot assume that all 

would be living in accessible units or units that fit the accessibility needs of the 

household. 

A study commissioned by HUD found that people with disabilities using vouchers do not 

always search for housing solely to meet their accessibility needs.67 When asked why a 

household selected a current unit, only 10 percent reported that they selected the unit 

because it offered more accessible features than other available units. The top reasons 

were because the unit was located in a “better” neighborhood (39%), was closer to 

friends (34%), and/or was located near shopping (33%).68 About one-fourth did not 

even search for a new unit when they received their voucher, but instead stayed in

current rental unit.

 the 

69 And whether they moved or not, only 7 percent of the survey 

respondents indicated that they had asked for a modification to the unit. 

Finally, using Housing Choice Vouchers continues to mean encountering and dealing 

with barriers including discrimination and lack of uniform protections across the country. 

Recent analysis of Housing Choice Voucher utilization rates indicates that usage was 

down among all households in the 1990s, going from 81 percent utilization (i.e., getting 

to use the voucher to rent a unit) in 1993 to 69 percent in 2001. At the time, many 

attributed this to tight rental housing markets in many cities coupled with a shrinking 

affordable housing supply to access. The 2001 data suggests that nonelderly people 

46
with disabilities actually did better than average (74% success rate), while elderly 

people with disabilities did worse (54% success rate).70 It is unclear why this was the 

case. 

Multifamily Housing 

There are 1.47 million rental units in privately owned buildings maintained by both forprofit and nonprofit entities that have been developed with various federal multifamily 

housing programs. This includes at least 396,000 units designated elderly only, with 

most built under Section 202 (270,000 units as of 2004). In contrast, there are only 

about 72,700 units in HUD’s multifamily portfolio designated for people with disabilities 

only (which includes people ages 62 and older), with much of it built in the past 15 years 

under the Section 811 program. Other units were built under the Section 8 program and 

receive assistance to reduce rents in buildings so that low-income households pay only 

30 percent of their income for rent. Most of these developments are designated as 

family, although some are combined elderly and disabled. The same is true for units 

built under various other rental subsidy programs from the 1960s that are no longer 

funded, including the Section 221(d)(3) below-market interest rate program and the 

Section 236 program. Both produced affordable housing, but for renters with incomes 

slightly above the public housing income limits. Over time, deep rental subsidies were 

attached to some of these units to keep them affordable, but there still are about 

318,000 units that do not have these rental subsidies and therefore are not affordable to 

low-income households.71

Based on field inventories completed in 2008, there are approximately 156,000 

accessible units (11%) in subsidized multifamily housing developments.72 Not all are 

affordable to low-income households. Furthermore, as with public housing, the majority 

are likely to be in age-restricted developments, since 26 percent of the units in HUD’s 

multifamily housing portfolio are designated for elderly people, while only 5 percent are 

designated for people with disabilities.73 As with public housing, this means not all units 

in the accessible category can be accessed by younger people with disabilities. Finally, 

these figures in no way reflect the occupancy or bedroom size of accessible units and 

47
whether a person with a disability, regardless of age, was occupying the unit when it 

was surveyed. 

Section 811, which was authorized by the National Affordable Housing Act of 1990 and 

modified in 1992 by the Housing and Community Development Act, was specifically 

created to address the supportive housing need of people with disabilities. Section 811 

has two program components: the capital advance/Project Rental Assistance 

Component (PRAC) and the Tenant-Based Rental Assistance component administered 

by HUD under the Section 8 Mainstream Housing Opportunities for Persons with 

Disabilities program. As noted above, there are approximately 14,000 vouchers in the 

Mainstream program. 

As of 2007, about 27,000 units of housing had been produced through the 811 PRAC 

by nonprofit sponsors.74 There are three categories of housing allowed: group homes, 

independent living facilities, and condominiums. A group home is defined by law as a 

single-family residence that is designed for up to eight individuals to occupy, in either 

single- or double-occupancy bedrooms, and with at least one bathroom per four 

people.75 Also, the law says a group home developed with Section 811 funds is not to 

be located immediately next to or on the same lot as another group home. An 

independent living facility is like an apartment building, with separate dwelling units 

complete with their own kitchens, bathrooms, and bedroom(s); however, it also can 

include a unit for a staff person. These developments can be a single building on one 

site or multiple buildings scattered throughout the community. 

Based on a nonrepresentative sample of 136 PRAC developments in 2003, the majority 

(81) of the projects surveyed were in facilities with 8 to 24 units, which means most are 

independent living facilities.76 Furthermore, the majority of the surveyed developments 

targeted people with developmental disabilities (43 projects) and chronic mental illness 

(62 projects), rather than physical disabilities. While this data does not represent all 811 

housing, the results are likely to reflect the need for housing specifically for these 

populations that is not being produced by the private sector. 

48
The law limits to 24 the number of people with disabilities per 811 development; 

however, the annual Notice of Funding Availability limits this to 14 people with 

disabilities. 

Condominium projects are similar to independent living, with separate units. However, 

assuming these are units purchased in a building that was not intended to solely house 

people with disabilities, the program tries to promote integration by limiting the number 

of units to whichever is greater: 14 units or 10 percent of the total units in the 

development, not to exceed 24 units. Still, HUD grants waivers to allow a larger 

percentage and therefore number of units both in existing buildings and in new 

developments. 

While effective at creating housing, a concern is that the 811 program has also 

contributed to the segregation of people with disabilities from people without disabilities 

and also by different disabilities. Legislation states that 811 housing target people with 

physical disabilities, developmental disabilities, and chronic mental illness, or a 

combination of these three. However, through a waiver process, HUD can approve a 

project sponsor’s request to not only target only one of these three but then also a 

subcategory of disability within it (e.g., autism). As long as HUD approves the waiver 

request (which it typically does), the project sponsor can deny housing to someone that 

fits the broader disability category (i.e., developmental disability) if that person is not 

part of the project’s specific target population (i.e., autism). This is especially important 

to keep in mind given the relatively small number of Section 811 units when compared 

to the large number of people with disabilities. 

HUD Formula-Based Housing Grant Programs 

Community Development Block Grant 

The Community Development Block Grant (CDBG) program, which began in 1974, 

provides funding to help metropolitan cities, urban counties, and States to “meet their 

housing and community development needs.” The block grant is distributed through a 

formula based on need and size as well as housing conditions to entitlement 

49
communities and States. Currently HUD provides annual CDBG grants to 1,180 units of 

local government. States distribute these funds to other smaller local jurisdictions 

(nonentitlement communities) based on need, while cities and counties distribute CDBG 

through different agencies delivering services and producing housing.77 

In general, CDBG funds may be used for neighborhood revitalization, economic 

development, and improvement of community facilities and services. All activities must 

achieve one of the program’s national objectives, such as benefitting low- and 

moderate-income people, aiding in the prevention or elimination of slums and blight, or 

meeting urgent community development needs. A minimum of 70 percent of funds are 

to be used to benefit low- and moderate-income people; however, this does not only 

mean housing assistance and production. 

Currently, about 26 percent of CDBG on average goes to housing, which includes 

single-family and multifamily housing; however, the rate is much lower when looking at 

State allocation of CDBG funds, which is around 16–17 percent for housing.78 Based on 

data for the past 8 years, about half of the housing funding has gone directly to singlefamily rehabilitation.79 This may include retrofitting for accessibility, since this is an 

eligible use of funds; however, because the level of detail in reporting is not that 

specific, we cannot know if this is occurring.80

HOME Investment Partnerships Program 

The HOME program is the largest federal block grant to State and local governments to 

exclusively create affordable housing for low-income households, allocating 

approximately $1.7 billion per year. HOME funds are exclusively for housing-related 

investments including Tenant-Based Rental Assistance (TBRA), housing rehabilitation, 

homebuyer assistance, and housing construction, as well as site acquisition and 

improvements. Funds may not be used for public housing or as a contribution to other 

programs. A portion of funds must target very low income people, and income levels 

and rental prices must meet HUD limits. All assisted housing must remain affordable in 

the long term (20 years for new construction of rental housing and 5–15 years for 

50
homeownership housing). For rental housing and TBRA, at least 90 percent of families 

benefiting from HOME funding must have incomes that are no more than 60 percent of 

the HUD-adjusted family Area Median Income for the area. In rental projects with five or 

more assisted units, at least 20 percent of the units must be occupied by families with 

incomes that do not exceed 50 percent of the HUD-adjusted median. 

To date, HOME funds have been used to produce more than 756,000 units of housing 

since the inception of the program (does not include Tenant-Based Rental Assistance 

[TBRA]).81 While the allocation for HOME has generally increased over time, the annual 

completion rate is somewhat uneven. One constant is that HOME funds are strongly 

leveraged, generating nearly $4 for every $1 of federal funds provided, and commitment 

to Community Housing Development Organizations (CHDOs) has been above the 

15 percent minimum at nearly 21 percent annually. 

Unfortunately, like CDBG, the reporting system does not provide specific information to 

assess how people with disabilities benefit. A growing concern is that despite flexibility 

in how funds can be used, new homebuyers and existing owners consistently benefit 

the most from HOME. About 60 percent of HOME dollars have gone to homeowners 

receiving either rehabilitation or acquisition grants, while rental housing production 

under HOME is only 40 percent of the total unit count. Relatively speaking, rent 

assistance (TBRA) is more cost effective than production programs at about 10 times 

less per unit (compare an average of $3,151 per household for TBRA to an average of 

$35,495 per unit of new construction). The current TBRA commitment, which is less 

than 3 percent of the 2008 HOME budget, will assist about 200,000 households. Most 

families assisted are extremely low income (78%).82 This income bracket could include 

people with disabilities relying on SSI, as well as most households with worst-case 

housing needs. 

Homeless Shelter and Housing Programs 

The McKinney-Vento Act passed in 1986 was the first legislation to directly deal with 

homelessness at the federal level. The act provides funds to develop and operate 

51
emergency shelters, transitional housing, and permanent housing via a networked 

system of shelter and service providers known as the Continuum of Care (CoC).83 In 

addition, P.L. 102–590 passed in 1992 enabling the Department of Veterans Affairs to 

develop transitional housing (the Grant and Per Diem program). 

Today, HUD manages several homeless assistance programs that provide federal 

funding to local communities either through a formula (noncompetitive) or on a 

competitive basis. Competitive funding is awarded to applicants through the State’s or 

local jurisdiction’s Continuum of Care (CoC) plan, which is produced annually by a 

network of homeless-service providers and other stakeholders (including homeless 

people) working together either through or in conjunction with a government agency. 

The CoC plan is to guide the development and delivery of an integrated set of programs 

and services in the community that aim to help people once homeless eventually 

become permanently housed. 

A significant shift in the last few years has been toward producing more supportive 

housing and less emergency shelter and transitional housing. As HUD defines it, 

supportive housing “provides long-term housing with supportive services for homeless 

persons with disabilities. This type of supportive housing enables special needs 

populations to live as independently as possible in a permanent setting.”84 Included in 

this are permanent supportive housing units developed specifically for people with 

disabilities and units developed via HUD’s Shelter plus Care (S+C) program, which 

“assists hard to serve homeless individuals with disabilities and their families. These 

individuals primarily include those with serious mental illness, chronic problems with 

alcohol and/or drugs, and HIV/AIDS or related diseases.”85 

As of 2008, there were 195,724 “beds” in permanent supportive housing, of which 

119,143 were for individual adults and the remaining 76,581 for families. While still not 

surpassing emergency and transitional housing overall (211,000 and 205,000 beds, 

respectively), permanent supportive housing increased the most in terms of the 

proportion of programs and number of beds added from 2007 to 2008. All permanent 

supportive housing built with these funds for the homeless requires the person entering 

52
the program to be homeless prior to leasing the unit or being admitted. Such 

requirements, while useful at targeting people in need, nonetheless mean these 

“permanent” housing units can only play a limited role in meeting the needs of people 

with disabilities. 

Low Income Housing Tax Credit Program 

Since 1986, the Low Income Housing Tax Credit (LIHTC) program has been the primary 

source of funding for affordable housing in the United States. The LIHTC program is 

regulated by the Treasury Department through the Internal Revenue Service (IRS). The 

basic premise is that tax credits issued by the IRS get turned into equity, which is then 

used to reduce the cost of development and subsequently the rent the developer needs 

to charge to cover expenses for developing and operating the housing.86 In exchange, 

the investor (equity partner) gets an annual tax credit for 10 years as long as the 

housing development and operator meets the compliance requirements. This includes 

keeping units occupied and restricting rents in a portion of units for 30 years or longer, 

depending on the agreement with the agency issuing the tax credits. Most housing 

produced through the LIHTC program is intended to be affordable to the “working 

poor”—households earning up to 40 and 60 percent of median income. 

Unlike HUD funding, tax credits are not budget outlays but rather taxes that are not 

collected, which is fiscally and politically appealing to many. The allocation of the tax 

credit is based on a per capita rate for each State.87 Beginning in 2003, the rate was set 

at $1.75 per person and is to be adjusted for inflation.88 Guiding the allocation of the tax 

credits in each State is a Qualified Allocation Plan (QAP). States use these plans to 

evaluate development proposals from private and nonprofit developers building 

affordable housing and give points for different features or aspects of the proposed 

development. The QAP, which must be consistent with the State’s Consolidated Plan, is 

also required by federal law to give priority to projects that (1) serve the lowest-income 

families, and (2) are structured to remain affordable for the longest period of time. 

Federal law also requires that 10 percent of each State’s annual housing tax credit 

53
allocation be set aside for projects owned by nonprofit organizations.89 Beyond these 

requirements, criteria for awarding points vary greatly across the States. 

Based on the latest data available, which is 2007, a little over $9 billion dollars in tax 

credits have been used to produce 1,669,300 units. This is an average of $5,400 tax 

credit dollars per unit developed. Since 1997, an average of between 1,300 and 1,400 

new developments have been completed each year. Over time, the noticeable trend has 

been that the average development size increases from about just below 40 units in 

1992 to around 80 in 2005.90 Developments built 1995–2005 had mostly two-bedroom 

(42%) and one-bedroom units (31%).91

The units produced by the LIHTC program has exceeded the number of housing units 

built during the 60 years of public housing development and in one-third of the time.92

Nearly 95 percent of the units are rent restricted to benefit low-income families.93 Still, 

with many units for families earning close to 60 percent of the Area Median Income, 

many LIHTC units cannot be rented by households with worst-case needs because rent 

is fixed and not adjusted for income. For most very low income families to access these 

units would require substantial rental subsidy to make them affordable.94 While no 

current data is available on how many units of LIHTC are also being subsidized by 

tenants using Housing Choice Vouchers, a Government Accountability Office (GAO) 

report in 1997 found that about 39 percent of the households living in LIHTC housing 

also directly received vouchers.95 

While LIHTC is the most important affordable housing production tool in the United 

States today, we know very little about how it has benefited people with disabilities. For 

the most part, the reason is that there is limited reporting on who occupies these units 

other than by income bracket, since that is critical for meeting compliance requirements 

and assuring that investors continue to receive their tax credit. Still, we know that 

developers using tax credits sometimes target specific populations, including people 

with disabilities. Recent data now collected for inclusion in HUD’s LIHTC database 

suggests that 27 percent of the developments put in service between 2003 and 2005 

were to be for people with disabilities, and about 12 percent for the elderly (about 

54
41,600 units).96 However, most of these are likely to be permanent supportive housing 

for homeless people, and therefore only accessible to people with disabilities who are 

homeless. 

A key distinction between HUD housing and LIHTC properties is that tax credit units are 

not covered by Section 504 regulations, though most are affected by the Fair Housing 

Act, since most units were built after 1991. However, since many developments use 

additional sources of funding, including federal dollars that are subject to 504, the 

assumption would be that if substantial, these dollars would trigger compliance. About 

31 percent of developments that target either the elderly or people with disabilities used 

HOME funding, while fewer used other public sources.97

In general, we know that proportionately about half of all LIHTC projects are located in 

central cities, about 38 percent are in suburban communities, and the remaining 

12 percent are in nonmetropolitan areas. The distribution of housing targeted for people 

with disabilities appears to be about the same for central city, suburban, and 

nonmetropolitan areas, representing 12 to 13 percent of developments placed in service 

between 2003 and 2005.98 In contrast, housing targeting an older population is 

proportionally higher in suburban locations (35%) than nonmetro areas (28%) and 

central cities (21%).99 Since this data does not include units placed in service before 

2003, it is not known if this pattern applies to all LIHTC developed since 1987. We do 

know that about 22 percent of the units developed in this time period that target people 

with disabilities were in communities where more than 30 percent of the people were 

below the poverty line. In comparison, less than 16 percent of the LIHTC units that 

target the elderly were in high-poverty communities. 

Rural Housing 

The U.S. Department of Agriculture (USDA) housing program began with the 1949 

Housing Act (Title V, P.L. 81–171), which authorized USDA to make loans to farmers for 

the construction of new housing and to refurbish existing homes and other farm 

buildings to ensure safe, decent housing for themselves and other tenants, lessees, 

55
sharecroppers, and farm workers living on their land. Currently, through its Rural 

Development (RD) division, USDA makes housing loans and grants to rural residents 

and to developers of properties in rural areas. To date, about $116 million has been 

expended since 1949, assisting nearly 3.5 million households.100 

The rural housing programs offered through USDA’s RD division fall into two main 

categories: single-family and multifamily. While a few programs identify as eligible 

recipients people with disabilities and those who are aging, no RD program targets 

either group exclusively. This report focuses on RD programs most likely to benefit 

people with disabilities: 502 loans and grants, 504 loans and grants, 515 multifamily 

rental housing, 538 multifamily loans, and 521 rental assistance. 

Single-Family Housing 

About 80 percent of all development dollars available for rural housing has gone to 

assist in the production and rehabilitation of single-family homes. In general, rural 

homeownership (75%) continues to be higher than in urban areas (64%) and the U.S. 

rate (66%), which means that people with disabilities and/or who are aging living in rural 

areas are more likely to reside in single-family homes they own.101 This has implications 

for accessibility requirements associated with federal housing funds as well as 

expectations for integration and affordability. 

The two primary programs for rural single-family housing assistance are under Section 

502: direct loans and guaranteed loans. Direct loans are made to the applicant via 

USDA’s Housing and Community Facilities Program (HCFP). This is USDA’s largest 

outlay for housing, helping more than 2 million low-income people purchase or construct 

homes in rural areas. Up to 100 percent financing may be obtained to buy, build, repair, 

or move a home, as well as to purchase and prepare home sites. Individuals or families 

may be eligible if they have an income up to 80 percent of the Area Median Income.102

They also must be without adequate housing, be able to afford mortgage and other 

payments, be unable to obtain credit elsewhere, and have a reasonable credit history. 

Housing must be modest in size, design, and cost and meet all applicable building 

56
codes. Loans are for up to 38 years, with the interest rate set by HCFP and modified by 

the payment subsidy. 

In comparison, guaranteed loans are secured by the household through an approved 

lender and then guaranteed by USDA. These loans are generally used to help lowincome people purchase homes in rural areas. Funds may also be used to build, repair, 

or move a home, as well as to purchase and prepare home sites. Low-income 

households may be eligible if they have an income up to 115 percent of the Area 

Median Income. Because these loans are provided by outside lenders and guaranteed 

by USDA, the applicant must able to afford the mortgage and other payments and have 

a reasonable credit history. Housing must be modest in size, design, and cost and meet 

all applicable building codes and loan limits (value) set by USDA.103 Loans are 

guaranteed for 30 years, interest rates and repayment are set by the lender, and no 

down payment is required. Approved lenders include State Housing Agencies, Farm 

Credit System institutions with direct lending authority, and lenders participating in 

USDA Rural Development guaranteed loan programs. While the program began in 

1977, it really did not take off until 1991. To date, more than 422,000 loans have been 

made through this program. 

In addition, the Section 504 Housing Repair and Rehabilitation Loan program helps very 

low income homeowners with repairs and accessibility improvements. Loans of up to 

$20,000 are offered to help very low income individuals who own and occupy a home in 

need of repairs. Loans can be used to cover cost to repair, improve, modernize, or 

remove hazards in a home. Since its inception in 1950, about 161,000 loans have been 

made. Repair and Rehabilitation Grants are also provided specifically to help very low 

income senior individuals who own and occupy a home in need of repairs or 

accessibility improvements. Grants of up to $7,500 may be obtained for repairs and 

improvements in order to remove health and safety hazards in a home. The grant may 

be used in conjunction with a Rural Housing Repair and Rehabilitation Loan. Since 

1950, about 157,000 loans have been made, and, as with the loan program, the number 

of grants has been steadily increasing since 1990. 

57
Multifamily Housing 

As with HUD’s multifamily properties, USDA’s multifamily housing program was 

designed to provide private sector—for-profit or nonprofit—developers with loans and 

grants to assist in the development of rental housing. USDA also makes these funds 

available to the public sector to produce housing, though not as “public housing” 

managed by a public housing authority. Someone looking to rent subsidized affordable 

housing in a rural area can use the RD online search engine to find housing via the 

location (State, county, town, or ZIP code) or property owner.104 Property information 

includes total number of units, number of units assisted, and number of units by 

bedroom size and “complex type,” which can be family, elderly, mixed, group home, or 

congregate. 

Through all its multifamily programs, USDA has helped to produce or preserve about 

668,000 units. Most are through the Section 515 loan program. Since its inception in 

1963, the 515 program has produced 530,500 units of rental housing, which are widely 

distributed across the United States, Puerto Rico, Virgin Islands, and West Pacific 

territories. Based on a recent analysis by the Housing Assistance Council (HAC), nearly 

89 percent of all U.S. counties (2,800) have at least one Section 515 development.105

Half these counties have fewer than 5 projects, and 40 percent have between 5 and 10 

properties at most. Despite the fact that most counties in the United States have at least 

one Section 515 property, most of the units are located in the Southeast (e.g., Florida, 

Georgia, Mississippi, Alabama, North Carolina, Arkansas) and Midwest (e.g., Missouri, 

Michigan, Illinois, Iowa, Indiana, Ohio). 

The Section 538 Rural Rental Housing Guaranteed Loan program began in 1996 to 

target the same population as Section 515, but instead of providing the loan directly to a 

developer, USDA guarantees the loan secured through a lender. Eligible lenders 

include State Housing Finance Agencies and those approved by the Federal National 

Mortgage Association, the Federal Home Loan Mortgage Corporation, Federal Home 

Loan Bank members, or the Department of Housing and Urban Development. USDA 

guarantees such loans, which are for up to 40 years and have fixed rates. As a result, 

58
about 24,000 units have been developed through FY 2007, with an average of about 

2,500 units per year. 

In addition, USDA has provided rental assistance through the Section 521 program to 

nearly 981,000 households since 1978. As with HUD’s voucher program, these 

subsidies are to be used to help low-income households with their rent. This includes 

people with disabilities and who are aging. However, unlike HUD’s voucher program, 

which allows the tenant the “choice” to look anywhere in the housing market, this 

assistance is tied to properties funded by the HCFP through its Rural Rental Housing 

programs. HCFP establishes 5-year contracts with property owners in which they pay 

the difference between the tenant’s affordable contribution and the monthly rental rate. 

Requests for funding are generally initiated by property owners; however, tenants may 

also petition such owners to obtain funding through this program. This competitive 

program is designed to give priority to housing with the highest percentage of tenants in 

need of rental assistance and areas with the greatest housing need in the State. 

Recent estimates suggest that about 58 percent of Section 515 rental units are 

occupied by people with disabilities and/or people who are aging; however, this does 

not necessarily mean that these units are accessible.106 Instead, this estimate is based 

on the designation of the property, which determines who can and cannot live in the 

development. As with HUD housing, a large portion—at least 40 percent—are age 

restricted (i.e., for elderly only). 

A breakdown of USDA accessible housing is not available. Assuming that the 

multifamily housing met the 5 and 2 percent rule (Section 504 regulations require 

5 percent but not less than one dwelling unit to be accessible to people with mobility 

disabilities, and at least 2 percent but not less than one dwelling unit to be accessible 

for people with visual and hearing disabilities), there could be about 33,000 units 

accessible in total for people with mobility limitations and 13,000 units for people with 

sensory impairments. However, a 2004 study by the National Fair Housing Alliance 

(NFHA) suggests this is likely not the case, as it found that several projects had less 

than 5 percent accessible units.107 Moreover, even with sites that might have the 

59
minimum number of accessible units, access for people with disabilities might be 

restricted. The 2004 NFHA study found that in extensive paired testing in 24 States 

where most rural rental housing is located, more than 20 percent of the sites were 

“illegally denied to potential renters based on their race, national origin, disability or 

familial status.”108 Based on paired disability tests, 36 percent “revealed some 

differential treatment on basis of disability.”109 This included inaccessible offices and 

entrances to apartment buildings; “blatant statements” about reasonable 

accommodations that would not be allowed and/or would not be accommodated if 

requested; and suggesting that fees might be charged for some accommodation 

requests that should not.110 This data suggests then that even when USDA rental 

housing is accessible, it might not be available to people with disabilities and that it is 

likely to be segregated because of designation as either “elderly” or “disabled” or “group 

home” and/or discrimination. 

Since its inception in 1978, the Section 515 program has assisted nearly 1 million 

households living in rural rental housing. However, over the years it has not necessarily 

ensured sufficient rent to cover the cost of maintaining the housing stock. A study done 

in 2004 for USDA concluded that a significant portion of the Section 515 Rural Rental 

Housing program portfolio was at risk of being lost due to insufficient reserves and 

inadequate cash flow.111 As a result, the study concluded that the rate of decline was 

likely to accelerate in many properties, putting families at risk of losing their rental units 

and the overall supply of affordable rural rental housing reduced. 

Complicating matters was the fact that many properties were eligible to “prepay” and 

become market-rate housing upon leaving the program, assuming RD determined that 

there should be no restrictions on keeping rents affordable. While technically this 

applied to about 60 percent of the Section 515 portfolio, the study determined that only 

about 10 percent would likely choose to prepay early in order to “opt out” of the 

program. Between 2001 and 2007, 880 properties representing nearly 15,000 units 

have prepaid. While this represents only about 5 percent of the Section 515 housing 

properties, this does not include a large portion of properties—another 7,300 properties 

60
with 195,000 units—that are now eligible to prepay and potentially become 

unaffordable.112 

In response to this problem, USDA developed the Rural Development Voucher 

demonstration program. This 1-year rental subsidy program was intended to “protect 

tenants of USDA Multi-Family Housing (Section 515) properties who have had their 

USDA loans foreclosed or prepaid between Oct. 1, 2005, and Sept. 30, 2006.” These 

vouchers are in addition to the rental subsidy provided via Section 521, and can be 

used with the tenant’s current housing to offset higher rents if the owner raises rents to 

market rate or can be used elsewhere in other rental property as with any tenant-based 

voucher. As of FY 2007, nearly $3 million had been committed for 1,100 vouchers. This 

suggests that many of the families in properties that opted out of the program did not 

seek voucher assistance, either because they did not need it or were not eligible for it.

Looking Ahead 

The following highlights proposed legislation, new programs, and new directions that 

have only just been implemented or proposed and therefore cannot be evaluated, but 

nonetheless point to potentially promising practices. 

Section 811 Legislation 

H.R. 1675, the Frank Melville Supportive Housing Investment Act of 2009, is bipartisan 

legislation that will make significant reforms and essential improvements to the HUD 

Section 811 Supportive Housing for Persons with Disabilities program. An identical 

bill—H.R. 5772—unanimously passed the House of Representatives under Suspension 

of the Rules in September 2008. H.R. 1675 will help address the serious housing crisis 

facing millions of extremely low income people with disabilities by: 

● Authorizing a new cost-effective Section 811 demonstration program that could 

triple the number of integrated units created through Section 811 without any 

increase in the program’s appropriation. This demonstration program is 

designed to highly leverage capital funding provided through other federal 

61
affordable housing programs, including the Low Income Housing Tax Credit and 

HOME programs. 

● Enacting long-overdue reforms to the current Section 811 production program 

to reduce longstanding bureaucratic barriers and improve the program’s 

efficiency and cost effectiveness. 

● Authorizing a cost-neutral shift of fiscal responsibility for the Section 811–

funded Mainstream Voucher program to the Housing Choice Voucher 

appropriation. Although funded and renewed from 811 appropriations, an 

estimated 14,000 Mainstream Vouchers created between 1996 and 2002 have 

been administered as Housing Choice Vouchers, have never been used for 

permanent supportive housing, and have never been targeted to people with 

the most serious and long-term disabilities. 

For the past few years, because of Section 811’s outdated structure, the program has 

produced only 800 to 900 new supportive housing units annually. H.R 1675 will 

reinvigorate the program by creating 3,000 or more new units annually through the 

demonstration program, and by authorizing more integrated housing approaches and 

models that are consistent with the housing needs and choices of people with 

disabilities. 

New Funding for Affordable Housing via the National Affordable Housing Trust 

Fund113

On July 30, 2008, President George W. Bush signed the Housing and Economic 

Recovery Act, which included the establishment of a National Housing Trust Fund 

(NHTF)—an ongoing, permanent, and dedicated source of revenue to build, rehabilitate, 

and preserve 1.5 million units of housing for the lowest-income families over the next 10 

years. This is the first housing program since 1974 directly dedicated to rental housing 

for very low income households, which can benefit people with disabilities, among 

others. At least 90 percent of NHTF resources must be spent on rental housing and 

75 percent of all rental funds must benefit extremely low income households at or below 

30 percent of Area Median Income. These funds are to be administered by States that 

62
then make grants to developers with established capacity to build affordable housing, 

including nonprofit and for-profit organizations. Although no source of dedicated funding 

for the National Housing Trust Fund has been identified, HUD has requested $1 billion 

in new funding for this program in its FY 2010 budget request to Congress.

New Vouchers for Nonelderly People with Disabilities 

In both the FY 2008 and FY 2009 HUD budgets, Congress provided $30 million each 

year to fund approximately 3,500 new vouchers for nonelderly people with disabilities. 

These appropriations signal the willingness of Congress to return to policies adopted 

between 1997and 2001 to provide new vouchers for nonelderly people with disabilities 

each year to offset the loss of subsidized public and HUD-assisted housing units from 

properties designated “elderly only.” PHAs must be willing to apply for these new 

vouchers, and could use them to create special initiatives, such as targeting them for 

people with disabilities who are leaving segregated institutional settings. 

New Vouchers for Veterans114

In 1992, HUD and the Veterans Administration—now the Department of Veterans 

Affairs (VA)—collaborated to launch a Supportive Housing Program, known as HUD–

VASH. Its objective was to serve homeless mentally ill veterans by providing affordable 

housing (through HUD’s Section 8 voucher program) and case management services 

(through the VA). Almost 1,800 vouchers were provided. The housing retention rates of 

HUD–VASH compare favorably to other supported housing programs. Furthermore, 

there were significant gains in employment, mental health, and reduction of drug and 

alcohol problems among participants.115 In 2008, HUD–VASH was expanded to provide 

local PHAs with approximately 10,000 new rental assistance vouchers specifically 

targeted to assist homeless veterans and their families. An additional 10,000 vouchers 

have recently been added with the passage of the Omnibus Appropriation Act of 2009. 

A joint effort of the Veterans Administration and HUD will link VA medical centers to 

local PHAs to provide supportive services and case management to eligible homeless 

veterans. 

63
Inclusive Home Design Act (H.R. 1408)116

This new legislation, introduced on March 10, 2009, by U.S. Representative Jan 

Schakowsky, aims to increase the number of affordable homes accessible to people 

with disabilities. The act would require that all newly built single-family homes and 

townhouses receiving federal funds meet four specific standards: 

● Include at least one accessible (“zero-step”) entrance into the home. 

● Ensure all doorways on the main floor have a minimum of 32 inches of clear 

passage space. 

● Include at least one wheelchair-accessible bathroom on the main floor. 

● Place electrical and climate controls (such as light switches and thermostats) at 

heights reachable from a wheelchair. 

Potential New HOPE VI Legislation117

On January 17, 2008, the House of Representatives approved H.R. 3524, the HOPE VI 

Improvement and Reauthorization Act of 2007, which would reauthorize the program for 

7 years and make important improvements to the program. Specifically, improvements 

include requirements that all units demolished under future HOPE VI awards be 

replaced (i.e., one-for-one replacement), that the plans include offsite replacement 

housing in low-poverty areas, and that new HOPE VI projects offer more assistance for 

displaced families using housing vouchers. While this bill did not progress, advocates of 

public housing see promise in the groundwork laid. As described by the Center for 

Budget and Policy Priorities (CBPP), looking forward, the aim should be “to maximize 

the program’s positive results and minimize any negative impacts it might have on 

people who are displaced when their homes are demolished.”118 

Section 202 Supportive Housing for the Elderly Act of 2009 (S. 18) 

Currently in the Senate, a bill to amend Section 202 of the Housing Act of 1959 would 

significantly change the funding and operation of developments and how funds are 

allocated for developments regionally. It would give more discretion and autonomy to 

64
owners of such properties.119 It also would require the HUD Secretary to establish and 

operate a national senior housing clearinghouse. 

HUD’s Real Estate Management System (REMS) 

At this time, we do not know the level of integration of units or tenants within buildings or 

developments. However, we may be able to learn in the near future the utilization rate in 

multifamily housing through HUD’s integrated Real Estate Management System, which 

currently does or will collect data on the occupants of housing for people with disabilities 

and more detailed information about the bedroom size and specific accessibility 

features.120 This will include, by bedroom size: 

● Number of mobility impaired accessible units 

● Number of vision and/or hearing impaired accessible units 

● Number of people on waiting lists eligible for accessible units 

● Number of accessible units occupied by elderly or family tenants 

● Number of accessible units occupied by nonelderly tenants with disabilities that 

require the features of the unit 

● Number of accessible units occupied by elderly tenants with disabilities that 

require features of the unit 

This relatively new data collection system, which is used to independently monitor 

HUD’s portfolio of multifamily housing, is an opportunity to look more closely at how 

people with disabilities and the elderly are integrated within housing developments and 

communities.

New Requirements for Low Income Housing Tax Credit Reporting 

The Housing and Economic Recovery Act (HERA) of 2008 now requires HUD to collect 

and report for all LIHTC tenants race, ethnicity, family composition, age, income, use of 

Section 8 (or similar) rental assistance, disability status, and monthly rental payment. 

Not only will this data be of use for assessing how well the LIHTC program is serving 

65
people with disabilities and the elderly, it will also provide a better understanding of how 

many LIHTC units are made affordable with the use of additional rental subsidies. 

Green Efficient Public Housing 

The Council of Large Public Housing Authorities released its Future of Public Housing 

Framework in October 2008, which included a commitment to “fully integrate green 

building standards to rebuild or retrofit all 1.2 million public housing units as part of the 

reinvestment strategy” and to raising $10 billion over the next 10 years to accomplish 

this goal.121 The 2009 stimulus package includes funds to kick off this initiative. 

Promoting Livable Communities 

On June 16, 2009, a new partnership among HUD, the Department of Transportation 

(DOT), and the Environmental Protection Agency (EPA) was announced to support the 

creation of more sustainable development in urban, suburban, and rural areas. The 

agencies will focus on coordinating housing and transportation investment “while 

simultaneously protecting the environment, promoting equitable development, and 

helping to address the challenges of climate change.”122 This includes strategies that: 

● Provide more transportation choices 

● Promote equitable, affordable housing 

● Enhance economic competitiveness 

● Support existing communities 

● Coordinate policies and leverage investment 

● Value communities and neighborhoods 

While these strategies are capable of producing livable communities for people with 

disabilities and the elderly, the initiative—at least in its fact sheet for the public—does 

not include specific language or discussion of either group. 

66
CHAPTER 3. Geographic Dispersion of Housing 

Programs and Expenditures 

Most federal funding for affordable housing is distributed and implemented through 

State and local government. This section reviews the distribution of federal funding for 

housing programs that can benefit people with disabilities distributed through State and 

local government via formula grants relative to the needs. First, however, we briefly 

review the State and local mechanisms that affect what type of housing is built and 

where it is located. 

Since the early part of the 20th century, the development and location of any type 

housing in the United States has been primarily determined by building codes and 

zoning enacted through local and State government. Building codes aim to ensure 

housing meets health, safety, welfare, and property protection goals. However, as a 

2001 HUD report points out, these “have been expanded in recent years to include 

other societal goals” including energy conservation, accessibility, disaster mitigation, 

historic preservation, and affordability.123 While building codes are locally controlled, 

communities have long adopted standard building codes. Beginning in 2000, the 

International Building Code was developed by the International Code Council (ICC).124

ICC provides guidance for accessibility from the American National Standard Institute 

and the U.S. Access Board. In addition to building codes, local ordinances and State 

legislation also provide specific instructions for making housing visitable. However, 

these are often voluntary, although frequently they come with incentives to encourage 

visitability. 

Despite movement toward uniform building codes across the United States, regulatory 

barriers including zoning, local politics, and planning practices, among others, greatly 

affect where and if affordable, integrated, and accessible housing is built.125 To a 

certain extent, federal policy and subsequent funding streams that flow into States and

local jurisdictions to produce affordable housing acknowledge these variations by 

devolving to State and local government the ability to develop localized plans to expen

federal funds. HUD requires each State to produce a Consolidated Plan, which outline

d 

s 

67
how federal funding will be allocated to address housing and community development 

needs in each State. This plan must also include an analysis of barriers to fair housin

and plans to remove or reduce them in line with the goals of the Fair Housing Act and

its amendments

g 

. 

The federally mandated Consolidated Plan identifies housing needs for different groups, 

including people with disabilities, and then outlines how funds will be used to meet 

those needs given the current and near future housing conditions. Developed for a 5-

year window, the purpose of the Consolidated Plan is to guide the use of all federal 

housing dollars and other federal grants awarded either to or through the State. Each 

State and local jurisdiction receiving CDBG and HOME funds is required to develop its 

Consolidated Plan with citizen participation and public review prior to submission to 

HUD for approval. An annual plan report is used to monitor progress and also make 

adjustments, if needed, to the 5-year plan in order to respond to new conditions or 

opportunities. Unfortunately, there is no requirement that State and local governments 

coordinate or review plans to make sure they do not conflict. 

The Consolidated Plan uses census data provided by HUD to assess needs among 

people with disabilities.126 Appendix A, “Data Tables,” provides detailed data on the 

distribution of people with disabilities (defined on a limited basis by mobility limitations) 

that have “housing problems” by income, tenure, and age, for each State. A housing 

problem is identified as having one or more of substandard or poor-quality housing 

(lacking complete plumbing facilities or lacking complete kitchen facilities), living in 

overcrowded conditions (with 1.01 or more people per habitable room), or being cost 

burdened (paying more than 30 percent of income for housing). 

Overall, HUD’s Consolidated Plan data shows that for all households with at least one 

person with a disability and some sort of housing problem, twice as many own their 

homes (12.8 million) than rent (6.3 million). Among renters, the largest number and 

proportion of renters of any income group with mobility impairments and housing 

problems in the United States is in California (13% of renters; 811,000 households), 

New York (10%; 645,000 households), Texas (6%; 391,000 households), Florida (5%; 

68
330,000 households), and Pennsylvania (4%; 258,000 households). The majority of 

these renters are very low income, so it is likely that the housing problem is due to 

housing cost burden. 

HUD Consolidated Plan data also reveals that nearly 13 million homeowners with 

mobility impairments have a housing problem. Unlike renters, the majority of these 

homeowners were in the higher-income bracket (6.9 million were above 80% of Area 

Median Income), which means they may not qualify for some or most public housing 

assistance (with exception of some local programs for owners). 

A review of Consolidated Plans on HUD’s Web site illustrates the variety of approaches 

States take to meet their affordable housing needs.127 However, there is not always a 

clear connection made between need and the objectives/targets outlined in the plan 

when it comes to housing for people with disabilities, other than what is required at a 

minimum by law. In part, this may be due to the limited guidance HUD provides on 

using funds to meet the housing needs of people with disabilities and the aging 

population.128 Still, some of these Consolidated Plans demonstrate promise, at least in 

terms of initiatives that respond specifically to people with disabilities. 

Generally, the federal resources needed for affordable accessible housing are not 

sufficient to meet the needs in most if not all communities. In part, this is simply the 

result of historical funding patterns and allocation decisions. This makes it difficult to 

assess how well distributed federal housing funds are allocated relative to need, though 

most entitlement funding based on formulas designed to reflect need on a per capita 

basis are matched with population rather than relative need. For example, the State with 

the largest estimated number of noninstitutionalized people with disabilities is California 

(4,279,000 people), followed by Texas (3,050,000), Florida (2,610,000), New York 

(2,533,000), and Pennsylvania (1,865,000). These same States have the largest 

number of renters with mobility impairments and housing problems in the United States, 

and also the largest share of HOME and Community Development Block Grant dollars 

annually. In comparison, Puerto Rico has the highest disability prevalence rate at 

27 percent of its population (963,000 people), followed by West Virginia (24%), 

69
Kentucky (21%), Arkansas (21%), and Mississippi (21%). These are all higher rates 

than California, which has a 13 percent prevalence rate; however, because of 

population size, these States get significantly less HOME and CDBG funding. 

Funding for subsidized housing units for people with disabilities—both public housing 

and multifamily housing—is not subject to formula but instead comes from direct grants 

and loans from the Federal Government. Much of this housing was built before the 

Consolidated Plan requirement. Looking across the States, we find: 

● New York—and particularly New York City—has long had the largest share of 

public housing (205,000 units) in the United States, with four times the number 

of units than in Pennsylvania (52,000), the next largest supplier. Furthermore, 

New York has the most public housing for people with disabilities, elderly 

people (ages 62 and older), and families, and the largest supply of federally 

funded multifamily housing (108,000 units), though only second and third, 

respectively, for units designated for people with disabilities and elderly 

designated units. The State ranks lower for Housing Choice Vouchers. 

● California, while home to nearly twice as many people with disabilities as New 

York, has relatively little public housing (fewer than 40,000 units). Instead, the 

State has the largest number of Housing Choice Vouchers (290,000), with 

78,000 being used by people with disabilities, 28,000 by elderly households, 

and 55,000 by households that are both elderly and with disabilities. California 

also has the largest number of federally subsidized multifamily housing units 

designated for elderly (39,000) and for people with disabilities (5,000). 

● States that rank consistently in the top 10 across all categories of housing 

based on units are Illinois, Ohio, Pennsylvania, and Texas. 

● States ranking consistently in the bottom 10 across all categories of housing, 

based on the number of units, are Alaska, Idaho, Montana, North Dakota, South 

Dakota, and Wyoming, along with the District of Columbia. 

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CHAPTER 4. Public Sector Initiatives to Increase the 

Housing Status of People with 

Disabilities 

The Americans with Disabilities Act (ADA) expanded the fair housing rights of people 

with disabilities to include community integration and full citizen participation.129 In 1999, 

the application of this right to “least restrictive” community living choice was put to fore 

within the U.S. Supreme Court case Olmstead v. L.C. (98-536) 527 U.S. 581,138 F.3d 

893 (1999), referred to as the Olmstead decision.130 At the crux of this case was the 

issue of integration, that is, whether people with disabilities have a right to live in least 

restrictive settings of choice, including community-based options, and whether States 

have responsibilities related to providing community living supports equitable to those 

given to people living in institutional and nursing home settings to realize this “real 

choice.” The Olmstead decision enforced this right and States’ responsibilities, 

mandating each State develop “comprehensive, effectively working plans,” referred to 

as Olmstead plans. The purpose of these plans is to show what States would do to 

support community reintegration (e.g., from nursing home to community) and long-term 

community living (e.g., maintaining choice and preventing institutionalization). However, 

States vary as to whether Olmstead plans exist, are available to people with disabilities 

in accessible formats, the level of detail in relation to proposed actions to rebalance 

funding and address institutional bias within the State, inclusion of methods to monitor 

and enforce plan implementation, outcomes realized, and actions taken to address 

continuing needs and gaps.131 

Movement to Coordinate Housing and Community Living Supports and 

Systems 

In addition to planning, the Olmstead decision also sparked disability advocacy and 

systems changes within States to rebalance funding to address issues of institutional 

bias. Starting in 2000, the Centers for Medicare and Medicaid (CMS) was instrumental 

in coordinating Real Choice Systems Change Grants for Community Living to fund the 

needed infrastructure, systems change, and policy revisions to offer real choice related 

71
to community living with supports. This systems change was further reinforced within 

the New Freedom Initiative and President George W. Bush’s Executive Order 13217 

titled Community-Based Alternatives for Individuals with Disabilities.132 

A number of significant changes were made to Medicaid’s coverage of long-term care 

services within the 2005 Deficit Reduction Act (DRA) to further support use of funds 

toward community living options. Through March 2008, CMS also awarded 

approximately $285 million in Real Choice Grants that were used to support States in 

providing community reintegration supports (e.g., transition from nursing home or 

institution to community), cross-system coordination and infrastructure, and resource 

rebalancing to address institutional bias. For many States, this involved the creation and 

expansion of Home- and Community-Based Waivers (HCBSs) and long-term 

community living programs. For some States, such as Texas with its Rider 37, this 

systems change was also legislated. However, many States remained challenged in 

implementing real choice, with great disparities between States on implementation and 

resource rebalancing.133 

The concept of Money Follows the Person (MFP) then was proposed and advocated as 

a mechanism for monies to follow the person into the community at levels equitable to 

those allocated for institutional/nursing home care. The MFP movement also brought to 

the fore the coordination of information, supports, services, and funding across systems, 

and the need for consumer direction and control throughout the process. CMS funded 

over $1.75 billion in MFP demonstration grants in 31 States, with States estimating to 

transition more than 27,000 people out of nursing homes and other institutions to the 

community using these initiatives. Of note, States needed to also show a plan to 

maintain these MFP initiatives long term after the demonstration period. 

At the same time, disability activists rallied for accompanying MFP-related legislation 

that has since been enacted or is now pending in several States. This advocacy 

continues nationally with the Community Choice Act and other related legislation. 

Additionally, many class action lawsuits were brought against States in relation to 

violation of ADA civil rights and the Olmstead decision, further influencing systems 

72
change and funding rebalancing within specific States.134 In some cases, these suits 

resulted in the creation of promising practices from which other States can learn. 

This brief historical overview demonstrates how and why different systems and funding 

mechanisms exist, their differing groundings and philosophies, and the complexity of 

housing and community living choice at the legislative and policy levels. 

Key Issues Influencing “Real Choice” 

States, and citizens with disabilities living in them, are facing several key issues 

influencing “real choice” access to affordable, accessible, and integrated housing.135

These include differences in (1) definitions related to housing and community 

living/integration, (2) eligibility criteria, (3) systems funding levels and disparities, (4) 

information access, (5) coordinated, consumer-directed system delivery, and (6) 

monitoring and enforcement across systems. 

Differences in Definitions 

One key issue facing States is the variation in definitions related to disability, housing 

features such as accessibility and affordability, and community integration. 

1. Defining Disability 

For States providing housing services through HUD and community living supports 

through CMS, how disability is defined determines who receives services. For CMS and 

State providers, a disability determination is criteria-based and complex. By law, 

disability is defined as “the inability to engage in any substantial gainful activity (SGA) 

by reason of any medically determinable physical or mental impairment(s) which can be 

expected to result in death or which has lasted or can be expected to last for a 

continuous period of not less than 12 months.”136 This definition centers on showing 

proof of long-term medical need and economic need related to productive 

employment/gainful activity. Additional criteria related to medical necessity, functional 

performance status, and age further influence specific CMS program eligibility. For HUD 

73
housing programs and providers, disability is defined at both the individual and 

household levels. 

In comparison to these systems definitions, the Americans with Disabilities Act and 

ensuing systems change initiatives are based upon the civil rights framing of disability, 

which is “The term ‘disability’ means, with respect to an individual, a physical or mental 

impairment that substantially limits one or more of the major life activities of such 

individual; a record of such impairment; or being regarded as having such an 

impairment.”137 This definition was used in the Olmstead decision to assert the right to 

least restrictive choice; however, the systems involved in implementing those rights 

continue to use existing medical and economic-based definitions that shift the onus to 

the individual to demonstrate need, versus to society and the systems within it to 

support the civil rights of citizens with disabilities. 

2. Defining Accessibility 

The other side of the coin relates to how we then define the environment, as in housing 

and environmental modifications, at the federal, State, and local levels. This brings to 

the fore definitions related to accessibility, most often defined by the Architectural 

Barriers Act, the Federal Fair Housing Act of 1988 accessibility guidelines,138 and 

Section 504 of the Rehabilitation Act of 1973 as amended (29 U.S.C. 794). Additionally, 

many housing developers point to Uniform Building Code or the International Building 

Code standards of accessibility, as well as to State and local codes and regulations.139

Each of these offers differing versions of “accessibility,” which are further complicated 

by terms such as adaptable and visitable. Adaptable housing does not implement full 

accessibility features and is built to allow for easier adaptation or addition of these 

features should the person need it in the future. For example, the housing may have a 

closet or storage space built in a way that could accommodate an elevator or lift 

addition if needed. “Visitability” focuses on building in a minimal set of access features 

so people with disabilities can visit others in the community and be able to move around 

and use the first-floor entrance and bathroom.140 Neither “adaptable” nor “visitable” 

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corresponds to full accessibility, and many consumers are confused by the differences 

in these terms and the accessibility or lack thereof when they move in. Many also are 

not aware that it would be their responsibility to pay for such adaptations to make the 

housing accessible, even though it is their right to add it. Additionally, “accessible” 

primarily pertains to physical and sensory access, with far less coverage and 

consideration of diverse issues related to cognitive, social, psychological, and 

environmental sensitivity. 

Another area of confusion—and contention—is that many people believe that 

townhouses and single-family detached homes are not covered by these accessibility 

regulations, therefore excluding a large section of housing supply from scrutiny and 

requirements. While these regulations may not directly require that some types of 

housing include accessibility features when developed or rehabilitated, all housing is 

subject to requirements of reasonable accommodation. Furthermore, all public housing 

programs are subject to 504 requirements, so if this type of housing is produced with 

federal funds, it must comply with these laws. 

3. Defining Affordable 

Among the different State plans, private and nonprofit housing is expected to be built 

and/or made affordable through use of a diverse collection of public and private funds. 

Since the 1960s, the Federal Government has gauged affordability relative to 

assumptions about precisely how much all consumers should pay for housing as a 

portion of their incomes, which currently is 30 percent of income. For renters, this cost 

includes monthly contract rent plus utilities. For owners, it includes monthly mortgage 

payments, insurance, utilities, and taxes. For both renters and owners, regardless of 

income level, housing is not affordable if a household has to use more than 30 percent 

of its income on it. 

4. Defining Integration 

States have not specifically defined “integration,” but instead rely on ADA and Olmstead

decision terminology related to “least restrictive” choice to guide the provision of 

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integrated housing, programs, and services. This framing focuses on what integrated 

choice is not—placement in nursing homes or other institutional settings without choice 

about community-based options—rather than describing what it is. More recently, MFP 

legislation and policies have referred to specific numbers in which “community-based” 

options may not include more than four people with disabilities living together. Thus, a 

group home with 8 to 10 people in it would not be considered a community-based option 

under current legislation. However, these criteria and their enforcement differ by State. 

There is great variance within States, and particularly among housing developers and 

providers within them, in what “integrated” or “least restrictive” choice includes, often 

leading to class action lawsuits to put parameters around integration and enforcement 

related to it. 

Why are definitions important? These different framings and multiple definitions make it 

very difficult not only to deliver coordinated housing and community living services, but 

also to show need versus supply disparities, to compare issues and outcomes across 

States, and to monitor enforcement and learn from promising practices. 

Differences in Qualifying and Eligibility Criteria 

For the most part, States defer to funding sources to set qualification and eligibility 

criteria, and different funding sources use different criteria.141 As an example, both CMS 

and HUD use income/asset criteria; however, each uses different thresholds to 

determine initial and continuing eligibility (e.g., HUD uses median income in relation to 

national poverty and income thresholds, while Medicaid uses income/asset thresholds 

determined via individual State statute). 

Qualifications are not just based on income. For those individuals who also need to 

obtain community living supports through Medicaid, States also use functional needs 

determination and risk management assessments to determine eligibility, criteria that 

may vary significantly among States. Additionally, type of disability (e.g., physical, 

psychiatric, developmental) or age may preclude people with disabilities from accessing 

specific State programs even if they have a need. For people who identify with multiple 

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disabilities or acquire them as they age, access to housing and community living 

supports becomes much more complicated. They may lose access or be offered very 

different services when transitioning between or among systems, again placing them at 

risk for premature or unwanted institutionalization or homelessness. 

Differences in Funding and Parity of Supports and Services 

States also face significant issues related to funding of housing and community living 

supports, as well as disparities among different disability and aging constituencies in 

accessing this funding. 

1. Housing System Funding 

As part of States’ Consolidated Plans, allocation of housing resources is to be guided by 

need; however, need far exceeds what is available. This is true also for the LIHTC 

program; while it is based on a per capita formula, the actual dollars it can generate per 

State are quite small relative to the cost of building new housing. In addition, as noted 

previously, the complexity of using multiple layers of financing makes it quite difficult for 

many affordable housing developers to juggle the different eligibility requirements of 

different funding streams, which can deter or derail efforts to produce quality integrated 

housing. Finally, while State plans provide counts of units for people with disabilities and 

seniors, it is very difficult to ascertain the number of people with disabilities who actually 

receive housing units, housing subsidies, or monies for eligible housing retrofitting, 

rehabilitation, and supportive services. Also, the data does not examine differences by 

different disability type. All these issues significantly influence whether people have “real 

choice” in deciding where they live, whether they are able to support or maintain that 

living over time, and the quality of their living situation. 

2. Community Living and Long-Term Services and Supports Funding 

To live in community-based housing options, many people with disabilities also need 

accompanying community living supports that are often funded by Home- and 

Community-Based or related Medicaid waiver programs, and/or other State long-term 

services and supports programs that fall outside waiver designations. One indicator of 

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whether States have progressed in rebalancing funds to address institutional bias and 

provide community-based living choice is to compare funds spent on institutional longterm care (including nursing homes, State institutions, Intermediate Care Facilities 

[ICFs], etc.) to those spent on Medicaid waiver programs to support community living 

and trends over time. Based on federal data, a recent analysis by Thomson Reuters142

shows that significant progress has been made nationally in this rebalancing, moving 

from institutional to community funding ratios of 85 percent institutional/15 percent 

community in 2000, to 58 percent institutional/42 percent community as of 2007, with an 

average growth of 10 percent a year in community-based funding from 2002 to 2007. 

However, this data is limiting and can be misleading. First, the data does not tell us 

about community-based housing funding needs and trends, as they only reflect longterm care system funding. The data also does not reflect the number of people who are 

on waiting lists for community-based services, or those who cannot find affordable and 

accessible housing and therefore remain in institutional settings. 

Additionally, this data is complex to interpret. Although we have made gains in 

rebalancing on a national level, the funding ratios vary significantly by State. As of 2007, 

only 11 States had rebalanced their spending to support community-based options at 

levels of 50 percent or more of their total long-term care budget (New Mexico, Oregon, 

Arizona, Minnesota, Alaska, Washington, Wyoming, California, Kansas, Colorado, and 

Maine). In comparison, the rest of the States spent less than 50 percent on communitybased services, with several reporting 30 percent or less (Mississippi, North Dakota, 

Pennsylvania, Alabama, New Jersey, Tennessee, Arkansas, Ohio, and Kentucky). 

Thus, the State in which you live influences real choice. 

Another example of State differences is how funds are allocated between different 

programs (e.g., aging, and physical, psychiatric, or developmental disability). The 

national ratio of 58 percent institution to 42 percent community across all disability 

groups shifts to 69 percent institution to 31 percent community when looking specifically 

at aging and physical disability group funding, with 16 States reporting less than 

20 percent allocated for community waivers for these groups. Thus, one’s age or 

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disability designation as defined by each State also influences real choice. For example, 

in some States, older adults with disabilities may be able to access funding for either 

personal attendant or homemaker supports depending on their level of need, while in 

other States, their choice is limited to homemakers who may not be trained or 

authorized to help with heavy lifting or personal care tasks such as bathing. In many 

States, waiver programs are not available to people with psychiatric disabilities, 

significantly limiting their choices. For people with developmental disabilities, some 

States offer funding for a full range of living options, including innovative family and 

least restrictive shared living options of four or fewer, while other States continue to 

primarily fund more segregated living options such as Intermediate Care Facilities or 

shared living situations of more than four people, thus also limiting real choice. 

Additionally, some States impose service limits, or caps, on individual funding that may 

further restrict community-based services, while other States using a more flexible 

Money Follows the Person (MFP) approach in which funds that would have been spent 

on institutional services follow the person to the community to be used more flexibly, as 

needed and as directed by the individual. In summary, although States have progressed 

in addressing institutional bias issues, significant disparities continue to exist among 

States in regard to real choice and long-term control in housing and community living. 

Differences in Information Access 

The need for accurate, accessible, and transparent information also is critical for people 

with disabilities to have “real choice,” so they can make informed decisions about where 

and how they live. Information access, quality, and coordination are key issues within 

States, especially for people with disabilities who may be trying to access information 

during times of housing or health crises or emergencies, or from within settings where 

information access is difficult, unavailable, or withheld. Additionally, information needs 

to be accessible via alternative formats if consumers and significant others in their lives 

are to actually use that information to make a “real choice.” Accessibility may also 

involve modifications in policies or strategies, such as increased time to process 

information before making decisions, or use of peer supports or other accommodations 

during the process. Accessibility also relates to information technology use, such as cell 

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phones, computers, Internet, and email. In some States, emergency cell phones and 

basic Internet access have been integrated into housing and community living support 

services and funding. 

Information about choices also needs to be accurate and consistent across different 

systems and providers, such as homeless shelters, emergency systems, information 

hotlines/centers, community organizations, medical and rehabilitation systems, nursing 

homes, and other long-term care settings. Disability advocates also point to problems 

providing this information in a way that is unbiased, highlighting the potential role of 

Centers for Independent Living, Senior Centers, and Disability and Aging Resource 

Centers to collaborate on offering access to information and to support consumers in 

navigating across different systems. Some States also have collaborated with these 

groups to implement housing locator systems that provide information on accessible 

and affordable housing; however, the availability, quality, accuracy, and level of 

accessibility detail vary widely among these systems.143 

Differences in Coordination of Supports and Services Across Systems and 

Quality Control, Monitoring, and Enforcement 

As referenced throughout this report, States have shifted toward coordination of housing 

and community living systems, particularly within Real Choice and MFP demonstration 

grants and related State initiatives. However, coordination of services and funding 

sources currently varies widely by State. In many States, housing systems have not 

been coordinated with community living and long-term services and supports systems, 

making it very difficult for people with disabilities to coordinate housing vouchers or 

subsidies with needed community living supports. As shown previously, many States 

continue to use silo systems, with services based on different disability or funding 

systems, such as those related to aging, physical disability, psychiatric disability, and 

developmental disability. In comparison, some States have used Real Choice and MFP 

grants to break down these silos and offer coordinated information and services, as well 

as equitable access to community living supports across systems. Coordination of 

services and funding is also an issue for people with disabilities who move to different 

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communities within States, as well as those who relocate to another State. The 

challenge is to provide “no wrong door,” that is, coordinated points of entry so that 

consumers can understand their rights and access housing and community living 

information and supports. This also means that States need to develop and fund 

infrastructure to coordinate policies and monitor access to and provision of coordinated 

services. This coordination is especially important to consistently and rigorously 

compare outcomes, impact, needs, and disparities across States and across the nation. 

Housing and Community Living Promising Practices 

Despite these challenges and limitations, we see “promising practices” that have been 

or are being implemented by and within States in the areas of systems change, 

information access, legislation, monitoring and enforcement, and research related to 

housing and community living. 

Systems Change and Coordination 

One of the most promising trends at the State level has been the increasing crosscoordination of housing with community living and support systems, funding, and 

service delivery. These have been referred to as Single Access Points, One Stop Shop, 

No Wrong Door, and Comprehensive Entry Point systems. These systems enable 

consumers to enter through many different “doors,” or systems/programs, yet still 

receive coordinated, consistent, and quality information, counseling, housing, and 

community living supports and services. The Rutgers Center for State Health 

Policy/NASHP (National Academy for State Health Policy) Community Living Exchange 

Collaborative reported 43 single entry points operating across Medicaid programs in 32 

States.144 Many of these initiatives were developed with systems change demonstration 

grants from CMS and related national initiatives (e.g., Robert Wood Johnson’s selfdetermination and cash and counseling projects).145 

Although many States used these initiatives to streamline entry within specific Medicaid 

programs, some States have used them to break down silos created by categorizing 

people by disability type (e.g., developmental, physical) or age across all State 

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programs, so no matter how or where people enter, they receive information about their 

choices and coordinated access housing and community living supports.146 Such 

commitment to long-term, cross-systems change has been especially useful to people 

who are transitioning between living situations (such as moving from a nursing home, 

institution, or ICF to community living) or people having to navigate multiple systems 

(such as people with disabilities as they age, people who identify with multiple 

disabilities, or families in which multiple people with disabilities are living and aging 

together and need supports across systems). They are also useful for maintaining 

community living choices over a lifetime (including coordination of young child, adult, 

and older adult systems), and preventing or responding to institutional placements that 

are not of choice at any time. 

These initiatives offer valuable strategies to States to formally integrate consumer 

direction and control across systems.

147 They also offer infrastructure and strategies for 

States to document needs, service delivery, costs, and outcomes over time across 

systems,148 contributing to research that documents their impacts and cost 

effectiveness.149

Even more promising, several States are expanding to coordinate community living with 

housing systems and delivery. Many of these initiatives are based upon a Money 

Follows the Person framework to offer cross-system, consumer-directed choice. These 

involve development of new policies to enable States to fund and deliver this 

coordinated package across systems. Current promising practices include: 

● State initiatives to coordinate Home- and Community-Based Waivers with 

housing vouchers or subsidies via innovative funding collaborations, including 

use of HOME funds for rental assistance during transition to the community 

(e.g., Kentucky’s Housing Finance Agency has allocated $50,000 in HOME 

funds to fund bridge subsidies, and Ohio’s Dayton Metropolitan Housing 

Authority announced the use of HOME funds to fund tenant-based assistance 

and Section 8 funds for project-based vouchers for people with mental illness 

who are homeless). 

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● Development of Home Modification/Barrier Free Housing Trust Funds. 

● Reuse of funds from institutional downsizing and closures for expanded housing 

vouchers, rental assistance, and community support packages. 

As an example, Pennsylvania is implementing several of these practices in its Statewide 

systems change initiative, which coordinates between the Pennsylvania Department of 

Public Welfare and the Pennsylvania Housing Finance Agency (PHFA). 

Two States, North Carolina and Louisiana, have been featured as examples for 

implementing Statewide, cross-systems change initiatives to coordinate mainstream 

affordable housing and community living systems for people with long-term disabilities, 

including people with disabilities who are homeless.150 These include a targeted 

collaboration of health and human services systems and housing authorities across the 

State, including the use of bonus points within Qualified Allocation Plans (QAPs) with 

housing developers to target 10 percent set-asides for people with disabilities with 

extremely low incomes (below 30% of AMI), and the use of Targeting Plans and Local 

Lead Agencies to ensure coordination among community service providers and property 

managers with tenants with disabilities, and the provision of reasonable 

accommodations and supports. Louisiana replicated North Carolina’s systems change 

to further target the needs of people with disabilities post-Katrina, adding the use of 

CDBG funds to support infrastructure and long-term support provision. 

Cross-System Navigation 

Several of these systems change coordination initiatives have formally incorporated 

coordination with regional Aging and Disability Resource Centers, Area Agencies on 

Aging, and Centers for Independent Living to provide information, case management, 

peer mentoring, legal assistance, and connections to related community living, 

transportation, social participation, and employment opportunities. Coordination also 

involves continuous education of staff across systems and delivery programs. Public 

Housing Agencies have used service coordinators to assist consumers with locating 

housing, employment, and social service information. Several States are using Centers 

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for Independent Living (CILs) and peer mentors to support consumers in navigating 

complex housing and community living systems and programs. For example, 

Pennsylvania is funding regional housing coordinators whose role is to provide 

coordinated information and assistance to individuals and organizations that help 

people with disabilities transition from institutions to community living, to educate 

property managers and housing developers on how to develop and market least 

restrictive housing options to people with disabilities, and to monitor that the housing 

needs of people with disabilities are being addressed. 

Another example of such an initiative has been facilitated by Access Living, a Center for 

Independent Living in Chicago, Illinois.151 Access Living has collaborated with the 

Chicago Housing Authority (CHA) to promote coordinated housing and community living 

information, increased access to and use of housing vouchers (Home Choice) by 

people with disabilities, and designated vouchers for people moving out of nursing 

homes and institutions to community-based options. This close collaboration has 

resulted in actions, such as the creation of an Office on Disability Policy within the CHA, 

a 504 self-evaluation, a 504 Voluntary Compliance Agreement, audits of accessibility of 

new housing by an architectural firm specializing in disability-related access, funding of 

a home modification fund for people receiving Home Choice Vouchers, time extensions 

and transportation support during the housing search, and creation of a targeted 

program and vouchers for people moving out of nursing homes to the community. Joint 

counseling sessions by Access Living and the CHA are conducted at Access Living to 

support people during this process and ensure the successful use of vouchers. 

Promoting Integrated and Least Restrictive Choice 

Several States have targeted initiatives to create and expand integrated housing 

choices. As an example, Washington is using federal demonstration grant funding to 

collaborate with local housing authorities throughout the State to develop more 

integrated and less restrictive (four or fewer) community living choice models and 

evaluate their impact. Oregon continues to expand community housing in small 

neighborhood homes, and is also developing individual apartment housing in which 

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consumers can share support services with other consumers with developmental 

disabilities. Virginia is working to revise legislation and policies to enable people with 

developmental disabilities to share an apartment or single-family home with supports. 

Increasing Information Access with Housing Locator Systems 

Access to consistent, quality, and current information about affordable, accessible, and 

integrated housing choices and features is critical. A number of States have developed 

housing locator systems that allow online searches of affordable housing units.152

These systems range from minimal databases of State-financed developments to

sophisticated sites with multiple search options, detailed accessibility information, 

updated vacancy and occupancy status, and links to local service agencies and 

resources. Following are some examples of housing locator promising practices. 

 more 

Socialserve.com 

Socialserve.com is a nonprofit agency and the largest database provider of multistate 

housing registry services. Registries include listings of affordable rental properties in 27 

States, and affordable housing for sale in 8 States and 1 county. Socialserve.com 

includes a toll-free call center with multilingual staff members who help landlords and 

tenants search the database. They can work with a particular State or community to 

customize a housing registry to meet specific needs. For example, registries can include 

a filter for searching for specific accessible features, such as bathrooms with grab bars 

and/or roll-in showers, kitchens with low counters, or entryways with flat or no-step 

entry.153

Mass Access: The Accessible Housing Registry 

Maintained by the Citizen’s Housing and Planning Association, Mass Access helps 

people with disabilities find barrier-free, accessible housing in Massachusetts. This 

housing locator includes information on the availability of affordable and accessible 

apartments, waiting list openings, information on homeownership opportunities, and 

links to housing locators in other States. Users can also search for specific 

accessible/adaptable features.154

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Access Virginia: Virginia’s Accessible Housing Registry 

Access Virginia is sponsored by the Virginia Housing Development Authority and the 

Virginia Board for People with Disabilities. Access Virginia includes information on 

affordable and accessible apartments, as well as information about accessibility 

requirements and universal design. The site includes an Accessible Apartment Finder, 

an index of accessible housing resources, an interactive map to Centers for 

Independent Living (CILs) in Virginia, and links to related housing services and retailers 

of accessible appliances.155

National Accessible Apartment Clearinghouse 

This clearinghouse is a national database of more than 80,000 accessible apartments 

across 50 States. The clearinghouse is a public service program of the National 

Apartment Association, the Virginia Housing Development Authority, and other 

organizations. Information is available from the clearinghouse via the Web, fax, or a tollfree hotline.156

Housing Connections 

In Portland, Oregon, Housing Connections is an example of a city-sponsored site 

maintained by the city’s Bureau of Housing and Community Development, with data 

provided by landlords on rental, for-sale, and shared housing.157 

To link locators to long-term systems change, some States, such as Louisiana, have 

incorporated housing locators into housing developer contracts to make it easier for 

individuals to identify available housing options and to improve marketing of affordable 

and accessible units by developers to consumers. 

Legislative Promising Practices 

Many States have been hampered by current policies that restrict how monies can be 

used to provide services in a least restrictive, community-based setting. Given ongoing 

disability advocacy, some States have enacted legislation to rebalance Medicaid 

monies toward community-based options. Two examples are Texas and Vermont. 

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Texas Rider 37 of the General Appropriations Act of the 77th Legislature enables the 

Texas Department of Human Services to allow money to follow the person from a 

nursing facility to the community. Funds were transferred from nursing home 

appropriations to the HCBS waiver program to provide “real choice.” Texas was one of 

the first States to enact such State legislation and policy, and estimates that as of 2007, 

13,300 people will have transitioned from nursing homes to the community via this 

initiative.158 Passed in 1996, Vermont Act 160 allows funds appropriated for nursing 

home care to be used for home- and community-based services, including for people 

who have the most significant support needs. In addition, the act created a Statewide 

system of Long-Term Care Community Coalitions to improve the infrastructure for 

Medicaid waivers and the long-term services and supports programs.159

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CHAPTER 5. Best and Promising Practices in 

Accessible and Affordable Housing 

While accessible, affordable, integrated housing remains elusive for many people with 

disabilities, various private and nonprofit organizations have tackled the problem by 

challenging federal and State policies that foster segregation and institutionalization; by 

capitalizing on federal State and local programs that offer various financial incentives 

and resources; and by building, operating, and managing housing that fosters the spirit 

and goals of independent living and self-determination for people with diverse 

disabilities. In some cases, multiple community partners working together have found 

ways to tap a variety of funding sources to ensure that residents have access to 

housing that is affordable, accessible, and integrated, and also provide voluntary 

supportive services as needed. 

Most housing and supportive services that people with disabilities require to live as 

independently as possible exist in large measure because federal, State, and local 

housing policies dictate specific goals and allocate annual funding. Private and nonprofit 

organizations that develop and manage or operate housing or provide supportive 

services are dependent to a significant degree upon a combination of these public 

resources, as well as on certain private sources of funding that vary regionally. 

Consequently, any discussion of promising housing practices must acknowledge the 

extent to which public policy drives the development of projects as well as the influence 

of effective disability advocacy on both policies and final projects. Many of the following 

promising housing policies and practices illustrate the extent to which these factors are 

inseparable. 

Examples of innovative policies, partnerships, and programs are described below that 

increase access to homeownership for low-income people with disabilities; facilitate, 

promote, or illustrate the principles of integration, affordability, accessibility, and 

scattered-site placement; and exemplify supportive housing. Examples of local and 

State policies calling for universal design or visitability are also presented. Several 

multiuse, low-income, integrated housing projects are described that embody principles 

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of universal design, and outcomes of several disability rights lawsuits illustrate how the 

promise of increasing integrated, accessible, affordable housing can be realized through 

litigation. 

Intensive Homeownership and Housing Support 

United Cerebral Palsy of Texas, Austin, Texas 

Founded in 1954, the nonprofit United Cerebral Palsy of Texas (UCP Texas), Austin, 

Texas, is the State affiliate of United Cerebral Palsy, a national advocacy and support 

network for people with disabilities. The mission of UCP Texas is “to ensure that people 

with cerebral palsy and similar disabilities have the opportunity to participate fully and 

equally in every aspect of our society.”160 Serving all ages and people with all 

disabilities, UCP Texas provides technical assistance and support to families and 

individuals, advocates for people with disabilities, and organizes a variety of programs 

and services. A central component of UCP Texas’s work focuses on assisting people 

with disabilities and their families to find housing. This work is driven by four goals: “to 

increase homeownership opportunities for people with disabilities; to increase the 

housing stock of accessible homes; to increase awareness of the need for more 

affordable, accessible, and integrated housing; and to educate people with disabilities 

on how to be successful homeowners.”161 These goals guide innovative housing 

programs that aim to provide affordable, accessible, and integrated residences for 

people with disabilities. Program descriptions follow. 

The Texas Home of Your Own (HOYO) program, supported by HOME funds awarded 

through the Texas Department of Housing and Community Affairs, began in 1995 as 

part of the now-defunct National Home of Your Own Alliance and is now offered by UCP 

Texas. HOYO provides first-time homebuyers who are eligible with up to $15,000 in 

down payment assistance. These funds are awarded as a 10-year, deferred, nointerest, and forgivable loan that depreciates 10 percent each year; a second lien is 

placed on the home for 10 years. After that period of time, the loan is forgiven if the 

homeowner does not foreclose or sell the home, seek a home equity loan, or cease 

using the home as a primary residence. As of 2007, approximately 320 households or 

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individuals had become homeowners through the HOYO program. In order to be eligible 

for assistance, household income (typically SSI - Supplemental Security Income, and/or 

SSDI - Social Security Disability Insurance) cannot exceed 80 percent of Area Median 

Income (AMI), and most of the individuals UCP Texas has served through this program 

have had incomes at or near 50 percent of AMI.162

UCP Texas also provides for very low income people with disabilities to rent. Using 

affordable integrated, accessible apartments Section 811 funds from HUD, UCP Texas 

purchased two sets of condominium units, the first in March 2005 and the second in 

April 2008. Section 811 funds are frequently used to construct segregated group homes 

or apartment complexes for people with disabilities. However, UCP opted to use its 

Section 811 money to purchase 16 units integrated within two buildings populated 

primarily by professionals, students, and retired individuals.163 It then found tenants by 

advertising through disability organizations and quickly filled the units. 

UCP Texas also provides support, training, research, and advocacy to promote housing 

opportunities for people with disabilities. The organization’s direct involvement with 

housing for people with disabilities has helped promote affordable, accessible, and 

integrated housing. UCP developed a comprehensive training package that the 

organization has used to train more than 100 public housing authority staff members. In 

addition, UCP trains nonprofit housing, social service, and disability advocacy 

professionals on how to promote consumer-directed barrier removal, and it provides 

technical assistance to the city of Austin as it undergoes an architectural barrier removal 

program.164

UCP Texas has successfully created integrated, affordable, and accessible housing for 

people with disabilities through HOYO and its use of Section 811 funds, “doing 

something that very few people thought was possible 10 years ago.”165 Furthermore, 

the program’s support to homebuyers enabled them to weather the recent subprim

mortgage crisis. None of the individuals who took advantage of HOYO financial 

assistance faced foreclosures, an unexpected benefit that came from stringent 

e 

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requirements UCP Texas places on its homebuyers: loans that UCP supports must be 

than 1.25 percent above prime rate.166

Yet this work has not been without its share of challenges. Housing programs are 

expensive, and federal and State funding is limited. Home prices have increased from 

as little as $55,000, when HOYO began, to today, when “potential homebuyers have a 

hard time finding anything less than $100,000.”167 New State funding restrictions on 

HOME funds have forced UCP Texas to discontinue its home rehabilitation program, 

which supported accessibility modifications for new home purchasers. Furthermore, the 

organization not only has to plan and implement its programs, but it also has to 

challenge the perception that people with disabilities are dependent. UCP Texas found 

that they have to educate lenders about the disability community, many of whom rely on 

nontraditional income sources like SSD/SSI: “Early on, we had to do a lot of education, 

telling lenders [that SSI/SSD] income is steady income.”168 Moreover, UCP Texas had 

to sell the idea of scattered-site rentals to both HUD and the State of Texas because the 

norm is segregated disability communities.169

Housing Initiatives Program, Institute for Disability Studies, University of 

Southern Mississippi, Hattiesburg, Jackson, and Gulf Park, Mississippi 

Based in Hattiesburg, with satellite offices in Jackson and Gulf Park, the Institute for 

Disability Studies (IDS) of the University of Southern Mississippi is the State’s University 

Center for Excellence in Developmental Disabilities (UCEDD). A university-based 

nonprofit, IDS serves people with disabilities through a range of activities, including 

direct service, training, technical assistance, and research. Among these activities is 

IDS’s Housing Initiatives program, which provides or facilitates homeownership 

assistance and loans, technical assistance, and training opportunities, as well as direct 

service to homeless people with disabilities. These efforts aim to serve people with 

diverse disabilities, including mental health issues and chronic illnesses. IDS’s Housing 

Initiatives began in 1997 with a $25,000 HOME funds grant from the Mississippi 

Department of Economic and Community Development.170 The program has expanded 

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through subsequent competitive grants and now has an annually allocated, 

noncompetitive budget. 

The largest component of IDS’s Housing Initiatives is its Home of Your Own (HOYO)

program, which provides home purchasing assistance grants of $10,000 and $15,000 to 

low- to moderate-income people with disabilities and families with a member with a 

disability. Along with these grants, HOYO offers its participants person-centered 

planning through individualized support and guidance. This includes helping participants 

secure a loan for the remainder of the house’s cost, pre- and post-purchase homebuyer 

counseling, referrals to services as needed, and advocacy with lenders. HOYO grants 

may be used for down payment, closing costs, principal reduction, and modifications 

necessary for accessibility. HOYO participants then choose from one of 15 partner 

lenders, many of whom use Fannie Mae’s Community HomeChoice product for low- to 

moderate-income people with disabilities. The HOYO program has three primary 

components as determined by its funding sources. The first is HOME funds set aside by 

the Mississippi Development Authority ($500,000), Mississippi HOYO, which has 

assisted 256 individuals in obtaining homeownership in 44 of the State’s 82 counties.171

Second, drawing on HOME funds from the city of Jackson, Community Service Division 

($264,000), HOYO has helped 52 individuals and their families to secure homes within 

Jackson’s city limits. The third component, funded by the City of Hattiesburg, 

Community Development Division, provides counseling and $15,000 HOME grants to 

Hattiesburg residents. 

The income for approximately 75 percent of HOYO participants comes primarily from 

Social Security benefits, while the income of the remaining 25 percent comes from 

conventional employment.172 In spite of problems that confront current would-be 

homeowners, HOYO participants have less than a 2 percent default rate on 

mortgages.173 IDS staff attribute this success to HOYO’s “wraparound” support 

services, which involve counseling and advocacy.174 These successes have been 

recognized with the HUD 100 Best of the Best Practices Award (2000) and the 

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Mississippi Governor’s Communities of Excellence Award for the State’s best 

homebuyer program (2002 and 2007). 

The IDS administers several other programs supported by the Federal Home Loan 

Bank (FHLB) that provide funds and support to assist people with disabilities in 

becoming homeowners. First, the FHLB Disability Initiative has provided a $10,000 

home purchase assistance grant for down payment, closing costs, and principal 

reduction to 10 very low income, 10 low-income, and 3 moderate-income families with a 

member with a disability.175 Second, the Special Needs Assistance Program (SNAP)

grant has provided $5,000 to 8 eligible families whose gross household income exceeds 

80 percent of the median income level (adjusted by household size and county) to 

support home rehabilitation to make the homes accessible.176 Finally, the Mississippi 

Disability Initiative has provided a $15,000 grant to each of 30 very low income to 

moderate-income families with a member with a disability in rural communities. 

In addition to the financial assistance programs, IDS runs six other outreach, 

counseling, education, and direct support programs relating to housing for people with 

disabilities. First, the Delta Housing Initiative, funded by the F. B. Heron Foundation 

and started in January 2007, provides pre- and post-purchase counseling to 120 

households and offers assistance to people with disabilities to find safe, affordable 

housing and community-based supports.177 Second, IDS provides credit counseling, 

homebuyer education, and counseling services to Mississippi residents with funds from 

the Mississippi Home Corporation (MHC)/Freddie Mac Comprehensive Housing 

Counseling Grant. Third, IDS’s HousingSmart program provides outreach to individuals 

with disabilities. To date, it has sponsored a total of 40 workshops that trained 657 

people and disseminated printed and electronic fair housing information to an estimated 

71,276 individuals.178 Fourth, the Individual Development Account (IDA) initiative is 

designed to help low-income individuals and families who meet requirements set by the 

supporting foundation to become homeowners with a 3 to 1 match on funds to use for 

down payment or closing costs.179 

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The last two programs target homeless individuals with disabilities and their families. 

HUD-funded efforts, the Shelter for All and Comprehensive Housing Counseling

programs, together provide one-on-one counseling, referrals, and specialized disabilityrelated case management to eligible potential homebuyers. These services involve 

optional person-centered planning sessions that allow people with disabilities to gather 

relevant people (family, advocates, etc.) to collectively identify goals and challenges and 

plan how to secure permanent housing.180 As of May 2008, these homelessnessrelated efforts have served more than 805 individuals.181

The Lease-to-Own Model: The Arc of the Central Chesapeake Region (formerly 

The Arc of Anne Arundel County), Maryland 

The Arc of the Chesapeake Region in Annapolis, Maryland, a nonprofit service and 

support provider for people with developmental disabilities, started a project called 

Opening Doors in 1999, with a 2003 follow-up project called More Doors to Open. 

The Arc seeks to provide people with disabilities housing opportunities that are 

integrated, affordable, and emphasize self-determination. The Arc’s housing efforts 

involve several components, including independent living counseling.182 When Opening 

Doors began, the organization recruited four people with disabilities interested in living 

at a development through a lease-to-own model, and two others interested in renting 

other apartments. At the same time, the Arc helped people with disabilities attain 

Section 8 rental vouchers and State supports, published two guides related to housing 

for people with disabilities, and developed a “designated representative” role to allow a 

person with a disability to select someone to act on his or her behalf in housing matters. 

The Arc’s homeownership efforts culminated in a 56-unit complex named Homes at the 

Glen, the residents of which are restricted to 50 percent of Area Median Income.183

Monthly rent payments include $15 payments to accounts that will be used to help buy 

the unit at the conclusion of the 15-year lease. Residents are responsible for home 

maintenance, volunteering, and taking part in self-governance activities. Service 

coordination and case management is provided by an agency funded by the Maryland 

Developmental Disabilities Administration. Anecdotal evidence suggests the Homes at 

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the Glen initiatives have been very successful.184 Resident comments are positive and 

they report satisfaction with living independently in places they have chosen, they 

volunteer and participate in other community activities, and they appear to have 

improved their employment and health stability.185 Currently, the Arc is working to 

expand its efforts with a new financial literacy program, a plan to replicate the program 

elsewhere, and by increasing the participation of communities of color.186

A combination of private, State, and local funds and support, together with innovative 

State policies, paved the way for the successes of the Opening Doors and More Doors 

to Open projects. Residents of the Homes at the Glen development benefited from 

Maryland’s 1915(c) waiver, which allows States to offer Home- and Community-Based 

Services (HCBS) waivers that provide individuals with support (employment, direct 

personal care, home modifications, etc.) to remain in their own homes rather than in 

institutions. Direct grants came from private foundations, the Maryland Developmental 

Disabilities Council, and the Maryland Developmental Disabilities Administration.187 The 

Maryland Department of Housing and Community Development (MDHCD) provided a 

second mortgage to the project and an annual allocation of $501,447 in equitygenerating tax credit.188 On the local level, the Anne Arundel County Housing 

Commission granted a $700,000 HOME loan, and the city of Annapolis and Anne 

Arundel County granted low payments in lieu of real estate taxes to make rent 

affordable. Another important State resource for this project was a 2002 MDHCD 

amendment to the State Qualified Allocation Plan.189 The amendment provides bonus 

points in the competition for federal Low Income Housing Tax Credits (LIHTCs), as well 

as gap financing to applicants who build units for people with disabilities. LIHTC and 

gap-financing applicants who seek the points must reserve and market as much as 

10 percent of the proposed project’s units to people with disabilities for at least 30 days, 

beginning when the project is 80 percent complete. When completed, the project must 

be marketed exclusively to people with disabilities for 30 days. 

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Support for Independent Living 

Neighbors, Inc., Franklin Park, New Jersey 

Founded in 1995, nonprofit Neighbors, Inc., of Franklin Park, New Jersey, aims to 

support people with disabilities in living self-directed lives. Supporting more than 100 

people in New Jersey and Pennsylvania, Neighbors emphasizes empowering 

individuals and their families rather than agencies, listening to people’s aspirations and 

working to realize them, and helping them find friends, jobs, and homes.190 Based on 

the founders’ experiences with agencies with costly offices and overhead, they selected 

an alternative model of organization and support.191 With no central office, the staff is 

small, with an executive director, an agency director, and five advisors who coordinate 

support for five to seven people. 

Neighbors’ employees view themselves as agents for the people they support.192 To 

this end, Neighbors will work with anyone who chooses the agency to develop a supp

plan based on a budget determined by the individual. With support from Neighbors, 

many people who once lived in group homes or other institutions have been able to 

move on their own or with housemates into integrated housing that include apartments, 

condos, rentals, and homes they own.

ort 

193 Neighbors also provides daytime support for 

employment, volunteering, business ventures, and other community activities as 

alternatives to sheltered employment and day habilitation facilities. Meeting once a 

week or more, advisors assist each person with a variety of tasks, including hiring 

personal assistants (PAs), scheduling and managing PAs, and searching for 

employment or volunteer opportunities. By supporting people who may need assistance 

in managing PA services, Neighbors enables them to make use of another resource for 

increasing self-direction.194 Finally, advisors also facilitate meetings between each 

person and his or her family, PAs, and case managers to further planning. 

Neighbors has succeeded in supporting people with disabilities who want to live in 

integrated community settings. However, the organization faces challenges, such as 

limited funding, which mostly comes from State contracts through Medicaid waivers and 

private donations.195 The Neighbors director explains that the flexibility and openness of 

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relevant State officials to the organization’s alternative service model and a New Jersey 

Division of Developmental Disabilities program called Real Life Choices assists the 

organization’s work. Real Life Choices promotes greater self-determination through 

individual budgets, which it arranges through allocations from Medicaid waivers guided 

by individually based reviews of support needs.196

Onondaga Community Living (OCL), Syracuse, New York 

Based in Syracuse, New York, Onondaga Community Living (OCL) is a nonprofit that 

seeks to “empower and individually support people with developmental disabilities in 

their efforts to live full lives as integral, respected members of their community.”197

Started in 1987, OCL’s current efforts grew out of lessons learned from operating group 

homes. OCL staff perceived that such homes were not meeting the needs or desires of 

their residents. In an effort to individualize and personalize services, the organization 

closed two of the homes and implemented a support model based on the needs, 

desires, and aspirations of the individual. The support enables the individual to live in 

integrated housing that is neither linked to services nor removed from participation in 

the wider community. 

OCL’s support takes several forms, including residential support, which is provided to 

approximately 50 people throughout Syracuse and the surrounding area in both urban 

and rural settings.198 This support helps individuals remain in their own housing, which 

includes rentals and homes they own or that are held in trust. Support ranges from a 

few hours per week up to 24 hours a day through OCL-facilitated live-in housemates. 

General support may include personal care, housekeeping, cooking, nursing, or other 

services, but emphasis is always placed on the belief that everyone’s home life is 

different and that everyone has unique desires and needs. Support outside the home 

includes service coordination, vocational assistance, and an academic initiative that 

enables people to attend college classes and activities (e.g., labs and social events) at 

Syracuse University. 

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OCL’s support services are funded through Medicaid waivers.199 Historically, federal 

and State policies have not encouraged or emphasized person-centered residential 

support services. In the absence of such policies, the OCL’s executive director 

attributes its successes to its personalized model and philosophy of support, as well 

encouragement from and the flexibility of the New York State Office of Mental 

Retardation and Developmental Disabilities. In light of the predominance of relatively 

traditional group and congregate homes and related service systems for people with 

developmental disabilities, the State has nonetheless been open to alternative 

strategies for the use of funding. Further testifying to the promise of its support model, 

OCL is replicating its efforts elsewhere. To support greater numbers of people while 

remaining relatively small, the organization has developed a new organization called 

Connections of CNY, Inc., Syracuse, New York, which is currently in the process of 

raising start-up funds. 

Options in Community Living, Madison, Wisconsin 

Founded in 1981, the nonprofit Options in Community Living in Madison, Wisconsin, 

provides residential support to 102 people with developmental disabilities, ages 23 to 

30. By using Section 8 rental subsidies, these individuals live in housing dispersed 

through the Madison metropolitan area, rather than remaining in congregate facilities. 

Approximately 45 of those participating in the program have roommates, 11 are 

homeowners, 2 live in homes held by family members on their behalf, and almost all the 

remaining individuals hold leases on rental units.200 Options aims to support these 

individuals so they can participate as full community members. The organization does 

this by “approach[ing] support by building relationships with individuals,” emphasizing 

each person’s “hopes, dreams, and interests,” and collaborating with family members 

when possible.201 Intended to assist each person to “live life without life being about 

services,” support is based on the model of self-direction.202 The organization begins by 

carefully matching individuals seeking support with staff members who fit their 

personalities and can help address their needs. Service coordinators provide 

organizational oversight and help address challenges with other agencies, but the focus 

remains on the needs and desires of each individual being supported. Services, which 

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range from a few hours a week to 24 hours a day, might include personal care, 

household management, dealing with a landlord, assisting with financial management or 

energy assistance, and access to transportation systems, including paratransit. 

Options has benefited from strong county support, including a commitment to selfdirected services and the county’s exceeding the required match on Medicaid waiver 

funds available for services that promote dispersed housing.203 The organization also 

benefits from Wisconsin’s relatively minimal requirements for service providers to qualify 

for funds from Medicaid waivers. The organization’s director explains that this flexibility 

allows them to support people as active leaders in their own process, instead of having 

to follow conventional models focused on providing services to passive clients. 

Recently, however, county budget cuts have undermined the organization’s capacity. 

Consequently, in order to continue being supported, 11 individuals have moved to a 60-

unit building with affordable units rather than remaining in housing dispersed throughout 

the community. Though this has allowed these individuals to continue with support, the 

organization views this “clustering” unfavorably, since it undercuts the commitment to 

dispersed, integrated housing and the principle of supporting individuals rather than 

groups.204

LifeLong Supportive Housing Program (Alameda County Health, Housing, and 

Integrated Services Network), Oakland and Berkeley, California 

LifeLong Medical Care (LMC), which currently provides a broad range of health and 

social services to people of all ages, began as a storefront operation by the Gray 

Panthers, a senior citizens advocacy organization that merged with Berkeley Primary 

Care Access Clinic in the mid-1990s and rapidly expanded to become a community 

health center (CHC) with clinics located on five sites. LMC is a “safety net” provider of 

medical services to people who are uninsured and who experience complex health 

needs in Berkeley, Albany, Emeryville, and parts of Oakland, California. 

LMC’s Supportive Housing Program (SHP), also known as the Alameda County Health, 

Housing, and Integrated Services Network, is a collaboration of public and private 

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agencies that provide permanent housing and social and health services to formerly 

homeless people with disabilities. SHP provides onsite support services to 

approximately 600 tenants living in eight subsidized housing sites scattered throughout 

Berkeley and Oakland. Services provided by SHP are optional and available to all 

tenants living in this housing. LMC collaborates with nonprofit housing development 

corporations that create and operate affordable housing in Alameda and 

Contra Costa counties. Supportive services include outreach, intensive case 

management, housing stabilization, eviction prevention, benefits advocacy, money 

management, medical care, mental health and substance abuse services, community 

building and social activities, and employment and vocational support. 

Supportive Housing Programs for People with Psychiatric Disabilities 

The following offers a closer look at three types of permanent housing programs for 

people with psychiatric disabilities. Pathways to Housing is the nation’s oldest 

“housing first” program and has been heavily studied. It provides permanent, scatteredsite supportive housing with voluntary, flexible, and individualized support services 

delivered by a staff that is heavily composed of peer providers. There are no 

requirements to use support services or abstain from substance abuse to either obtain 

or maintain housing, and tenants are accepted directly from the streets, homeless 

shelters, psychiatric wards, and correctional facilities. 

The Mental Health Association of New Jersey’s Residential Intensive Support 

Team (RIST) program is a modified housing first program because it requires 

agreement to continue psychiatric medications and participate in a treatment plan as a 

condition of obtaining housing, but not as a condition of maintaining it. Until 2009, all of 

its tenants came from a psychiatric hospital through a discharge planning program. It 

provides individualized onsite support services in scattered-site housing delivered 

primarily through psychiatric survivors. 

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Main Street Housing does not meet the definition of permanent supportive housing 

because it offers only housing. Rather than directly offering support services, it provides 

referrals to community-based support services upon request. It offers a mix of 

congregate and single-residency housing, and does not accept tenants with cooccurring substance abuse or who have committed violent crimes. Because it does not 

offer support services, it only accepts tenants who can demonstrate an acceptable 

degree of “wellness.” However, it is included here because it appears to be the nation’s 

only housing program for people with psychiatric disabilities that is entirely run by 

psychiatric survivors, and service provision by peers has been found to be an important 

predictor of housing success for people with psychiatric disabilities. 

Pathways to Housing 

In 1992, Pathways to Housing (Pathways) pioneered a new way of housing people with 

psychiatric disabilities that has come to be known as the “housing first” model.205 Based 

in New York City, the program was founded by Dr. Sam Tsemberis, a clinical 

psychologist who had worked with homeless people with psychiatric disabilities. 

Tsemberis believes that housing is a basic human right, and should therefore be offered 

without any precondition, whether or not tenants agree to pursue treatment.206 

Pathways provides housing to homeless people with mental illness and co-occurring 

substance abuse—the population that other homeless prevention programs have found 

most difficult to place. Tenants are offered independent private housing in the 

community when they enter the program. The only requirements to obtain housing are 

to agree to participate in biweekly visits by a service coordinator, attend a money 

management program, agree to pay 30 percent of income toward rent, and abide by a 

standard lease. 

Pathways rents apartments via a network of landlords, and sublets the units to its 

tenants. By making timely rent payments and intervening quickly to solve tenancy 

problems, Pathways is able to maintain a stable number of units. Tenants are offered up 

to three units to choose from when they enter the program. 

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To ensure full community integration, the program does not rent more than 10 to 

20 percent of the units in a building. Tenants are free to stay as long as they wish. 

There is no requirement to participate in mental health or substance abuse treatment. 

Tenants choose whatever support services, if any, they want. 

Services are delivered onsite and are available 24 hours a day, 7 days a week, via an 

Assertive Community Treatment (ACT) team or at Pathways offices. ACT teams consist 

of a case manager—typically a peer counselor or former consumer—and a nurse, 

psychiatrist, social worker, vocational rehabilitation counselor, drug counselor, and 

administrative assistant. Approximately half of Pathways staff are in recovery from 

mental illness, substance abuse, or homelessness. 

Staff help tenants develop independent living skills by accompanying them on trips to 

buy groceries, visit doctors, and perform other activities in the community. Depending 

on what a client wants, case managers can work directly with the client or, as tenants 

proceed toward recovery, can provide referrals to community services. The intensity of 

services is adjusted relative to a client’s evolving abilities. 

Pathways offices offer a range of support services and opportunities for socializing and 

recreation. There are writing groups, photography groups, computer classes, science 

groups, and people go to the movies together and socialize. 

A person with a psychiatric disability’s need for housing is no different from anyone 

else’s. Housing is constant, while services vary as a function of disability. Unlike 

supportive housing programs that preceded Pathways, tenants who refuse mental 

health and/or substance abuse treatment and those who continue to abuse drugs or 

alcohol are not threatened with loss of housing, so long as they continue to comply with 

their lease. 

Tsemberis believes that people with psychiatric disabilities have the capacity to 

immediately move into their own home in the community. He points out that homeless 

people have substantial survival skills that are masked by their disability. Homeless 

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people know where to go for meals, where to collect SSI checks, where to seek medical 

care, the location and eligibility rules for shelters, where to sleep when shelters are full, 

and what parts of the town are relatively safe to travel through. Tsemberis also believes 

that relief from the daily stress of life on the streets allows tenants to begin to focus on 

addressing other needs and developing the skills that can foster recovery. 

Pathways to Housing provides people with an apartment of their own first, so 

that they may find a reprieve from the war zone that is homelessness. 

Assistance is provided every step of the way so that tenants have all the 

support necessary to move and integrate into their community, and to begin 

the long journey through the recovery and rehabilitation process.207 

Research substantiates the effectiveness of the housing first approach. One study 

demonstrated a direct relationship between participating in a housing first program and 

decreased homelessness and increased perceived choice.208 This study also 

suggested that this approach may have a distal effect on decreased psychiatric 

symptoms. People in the housing first program obtained housing earlier, remained 

stably housed, and reported higher perceived choice.209 Living in their own apartment

through a housing first program and having choices also had a great impact on the 

psychological and social integration of people with mental illnesses.210

Pathways to Housing separates housing from treatment. It treats 

homelessness by providing people with individual apartments, and then treats 

mental illness by intensive and individualized programs that seek out and 

actively work with tenants as long as they need, in order to address their 

emotional, psychiatric, medical and human needs, and on a twenty-four-hour, 

seven-day-a-week basis.211 

Tsemberis believes the housing first approach is far superior to the status quo: “People 

with mental illness are in jail, or homeless, or in and out of psychiatric institutions. This 

is better, and far more cost-effective.... A housing first approach requires an agency to 

take the risk of putting people with mental illness and addiction into apartments and 

assume liability for that. Most programs want a containment/supervision model—that’s 

not based on data, but rather on prejudice about mental illness.”212

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Finally, Pathways has an 80 percent tenant retention rate and is far more cost effective 

than emergency services used by homeless people with severe mental illness.213

Mental Health Association of New Jersey: Residential Intensive Support Team 

(RIST) 

The Mental Health Association of Morris County, New Jersey, operates a permanent 

Supportive Housing Program for patients leaving Greystone Park Psychiatric 

Hospital.214 It is known as the RIST program because it uses a Residential Intensive 

Support Team to provide support services. The program began housing 21 people in 

2004 and has grown slowly since. By the end of 2008, the program served 36 people, 

and a total of 49 people had been housed directly from hospital discharge since the 

program’s inception. 

RIST staff meet with potential tenants before they are discharged from Greystone. They 

help patients locate private, single-residency, scattered-site housing in the 

neighborhood of their choice. The patients are then discharged directly into their new 

homes. The lease is in the tenant’s name. 

RIST is a modified housing first program, in that it seeks to serve “recovery-oriented” 

patients deemed ready for discharge. Patients must agree to continue to take their 

medication and participate in a treatment plan to win acceptance into the program. 

However, patients—referred to as “customers” by RIST staff—are not removed from 

their housing or from the program if they refuse to take medication or adhere to their 

treatment plan. The only criterion for maintaining housing is lease compliance. 

Housing is permanent, with allowance for periods of absence from the unit of up to 

approximately 6 months, and sometimes longer on a case-by-case basis. If a customer 

cannot comply with the lease and is evicted, RIST staff will offer a new placement. 

Customers are allowed three housing placements before they are turned away from the 

program. 

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RIST customers are offered a rich array of support services in their units, in the 

community, and at a RIST drop-in center/social club. Most services consist of 

developing independent living skills, such as cooking, housekeeping, hiking, and 

accompaniment to spiritual services. Services are delivered by nine community life 

coaches, all of whom are consumer providers. RIST staff also help customers access 

vocational rehabilitation programs and educational programs. One customer obtained a 

massage therapy license, another completed a program in heating and air conditioning 

repair, and a third graduated from the RIST program and is pursuing a degree in 

pastoral counseling. Services are available 24 hours a day, 7 days a week. 

In addition to community life coaches, RIST staff include one master’s level residential 

coordinator, one full-time assistant coordinator, three full-time senior residence 

counselors (one of whom is a consumer provider), and a part-time nurse consultant. In 

addition, the program shares a bookkeeper, a housing development specialist, and a 

psychiatrist with other Mental Health Association of Morris County programs. 

The RIST program defines successful community integration by several measures, 

including avoidance of hospital and jail stays, positive relationships with friends and 

family, and involvement in educational or vocational training. RIST has a goal that 

80 percent or more of housed customers will participate in three or more different 

social/leisure activities each quarter. Social participation per quarter in 2008 ranged 

from 81 percent to 92 percent. 

RIST has a goal that 75 percent or more of housed customers will be involved in one or 

more prevocational or vocational activities. Vocational and prevocational participation 

per quarter in 2008 ranged from 79 percent to 82 percent. This included 12 customers 

who were employed either part-time or full-time during the year. 

RIST attributes much of its success to its use of consumer providers, who make up 

71 percent of its staff. The key component of the program is the relationship between 

life coaches and customers, who are matched carefully to foster trust and teamwork. 

Having experienced psychiatric disabilities as well as recovery, life coaches can offer 

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more empathy, understanding, and tolerance, and can “meet their customers where 

they’re at,” while serving as role models. 

Main Street Housing 

Another emerging model of housing for people with psychiatric disabilities is Main Street 

Housing (MSH) in Maryland. A subsidiary of On Our Own of Maryland, an organization 

of psychiatric survivors, MSH was incorporated in 2001 as a nonprofit and began 

offering housing the following year. It was formed to provide an alternative to board and 

care homes and residential settings tied to service provision.215 

MSH offers a consumer-run “housing only” model that differs from Pathways and RIST 

in several ways. It only offers housing, with no support services provided, although MSH 

staff are familiar with local services and will refer tenants to support services in their 

communities. 

Today, MSH owns 15 buildings in nine Maryland counties that contain a total of 27 units 

and house 53 adults and families. Approximately half of the tenants live alone; the rest 

are families or adult roommates. Units include efficiencies, one- and two-bedroom units, 

and three-bedroom units for families. 

Unlike Pathways, MSH owns its homes and leases them directly to its tenants. MSH’s 

Executive Director, Ken Wineman, says homeownership enables his organization to 

build equity it can use to leverage the purchase of new homes, and to offer the 

opportunity for tenants to sign leases and experience the responsibilities and privileges 

of tenancy. 

MSH chooses its tenants carefully. Each applicant is screened by Ken Wineman, who is 

both a consumer and a social worker. Although treatment is not a prerequisite to obtain 

housing, applicants must demonstrate a “certain wellness level” to be accepted. Current 

substance abuse is not permitted, nor is a history of arrest for violent crimes. 

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Tenants must agree to monthly inspections for safety and cleanliness. If the home is not 

kept well, staff offer, but do not force, referrals for support services. When adults live 

together, each tenant must agree to be responsible for the upkeep of a specific common 

area. Housemates are expected to work out any problems that come up, and house 

meetings are the usual method used to do so. Staff are available to informally mediate 

disputes upon request. When a new tenant first moves in, staff will visit more frequently 

to help ensure a smooth transition. Staff will sometimes contact a tenant’s case 

manager or other support staff if needed. Alcohol and tobacco use is discouraged but 

not prohibited—however, in shared living situations a tenant can request that his or her 

roommate not use either in the home. 

Rent is kept low—typically it ranges from $200 to $275 per month. Section 8 vouchers 

are accepted, and MSH has adopted the housing authority rules of occupancy to ensure 

that Section 8 vouchers will be offered to its tenants. Wineman explained, “People in the 

mental health system see us as a model. We get referrals from State hospitals—and 

that enables workers there to see that it’s possible to offer housing separate from 

support services.”216 Housing is permanent—tenants can stay as long as they wish. 

Wineman is particularly proud that MSH was able to help a mother regain custody of her 

child by offering stable housing for both. 

MSH has successfully avoided “not in my backyard” (NIMBY) problems. When a home 

is purchased, no neighborhood notification occurs. If neighbors drop by while a home is 

being prepared for occupancy or when staff are doing repairs and maintenance, 

neighbors are welcomed and told that MSH is the landlord and will quickly respond to 

calls about any concerns neighbors may have. Wineman says that neighbors have 

responded well to this approach, which satisfies concerns without stigmatizing tenants 

by announcing the presence of mental health consumers. 

Although MSH has not yet conducted studies, Wineman states that his experience at 

MSH has convinced him that stable housing leads to employment and more stability 

and grounding in nonpatient roles. To avoid segregation, MSH purchases buildings that 

range from single-family homes to buildings that contain no more than four units. No 

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more than six people reside per multiunit building. He explained, “I don’t buy anything I 

wouldn’t live in.”217 

Finally, Wineman believes that the fact that MSH is completely consumer run provides 

significant advantages that contribute to the success of the program. Consumer staff 

provide role models and hope for tenants, and educate the broader mental health 

community that recovery is possible. Wineman also believes that a consumer-run 

program fosters a greater degree of tenant accountability, because staff have higher 

expectations of tenants to be self-sufficient. Tenants feel more comfortable interacting 

with staff who have faced similar mental health challenges. Tenants find the staff to be 

compassionate and nonjudgmental, and hence easier to approach for help. The 

presence of role models and the sense of acceptance help tenants develop their selfesteem. Research implies that peer support empowers people with psychiatric 

disabilities to make decisions relatively autonomous from professional staff.218

Affordable, Accessible, Integrated, Mixed-Use Housing Development 

University Neighborhood Apartments, Berkeley, California 

The nonprofit developer Affordable Housing Associates, Inc., built the University 

Neighborhood Apartments to increase affordable, accessible housing for individuals and 

families, including people with disabilities. All the apartments are designed using 

universal design principles and are fully accessible. Universal features include “onestory living; wide doorways and hallways; low countertops, cabinets, and keyholes; 

extra floor space to accommodate a wide turning radius; pull-out cutting boards; stoves 

with buttons on the front; push/pull lever faucets; and roll-in showers.”219 All the units 

are available to households with 30 to 60 percent of Area Median Income, including 20 

project-based Section 8 units and 9 units designated for households that include 

individuals with disabilities. 

This building consists of 29 apartments, residential common areas that include a 

multipurpose room, management and service spaces, a large outdoor courtyard, 

ground-floor commercial areas, and a tenant parking garage. The building is located on 

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a main transportation corridor in the city of Berkeley and is approximately two blocks 

from the downtown area. The building is four stories, including three residential and one 

commercial story. A restaurant featuring ethnic African meals recently opened on the 

first floor of the commercial space. The 29 apartments are made up of 1 studio 

apartment, 3 one-bedroom, 14 two-bedroom, and 11 three-bedroom units.220 

The building is designed so that all apartments are adjacent to a large interior central 

courtyard, which includes natural landscaping, seating, and a play area. A 

multipurpose/community room is located near the outdoor courtyard and offers a 

computer work area, service office, and kitchenette. The multipurpose room is used for 

educational classes, computer workstations, crafts, exercise classes, social gatherings, 

and meetings. The services office is used for counseling and for coordinating 

educational classes. A laundry room is located on the first floor and the manager’s office 

is located adjacent to the courtyard.221

The development was funded by Bank of America, N.A., the Low Income Housing Tax 

Credit program, the State of California’s Multifamily Housing Program, the Federal 

Home Loan Bank, Alameda County Housing Opportunities for People with AIDS, the 

city of Berkeley’s Housing Trust Fund Program, and a HUD 108 loan. A California 

Housing Enabled by Local Partnerships Program loan was made by the city of Berkeley 

to assist with the initial acquisition of the property site. 

Helios Corner, Berkeley, California 

The nonprofit developer Satellite Housing, Inc., built Helios Corner, which provides 

affordable senior rental housing. All 80 units are affordable to seniors with incomes 

between 30 and 60 percent of Area Median Income. All units can be adapted for 

accessible features, 10 units are already accessible, and 40 units are project-based 

Section 8. Two of the accessible units also include features that enhance access for 

people with sight and/or hearing impairments, such as blinking doorbells and louderthan-average buzzers. 

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This four-story mixed-use building consists of three residential levels above 5,900 

square feet of ground-floor commercial/office space and parking. The site is within short 

walking distance of community services and amenities, and is surrounded by a mixture 

of uses—single-family neighborhoods are to the north and west, and neighborhood 

commercial settings are to the south and east. A bus stop is located outside the front 

steps of the apartment complex and the North Berkeley BART station is just two blocks 

away. 

The building consists of ground-floor office space for Satellite Housing and the Salvation 

Army. The main floor of the building houses the property manager’s office, the service 

coordinator’s office, a multipurpose room, and a large community room with a 

landscaped courtyard that is open to residents for daily recreational activities, family 

gatherings, community parties and meetings, movies, music, and classes. Satellite 

Housing focuses on tailored coordination, case management, and referral by its inhouse service coordinators who work directly with service providers to ensure residents 

are able to access the services they need. Supportive services are also available onsite. 

The development was financed by Low Income Housing Tax Credits, Silicon Valley 

Bank, the Federal Home Loan Bank, and city of Berkeley Housing Trust Fund. A 

California Housing Enabled by Local Partnerships Program loan was made by the city 

of Berkeley to assist with the initial acquisition of the property site. 

Housing Cooperatives (Co-ops) 

Housing Cooperatives allow residents to own and control their apartment through a 

corporation in which they own stock and are actively involved in management and 

programming. Maintaining affordability is difficult, but may be achieved by restricting 

resale prices, as in the case of Limited-Equity Cooperatives (LECs). Collectively owned 

and governed, LECs cap resale prices of shares by either regulating the resale price or 

the income levels of buyers.222 A significant percentage of housing in Scandinavian 

countries, LECs are also growing in significance in the United States. A 2003 survey by 

the National Association of Housing Cooperatives reported 425,000 limited- and zero111
equity co-ops throughout the nation.223 LECs enable stable affordable housing and the 

security this ensures, greater levels of tenant control and satisfaction, and neighborhood 

revitalization in economically depressed areas.224

LECs have promise for people with disabilities as a means to self-determination and 

affordable, accessible, integrated housing, with the possibility of support and services 

as needed. Services may or may not be offered onsite, can be informal or formal, and 

might involve either joint purchasing and/or scheduling of services or a coordinated and 

managed services program staffed by community agencies or the cooperative itself. 

Potential benefits for low-income people with disabilities include a relatively low financial 

investment and greater control over housing and the environment.225 Moreover, 

research on Canadian LECs reveals that there they provide accessible, affordable, and 

integrated housing for people with disabilities.226 Anecdotal evidence from the United 

States suggests these findings hold elsewhere. A resident of the integrated and 

accessible Connecticut LEC, A Common Thread Cooperative, in Manchester, 

Connecticut, observes that her co-op is cheaper than an apartment, enables her to 

influence the decisions of an active community, and allows her to participate in networks 

of mutual support among neighbors.227 She adds, “If I get in a jam, I know people I can 

call. I know all my neighbors. I know they will be there for me.”228

Penn South Cooperative, New York, New York 

Penn South Cooperative, New York, New York, is a Limited-Equity Cooperative built in 

1961 with 2,820 units, 6,200 residents, and 15 buildings spread over 20 acres. The coop is geared toward individuals with low to moderate incomes; 55 percent of co-op 

residents have gross incomes under $40,000.229 To preserve affordable rent, the co-op 

has also secured “shelter-rent” status from the city of New York, which bases property 

taxes on property income rather than value. With more than 50 percent of its residents 

over the age of 60, Penn South is also a Naturally Occurring Retirement Community 

(NORC) (see NORC, below).230 As residents began to age, the co-op set up a 

collaborative program with community agencies to provide supportive services. Now a 

separate nonprofit agency offers cultural and educational programs, case management, 

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home care services, personal care, primary health care and wellness services, and a 

variety of other supportive services. All buildings are accessible, and people with 

disabilities make individualized access modifications to their units as needed. 

Aging in Place 

The “aging in place” movement is driven by the insight that most individuals prefer to 

remain in their homes rather than move to nursing homes or other facilities as they grow 

older. A 2005 AARP nationwide survey found that 89 percent of people ages 50 and 

over want to remain in their homes as long as possible.231 Aging in place is made 

possible when individuals have access to appropriate support and services, including 

home modifications. Different models embody various aging in place ideals. All these 

models, however, recognize the preferences of people who wish to remain in their own 

homes in the context of an integrated community that mitigates social isolation and 

enables the accessibility and affordability of home care and personal assistance, house 

maintenance, shopping, and transportation. 

Prominent examples of aging in place models include the “Village” and Naturally 

Occurring Retirement Communities (NORCs). A relatively new concept, Villages are 

community-initiated, -governed, and -operated organizations designed to meet the longterm support needs of older adults in the neighborhoods where they live. The Village 

model was initiated by Boston’s Beacon Hill Village, which is creating a technical 

assistance support center in conjunction with the nonprofit NCB Capital Impact to 

support Villages throughout the nation. 

NORCs are typically defined as a geographic area, neighborhood, or building originally 

inhabited by people of all ages, which has evolved over time to contain a high 

proportion of older adults. In many NORCs, residents have collaborated with community 

service providers to develop supportive services that respond to the evolving 

requirements of aging residents. NORCs frequently provide supportive services to all 

residents regardless of income, disability, or health status. 

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Vladeck Cares/NORC Supportive Services Program, New York, New York 

Vladeck Cares/NORC Supportive Services Program is operated by the Henry Street 

Settlement, which delivers a wide range of social services to New York residents. Henry 

Street Settlement’s NORC program brings comprehensive supportive services to the 

Lower East Side community’s older residents in response to their unique needs and 

cultural diversity. Vladeck Cares serves seniors living in Vladeck House, a public 

housing project with 27 buildings and 3,000 residents, 860 of who are elderly, many with 

disabilities. 

The Vladeck Cares/NORC Supportive Services Program is a financial and cooperative 

partnership between the Henry Street Settlement and the New York City Housing 

Authority. This model brings social and health care services to Vladeck House, the first 

NORC located in public housing. Funded by the city, the State Department on Aging, 

and private sources, the program provides preventative health and social services, 

medical and health services, case management, mental health counseling, and 

educational and cultural opportunities.232 The Vladeck NORC program helps develop, 

host, and link supportive services because they increase the autonomy and 

independence of seniors living in the community. In turn, the supportive services are 

able to provide more organized and comprehensive care to the populations they serve. 

Increasing Very Low Income Housing Through the Low Income Housing 

Tax Credit (LIHTC) Program 

The LIHTC program, which is based on Section 42 of the Internal Revenue Code, was 

enacted by Congress in 1986 to provide the private market with an incentive to invest in 

affordable rental housing. Federal housing tax credits are awarded to developers of 

qualified projects, who then sell these credits to investors to raise capital (or equity) for 

their projects, thereby reducing the debt that the developer would otherwise have to 

incur. Because the debt is lower, a tax credit property can, in turn, offer lower, more 

affordable rents. 

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Provided the property maintains compliance with the program requirements, investors 

receive a dollar-for-dollar credit against their federal tax liability each year over a period 

of 10 years. The amount of the annual credit is based on the amount invested in the 

affordable housing.233 State Housing Agencies allocate LIHTCs through a competitive 

process. These agencies must develop an annual plan, called a Qualified Allocation 

Plan (QAP), for allocating the credits that is consistent with the State’s Consolidated 

Plan. QAPs establish criteria for awarding points in the competition for tax credits, and 

they tend to vary greatly across the States because they are often written to meet State 

priorities. Federal law requires that a QAP give priority to projects that serve the lowestincome families, and are structured to remain affordable for the longest period of time. 

Federal law also requires that 10 percent of each State’s annual housing tax credit 

allocation be set aside for projects owned by nonprofit organizations.234

Typically, LIHTCs have not been used to create housing for the lowest-income groups, 

including people at or below poverty level. In most States, only up to 10 percent of 

LIHTCs are targeted at people at or below 30 percent of AMI.235 That is changing, 

however. To meet a demand that outpaces the supply, some States are increasing the 

number of units for individuals whose income is at the SSI level by awarding points for 

projects that target units for those individuals. LIHTCs hold a similar promise for people 

with disabilities, including very low income and low-income people with disabilities. 

Recent nationwide financial difficulties may have affected the demand for LIHTCs, but a 

revitalized housing market should reinvigorate this lag. 

North Carolina LIHTC Development 

Stemming from cooperation between the North Carolina Department of Health and 

Human Services and the North Carolina Housing Finance Agency, the State’s QAP 

requires that all LIHTC developments must develop a Targeting Plan that reserves 

10 percent of total units for people with disabilities or homeless populations, and at least 

five units must be reserved regardless of development size.236 Furthermore, 5 percent 

of all units in new developments must be fully accessible beyond federal and State 

accessibility requirements. Also required is a memorandum of understanding among all 

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relevant parties (the developer, property manager, and local lead agencies) to ensure 

the availability of and access to supportive services and accommodations for residents. 

Further safeguards include marketing priorities and vacancy reservations for people 

with disabilities for 90 days after the units are finished. Importantly, tenancy cannot be 

conditioned on participation in these supportive services. 

Targeting units for people with disabilities within LIHTC-financed properties is a 

promising strategy for ensuring housing accessibility, affordability, integration, and the 

delinking of housing from services.237 Because North Carolina’s housing initiatives for 

people with disabilities center on LIHTCs, they remain reasonably insulated from 

fluctuating State budgets. They have also supported the construction of substantial 

numbers of affordable housing. Between 2002 and 2006, approximately 900 units with 

voluntary services for people with disabilities were funded.238 Other States have 

replicated these efforts. The Louisiana Housing Finance Agency, for example, is 

administering a tax-credit initiative for people with disabilities intended to create up to 

3,000 units of housing with voluntary services.239

Disability Organizations Advocate for Very Low Income Housing with LIHTCs 

Boston’s Disability Law Center (DLC) and nine Independent Living Centers throughout 

Massachusetts filed comments with the Massachusetts Department of Housing and 

Community Development (DHCD). These organizations called for more housing 

resources under the LIHTC program to be set aside for very low income people with 

disabilities, even though the Massachusetts LIHTC program had exceeded the national 

average by requiring that 10 percent of all LIHTC target households whose incomes are 

at or below 30 percent of the Area Median Income (AMI). DLC and the ILCs 

recommended that an additional 10 percent of the units be targeted for people with 

disabilities with SSI-level incomes (well below 30% of AMI) through project-based 

vouchers. They also called for developers who are awarded LIHTC as a result of the 

competitive process to be required to submit a plan to ensure that the additional 

10 percent of the units be made available to very low income individuals with 

disabilities. To ensure people with disabilities are integrated, the DLC and ILCs 

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recommended that Massachusetts establish a policy that calls for LIHTC projects to 

ensure integration by having no more than 15 percent of the total units in a project 

occupied by people with disabilities (absent a compelling programmatic reason to do 

otherwise). Finally, the groups called for visitability to be a threshold requirement for all 

new construction and renovation of existing housing units. 

Increasing Accessible, Integrated, Supportive Housing Through Legal 

Advocacy 

Laguna Honda Hospital Settlement, San Francisco, California 

A class action settlement in the civil rights class action lawsuit Chambers et al. v. City 

and County of San Francisco, filed to prevent unnecessary institutionalization of people 

with disabilities at Laguna Honda Hospital, promises to greatly increase communitybased housing and service options in San Francisco and improve coordination of care.

The settlement creates an innovative program to coordinate services across city 

departments, enabling San Franciscans with disabilities who live at, or are referred to, 

Laguna Honda, one of the country’s largest nursing homes, to instead receive 

community-based housing and services. Eligible individuals will be assessed for, 

referred to, and provided with subsidized housing, personal assistance, nursing care, 

case management, substance abuse treatment, mental health services, and assistance 

with meals. 

Several hundred Medi-Cal Home- and Community-Based Waiver slots, which allow 

people to receive long-term health care in their homes instead of in institutions, will be 

made available to those who qualify. Another innovative aspect of the settlement 

agreement is the development of a rental subsidy program, through which San 

Francisco will, over the next 5 years, secure and subsidize scattered-site, accessible, 

independent housing for approximately 500 people with disabilities and seniors who are 

eligible for community-based services. 

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Fair Housing and Americans with Disabilities Act Housing Access Settlements 

Based in Washington, D.C., the Equal Rights Center (ERC) conducted a survey of 

multifamily construction covered by the Fair Housing Amendments Act (FHAA) and 

ADA. The survey uncovered widespread violations by some of the largest American 

apartment and condominium developers. Several sets of surveys, reaching about 390 

properties throughout the Washington, D.C., metro area and several States, uncovered 

some form of FHAA accessibility noncompliance in 100 percent of those properties.240

Following up on this research, ERC initiated in-depth investigations into the practices of 

several prominent developers that led to a series of lawsuits and settlements. 

By using litigation and related negotiations to ensure compliance with fair housing 

regulations, ERC has effected the retrofitting for federally mandated accessibility of 

more than 20,000 units in multifamily homes throughout the United States.241 These 

legal successes have also yielded benefits beyond accessibility in a substantial number 

of homes. One of these settlements, with Trammell Crow Residential, led the developer 

to contribute $1.5 million to support ERC’s Multifamily Housing Resource Program, 

which promotes compliance with housing laws through training and education, best 

practices, and compliance monitoring. Following another settlement that resulted in the 

retrofitting of more than 2,000 units, the developer, Bozzuto & Associates, adopted 

accessibility standards in townhomes and single-family homes that go beyond federal 

requirements.242 These features draw on “aging in place” concepts and include no steps 

between areas in the same level, wide hallways and entries, accessible doorbells, 

handrails, and at least one wheelchair-maneuverable main level bathroom. Bozzuto 

committed to incorporating these features for at least 5 years in 75 percent of its upperlevel garden-style condominium units and 50 percent of its single-family homes and 

townhomes.

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Universal Design 

6 North Apartments, St. Louis, Missouri 

6 North Apartments is one of the nation’s first examples of a multifamily residential 

building featuring 100 percent universal design (UD). All 80 of the project’s one- and 

two-bedroom apartments—as well as its common spaces, coffeehouse, and live/work 

units—are fully usable by people with and without disabilities. The residential/mixed-use 

and mixed-income building is located at the corner of Laclede Avenue and Sarah Street 

in St. Louis’s central-west end. UD features incorporated at 6 North include stepless 

entries, open floor plans, adjustable countertops and shelves, and high-contrast color 

and surface texture schemes. The three-story project contains 56 percent market-rate 

and 44 percent affordable units. As of 2006 it was fully leased, with eight apartments 

currently occupied by households that include at least one disabled member. 

The project was spearheaded by Brinkmann Construction and real estate developer 

McCormack Baron Salazar. The project apartments and the concept for creating 

universal design were in the making for several years at McCormack and arose out of a 

need for affordable housing in the city and effective advocacy by Paraquad, the local 

Center for Independent Living. The $12.9 million development was funded in part by 

U.S. Bank, a $540,000 loan from the Missouri Housing Commission, and the St. Louis 

Affordable Housing Commission.243 The project was awarded the John M. Clancy 

Award for Socially Responsible Housing. 

University Neighborhood Apartments, Berkeley, California 

The nonprofit developer Affordable Housing Associates, Inc., built the University 

Neighborhood Apartments to increase affordable, accessible housing for individuals and 

families, including people with disabilities. All the apartments are designed using 

universal design principles and are fully accessible. All the units are available to 

households having 30 to 60 percent of Area Median Income, including 20 project-based 

Section 8 units and 9 units designated for households that include individuals with 

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disabilities. Fourteen of the apartments are set aside for tenants with disabilities. (See 

above for additional information about this project.) 

Universal Design and Visitability: Mandatory and Voluntary Policy 

Models 

As of January 2008, the Rehabilitation Engineering Research Center (RERC) on 

universal design, School of Architecture and Planning, at the State University of New 

York at Buffalo, reports that 37 U.S. cities have adopted either voluntary or mandatory 

requirements for some level of universal design or visitability. These policies vary widely 

in terms of the type of homes to which the policies apply, building specifications, and 

whether the requirement is triggered only when federal, State, or local subsidies are 

involved. According to RERC, 15 cities have adopted voluntary policies and 22 have 

mandatory rules. Estimates by RERC and also by Concrete Change indicate that nearly 

30,000 homes have been constructed that include visitability-related aspects of 

accessibility (e.g., zero-step entries, 32-inch-minimum interior doorways, levered 

handles, reinforced bathrooms for later grab bar installation, lowered electrical 

controls).244 Several of these policies are highlighted below. 

Concrete Change and Habitat for Humanity, Atlanta, Georgia 

Beginning in 1987, the group Concrete Change developed a principle called “basic 

home access,” later known as “visitability,” and promoted it to housing developers and 

others. The basic features of visitability include a zero-step entrance, wide interior 

doors, and a half-bathroom on the main floor.245 In 1989, Concrete Change persuaded 

the Atlanta chapter of Habitat for Humanity to include this basic access in new homes. 

By early 2006, Habitat Atlanta had built over 600 visitable houses.246 In 1992, following 

outreach efforts by Concrete Change, the city of Atlanta passed the first U.S. visitability 

ordinance, requiring basic visitability in all private single-family homes and duplexes that 

receive tax incentives, city loans, land grants, fee waivers, and/or federal block 

grants.247 Because of the ordinance, more than 600 homes have been constructed in 

Atlanta in compliance with the visitability standard as of 2002.248 Moreover, similar 

requirements have been passed in cities throughout the United States, as well as at the 

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State level in Texas, Georgia, and Kansas. Visitability standards have been successfully 

replicated because of their affordability, especially when compared to the cost of 

retrofitting, among other reasons. While visitability dramatically expands the number of 

people who can visit or live in a house, the costs at the time of construction are 

relatively small. Concrete Change estimates that a zero-step entrance on a concrete 

slab should cost around $200, with an extra $50 for expanded doors.249

Minimum Universal Design Requirements for New Construction Using Affordable 

Housing Trust Funds from the City of St. Louis 

In 2004, the city of St. Louis adopted policy to require that universal design principles be 

applied to new construction using Affordable Housing Trust Funds. All developers hire a 

registered project architect to produce detailed construction drawings prior to 

commencing construction and to oversee construction of the project. All new 

construction projects require written architectural certification at the time of application, 

at execution of the loan agreement, and at closeout by the project architect and the 

developer that the project is designed and built in compliance with universal design 

requirements. If construction begins prior to the review of the required documents, 

affordable housing funds may be revoked. The first certification requires that the project 

will be drawn and built in compliance with universal design requirements. Following the 

awarding of funds and prior to construction, the developer and architect must sign a 

second certification that includes a verification checklist.250

Design for Life Montgomery, Montgomery County, Maryland 

Design for Life Montgomery is the first voluntary certification program in Maryland for 

visitability and “livability” in single-family attached and detached homes located in 

Montgomery County. Its guidelines apply to both new construction and renovation of 

existing homes. The program features two optional standards of accessibility and is 

voluntary, following the National Association of Home Builders’ guidelines that support 

voluntary programs. New construction and renovation of existing homes are targeted by 

the program, which represents a successful informal partnership involving county, 

building, and business interests and advocates. The program is administered by the 

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county as part of the regular permitting process and is not a special process. A 

checkbox for review and certification can be found on the standard application for 

permit, and there are no additional permitting costs beyond the standard fees. 

The program started in March 2007. As of August 2008, 12 permits have been issued. 

Eight are for new construction, three for additions to existing buildings, and one for 

alteration of an existing structure. The program generally follows visitability principles 

and does not meet FHAA or ADA requirements or universal design guidelines. 

California Model Universal Design Ordinance 

Assembly Bill 2787, enacted in 2002, requires the California Department of Housing and 

Community Development to develop and certify one or more model universal design 

ordinances applicable to new construction and alterations for voluntary adoption by 

cities and counties. The department’s model ordinance identifies rooms and denotes 

features that must be offered by a builder in residential units subject to the ordinance 

that are being newly constructed or substantially rehabilitated, but are only installed if 

requested by the buyer/owner and which would not cause an unreasonable delay or 

significant nonreimbursable costs to the developer or builder. In general, the model 

ordinance provides (1) definitions for critical terms, (2) local option as to types of units 

(owner-occupied and/or rental) and number of units, and (3) specific exemptions and 

enforcement mechanisms. 

While voluntary models like A.B. 2787 and Design for Life Montgomery do not have the 

same impact as mandatory requirements, they are often important first steps, spurring 

the testing of a new concept that brings needed attention to the issue, while 

demonstrating it is both affordable and practical. They eventually contribute to the 

critical mass that is needed to generate stronger legislation or adoption of more 

comprehensive policies. 

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CHAPTER 6. Lessons Learned from National 

Emergencies Regarding the Provision of 

Accessible and Affordable Housing 

A study by the U.S. Government Accountability Office indicated that “special needs 

populations are often overlooked in planning for disaster housing assistance.”251 In 

January 2009, the Federal Emergency Management Agency (FEMA) released a 

National Disaster Housing Strategy that included consideration of people with 

disabilities—the first significant statement by the lead disaster organization on this topic. 

Efforts to address the need through policy, practice, and research are emerging, 

although most of those efforts remain to be assessed. A careful look at the issues 

associated with emergency housing is thus required. 

Key Issues 

A number of reports published by the National Council on Disability, the National 

Organization on Disability, the U.S. Government Accountability Office, and independent 

researchers indicate that certain issues recur in disaster situations for people with 

disabilities. Problems start when officials notify the public of an impending emergency. 

Described as a “hole” in the warning system, notifications concerning rapid onset of 

weather events (e.g., a tornado) usually miss people who are deaf.252 Closed captioning 

during emergencies is often not available despite Federal Communications Commission 

(FCC) policies requiring such dissemination of information. Further, notifications nearly 

always lack information for protective measures that are appropriate for people with 

disabilities.253 However, even when people are notified, evacuation planning has been 

insufficient to accommodate people with disabilities who do learn of the warning and 

attempt to leave. Accessible public transportation is limited and typically dependent on 

self-identification in advance of an event. 

Once people are in a shelter, their stay can be lengthy and traumatic. Problems stem 

from the lack of accessible and affordable temporary units, including public housing, 

rental units, and government-provided trailers. A key challenge is that rental units may 

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not have needed accessibility features. While FEMA recently established a Disaster 

Housing Portal that indicates if a unit offers basic accessibility and the U.S. Department 

of Housing and Urban Development (HUD) recently created a National Housing Locator 

System that helps people search for accessible units, these units are at times located at 

a considerable distance from one’s original location. In some disasters, the Federal 

Government may authorize mobile homes or travel trailers, which are far from ideal and 

take time to transport and place, especially if an area requires the construction of roads 

and utilities. 

Once people have been relocated into temporary units, other problems tend to arise. 

This can include proximity to accessible transportation as well as key health and social 

services during a temporary relocation, challenges faced by caseworkers in assisting 

people with disabilities into temporary or permanent housing, and the failure of most 

communities to conduct any type of pre-disaster recovery planning. Historically, few 

communities or organizations have made disabilities a key issue either before or after a 

disaster. In short, American communities are not ready to expeditiously and 

appropriately assist people with disabilities to secure emergency housing. 

The Emergency Housing Process 

Overall, the emergency housing process begins with dislocation from one’s home into 

either emergency or temporary shelter followed by moving into either temporary housing 

or (eventually) some form of permanent housing.254 

Emergency Shelter 

This phase is typically ad hoc and short lived. People may seek out locations such as 

cars, tents, or lawns to stay for a short duration before moving to a more amenable 

location. For Hurricane Katrina, those emergency shelter locations included overpasses, 

rooftops, and places like the New Orleans convention center. Such locations typically 

vary in their access to food, water, medical assistance, or personal security. Such 

circumstances can range from being places of simple discomfort to acute and lifethreatening locales for anyone, and especially so for those who are medically fragile. 

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Temporary Shelter 

The second phase provides basic amenities that include, at a minimum, food, water, 

and a place to sleep free from exposure to the elements. Two kinds of temporary 

shelters may be available: general population and special or medical needs shelter. 

Usually, emergency managers identify and announce predesignated general population 

shelter locations most commonly established by the American Red Cross. General 

population shelters usually offer shower facilities, first aid, psychological support, case 

management, and more. These locations must accept and accommodate people with 

disabilities and service animals, though reports from Hurricane Katrina suggest that this 

was problematic.255 Some areas may choose an alternative system where the Red 

Cross provides support. In Texas, for example, a shelter hub system is used under the 

State’s emergency response plan. This mass care system is managed by a designated 

liaison between voluntary organizations and the State, with support from a variety of 

health, medical, and voluntary organizations. In addition there are often ad hoc shelters 

that can vary from a local worship location that sets up cots and has congregants 

provide food to the mega-shelters established by Texas officials in large facilities to host 

massive numbers of Katrina evacuees. The abilities of ad hoc shelters to accommodate 

people with disabilities can vary widely, relying on local resources and personal 

networks. In all, staff and/or volunteer understanding of disability issues can also vary. 

Typically, less than 20 percent of the population goes to a public shelter, preferring 

instead to stay with family, friends, or in a motel, or try and remain in their own 

homes.256 People who do go to a public shelter tend to be lower income. Because 

people with disabilities tend to have lower-than-average incomes, it seems more likely 

they would go to public shelters. However, some research suggests that if people with 

disabilities do not believe shelters are ready for them, they will not evacuate when they 

should.257 

The second kind of shelter, special or medical needs, is usually opened and staffed by 

county or State agencies, coordinated and planned in advance of a disaster, and 

supported (or even operated alone) by federal agencies. Transportation to medical 

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needs shelters is provided by State or federal resources in many instances, including 

contracts with private ambulance services and even the military. For Hurricane Ike in 

2008, Gulf Coast officials worked in concert with the Federal Government and military to 

convey patients from congregate facilities and private homes to reception centers away 

from areas of risk. 

A triage system based on specific criteria is usually used to determine if the individual 

should go to a general population or medical needs shelter or on to an advanced care 

facility such as a Federal Medical Station, a nursing home, or hospital. At all shelters, 

there is an intake or registration process, which can also vary from minimal to extensive. 

Ideally, registration processes should identify the specific needs that an individual may 

have, including disabilities and related support issues. In a preplanned and wellmanaged shelter, those issues are accommodated in an appropriate manner. In reality, 

considerable gaps exist in shelters across the nation generally due to a lack of 

knowledge among shelter providers, adequate resources, and connections to disability 

organizations.258 Medical needs shelters, particularly those in areas of repetitive risks, 

have improved since Hurricane Katrina, but planning and implementation for such 

facilities ranges from nonexistent to extensive across the nation at present. 

Transitioning into Temporary or Permanent Housing 

Temporary housing is defined as housing that allows for reestablishing normal 

household routines that may include cooking, laundry, and sleeping in a safe, secure 

location.259 For people with disabilities, temporary housing may also require particular 

accommodations, such as ramps, communication devices, or kitchen counters at an 

appropriate height. Permanent housing means that no more moves are necessary. It is 

not unusual for people to move many times before finding or rebuilding a permanent 

home. To help people with the transition from shelters into temporary or permanent 

housing, a discharge process is usually recommended to identify issues that can 

impede relocation and to link the evacuee with appropriate support services. In some 

communities, a case management process may develop, although the organization and 

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delivery of such services is never guaranteed and the credentials of the case workers 

may vary considerably. 

Moving people through the sheltering stages into temporary or permanent housing is a 

time-consuming process that depends on several conditions. First, units must be 

available in the community, and must be accessible and in an environment well suited 

to the individual’s particular type of disability. It also means that resources must be 

secured to offset expenses ranging from moving to storage to the cost of a rental unit. 

While insurance companies must provide settlements to those holding policies, the 

process can take time depending on the type of disaster. To obtain government 

assistance, a Presidential Disaster Declaration must be issued. When that occurs, 

FEMA makes Individual Assistance payments to those affected. Individuals must first 

apply to the U.S. Small Business Administration for a loan. If rejected (usually because 

of income, credit history, or inability to repay), then applicants can seek a federal grant. 

In 2009, the maximum grant amount was $33,300, an amount that changes with the 

fiscal year every October 1. Grants are provided to those who meet income 

requirements; FEMA must inspect the property in question to verify the claim, often with 

little to no recourse or appeal process for the homeowner if denied. 

Federal Programs for Temporary and Permanent Housing 

Several federal agencies provide direct assistance to disaster survivors to help them 

after disasters, including FEMA, the U.S. Small Business Administration (SBA), and 

HUD. 

Federal Emergency Management Agency (FEMA) 

FEMA programs cover temporary housing (money to rent a place to live for a limited 

period of time); repair (money for homeowners to repair damage from the disaster to 

their primary residence that is not covered by insurance); replacement (money so 

homeowners can replace their home destroyed in the disaster that is not covered by 

insurance); and permanent housing construction (direct assistance or money for the 

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construction of a home but in locations specified by FEMA, where no other type of 

housing assistance is possible). 

FEMA also provides additional funds to cover costs such as medical, dental, funeral, 

and burial needs; clothing, household items, tools related to employment and some 

educational resources; fuel for heating a home; resources to clean a damaged home; 

vehicle damage due to the disaster; moving and storage; and other “necessary 

expenses or serious needs as determined by FEMA” and “authorized by law.” FEMA 

also operates a special needs desk that responds to questions regarding disabilities. 

The FEMA Office of Equal Rights exists to promote equal access to programs and 

benefits and provides both technical assistance and complaint resolution through its civil 

rights program.260 

In most disasters, FEMA is reluctant to provide trailers because they are not an ideal 

temporary solution, particularly for an individual with a disability. Still, this may be 

needed when rental property is not available. A number of issues exist with establishing 

trailers. A location with appropriate utilities and roads must exist or be created. Months 

can pass before such locations become available in even a small-scale disaster. Either 

mobile homes or smaller travel trailers may be made available. The latter are 

particularly unpleasant, as such units provide cramped conditions not conducive to 

quality of life let alone the ability to maintain independence with a disability. Along these 

lines, a serious challenge is finding sufficient accessible trailers. Five months after 

Katrina, less than 1 percent of trailers complied with accessibility guidelines. As a result 

of the settlement of Brou v. FEMA—and nearly 2 years after the disaster—1,260 

households received accessible trailers and 256 were awarded modifications.261

Furthermore, trailers have been found to contain or produce health hazards that while 

dangerous for all people, can be especially so for people with chemical sensitivities. 

Small Business Administration (SBA) 

SBA makes disaster loans available to homeowners or renters for repairs or 

replacement of “damaged real estate or personal property owned by the victim.” SBA 

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loans require that applicants have an acceptable credit history and demonstrate an 

ability to repay loans. They require collateral for loans over $14,000, and interest rates 

vary from 2.187 percent to 4.375 percent as of January 30, 2009. Home loans are 

limited to $200,000 for real estate repairs and $40,000 for personal property damage. 

Loan recipients are also required to carry insurance. 

U.S. Department of Housing and Urban Development (HUD) 

After the 2008 Gulf hurricanes and flooding across Iowa, Indiana, and Wisconsin, HUD 

granted a 90-day moratorium on foreclosures of mortgages that the Federal Housing 

Administration (FHA) had insured and encouraged that “loan services take such actions 

as special forbearance, loan modification, refinancing, and waiver of late charges.”262

Under a Presidential Disaster Declaration, HUD may allow States to use their 

Community Development Block Grant (CDBG) and HOME programs for housing 

victims. HUD also has the capacity to provide mortgage insurance under its Section 

203(h) program for disaster victims and can give local and State governments Section 

108 loan guarantees for “housing rehabilitation, economic development and repair of 

public infrastructure.” 

U.S. Department of Justice (DOJ) 

The DOJ offers support to communities damaged by disasters through its Project Civil 

Access,263 which provides technical assistance to communities to increase compliance 

with ADA and is not based on any complaints. Ultimately, the technical assistance can 

result in new codes and construction that is more accessible. Case examples after 

Hurricane Katrina (Mississippi and Louisiana) and a toolkit can be found at the Project 

Civil Access Web site. 

Rebuilding Permanent Housing 

Even more challenges exist for those seeking to rebuild their homes. Depending on the 

extent of the disaster, it may be extremely difficult to secure the key resources needed 

to rebuild. From permission to rebuild through securing funding, contractors, 

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subcontractors, labor, and supplies, the rebuilding process is cumbersome and 

exhausting for anyone. For a person with a disability, particularly a senior citizen, the 

rebuilding process may be too daunting. The loss of community, social networks, and 

home associated with a disaster and having to face the rebuilding may mean that a 

person cannot return home. 

When a community experiences a disaster, local officials typically act to improve the 

quality and disaster resistance of local housing. Doing so takes planning and time to 

implement, which can delay the reconstruction process. In a large-scale disaster, the 

delays can be considerable as local, State, and federal officials conduct assessments to 

determine recommendations. Contractors, subcontractors, voluntary organizations 

providing labor, and building inspectors all must become familiar with new codes and 

ordinances, and the local offices responsible for implementing and monitoring the new 

procedures must take on additional work. People must come to understand how this 

system works, which is often a new, confusing experience for those now facing 

reconstruction. Although the anticipated outcome is desirable, the time and personal 

cost to someone with a disability living in a temporary situation can be burdensome. 

Renters remain dependent on building owners to reconstruct their properties. Building a 

multistory unit takes considerably more time than a typical single-family unit. People 

living in public housing may have several options. If availability exists, they can relocate 

to a new unit or another location can be approved by the local housing authority. 

For homeowners, insurance is the key to recovery. However, insurance remains 

expensive and in some areas, such as earthquake and hurricane zones, coverage may 

be prohibitively expensive, especially for those at low incomes. In either case, 

policyholders’ coverage may be insufficient to cover the current cost of rebuilding. If a 

Presidential Disaster Declaration is issued, the homeowner may qualify for either an 

SBA loan or a grant from FEMA. However, few programs specifically target the kinds of 

rebuilding needs associated with disabilities. Some additional funds may be available 

for disability concerns, but disaster survivors report they must aggressively pursue 

those funds. Regardless, the FEMA Individual Assistance amount is assumed to be 

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supplemented by personal insurance and personal funds. These assumptions, coupled 

with the realities of living at lower incomes, mean that many people with disabilities face 

considerable trouble in rebuilding. 

To assist, a long-term recovery committee often forms in disaster-stricken communities. 

Such a committee can take the place of a formal planning unit with elected or appointed 

officials and/or representatives, or it may evolve from an interfaith group of faith-based 

organizations. Most such entities tend to bring in voluntary organizations and labor 

teams to rebuild homes. These voluntary organizations usually work within the case 

management system described earlier to target the homes of those with low incomes, 

senior citizens, single parents, and people with disabilities. Faith-based voluntary 

organizations are often the key to helping people return home, as they provide labor, 

expertise, and resources to rebuild cost effectively. Such organizations, though, may 

require some guidance and advice as they rebuild, so that they incorporate accessibility 

into the projects. Contractors and subcontractors may also need guidance. Some 

communities offer housing fairs to encourage various kinds of rebuilding, including 

green rebuilding and energy-efficient designs. However, such events typically fail to 

offer insight into universal design, ADA compliance, or accessibility features. Project 

Civil Access mentioned earlier, which links federal technical assistance to State and 

local government on access issues, can provide a means to do so. 

Further, local commitment to the permanent housing process can vary in regard to 

accessibility and affordability. Although affordable housing remains a concern across 

the nation, few communities specifically plan for post-disaster housing, let alone taking 

into consideration issues of affordability or accessibility. However, the city of 

Watsonville, California, did so in 1989 after the Loma Prieta earthquake, by passing an 

ordinance that requires 25 percent of all new housing to meet standards for 

affordability.264 Communities facing disaster could do the same by adding elements to 

their recovery plans that emphasize accessibility and affordability. ADA standards 

beyond basic levels could be mandated, and universal design elements could be 

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required as part of building codes. Disaster represents not only an unfortunate 

circumstance; it is also an opportunity for change. 

Congregate Care and Group Locations 

Little is known about the reconstruction process for larger facilities, which tend to be 

privately owned and are usually covered by sufficient insurance. It is fairly clear that 

facilities owned by larger chains are more likely to be able to relocate their residents. 

Smaller, independent facilities face considerable challenges from evacuation to 

relocation. While many plan for evacuation, just as many fail to drill or to think through 

the consequences of long-term or permanent relocation.265 In one creative response for 

temporary housing, an effort in Santa Cruz, California, relocated residents who were low 

income, elderly, and/or with disabilities from a downtown, earthquake-damaged hotel 

into a vacant nursing home facility for nearly 2 years.266 A local day care provider for 

adults with dementia served as the facility administrator with support and funding from 

local social services and FEMA. Some permanent housing solutions for the population 

included moving back in with family or to an assisted living or nursing home facility. 

After Katrina, Louisiana and Mississippi social workers also reported a similar pattern. 

Individuals who could not return to their facilities or their homes moved into congregate 

care locations either by choice or not. 

Risk Mitigation 

Ideally, reconstruction allows for mitigation of the risk that prompted relocation. 

Mitigation may include either structural or nonstructural measures. Structural measures 

might allow for elevations, (re)building levees, hurricane lamps, shutters, or safe rooms. 

Nonstructural measures include building codes, insurance programs, and public 

education. Structural mitigation measures have not been assessed for their impact, 

positive or negative, on people with disabilities. Presumably, mitigation would reduce 

risk for them, too. However, some mitigation efforts, such as creating new standards for 

building elevations, have been critiqued as displacing people with disabilities 

permanently from their homes, if the new standards make it difficult to make housing 

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accessible. Existing codes and plans for large-scale safe rooms usually fail to address 

accessibility issues.267 In Mississippi after Katrina, some social workers reported that 

some residents felt compelled to move into congregate care facilities, thus losing their 

independence. A few elevations along the Louisiana coast after Hurricane Andrew 

(1992) included elevators so that people could return to their home communities. 

Ramps may also provide access, but organizations involved in rebuilding may require 

education and resources to provide these features. At present, federal programs do not 

provide funds specifically for disability mitigation needs. Some funds may be added to 

an SBA loan for mitigation purposes, although this information is not widely advertised. 

A nonstructural mitigation measure that has been attempted, particularly in areas of 

repetitive flooding, is relocation. In a relocation, also called a federal buyout, the Federal 

Government can offer fair market value for a home. Yet, relocation buyouts can still be 

difficult for the individual, because moves undermine established relationships, 

resources, and services that may be critical to independence. Relocation efforts must 

be worked out in the context of potential impacts such programs can have on people 

with disabilities. Successful relocation efforts integrate the needs of an individual with a 

disability in the relocation planning process. The individuals, their advocates or 

representatives, and those providing the relocation must negotiate a new environment 

thoughtfully. Ideally, relocation will afford greater safety and allow the resident to remain 

in a set of social, economic, and health care relationships that allow that individual to 

retain or return to his or her original quality of life. 

Promising Practices 

Several principles should undergird efforts to strengthen emergency housing. First, 

forethought and planning for disabilities and special needs should serve as the main 

strategy for emergency housing. Second, to help planners and those involved in all 

aspects of emergency housing identify problems and address solutions, people with 

disabilities, disability organizations, and advocates should be actively involved. Third, 

resources must be made to support these recommendations. 

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Much of the progress made in the promising practices below derives from two sources: 

post-Katrina legislation drove changes in awareness and prompted the creation of 

guidance and planning materials, while community and organizational initiatives have 

proved to be important agents of change. 

A Functional Model 

Historically, disabilities have been viewed as a limitation and have been “treated” with 

some type of remediation that is often medical in nature, such as referring people with 

disabilities to special needs or medical shelters rather than providing accommodations 

in general population shelters. A functional approach to special needs looks at specific 

assistance that is required centering on communication, medical needs, independence, 

supervision, and transportation, also called the C-MIST model.268 Special needs groups 

may include people with disabilities but also individuals with morbid obesity, higher-risk 

pregnancies, in need of kidney dialysis or other critical support, or those lacking 

transportation. The diversity that exists across disabilities means that while some may 

require C-MIST assistance, many others will not. The implications for emergency 

housing are significant: planning for a variety of communication needs; screening for 

functional independence needs; training staff and volunteers to supervise people with 

dementia, disorientation, and other conditions in either general population or special 

needs shelters as deemed appropriate; and providing accessible transportation. The 

functional model serves as a means to identify and address issues associated with 

those at highest risk but also provides a lens to think through what is truly needed in all 

types of emergency housing. 

U.S. Department of Justice Guidance for Emergency Shelters 

DOJ has created a useful set of materials in the ADA Best Practices Toolkit for State 

and Local Governments that provide guidance for shelters and rely implicitly on the 

functional model. The documents include why people with disabilities should be 

accommodated in general population shelters, descriptions of ways to provide such 

accommodations, and checklists for planning purposes. While these documents can be 

used at the local, State, regional, and national levels by any entity involved in sheltering, 

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it is not known how influential and extensively these materials are either known or 

utilized. 

Search Tools 

Internet-based search tools provide a resource for both individuals and case managers 

to search for suitable emergency housing. The U.S. Department of Housing and Urban 

Development initiated a National Housing Locator System as a result of Hurricane 

Katrina and implemented it after the 2007 California wildfires.269 To help evacuees after 

Hurricane Ike, HUD’s National Housing Locator System (NHLS) was supplemented with 

government and local databases. The NHLS required those listing rentals to comply 

with the Fair Housing Act and to make reasonable accommodations for people with 

disabilities.270 Similarly, the U.S. Access Board initiatives include links and information 

for accessible housing after a disaster. A key link is to the National Network of ADA 

Centers that was used after Hurricane Katrina.271 In a related vein, FEMA has created a 

National Housing Portal to assist people with finding suitable post-disaster homes.272

The portal allows for basic and advanced searches by State, county, city, ZIP code, 

number of bedrooms, and cost. The advanced search allows a user to look for 

accessible units, although detailed information on the nature of that accommodation 

may not be provided. 

U.S. Department of Housing and Urban Development 

HUD’s participation in disasters has varied over the past 30 years, focusing on both 

temporary and permanent housing. Specifically, the Department: 

● Administers two mortgage insurance programs, which assist disaster survivors 

in purchasing, renovating, or rebuilding housing. 

● Administers an insured housing rehabilitation loan program. 

● Makes its foreclosed housing portfolio available for purchase by disaster 

survivors at a discount in areas affected by a declared disaster. 

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● Provides annual grants (grants through supplemental appropriations may also 

be available) that may be reprogrammed post-disaster (Community 

Development Block Grant and HOME Investment Partnerships Program) to 

local, county, and State governments that would directly assist eligible 

recipients to purchase, rehabilitate, or construct housing. 

● Provides a 90-day moratorium on the repayment of FHA-insured mortgages for 

homes damaged in a declared disaster area. 

● Encourages private mortgage lenders to take special forbearance, loan 

modification, refinancing, and waivers of late charges on loans they hold. 

HUD’s efforts in New Orleans post-Katrina included the Road Home small landlord 

rental program, which used Community Development Block Grants (CDBGs) to provide 

landlord incentives. Those who rebuild using the funds must maintain units at affordable 

prices for up to 5 years, which qualifies the landlord for loan forgiveness. HUD also 

offers the Disaster Housing Assistance Program (DHAP), which provides for the public 

housing authority to pay landlords a Fair Market Rent (FMR) for 6 months. Thereafter, 

the tenant pays $50 of the rent, an amount that increases $50 monthly until the full rent 

is being paid or the renter leaves the program. The Disaster Voucher Program transfers 

those in Section 8 or the Housing Choice Voucher program to other housing authorities 

where housing is available. 

Mortgage and Rental Relief 

The Mortgage and Rental Assistance Act of 2007 served to help people keep their 

homes under the duress of a disaster event. The intent of the legislation was to 

reinstate the funds after a revision of the Stafford Act dropped the program. Eligibility is 

income based, although exceptions can be made in areas with high costs of living.273 In 

addition, FHA under Section 203(h) offers insurance that protects lenders of qualified 

disaster victims. The intent of the program is to support those with low and moderate 

incomes and is limited by HUD by amount, home type, and location.274

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FEMA Comprehensive Planning Guide 

FEMA is creating a series of Comprehensive Planning Guides (CPGs) that includes 

CPG-301 (Emergency Management Planning Guide for Special Needs Populations) 

and CPG-302 (State, Territorial, Tribal, and Local Government Household Pets and 

Service Animals Plan). The current sheltering and mass care section describes basic 

guidelines for shelters and refers users to DOJ and FEMA Office of Equal Rights 

guidance materials. A shorter section indicates that jurisdictions should provide 

communication services to assist people with special needs through the disaster 

assistance application process and that “accessibility of both temporary and permanent 

housing is crucial. Timely allocation of adequate stock of accessible housing safeguards 

against individuals with disabilities (e.g., physical impairments) having to remain in a 

shelter environment longer than others or being inappropriately relocated to a 

congregate setting.”275 The document indicates that housing provided through 

government sources must comply with the Fair Housing Act and “meet physical 

accessibility requirements.”276 CPG-301 also recommends that recovery planners 

involve special needs populations and use the recovery as an opportunity to meet 

accessibility requirements. 

CPG-302 resulted from Katrina experiences, particularly the unwillingness of people to 

evacuate without their pets. This observation prompted Congress to pass the Pets 

Evacuation and Transportation Standards (PETS) Act in 2006. The intent of CPG-302 is 

to aid jurisdictions to plan for and evacuate both pets and service animals. A FEMA fact 

sheet indicates that content will discuss integration with the National Incident 

Management System as well as planning principles and strategies for household pet 

and service animals. 

National Disaster Housing Strategy 

In January 2009, FEMA approved a National Disaster Housing Strategy.277 Sections 

specifically address disability issues, including building partnerships to assist in the 

evaluation and identification of special needs; compliance with Section 504 and ADA for 

shelters and Fair Housing Act regarding housing; and working with local groups and 

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organizations to find accessible interim housing. A National Disaster Housing Joint Task 

Force is to be convened to enhance existing outreach programs by involving disability 

organizations, and State-led Disaster Housing Task Forces should also be convened to 

do the same. While this represents an important step forward in a national commitment 

to people with disabilities affected by disaster, it also makes equally clear that although 

existing disaster assistance programs apply to everyone, there are no standalone 

disaster housing programs specifically for people with disabilities. 

Concerns About Federal Guidance 

At the January 2008 National Council on Disability Quarterly Meeting, participants 

raised public comments about the guidance materials and new criteria for special needs 

planning. The main concerns centered on a lack of funds or resources available to 

implement the planning recommendations and that “the worry is that local jurisdictions 

are being set up to fail and not meet new criteria.” A related critique of the National 

Response Framework, which includes ESF#6 Mass Care (shelter) and ESF#14 

(recovery), did not “provide clear direction to the States and local jurisdictions about 

how to operationalize the concepts.”278 

FEMA Disability Coordinator(s) 

The 2006 Post-Katrina Emergency Reform Act (PKEMRA) allowed for the appointment 

of a Disability Coordinator to assist with and support issues related to disabilities in 

disasters. The FEMA position was posted and filled in 2007. The Disability Coordinator 

position is situated in the FEMA Office of Equal Rights. Since then the Disability 

Coordinator has been onsite for multiple disasters and continues to provide guidance on 

disability issues before, during, and following a disaster. In December 2008, the FEMA 

National Advisory Council (NAC) recommended the creation of Regional Disability 

Coordinator positions for each of the 10 FEMA regional offices, to serve as useful 

liaisons between State and federal levels and increase personnel available to 

coordinate and support outreach to victims with special needs. This proposal has been 

supported in March 2009 testimony before the U.S. House Subcommittee on 

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Emergency Communications, Preparedness and Response, and the National Council 

on Disability report issued in August 2009. 

Voluntary and Community Organizations and Advocates 

As noted at the January 2008 NCD Quarterly Meeting in New Orleans, a number of 

local, State, regional, and national organizations and advocates were critical in dealing 

with emergency housing after Hurricanes Katrina and Rita. This includes sharing 

information, case management, even helping to expedite rebuilding accessible housing 

since so little existed before the disaster. Local organizations have also stepped in to 

advocate for and empower disaster survivors with disabilities to find housing 

themselves. And since housing resources are so scarce, voluntary and community 

organizations and advocates that already focus on low-cost affordable housing 

development, including faith-based groups, have proven critically important. Without 

their free labor, construction expertise, and commitment, many people with disabilities 

would never be able to return home again.

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CHAPTER 7. Recommendations 

The following recommendations derive from the findings presented in this report and the 

five detailed briefs that were produced on specific topics (see NCD Topical Briefs 1–5). 

Many are cross-cutting and have been organized thematically. Others are narrowly 

focused on specific issues, including changes in how States implement and respond to 

federal policy; how local providers of housing for people with psychiatric disabilities 

operate programs; and how people with disabilities are accommodated in disasters and 

emergency housing. A crosswalk follows that links specific recommendations by theme 

back to the topical brief(s) for more in-depth analysis. 

Recommendations by Theme 

1. Increase affordable, accessible, and integrated housing for people with 

disabilities to meet needs and demand. 

The most pressing need for people with disabilities is affordable housing. This 

need, which is evident in the number of people with disabilities who are 

homeless, have worst-case housing needs, or just cannot afford their housing, 

can be met with new housing construction, rehabilitation of existing units, and by 

increasing Housing Choice Vouchers. While each requires additional funding, 

there are several sources being considered in Congress that can be tapped 

immediately once legislation is enacted. This includes H.R. 1675, which will 

increase production in the Section 811 program from 800 to 900 units a year to 

3,000 units annually. Another source is to pass legislation that fully funds the 

National Housing Trust Fund. Funding can also come from shifting resources 

expended on board and care homes, nursing facilities, and psychiatric hospitals 

to housing programs that maximize client choice and community integration. 

 More units can also result from requiring more accessible units in new 

developments. This includes significantly increasing the minimum percentage 

that Section 504 of the Rehabilitation Act currently requires in all federal housing 

and encouraging all new federally funded development to be visitable, including 

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for people with environmental sensitivities. Congress should modify the Internal 

Revenue Code so that Low Income Housing Tax Credit properties are 

considered recipients of federal funding and hence are obliged to comply with 

Section 504. Along these lines, States should adopt policies that award points 

under the Low Income Housing Tax Credit program for projects that (1) target 

housing units for people with disabilities whose incomes are either at the SSI 

level or at less than 30 percent of average monthly income for the area; (2) 

include visitability features in all projects; (3) include universal design principles 

in all designs; and (4) ensure integration by limiting the total units in a project 

occupied by people with disabilities to 15 percent, unless there exists a 

compelling reason to do otherwise. 

2. Increase access to existing units.

In addition to developing new units, another means to meeting housing needs is 

by opening up and making available existing federal housing currently not 

accessible to people with disabilities. Many people with disabilities are denied 

accessible housing simply because of program definitions and targeting. HUD 

and UDSA can change this by reforming their existing programs to be universally 

designed to accommodate all people with disabilities regardless of age or type of 

disability. This would require reframing programs so that people with disabilities 

are no longer narrowly defined as “special needs” and instead, all programs, 

services, and activities are made accessible and available to people with different 

types of disabilities, including people with environmental sensitivities. At the 

same time, HUD should incentivize PHAs to set local preferences to give people 

with disabilities “preference” on all waiting lists for housing, including people in 

institutions, and verify that PHAs are meeting the minimum 504 requirements in 

all its housing. 

3. Prevent further loss of affordable, accessible housing. 

This should be a goal for all communities and States in general; however, 

specific changes in national policy could help further this goal. Congress should 

review current public housing redevelopment plans to make sure sufficient 

accessible replacement units are planned for and provided, and, if not, place a 

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moratorium on plans requiring demolition and/or redevelopment until plans are 

revised. Congress should also pass new HOPE VI legislation that requires more 

replacement units than under the previous program. 

Housing Choice Vouchers provide the most flexible form of housing assistance 

for renters and even homebuyers. While not a substitute for permanent 

affordable universally designed and integrated housing, vouchers present the 

most potential for helping people with disabilities find accessible housing in a 

livable community. Congress must increase Housing Choice Voucher funding 

targeted at people with disabilities. Furthermore, Congress and the President 

should develop a permanent “Barrier Elimination Trust Fund” (BETF) for 

accessibility modifications for people transitioning out of institutions, including 

nursing homes and group homes, and those at risk of institutionalization. Funding 

for the BETF could come from fines for failure to comply with Section 504 and 

Fair Housing Amendments Act requirements. HUD should provide incentives to 

increase use of HOME funds for rental assistance for people with disabilities, and 

especially those who are leaving institutions. 

 Before appropriating annual funds for all Mainstream and Designated Vouchers 

for people with disabilities, Congress should make sure that all vouchers funded 

through these programs in the past that had been converted to regular Housing 

Choice Vouchers (i.e., not specifically for people with disabilities) are 

recommitted to people with disabilities. Also, Public Housing Agencies should 

participate in HUD-approved programs to assist low-income people with 

disabilities to pursue homeownership using Housing Choice Vouchers as one 

source of funding. 

5. Improve fair housing enforcement of disability rights.

Changes are needed within HUD to expand and improve local fair housing work 

to prevent and mitigate discrimination and to reduce the time cases filed by 

people with disabilities remain open. This includes providing regular mandatory 

training to educate all HUD and Fair Housing Act enforcement offices to be 

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consistent in interpretation of the laws guiding accessibility of new development 

and rehabilitation, including Section 504, FAIR HOUSING ACT, and ADA.279

HUD should work with the U.S. Access Board to adapt a single design standard 

for new construction that harmonizes 504 and the Fair Housing Act with the 

ADA/ABA Accessibility Guidelines and model building codes to minimize 

differences with State and local accessibility codes. 

 HUD should also require enforcement offices to coordinate with disability rights 

organizations/groups and to partner with the disability community to develop 

testing, education, and enforcement strategies focused on disability rights and 

housing. Congress also must increase funding to ensure enforcement of the Fair 

Housing Act’s accessibility requirements, including more resources for staff in 

field offices, for contracted fair housing organizations, and for litigation work. 

Along these lines, HUD should produce a follow-up study to its 2005 Disability 

Discrimination Study. A report on activities since the 2005 study can encourage 

additional, comprehensive disability-based testing and support future disabilityrelated enforcement and education. 

6. Review HUD and PHAs for compliance with Section 504 and the Fair 

Housing Act.

If federal agencies want private sector developers to comply with fair housing 

requirements, then the federal housing stock should be in compliance. HUD, over 

the next 5 years, should evaluate all PHAs for compliance with Section 504 and, 

as appropriate, enter into Voluntary Compliance Agreements with them, and take 

enforcement action for noncompliance. The same should be done in HUD field 

offices. HUD should also provide regular comprehensive training for staff in 

PHAs and field offices, as well as fair housing contractors, on fair housing for 

people with disabilities, including providing accommodations. 

7. Support and enact new legislation.

Besides H.R. 1675 (see above, recommendation 1), there currently are several 

bills in need of immediate support from Congress that can directly impact 

housing for people with disabilities as highlighted in this report. This includes the 

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Inclusive Home Design Act (H.R. 1408) that will ensure a basic level of 

accessibility (i.e., visitability) in all housing built with federal funds that are not 

covered by the Fair Housing Act, and the Community Choice Act to ensure least 

restrictive housing choice and control and equitable provision of supports and 

services to enable real choice. In addition, Congress should also amend the 

Assets for Independence Act (P.L. 105–285) to specifically include people with 

disabilities among the target populations. Finally, in broad terms, any new 

legislation dealing with housing and economic recovery should include, to the 

extent possible, specific requirements and guidance for maximizing benefits to 

people with disabilities. 

8. Adapt and implement new federal guidance on helping people with 

disabilities in an emergency. 

So much has been learned from the catastrophic disasters in the last few years. 

A key to moving forward is adapting and implementing new guidance from the 

Federal Government found in the 2009 National Disaster Housing Strategy, 

which has sections that specifically speak to disability issues. Moving this 

forward, the Federal Emergency Management Agency should publish as soon as 

possible the Emergency Management Planning Guide for Special Needs 

Populations (CPG-301) and State, Territorial, Tribal, and Local Government 

Household Pets and Service Animals Plan (CPG-302), and provide resources to 

publicize, train, and implement plan elements at the State and local levels. In 

addition, State and local disaster planning entities should review its various 

reports and seek input from people with disabilities in all phases of planning. 

9. Develop cross-system coordination and collaboration.

This recommendation is multifaceted and needs attention at all levels to ensure 

continued progress on providing more effective housing and community support 

for people with disabilities and our aging population. The key is bringing together 

public and private entities such as HUD, State and local housing agencies, 

private foundations, and housing referral and advocacy organizations to form a 

partnership to establish and fund a new disability and housing technical 

assistance initiative. Concurrently, CMS and HUD should build on current work 

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together through its HUD–HHS partnership. This includes examining current 

policies, regulation, and funding requirements to improve cross-system 

coordination with the intent to ensure timely, quality access to accessible, 

affordable, and integrated housing and community living supports by people with 

diverse disabilities across their lifespan, including people who are homeless or 

choose to move out of institutional settings to the community. This should include 

expanding cross-agency funding of Money Follows the Person and Community 

Choice systems change demonstration projects to focus on cross-system, 

coordinated delivery, and funding of housing and community living supports in 

States, and especially in those that have not shown significant progress in 

rebalancing funding to address institutional bias. This should also include 

implementation of No Wrong Door quality, consistent information access 

regardless of type of disability, age, or system entered. 

10. Change systems at the State level.

Much of the coordination and collaboration needed to change systems and 

increase affordable, accessible housing for people with disabilities needs to 

happen at the State level. A key here is to identify and eliminate barriers to 

coordination and systems change. This should begin by the National Conference 

of State Legislatures collaborating with national disability and aging advocacy 

organizations to convene a task force to examine federal policies to support 

cross-system delivery of housing and community living supports within States, 

and make it easier for States to provide these in a timely fashion. This can 

include requiring nursing homes and institutional settings to provide periodic 

reevaluation and meaningful transitional planning to support people with 

disabilities’ right to choice and to support transition to community living in a timely 

manner. Also, jails and prisons should be required to provide meaningful 

discharge planning that helps prisoners with psychiatric disabilities identify and 

apply for quality supportive housing prior to release, to minimize recidivism and 

maximize successful transition to independent living in the community. Similarly, 

probation services should help people with psychiatric disabilities obtain stable 

146
supportive housing and support services that foster independence and 

meaningful participation in community life. 

 State and local disability organizations should actively participate in HUD’s 

Consolidated Planning process in order to help expand homeownership and 

affordable rental housing for people with disabilities. These organizations should 

also share best practices—many documented in this report—to demonstrate how 

others can develop integrated least restrictive housing options. 

11. Provide guidance for housing programs for people with psychiatric 

disabilities. While specific policy change to affect housing for this population is 

needed, more discussion, debate, and research are also needed. In the interim, 

the following strategies may make housing less restrictive and more integrated 

for people with psychiatric disabilities: 

● Prospective tenants should participate in choosing their housing, and such 

choice should be preceded by a meaningful opportunity to observe and 

understand what is being offered and resolve any concerns they may have. 

People who prefer not to live in such housing should not be forced to do so. 

● Housing must be offered without being tied to treatment or use of supports as 

a condition of obtaining or maintaining housing. Lease compliance should be 

the only criterion for maintaining housing.

● Housing providers must self-assess to determine that people with psychiatric 

disabilities are entitled to the legal protections offered all tenants.

● Brief absences should be tolerated without loss of housing, and program staff 

should stay in close touch with tenants and landlords to maximize the 

chances that tenants will return to their homes.

● Tenants should be offered individualized, flexible support services that are 

available 24 hours a day, 7 days a week. 

● Whenever possible, housing and support services should be staffed by 

people who have themselves recovered from mental illness. For programs 

that serve tenants with both psychiatric disabilities and substance abuse 

147
problems, staff should include people who have recovered from drug and/or 

alcohol abuse.

● Program staff should be responsive to concerns from property managers, 

landlords, and neighbors, and intervene promptly to resolve tenancy problems 

to help tenants avoid eviction.

● Program staff, tenants, and landlords should be educated about fair housing 

rights and responsibilities, with emphasis on the right to reasonable 

accommodation. Housing staff should have formal backup support from fair 

housing attorneys for training, advice, and help in resolving disputes. 

12. Improve the data on people with disabilities and housing needs. Understanding 

needs and monitoring progress toward meeting those needs requires reliable and 

credible data. Congress and the Administration should develop initiatives to produce 

effective data on housing needs of people with disabilities, including people with 

environmental sensitivities (chemical and/or electromagnetic), psychiatric disabilities, 

and other disabilities that are currently not accounted for in housing need. HUD and 

USDA should produce an annual report on occupancy of their accessible units to 

determine if these units are actually occupied by people who need accessible 

features. HUD should improve its Worst-Case Housing Needs estimates by using 

data from the American Community Survey and Survey of Income and Program 

Participation (SIPP) to address the dearth of disability data available in the Annual 

Housing Survey. Congress and HUD should require inclusion of people in group 

quarters (i.e., correctional facilities, nursing homes, mental hospitals, college 

dormitories, military barracks, group homes, and shelters) in estimating worst-case 

needs and other assessments, including people with disabilities. 

148
Crosswalk for Specific Recommendations 

The following table identifies the topical brief(s) to refer to for more background 

information on each recommendation. Reports are identified by number: 

1. Federal Evaluation 

2. Private and Nonprofit Sector Housing 

3. Mental Health Issues—Housing for People with Psychiatric Disabilities 

4. Homeland Security and Emergency Housing Evaluation 

5. State Evaluation 

Table 2. Recommendations and Corresponding Topical Briefs 

1. Increase affordable, accessible, and integrated housing for people 

with disabilities to meet needs and demand. Brief 

HUD and USDA should require that a higher percentage of affordable 

housing constructed with federal funding be accessible for people with 

disabilities as allowed at 24 C.F.R. 8.22 of Section 504 of the Rehabilitation 

Act. 

1 

Congress and the President should substantially increase funding for 

construction of accessible, affordable, integrated housing. This should 

include fully funding the National Housing Trust Fund to ensure very low 

income renters are assisted. 

1 

Congress and the President should enact and immediately implement H.R. 

1675. 

1, 2, 5 

HUD and USDA should award incentives in all new Notices of Funding 

Availability (NOFAs) to encourage visitability features, including for people 

with environmental sensitivities, in all housing funded. 

1 

Congress should redirect federal housing and treatment funds from board 

and care homes, nursing facilities, and psychiatric hospitals to housing first 

programs that maximize client choice and community integration. 

3, 5 

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Table 2. Recommendations and Corresponding Topical Briefs (cont’d)

2. Increase access to existing units. Brief 

Reform existing HUD programs to end the definition of people with disabilities 

as a “special needs” category and make all programs, services, and activities 

accessible to people with different types of disabilities, including people with 

environmental sensitivities. 

1, 2, 3, 5

HUD should incentivize Public Housing Agencies (PHAs) to set local 

preferences to give people with disabilities “preference” on all waiting lists for 

housing, including people with disabilities in nursing homes. 

1 

HUD should make sure all PHA housing meets the minimum Section 504 

thresholds, including all new HOPE VI developments and redeveloped public 

housing. 

1 

HUD and USDA must make sure publicly subsidized housing for people with 

disabilities is offered without being tied to treatment or use of supports as a 

condition of obtaining or maintaining housing. Lease compliance should be 

the only criterion for maintaining housing. 

1, 2, 3 

HUD should establish a well-funded national modification fund to pay for 

reasonable modifications that are necessary to make private units accessible 

(or at least usable by people with disabilities). This can include strongly 

recommending that entitlement communities direct a portion of their CDBG 

funding to modification activities as a means of complying with affirmatively 

furthering fair housing opportunities for people with disabilities. 

1, 5 

States should adopt policies that award points under the Low Income 

Housing Tax Credit program for projects that (1) target housing units for 

people with disabilities whose incomes are either at the SSI level or at less 

than 30 percent of average monthly income for the area, (2) include 

visitability features in all projects, (3) include universal design principles in all 

designs, and (4) ensure integration by limiting the total units in a project 

occupied by people with disabilities to 15 percent, unless there exists a 

compelling reason to do otherwise. 

1, 5 

Congress should modify the Internal Revenue Code so that LIHTC properties 

are considered recipients of federal funding and hence are obliged to comply 

with Section 504 of the Rehabilitation Act. 

1 

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Table 2. Recommendations and Corresponding Topical Briefs (cont’d)

3. Prevent further loss of affordable, accessible housing. Brief 

Congress should review current public housing redevelopment plans to make 

sure sufficient replacement units are planned for and provided; if not, then a 

moratorium on demolition and/or redevelopment should be issued until plans 

are revised. 

1

Congress should pass new HOPE VI legislation. 1 

4. Expand and focus usage of vouchers. Brief 

Congress must substantially increase Housing Choice Voucher funding 

targeted to people with disabilities. 

1, 2, 3, 5

Congress, before appropriating annual funds for all Mainstream and 

Designated Vouchers for people with disabilities, should make sure that all 

vouchers under both programs are committed to people with disabilities. This 

includes any vouchers that may have been turned into regular Housing 

Choice Vouchers. 

1, 2, 3, 5

HUD should recommend and provide incentives to increase the use of HOME 

funds designated as Tenant-Based Rental Assistance for use by people with 

disabilities, and especially for people who are leaving institutions. 

1, 2, 3, 5

Congress and the President should create new “reintegration” housing 

vouchers for people transitioning out of institutions, including nursing facilities 

and group homes, annually for a fixed period. This requires HUD and the 

Centers for Medicaid and Medicare Services (CMS) to work together to make 

sure that these vouchers go to people, regardless of type of disability or age, 

living in nursing facilities and other institutions. This cooperation has begun 

with implementation of the Money Follows the Person demonstration program 

but needs to be vastly expanded. 

1, 2, 3, 5

Congress and the President should develop a permanent “Barrier Elimination 

Trust Fund” (BETF) for accessibility modifications for people transitioning out 

of institutions, including nursing homes and group homes, and those at risk of 

institutionalization. This fund should be increased annually using the 

Consumer Price Index. Funding for the BETF could come from fines for 

failure to comply with Section 504 and Fair Housing Amendments Act 

requirements. 

1, 2 

HUD should strongly encourage Public Housing Agencies to develop 

programs that use Housing Choice Vouchers to assist low-income people 

with disabilities to purchase homes. 

2 

151
Table 2. Recommendations and Corresponding Topical Briefs (cont’d)

5. Improve fair housing enforcement of disability rights. Brief 

Congress must increase funding for HUD’s Fair Housing Initiatives Program 

(FHIP) to expand enforcement of the provisions of the Fair Housing Act as 

amended, including accessibility requirements, and to extend FHIP grant 

periods to 2 or more years. 

1, 5 

HUD should provide mandatory training to educate all HUD and Fair Housing 

Act enforcement offices and contractors so they can be consistent in the 

interpretation of the laws guiding federal accessibility requirements. 

1, 5 

HUD should convene a small working group, including design and 

construction professionals and people with disabilities, to explore the 

feasibility of developing a single design standard for new construction under 

the Fair Housing Act that would be harmonized with all other federal 

accessibility guidelines (ADAAG), ABA, 504) and model building codes, to 

help eliminate conflicts with other federal standards and minimize differences 

with State and local accessibility codes. 

1, 5 

HUD should encourage consumer-directed organizations (e.g., Centers for 

Independent Living) to apply for FHIP funding under the education and 

outreach category. 

1, 5 

HUD should dramatically ramp up its enforcement of Section 504 of the 

Rehabilitation Act by providing more resources (funding and staff) to field offices, 

and by requiring enforcement offices and fair housing contractors to coordinate 

with disability rights organizations/groups and to partner with the disability 

community to develop testing, education, and enforcement strategies. 

1, 5 

HUD should proactively disseminate information to all field offices and fair 

housing contractors about “best practices” with regard to disability-related 

enforcement activities, testing campaigns, compliance, and educational 

activities. 

1 

HUD should regularly follow up on its 2005 Disability Discrimination Study

(see Barriers at Every Step) as a means to encourage additional, 

comprehensive disability-based testing and as a lever to support future 

disability-related enforcement and education. 

1 

HUD should effectively coordinate with the Department of Justice to issue 

public written binding guidance that interprets the statute of limitations period 

for fair housing complaints in new development broadly and states that a 

failure to design and construct accessible housing is a violation of the Fair 

Housing Act that continues until the violations are corrected. 

1 

152
Table 2. Recommendations and Corresponding Topical Briefs (cont’d)

6. Review HUD and PHAs for compliance with Section 504 and the Fair 

Housing Act. Brief 

HUD should ensure that compliance with Section 504 is built into its ongoing 

monitoring activities for PHAs and enter into Voluntary Compliance 

Agreements (VCAs) with noncompliant PHAs, and, if necessary, take 

enforcement action for noncompliance with those requirements. HUD should 

include disability rights advocates in the development of VCAs. 

1 

HUD should conduct a 504 self-evaluation of the programs, services, and 

activities of its field offices and, as needed, develop a VCA and transition 

plan for each office not in compliance. 

1 

HUD should develop a comprehensive 504 and fair housing training program 

for all PHAs with mandatory certification every 5 years. 

1 

7. Support and enact new legislation. Brief 

Congress should support the Community Choice Act to ensure least 

restrictive housing choice and control and equitable provision of supports and 

services to enable real choice. 

3, 5 

Congress should support the Inclusive Home Design Act (H.R. 1408) that will 

ensure a basic level of accessibility (i.e., visitability) in all housing built with 

federal funds but not covered by the Fair Housing Act. 

1 

In any new legislation dealing with housing and economic recovery, include, 

to the extent possible, specific requirements and guidance for maximizing 

benefits for people with disabilities. 

1 

Congress should amend the Assets for Independence Act (P.L. 105–285) to 

specifically include individuals with disabilities among the target populations, 

require related reporting from Assets for Independence (AFI) projects to 

include information on participants with disabilities, and encourage funders 

who match AFI dollars to eliminate categorical restrictions that serve as 

additional barriers to participation by people with disabilities. 

2

153
Table 2. Recommendations and Corresponding Topical Briefs (cont’d)

8. Adapt and implement new federal guidance for helping people with 

disabilities in an emergency. Brief 

FEMA should publish CPG-301 and CPG-302 as soon as possible and 

provide resources to publicize, train, and implement plan elements at the 

State and local levels. 

4 

FEMA should create and fill the Regional Disability Coordinator positions in 

FEMA and add Regional Advisory Committees to support the positions as 

soon as possible. 

4 

Temporary locations such as trailer parks for temporary disaster housing 

must include accessible transportation, so that people can travel to work, 

grocery stores, senior centers, Centers for Independent Living, medical 

facilities, and other locations. 

4 

Congregate facilities should be required by law to locate appropriate 

temporary locations in advance of disaster as part of their annual disaster 

planning. Facilities should plan to transfer residents and their caregivers, 

family, and medical records to reduce transfer trauma. 

4 

The Federal Emergency Management Agency should continue post-disaster 

reports under the National Response Framework’s Emergency Support 

Function #14 on special needs and disability issues. 

4 

Additional federal funding beyond the Federal Emergency Management 

Agency Individual Assistance maximum for disaster recovery is needed to 

replace disability-specific items like durable medical equipment, assistive 

technologies, service animal needs, and ramps, and to fund accessible 

features in post-disaster reconstruction. 

4 

HUD must continue to expedite the certification of new Section 8 units after 

disaster and supplement these units with funds for increased utilities. HUD’s 

Disaster Housing Assistance Program should be continued and ensure that a 

portion of funds are set aside for accessibility issues. 

4

Local and State governments should revise building codes after disaster to 

increase accessibility, including universal design. 

4

Mitigation funding and programs that increase rather than displace people 

with disabilities need to be developed and provided. 

4 

154
Table 2. Recommendations and Corresponding Topical Briefs (cont’d)

9. Develop cross-system coordination and collaboration. Brief 

CMS and HUD should examine current policies, regulation, and funding 

requirements to improve cross-system coordination and timely, quality 

access to accessible, affordable, and integrated housing and community 

living supports by people with diverse disabilities across their lifespan, 

including people who are homeless or choose to move out of institutional 

settings into the community. 

5 

Disability organizations should actively participate in HUD’s Consolidated 

Planning process in order to help expand affordable for-sale and rental 

housing for people with disabilities. 

1, 5 

Public and private entities such as HUD, State and local housing agencies, 

private foundations, and housing referral and advocacy organizations should 

form a partnership to fund a new disability and housing technical assistance 

initiative, and support an active affordable, accessible housing registry. 

5 

Public and private partners should draw on the experience of the Arc of the 

Central Chesapeake Region, Maryland, to create lease-to-own projects for 

very low income people with disabilities. 

2, 5 

10. Change systems at the State level. Brief 

Nursing homes and institutional settings should be required by State systems 

to provide periodic reevaluation and meaningful transitional planning to 

support people with disabilities to become informed of their right to choice, to 

identify and apply for affordable, accessible, and integrated housing and 

supports, and to support transition to community living in a timely manner. 

These evaluations and informed choice counseling and supports should be 

provided in collaboration with community and disability/aging organizations 

and peer mentors. 

5 

In collaboration with the National Conference of State Legislatures and 

national disability and aging advocacy organizations, convene a task force to 

examine federal policies to support cross-system delivery of housing and 

community living supports within States, and make it easier for States to 

provide these in a timely fashion. 

5 

Expand cross-agency funding of Money Follows the Person and Community 

Choice systems change demonstration projects (across CMS and HUD) to 

focus on cross-system, coordinated delivery, and funding of housing and 

community living supports in States, especially in States that have not shown 

significant progress in rebalancing funding to address institutional bias. This 

should include implementation of No Wrong Door quality, consistent 

information access, regardless of type of disability, age, or system entered. 

5 

155
Table 2. Recommendations and Corresponding Topical Briefs (cont’d)

10. Change systems at the State level. (cont’d) Brief 

Sponsor and share innovative models of financing least restrictive, 

community-based options, such as use of combined waiver and voucher 

funding, use of HOME funds toward rental assistance, bridge subsidies 

during transitions, development of integrated least restrictive housing options, 

and home modification trust funds and programs. 

5 

Fund the development of a network of housing registry systems and 

infrastructure to report, share information, and monitor housing accessibility, 

affordability, and integration within and across States. Fund mechanisms for 

community-based organizations, such as Centers for Independent Living, Area 

Agencies on Aging, and Aging and Disability Resource Centers to coordinate 

and maintain these resources and serve as Housing and Community Living 

Navigators. 

5

11. Provide guidance for housing programs for people with psychiatric 

disabilities. Brief 

Prospective tenants should participate in choosing their housing, and such 

choice should be preceded by a meaningful opportunity to observe and 

understand what is being offered and resolve any concerns they may have. 

People should not be forced into housing they do not choose. 

3 

Housing must be offered without being tied to treatment or use of supports as 

a condition of obtaining or maintaining housing. Lease compliance should be 

the only criterion for maintaining housing. 

3 

Housing providers must self-assess to determine that people with psychiatric 

disabilities are entitled to the legal protections offered all tenants. 

3 

Brief absences should be tolerated without loss of housing, and program staff 

should stay in close touch with tenants and landlords to maximize the 

chances that tenants will return to their homes. 

3

Tenants should be offered individualized, flexible support services that are 

available 24 hours a day, 7 days a week. 

3

Whenever possible, housing and support services should be staffed by 

people who have recovered from mental illness. For programs that serve 

tenants with both psychiatric disabilities and substance abuse problems, staff 

should include people who have recovered from drug and/or alcohol abuse. 

3 

Program staff should be responsive to concerns from property managers, 

landlords, and neighbors, and intervene promptly to resolve tenancy 

problems to help tenants avoid eviction. 

3

156
157

Table 2. Recommendations and Corresponding Topical Briefs (cont’d)

11. Provide guidance for housing programs for people with psychiatric 

disabilities. (cont’d) Brief 

Program staff, tenants, and landlords should be educated about fair housing 

rights and responsibilities, with emphasis on the right to reasonable 

accommodation. Housing staff should have formal backup support from fair 

housing attorneys for training, advice, and help in resolving disputes. 

3

Jails and prisons should be required to provide meaningful discharge 

planning that helps prisoners with psychiatric disabilities identify and apply for 

quality supportive housing prior to release, to minimize recidivism and 

maximize successful transition to independent living in the community. 

Similarly, probation services should help people with psychiatric disabilities 

obtain stable supportive housing and support services that foster 

independence and meaningful participation in community life. 

3 

12. Improve the data on people with disabilities and housing needs. Brief 

Congress and the Administration should develop initiatives to create effective 

data collection on the housing needs of people with disabilities, including 

people with environmental sensitivities. 

1, 5 

HUD and USDA should collect data annually on the accessibility features and 

occupancy of its accessible units, and report how many units are actually 

occupied by people who need accessible features. 

1 

HUD should improve its Worst-Case Housing Needs estimates by using data 

from the American Community Survey and Survey of Income and Program 

Participation to supplement Annual Housing Survey data already used. 

1 

Congress and HUD should include people in group quarters (i.e., institutional: 

correctional facilities, nursing homes, and mental hospitals, and 

noninstitutional: college dormitories, military barracks, group homes, 

missions, and shelters) in further analysis for the worst-case needs and other 

assessments that include people with disabilities. 

1

The U.S. Census Bureau should develop SIPP reports that analyze relevant 

housing data for households of people with disabilities (i.e., not just 

individuals). 

1 
158
159

NCD Topical Brief #1 

Federal Evaluation 
160
Contents 

Introduction ............................................................................................................... 163

Need for Housing ...................................................................................................... 165

Affordability............................................................................................... 167

Accessibility.............................................................................................. 169

Accessibility Requirements in Federal Programs.................................................. 173

U.S. Department of Housing and Urban Development Programs......................... 177

Public Housing ......................................................................................... 180

Housing Choice Vouchers (HCVs) ........................................................... 182

Multifamily Housing Programs.................................................................. 184

Integration of HUD Housing Programs ..................................................... 185

People with Disabilities ................................................................. 185

People Who Are Aging.................................................................. 187

HUD Formula-Based Programs................................................................ 189

Community Development Block Grants (CDBGs)......................... 190

HOME Investment Partnerships Program..................................... 191

Homeless Shelter and Housing Programs.................................... 194

Housing Opportunities for People with AIDS (HOPWA)................ 200

Low Income Housing Tax Credit Program.............................................................. 203

U.S. Department of Agriculture Rural Housing ...................................................... 207

Single-Family Housing ............................................................................. 208

Section 502 Rural Housing Direct Loans ...................................... 209

Section 502 Rural Housing Guaranteed Loans............................. 209

Section 504 Rural Housing Repair and Rehabilitation Loans ....... 210

Section 504 Rural Housing Repair and Rehabilitation Grants ...... 210

Multifamily Housing .................................................................................. 211

Section 515 Rural Rental Housing Loans ..................................... 211

Section 538 Rural Rental Housing Guaranteed Loan Program .... 212

Section 521 Rental Assistance Program....................................... 213

Location of USDA Rental Housing ........................................................... 214

Accessibility and Integration..................................................................... 216

161
Recent Trends in Federal Housing .......................................................................... 217

Funding .................................................................................................... 217

Lost Housing Units ................................................................................... 218

Lost Public Housing Units ............................................................. 218

Lost Multifamily Housing............................................................... 219

Lack of Complete Inventory of Accessible Units....................................... 220

Discrimination........................................................................................... 223

Enforcement............................................................................................. 224

Advancing Accessibility and Integration ................................................... 225

Going Green............................................................................................. 226

Looking Ahead .......................................................................................................... 227

Section 811 Legislation ............................................................................ 227

New Funding for Affordable Housing via the National Affordable 

Housing Trust Fund.................................................................................. 228

New Vouchers for Nonelderly People with Disabilities ............................. 228

New Vouchers for Veterans...................................................................... 229

Inclusive Home Design Act (H.R. 1408)................................................... 229

New HOPE VI Legislation......................................................................... 230

Section 202 Supportive Housing for the Elderly Act of 2009 (S. 18) ........ 230

HUD’s Real Estate Management System (REMS)................................... 230

New Requirements for Low Income Housing Tax Credit Reporting ......... 231

Green Efficient Public Housing................................................................. 231

Promoting Livable Communities............................................................... 232

Recommendations .................................................................................................... 233

162
Introduction 

This report examines the range of publicly assisted housing options available to people 

with disabilities in the United States through different federal programs. There are three 

main sources of funding offered by the Federal Government that either target or can 

benefit people with disabilities: U.S. Department of Housing and Urban Development 

(HUD), U.S. Department of Agriculture rural housing, and Low Income Housing Tax 

Credits (LIHTC). In addition, the Department of Veterans Affairs offers a number of 

housing programs that help veterans who have mental and physical disabilities, some in 

conjunction with HUD and others with State agencies. 

This report begins by reviewing the need for housing and continues with a summary of 

housing programs, including estimates of accessible units and, when known, people 

with disabilities and the aging population benefiting from these programs. This inventory 

is critical, as the United States has had significant and noticeable changes in its portfolio 

of public sector housing in the past decade. These changes include: 

● Reducing the overall number of public housing and project-based assisted units 

that have traditionally served very low income individuals and families, both with 

and without disabilities, through various changes in policy. These changes 

include granting property owners the ability to “opt out” of the Section 8 projectbased housing program and giving local public housing authorities the ability to 

designate public housing developments as “senior only.” 

● Transforming public housing sites into mixed-income/mixed-tenure 

developments through the HOPE VI program. 

● Expanding the use of housing vouchers to subsidize relocated public housing 

residents and other low-income renters in private sector housing. 

● Relying heavily on the Low Income Housing Tax Credit to produce most new 

affordable housing in the United States, which generally serves a higher-income 

group of renters than currently in public housing. 

163
This report then provides an overview of recent trends and makes recommendations to 

improve housing options for people with disabilities. 

164
Need for Housing 

Recent federal research estimates that there are 54.4 million people with disabilities in 

the civilian population living in the United States, representing approximately 

18.7 percent of the noninstitutionalized population.280 At all ages, women (24%) have a 

higher prevalence of disability when compared to men (19%). For all, the prevalence of 

disability increases with age, from 11 percent for people 18 to 44 years of age to 

52 percent for people 65 years and older.281

An estimated 11 million people 6 years and older need personal assistance with the 

activities of daily living (ADLs), such as bathing, eating, dressing, and getting around 

inside the home, or with instrumental activities of daily living (IADLs), which includes 

household chores, doing necessary business, shopping, and getting around for other 

purposes.282 Approximately 35 million people have a severe disability.283 The number 

and percentage of people with a severe disability increase with age, so that of those 65 

and older with a disability, more than one-third (37%) have a severe disability. In 

addition to needing appropriate medical and public health services, this segment of 

people with disabilities is likely to need personal assistance and specific accessibility 

features within the home and in the community. 

National housing survey estimates suggest that there are about 35.1 million households 

with one or more person with a disability, which is about 32 percent of the households in 

the United States in 2007.284 These households are:285

● More likely to headed by someone age 65 or older (60% of households with a 

disability are in this age group; in comparison, only 2% of households without a 

disability are age 65 or older).

● Small in size, with about three-fourths of households in one- and two-person 

households.

● More likely to be low-income (65% compared to 36% of households without a 

disability).

165
● Nearly 2.5 times more likely to be extremely low income, earning less than 

30 percent of the median, which is near the national poverty level (25% 

compared to 10% of households without a disability). 

● More likely to be paying more than 30 percent of income for housing costs (40% 

compared to 32% of households without a disability). 

● More likely to receive some form of government assistance with rent (9% 

compared to 2% for households without a disability). 

● Less likely to live in a central city (26%) or suburb (30%) and more likely to live 

in a rural area outside of a metropolitan area (20%) than a household without a 

disability. 

● More likely to live in manufactured housing (8% compared to 5% of households 

without a disability). 

● More likely to live in a building with a no-step entrance (45%) and in an 

apartment on the same floor as the building entrance (38% compared with 34% 

of households without a disability). 

● More likely to live in a building/development that offers “impersonal” services 

(such as meals, transportation, housekeeping, financial management, 

telephone aid, and shopping) and personal services (assistance with bathing, 

eating, moving about, dressing, and toilet use). 

Also important to note is that among people under the age of 65, people with disabilities 

are more likely than people without disabilities to rent their home (37% compared to 

31%). However, nearly 15.1 million households with a person with a disability between 

65 and 85 years old own their own home. This means that among homeowners in this 

age bracket, nearly 94 percent have a disability.286 Such high levels of ownership 

among this age group are likely due to the fact that many purchased their homes before 

acquiring a disability as they aged. Many of these homeowners are likely to face 

challenges if they want to remain independent in a home that often is not 

accommodating and may be costly to maintain. 

166
Finally, the data above does not include about 2.17 million people who live in nursing 

homes or group homes (1.6 million of these live in nursing homes).287 This includes 

125,000 people ages 22 to 64 with severe mental illness in nursing homes, which is a 

41 percent increase since 2002.288 Federal estimates of housing need among people 

with disabilities usually do not include people in “group quarters” (i.e., nursing homes 

and group homes). If current rates of growth continue without the development of new 

alternatives that allow people to remain in homes in their communities as they age, it is 

expected that there will be 3 million nursing home residents by 2030.289 

Affordability 

Poverty and low-income status of people with disabilities are key barriers to acquiring 

housing. The median monthly income earnings in 2005 for people with no disability 

($2,539) were significantly higher than for people with severe disabilities ($1,458). While 

people with nonsevere disabilities did better, their monthly median income was still 

lower ($2,250). Poverty is much higher among people ages 25 to 64 with severe 

disabilities (27%), when compared to people in the same age group with nonsevere 

disabilities (12%) and no disability (9%). For many, the reason is that they are 

unemployed. In 2005, less than half (46%) of the population ages 21 to 64 with a 

disability was employed. In comparison, 84 percent of people in this age group who did 

not have a disability were employed.290

Since the 1970s, policymakers and housing researchers have come to understand 

housing need based on assumptions about precisely how much consumers should pay 

for housing. Current federal guidelines fix the relationship between income and housing 

cost at 30 percent. That is, housing is affordable if it costs a household no more than 

30 percent of its income. For renters, this includes monthly contract rent plus utilities. 

For owners, cost includes monthly mortgage payments, insurance, utilities, and taxes. 

For both, and regardless of income level, housing is not affordable if a household uses 

more than 30 percent of its income for it. There is a need for affordable housing when 

there are fewer units than people can afford to pay according to this threshold. 

167
Congress requires the U.S. Department of Housing and Urban Development (HUD) to 

report periodically on the need for affordable housing among low-income households to 

determine how many have “worst-case needs.” Households considered to have worstcase needs are “unassisted renters with very low-incomes who have one of two ‘priority 

problems,’ either paying more than half of their income for housing (severe rent burden) 

or living in severely substandard housing.”291 HUD’s most recent report determined that 

nearly 6 million households in the United States have worst-case housing needs, with 

most being severely rent burdened. Further research suggests that of this total, 

between 1.3 million and 1.4 million are “nonelderly” (below 62 years of age) renter 

households with people with disabilities.292 In addition, nearly 1 million worst-case need 

families with children include nonelderly adults with disabilities.293 This means that there 

may be as many as 2.4 million very low income households with disabilities that are 

worst-case—a rate of between 35 and 40 percent of the overall worst-case housing 

needs in the United States. In addition, another million “elderly” households (ages 62 

and above) were also found to be worst-case need, which is likely to include people with 

disabilities.294

The fastest growing segment of worst-case need appears to be in rural areas.295 Less is 

known about the need for accessible housing in these areas, though data from the 2007 

American Housing Survey suggests there were about 7 million households with at least 

one person with a disability in rural nonmetropolitan areas in the United States. Of this 

total, about 2.5 million are extremely low income, but only about 10 percent are claiming 

any form of rental assistance from the government.296

A trend likely to be contributing to this problem is the continued increase in housing 

need among low-income people with disabilities living on Supplemental Security Income 

(SSI). According to Priced Out in 2008, a single person in the United States has an 

income that is five times greater than that of a person receiving SSI assistance, which 

on average is $668 a month. With such a low income, a person on SSI has limited 

housing options. No State in the United States has an average-priced one-bedroom or 

studio apartment that would be affordable to someone on SSI. In fact, the average 

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rental payment in the United States for a studio would require spending 100 percent of 

the monthly SSI payment and 112 percent of a monthly SSI payment to renting the 

average-priced one-bedroom unit. As a result, most of the 4.2 million people receiving 

SSI cannot afford housing in their community unless they receive some form of housing 

subsidy. 

For people with disabilities who work, the challenge is finding work that pays a sufficient 

wage to afford housing. The National Low Income Housing Coalition (NLIHC) examines 

housing costs annually to estimate the “housing wage” needed to afford housing, 

assuming a household pays no more than 30 percent of its income for monthly rent. 

NLIHC uses HUD’s Fair Market Rent, which is adjusted annually and by location to 

reflect regional variations. Nationally, a single person or household with one worker 

would need to earn at least $14.97 per hour (based on a 40-hour work week, working 

50 weeks a year) to be able to afford the average rent for a one-bedroom rental unit.297

This wage varies widely across the country, with a high of $24.15 per hour needed to 

afford to live in Hawaii and a low of $8.38 in North Dakota, which is still above the 

current national minimum wage of $7.25 an hour.298

Accessibility 

Many people with disabilities are able to live independently, although current research 

suggests that a growing number are unable to find appropriate housing to meet their 

needs relative to their disability, whether physical, cognitive, developmental, or 

environmental. Reasons include housing location, quality, physical accessibility, 

affordability, and an unmet need for supportive services that some individuals require in 

order to live independently in the community. 

Based on the most recent national data available, thousands of people with disabilities 

need basic home modifications to make their homes accessible.299 The greatest need is 

for grab bars or handrails (an estimated 788,000 households) that, relatively speaking, 

are not expensive to install. In addition, many people need basic features that make 

units “visitable,” including ramps to access the building or home (612,000 households), 

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elevator or lifts to access the unit once in the building (309,000 households), widened 

doorways and halls in the unit (297,000 households), and accessible bathrooms 

(566,000). As might be expected, renters have a proportionally greater unmet need for 

all features when compared to homeowners. 

In addition to modifications to make the physical environment more accessible, there is 

a need to consider the overall built environment, given the growing number of people 

affected by environmental exposures—a physical condition that is triggered by the 

environment.300 Symptoms include neurological, respiratory, muscular, cardiovascular, 

and/or gastrointestinal problems. Known triggers include: 

● Pesticides: weed killers, bug sprays, treated wood products 

● Solvents: paints, glues, gasoline, nail polish/remover 

● Indoor air Volatile Organic Compounds: new carpet, formaldehyde, plasticizers, 

chlorine, fragrances, and fragranced products 

● Cleaners: bleach, ammonia, phenolic disinfectants, air fresheners 

● Combustion-related: auto and diesel exhaust, tobacco smoke, natural gas, 

tar/asphalt 

● Drugs/medical devices: anesthetics, antibiotics, implants, vaccines 

● Electrical devices: microwaves, transformers, high-tension wires, fluorescent 

lighting, cell towers, cell phones 

These triggers can be in the housing unit, elsewhere in the building if a multifamily 

structure, and/or outside in the immediate community or locations the person needs to 

or would like to visit in daily life. While some of these products are used in development 

of housing (and buildings in general), many are introduced by people through the care 

and maintenance of buildings and by people in the building (e.g., someone wearing 

perfume). Current estimates suggest that 11 percent of the population has some sort of 

chemical sensitivity.301 For people with environmental sensitivities, accessible housing 

must be free of these environmental triggers. However, unless the housing is universally 

170
designed to accommodate different sensitivities, for some it is better to live in 

segregated housing that ensures control over potential exposures. 

Assistance is another means to accommodate and/or remove environmental barriers in 

and around a home. Many people with disabilities need help with certain activities of 

daily living to make their housing accessible.302 Using this “functional” definition of 

disability, current estimates of the population in need of accessible housing and 

communities who are under age 65 range from between 3.5 million to 10 million.303 This 

population will grow as the population of baby boomers soon reaches an age where 

housing accessibility and livable communities will become one of their highest priorities. 

People with disabilities also are living longer and their housing and supportive 

requirements are changing; such trends directly affect these individuals’ community 

living options. The population of people over age 65 is expected to double by 2030. 

Currently, 20 percent of people ages 65 and over require assistance with at least one 

activity of daily living. This number is expected to increase to 50 percent by age 85. 

Over the next 30 years, disability rates for people 85 years and older are expected to 

rise as this population triples.304

For people with psychiatric disabilities, accessible housing is a relatively recent public 

policy concern that focuses on promoting integrated, rather than segregated, community 

living. Before the 1960s, people diagnosed with serious mental illness were considered 

incapable of living outside institutions. The development of psychotropic medications, a 

desire to save public funds, and growing concern about conditions in institutions led to a 

nationwide movement to deinstitutionalize hospital residents. In 1956, 559,000 people 

diagnosed with mental illness lived in public institutions.305 By 1980, only 154,000 

people diagnosed with mental illness lived in public institutions.306 People released from 

mental institutions were supposed to receive treatment and support services in the 

community, but the promise of community-based treatment proved illusory, and the lack 

of support services coupled with the dearth of affordable housing swelled the ranks of 

people with mental illness living without shelter. 

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The need for community-based housing for people with psychiatric disabilities sparked the 

development of a new type of institution called the board and care home.307 Board and 

care homes, which provide 24-hour supervision and food to residents, range in size from 

to more than 200 residents. The majority house more than 50 people. Currently

approximately 330,000 people with psychiatric disabilities live in board and care homes. 

Board and care homes are not designed to lead to recovery—they simply fill the housing 

gap created by deinstitutionalization. Today, most board and care homes function as miniinstitutions within the community. They provide very little privacy, a limited scope of 

services, and little opportunity to interact with people without disabilities in the community. 

In most homes, residents have no opportunity to exercise choice in their day-to-day lives 

over roommates, meals, bedtimes, or other daily functions. Virtually all resident income 

goes directly to the home, making it impossible for residents to save sufficient funds to 

consider moving to private housing.

2 

, 

a 

308 Also, most homes are unlicensed with little 

oversight, and as a result there have been multiple press stories about abusive conditions 

in board and care homes.309 Finally, few board and care homes help residents develop 

independent living skills or move on to independent housing.310 

NCD’s report, Livable Communities for People with Psychiatric Disabilities, underscores 

the need for new and more options beyond this form of congregate living.311 While 

“different perspectives exist” on which is the best housing approach, when given the 

choice, consumers are likely to choose independent, integrated living over some form of 

congregate arrangement.312 This also aligns with national surveys that consistently 

report that 80 to 95 percent of people with disabilities and seniors strongly prefer to 

remain in their own homes,313 and experience higher quality of life when they are able 

to remain in the community.314 However, data also illustrates how community living is 

constant fight to manage housing, finances, and transportation—all survival issues that 

directly affect people’s choice, and potentially their health and participation.315 Problems 

worsen when people do not have information to make informed decisions about least 

restrictive living.316 People with disabilities need information they can use to become 

informed on their choices, as do policymakers and other stakeholders who can help 

expand choice. 

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Accessibility Requirements in Federal Programs 

All housing produced and operated with federal funds is subject to the requirements of 

the 1973 Rehabilitation Act (Section 504), which provides for nondiscrimination in all 

programs, services, and activities receiving federal financial assistance, and in 

programs, services, and activities conducted by executive agencies. Section 504 

regulations require 5 percent (but not fewer than one unit) of dwelling units to be 

accessible to people with mobility disabilities and at least 2 percent (but not fewer than 

one unit) of dwelling units to be accessible for people with visual and hearing 

disabilities. Section 504 regulations require compliance with the Uniform Federal 

Accessibility Standards (UFAS), which was published in 1984 by HUD and three other 

federal agencies to provide uniform standards for the design, construction, and 

alteration of buildings in accordance with the Architectural Barriers Act (ABA), 42 U.S.C. 

4151–4157. ABA applies to buildings and facilities designed, constructed, altered, or 

leased with federal construction funds. HUD is in the process of updating its ABA 

standards, which apply to federally funded residential facilities. While the ABA only 

covers the facilities, Section 504 also covers programs, services, and activities, which 

must be accessible to people with disabilities. 

Section 504 also aims to produce integrated housing by providing guidance for 

distributing accessible units within buildings and developments, and on how to 

“maximize the utilization of such units by eligible individuals.”317 Section 8.26 within the 

Section 504 legislation states that: 

Accessible dwelling units required by Sec. 8.22, 8.23, 8.24 or 8.25 shall, to the 

maximum extent feasible and subject to reasonable health and safety 

requirements, be distributed throughout projects and sites and shall be 

available in a sufficient range of sizes and amenities so that a qualified 

individual with handicaps’ choice of living arrangements is, as a whole, 

comparable to that of other persons eligible for housing assistance under the 

same program.”318 

Furthermore, Section 8.27 states that: 

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(a) Owners and managers of multifamily housing projects having accessible 

units shall adopt suitable means to assure that information regarding the 

availability of accessible units reaches eligible individuals with handicaps, and 

shall take reasonable nondiscriminatory steps to maximize the utilization of 

such units by eligible individuals whose disability requires the accessibility 

features of the particular unit. To this end, when an accessible unit becomes 

vacant, the owner or manager before offering such units to a non-handicapped 

applicant shall offer such unit: 

(1) First, to a current occupant of another unit of the same project, or 

comparable projects under common control, having handicaps requiring the 

accessibility features of the vacant unit and occupying a unit not having 

such features, or, if no such occupant exists, then 

(2) Second, to an eligible qualified applicant on the waiting list having a 

handicap requiring the accessibility features of the vacant unit. 

(b) When offering an accessible unit to an applicant not having handicaps 

requiring the accessibility features of the unit, the owner or manager may 

require the applicant to agree (and may incorporate this agreement in the 

lease) to move to a non-accessible unit when available.319

Federal housing is also subject to the American with Disabilities Act (ADA) Title II 

regarding public access and Title III regarding places of public accommodation in 

private multifamily properties. Finally, all housing is subject to State and local 

regulations, including zoning and building codes.320 

In addition, with few exceptions and regardless of funding source, all multifamily 

housing with four or more units in a single structure built after March 13, 1991, is subject 

to the design and construction requirements of the Fair Housing Act (1988). However, 

the law does not ensure the majority of rental units will be accessible to people with 

disabilities, since more than 85 percent of the rental housing in the United States was 

built before 1991.321 For these units, there is the expectation that reasonable 

accommodations can be made to meet different accessibility needs of people with 

disabilities. This was recently reinforced through a jointly issued statement from HUD 

and the Department of Justice (DOJ) on June 17, 2004, which reminded that: 

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One type of disability discrimination prohibited by the [Fair Housing] Act is the 

refusal to make reasonable accommodations in rules, policies, practices, or 

services when such accommodations may be necessary to afford a person 

with a disability the equal opportunity to use and enjoy a dwelling [42 U.S.C. 

§ 3604(f)(3)(B)]. HUD and DOJ frequently respond to complaints alleging that 

housing providers have violated the Act by refusing reasonable 

accommodations to persons with disabilities.322 

The statement aims to help housing providers better understand the rights of people 

with disabilities and the obligations of housing providers under the act. While 

determining what is a reasonable accommodation is dependent on the individual with 

the disability, the statement provides some examples that are likely common 

accommodation requests, including assigning a parking space close to an entrance for 

a person with a mobility limitation, allowing different means for paying rent (e.g., via mail 

instead of in person), and waiving “no pet” policies to allow assistance animals in the 

unit. Also, the statement reminds that housing providers cannot charge a fee for 

providing a reasonable accommodation. 

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176
U.S. Department of Housing and Urban Development 

Programs 

The U.S. Department of Housing and Urban Development (HUD) administers all funding 

for public housing and the Housing Choice Voucher (HCV) program implemented by 

Public Housing Agencies (PHAs) and private developers. HUD also administers two 

competitive multifamily housing programs in which developers apply directly to HUD: 

Section 202 housing for “elderly” (ages 62 years and older) and Section 811 housing for 

people with disabilities. HUD also has oversight responsibility for a portfolio of 

multifamily developments created through production programs that are now inactive 

(e.g., project-based Section 8, Section 236 Interest Reduction program). Finally, HUD 

administers several formula-based grant programs that allocate funds to State and local 

agencies, which are given fairly broad discretion on spending on housing. This includes 

the HOME program, Community Development Block Grant (CDBG), and the Continuum 

of Care (Homeless) program, which produces permanent and transitional housing and 

emergency shelters for homeless people, including people with disabilities and with 

HIV/AIDS. HUD is responsible for approving all Consolidated Plans (State and local), 

which establish specific priorities for allocating federal funds for housing and community 

development.323

The ability for anyone to access HUD housing programs is determined by income limits 

using annual family Area Median Income (AMI), which is adjusted for family size.324

HUD further distinguishes “extremely low income” households (income below 30% of 

AMI), “very low income” (income below 50% of AMI), and “low-income” (income below 

80% of AMI). Table 1 below illustrates the variation in median income and the income 

limits associated with each HUD income category based on a family of four, which is the 

standard usually cited when public officials talk about median income. In this sample of 

11 cities, the median income ranges from a high of $102,700 in Washington, D.C., to a 

low of $61,100 in Houston, Texas. Using HUD’s calculations, an extremely low income 

family in Washington, D.C., has an annual income of no more than $30,800, while in 

Houston it would be $18,350. However, since many people with disabilities live alone, it 

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Table 1. HUD Income Limits for a Four-Person Family 

in Selected Cities, 2009326

Extremely 

low income 

30% of median 

Very low income

50% of median 

Low-income 

80% of median Median 

New York City $23,050 $38,400 $61,450 $61,600

Los Angeles 23,800 39,650 63,450 62,100

Chicago 22,600 37,700 60,300 74,900

Houston 18,350 30,550 48,900 61,100

Philadelphia 23,350 38,900 62,250 77,800

Phoenix 19,750 32,950 52,700 65,900

Jacksonville 19,550 32,550 52,100 65,100

Washington, D.C. 30,800 51,350 64,000 102,700

Denver 22,800 38,000 60,800 76,000

Atlanta 21,500 35,850 57,350 71,700

Seattle 25,300 42,150 64,000 84,300

is important to see how these income categories vary depending on family size. For 

example, in Washington, D.C., a one-person household would be extremely low income 

earning $21,550 annually, while an eight-person family would go up to $40,650. In 

Houston, the range would be from $13,400 to $25,300.325

Beyond income, HUD also identifies tenants as one of the following: elderly family, 

disabled family, or both elderly and disabled. A disabled family, according to HUD, 

means a family whose head, spouse, or sole member is a person with a disability. It 

may include two or more people with a disability living together, or one or more people 

with a disability living with one or more live-in aides. By definition, a family with a child 

with a disability, but no other adult with one, is not a disabled family. HUD uses several 

means to determine disability status for purposes of qualifying for housing: Section 223 

of the Social Security Act (42 U.S.C. 423), Section 102 of the Developmental Disabilities 

Assistance, the Bill of Rights Act (42 U.S.C. 6001[5]), or: 

determined by HUD regulations to have a physical, mental, or emotional 

impairment that: a) is expected to be of long, continued, and indefinite duration; 

b) substantially impedes his or her ability to live independently; and c) is of 

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such a nature that such ability could be improved by more suitable housing 

conditions.... The definition of a person with disabilities does not exclude 

persons who have the disease acquired immunodeficiency syndrome (AIDS) or 

any conditions arising from the etiologic agent for acquired immunodeficiency 

syndrome (HIV). However, for the purpose of qualifying for low-income 

housing, the definition does not include a person whose disability is based 

solely on any drug or alcohol dependence. (Note: The definition of a person 

with disabilities as defined in 24 CFR 8.3 must be used for purposes of 

reasonable accommodations and program accessibility for persons with 

disabilities.)327

Elderly family means a family whose head, spouse, or sole member is 62 years of age 

or older. The term family includes a single elderly person, two or more elderly people 

living together, and one or more elderly people living with one or more people who are 

determined to be essential to the care or well-being of the elderly person(s). An elderly 

family may include people with disabilities and other family members who are not 

elderly. To be classified as both elderly and disabled, the head, spouse, or sole member 

must be a person with a disability and 62 years of age or older. 

Public Housing Agencies (also referred to as PHAs) are responsible for local 

implementation and management of federal public housing and usually Tenant-Based 

Rental Assistance through the Housing Choice Voucher program within their 

jurisdictional area. Some PHAs also administer other HUD programs, but many do not. 

Public housing administration includes collecting monthly rents; assuring tenant 

compliance with leases; setting other charges (e.g., security deposit, excess utility 

consumption, and damages to unit); annual reexamination of tenant household income; 

transferring families from one unit to another to correct over/under crowding, repair or 

renovate a dwelling, or because of a resident’s request to be transferred; terminating 

leases; and maintaining the development in a decent, safe, and sanitary condition.328

Currently, there are approximately 3,300 PHAs in the United States. Most are quasigovernmental; however, some PHAs are part of local government. Housing authorities 

serving predominantly rural areas or low-density areas often operate at the county level 

and in some States the State Housing Agency may administer the Housing Choice 

Voucher program for the entire State (e.g., Michigan and Massachusetts). 

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Public Housing 

Most public housing was built between 1937 and the mid-1980s to provide low-income 

families affordable housing. Depending on the time period, public housing may be lowrise townhouses, mid-rise multifamily developments, or high-rise apartment buildings. 

Potential tenants have to be qualified based on their income, which cannot exceed the 

low-income limit for their area and family size; however, this does not guarantee that a 

household will be able to lease a unit, since this depends on availability. In many larger 

urban areas, applicants are on waiting lists for many years. Often PHAs only open 

waiting lists periodically (e.g., every few years) and fill up after being open for only a 

short time. PHAs can set “local preferences” to move a household with greater housing 

needs up on the waiting the list, as long as these preferences are approved by HUD. 

This can include people with people with disabilities. 

Once in a unit, tenants are required to pay either a minimum of $50 or 30 percent of 

income (as determined by HUD’s eligibility criteria) for rent, depending on which is 

higher. The remaining rent—the actual cost of operating and maintaining the unit—is 

paid to the PHA through a contract with HUD. Rent usually includes some utility 

assistance or allowance. Each household is reviewed annually to verify income and 

adjust rent payments if income has changed. 

Currently there are about 976,000 occupied public housing units in the United States.329

This is less than 1 percent of all housing in the United States, and substantially lower 

than the 1.28 million public housing units that existed throughout the United States and 

Puerto Rico in 2000.330 The 24 percent reduction in units is mainly due to the demolition 

of 150,000 public housing units under the HOPE VI program in order to develop new 

mixed-income housing developments, which, when completed, will have fewer than 

50,000 replacement public housing units.331 This lower number also reflects the loss of 

units that have been declared uninhabitable and other units permanently eliminated 

through demolition. 

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According to HUD data on public housing tenants, there were 210,760 “disabled 

families” (22%) and 307,782 “elderly families” (32%), of which 135,218 (11%) have a 

disability, living in public housing as of December 2008. The remaining 457,182 are 

families (47%) in which the adult head of household is neither elderly nor with a 

disability.332

There is no current information on how many public housing units are accessible. 

Section 504 requires PHAs to do a self-evaluation of all their programs, housing, and 

facilities to determine if they are in compliance and to develop transition plans to deal 

with conditions that are not in compliance. While these documents are considered 

public and should be available upon request from a PHA, there is no publicly available 

master list of all evaluation results that could help determine what proportion and 

number of public housing units are up to UFAS standards. However, assuming the 

minimum of 5 percent for mobility and 2 percent for vision/hearing impaired required by 

504, we estimate there should be at least 68,300 units of accessible public housing in 

the United States based on current inventory.333 Since this estimate is not based on 

actual data, the real number may be higher or lower. 

Recent compliance reviews of several large PHAs suggest that the number is lower. 

Based on Voluntary Compliance Agreements with HUD, we know that at least nine 

PHAs (Atlanta, Boston, Chicago, Lafayette (LA), Las Vegas, Miami-Dade, Pittsburgh, 

Puerto Rico, and Seattle) and one State financing agency (Alaska) were not meeting 

the minimum threshold.334 With the exception of Chicago, all were given the mandate to 

make at least 5 percent of their units UFAS accessible. The Chicago Housing Authority 

was given a minimum of 5.3 percent for mobility impairments and 2.1 percent for 

sensory impairments.335 Some PHAs were also required to complete a needs 

assessment to determine more precisely what is needed. Given the number of disabled 

families plus the number of elderly families that have someone with a disability, the 

minimum number of accessible units required under Section 504 appears to be 

significantly smaller than the need. 

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Finally, a further limitation to consider is that many accessible public housing units are 

in age-restricted “elderly only” developments (i.e., for people who are 62 years or older) 

and therefore not available to all people with disabilities. Beginning in 1992, HUD 

allowed PHAs to designate public housing developments as elderly only. As of 2009, 

about 65,000 units had been added to this category, with the majority being onebedroom units (40,900 units).336In addition, the elderly only designation of another 

35,000 units had expired, while 60 requests from PHAs were denied elderly only 

designation status and another 50 requests had been withdrawn.337 

Housing Choice Vouchers (HCVs) 

This program allows the household the same benefits as HUD’s public housing 

program, but in the private rental market. To qualify for an HCV, the household must be 

very low income (at 50% of the Area Median Income), which is a lower income 

threshold than that required for public housing. A household with a voucher pays 

30 percent of its income for rent (though it can choose to pay more if it wants). With a 

grant from HUD, the PHA pays the difference up to the Fair Market Rent, which is near 

the median rent for the area.338 Housing units are required to meet HUD-specified 

quality standards verified through an inspection, and are subject to annual reviews to 

make sure they remain in compliance. As with public housing, there is likely to be a 

waiting list and PHAs can establish HUD-approved local preferences. 

Currently, about 1.97 million households are using HCVs in the United States. These 

figures include households that receive assistance through special voucher allocations 

that Congress has provided for the exclusive use of nonelderly disabled households. An 

estimated 64,000 vouchers are included in two programs: the Designated Voucher 

Program and the Mainstream Housing Opportunities for Persons with Disabilities 

program. The Designated Voucher Program began in 1997 as an effort by Congress to 

provide new vouchers for nonelderly people with disabilities who would have qualified 

for studio and one-bedroom units in federal public and assisted housing properties that 

were designated elderly only. An estimated 50,000 Designated Vouchers for nonelderly 

people with disabilities were appropriated between 1997 and 2001. Congress requires 

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PHAs to make these vouchers available only to people with disabilities upon turnover. 

The Mainstream Housing Opportunities for Persons with Disabilities program is 

administered as the HCV program, but is funded through the Section 811 Supportive 

Housing for Persons with Disabilities program. Congress has appropriated an estimated 

14,000 Mainstream Vouchers, which must also continue to be used solely by people 

with disabilities if they turn over. 

Of the total number of HCV holders, HUD data identifies 544,561 as “disabled families” 

(28%) and 374,265 as “elderly families” (19%), of which 150,499 also include someone 

with a disability (11%). As with public housing, most voucher holders are nonelderly 

families with no person with a disability as head of household (1,052,906 households; 

53% of total), and we do not know if there are children or other adults with disabilities in 

these families, since HUD does not identify them. Based on the number of disabled 

families in the HCV program, it appears that the majority did not gain access to federal 

housing assistance through the Designated or Mainstream programs. As a result, the 

majority of vouchers currently benefiting people with disabilities are not guaranteed to 

continue to do so if returned, since there is no requirement for turnover to another 

disabled family. 

Regardless of the type of voucher, there is no record of what, if any, accessibility 

features are in the units that tenants with disabilities occupy. While some public housing 

authorities and disability advocates keep a list of landlords with accessible rental units, 

there is no systematic recordkeeping for HUD on the number of voucher holders with 

disabilities renting accessible and/or adaptable units. Even if all vouchers in both of 

these programs were being used by people with disabilities, we cannot assume that all 

would be living in accessible units or units that fit the accessibility needs of the 

household. 

A study commissioned by HUD found that people with disabilities using vouchers do not 

always search for housing solely to meet their accessibility needs.339 When asked why 

a household selected a current unit, only 10 percent reported that they selected the uni

because it offered more accessible features than other available units. The top reasons 

t 

183
were because the unit was located in a “better” neighborhood (39%), was closer to 

friends (34%), and/or was located near shopping (33%).340 About one-fourth did not 

even search for a new unit when they received their voucher, but instead stayed in the 

current rental unit.341 And whether they moved or not, only 7 percent of the survey 

respondents indicated that they had asked for a modification to the unit. 

Multifamily Housing Programs 

There are 1.47 million rental units in privately owned buildings maintained by both forprofit and nonprofit entities that have been developed with various federal multifamily 

housing programs. This includes at least 396,000 units designated elderly only, with 

most built under Section 202 (270,000 units as of 2004). In contrast, there are only 

about 72,700 units in HUD’s multifamily portfolio designated for people with disabilities 

only (which includes people ages 62 and older), with much of it built in the past 15 years 

under the Section 811 program. Other units were built under the Section 8 program and 

receive assistance to reduce rents in buildings so that low-income households pay only 

30 percent of their income for rent. Most of these developments are designated as 

family, although some are combined elderly and disabled. 

The same is true for units built under various other rental subsidy programs from the 

1960s that are no longer funded, including the Section 221(d)(3) below-market interest 

rate program and the Section 236 program. Both produced affordable housing, but for 

renters with incomes slightly above the public housing income limits. Over time, deep 

rental subsidies were attached to some of these units to keep them affordable, but there 

still are about 318,000 units that do not have these rental subsidies and therefore are 

not affordable to low-income households.342

Based on field inventories completed in 2008, there are approximately 156,000 

accessible units (11%) in subsidized multifamily housing developments.343 Not all are 

affordable to low-income households. Furthermore, as with public housing, the majority 

are likely to be in age-restricted developments, since 26 percent of the units in HUD’s 

multifamily housing portfolio are designated for elderly people, while only 5 percent are 

184
designated for people with disabilities.344 As with public housing, this means not all units 

in the accessible category can be accessed by younger people with disabilities. Finally, 

these figures in no way reflect the occupancy or bedroom size of accessible units and 

whether or not a person with a disability, regardless of age, was occupying the unit 

when it was surveyed. 

Integration of HUD Housing Programs 

The degree to which federal housing is integrated can be examined at different levels: 

regionally, relative to need and conditions; within each program, relative to population 

served; and within a development /building, relative to distribution of units and people. 

We currently do not have data on the distribution of people with disabilities in public 

housing relative to the communities in which developments are located. For the most 

part, data is lacking on the integration of people with disabilities in HUD housing at all of 

these levels. 

Within HUD programs, targeted housing assistance aims to assist specific populations: 

families with children, nonelderly people with disabilities, and people who are aging 

(generally 62 years and older), whether or not they have a disability. Only one program, 

Section 811, targets people with disabilities, while many target or provide special 

assistance for people who are aging. This includes HUD housing units that can benefit 

people with disabilities but, due to changes in policy in 1992, are now designated as 

elderly only.345 The following reviews what we do know about how each population 

“category” is integrated in HUD housing programs. 

People with Disabilities 

Section 811, which was authorized by the National Affordable Housing Act of 1990 and 

modified in 1992 by the Housing and Community Development Act, was specifically 

created to address the supportive housing needs of people with disabilities. Section 811 

has two program components: the capital advance/Project Rental Assistance 

Component (PRAC) and the Tenant-Based Rental Assistance component administered 

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by HUD under the Section 8 Mainstream Housing Opportunities for Persons with 

Disabilities program. As noted above, there are approximately 14,000 vouchers in the 

Mainstream program. 

As of 2007, about 27,000 units of housing had been produced through the 811 PRAC 

by nonprofit sponsors.346 There are three categories of housing allowed: group homes, 

independent living facilities, and condominiums. A group home is defined by law as a 

single-family residence that is designed for up to eight individuals to occupy, in either 

single- or double-occupancy bedrooms, and with at least one bathroom per four 

people.347 Also, the law says a group home developed with Section 811 funds is not to 

be located immediately next to or on the same lot as another group home. An 

independent living facility is like an apartment building, with separate dwelling units 

complete with their own kitchens, bathrooms, and bedroom(s); however, it also can 

include a unit for a staff person. These developments can be a single building on one 

site or multiple buildings scattered throughout the community. 

Based on a nonrepresentative sample of 136 PRAC developments in 2003, the majority 

(81) of the projects surveyed were in facilities with 8 to 24 units, which means most are 

independent living facilities.348 Furthermore, the majority of the surveyed developments 

targeted people with developmental disabilities (43 projects) and chronic mental illness 

(62 projects), rather than physical disabilities. While this data does not represent all 811 

housing, the results are likely to reflect the need for housing specifically for these 

populations that is not being produced by the private sector. 

The law limits to 24 the number of people with disabilities per 811 development; 

however, the annual Notice of Funding Availability limits this to 14 people with 

disabilities. 

Condominium projects are similar to independent living, with separate units. However, 

assuming these are units purchased in a building that was not intended to solely house 

people with disabilities, the program tries to promote integration by limiting the number 

of units to whichever is greater: 14 units or 10 percent of the total units in the 

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development, not to exceed 24 units. Still, HUD grants waivers to allow a larger 

percentage and therefore number of units both in existing buildings and in new 

developments. 

While Section 811 is effective at creating housing, one concern is that the program has 

also contributed to the segregation of people with disabilities, not only from people 

without disabilities, but also by different disabilities. Legislation states that 811 housing 

target people with physical disabilities, developmental disabilities, and chronic mental 

illness, or a combination of these three. However, through a waiver process, HUD can 

approve a project sponsor’s request to not only target only one of these three, but then 

also a subcategory of disability within it (e.g., autism). As long as HUD approves the 

waiver request (which it typically does), the project sponsor can deny housing to 

someone that fits the broader disability category (e.g., developmental disability) but not 

the project’s specific target population (e.g., autism). This means that fit is determined 

based on how well the housing and households in each disability category line up. This 

is especially important given the relatively small number of 811 units relative to need. 

People Who Are Aging 

The U.S. GAO recently issued a report that examines the different federal programs that 

target the elderly (this includes USDA rural housing) to determine what proportion of the 

units were occupied (or in the case of vouchers, what proportion were being used) by 

this population.349 This data, which is drawn from 13 federal programs, illustrates the 

degree to which the aging population is using public housing assistance.350 Whether or 

not the subsidy targets them, the U.S. GAO estimates that about 30 percent of the 

housing was being used by someone age 62 or older (about 1.36 million households). 

However, this is based on a large number of elderly people living in Section 202 rental 

housing, which is now exclusively for the elderly.351 When compared to the usage rates 

within public housing and the different multifamily rental programs, relatively few seniors 

use Housing Choice Vouchers (16%). This suggests that older renters receiving federal 

housing subsidies are more likely to be segregated—living with other elderly 

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households—than integrated, since vouchers provide the most opportunity for anyone 

to rent in nonelderly and nondisability-only or -majority buildings. 

In the past, segregated housing has been justified on the basis that makes it easy to 

efficiently provide specific services to assist people with disabilities and/or an aging 

population. This can include meals, personal care, transportation, housekeeping, and 

social and recreational activities that may be offered onsite or offsite. However, the U.S. 

GAO report found that relatively few housing assistance programs that either target or 

are significantly used by the elderly can also use federally funded supportive services 

programs. This means that many housing programs do not directly offer federally 

funded supportive services, and instead must rely on external resources and services 

for tenants.352 So, while people are grouped according to disability in federal housing, 

this does not ensure services are offered. 

HUD did offer for 1 year the HOPE for Elderly Independence (HOPE IV) demonstration 

program, which combined rental assistance with case management and supportive 

services to “help very low-income, frail, elderly persons remain in an independent living 

environment and to prevent their premature placement in nursing homes.”353 HUD 

awarded grants to 16 agencies for a 5-year demonstration period. Eligible participants 

had to be elderly (householder 62 years or older). Participants were to pay 10 percent of 

the supportive service cost (HUD paid 40% and the Public Housing Agency provided 

50%). 

Service coordinators were to assess residents’ needs, identify and link residents to 

appropriate services, and monitor the delivery of nonmedical services. Eligible social 

services included housekeeping, transportation, home-delivered meals, in-home health 

care, personal care, meals at a senior center, recreation, and counseling. A service 

coordinator could also educate residents about what services are available and how to 

use them, or help residents build informal support networks with other residents, family, 

and friends. The resident was not required to accept the supportive services, and a 

Professional Assessment Committee (PAC), in conjunction with a service coordinator, 

was to determine each participant’s condition and needs. 

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Evaluation of the demonstration program recommended some type of formal program 

that would include connecting frail Section 8 households to supportive services that 

could help them to maintain their independence. This was based on two complementary 

findings: 

First, the study showed that the HOPE IV demonstrations were successful in 

improving the quality of life and care for low-income, frail elderly tenants by 

providing a unique combination of housing assistance, case management, and 

supportive services that was often unavailable elsewhere in the community. A 

second finding, however, was that even with the benefit of separate funding 

and a PHA commitment for the program, these demonstrations had to first 

overcome substantial structural and functional barriers to implementation within 

their own host agencies and among other community partners, in addition to 

the extensive effort required to serve a population with considerable needs.354 

On the latter finding, the evaluation team stressed the importance of having the service 

coordinator not only work with tenants but also to help change the culture in the public 

housing agency, to be more responsive and proactive in dealing with and placing frail 

elderly in the community with vouchers. They also noted, however, that the long waiting 

lists for vouchers makes it difficult to use as a means to prevent institutionalization, 

unless more vouchers are added and/or existing ones are targeted so that upon 

turnover some proportion go to frail elderly people in public housing.355

HUD Formula-Based Programs 

The following sources of funding do not exclusively produce affordable housing, but can 

be used to develop, rehabilitate, and subsidize affordable housing, offer housing-related 

services, and/or produce shelter. Like the HUD programs above, all are subject to the 

same federal accessibility requirements. For all, the use of funds is to be driven by a 

comprehensive plan, known as the Consolidated Plan, which identifies needs, includes 

a housing market analysis, and outlines how funds will be used to meet those needs 

given current and near future housing conditions.356 Developed for a 5-year window, the 

Consolidated Plan is to guide the use of all federal housing and community 

development dollars. It is to be developed with “citizen participation” and reviewed by 

the public prior to local government approval and submission to HUD for approval. 

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Community Development Block Grants (CDBGs) 

Begun in 1974, the CDBG program is managed through HUD’s Community Planning 

and Development office and is one of the older continuous sources of federal funds still 

being used to produce affordable housing.357 CDBG provides funding to help 

metropolitan cities, urban counties, and States to “meet their housing and community 

development needs.” The block grant concept was offered as a means to consolidate a 

seemingly large collection of federal funding programs for housing and community 

development work into one pot of funding, which was then distributed to State and local 

governments through a formula based on need, size, and housing conditions. The logic 

behind the block grant was that it would be more efficient to manage at the federal level 

and be used more effectively at the local level. Both points appealed to lawmakers. And 

while block grants also appealed to local government, the shift to a block grant meant 

that some communities would have direct access to federal housing and community 

development funds, because the formula determined which communities were “entitled” 

to the funds and which were not. 

Communities that receive CDBG funds are known as entitlement communities, which 

include metropolitan cities—principal cities of metropolitan areas or other cities within 

such areas with populations of at least 50,000, and urban counties with a population of 

200,000 or more not within metropolitan cities. In addition, all States get an allocation of 

CDBG funding. Both State and county government then can distribute these funds to 

other smaller local nonentitlement jurisdictions based on need, while cities distribute 

these funds through discretionary funds and reviewed applications for support from 

different agencies that deliver services and produce housing. Currently, the CDBG 

program provides annual grants on a formula basis to about 1,200 general units of local 

government and States.358

In general, CDBG funds may be used for neighborhood revitalization, economic 

development, and improvement of community facilities and services. All activities must 

achieve one of the program’s national objectives, such as benefit low- and moderateincome people, aid in the prevention or elimination of slums and blight, or meet urgent 

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community development needs. The amount of annual grants is determined by 

community need based on poverty rate, population size, housing overcrowding, age of 

housing, and growth lag. 

While the CDBG program contributes to the production of affordable housing in the 

United States, this is not the sole activity supported by CDBG. It can also be used for 

economic development and to improve infrastructure, as long as a minimum of 

70 percent of funds are used to benefit low- and moderate-income people. About 

26 percent of CDBG on average currently goes to housing ($1.16 billion in FY 2008), 

which includes both single-family and multifamily housing. The rate is much lower when 

looking at State allocation of CDBG funds, which is around 16 to 17 percent for 

housing.359 Based on data for the past 8 years, about half the funding has gone directly 

to single-family rehabilitation ($582 million), followed by rehabilitation administration 

($138 million), and code enforcement ($137 million).360 Rehabilitation may include 

retrofitting a home to make it accessible, since this is an eligible use of funds; however, 

it is hard to know if this is occurring because the level of detail in reporting is not that 

specific. More generally, we cannot know if or how many people with disabilities benefit 

from CDBG, since the outcomes reported in HUD’s Integrated Disbursement and 

Information System (IDIS) do not include this detail.361

HOME Investment Partnerships Program 

The HOME program is the largest federal block grant to State and local governments to 

exclusively create affordable housing for low-income households, allocating 

approximately $1.7 billion per year the past few years. The HOME program is 

authorized under Title II of the Cranston-Gonzalez National Affordable Housing Act 

(NAHA), which was passed in 1990. NAHA was the result of a bipartisan group of 

senators and housing experts, which created the National Housing Task Force in 1988. 

The task force’s report, A Decent Place to Live, condoned the diminished role of the 

Federal Government in directing local housing activities, but also recognized the need 

to increase federal housing funding. It also acknowledged: “A new generation of 

community based nonprofit development corporations, propelled by persistence and 

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inventiveness, is an important part of the new delivery system.”362 The task force’s 

centerpiece was a proposed $3 billion housing block grant to States and local 

governments to be provided “with maximum flexibility and minimum (Federal 

Government) interference.” Out of this recommendation came the HOME program. Its 

initial allocation was just $1.5 billion—half of what the task force recommended. 

Today the program enjoys widespread support in Congress and among the housing 

community. HOME funds are exclusively for housing-related investments, including 

Tenant-Based Rental Assistance, housing rehabilitation, homebuyer assistance, 

housing construction, and site acquisition and improvements. Funds may not be used 

for public housing or as a contribution to other programs. A portion of housing and 

assistance must be for very low income people, and incomes and rental prices must 

meet HUD limits. For rental housing and rental assistance, at least 90 percent of 

families benefiting from HOME funding must have incomes that are no more than 

60 percent of the HUD-adjusted family Area Median Income. In rental projects with five 

or more assisted units, at least 20 percent of the units must be occupied by families with 

incomes that do not exceed 50 percent of the HUD-adjusted median. All assisted 

housing must remain affordable in the long term, which is 20 years for new construction 

of rental housing and 5 to 15 years for construction of homeownership housing and 

housing rehabilitation, depending on the amount of HOME subsidy. 

Creation of the HOME program guidelines was influenced by a nationwide movement of 

low-income housing advocates, which resulted in the specific program rule that requires 

States and local jurisdictions to set aside 15 percent of funds for use by communitybased housing groups known as Community Housing Development Organizations 

(CHDOs). CHDOs are certified nonprofit organizations that must: 

(1) Maintain at least one-third of its governing board’s membership for 

residents of low-income neighborhoods, other low-income community 

residents, or elected representatives of low-income neighborhood 

organizations; and (2) Provide a formal process for low-income program 

beneficiaries to advise the organization in all of its decisions regarding the 

design, siting, development, and management of affordable housing 

projects.363

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The HOME program is implemented through government entities called Participating 

Jurisdictions (PJs). A PJ may be a State or unit of local government, including urban 

counties and cities. To be an eligible PJ, cities and counties must qualify for at least 

$500,000 in direct funding under the formula described below. Localities that are in 

proximity to each other can join together to form “consortia” in order to qualify for the 

minimum amount. PJs must match every dollar of HOME funds used (except for 

administrative costs) with 25 cents from nonfederal sources, which may include donated 

materials or labor, the value of donated property, proceeds from bond financing, and 

other resources. This requirement can be waived for PJs following a Presidential 

Disaster Declaration. 

Nationally, HOME funds are allocated according to a formula designed to make sure 

funds are not allocated excessively to any one community or State based on the 

following criteria: 

● Relative inadequacy of housing supply

● Supply of substandard rental housing (worst-case housing needs)

● Number of low-income families in rental housing units likely needing repair

● Cost of producing housing

● Number of families in poverty 

● Fiscal incapacity to carry out housing activities without federal assistance

As with CDBG, HOME funds are to be guided by the Consolidated Plan to make sure 

the affordable housing needs of each community are addressed relative to local supply 

and demand. The most current HOME National Production Report provides a good 

overview of the program in terms of production (new construction, rehab, acquisition), 

commitment to CHDO activity, and income and tenure targeting. 

To date, HOME funds have been used to produce more than 756,000 units of housing 

since the inception of the program (does not include Tenant-Based Rental Assistance 

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[TBRA]).364 While the allocation for HOME has generally increased over time, the 

annual completion rate is somewhat uneven. One constant is that HOME funds are 

strongly leveraged, generating nearly $4 for every $1 of federal funds provided, and 

commitment to CHDOs has been above the 15 percent minimum at nearly 21 percent 

annually. 

Unfortunately, like CDBG, the reporting system does not provide specific information to 

assess how people with disabilities benefit. A growing concern is that despite flexibility 

in how funds can be used, new homebuyers and existing owners consistently benefit 

the most from HOME. About 60 percent of HOME dollars have gone to homeowners 

receiving either rehabilitation or acquisition grants, while rental housing production 

under HOME is only 40 percent of the total unit count. Relatively speaking, rent 

assistance (TBRA) is more cost effective than production programs, at about 10 times 

less per unit (compare an average of $3,151 per household for TBRA to an average of 

$35,495 per unit of new construction). The current TBRA commitment, which is less 

than 3 percent of the 2008 HOME budget, will assist about 200,000 households. Most 

families assisted are extremely low income (78%).365 This income bracket could include 

people with disabilities relying on SSI, as well as most households with worst-case 

housing needs. 

Homeless Shelter and Housing Programs 

In 1986, the Federal Government passed the McKinney-Vento Act, which was the first 

legislation to directly address homelessness at the federal level. Prior to this, most 

programs—shelters and services—were developed and operated through local 

nonprofit and religious organizations with funding from foundations and other charitable 

giving. The McKinney-Vento Act provides funds to develop and operate emergency 

shelters, transitional housing, and permanent housing through a networked system of 

shelters and service providers.366

Today, HUD manages several homeless assistance programs that provide federal 

funding to local communities either through a formula (noncompetitive) or on a 

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competitive basis. Formula funding goes primarily to local entitlement jurisdictions and 

States to provide resources to develop (renovate or convert) buildings for use as 

emergency shelters or transitional housing; to provide related social services (case 

management, physical and mental health treatment, substance abuse counseling, and 

childcare); operating costs (rent, maintenance, security, insurance, utilities, and 

furnishings); and homeless prevention (e.g., short-term and first-month’s rent, eviction 

or foreclosure assistance, utility payments, security deposits, landlord-tenant mediation, 

and tenant legal services). The receipt and use of these funds is tied the State’s or local 

jurisdiction’s Consolidated Plan. 

Competitive funding is awarded to applicants through the State’s or local jurisdiction’s 

Continuum of Care (CoC) plan, which is produced annually by a network of homelessservice providers and other stakeholders (including homeless people) working together 

either through or in conjunction with a government agency. The CoC plan is to guide the 

development and delivery of an integrated set of programs and services in the 

community that aim to help people who are homeless eventually become permanently 

housed. The Continuum of Care planning process is completed annually, and includes 

periodically collecting a point-in-time count of homeless people in the community.367

HUD defines the term homeless as “a person sleeping in a place not meant for human 

habitation (e.g., living on the streets) or living in a homeless emergency shelter.” This 

excludes people who are “doubled up” or staying temporarily at the home of a friend or 

family member, and it does not include people at risk of losing their housing due to 

being extremely cost burdened and usually low income. 

Based on the latest aggregated annual CoC data, which is from October 2007 through 

September 2008, at a minimum, 43 percent of homeless adults (about 421,200 people) 

who stayed in a shelter have a self-reported disability.368 Most are adult individuals not 

in families, and most (about 73%) stayed in emergency shelters during this period, while 

the remaining stayed in transitional housing or both. While the majority of homeless 

people with disabilities are found in shelters in cities, 42 percent were in suburbs and 

rural areas where there generally are fewer shelter and transportation options. HUD’s 

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data also includes veterans who may or may not be disabled. Relatively speaking, 

during this time period there were fewer homeless veterans (135,600) in shelters than 

people with disabilities overall. 

Missing from this account is the number of homeless children with disabilities and all 

people with disabilities not in a shelter who are literally homeless, living on the streets, 

in abandoned buildings, or elsewhere not intended for human habitation. Furthermore, 

this does not include anyone at risk of being homeless because they live in precarious 

housing situations. HUD’s report also does not include estimates of people who are 

unsheltered. These estimates come from local Continuum of Care groups, which 

conduct annual (or biannual) “point-in-time” counts of people who are to include 

sheltered and unsheltered people. This means going out on the streets, into parks, 

abandoned buildings, and other places likely to be “hot spots” for homeless people. To 

limit double counting people who stay in shelters overnight, this count is usually 

completed late at night into early morning, after shelters stop taking people in, and is 

usually conducted in the winter, when the weather is coldest, and near the end of the 

month when people are likely to be low on cash while waiting for the next month’s 

assistance check.369 

The Point-in-Time (PIT) count data for a single night in January 2007 estimated 671,888 

sheltered and unsheltered homeless people nationwide. About 58 percent of them were 

sleeping in an emergency shelter or transitional housing facility. This means 42 percent 

(about 282,200 people) were sleeping on the streets or in other places not meant for 

human habitation. Because data is often collected by observation only (i.e., individuals 

are not surveyed), disability, veteran status, age, etc., are not known. However, the 

National Alliance to End Homelessness (NAEH) provides some insight into these 

populations. 

NAEH estimates that up to one-fourth of unsheltered homeless people are veterans, 

with 150,000 to 200,000 homeless veterans on the street “on any given night.” It also 

cites the 2008 U.S. Department of Veterans Affairs (VA) PIT estimate that 154,000 

veterans are homeless.370 This suggests that NAEH estimates a larger number of 

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unsheltered homeless people overall. NAEH also makes the distinction between 

veterans of different conflicts when looking at veteran homelessness: 

Research indicates that those serving in late Vietnam and post-Vietnam era 

are at greatest risk of homelessness. Veterans returning from the current 

conflicts in Afghanistan and Iraq often have severe disabilities that are known 

to be correlated with homelessness. Among these new veterans, women are 

more common than in the past.371

Regarding people with disabilities who are homeless, NAEH uses a broader definition 

that includes people with mental health and physical health problems to consider 

preventative, acute, and long-term health care needs, as well as their housing/shelter 

needs. NAEH states that “approximately half of people experiencing homelessness 

suffers from mental health issues. At a given point in time, 45 percent of homeless 

report indicators of mental health problems during the past year, and 57 percent report 

having had a mental health problem during their lifetime. About 25 percent of the 

homeless population has serious mental illness, including such diagnoses as chronic 

depression, bipolar disorder, schizophrenia, schizoaffective disorders, and severe 

personality disorders.”372 In addition, there are known high rates of alcohol and drug 

use, and, in some cases, these problems exacerbate health problems. In 2007, the VA’s 

Health Care for Homeless Veterans treated 65,802 homeless veterans, of whom 39,086 

completed a formal intake and assessment. According to this, 51 percent had a serious 

psychiatric condition, 66 percent were dependent on drugs and/or alcohol, and 

57 percent had a serious medical problem.373

Based on this data and accumulated experience over the past 20 years, HUD and the 

Continuum of Care have changed the way we look at homelessness in the United 

States, defining different categories of homeless people for planning and service 

delivery purposes. In current practice, this includes seven groups: chronically homeless, 

severely mentally ill, chronic substance abusers, veterans, people with HIV/AIDS, 

victims of domestic violence, and unaccompanied youth (under 18 years of age). This 

list does not specifically distinguish people with disabilities, but instead focuses on 

people who are severely mentally ill. In part, this reflects the fact that so many homeless 

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people are severely mentally ill and in need of both housing and health care. It also 

reflects past research that demonstrated that, when looking at the expenditure of public 

resources for homeless services, this population has generally required a great deal of 

assistance, because people with mental illness cycle through shelters and programs 

without necessarily getting into permanent housing.374 This concern is reflected in the 

latest category added: chronically homeless. While not apparent, many people with 

disabilities are counted in the “chronically homeless” category. 

By federal definition, a chronically homeless person is either (1) an unaccompanied 

homeless individual with a disabling condition who has been continuously homeless for 

a year or more, or (2) an unaccompanied individual with a disabling condition who has 

had at least four episodes of homelessness in the past 3 years.375 According to HUD, a 

disabling condition is “a diagnosable substance abuse disorder, a serious mental 

illness, developmental disability, or chronic physical illness or disability, including the cooccurrence of two or more of these conditions.” In addition, “a disabling condition limits 

an individual’s ability to work or perform one or more activities of daily living.”376 

Based on CoC PIT counts, there were 123,833 chronically homeless people on a single 

night in January 2007, which was about 18 percent of the combined sheltered and 

unsheltered homeless population. More important, two-thirds of chronically homeless 

people were sleeping on the streets or in places not meant for human habitation. 

While the McKinney-Vento Act has provided much-needed assistance for millions of 

homeless families and individuals over the past 20 years, it has also raised concerns 

that we are institutionalizing homelessness rather than reducing it. In part, this can be 

attributed to the McKinney-Vento Act, which primarily targets people who are already 

homeless rather than focuses on prevention. However, many advocates also point to 

the lack of sufficient permanent affordable housing for very low income people—

including people with disabilities—as a problem that concurrently needs to be 

addressed if we ever are to end or even reduce homelessness. To this end, the 

National Alliance to End Homelessness announced in 2000 A Plan, Not A Dream: How 

to End Homelessness in Ten Years. The plan focuses on “closing the front door to 

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homelessness through prevention programs, and opening the back door out of 

homeless by rapidly re-housing individuals and families,” and “calls for building an 

infrastructure by increasing incomes, expanding affordable housing, and helping 

individuals and families access needed services.”377

Still, when appropriate support services are provided, traditional transitional housing 

programs can play an important role in addressing homelessness, as evidenced by the 

success of the Department of Veterans Affairs Grant and Per Diem (GPD) program, 

which was developed after passage of P.L. 102–590 in 1992. GPD promotes the 

development and provision of supportive housing and/or supportive services to help 

homeless veterans achieve residential stability, increase their skill levels and/or income, 

and gain greater self-determination. Even while working with a high-needs population 

(with over 75% of admissions reporting alcohol or drug problems, 66% reporting mental 

health problems, and 73% reporting medical problems), GPD has demonstrated a high 

success rate placing and keeping veterans in community housing. A recent study of VA 

discharges determined that 83 percent of those leaving GPD and homeless programs 

remained housed 1 year after discharge.378

Since the 2000 announcement by the National Alliance to End Homelessness, the 

concept of local planning to end homelessness has taken root, and hundreds of 

communities have committed to ending homelessness by dramatically transforming 

their homeless assistance systems. Each community commitment starts with a plan that 

outlines a framework to guide communitywide efforts. The alliance and the many 

communities involved see these plans as a critical component in the effort to prevent, 

reduce, and end homelessness nationwide. Similarly, recent research has 

demonstrated and argues for efficiencies gained, as well as more humane treatment of 

people, by focusing on housing first models, prevention, and any form of service and 

assistance that can keep families or individuals in their homes.379

To this end, a significant shift in the last few years has been toward producing more 

supportive housing and less emergency shelter and transitional housing. As HUD 

defines it, supportive housing “provides long-term housing with supportive services for 

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homeless persons with disabilities. This type of supportive housing enables special 

needs populations to live as independently as possible in a permanent setting. Included 

in this are permanent supportive housing units developed specifically for people with 

disabilities and units developed via HUD’s Shelter plus Care (S+C) program. As HUD 

describes the S+C program, it “assists hard to serve homeless individuals with 

disabilities and their families. These individuals primarily include those with serious 

mental illness, chronic problems with alcohol and/or drugs, and HIV/AIDS or related 

diseases.”380

As of 2008, there were 195,724 “beds” in permanent supportive housing, of which 

119,143 were for individual adults and the remaining 76,581 for families. While still not 

surpassing emergency and transitional housing overall (211,000 and 205,000 beds 

respectively), permanent supportive housing increased the most in terms of the 

proportion of programs and number of beds added from 2007 to 2008. Permanent 

supportive housing has more units and a larger share of housing in central cities than in 

suburban rural areas in 2007, and are larger in cities (average 37 units) than in 

suburban and rural areas (average 24 units). 

Finally, permanent supportive housing built with these homeless funds requires the 

person entering the program to be homeless prior to leasing the unit or being admitted. 

Such requirements, while useful at targeting people in need, nonetheless mean these 

“permanent” housing units can only play a limited role in meeting the needs of people 

with disabilities. 

Housing Opportunities for People with AIDS (HOPWA) 

More than 1 million people in the United States are living with AIDS or HIV.381 The 

HOPWA program grew out of the 1990 National Affordable Housing Act as a targeted 

source of funding to provide stable housing for people with HIV or AIDS who are low 

income and need housing, often because they are unable to work and have high 

medical bills. HOPWA grants help governments and nonprofit organizations provide 

housing and supportive services to low-income people and their families living with 

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HIV/AIDS. The program assists in creating long-term comprehensive strategies to 

provide housing, thus reducing the risk of homelessness and improving access to health 

care and support. HOPWA funds may be used for planning, development, and 

implementation of rental housing and the accompanying services. They may provide 

transitional housing, community residences, and single-room occupancy dwellings. 

Priority now is given for the renewal of projects that provide permanent supportive 

housing. Grantees are selected in formula allocations or competitively awarded grants: 

● Formula program uses a statutory method to allocate HOPWA funds to eligible 

States and cities on behalf of their metropolitan areas. 

● Competitive program is a national competition to select model projects or 

programs. 

● National technical assistance funding makes awards to strengthen the 

management, operation, and capacity of HOPWA grantees, project sponsors, 

and potential applicants of HOPWA funding. 

Appropriations for formula grants are the largest portion of HOPWA, at about 10 times 

that of competitive grants ($267 million compared to $29 million in FY 2008). With the 

exception of the technical assistance fund, which has declined over the years from 

$2.5 million in FY 2001 to $1.5 million in FY 2008, federal support for HOPWA has 

increased steadily over time. 

Since 1992, the Federal Government has provided more than $4 billion in HOPWA 

funds to help create and operate HIV/AIDS housing initiatives. HUD estimated that the 

FY 2004 HOPWA appropriation of nearly $295 million would provide housing assistance 

to about 74,000 households, which includes family members who reside with the person 

living with HIV/AIDS.382 More than half those units (approximately 45,000) were to 

prevent homelessness though small, short-term payments. An additional 25,000 units 

received ongoing rental assistance payments. Approximately 5,000 units in supportive 

housing facilities, single-room occupancy (SRO) dwellings, and community residences 

were developed or operated with HOPWA funds. 

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Low Income Housing Tax Credit Program 

The Low Income Housing Tax Credit (LIHTC) program is the primary source of funding 

for affordable housing in the United States. The LIHTC program began in 1986 when 

the Federal Government changed tax laws to encourage private investment into 

“affordable” rental housing produced by private nonprofit developers. The LIHTC 

program is not a HUD program—it is part of the tax code and therefore regulated by the 

Treasury Department through the Internal Revenue Service (IRS). The basic premise is 

that tax credits issued by the IRS get turned into equity, which is then used to reduce 

the cost of development and subsequently the rent the developer needs to charge to 

cover expenses for developing and operating the housing.383

In exchange, the investor (equity partner) gets an annual tax credit for 10 years, as long 

as the housing development and operator meet the compliance requirements. This 

includes high-occupancy levels and the “low-income occupancy threshold,” which 

means meeting one of the following. 

● 20–50 Rule: At least 20 percent of the units must be rent restricted and 

occupied by households with incomes at or below 50 percent of the HUDdetermined Area Median Income (adjusted for household size). 

● 40–60 Rule: At least 40 percent of the units must be rent restricted and 

occupied by households with incomes at or below 60 percent of the HUDdetermined Area Median Income (adjusted for household size). 

As a result, most housing produced through the LIHTC program is intended to be 

affordable to the “working poor”—people usually earning incomes higher than people 

living in public housing, but who are still unable to afford market-rate housing. To keep 

the housing affordable, the developers must restrict rents, including utility charges, in 

low-income units and operate under the rent and income restrictions for 30 years or 

longer, depending on the agreement with the agency issuing the tax credits. 

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Unlike HUD funding, tax credits are not budget outlays but rather taxes that are not 

collected, which is fiscally and politically appealing to many. The allocation of the tax 

credit is based on a per capita rate for each State.384 Beginning in 2003, the rate was 

set at $1.75 per person and is to be adjusted for inflation.385 Guiding the allocation of 

the tax credits in each State is a Qualified Allocation Plan (QAP). States use these 

plans to evaluate development proposals from private and nonprofit developers building 

affordable housing and give points for different features or aspects of the proposed 

development. The QAP, which must be consistent with the State’s Consolidated Plan, is 

also required by federal law to give priority to projects that (1) serve the lowest-income 

families, and (2) are structured to remain affordable for the longest period of time. 

Federal law also requires that 10 percent of each State’s annual housing tax credit 

allocation be set aside for projects owned by nonprofit organizations.386 Beyond these 

requirements, criteria for awarding points vary greatly across the States. 

Based on the latest data available, which is 2007, a little over $9 billion dollars in tax 

credits have been used to produce 1,669,300 units. This is an average of $5,440 tax 

credit dollars per unit developed. The units produced by the LIHTC program has 

exceeded the number of housing units built during the 60 years of public housing 

development, but in a third of the time.387 While not all these units are targeted as 

described above, the average “qualifying ratio” was about 95 percent, which means 

nearly all meet the tax credit requirements and are therefore rent restricted to benefit 

low-income families. Still, at between 50 and 60 percent of the family Area Median 

Income (AMI), the corresponding rents charged are not necessarily affordable to most 

people in public housing, given that most have incomes below 30 percent of the AMI 

(see above).388 This limits access to LIHTC units for extremely low income families, 

because rent is not adjusted for income, but rather set at the price point that these 

higher-income thresholds can afford. For example, if rent is based on being affordable 

to a family of four at 50 percent of AMI in Washington, D.C., the monthly rent could be 

up to $1,200 (estimate, not actual). For extremely low income families to access these 

units would require substantial rental subsidies to make them affordable (i.e., paying no 

more than 30% of income for rent).389 While no current data is available on how many 

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units of LIHTC are also being subsidized by tenants using Housing Choice Vouchers, a 

GAO report in 1997 found that about 39 percent of the households living in LIHTC 

housing also directly received vouchers.390

On average, between 1,300 and 1,400 new developments have been completed each 

year since 1987. Over time, the noticeable trend has been that the average 

development size increases from just below 40 units in 1992 to around 80 in 2005.391

Data on the distribution of units by bedroom size of developments built between 1995 

and 2005 indicates that, on average, the majority of units are two-bedroom (42%) and 

one-bedroom units (31%), with some three-bedroom units (20%), and few studio 

apartments (4%) or four-bedroom units (3%).392

While LIHTC is the most important affordable housing production tool in the United 

States today, we know very little about how it has benefited people with disabilities. For 

the most part, the reason is that there is limited reporting on who occupies these units 

other than by income bracket, since that is critical for meeting compliance requirements 

and assuring that investors continue to receive their tax credit. Still, we know that 

developers using tax credits sometimes target specific populations, including people 

with disabilities. Recent data now collected for inclusion in HUD’s LIHTC database 

suggests that 27 percent of the developments put in service between 2003 and 2005 

were to be for people with disabilities, and about 12 percent for the elderly (about 

41,600 units).393 However, most of these are likely to be permanent supportive housing 

for homeless people, and therefore only accessible to people with disabilities who are 

currently homeless. 

A key distinction between HUD housing and LIHTC properties is that tax credit units are 

not covered by Section 504 regulations, though most are affected by the Fair Housing 

Act, since most units were built after 1991. However, since many developments use 

additional sources of funding, including federal dollars that are subject to 504, the 

assumption would be that if substantial, these dollars would trigger compliance. About 

31 percent of developments that target either the elderly or people with disabilities used 

HOME funding, while fewer used other public sources.394

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In general, we know that proportionately about half of all LIHTC projects are located in 

central cities, about 38 percent are in suburban communities, and the remaining 

12 percent are in nonmetropolitan areas. The distribution of housing targeted for people 

with disabilities appears to be about the same for central city, suburban, and 

nonmetropolitan areas, representing 12 to 13 percent of developments placed in service 

between 2003 and 2005.395 In contrast, housing targeting an older population is 

proportionally higher in suburban locations (35%) than nonmetro areas (28%) and 

central cities (21%).396 Since this data does not include units placed in service before 

2003, it is not known if this pattern applies to all LIHTC developed since 1987. 

Finally, about 22 percent of the units developed in this time period that target people 

with disabilities are in communities where over 30 percent of the people are below the 

poverty line. However, less than 16 percent of the LIHTC units that target the elderly are 

in high-poverty communities.397

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U.S. Department of Agriculture Rural Housing 

The U.S. Department of Agriculture (USDA) housing program began with the 1949 

Housing Act (Title V, P.L. 81–171), which authorized USDA to make loans to farmers for 

the construction of new housing and to refurbish existing homes and other farm 

buildings to ensure safe, decent housing for themselves and other tenants, lessees, 

sharecroppers, and farm workers living on their land. Currently, through its Rural 

Development (RD) division, USDA makes housing loans and grants to rural residents 

and to developers of properties in rural areas. To date, about $116 million has been 

expended since 1949, assisting nearly 3.5 million households.398 

The rural housing programs offered through USDA’s RD division fall into two main 

categories: single-family and multifamily. While a few programs identify people with 

disabilities and those who are aging as eligible recipients, no RD program targets either 

group exclusively. This report focuses on RD programs most likely to benefit people 

with disabilities: 502 loans and grants, 504 loans and grants, 515 multifamily rental 

housing, 538 multifamily loans, and 521 rental assistance. 

As with HUD programs and the LIHTC program, RD programs have income guidelines. 

However, they also have geographic restrictions, so unlike the other two, eligibility for a 

RD housing is also determined by the location of the housing for which assistance is 

being sought, whether development funds, an individual loan, a grant, or rental 

assistance. In general, USDA Rural Development targets communities with a population 

of 10,000 or fewer in locations that are not closely associated with urban areas. 

However, under specific circumstances, loans can be made in towns or cities with 

populations between 10,000 and 25,000. 

Based on the trends in worst-case housing needs identified by HUD, the need for 

affordable housing in rural areas has increased since 2003.399 Less is known about the 

need for accessible housing. The Housing Assistance Council (HAC), which does 

extensive research on rural housing policy, programs, and needs, points out that: 

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Residents of rural areas tend to value independence, self-reliance, and 

individualism. Although these are positive values, they also contribute to a 

reluctance to seek help from mental or physical health professionals among 

persons with disabilities in rural areas. This factor also makes it difficult to 

assess the need for accessible housing in rural areas.400

HAC includes this statement in its fact sheet on people with disabilities, suggesting that 

meeting the housing needs of people with disabilities in rural areas requires first 

understanding what will make people respond if assistance is offered. The HAC fact 

sheet also points out that even if need is identified and people are interested, it can be 

difficult to develop rural rental housing for people with disabilities if the plan is for group 

homes, since: 

Local zoning and land use restrictions often limit the siting of group homes in 

both urban and rural areas. These restrictions include dispersion requirements 

(prohibiting group homes from locating too close to one another), concentration 

requirements (prohibiting the location of group homes in certain areas), and 

occupancy requirements (limiting the number of residents).401

Moreover, transportation or the lack thereof is a key barrier for choosing a place to live, 

which means people with disabilities are likely to make trade-offs between accessibility 

features and affordability when searching for housing. This is especially important for 

people who may need regular access to medical treatment. Given the geographic 

dispersion of households in rural areas, medical facilities—even pharmacies—tend to 

be concentrated in communities with larger populations (e.g., the county seat) and may 

serve several counties or a larger urban region. Finally, for the growing aging 

population, assuming that most people prefer to stay in their own home, assistance with 

retrofitting existing housing becomes an important factor in determining and meeting 

need. 

Single-Family Housing 

About 80 percent of all development dollars available for rural housing has gone to 

assist in the production and rehabilitation of single-family homes. In general, rural 

homeownership (75%) continues to be higher than the U.S. overall (66%) and higher 

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than in urban areas (64%), which means that people who have disabilities and are 

aging in rural areas are more likely than not to reside in single-family homes.402 This 

has implications for accessibility requirements associated with federal housing funds as 

well as expectations for integration and affordability. 

The two primary programs for rural single-family housing assistance are under Section 

502, which allows for direct loans and guaranteed loans. A direct loan means the loan is 

made directly to the applicant via USDA’s Housing and Community Facilities Program

(HCFP). Guaranteed loans are secured by the household through an approved lender 

and then guaranteed by USDA. In addition, the Section 504 Housing Repair and 

Rehabilitation Grant and Loan program helps very low income homeowners with repairs 

and accessibility improvements.

Section 502 Rural Housing Direct Loans 

This is USDA’s largest outlay for housing, helping more than 2 million low-income 

people purchase or construct homes in rural areas. Up to 100 percent financing may be 

obtained to buy, build, repair, or move a home, as well as to purchase and prepare 

home sites. Individuals or families may be eligible if they have an income of up to 

80 percent of the Area Median Income.403 They also must be without adequate housing, 

be able to afford mortgage and other payments, be unable to obtain credit elsewhere, 

and have a reasonable credit history. Housing must be modest in size, design, and cost, 

and meet all applicable building codes. Loans are for up to 38 years, with the interest 

rate set by HCFP and modified by the payment subsidy. The late1970s was the peak of 

the 502 loan program, averaging up to 140,000 loans in a year. Current loan activity 

since 1986 has been averaging about 20,000 homes a year. 

Section 502 Rural Housing Guaranteed Loans 

These loans are generally used to help low-income individuals purchase homes in rural 

areas. Funds may also be used to build, repair, or move a home, and to purchase and 

prepare home sites. Low-income individuals may be eligible for this assistance if they 

have an income of up to 115 percent of the Area Median Income. Because these loans 

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are provided by outside lenders and guaranteed by USDA, the applicant must be able to 

afford the mortgage and other payments and have a reasonable credit history. Housing 

must be modest in size, design, and cost, and meet all applicable building codes and 

loan limits (value) set by USDA.404 Loans are guaranteed for 30 years, interest rates 

and repayment are set by the lender, and no down payment is required. Approved 

lenders include State Housing Agencies, Farm Credit System institutions with direct 

lending authority, and lenders participating in USDA Rural Development guaranteed 

loan programs. Qualified lenders also include those approved by HUD, the U.S. 

Department of Veterans Affairs, Fannie Mae, and Freddie Mac as qualified family 

mortgagees. While the program began in 1977, it really did not take off until 1991, which 

marked the beginning of a steady rise in loans to the peak of 40,000 a year in 2000. 

This has dropped to between 30,000 and 35,000 per year as of 2007. 

Section 504 Rural Housing Repair and Rehabilitation Loans 

Loans of up to $20,000 are offered to help very low income individuals who own and 

occupy a home in need of repairs. Loans can be used to cover costs to repair, improve, 

modernize, or remove hazards in a home. Homeowners may be eligible if they have an 

income up to 50 percent of the Area Median Income, are unable to obtain credit 

elsewhere, and need to make repairs to improve sanitary conditions or remove health 

and safety hazards in their home. Repaired housing must meet local and other 

requirements, and only the major health and safety hazards must be removed. Loans 

are for up to 20 years with 1 percent interest, and mortgage and title are generally 

required. Since its inception in 1950, about 161,000 loans have been made, and the 

number, while small, has been steadily increasing since 1990, with about 5,000 loans 

granted in 2007. 

Section 504 Rural Housing Repair and Rehabilitation Grants 

Grants are provided to help very low income elderly individuals who own and occupy a 

home in need of repairs or accessibility improvements. Grants of up to $7,500 may be 

obtained for repairs and improvements to remove health and safety hazards in a home, 

including those related to a disability need. Homeowners may be eligible if they are over 

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62 years old and cannot repay a Section 504 loan. Applicants must have an income of 

up to 50 percent of the Area Median Income and be unable to obtain credit. Repaired 

housing must meet local and other requirements, and only the major health and safety 

hazards must be removed. The grant may be used in conjunction with a Rural Housing 

Repair and Rehabilitation Loan. Since 1950, about 157,000 grants have been made, 

and the number of grants has been steadily increasing since 1990, with about 6,000 

grants awarded in 2007. It is unknown how many of these grants are in addition to a 

Section 504 loan, or how many were used to make housing accessible. 

Multifamily Housing 

As with HUD’s multifamily properties, USDA’s multifamily housing program was 

designed to provide private sector—for-profit or nonprofit—developers with loans and 

grants to assist in the development of rental housing. USDA also makes these funds 

available to the public sector to produce housing, although not as public housing 

managed by a Public Housing Agency. Someone looking to rent subsidized affordable 

housing in a rural area can use the RD online search engine to find housing by location 

(State, county, town, or ZIP code) or property owner.405 Property information includes 

total number of units and number of units by bedroom size and “complex type,” which 

can be family, elderly, mixed, group home, or congregate. Based on a count of all 

multifamily programs, USDA has helped produce or preserve about 668,000 units, 

including housing for domestic farm labor. In addition, USDA has provided rental 

assistance through the Section 221 program to nearly 981,000 households since 1978. 

Section 515 Rural Rental Housing Loans 

These loans are to help purchase affordable multifamily rental housing for families that 

are at or below moderate income (slightly above the Area Median Income). Loans can 

be made to individuals, nonprofit and for-profit corporations, Limited-Equity 

Cooperatives, American Indian tribes, and public agencies. Applicants must be unable 

to obtain credit elsewhere at a rate that will allow them to charge affordable rents. 

Properties can target specific populations, including the elderly and people with 

disabilities. Loans are competitive and priority is given to projects targeting very low 

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income households and those living in substandard housing. Evaluation criteria and 

target communities are identified yearly in a Notice of Funding Availability. 

At its peak in 1978, the Section 515 program produced 40,000 units in a year. Soon 

after, production began dropping, so that by 1996, only about 2,000 units were 

produced, and in the past few years (2005–2007), fewer than 100 new units have been 

added annually. Since its inception in 1963, the program has produced 530,536 rental 

housing units, which are widely distributed across the United States, Puerto Rico, Virgin 

Islands, and West Pacific territories. Based on a recent analysis by the Housing 

Assistance Council, nearly 89 percent of all U.S. counties (2,800) have at least one 

Section 515 development.406 Half these counties have fewer than 5 projects, and 

40 percent have between 5 and 10 properties. Despite the fact that most counties in the 

United States have at least one Section 515 property, most of the units are located in 

the Southeast (e.g., Florida, Georgia, Mississippi, Alabama, North Carolina, Arkansas) 

and Midwest (e.g., Missouri, Michigan, Illinois, Iowa, Indiana, Ohio). 

Developing affordable housing requires multiple sources of housing subsidies, which 

means that when attributing units to a program, there is potential to double count units 

(or more, depending on how many sources of financing are used). Recent estimates 

indicate that one-fifth of all Low Income Housing Tax Credit projects (5,542 properties) 

and 10 percent (1,464 properties) of Section 8 project-based developments also have 

Section 515 funding. In addition, many project-based developments with 515 funding 

also receive Section 202 or Section 811 assistance.407

Section 538 Rural Rental Housing Guaranteed Loan Program 

Begun in 1996, this relatively new program targets the same population as Section 515, 

but instead of providing the loan directly to a developer, USDA guarantees a loan 

secured through a lender. As with the guaranteed loan program for single-family homes, 

the Section 538 program works through USDA’s Housing and Community Facilities 

Program. Loan applicants may be individual developers, nonprofit organizations, local 

governments, American Indian groups, or for-profit corporations. Eligible lenders include 

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State Housing Finance Agencies and those approved by the Federal National Mortgage 

Association, the Federal Home Loan Mortgage Corporation, Federal Home Loan Bank 

members, or the Department of Housing and Urban Development. USDA guarantees 

such loans, which are for up to 40 years and have fixed rates. As a result, about 24,000 

units have been developed through FY 2007, with an average of about 2,500 units per 

year. 

Section 521 Rental Assistance Program 

As with HUD’s voucher program, these subsidies are to be used to help low-income 

households with their rent. This includes people with disabilities and those who are 

aging. However, unlike the voucher program, which allows the tenant the “choice” to 

look anywhere in the housing market, this assistance is tied to properties funded by 

USDA’s Housing and Community Facilities Program. Households are eligible for 

assistance if the rent they can afford (30% of their adjusted monthly income) is below 

that of the unit’s rent. HCFP establishes 5-year contracts with property owners in which 

the program pays the difference between the tenant’s affordable contribution and the 

monthly rental rate. Requests for funding are generally initiated by property owners; 

however, tenants may also petition such owners to obtain funding through this program. 

This competitive program is designed to give priority to housing with the 

highest percentage of tenants in need of rental assistance and the areas with the 

greatest housing need in the State. 

Since its inception in 1978, the 521 program has made up the difference between what 

a tenant can afford to pay and the actual rent for a unit. While this model has assisted 

nearly 1 million households living in rural rental housing, over the years it has not 

necessarily ensured sufficient rent to cover the cost of maintaining the housing stock. A 

2004 study for USDA concluded that a significant portion of the Section 515 Rural 

Rental Housing program portfolio was at risk of being lost due to insufficient reserves 

and inadequate cash flow.408 As a result, the study concluded that the rate of decline 

was likely to accelerate in many properties, putting families at risk of losing their rental 

units and reducing the overall supply of affordable rural rental housing. 

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Complicating matters is the fact that many properties are eligible to “prepay” and 

become market-rate housing upon leaving the program, assuming RD determines that 

there should be no restrictions on keeping rents affordable. While technically this 

applies to about 60 percent of the Section 515 portfolio, the study concluded that given 

the poor conditions of many of the rental properties, only about 10 percent would likely 

choose to prepay early in order to opt out of the program. Between 2001 and 2007, 880 

properties, representing nearly 15,000 units, have prepaid. While this number 

represents only about 5 percent of the total Section 515 housing properties, it does not 

include a large portion of properties—another 7,300 properties with 195,000 units—that 

are now eligible to prepay and potentially become unaffordable.409 

In response to this problem, USDA developed the Rural Development Voucher 

demonstration program. This 1-year rental subsidy program was intended to “protect 

tenants of USDA Multi-Family Housing (Section 515) properties who have had their 

USDA loans foreclosed or prepaid between October 1, 2005 and September 30, 

2006.”410 These vouchers are in addition to the rental subsidy provided by Section 521 

and can be used with the tenant’s current housing to offset higher rents, assuming the 

owner raises rents to market; or they can be used elsewhere in another rental property, 

as with any tenant-based voucher. As of FY 2007, nearly $3 million had been committed 

for 1,100 vouchers. This suggests that many of the families in prepaid housing did not 

need, were not eligible for, or did not seek voucher assistance. 

Location of USDA Rental Housing 

A 2008 Housing Assistance Council (HAC) report found the distribution of most Section 

515 properties fall into four types of counties: 

● Remote, nonmetropolitan counties (5,878 properties).411 These represent 

nearly one-half (46%) of total subsidized rental properties and over 36 perc

of subsidized rental units in these counties

ent 

. 

● Urbanizing counties (nearly 1,500 properties). These 40,000 units make up 

34 percent of the subsidized housing stock in these fast-growing counties. With 

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population increasing and the economy developing, demand for housing is 

expected to be causing rents to rise, “giving owners of Section 515 

developments a strong economic incentive to prepay their restricted-use 

mortgages in order to charge market-rate rents.”412

● Nonmetropolitan housing stress counties (46,137 properties). HAC identifies 

“housing stress counties” as those where at least one-third of the households 

are experiencing some housing problem, such as rent burden, overcrowding, or 

poor housing quality. Currently, Section 515 accounts for 38 percent of federally 

subsidized units in these counties, and almost half are eligible for prepayment. 

A key concern is that “tenants from a Section 515 property in a housing stress 

county are very unlikely to be able to find alternative rentals nearby.”413

● Counties with proportionately high populations of people from diverse racial 

backgrounds. HAC identified all counties that had a specific racial or ethnic 

diverse population of one-third or more in 1980, 1990, and 2000. Section 515 

units comprise fully 44 percent of subsidized rentals in American Indian 

counties, 22 percent in African-American counties, 18 percent in Latino 

(Hispanic) counties, and 7 percent in Asian-American counties.414 Again, a key 

concern is that since this is an important part of the housing stock in many of 

these communities, attention to preservation in light of prepayment and other 

risks of losing housing is critical to ensure continued housing opportunities for 

people from diverse racial backgrounds in rural areas. 

In addition to locating Section 515 housing, the Housing Assistance Council looked at 

the spatial relationship of housing options through HUD programs, assuming this is an 

option if a family wants to relocate to other assisted housing. On average, there is HUDsubsidized housing within about 6 miles of most Section 515 buildings. Most of these 

units are in public housing, which may or may not be easily attained, depending on the 

housing authority, its waiting list, and whether the public housing is age restricted, 

accessible for people with disabilities, and the right fit in terms of bedroom size. The 

average distance for Section 202 and Section 811 is about three times that, at nearly 16 

miles, which means a much greater distance to move if someone is seeking either age215
specific or accessible housing for people with disabilities. On average, Low Income 

Housing Tax Credit properties are just slightly closer (15 miles from Section 515 

housing); however, as noted above, there is no assurance that there will be accessible 

housing, even though most of these developments are covered by Fair Housing Act 

requirements. 

Accessibility and Integration 

Recent estimates suggest that about 58 percent of Section 515 rental units are 

occupied by people with disabilities and/or the elderly.415 This does not necessarily 

mean that units occupied by people with disabilities are accessible. Instead, this is 

based on the designation of the property, with at least 40 percent being age restricted 

(i.e., for elderly only), which means only about 18 percent are likely designated for 

people with disabilities. 

As with most HUD housing, a breakdown of USDA accessible housing is not available 

for either the single-family or multifamily programs. Assuming that the multifamily 

housing meets the 5 and 2 percent rule, there could be a total of about 33,000 units 

accessible for people with mobility limitations and 13,000 units for people with sensory 

impairments. However, a 2004 study by the National Fair Housing Alliance (NFHA) 

suggests this is likely not the case, as it found that several projects had less than 

5 percent accessible units.416 Moreover, even with sites that might have the minimum 

number of required accessible units, access might be restricted by age. The same 

NFHA study found that in extensive paired testing in 24 States where most rural rental 

housing is located, more than 20 percent of the sites were “illegally denied to potential 

renters based on their race, national origin, disability, or familial status.”417 Based on 

paired disability tests, 36 percent “revealed some differential treatment on basis of 

disability.”418 This included inaccessible offices and entrances to apartment buildings, 

“blatant statements” about reasonable accommodations that would not be allowed 

and/or would not be accommodated if requested, and suggesting that fees might be 

charged for some accommodation requests.419

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Recent Trends in Federal Housing 

This section reviews current conditions and issues affecting the supply of federally 

funded housing for people with disabilities. Most significant is the decreasing rate of 

housing assistance that can directly benefit very low income families with housing 

needs, coupled with the loss of real housing units for the same population. 

Funding 

Efforts in recent years to reduce domestic spending have led to cuts in housing 

assistance during a time of significantly increased housing need, as evidenced by the 

6 million very low income households with worst-case housing needs—an increase of 

nearly 800,000 households (16%) between 2003 and 2005.420 A review of the budget 

for federal housing assistance points to several concerns that warrant attention. First, 

HUD’s annual budget, which was $37.6 billion in FY 2008, declined or remained 

relatively flat since 2004 when adjusted for inflation. A significant dip—nearly 

$3.3 billion—between 2004 and 2006 resulted in a loss of more than 150,000 Housing 

Choice Vouchers.421 Second, the largest portion of HUD’s annual budget has been and 

continues to be Tenant-Based Rental Assistance/vouchers ($16.4 billion or about 44% 

in FY 2008). While it can appear that federal outlays for this program have increased 

over the past 4 years, this is deceiving since most of the increase has been due to the 

loss of project-based housing assistance, which began as multifamily property owners 

chose to “opt out” of federal housing programs when contracts began expiring in the 

mid-1990s, and the demolition of federal public housing began through the HOPE VI 

program. 

Public housing funding has declined more than 25 percent since passage of the Quality 

Housing and Work Responsibility Act (QHWRA) in 1998. On the heels of the permanent 

repeal of the one-for-one replacement rule for public housing in 1995, Congress 

enacted the QHWRA, which required housing authorities to assess their stock and 

determine if it would be more cost effective to rehabilitate or demolish units in any 

development with 250 or more units. If demolition was decided, then the PHA would 

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“voucher out” residents. PHAs could also seek grant money from HUD to replace many 

of their housing units through mixed-income housing.422 While tied to the development 

of a comprehensive plan for the entire PHA portfolio, which includes rehabilitation as 

well as demolition, QHWRA signaled a clear turning point away from permanent public 

housing and toward Housing Choice Vouchers (formerly Section 8 vouchers, newly 

named to emphasize choice with QHWRA legislation). When adjusted for inflation, the 

outlay for public housing (both operating and capital) has dropped steadily since 2001. 

A slight increase rather than decrease occurred in 2007 and 2008; however, this was for 

operations and not capital.423

Lost Housing Units 

The inventory of older housing built with public funds has been reduced through 

changes in different policies over the past 10 to 15 years. This includes efforts to 

transform public housing with the HOPE VI program and QHWRA, and efforts to reduce 

the cost of subsidizing privately operated multifamily housing through efforts to 

refinance outstanding federal loans in the 1990s. 

Lost Public Housing Units 

HOPE VI, which began in 1993 as a means to transform our “severely distressed” public 

housing, has demolished more than 150,000 units, but will only replace about 50,000, 

based on grants as of FY 2007. In 2000, there were approximately 1.28 million public 

housing units throughout the United States and Puerto Rico. In September 2008, the 

inventory was at 1.19 million (about a 7.5% reduction). Most of these units were 

demolished under the HOPE VI program. At that time, it was estimated that nearly 

100,000 units fit this category, and the plan was to replace these developments with 

new “mixed-income” communities that would have a blend of public and private housing 

and income levels. 

To date, the plans approved by HUD have exceeded the target number to be 

demolished by 50,000 units and have produced much less replacement housing than 

was expected. Furthermore, while there are “affordable” units included in the 

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replacement mix, these units usually are built with Low Income Housing Tax Credits and 

therefore are not affordable to most public housing families. Another concern is that 

replacement housing resulting from HOPE VI and QHWRA may not be in compliance 

with Section 504, even though it is subject to the same requirements as public housing 

and required to be compliant with the Fair Housing Act.424 

Looking ahead, while few public housing developments specifically serving people with 

disabilities are “severely distressed,” those that are either already have been approved 

for HOPE VI redevelopment or have housing conditions that might qualify for HOPE VI 

funding.425 Severely distressed status is based on design, obsolescence, deferred 

maintenance, physical deterioration, and/or problems with the physical plant, which can 

include not meeting physical accessibility requirements under 504—a strong possibility 

for many older developments. However, it can also be attributed to the high level of 

poverty in the development and/or the decline of the surrounding community as 

evidenced by disinvestment.426 This includes many public housing developments in the 

United States, though less now than in the past, since many have been demolished 

under HOPE VI.427 

Lost Multifamily Housing 

Long-term contracts with HUD through the Section 8 program for housing assistance to 

privately owned multifamily developments began coming due in the 1990s. The Federal 

Government saw this as an opportunity to refinance high-interest rate mortgages on 

developments built in the 1970s.428 While some property owners did refinance, others 

decided to opt out of the program or prepay their mortgage, often to convert their 

property to market-rate, unsubsidized housing. This was common in communities where 

market conditions had improved and overall housing prices were increasing. As a result, 

many properties that had been part of the inventory of subsidized housing were no 

longer affordable to rent. While HUD provided tenants a Housing Choice Voucher to 

offset the increase in rent, the unit itself was no longer automatically affordable to the 

next qualified low-income tenant. Early on, HUD realized that this would be a problem 

for specific populations—namely the elderly and people with disabilities—so properties 

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that targeted these groups, such as Section 202 and 811, were not able to opt out or 

prepay. This did not prevent nondesignated or targeted properties that had older people 

or people with disabilities from leaving the program. However, most opt-outs were family 

developments.429 Across the board, many properties left the program because of 

foreclosure rather than prepayment or opting out. 

While recent estimates show most project-based Section 8 multifamily developments 

with expiring contracts are renewing rather than opting out, we should still anticipate 

losing more permanent affordable units and shifting to tenant-based Housing Choice 

Vouchers. Current estimates show a 92 percent annual renewal rate the past few 

years.430 Still, this means about an 8 percent shrinkage of the overall supply of 

permanent affordable housing units. And while vouchers are provided to help tenants to 

either stay or move, given the levels of discrimination coupled with usage rates, it is not 

necessarily an easy transition for displaced tenants. Furthermore, based on experience 

in 2004 to 2006, when funding allocations for tenant-based assistance dropped 

significantly with budget cuts effectively eliminating thousands of vouchers, people are 

not necessarily feeling secure in using them. Funding cutbacks for project-based units 

can have devastating effects, but so can cutting a household’s rental subsidy, which not 

only affects the family’s ability to pay rent, but also the landlord, who may choose to 

evict the family. This is why rural housing advocates are concerned about the shift to 

tenant-based vouchers in the Section 515 program. While the program aims to keep 

people from losing housing that is either prepaid (opting out) or foreclosed, it does not 

provide quite the same security as an affordable housing unit.431

Lack of Complete Inventory of Accessible Units 

Despite Section 504’s being in place since 1973, there currently is no complete picture 

of the accessibility of federally funded housing. In the late 1980s, HUD pushed to get all 

PHAs to complete a self-study to assess their programs and housing to determine what 

would be needed to comply with Section 504 requirements. However, no formal count of 

accessible units has been produced, and in most recent cases, compliance reports are 

not public because the case is open while HUD and the PHA negotiate. While this limits 

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researchers’ ability to determine the exact number of accessible units for people with 

disabilities, it also raises concerns that people with disabilities are not getting complete 

information on what accessible affordable housing is available—or is not—in their 

communities. Currently, the only way to find out what may have been agreed upon 

between HUD and the PHA is in the Voluntary Compliance Agreement. While HUD has 

published some of these agreements (several referred to above), the outcomes of most 

recent reviews are not known.432 

The LIHTC, which is the primary source of new construction of affordable housing, is 

usually not affordable to most lower-income people with disabilities and is not subject 

504 regulations, although it is subject to Fair Housing Act requirements if a development 

is more than four units. Only recently, beginning in 2003, has any data been collected to 

know how many LIHTC developments are even targeted to the elderly and/or people 

with disabilities. It is still unknown how much of the current stock conforms to Fair 

Housing Act requirements, since these units are not technically regulated by Section 

504. Still, given the fact that LIHTC has produced so much housing and that many units 

are built with other federal funds that are subject to 504, they should be included in an 

inventory as described above. Furthermore, given the cost of these units is higher than 

what extremely low income households can afford, it would be helpful to know what 

proportion are also using Housing Choice Vouchers. 

Along these lines, there is a broader concern that housing built after the Fair Housing 

Amendments Act continues to offer fewer physically accessible units than is required by 

the law. A study completed for HUD in 2003, Multifamily Building Conformance with the 

Fair Housing Accessibility Guidelines, provides some potential insight—at least for 

housing built during the study period of 1991 to 1997.433 Based on a survey of a sample 

of 397 multifamily projects and interviews with 20 architects and builders, the authors 

developed composite measures to determine conformance with Fair Housing Act 

guidelines, which includes these seven key items: 

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● Accessible building entrance on accessible route 

● Accessible and usable public and common use area 

● Usable doors 

● Accessible route into and through the dwelling unit 

● Light switches, electrical outlets, thermostats, and environmental controls 

● Reinforced walls for grab bars 

● Usable kitchens and bathrooms 

This survey included both the original approved plans for the development and visits 

into the field to measure the actual buildings that were constructed to see if they 

complied with the requirements. Based on the overall composite scores for each of the 

major requirement areas in the guidelines, plan conformance always scored higher than 

“field” conformance, which is based on the building inspection survey.434 The exception 

was elevators, which scored nearly 15 percent higher in the field than in original plans. 

While the HUD report suggests a high level of conformance across the different 

requirements, none reached 100 percent. On the first criterion, accessible building 

entrance on an accessible route, the survey estimated that 8 percent of the buildings 

built between 1991 and 1997 were inaccessible according to Fair Housing Act 

guidelines, which means that no units in those buildings are technically accessible—

even if they meet all the other requirements of the law. Applying this conformance rate 

to the 1,275,000 units in buildings built between 1991 and 1997, this would mean that at 

least 102,000 units in multifamily buildings with five or more units are not accessible 

because the building entrance is not accessible.435 For those that do have accessible 

entrances, it still would need to be determined inside the building what units are and are 

not accessible according to the other criteria. Given the field scores for the other 

composite measures in the HUD report, it is likely that the number of inaccessible units 

would increase. At this rate, given the number of new multifamily housing units added 

since 1997, several hundred thousands of units that should be accessible may not be. 

Unless they are inspected for purposes of determining compliance, we will never know if 

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this is the case. And, even when fair housing complaints are filed against developers 

who fail to comply fully with the law, these cases take years to settle. Perhaps worse, 

some noncompliant developments are too old relative to the 2-year statute of limitations 

when discovered, so nothing legally can be done.436

Discrimination 

Using Housing Choice Vouchers—whether to relocate from public housing or not—

continues to mean encountering and dealing with barriers, including discrimination and 

lack of uniform protections across the country. Recent analysis of Housing Choice 

Voucher “success” rates indicates that households that had been issued vouchers had 

difficulty finding units to rent using the voucher. From 1993 until 2001, PHA “success” 

rates dropped from 81 percent (meaning 81% of households issued vouchers actually 

found an approvable unit and a willing landlord within the time frame allowed by the 

PHA) to 69 percent. At the time, many attributed this to the tight rental housing markets 

in many cities, landlords’ being unwilling to accept households with vouchers, and a 

shrinking supply of units within the voucher program’s Fair Market Rent standards. The 

2001 data suggests that nonelderly people with disabilities actually do better than 

average (74% success rate), while elderly people with disabilities do worse (54% 

success rate).437

Still, we know that compounding problems in accessing housing is discrimination in the 

housing market. A study of the Chicago metropolitan area, Barriers at Every Step, 

completed for the U.S. Department of Housing and Urban Development, provides 

evidence that discrimination based on disability still occurs.438 As part of a larger 

nationwide study, the Chicago area served as a pilot study that focused on the 

treatment of people who are deaf using the TTY system—a device that allows 

individuals to make and receive text phone calls—to inquire about advertised rental 

housing and the treatment of people using wheelchairs when visiting rental properties to 

inquire about available units. The findings indicate that “adverse treatment against 

people with disabilities occurs even more often than adverse treatment of African 

Americans or Hispanic renters in the Chicago-area market.”439 This was evident in lower 

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rates of service, information provided, and units available, and in higher denial rates 

when requesting the opportunity to inspect units for home seekers with a disability than 

for comparable home seekers without a disability.440

Enforcement 

Compounding the problem of discrimination, HUD continues to lag in handling fair 

housing complaints, the majority of which are by people with disabilities.441 Assuming 

someone knows he or she has been discriminated against—which may not always be 

the case—a fair housing complaint can be filed up to 1 year after the alleged 

discrimination (180 days if filing under 504). Once filed, HUD is expected to take action. 

Currently, HUD outlines the process on its Web site.442 Up front, HUD states it will 

“notify you if it cannot complete an investigation within 100 days of receiving your 

complaint,” and then, “If, after investigating your complaint, HUD finds reasonable cause 

to believe that discrimination occurred, it will inform you. Your case will be heard in an 

administrative hearing within 120 days, unless you or the respondent wants the case to 

be heard in Federal district court.”443

While the speed of the process is subject to many factors, including the cooperation of 

the person filing the complaint, there is concern that despite these commitments to 

timeliness, there is sharp evidence to the contrary, especially for people with disabilities. 

A 2001 National Council on Disability report revealed that cases were open on average 

nearly 500 days in 2000. Based on a recent review by the National Fair Housing 

Alliance (NFHA), it appears not much has changed. NFHA found in its review of cases 

in which a charge was issued between January 2004 and October 21, 2008, that “the 

average age of cases in which a determination of reasonable cause was made and a 

charge issued was 502 days. The shortest time period between filing the complaint and 

the issuance of a charge was 143 days, while the longest was 1,254 days.”444

On the development side, based on compliance review agreements between HUD and 

several public housing authorities (e.g., Atlanta, Boston, Chicago, Miami-Dade, 

Pittsburgh, and Seattle), there is evidence that oversight of new housing built by private 

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sector developers to replace public housing is the result of advocates and people with 

disabilities and not HUD’s proactively monitoring compliance. At this time, it is not 

known how much of the new mixed-income public housing is accessible and if it is 

meeting the minimum rate required under Section 504 and complying with the Fair 

Housing Act. An underpinning concern is that HUD encouraged use of New Urbanist 

design concepts to guide these new developments, which include walk-up front 

entrances that reduce accessibility.445 In 2004, several disability groups, Access Living, 

Disability Rights Action Coalition for Housing (DRACH), and Concrete Change, 

requested that the Congress for New Urbanism (CNU) at least educate developers 

about visitable standards, including no-step entrances and an accessible first-floor 

bathroom. Since then, CNU has included images and discussions of visitable and 

accessible housing in its design resources, with particular attention to the aging 

population.446 However, it is unclear how much of this has translated specifically into 

changing the approach taken in HOPE VI developments, as the CNU actions came after 

most replacement housing was built. 

Advancing Accessibility and Integration 

HUD continues to use the UFAS as the standard for accessibility, but it does not 

uniformly require or even encourage visitability or universal design in its housing 

programs. In 1996, HUD published Residential Remodeling and Universal Design, 

aimed at private homeowners and remodelers. In 2000, HUD published Strategies for 

Providing Accessibility & Visitability for HOPE VI and Mixed Finance Homeownership.

While this is important guidance when remodeling or building replacement housing, it by 

no means requires applying standards to new construction—the time at which it can be 

done cost effectively and easily. More important, HUD does not require visitability or 

universal design in any new construction of federal housing, though it does “strongly 

encourage” it with the HOME program.447 

While LIHTC units are subject to the Fair Housing Act, HUD could also require 

developers to incorporate visitable and/or universal design features in units. Federal 

housing that is subject to 504 does not ensure that universal design standards are 

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considered or applied. Clearly, the latter are not substitutes for the UFAS; however, they 

are means to achieve the end (i.e., access) and can help produce units that do not 

segregate people with disabilities by design and can help create design spaces that do 

not prevent people from using services or programs. 

Current funding also affects any ability to easily produce integrated housing for people 

with disabilities. If the goal is to provide more dispersed and less segregated housing 

throughout our communities, then this requires making it possible to use production 

dollars that target people with disabilities in ways that can foster integration. While the 

Section 811 “mixed-finance” regulation published by HUD in 2005 permits Section 811 

funding to be combined in federal Low Income Housing Tax Credit–financed properties, 

glitches have made the regulation difficult to use and have stalled the widespread 

development of Section 811 mixed-finance housing such as that been produced in 

Texas.448 

Going Green 

A scan of HUD and rural programs verifies that until recently, green and environmentally 

sound development practices have not been actively encouraged or systematically 

pursued for affordable new or rehab housing. While there are incentives through 

foundations and other public programs that can be used by developers engaged in 

development using HUD and USDA funding, this is really left up to the discretion of the 

developer. Given the potentially high upfront cost of many “green” or environmental 

features, it can be difficult for even a motivated developer to pursue these, especially in 

higher-cost markets. As a result, while there is a growing collection of local examples of 

green projects, these are all relatively “one-off” with little documentation to assess cost 

effectiveness or potential benefits of scaling up these practices.449 With new attention to 

sustainable and livable communities, many expect more widespread inclusion of green 

technology in all federal housing, including for people with disabilities. Furthermore, it 

presents new opportunities to expand beyond green to consider ways to improve the 

overall built environment to benefit people with different environmental sensitivities. 

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Looking Ahead 

The following highlights proposed legislation, new programs, and new directions that 

have only just been implemented or proposed and therefore cannot be evaluated, but 

nonetheless point to potentially promising practices. 

Section 811 Legislation 

H.R. 1675, the Frank Melville Supportive Housing Investment Act of 2009, is bipartisan 

legislation that will make significant reforms and essential improvements to the HUD 

Section 811 Supportive Housing for Persons with Disabilities program. An identical 

bill—H.R. 5772—unanimously passed the House of Representatives under Suspension 

of the Rules in September 2008. H.R. 1675 will help address the serious housing crisis 

facing millions of extremely low income people with disabilities by: 

● Authorizing a new cost-effective Section 811 demonstration program that could 

triple the number of integrated units created through Section 811 without any 

increase in the program’s appropriation. This demonstration program is 

designed to highly leverage capital funding provided through other federal 

affordable housing programs, including the Low Income Housing Tax Credit and 

HOME programs. 

● Enacting long-overdue reforms to the current Section 811 production program 

to reduce longstanding bureaucratic barriers and improve the program’s 

efficiency and cost effectiveness. 

● Authorizing a cost-neutral shift of fiscal responsibility for the Section 811–

funded Mainstream Voucher program to the Housing Choice Voucher 

appropriation. Although funded and renewed from 811 appropriations, an 

estimated 14,000 Mainstream Vouchers created between 1996 and 2002 have 

been administered as Housing Choice Vouchers, have never been used for 

permanent supportive housing, and have never been targeted to people with 

the most serious and long-term disabilities. 

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For the past few years, because of Section 811’s outdated structure, the program has 

only produced 800 to 900 new supportive housing units annually. H.R 1675 will 

reinvigorate the program by creating 3,000 or more new units annually through the 

demonstration program, and by authorizing more integrated housing approaches and 

models that are consistent with the housing needs and choices of people with 

disabilities. 

New Funding for Affordable Housing via the National Affordable 

Housing Trust Fund450 

On July 30, 2008, President George W. Bush signed the Housing and Economic 

Recovery Act, which included the establishment of a National Housing Trust Fund 

(NHTF)—an ongoing, permanent, and dedicated source of revenue to build, rehabilitate, 

and preserve 1.5 million units of housing for the lowest-income families over the next 10 

years. This is the first housing program since 1974 that is directly dedicated to rental 

housing for very low income households, which can benefit people with disabilities, 

among others. At least 90 percent of NHTF resources must be spent on rental housing 

and 75 percent of all rental funds must benefit extremely low income households at or 

below 30 percent of Area Median Income. These funds are to be administered by States 

that then make grants to developers with established capacity to build affordable 

housing, including nonprofit and for-profit organizations. Although no source of 

dedicated funding for the National Housing Trust Fund has been identified, HUD has 

requested $1 billion in new funding for this program in its FY 2010 budget request to 

Congress. 

New Vouchers for Nonelderly People with Disabilities 

In both the FY 2008 and FY 2009 HUD budgets, Congress provided $30 million each 

year to fund approximately 3,500 new vouchers for nonelderly people with disabilities. 

These appropriations signal the willingness of Congress to return to policies adopted 

between 1997and 2001 to provide new vouchers for nonelderly people with disabilities 

each year to offset the loss of subsidized public and HUD-assisted housing units from 

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properties designated “elderly only.” PHAs must be willing to apply for these new 

vouchers, and could use them to create special initiatives, such as targeting them for 

people with disabilities who are leaving segregated institutional settings. 

New Vouchers for Veterans451

In 1992, HUD and the VA collaborated to launch a Supportive Housing Program, known 

as HUD–VASH. Its objective was to serve homeless mentally ill veterans by providing 

affordable housing (through HUD’s Section 8 voucher program) and case management 

services (through the VA). Almost 1,800 vouchers were provided. The housing retention 

rates of HUD–VASH compare favorably to other supported housing programs. 

Furthermore, there were significant gains in employment, mental health, and reduction 

of drug and alcohol problems among participants.452 In 2008, HUD–VASH was 

expanded to provide local Public Housing Agencies with approximately 10,000 new 

rental assistance vouchers specifically targeted to assist homeless veterans and their 

families. An additional 10,000 vouchers have recently been added with the passage of 

the Omnibus Appropriation Act of 2009. A joint effort of the Department of Veterans 

Affairs and HUD will link VA medical centers to local PHAs to provide supportive 

services and case management to eligible homeless veterans. 

Inclusive Home Design Act (H.R. 1408)453

This new legislation, introduced on March 10, 2009, by U.S. Representative Jan 

Schakowsky, aims to increase the number of affordable homes accessible to people 

with disabilities. The act would require that all newly built single-family homes and 

townhouses receiving federal funds meet four specific standards: 

● Include at least one accessible (“zero-step”) entrance into the home. 

● Ensure all doorways on the main floor have a minimum of 32 inches of clear 

passage space. 

● Include at least one wheelchair-accessible bathroom on the main floor. 

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● Place electrical and climate controls (such as light switches and thermostats) at 

heights reachable from a wheelchair. 

New HOPE VI Legislation454 

On January 17, 2008 the House of Representatives approved H.R. 3524, the HOPE VI 

Improvement and Reauthorization Act of 2007, which would reauthorize the program for 

7 years and make important improvements to the program. Specifically, improvements 

include requirements that all units demolished under future HOPE VI awards be 

replaced (i.e., one-for-one replacement), that the plans include offsite replacement 

housing in low-poverty areas, and that new HOPE VI projects offer more assistance for 

displaced families using housing vouchers. While this bill did not progress, advocates of 

public housing see promise in the groundwork laid. As described by the Center for 

Budget and Policy Priorities, looking forward, the aim should be “to maximize the 

program’s positive results and minimize any negative impacts it might have on people 

who are displaced when their homes are demolished.”455 

Section 202 Supportive Housing for the Elderly Act of 2009 (S. 18) 

Currently in the Senate, a bill to amend Section 202 of the Housing Act of 1959 would 

significantly change the funding and operation of developments and how funds are 

allocated for developments regionally. It would give more discretion and autonomy to 

owners of such properties.456 It also would require the HUD Secretary to establish and 

operate a national senior housing clearinghouse. 

HUD’s Real Estate Management System (REMS) 

At this time, we do not know the level of integration of accessible units or tenants with 

disabilities within buildings or developments. However, we may be able to learn in the 

near future the utilization rate in multifamily housing through HUD’s integrated Real 

Estate Management System, which currently does or will collect data on the occupants 

of housing for people with disabilities and more detailed information about the bedroom 

size and specific accessibility features.457 This will include, by bedroom size: 

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● Number of mobility impaired accessible units 

● Number of vision and/or hearing impaired accessible units 

● Number of people on waiting lists eligible for accessible units 

● Number of accessible units occupied by elderly or family tenants 

● Number of accessible units occupied by nonelderly tenants with disabilities that 

require the features of the unit 

● Number of accessible units occupied by elderly tenants with disabilities that 

require features of the unit 

This relatively new data collection system, which is used to independently monitor 

HUD’s portfolio of multifamily housing, is an opportunity to look more closely at how 

people with disabilities and the elderly are integrated within housing developments and 

communities.

New Requirements for Low Income Housing Tax Credit Reporting 

The Housing and Economic Recovery Act (HERA) of 2008 now requires HUD to collect 

and report for all LIHTC tenants race, ethnicity, family composition, age, income, use of 

Section 8 (or similar) rental assistance, disability status, and monthly rental payment. 

Not only will this data be of use for assessing how well the LIHTC program is serving 

people with disabilities and the elderly, it will also provide a better understanding of how 

many LIHTC units are made affordable with the use of additional rental subsidies. 

Green Efficient Public Housing 

The Council of Large Public Housing Authorities released its Future of Public Housing 

Framework in October 2008, which included a commitment to “fully integrate green 

building standards to rebuild or retrofit all 1.2 million public housing units as part of the 

reinvestment strategy,” and to raise $10 billion over the next 10 years to accomplish this 

goal.458 The 2009 stimulus package includes funds to kick off this initiative. 

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Promoting Livable Communities 

On June 16, 2009, a new partnership among HUD, the Department of Transportation 

(DOT), and the Environmental Protection Agency (EPA) was announced to support the 

creation of more sustainable development in urban, suburban, and rural areas. This 

includes coordinating housing and transportation investment, “while simultaneously 

protecting the environment, promoting equitable development, and helping to address 

the challenges of climate change.”459 This includes strategies that: 

● Provide more transportation choices 

● Promote equitable, affordable housing 

● Enhance economic competitiveness 

● Support existing communities 

● Coordinate policies and leverage investment 

● Value communities and neighborhoods 

While these strategies are capable of producing livable communities for people with 

disabilities and the elderly, the initiative—at least in its fact sheet for the public—does 

not include specific language or discussion of either group. 

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Recommendations 

The following recommendations assume that all policy development and decisions will 

include people with disabilities in the development of all housing policies, programs, and 

educational presentations. 

Expand the Definition of Disability in Federal Housing 

1. Congress and the Administration should develop initiatives to create a more 

effective and broader definition of people with disabilities in need of federal 

housing, including people with environmental sensitivities. 

● While the ADA definition of disability is broad, current federal housing policy 

and practice focus primarily on mobility limitations in the design and 

development of housing. Growing research on health, as well as “green” 

design, draws attention to a broader view of the built environment and the 

needs of people with “invisible” disabilities, such as psychiatric disabilities and 

chemical sensitivities. 

2. Reform existing HUD programs to end the use of definitions that identify people 

with disabilities as a “special needs” category. Instead of creating “special needs” 

programs for people with specific types of disabilities, HUD must ensure that all 

programs, services, and activities are accessible to people with different types of 

disabilities, including people with environmental sensitivities. 

● Current programs that target people with disabilities and the aging population 

preclude integration across groups, needs, and incomes, as well as with 

people without disabilities. 

Prevent Further Loss of Affordable, Accessible Housing 

3. Congress should review current public housing redevelopment plans to make 

sure sufficient replacement units are planned for and provided. If not, then a 

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moratorium on demolition and/or redevelopment should be issued until plans are 

revised. 

● A key concern is that these plans do not ensure sufficient replacement 

housing, since one-for-one replacement is not required, and because of the 

design of replacement housing. Also, some PHAs are designating 

rehabilitated developments as “elderly only,” which restricts access by age. 

Given the large number of people with disabilities in “worst-case need,” 

removal and designation of HUD housing may actually exacerbate the 

problem. Still, any decision should be weighed against keeping people in poor 

housing that does not meet their needs. 

Increase Affordable Housing for People with Disabilities 

4. A higher percentage of affordable housing constructed with HUD support should 

be reserved for people with disabilities. 

● Current formulas based in Section 504 of the Rehabilitation Act set limits that 

are significantly lower than the current population living in federal housing. 

Given the large number of people with disabilities with worst-case housing 

needs, an increase is justified. Under existing regulatory authority (see 24 

C.F.R. 8.22[c]), HUD can prescribe a percentage or number higher than the 

5 percent requirement for accessibility. 

5. Congress and the President should substantially increase funding for 

construction of accessible, affordable, and integrated housing. 

● Currently, federal funding for accessible housing is segmented and has been 

historically underfunded. Investment is needed to foster creative strategies to 

develop integrated housing that is also environmentally accessible and 

sustainable. 

6. Congress and HUD should consider different ways to control the proportion of 

units in 811 developments that can house people with disabilities. 

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● The goal to produce integrated, affordable, and accessible housing cannot be 

attained as long as funding programs continue to encourage/allow segregated 

housing. For example, a 25 percent cap was introduced in 2008 (under H.R. 

5772), which did not move forward. This can also include a percentage of 

funding that must be used to produce integrated housing with new 

developments. Also, Congress should eliminate the HUD Secretary’s ability to 

waive the limits on the maximum number of residents in group homes and 

independent living facilities. 

7. HUD should streamline the process for using 811 funding in integrated settings. 

● While Section 811 “mixed-finance” regulations published by HUD in 2005 

allow combining 811 funds with Low Income Housing Tax Credits, there are 

many barriers still within the program that make it very difficult to produce 

more integrated housing options for people with disabilities. 

Increase Access to Existing Units 

8. HUD should ensure that units designed for people with disabilities are actually 

occupied by people who need accessible features. 

● Currently, there is no way to systematically determine if people with 

disabilities are living in units that are accessible, or what is needed to 

accommodate these tenants. Section 504 requires PHAs and owners and 

managers of multifamily properties to take reasonable nondiscriminatory 

steps to maximize the utilization of accessible units by people with disabilities. 

9. Congress and the President should support a well-funded national modification 

fund to pay for reasonable modifications that are necessary to make private units 

accessible (or at least usable by people with disabilities). 

● Modification funds currently available are limited relative to need, and not 

consistently available in all communities. Such a fund could make many more 

units accessible in the short term and help integrate people with disabilities 

into the community. 

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10. HUD should require PHAs to determine local needs and set local preferences for 

public housing units and designate vouchers for people with disabilities who are 

leaving institutions. 

● Currently, this is allowed when placing people on waiting lists for vouchers, 

but it is not required. A PHA can establish local preferences based on 

housing needs and priorities of its community. 

Expand and Focus Voucher Usage 

11. Mainstream and Fair Share Vouchers that were turned into regular Housing 

Choice Vouchers by PHAs due to poor oversight by HUD should be recommitted 

to people with disabilities. 

● The Fair Share and Mainstream Voucher programs were created to address 

the housing needs of very low income people with disabilities. However, many 

of these vouchers were never used by people with disabilities and therefore 

“lost,” since they were never tracked and some PHAs gave them to people 

without disabilities. 

12. HUD should issue a policy requiring that a portion of HOME funds be designated 

as rental assistance for use by people with disabilities, and especially those who 

are leaving institutions. 

● Under HOME, this is an option. However, in most States and entitlement 

communities, HOME funds are used for development. Rental assistance can 

be a more cost effective way to benefit many more households, especially 

very low income households. This can also benefit communities with high 

vacancy rates in rental housing. 

13. Congress and the President should create new housing vouchers each year for a 

fixed period for exclusive use by people transitioning out of nursing facilities or 

other institutions. This requires HUD and the Centers for Medicaid and Medicare 

Services to work together to make sure that these vouchers go to people, 

regardless of type of disability or age, living in nursing facilities and other 

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institutions. This cooperation has begun with implementation of the Money 

Follows the Person demonstration program, but needs to be vastly expanded. 

14. Congress and the President should develop a permanent “Barrier Elimination 

Trust Fund” (BETF) for accessibility modifications for people transitioning out of 

institutions, including nursing homes and group homes, and those at risk of 

institutionalization. This fund should be increased annually using the Consumer 

Price Index. It is recommended that funding for the BETF could come from fines 

for failure to comply with Section 504 and Fair Housing Amendments Act 

requirements. 

15. Sufficient funding is needed for rental assistance and home modifications directly 

targeting people with disabilities who are at risk of being placed in institutions, 

including group and nursing homes, to realize fair housing goals and the goals of 

Olmstead.

Educate Fair Housing Act Enforcement on Disability Rights 

16. Require and provide regular training that educates various HUD and Fair 

Housing Act enforcement offices and contractors consistently about the 

interpretation of the law and new developments, encourages coordination with 

disability rights organizations/groups, and rewards development of partnerships 

with the disability community. 

● Currently, the various HUD enforcement offices and grantees have varying 

levels of expertise and commitment to disability rights issues, resulting in 

uneven handling of complaints. 

17. Require fair housing organizations to develop contractual partnerships with 

disability-based organizations on testing, education, and enforcement strategies. 

● Partnerships can ensure expertise on disability-related fair housing issues 

that many fair housing organizations do not have. Given the large number of 

cases currently filed, systematic testing can help raise awareness and elevate 

the issue beyond the individual case basis. 

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Improve and Increase Enforcement 

18. Congress should increase funding so that HUD can dramatically ramp up its 

enforcement efforts in the area of disability. 

● There continues to be a backlog of cases and a large number of complaints 

filed by people with disabilities. Without enforcement, the laws and various 

regulations are impotent. 

19. Encourage fair housing organizations to do systemic legal work/advocacy and 

provide incentives to do so and offer longer grant periods than are currently 

funded to facilitate such work. 

● Because systemic work, especially systemic litigation, can last for several 

years, fair housing organizations need secure and sufficient funding over 

multiple years to ensure sufficient staff and resources to pursue cases. 

20. HUD should encourage consumer-directed organizations (e.g., Centers for 

Independent Living) to apply for education and outreach grants. 

● Currently, these activities are separated out in HUD’s funding, yet many of the 

organizations that provide enforcement also offer education with funds from 

elsewhere. These activities are complementary and not contradictory, and 

both need greater financial support if the goal is to further fair housing by 

eliminating impediments. 

21. The statute of limitations period for fair housing complaints in new developments 

should be extended until the violations related to the failure to design and 

construct accessible housing are corrected. 

● Current interpretation of the law limits ability to enforce and seek redress, 

since the courts currently interpret the statute of limitations of “last occurrence 

of discrimination” to be the date of the issuance of the last applicable 

certificate of occupancy.

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Review HUD for Compliance with Section 504 and the Fair Housing Act 

22. HUD should ensure that compliance with Section 504 is built into its ongoing 

monitoring activities for PHAs and enter into Voluntary Compliance Agreements 

(VCAs) with noncompliant PHAs, and, if necessary, take enforcement action for 

noncompliance with those requirements. HUD should include disability rights 

advocates in the development of VCAs. 

● Currently, compliance is not systematically reviewed, and usually only when a 

complaint is filed. Recent compliance reviews of several large housing 

agencies found that PHAs were not in compliance and Voluntary Compliance 

Agreements were entered into with HUD. 

23. HUD should evaluate the programs, services, and activities of its Regional Field 

Offices regarding their respective records on Section 504 and demand 

improvements as appropriate. 

● HUD recently conducted its own self-evaluation. With this example set, 

regional offices have not yet done the same, or at least have not made public 

any results from self-study or evaluation exercises. 

24. HUD should take further steps to ensure that Public Housing Agencies know 

about and comply with all Fair Housing Act provisions, including the accessibility 

and accommodations requirements of the act. 

● Evidence of fair housing violations within HUD-sponsored housing, including 

public, multifamily, and tenant assistance, supports the need for education, 

awareness, and proactive behavior with guidance from HUD. 

New Legislation 

25. All new legislation should support the Inclusive Home Design Act that will ensure 

a basic level of accessibility (i.e., visitability). 

● This will target single-family and townhomes built with federal funds that are 

not covered by the Fair Housing Act. 

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26. In any new legislation dealing with economic recovery or foreclosures, HUD and 

other agencies need to include specific requirements and guidance for 

maximizing benefits to people with disabilities. 

● The Neighborhood Stabilization Program (NSP) and the American Recovery 

and Rehabilitation Act (ARRA) both had more potential to benefit people with 

disabilities than was realized in the final legislation and subsequent 

implementation. Future legislation to extend either NSP or ARRA should 

include requirements to expand housing opportunities for people with 

disabilities. 

Research and Dissemination 

27. HUD should follow up on its Disability Discrimination Study as a means to 

encourage additional comprehensive disability-based testing and as a lever to 

support future disability-related enforcement and education. 

● Discrimination Against Persons with Disabilities: Barriers at Every Step (2005) 

is a highly cited study that brought to light the systematic discrimination 

people with disabilities face in their search for housing. This kind of research 

helps to not only enforce the law, but also to educate all actors about fair 

housing. As the report introduction reminds us, “Not enough is known about 

the prevalence of housing discrimination against persons with disabilities. 

Only slightly more than half of Americans know that it is illegal for landlords to 

refuse to make reasonable accommodation for persons with disabilities or to 

permit reasonable modification to a housing unit [based on 2002 HUD 

report].”460

28. HUD should proactively disseminate information about “best practices” with 

regard to disability-related enforcement activities, testing campaigns, compliance, 

and educational activities. 

● There are many fair housing and advocacy groups doing interesting work to 

further fair housing. Being the primary source of funding, HUD is well 

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positioned to identify those practices that can be translated and transferred to 

other communities. 

Engage and Educate Design and Development Industry 

29. HUD should substantially increase funding to educate the public, especially the 

design and construction industry and housing providers, about disability-based 

fair housing rights. 

● Education can inform people about regulations and compliance. It can also be 

used to encourage positive responses to the Fair Housing Act and its 

amendments by demonstrating the cost effectiveness of complying (as 

opposed to having to do it later), as well the broader benefits of considering 

universal design features, through examples of best practices. 

30. HUD should convene a small working group, including design and construction 

professionals and people with disabilities, to consider the propriety of HUD and 

the Department of Justice charging the U.S. Access Board with the task of 

developing a single design standard for new construction under the Fair Housing 

Act. The new standard would be harmonized with ADA/ABA Accessibility 

Guidelines and model building codes to eliminate conflicts with other federal 

standards and minimize differences with State and local accessibility codes. 

● With different laws, regulations, and guidance, there is no single standard for 

construction. As a result, developers, designers, consumers, and even 

enforcement and fair housing advocates are confused by the ways these laws 

are interpreted and implemented. 

31. Congress should modify the Internal Revenue Code so that LIHTC properties are 

considered recipients of federal funding and hence are obliged to comply with 

Section 504. 

● Currently, the Low Income Housing Tax Credit program, which is the primary 

source of funds to produce affordable housing in the United States, is not 

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242

subject to 504. The exception to this is the specific tax credits converted into 

grants under the American Recovery and Reinvestment Act of 2009. 

Data and Reporting 

32. Congress and HUD should include people in group quarters, both 

institutionalized and not, in further analysis for the worst-case needs and other 

assessments of housing needs among people with disabilities. 

● Currently, group quarter data is excluded from analysis of worst-case needs 

by HUD as mandated by Congress. This data is needed to plan ahead and to 

gauge needs of people with disabilities in institutions who under Olmstead

might be able to integrate in the community. 

33. The U.S. Census Bureau should develop household-level reports using Survey of 

Income and Program Participation (SIPP) data to better understand the needs of 

households and families with people with disabilities. 

● Currently, SIPP data is analyzed at the individual level to understand disability 

prevalence and characteristics. Not all people with disabilities live alone and 

some live with other people with disabilities. Reports should be prepared 

using household-level data, so as to better understand the housing situation 

of people with disabilities, including satisfaction with their housing and their 

community—information currently found in SIPP data. 
NCD Topical Brief #2 

Private and Nonprofit Sector Housing 

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244
Contents 

Introduction ............................................................................................................... 247

Need ........................................................................................................................... 249

Key Issues ................................................................................................................. 251

Affordability............................................................................................... 251

Accessibility.............................................................................................. 252

Supportive Housing .................................................................................. 254

Homeownership ....................................................................................... 256

Promising Practices.................................................................................................. 259

Intensive Homeownership and Housing Support...................................... 260

United Cerebral Palsy of Texas, Austin, Texas............................. 260

Housing Initiatives Program, Institute for Disability Studies, 

University of Southern Mississippi, Hattiesburg, Jackson, and 

Gulf Park, Mississippi.................................................................... 262

The Lease-to-Own Model: The Arc of the Central 

Chesapeake Region (formerly The Arc of Anne Arundel 

County), Maryland ........................................................................ 265

Support for Independent Living ................................................................ 266

Neighbors, Inc., Franklin Park, New Jersey .................................. 266

Onondaga Community Living (OCL), Syracuse, New York........... 268

Options in Community Living, Madison, Wisconsin ...................... 269

LifeLong Supportive Housing Program (Alameda County 

Health, Housing, and Integrated Services Network), Oakland 

and Berkeley, California................................................................ 270

Affordable, Accessible, Integrated, Mixed-Use Housing Development..... 271

University Neighborhood Apartments, Berkeley, California .......... 271

Helios Corner, Berkeley, California............................................... 272

Housing Cooperatives (Co-ops) ............................................................... 273

Penn South Cooperative, New York, New York............................ 274

Aging in Place .......................................................................................... 274

Vladeck Cares/NORC Supportive Services Program, New 

York, New York............................................................................. 275

Increasing Very Low Income Housing Through the Low Income 

Housing Tax Credit (LIHTC) Program ...................................................... 276

North Carolina LIHTC Development ............................................. 277

Disability Organizations Advocate for Very Low Income 

Housing with LIHTCs .................................................................... 278

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Increasing Accessible, Integrated, Supportive Housing Through 

Legal Advocacy ........................................................................................ 279

Laguna Honda Hospital Settlement, San Francisco, California .... 279

Fair Housing and Americans with Disabilities Act Housing 

Access Settlements ...................................................................... 279

Universal Design ...................................................................................... 280

6 North Apartments, St. Louis, Missouri........................................ 280

University Neighborhood Apartments, Berkeley, California .......... 281

Universal Design and Visitability: Mandatory and Voluntary Policy 

Models...................................................................................................... 281

Concrete Change and Habitat for Humanity, Atlanta, Georgia ..... 282

Minimum Universal Design Requirements for New 

Construction Using Affordable Housing Trust Funds from the 

City of St. Louis............................................................................. 282

Design for Life Montgomery, Montgomery County, Maryland....... 283

California Model Universal Design Ordinance .............................. 284

Conclusion................................................................................................................. 285

Recommendations .................................................................................................... 289

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Introduction 

This brief explores four key issues that affect the housing and related community 

integration opportunities available to people with disabilities in the United States: (1) 

affordability, (2) accessibility, (3) the role of supportive housing, and (4) 

homeownership. Also highlighted is the role of private and nonprofit entities in providing 

housing and supportive services solutions to people with disabilities to ensure they have 

the opportunity to live as independently in the community as possible. Examples of 

promising practices illustrate the extent to which specific types of housing and 

supportive services developed or managed by private and nonprofit entities are 

inextricably linked to overarching federal, State, and local housing laws and policies. 

These practices relate to the key issues of the brief and include innovative bricks-andmortar solutions, local policies requiring that “universal design” principles be 

incorporated in new housing construction, and proactive advocacy by the disability and 

fair housing communities. Several promising practices involving public housing and 

seniors-only programs, as well as a specific example of municipal commitment to 

increasing housing vouchers, are also presented here because they represent new or 

unique responses to some of the most intransigent housing problems experienced by 

people with disabilities. The brief also presents recommendations for reform. 

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Need 

Recent federal research estimates that there are 54.4 million people with disabilities in 

the civilian population living in the United States, representing approximately 

18.7 percent of the noninstitutionalized population.461 Survey estimates suggest that 

there are about 35,085,550 households with one or more people with a disability; this 

figure constitutes approximately 31.7 percent of the 110.6 million households in the 

United States in 2007.462 In addition, about 2.17 million people live in nursing homes or 

group homes (1.6 million of these live in nursing homes).463 If current rates of growth 

continue without the development of new alternatives that allow people to remain in 

homes in their communities as they age, it is expected that there will be 3 million 

nursing home residents by 2030.464

In general, people with disabilities are more likely to rent than own their home, as 

compared to people without disabilities. Homeownership is generally lower among 

people with disabilities than for the general population, with one notable exception. 

Among homeowners between the ages of 64 and 84, 94 percent are people with 

disabilities.465 Such high levels of ownership are likely due to the fact that many of these 

individuals purchased their homes before acquiring disabilities as they aged. 

Many people with disabilities of any age are able to live independently, although current 

research suggests that a growing number are unable to find appropriate housing to 

meet their needs. Reasons include location, quality, physical accessibility, affordability, 

and an unmet need for supportive services that some individuals require in order to live 

independently in the community. 

Among the various barriers to acquiring housing that people with disabilities experience, 

poverty and low-income status rank among the highest. A recent report suggests that 

the number of “worst-case” very low income renters with nonelderly households with 

people with disabilities may number between 1.3 million and 1.4 million.466 The U.S. 

Department of Housing and Urban Development (HUD) defines households with “worstcase needs” as: “Unassisted renters with very low incomes who have one of two 

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“priority problems”—either paying more than half of their income for housing (‘severe 

rent burden’) or living in severely substandard housing.”467

In addition, the report estimates the existence of nearly 1 million worst-case very low 

income renter families with children that house nonelderly adults with disabilities. This 

means that there may be as many as 2.4 million very low income households with 

disabilities that are classified as worst-case, which is between 35 and 40 percent of the 

total worst-case housing needs in the United States. 

Regardless of income, between 9 and 12 million Americans need help with certain 

activities of daily living.468 Using this “functional” definition of disability, current estimates 

of the population in need of accessible housing and communities who are under age 65 

range from between 3.5 to 10 million.469 These estimates do not include people with 

disabilities who live in or are trying to transition out of institutional settings such as 

nursing homes. People with disabilities also live longer, and their housing and 

supportive requirements are changing. Such trends directly affect these individuals’ 

community living options. The population of people over age 65 is expected to double 

by 2030, with 20 percent of people age 65 and over requiring assistance with at least 

one activity of daily living. This number is expected to increase to 50 percent by age 85. 

Over the next 30 years, disability rates for people 85 years and older are expected to 

rise as this population triples.470 Furthermore, the population of aging baby boomers will 

soon reach an age where housing accessibility and livable communities will become 

one of their highest priorities. 

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Key Issues 

Affordability 

Lack of affordable housing is one of the most pressing problems faced by low-income 

people with disabilities. The majority of the 4 million people with disabilities who are not 

elderly and are living on an average of $632 per month from Supplemental Security 

Income (SSI) experience the greatest difficulty in affording housing. They have the 

greatest need for assistance with paying for housing of any group in the United 

States.471 According to Priced Out in 2008, SSI is equal to 18 percent of the national 

median income for a one-person household, almost 25 percent below the federal 

poverty level. The national average rent for a one-bedroom apartment was 112 percent 

of monthly SSI payments; therefore, those whose income is limited to SSI cannot afford 

even modestly priced rental housing.472

As a result, the core housing issue for most low-income people with disabilities is the 

need for federal rental subsidies in order to obtain housing that is affordable. While 

federal initiatives such as the Low Income Housing Tax Credit (LIHTC) program can 

provide financing that creates below-market-rate housing units for individuals with 

incomes at 50 to 60 percent of the local median income, few tools are available that 

subsidize the balance of the rent for individuals living on SSI-level incomes. Limited 

rental subsidies are available through the federal Housing Choice Voucher program, but 

the need far outpaces availability. The voucher program assists about 1.95 million 

households; about 17 percent of these include a person with a disability, but only one in 

four households that are eligible for vouchers receive any form of federal housing 

assistance. Most locales have long waiting lists for vouchers, and many housing 

agencies have even stopped accepting new applications because the backlog is so 

large.473 Furthermore, public housing, which has historically accommodated some lowincome people with disabilities, is not only very limited, but it is also in decline as a longterm housing solution. Housing for low-income older Americans created through Section 

202 Supportive Housing for the Elderly Program, HUD’s largest directly funded 

construction program, have high occupancy levels, low turnover, and lengthy waiting 

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lists. Construction of Section 202 housing has also been declining; production in 2004 

was 58 percent of the production levels of the 1980s.474

The crisis in affordable housing forces hundreds of thousands of people with disabilities 

to live at home with aging parents or in restrictive and costly settings such as nursing 

homes, board and care facilities, and other institutions. Federal programs such as the 

U.S. Department of Health and Human Services (HHS) Money Follows the Person 

(MFP) and Real Choice System Change recognize that it is less expensive for people 

with disabilities to live in the community than in institutions, and are intended to promote 

community integration. As a practical matter, however, lack of affordable housing that is 

most often made possible with rental subsidies has limited the number of people who 

can move into homes of their own. Increasing the availability of monthly rental subsidies 

provided through federal programs such as 811 Supportive Housing for People with 

Disabilities and the Housing Choice Voucher programs can make rents truly affordable 

for those with the lowest incomes, while still leaving money for other essentials such as 

food and clothing.475 

Accessibility 

Most private single-family and multifamily housing in the United States is built by 

commercial developers, yet basic accessibility features (e.g., level primary entrances, 

sufficiently wide interior doors and hallways, and an adequate turning radius in the 

bathroom to accommodate a wheelchair user) are limited. The 1988 Fair Housing 

Amendments Act requires that certain newly constructed private and public multifamily 

housing meet specific accessibility requirements for entryways and shared public 

spaces and include adaptability features within the units. Enforcement of the law has 

been inconsistent, however, and HUD data concerning the number of accessible or 

adaptable units that comprise current housing stock may not present an accurate or 

complete picture of accessibility.476 Consequently, housing advocates suggest that 

private housing with even minimal accessibility features appears to be in limited supply. 

A few locales have adopted either mandatory or voluntary “visitability” policies that apply 

to newly constructed housing that generally include level entrances, first-floor 

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bathrooms, and 32-inch doorways. An estimated 30,000 new housing units have been 

constructed under primarily mandatory legislation and are now considered visitable.477

Private and nonprofit housing built with diverse public and private funding and aimed at 

specific demographic populations and groups, including people with disabilities, 

generally include some accessibility features and accessible units. But by far the 

greatest number of single-family and multifamily homes are provided through the private 

market, thus limiting housing options and choices available to those people with 

disabilities who require accessibility features, irrespective of their income or need for 

supportive services. 

Further complicating matters, people with disabilities face unequal treatment and 

discrimination when they search for rental housing. A 2005 HUD study revealed that 

they experience discrimination in up to half of rental inquiries. In addition, up to one-third 

of rental properties advertised in the Chicago area, one of the locales where the study 

was conducted, were not accessible to wheelchair users.478 A similar study of private 

rental properties conducted in Newton, Massachusetts, revealed evidence of 

discrimination in 48 percent of tests conducted.479 Supporting these findings, in 2005 

HUD found that 41 percent of over 9,000 complaints received by the agency involved 

disability discrimination.480

Even as disability-based housing discrimination complaints make up the largest 

percentage of fair housing complaints filed with HUD, national studies have reported 

that HUD enforcement of fair housing laws that afford remedies to housing 

discrimination for people with disabilities is inadequate.481 Although complaints must be 

investigated within 100 days of being filed under most circumstances, long delays in 

investigation of complaints and complaint backlogs persist. While federal compliance 

reviews also serve as an effective tool for investigation of systemic violations of fair 

housing laws, this mechanism has been underutilized, thus limiting its potential impact 

on people with disabilities who experience housing discrimination. These and other 

weaknesses in fair housing enforcement add to the systemic difficulties people with 

disabilities face when they seek homes of their own.482

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In light of documented weaknesses in federal enforcement of fair housing laws, qualified 

private fair housing centers play an especially important role in conducting certain 

enforcement activities and educating the public about their fair housing rights and 

responsibilities. Enactment of the 1987 Fair Housing Initiatives Program (FHIP) 

legislation acknowledged the important role of such organizations. During the past 5 

years, private fair housing organizations have processed 65 percent of the fair housing 

complaints in the United States. Most of the remaining cases were handled by State 

and local fair housing enforcement agencies (25% of cases) responsible for laws that 

are generally equivalent to the Fair Housing Act, and HUD processed 10 percent of the 

cases.483

Supportive Housing 

The disability community has long advocated for policies and programs that enable 

individuals to live as independently as possible in homes of their own rather than in 

restrictive institutions and settings, such as nursing and board and care homes, that 

constrain freedom of choice and decision making. Until the 1990s, predominant public 

policy linked supportive services such as personal assistance to housing, in effect 

requiring that people with significant disabilities live in institutional settings. The principle 

of independent living espoused by disability advocates and the impact of the landmark 

U.S. Supreme Court decision in the Olmstead v. L.C. (Olmstead) case,484 which found 

that the institutionalization of people with disabilities violates the 1990 Americans with 

Disabilities Act (ADA), have together spurred efforts to move institutionalized individuals 

into homes in the community and delink supportive services from housing. People with 

disabilities prefer integrated housing on sites located throughout the community (often 

referred to as scattered-site development), because this model helps dispel disability 

stereotypes and reduces stigma, thus contributing to meaningful community inclusion 

and participation.485 In spite of both the legal mandate established by Olmstead and the 

preference of people with disabilities to live in homes of their own, however, systemic 

obstacles, barriers, and challenges to achieving this goal still remain. 

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In order to help people with disabilities to achieve independent living in the community, 

some organizations have developed new and innovative program models that promote 

housing options and provide voluntary, self-directed services for people with a variety of 

disabilities, including developmental and intellectual disabilities and mental health and 

substance abuse needs (see examples discussed below under “Support for 

Independent Living”).486 Such models have proved adaptable for a range of individual 

needs and aspirations. Moreover, housing provided by nonprofit housing organizations 

for people with disabilities must generally meet certain standards of affordability and 

accessibility. At the same time, based on federal funding restrictions, much of this 

housing has been targeted for people with specific disabilities (e.g., developmental, 

psychiatric) or for older Americans. While attempting to address the needs of discrete 

populations, disability-specific funding policies often serve to undercut community 

integration by fostering the creation of segregated buildings and facilities that house 

exclusively or predominantly people with disabilities. In particular, and despite the 

independent living advances of the 1990s, some organizations that own or manage 

housing developments for people with disabilities may continue to require a tenant to 

participate in programs or services as a condition of the rent contract. In addition to 

limiting choice and control, programs organized in this manner deprive renters of their 

housing if at some point they fail to participate, potentially sparking a cycle of 

homelessness or reinstitutionalization. 

States also play a central role in implementing federal housing policy and in creating 

incentives for the development of supportive services that people with disabilities might 

require in order to live independently. A few States are creatively coordinating multiple 

public and private funding sources and allocating new funds to increase housing and 

supportive services in order to reduce the number of people forced to live in institutions. 

Some States, however, have been slow to adopt policies that would foster the State 

agency coordination required to make supportive housing a reality, and communication 

among housing, social service, and other related agencies frequently remains poor.487 

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The concept of supportive housing is evolving to ensure that people with diverse 

disabilities have the opportunity to live in the community in homes of their own or in 

other settings they choose, while having access to supportive services they may require 

to live independently to the maximum extent possible. Best and promising practices in 

supportive housing ensure that housing is permanent and that residents have control 

over their environment. Individualized services must be delinked from housing and 

available to residents who want or need them. Housing also should be integrated and 

dispersed throughout the community on scattered sites near stores, transportation, and 

other amenities.488

Homeownership 

Historically, many people with disabilities who wished to purchase their own homes 

found it very difficult to do so. Traditional hurdles to homeownership have included 

developing a credit history, saving money for a down payment, documenting a stable 

source of income, and resource and employment limits imposed by federal income 

replacement and support programs such as Supplemental Security Income and Social 

Security Disability Insurance. Incorrect assumptions about the ability of some people 

with disabilities to manage the responsibilities of homeownership have also dissuaded 

some disability professionals from encouraging clients with disabilities to investigate or 

pursue homeownership. Current federal budget deficits and credit restrictions may add 

additional problems for low-income people with disabilities who aspire to 

homeownership in the near future. 

Owning a home of one’s own became more realistic in the early 1990s, when various 

federal home loan and financing programs were created specifically to reduce the 

inequity in homeownership experienced by low-income communities. People with 

disabilities, families, and advocates began taking advantage of these resources, which 

included a combination of rental subsidies, low- and no-interest financing, and public 

and private grants to help bridge the gap between the income of people with disabilities 

and the cost of housing determined by the market. Additional legislation enacted in 

2000 permits the use of housing rental vouchers as down payments on home 

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purchases, as well as monthly mortgage payments for eligible people with disabilities 

and their families. This legislation increases the probability that very low income people 

with disabilities can afford to pay the mortgage on a home of their own. While owning a 

home may not be for everyone, it is one of the most important mechanisms available to 

Americans to build assets, and it can reduce social perception that people with 

disabilities are dependent and noncontributing members of the community.489

Purchasing a home can be a complicated and difficult process for anyone, including 

people with disabilities. But various funding sources and programs can provide 

assistance, including the Federal Home Loan Bank, the HOME program, Fannie Mae’s 

Community HomeChoice program, and State Housing Finance Agencies. In addition, 

the 1977 Community Reinvestment Act (CRA)490 established the importance of financial 

institutions in meeting the credit needs of community members, particularly those in lowand moderate-income neighborhoods. In light of the goals of the Olmstead decision, 

CRA can serve as a tool to assist financial institutions and those concerned about 

housing opportunities for people with disabilities to form mutually beneficial 

partnerships.491 Other economic development tools are also being used by people with 

disabilities to build the resources needed to purchase a home. For example, special 

savings accounts called Individualized Development Accounts (IDAs) assist people with 

low incomes in achieving ownership through matched savings and financial education. 

Medicaid policies, such as the Live-In Care Provision created by the 1990 amended 

Medicaid Home- and Community-Based Services (HCBS) waiver statute, allows States 

to claim federal Medicaid reimbursement for the “room and board” (food and shelter) 

costs associated with having an individual live in a waiver recipient’s home and provide 

them with support. 

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Promising Practices 

While accessible, affordable, integrated housing remains elusive for many people with 

disabilities, various private and nonprofit organizations have tackled the problem by 

challenging federal and State policies that foster segregation and institutionalization, by 

capitalizing on federal, State, and local programs that offer various financial incentives 

and resources, and by building, operating, and managing housing that fosters the spirit 

and goals of independent living and self-determination for people with diverse 

disabilities. In some cases, multiple community partners working together have found 

ways to tap a variety of funding sources to ensure that residents have access to 

housing that is affordable, accessible, and integrated, and also provide voluntary 

supportive services as needed. 

Most housing and supportive services that people with disabilities require to live as 

independently as possible exist in large measure because federal, State, and local 

housing policies dictate specific goals and allocate annual funding. Private and nonprofit 

organizations that develop, manage, or operate housing or provide supportive services 

are dependent to a significant degree upon a combination of these public resources, as 

well as on certain private sources of funding that vary regionally. Consequently, any 

discussion of promising housing practices must acknowledge the extent to which public 

policy drives the development of projects, as well as the influence of effective disability 

advocacy on both policies and final projects. Many of the following promising housing 

policies and practices illustrate the extent to which these factors are inseparable. 

Described below are examples of innovative policies, partnerships, and programs that 

increase access to homeownership for low-income people with disabilities; facilitate, 

promote, or illustrate the principles of integration, affordability, accessibility, and 

scattered-site placement; and exemplify supportive housing. Examples of local and 

State policies calling for universal design or visitability are also presented. Several 

multiuse, low-income, integrated housing projects are described that embody principles 

of universal design. Outcomes of several disability rights lawsuits illustrate how the 

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promise of increasing integrated, accessible, affordable housing can be realized through 

litigation. 

Intensive Homeownership and Housing Support 

United Cerebral Palsy of Texas, Austin, Texas 

Founded in 1954, the nonprofit United Cerebral Palsy of Texas (UCP Texas), Austin, 

Texas, is the State affiliate of United Cerebral Palsy, a national advocacy and support 

network for people with disabilities. The mission of UCP Texas is “to ensure that people 

with cerebral palsy and similar disabilities have the opportunity to participate fully and 

equally in every aspect of our society.”492 Serving all ages and people with all 

disabilities, UCP Texas provides technical assistance and support to families and 

individuals, advocates for people with disabilities, and organizes a variety of programs 

and services. A central component of UCP Texas’s work focuses on assisting people 

with disabilities and their families to find housing. This work is driven by four goals: “to 

increase homeownership opportunities for people with disabilities; to increase the 

housing stock of accessible homes; to increase awareness of the need for more 

affordable, accessible, and integrated housing; and to educate people with disabilities 

on how to be successful homeowners.”493 These goals guide innovative housing 

programs that aim to provide affordable, accessible, and integrated residences for 

people with disabilities. Program descriptions follow. 

The Texas Home of Your Own (HOYO) program, supported by HOME funds awarded 

through the Texas Department of Housing and Community Affairs, began in 1995 as 

part of the now-defunct National Home of Your Own Alliance and is now offered by UCP 

Texas. HOYO provides first-time homebuyers who are eligible with up to $15,000 in 

down payment assistance. These funds are awarded as a 10-year, deferred, nointerest, and forgivable loan that depreciates 10 percent each year; a second lien is 

placed on the home for 10 years. After that period of time, the loan is forgiven if the 

homeowner does not foreclose or sell the home, seek a home equity loan, or cease 

using the home as a primary residence. As of 2007, approximately 320 households or 

individuals had become homeowners through the HOYO program. In order to be eligible 

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for assistance, household income (typically SSI or SSDI) cannot exceed 80 percent of 

Area Median Income (AMI), and most of the individuals UCP Texas has served through 

this program have had incomes at or near 50 percent of AMI.494

UCP Texas also provides affordable integrated, accessible apartments for very low 

income people with disabilities to rent. Using Section 811 funds from HUD, UCP Texas 

purchased two sets of condominium units, the first in March 2005 and the second in 

April 2008. Section 811 funds are frequently used to construct segregated group homes 

or apartment complexes for people with disabilities. However, UCP opted to use its 

section 811 money to purchase 16 units integrated within two buildings populated 

primarily by professionals, students, and retired individuals.495 It then found tenants by 

advertising through disability organizations and quickly filled the units. 

UCP Texas also provides support, training, research, and advocacy to promote 

housing opportunities for people with disabilities. The organization’s direct involvement 

with housing for people with disabilities has helped promote affordable, accessible, and 

integrated housing. UCP developed a comprehensive training package that the 

organization has used to train more than 100 public housing authority staff members. In 

addition, UCP trains nonprofit housing, social service, and disability advocacy 

professionals on how to promote consumer-directed barrier removal, and it provides 

technical assistance to the city of Austin as it undergoes an architectural barrier removal 

program.496

UCP Texas has successfully created integrated, affordable, and accessible housing for 

people with disabilities through HOYO and its use of section 811 funds, “doing 

something that very few people thought was possible 10 years ago.”497 Furthermore, 

the program’s support to homebuyers enabled them to weather the recent subprim

mortgage crisis. None of the individuals who took advantage of HOYO financial 

assistance faced foreclosures, an unexpected benefit that came from stringent 

requirements UCP Texas places on its homebuyers: loans that UCP supports must be 

more than 1.25 percent above prime rate.

e 

498

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Yet this work has not been without its share of challenges. Housing programs are 

expensive and federal and State funding is limited. Home prices have increased from as 

little as $55,000, when HOYO began, to today, when “potential homebuyers have a 

hard time finding anything less than $100,000.”499 New State funding restrictions on 

HOME funds have forced UCP Texas to discontinue its home rehabilitation program, 

which supported accessibility modifications for new home purchasers. Furthermore, the 

organization not only has to plan and implement its programs, but it also has to 

challenge the perception that people with disabilities are dependent. UCP Texas found 

that they have to educate lenders about the disability community, many of whom rely on 

nontraditional income sources like (SSDI/SSI): “Early on, we had to do a lot of 

education, telling lenders [that SSI/SSD] income is steady income.”500 Moreover, UCP 

Texas had to sell the idea of scattered-site rentals to both HUD and the State of Texas 

because the norm is segregated disability communities.501

Housing Initiatives Program, Institute for Disability Studies, University of 

Southern Mississippi, Hattiesburg, Jackson, and Gulf Park, Mississippi 

Based in Hattiesburg, with satellite offices in Jackson and Gulf Park, the Institute for 

Disability Studies (IDS) of the University of Southern Mississippi is the State’s University 

Center for Excellence in Developmental Disabilities (UCEDD). A university-based 

nonprofit, IDS serves people with disabilities through a range of activities, including 

direct service, training, technical assistance, and research. Among these activities is 

IDS’s Housing Initiatives program, which provides or facilitates homeownership 

assistance and loans, technical assistance, and training opportunities, as well as direct 

service to homeless people with disabilities. These efforts aim to serve people with 

diverse disabilities, including mental health issues and chronic illnesses. IDS’s Housing 

Initiatives began in 1997 with a $25,000 HOME funds grant from the Mississippi 

Department of Economic and Community Development.502 The program has expanded 

through subsequent competitive grants and now has an annually allocated, 

noncompetitive budget. 

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The largest component of IDS’s Housing Initiatives is its Home of Your Own (HOYO)

program, which provides home purchasing assistance grants of $10,000 and $15,000 to 

low- to moderate-income people with disabilities and families with a member with a 

disability. Along with these grants, HOYO offers its participants person-centered 

planning through individualized support and guidance. This includes helping participants 

secure a loan for the remainder of the house’s cost, pre- and post-purchase homebuyer 

counseling, referrals to services as needed, and advocacy with lenders. HOYO grants 

may be used for down payment, closing costs, principal reduction, and modifications 

necessary for accessibility. HOYO participants then choose from one of 15 partner 

lenders, many of whom use Fannie Mae’s Community HomeChoice product for low- to 

moderate-income people with disabilities. The HOYO program has three primary 

components as determined by its funding sources. The first is HOME funds set aside by 

the Mississippi Development Authority ($500,000), Mississippi HOYO, which has 

assisted 256 individuals in obtaining homeownership in 44 of the State’s 82 counties.503

Second, drawing on HOME funds from the city of Jackson, Community Service Division 

($264,000), HOYO has helped 52 individuals and their families to secure homes within 

Jackson’s city limits. The third component, funded by the city of Hattiesburg, Community 

Development Division, provides counseling and $15,000 HOME grants to Hattiesburg 

residents. 

The income for approximately 75 percent of HOYO participants comes primarily from 

Social Security benefits, while the income of the remaining 25 percent comes from 

employment.504 In spite of problems that confront current would-be homeowners, HOYO 

participants have less than a 2 percent default rate on mortgages.505 IDS staff attribute 

this success to HOYO’s “wraparound” support services, which involve counseling and 

advocacy.506 These successes have been recognized with the HUD 100 Best of the 

Best Practices Award (2000) and the Mississippi Governor’s Communities of Excellence 

Award for the State’s best homebuyer program (2002 and 2007). 

The IDS administers several other programs supported by the Federal Home Loan 

Bank (FHLB) that provide funds and support to assist people with disabilities in 

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becoming homeowners. First, the FHLB Disability Initiative has provided a $10,000 

home purchase assistance grant for down payment, closing costs, and principal 

reduction to 10 very low income, 10 low-income, and 3 moderate-income families with a 

member with a disability.507 Second, the Special Needs Assistance Program (SNAP)

grant has provided $5,000 to 8 eligible families whose gross household income exceeds 

80 percent of the median income level (adjusted by household size and county) to 

support home rehabilitation to make the homes accessible.508 Finally, the Mississippi 

Disability Initiative has provided a $15,000 grant to each of 30 very low income to 

moderate-income families with a member with a disability in rural communities. 

In addition to the financial assistance programs, IDS runs six other outreach, 

counseling, education, and direct support programs relating to housing for people with 

disabilities. First, the Delta Housing Initiative, funded by the F. B. Heron Foundation and 

started in January 2007, provides pre- and post-purchase counseling to 120 households 

and offers assistance to people with disabilities to find safe, affordable housing and 

community-based supports.509 Second, IDS provides credit counseling, homebuyer 

education, and counseling services to Mississippi residents with funds from the 

Mississippi Home Corporation (MHC)/Freddie Mac Comprehensive Housing Counseling 

Grant. Third, IDS’s HousingSmart program provides outreach to individuals with 

disabilities. To date, it has sponsored a total of 40 workshops that trained 657 people 

and disseminated printed and electronic fair housing information to an estimated 71,276 

individuals.510 Fourth, the Individual Development Account (IDA) initiative is designed to 

help low-income individuals and families who meet requirements set by the supporting 

foundation to become homeowners with a 3 to 1 match on funds to use for down 

payment or closing costs.511 

The last two programs target homeless individuals with disabilities and their families. 

HUD-funded efforts, the Shelter for All and Comprehensive Housing Counseling

programs, together provide one-on-one counseling, referrals, and specialized disabilityrelated case management to eligible potential homebuyers. These services involve 

optional person-centered planning sessions that allow people with disabilities to gather 

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relevant people (family, advocates, etc.) to collectively identify goals and challenges and 

plan how to secure permanent housing.512 As of May 2008, these homelessnessrelated efforts have served over 805 individuals.513

The Lease-to-Own Model: The Arc of the Central Chesapeake Region (formerly 

The Arc of Anne Arundel County), Maryland 

The Arc of the Chesapeake Region in Annapolis, Maryland, a nonprofit service and 

support provider for people with developmental disabilities, started a project called 

Opening Doors in 1999, with a 2003 follow-up project called More Doors to Open. 

The Arc seeks to provide people with disabilities housing opportunities that are 

integrated, affordable, and emphasize self-determination. The Arc’s housing efforts 

involve several components, including independent living counseling.514 When Opening 

Doors began, the organization recruited four people with disabilities interested in living 

at a development through a lease-to-own model, and two others interested in renting 

other apartments. At the same time, the Arc helped people with disabilities attain 

Section 8 rental vouchers and State supports, published two guides related to housing 

for people with disabilities, and developed a “designated representative” role to allow a 

person with a disability to select someone to act on his or her behalf in housing matters. 

The Arc’s homeownership efforts culminated in a 56-unit complex named Homes at the 

Glen, the residents of which are restricted to 50 percent of Area Median Income.515

Monthly rent payments include $15 payments to accounts that will be used to help buy 

the unit at the conclusion of the 15-year lease. Residents are responsible for home 

maintenance, volunteering, and taking part in self-governance activities. Service 

coordination and case management is provided by an agency funded by the Maryland 

Developmental Disabilities Administration. Anecdotal evidence suggests the Homes at 

the Glen initiatives have been very successful.516 Resident comments are positive and 

they report satisfaction with living independently in places they have chosen, they 

volunteer and participate in other community activities, and they appear to have 

improved their employment and health stability.517 Currently, the Arc is working to 

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expand its efforts with a new financial literacy program, a plan to replicate the program 

elsewhere, and by increasing the participation of communities of color.518

A combination of private, State, and local funds and support, together with innovative 

State policies, paved the way for the successes of the Opening Doors and More Doors 

to Open projects. Residents of the Homes at the Glen development benefited from 

Maryland’s 1915(c) waiver, which allows States to offer Home- and Community-Based 

Services (HCBS) waivers that provide individuals with support (employment, direct 

personal care, home modifications, etc.) to remain in their own homes rather than in 

institutions. Direct grants came from private foundations, the Maryland Developmental 

Disabilities Council, and the Maryland Developmental Disabilities Administration.519 The 

Maryland Department of Housing and Community Development (MDHCD) provided a 

second mortgage to the project and an annual allocation of $501,447 in equitygenerating tax credit.520 On the local level, the Anne Arundel County Housing 

Commission granted a $700,000 HOME loan, and the city of Annapolis and Anne 

Arundel County granted low payments in lieu of real estate taxes to make rent 

affordable. Another important State resource for this project was a 2002 MDHCD 

amendment to the State Qualified Allocation Plan.521 The amendment provides bonus 

points in the competition for federal Low Income Housing Tax Credits (LIHTCs), as well 

as gap financing to applicants who build units for people with disabilities. LIHTC and 

gap-financing applicants who seek the points must reserve and market as much as 

10 percent of the proposed project’s units to people with disabilities for at least 30 days, 

beginning when the project is 80 percent complete. When completed, the project must 

be marketed exclusively to people with disabilities for 30 days. 

Support for Independent Living 

Neighbors, Inc., Franklin Park, New Jersey 

Founded in 1995, nonprofit Neighbors, Inc., of Franklin Park, New Jersey, aims to 

support people with disabilities in living self-directed lives. Supporting more than 100 

people in New Jersey and Pennsylvania, Neighbors emphasizes empowering 

individuals and their families rather than agencies, listening to people’s aspirations and 

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working to realize them, and helping them find friends, jobs, and homes.522 Based on 

the founders’ experiences with agencies with costly offices and overhead, they selected 

an alternative model of organization and support.523 With no central office, the staff is 

small, with an executive director, an agency director, and five advisors who coordinate 

support for five to seven people. 

Neighbors employees view themselves as agents for the people they support.524 To this 

end, Neighbors will work with anyone who chooses the agency to develop a support 

plan based on a budget determined by the individual. With support from Neighbors, 

many people who once lived in group homes or other institutions have been able to 

move on their own or with housemates into integrated housing that include apartments, 

condos, rentals, and homes they own.525 Neighbors also provides daytime support for 

employment, volunteering, business ventures, and other community activities as 

alternatives to sheltered employment and day habilitation facilities. Meeting once a 

week or more, advisors assist each person with a variety of tasks, including hiring 

personal assistants (PAs), scheduling and managing PAs, and searching for 

employment or volunteer opportunities. By supporting people who may need assistance 

in managing PA services, Neighbors enables them to make use of another resource for 

increasing self-direction.526 Finally, advisors also facilitate meetings between each 

person and his or her family, PAs, and case managers to further planning. 

Neighbors has succeeded in supporting people with disabilities who want to live in 

integrated community settings. However, the organization faces challenges, such as 

limited funding, which mostly comes from State contracts through Medicaid waivers and 

private donations.527 The Neighbors director explains that the flexibility and openness of 

relevant State officials to the organization’s alternative service model and a New Jersey 

Division of Developmental Disabilities program called Real Life Choices assists the 

organization’s work. Real Life Choices promotes greater self-determination through 

individual budgets, which it arranges through allocations from Medicaid waivers guided 

by individually based reviews of support needs.528

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Onondaga Community Living (OCL), Syracuse, New York 

Based in Syracuse, New York, Onondaga Community Living (OCL) is a nonprofit that 

seeks to “empower and individually support people with developmental disabilities in 

their efforts to live full lives as integral, respected members of their community.”529

Started in 1987, OCL’s current efforts grew out of lessons learned from operating group 

homes. OCL staff perceived that such homes were not meeting the needs or desires of 

their residents. In an effort to individualize and personalize services, the organization 

closed two of the homes and implemented a support model based on the needs, 

desires, and aspirations of the individual. The support enables the individual to live in 

integrated housing that is neither linked to services nor removed from participation in 

the wider community. 

OCL’s support takes several forms, including residential support, which is provided to 

approximately 50 people throughout Syracuse and the surrounding area in both urban 

and rural settings.530 This support helps individuals remain in their own housing, which 

includes rentals and homes they own or that are held in trust. Support ranges from a 

few hours per week up to 24 hours a day through OCL-facilitated live-in housemates. 

General support may include personal care, housekeeping, cooking, nursing, or other 

services, but emphasis is always placed on the belief that everyone’s home life is 

different and that everyone has unique desires and needs. Support outside the home 

includes service coordination, vocational assistance, and an academic initiative that 

enables people to attend college classes and activities (e.g., labs and social events) at 

Syracuse University. 

OCL’s support services are funded through Medicaid waivers.531 Historically, federal 

and State policies have not encouraged or emphasized person-centered residential 

support services. In the absence of such policies, the OCL’s executive director 

attributes its successes to its personalized model and philosophy of support, as well 

encouragement from and the flexibility of the New York State Office of Mental 

Retardation and Developmental Disabilities. In light of the predominance of relatively 

traditional group and congregate homes and related service systems for people with 

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developmental disabilities, the State has nonetheless been open to alternative 

strategies for the use of funding. Further testifying to the promise of its support model, 

OCL is replicating its efforts elsewhere. To support greater numbers of people while 

remaining relatively small, the organization has developed a new organization called 

Connections of CNY, Inc., Syracuse, New York, which is currently in the process of 

raising start-up funds. 

Options in Community Living, Madison, Wisconsin 

Founded in 1981, the nonprofit Options in Community Living in Madison, Wisconsin, 

provides residential support to 102 people with developmental disabilities, ages 23 to 

30. By using Section 8 rental subsidies, these individuals live in housing dispersed 

through the Madison metropolitan area, rather than remaining in congregate facilities. 

Approximately 45 of those participating in the program have roommates, 11 are 

homeowners, 2 live in homes held by family members on their behalf, and almost all the 

remaining individuals hold leases on rental units.532 Options aims to support these 

individuals so they can participate as full community members. The organization does 

this by “approach[ing] support by building relationships with individuals,” emphasizing 

each person’s “hopes, dreams, and interests,” and collaborating with family members 

when possible.533 Intended to assist each person to “live life without life being about 

services,” support is based on the model of self-direction.534 The organization begins by 

carefully matching individuals seeking support with staff members who fit their 

personalities and can help address their needs. Service coordinators provide 

organizational oversight and help address challenges with other agencies, but the focus 

remains on the needs and desires of each individual being supported. Services, which 

range from a few hours a week to 24 hours a day, might include personal care, 

household management, dealing with a landlord, assisting with financial management or 

energy assistance, and access to transportation systems, including paratransit. 

Options has benefited from strong county support, including a commitment to selfdirected services and the county’s exceeding the required match on Medicaid waiver 

funds available for services that promote dispersed housing.535 The organization also 

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benefits from Wisconsin’s relatively minimal requirements for service providers to qualify 

for funds from Medicaid waivers. The organization’s director explains that this flexibility 

allows them to support people as active leaders in their own process, instead of having 

to follow conventional models focused on providing services to passive clients. 

Recently, however, county budget cuts have undermined the organization’s capacity. 

Consequently, in order to continue being supported, 11 individuals have moved to a 60-

unit building with affordable units rather than remaining in housing dispersed throughout 

the community. Though this has allowed these individuals to continue with support, the 

organization views this “clustering” unfavorably, since it undercuts the commitment to 

dispersed, integrated housing and the principle of supporting individuals rather than 

groups.536

LifeLong Supportive Housing Program (Alameda County Health, Housing, and 

Integrated Services Network), Oakland and Berkeley, California 

LifeLong Medical Care (LMC), which currently provides a broad range of health and 

social services to people of all ages, began as a storefront operation by the Gray 

Panthers, a senior citizens advocacy organization that merged with Berkeley Primary 

Care Access Clinic in the mid-1990s and rapidly expanded to become a community 

health center (CHC) with clinics located on five sites. LMC is a “safety net” provider of 

medical services to people who are uninsured and who experience complex health 

needs in Berkeley, Albany, Emeryville, and parts of Oakland, California. 

LMC’s Supportive Housing Program (SHP), also known as the Alameda County Health, 

Housing, and Integrated Services Network, is a collaboration of public and private 

agencies that provide permanent housing and social and health services to formerly 

homeless people with disabilities. SHP provides onsite support services to 

approximately 600 tenants living in eight subsidized housing sites scattered throughout 

Berkeley and Oakland. Services provided by SHP are optional and available to all 

tenants living in this housing. LMC collaborates with nonprofit housing development 

corporations that create and operate affordable housing in Alameda and 

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Contra Costa counties. Supportive services include outreach, intensive case 

management, housing stabilization, eviction prevention, benefits advocacy, money 

management, medical care, mental health and substance abuse services, community 

building and social activities, and employment and vocational support. 

Affordable, Accessible, Integrated, Mixed-Use Housing Development 

University Neighborhood Apartments, Berkeley, California 

The nonprofit developer Affordable Housing Associates, Inc., built the University 

Neighborhood Apartments to increase affordable, accessible housing for individuals and 

families, including people with disabilities. All the apartments are designed using 

universal design principles and are fully accessible. Universal features include “onestory living; wide doorways and hallways; low countertops, cabinets, and keyholes; 

extra floor space to accommodate a wide turning radius; pull-out cutting boards; stoves 

with buttons on the front; push/pull lever faucets; and roll-in showers.”537 All the units 

are available to households with 30 to 60 percent of Area Median Income, including 20 

project-based Section 8 units and 9 units designated for households that include 

individuals with disabilities. 

This building consists of 29 apartments, residential common areas that include a 

multipurpose room, management and service spaces, a large outdoor courtyard, 

ground-floor commercial areas, and a tenant parking garage. The building is located on 

a main transportation corridor in the city of Berkeley and is approximately two blocks 

from the downtown area. The building is four stories, including three residential and one 

commercial story. A restaurant featuring ethnic African meals recently opened on the 

first floor of the commercial space. The 29 apartments are made up of 1 studio 

apartment, 3 one-bedroom, 14 two-bedroom, and 11 three-bedroom units.538 

The building is designed so that all apartments are adjacent to a large interior central 

courtyard, which includes natural landscaping, seating, and a play area. A 

multipurpose/community room is located near the outdoor courtyard and offers a 

computer work area, service office, and kitchenette. The multipurpose room is used for 

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educational classes, computer workstations, crafts, exercise classes, social gatherings, 

and meetings. The services office is used for counseling and for coordinating 

educational classes. A laundry room is located on the first floor and the manager’s office 

is located adjacent to the courtyard.539

The development was funded by Bank of America, N.A., the Low Income Housing Tax 

Credit program, the State of California’s Multifamily Housing Program, the Federal 

Home Loan Bank, Alameda County Housing Opportunities for People with AIDS, the 

city of Berkeley’s Housing Trust Fund Program, and a HUD 108 loan. A California 

Housing Enabled by Local Partnerships Program loan was made by the city of Berkeley 

to assist with the initial acquisition of the property site. 

Helios Corner, Berkeley, California 

The nonprofit developer Satellite Housing, Inc., built Helios Corner, which provides 

affordable senior rental housing. All 80 units are affordable to seniors with incomes 

between 30 and 60 percent of Area Median Income. All units can be adapted for 

accessible features, 10 units are already accessible, and 40 units are project-based 

Section 8. Two of the accessible units also include features that enhance access for 

people with sight and/or hearing impairments, such as blinking doorbells and louderthan-average buzzers. 

This four-story mixed-use building consists of three residential levels above 5,900 

square feet of ground-floor commercial/office space and parking. The site is within short 

walking distance of community services and amenities, and is surrounded by a mixture 

of uses—single-family neighborhoods are to the north and west, and neighborhood 

commercial settings are to the south and east. A bus stop is located outside the front 

steps of the apartment complex and the North Berkeley BART station is just two blocks 

away. 

The building consists of ground-floor office space for Satellite Housing and the Salvation 

Army. The main floor of the building houses the property manager’s office, the service 

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coordinator’s office, a multipurpose room, and a large community room with a 

landscaped courtyard that is open to residents for daily recreational activities, family 

gatherings, community parties and meetings, movies, music, and classes. Satellite 

Housing focuses on tailored coordination, case management, and referral by its inhouse service coordinators who work directly with service providers to ensure residents 

are able to access the services they need. Supportive services are also available onsite. 

The development was financed by Low Income Housing Tax Credits, Silicon Valley 

Bank, the Federal Home Loan Bank, and city of Berkeley Housing Trust Fund. A 

California Housing Enabled by Local Partnerships Program loan was made by the city 

of Berkeley to assist with the initial acquisition of the property site. 

Housing Cooperatives (Co-ops) 

Housing Cooperatives allow residents to own and control their apartment through a 

corporation in which they own stock and are actively involved in management and 

programming. Maintaining affordability is difficult, but it may be achieved by restricting 

resale prices, as in the case of Limited-Equity Cooperatives (LECs). Collectively owned 

and governed, LECs cap resale prices of shares by either regulating the resale price or 

the income levels of buyers.540 A significant percentage of housing in Scandinavian 

countries, LECs are also growing in significance in the United States. A 2003 survey by 

the National Association of Housing Cooperatives reported 425,000 limited- and zeroequity co-ops throughout the nation.541 LECs enable stable affordable housing and the 

security this ensures, greater levels of tenant control and satisfaction, and neighborhood 

revitalization in economically depressed areas.542

LECs have promise for people with disabilities as a means to self-determination and 

affordable, accessible, integrated housing, with the possibility of support and services 

as needed. Services may or may not be offered onsite, can be informal or formal, and 

might involve either joint purchasing and/or scheduling of services or a coordinated and 

managed services program staffed by community agencies or the cooperative itself. 

Potential benefits for low-income people with disabilities include a relatively low financial 

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investment and greater control over housing and the environment.543 Moreover, 

research on Canadian LECs reveals that there they provide accessible, affordable, and 

integrated housing for people with disabilities.544 Anecdotal evidence from the United 

States suggests these findings hold elsewhere. A resident of the integrated and 

accessible Connecticut LEC, A Common Thread Cooperative, in Manchester, 

Connecticut, observes that her co-op is cheaper than an apartment, enables her to 

influence the decisions of an active community, and allows her to participate in networks 

of mutual support among neighbors.545 She adds, “If I get in a jam, I know people I can 

call. I know all my neighbors. I know they will be there for me.”546

Penn South Cooperative, New York, New York 

Penn South Cooperative, New York, New York, is a Limited-Equity Cooperative built in 

1961 with 2,820 units, 6,200 residents, and 15 buildings spread over 20 acres. With the 

co-op geared toward individuals with low to moderate incomes, 55 percent of co-op 

residents have gross incomes under $40,000.547 To preserve affordable rent, the co-op 

has also secured “shelter-rent” status from the city of New York, which bases property 

taxes on property income rather than value. With more than 50 percent of its residents 

over the age of 60, Penn South is also a Naturally Occurring Retirement Community 

(NORC) (see NORC, below).548 As residents began to age, the co-op set up a 

collaborative program with community agencies to provide supportive services. Now a 

separate nonprofit agency offers cultural and educational programs, case management, 

home care services, personal care, primary health care and wellness services, and a 

variety of other supportive services. All buildings are accessible, and people with 

disabilities make individualized access modifications to their units as needed. 

Aging in Place 

The “aging in place” movement is driven by the insight that most individuals prefer to 

remain in their homes rather than move to nursing homes or other facilities as they grow 

older. A 2005 AARP nationwide survey found that 89 percent of people ages 50 and 

over want to remain in their homes as long as possible.549 Aging in place is made 

possible when individuals have access to appropriate support and services, including 

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home modifications. Different models embody various aging in place ideals. All these 

models, however, recognize the preferences of people who wish to remain in their own 

homes in the context of an integrated community that mitigates social isolation and 

enables the accessibility and affordability of home care and personal assistance, house 

maintenance, shopping, and transportation. 

Prominent examples of aging in place models include the “Village” and Naturally 

Occurring Retirement Communities (NORCs). A relatively new concept, Villages are 

community-initiated, -governed, and -operated organizations designed to meet the longterm support needs of older adults in the neighborhoods where they live. The Village 

model was initiated by Boston’s Beacon Hill Village, which is creating a technical 

assistance support center in conjunction with the nonprofit NCB Capital Impact to 

support Villages throughout the nation. 

NORCs are typically defined as a geographic area, neighborhood, or building originally 

inhabited by people of all ages, which has evolved over time to contain a high 

proportion of older adults. In many NORCs, residents have collaborated with community 

service providers to develop supportive services that respond to the evolving 

requirements of aging residents. NORCs frequently provide supportive services to all 

residents regardless of income, disability, or health status. 

Vladeck Cares/NORC Supportive Services Program, New York, New York 

Vladeck Cares/NORC Supportive Services Program is operated by the Henry Street 

Settlement, which delivers a wide range of social services to New York residents. Henry 

Street Settlement’s NORC program brings comprehensive supportive services to the 

Lower East Side community’s older residents in response to their unique needs and 

cultural diversity. Vladeck Cares serves seniors living in Vladeck House, a public 

housing project with 27 buildings and 3,000 residents, 860 of who are elderly, many with 

disabilities. 

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The Vladeck Cares/NORC Supportive Services Program is a financial and cooperative 

partnership between the Henry Street Settlement and the New York City Housing 

Authority. This model brings social and health care services to Vladeck House, the first 

NORC located in public housing. Funded by the city, the State Department on Aging, 

and private sources, the program provides preventative health and social services, 

medical and health services, case management, mental health counseling, and 

educational and cultural opportunities.550 The Vladeck NORC program helps develop, 

host, and link supportive services because they increase the autonomy and 

independence of seniors living in the community. In turn, the supportive services are 

able to provide more organized and comprehensive care to the populations they serve. 

Increasing Very Low Income Housing Through the Low Income Housing 

Tax Credit (LIHTC) Program 

The LIHTC program, which is based on Section 42 of the Internal Revenue Code, was 

enacted by Congress in 1986 to provide the private market with an incentive to invest in 

affordable rental housing. Federal housing tax credits are awarded to developers of 

qualified projects, who then sell these credits to investors to raise capital (or equity) for 

their projects, which reduces the debt that the developer would otherwise have to incur. 

Because the debt is lower, a tax credit property can, in turn, offer lower, more affordable 

rents. 

Provided the property maintains compliance with the program requirements, investors 

receive a dollar-for-dollar credit against their federal tax liability each year over a period 

of 10 years. The amount of the annual credit is based on the amount invested in the 

affordable housing.551 State Housing Agencies allocate LIHTCs through a competitive 

process. These agencies must develop an annual plan, called a Qualified Allocation 

Plan (QAP), for allocating the credits that is consistent with the State’s Consolidated 

Plan. QAPs establish criteria for awarding points in the competition for tax credits, and 

they tend to vary greatly across the States because they are often written to meet State 

priorities. Federal law requires that a QAP give priority to projects that serve the lowestincome families, and are structured to remain affordable for the longest period of time. 

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Federal law also requires that 10 percent of each State’s annual housing tax credit 

allocation be set aside for projects owned by nonprofit organizations.552

Typically, LIHTCs have not been used to create housing for the lowest-income groups, 

including people at or below poverty level. In most States, only up to 10 percent of 

LIHTCs are targeted at people at or below 30 percent of AMI.553 That is changing, 

however. To meet a demand that outpaces the supply, some States are increasing the 

number of units for individuals whose income is at the SSI level by awarding points for 

projects that target units for those individuals. LIHTCs hold a similar promise for people 

with disabilities, including very low income and low-income people with disabilities. 

Recent nationwide financial difficulties may have affected the demand for LIHTCs, but a 

revitalized housing market should reinvigorate this lag. 

North Carolina LIHTC Development 

Stemming from cooperation between the North Carolina Department of Health and 

Human Services and the North Carolina Housing Finance Agency, the State’s QAP 

requires that all LIHTC developments must develop a Targeting Plan that reserves 

10 percent of total units for people with disabilities or homeless populations, and at least 

five units must be reserved regardless of development size.554 Furthermore, 5 percent 

of all units in new developments must be fully accessible beyond federal and State 

accessibility requirements. Also required is a memorandum of understanding among all 

relevant parties (the developer, property manager, and local lead agencies) to ensure 

the availability of and access to supportive services and accommodations for residents. 

Further safeguards include marketing priorities and vacancy reservations for people 

with disabilities for 90 days after the units are finished. Importantly, tenancy cannot be 

conditioned on participation in these supportive services. 

Targeting units for people with disabilities within LIHTC-financed properties is a 

promising strategy for ensuring housing accessibility, affordability, integration, and the 

delinking of housing from services.555 Because North Carolina’s housing initiatives for 

people with disabilities center on LIHTCs, they remain reasonably insulated from 

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fluctuating State budgets. They have also supported the construction of substantial 

numbers of affordable housing. Between 2002 and 2006, approximately 900 units with 

voluntary services for people with disabilities were funded.556 Other States have 

replicated these efforts. The Louisiana Housing Finance Agency, for example, is 

administering a tax-credit initiative for people with disabilities intended to create up to 

3,000 units of housing with voluntary services.557

Disability Organizations Advocate for Very Low Income Housing with LIHTCs 

Boston’s Disability Law Center (DLC) and nine Independent Living Centers throughout 

Massachusetts filed comments with the Massachusetts Department of Housing and 

Community Development (DHCD). These organizations called for more housing 

resources under the LIHTC program to be set aside for very low income people with 

disabilities, even though the Massachusetts LIHTC program had exceeded the national 

average by requiring that 10 percent of all LIHTC target households whose incomes are 

at or below 30 percent of the Area Median Income (AMI). DLC and the ILCs 

recommended that an additional 10 percent of the units be targeted for people with 

disabilities with SSI-level incomes (well below 30% of AMI) through project-based 

vouchers. They also called for developers who are awarded LIHTC as a result of the 

competitive process to be required to submit a plan to ensure that the additional 

10 percent of the units be made available to very low income individuals with 

disabilities. To ensure people with disabilities are integrated, the DLC and ILCs 

recommended that Massachusetts establish a policy that calls for LIHTC projects to 

ensure integration by having no more than 15 percent of the total units in a project 

occupied by people with disabilities (absent a compelling programmatic reason to do 

otherwise). Finally, the groups called for visitability to be a threshold requirement for all 

new construction and renovation of existing housing units. 

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Increasing Accessible, Integrated, Supportive Housing Through Legal 

Advocacy 

Laguna Honda Hospital Settlement, San Francisco, California 

A class action settlement in the civil rights class action lawsuit Chambers et al. v. City 

and County of San Francisco, filed to prevent unnecessary institutionalization of people 

with disabilities at Laguna Honda Hospital, promises to greatly increase communitybased housing and service options in San Francisco and improve coordination of care.

The settlement creates an innovative program to coordinate services across city 

departments, enabling San Franciscans with disabilities who live at, or are referred to, 

Laguna Honda, one of the country’s largest nursing homes, to instead receive 

community-based housing and services. Eligible individuals will be assessed for, 

referred to, and provided with subsidized housing, personal assistance, nursing care, 

case management, substance abuse treatment, mental health services, and assistance 

with meals. 

Several hundred Medi-Cal Home- and Community-Based Waiver slots, which allow 

people to receive long-term health care in their homes instead of in institutions, will be 

made available to those who qualify. Another innovative aspect of the settlement 

agreement is the development of a rental subsidy program, through which San 

Francisco will, over the next 5 years, secure and subsidize scattered-site, accessible, 

independent housing for approximately 500 people with disabilities and seniors who are 

eligible for community-based services. 

Fair Housing and Americans with Disabilities Act Housing Access Settlements 

Based in Washington, D.C., the Equal Rights Center (ERC) conducted a survey of 

multifamily construction covered by the Fair Housing Amendments Act (FHAA) and 

ADA. The survey uncovered widespread violations by some of the largest American 

apartment and condominium developers. Several sets of surveys, reaching about 390 

properties throughout the Washington, D.C., metro area and several States, uncovered 

some form of FHAA accessibility noncompliance in 100 percent of those properties.558

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Following up on this research, ERC initiated in-depth investigations into the practices of 

several prominent developers that led to a series of lawsuits and settlements. 

By using litigation and related negotiations to ensure compliance with fair housing 

regulations, ERC has effected the retrofitting for federally mandated accessibility of 

more than 20,000 units in multifamily homes throughout the United States.559 These 

legal successes have also yielded benefits beyond accessibility in a substantial number 

of homes. One of these settlements, with Trammell Crow Residential, led the developer 

to contribute $1.5 million to support ERC’s Multifamily Housing Resource Program, 

which promotes compliance with housing laws through training and education, best 

practices, and compliance monitoring. Following another settlement that resulted in the 

retrofitting of more than 2,000 units, the developer, Bozzuto & Associates, adopted 

accessibility standards in townhomes and single-family homes that go beyond federal 

requirements.560 These features draw on “aging in place” concepts and include no steps 

between areas in the same level, wide hallways and entries, accessible doorbells, 

handrails, and at least one wheelchair-maneuverable main level bathroom. Bozzuto 

committed to incorporating these features for at least 5 years in 75 percent of its upperlevel garden-style condominium units and 50 percent of its single-family homes and 

townhomes.

Universal Design 

6 North Apartments, St. Louis, Missouri 

6 North Apartments is one of the nation’s first examples of a multifamily residential 

building featuring 100 percent universal design (UD). All 80 of the project’s one- and 

two-bedroom apartments—as well as its common spaces, coffeehouse, and live/work 

units—are fully usable by people with and without disabilities. The residential/mixed-use 

and mixed-income building is located at the corner of Laclede Avenue and Sarah Street 

in St. Louis’s central-west end. UD features incorporated at 6 North include stepless 

entries, open floor plans, adjustable countertops and shelves, and high-contrast color 

and surface texture schemes. The three-story project contains 56 percent market-rate 

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and 44 percent affordable units. As of 2006 it was fully leased, with eight apartments 

currently occupied by households that include at least one disabled member. 

The project was spearheaded by Brinkmann Construction and real estate developer 

McCormack Baron Salazar. The project apartments and the concept for creating 

universal design were in the making for several years at McCormack and arose out of a 

need for affordable housing in the city and effective advocacy by Paraquad, the local 

Independent Living Center. The $12.9 million development was funded in part by U.S. 

Bank, a $540,000 loan from the Missouri Housing Commission, and the St. Louis 

Affordable Housing Commission.561 The project was awarded the John M. Clancy 

Award for Socially Responsible Housing. 

University Neighborhood Apartments, Berkeley, California 

The nonprofit developer Affordable Housing Associates, Inc., built the University 

Neighborhood Apartments to increase affordable, accessible housing for individuals and 

families, including people with disabilities. All the apartments are designed using 

universal design principles and are fully accessible. All the units are available to 

households having 30 to 60 percent of Area Median Income, including 20 project-based 

Section 8 units and 9 units designated for households that include individuals with 

disabilities. Fourteen of the apartments are set aside for tenants with disabilities. (See 

above for additional information about this project.) 

Universal Design and Visitability: Mandatory and Voluntary Policy 

Models 

As of January 2008, the Rehabilitation Engineering Research Center (RERC) on 

universal design, School of Architecture and Planning, at the State University of New 

York at Buffalo, reports that 37 U.S. cities have adopted either voluntary or mandatory 

requirements for some level of universal design or visitability. These policies vary widely 

in terms of the type of homes to which the policies apply, building specifications, and 

whether the requirement is triggered only when federal, State, or local subsidies are 

involved. According to RERC, 15 cities have adopted voluntary policies and 22 have 

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mandatory rules. Estimates by RERC and also by Concrete Change indicate that nearly 

30,000 homes have been constructed that include visitability-related aspects of 

accessibility (e.g., zero-step entries, 32-inch-minimum interior doorways, levered 

handles, reinforced bathrooms for later grab bar installation, lowered electrical 

controls.)562 Several of these policies are highlighted below. 

Concrete Change and Habitat for Humanity, Atlanta, Georgia 

Beginning in 1987, the group Concrete Change developed a principle called “basic 

home access,” later known as “visitability,” and promoted it to housing developers and 

others. The basic features of visitability include a zero-step entrance, wide interior 

doors, and a half-bathroom on the main floor.563 In 1989, Concrete Change persuaded 

the Atlanta chapter of Habitat for Humanity to include this basic access in new homes. 

By early 2006, Habitat Atlanta had built more than 600 visitable houses.564 In 1992, 

following outreach efforts by Concrete Change, the city of Atlanta passed the first U.S. 

visitability ordinance, requiring basic visitability in all private single-family homes and 

duplexes that receive tax incentives, city loans, land grants, fee waivers, and/or federal 

block grants.565 Because of the ordinance, more than 600 homes have been 

constructed in Atlanta in compliance with the visitability standard as of 2002.566

Moreover, similar requirements have been passed in cities throughout the United 

States, as well as at the State level in Texas, Georgia, and Kansas. Visitability 

standards have been successfully replicated because of their affordability, especially 

when compared to the cost of retrofitting, among other reasons. While visitability 

dramatically expands the number of people who can visit or live in a house, the costs at 

the time of construction are relatively small. Concrete Change estimates that a zerostep entrance on a concrete slab should cost around $200, with an extra $50 for 

expanded doors.567

Minimum Universal Design Requirements for New Construction Using Affordable 

Housing Trust Funds from the City of St. Louis 

In 2004, the city of St. Louis adopted policy to require that universal design principles be 

applied to new construction using Affordable Housing Trust Funds. All developers hire a 

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registered project architect to produce detailed construction drawings prior to 

commencing construction and to oversee construction of the project. All new 

construction projects require written architectural certification at the time of application, 

at execution of the loan agreement, and at closeout by the project architect and the 

developer that the project is designed and built in compliance with universal design 

requirements. If construction begins prior to the review of the required documents, 

affordable housing funds may be revoked. The first certification requires that the project 

will be drawn and built in compliance with universal design requirements. Following the 

awarding of funds and prior to construction, the developer and architect must sign a 

second certification that includes a verification checklist.568

Design for Life Montgomery, Montgomery County, Maryland 

Design for Life Montgomery is the first voluntary certification program in Maryland for 

visitability and “livability” in single-family attached and detached homes located in 

Montgomery County. Its guidelines apply to both new construction and renovation of 

existing homes. The program features two optional standards of accessibility and is 

voluntary, following the National Association of Home Builders’ guidelines that support 

voluntary programs. New construction and renovation of existing homes are targeted by 

the program, which represents a successful informal partnership involving county, 

building, and business interests and advocates. The program is administered by the 

county as part of the regular permitting process and is not a special process. A 

checkbox for review and certification can be found on the standard application for 

permit, and there are no additional permitting costs beyond the standard fees. 

The program started in March 2007. As of August 2008, 12 permits have been issued. 

Eight are for new construction, three for additions to existing buildings, and one for 

alteration of an existing structure. The program generally follows visitability principles 

and does not meet FHAA or ADA requirements or universal design guidelines. 

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California Model Universal Design Ordinance 

Assembly Bill 2787, enacted in 2002, requires the California Department of Housing and 

Community Development to develop and certify one or more model universal design 

ordinances applicable to new construction and alterations for voluntary adoption by 

cities and counties. The department’s model ordinance identifies rooms and denotes 

features that must be offered by a builder in residential units subject to the ordinance 

that are being newly constructed or substantially rehabilitated, but are only installed if 

requested by the buyer/owner and which would not cause an unreasonable delay or 

significant nonreimbursable costs to the developer or builder. In general, the model 

ordinance provides (1) definitions for critical terms, (2) local option as to types of units 

(owner-occupied and/or rental) and number of units, and (3) specific exemptions and 

enforcement mechanisms. 

While voluntary models like A.B. 2787 and Design for Life Montgomery do not have the 

same impact as mandatory requirements, they are often important first steps, spurring 

the testing of a new concept that brings needed attention to the issue, while 

demonstrating it is both affordable and practical. They eventually contribute to the 

critical mass that is needed to generate stronger legislation or adoption of more 

comprehensive policies. 

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Conclusion 

Housing for people with disabilities is not simply a matter of bricks and mortar. Creating 

and sustaining safe, accessible, affordable, and integrated housing can involve 

challenging and complex barriers that arise from the interaction of poverty, 

inaccessibility, Byzantine funding rules related to acquiring supportive services, and a 

disability policy system rooted in the outmoded model of segregating people with 

disabilities from the mainstream community. Potential best practices and models that 

respond to the most intractable barriers almost always involve public policy that 

supports, or can be interpreted to support, a particular solution, multiple public and 

private funding sources, local ingenuity and community commitment, and, in some 

situations, the courts. While examples of effective housing solutions exist, they 

generally are not yet sufficiently scaled to meet the need. For example, progressive 

nonprofit developers are responding to demands from the disability community and 

others for affordable, accessible scattered-site housing, yet they can only provide 

homes for a small number of the people who need and want them. Such a development 

opened recently in northern California, where 3,000 low-income individuals applied for 

79 apartments,569 illustrating that the demand for affordable housing among people with 

disabilities and other low-income communities far outstrips what is available, and that 

many locales are unable to meet such needs. 

Some low-income people with disabilities have been able to purchase their own homes. 

Yet, while the actual number of people who have become homeowners is not known, it 

is likely to be small, and the hurdles that prospective buyers encounter, such as 

securing financing, can be daunting. Although commercial rental housing is generally 

readily available in most locales, it is frequently unaffordable for many people with 

disabilities. The cost of most market-rate housing in the United States exceeds the 

entire monthly budget of people with disabilities living on SS-level incomes. The single 

greatest barrier to the efforts of people with disabilities to acquire homes of their own 

may be the combination of too little subsidized housing and inadequate federal, State, 

and local funding for Housing Choice Vouchers that close the gap between very low 

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incomes and housing rental costs. Furthermore, most market-rate housing also lacks 

basic accessibility, and some private building industry groups oppose additional 

mandatory accessibility requirements for new home construction. Bureaucratic 

complexities tied to acquiring funding for supportive services, such as personal 

assistance, provided outside of institutional settings add additional challenges and 

layers of difficulty. Many people with disabilities therefore continue to face dire problems 

acquiring appropriate housing. 

At a minimum, long-range solutions must include comprehensive changes in public 

policy. Such changes include substantially increasing funding for housing vouchers, 

creating incentives for inclusion of housing units for very low income people with 

disabilities in all federal and State programs that support housing development and 

construction, and adopting accessibility standards and universal design principles for all 

home construction by States, counties, and cities, as well as by the building and 

housing construction industry. 

Although serious problems remain, some notable successes suggest that momentum is 

building for broader reforms. For example, the movement for housing to be constructed 

according either to universal design or visitability principles appears to be gaining 

currency. Designers, architects, and homebuyers are growing increasingly interested in 

these principles. Thirty-seven cities across the nation have adopted either mandatory or 

voluntary policies that are beginning to generate results: because of such policies, 

roughly 30,000 homes have been constructed with some level of accessibility.570 These 

advances are serving as models for other locales that demonstrate that features like 

visitability can be achieved without undue cost or administrative burden. As part of the 

recovery plan developed following the devastation wrought by Hurricane Katrina, 

Louisiana plans to create 3,000 new supportive housing units for people with disabilities 

using multiple sources of funding. 

Exemplary models of scattered, affordable, accessible mixed-income and mixed-use 

housing are being created by for-profit and nonprofit developers that set the bar for what 

can be accomplished. Other housing models are evolving that hold promise for people 

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with disabilities, including Naturally Occurring Retirement Communities (NORCs) and 

Limited-Equity Cooperatives (LECs). Supportive living programs ensure that people with 

disabilities receive the help they want and need to live as independently as possible in 

their own homes. The evolution of these programs nationwide has helped significantly 

reduce the number of people who are forced to live in restrictive institutions. Much 

remains to be done, but these and other areas of progress reveal that an important shift 

is taking place that eventually will lead to an increase in and improvement of housing 

and supportive service options for people with disabilities. 

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Recommendations 

1. Congress should pass legislation to modernize the Section 811 

Supportive Housing for Persons with Disabilities program.

The Section 811 Supportive Housing for Persons with Disabilities program 

(Section 811) provides capital funding and project rental assistance for 

nonprofits to develop new permanent supportive housing for people with 

disabilities. Section 811 is the only HUD permanent Supportive Housing 

Program exclusively serving people with disabilities. H.R. 5772, the Frank 

Melville Supportive Housing Investment Act of 2008, was passed unanimously 

by the U.S. House of Representatives in September 2008 and has been 

reintroduced in 2009 as H.R. 1675. The bill will create a Project-Rental 

Assistance demonstration program to expand the supply of permanent 

supportive housing for low-income people with disabilities by including 

integrated supportive housing units in federal LIHTC- and HOME-funded 

properties that also provide housing for people without disabilities. It will also 

permanently set aside rental subsidies for people with disabilities and authorize 

that these vouchers be permanently funded through the Housing Choice 

Voucher program. 

2. Congress should increase Housing Choice Voucher funding targeted to 

people with disabilities. 

The HUD FY 2008 and 2009 budgets both contained $30 million in 

appropriations for an estimated 7,000 new Housing Choice Vouchers. These 

funds offer a new opportunity for collaboration among State and federal 

agencies and Public Housing Agencies to establish initiatives that support the 

goal of increasing community integration for people with disabilities. Such 

integration can be achieved by using Housing Choice Vouchers to close the 

gap between the cost of market-rate housing and the very low incomes of 

many people with disabilities. However, the increase is still insufficient to 

ensure that many who need assistance will receive it. Additional funding for 

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Housing Choice Vouchers is required annually to ensure that those with the 

lowest incomes can compete successfully for units in the private rental market. 

3. States should call for an increase in HOME funds to allow for the 

allocation of more funds for Tenant-Based Rental Assistance by 

participating jurisdictions when developing Consolidated Plans.

The HOME program is one of the largest federally funded housing programs 

that affect low-income people with disabilities. HOME funds can be used for 

new construction, rehabilitation, homebuyer assistance, and Tenant-Based 

Rental Assistance. State agencies receive about 40 percent of the total HOME 

funds and the remaining 60 percent is divided among local participating 

jurisdictions, based on the size of their populations. Only about 2 percent of 

HOME funds are used for Tenant-Based Rental Assistance.571 Income targets 

for HOME funds vary dramatically by State and are discretionary within specific 

limits. In light of the extraordinary need for rental assistance by very low 

income people with disabilities, States should identify the need to increase use 

of HOME funds for this purpose when developing Consolidated Plans. 

4. Housing authorities should participate in HUD-approved programs to 

assist low-income people with disabilities to pursue homeownership 

using Housing Choice Vouchers as one source for funding.

Congress and HUD have authorized Public Housing Agencies throughout the 

country to work with and assist low-income individuals and families in 

purchasing their homes, yet fewer than 800 housing authorities out of nearly 

3,000 have done so.572

5. States should adopt policies that award points under the Low Income 

Housing Tax Credit (LIHTC) program for projects that (1) target housing 

units for people with disabilities whose incomes are either at the SSI 

level or at less than 30 percent of AMI for the area, (2) include visitability 

features in all projects, (3) include Universal Design principles in all 

designs, and (4) ensure integration by limiting the total units in a project 

occupied by people with disabilities to 15 percent, unless there exists a 

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compelling reason to do otherwise.

Historically, LIHTCs have not been targeted to individuals with the lowest 

incomes. States should use the demand for tax credits, where it exists, as a 

mechanism to leverage developer interest in projects that are targeted to very 

low income people with disabilities, feature elements of visitability and 

universal design, and promote integration. 

6. Congress should amend the Assets for Independence Act (P.L. 105–285) 

to specifically include individuals with disabilities among the target 

populations, require related reporting from Assets for Independence 

(AFI) projects to include information on participants with disabilities, and 

encourage funders who match AFI dollars to eliminate categorical 

restrictions that serve as additional barriers to participation by people 

with disabilities.

The Assets for Independence Act, which established an assets-based 

approach to assist targeted low-income individuals to move out of poverty, 

does not specifically identify individuals with disabilities as a target population. 

While some people with disabilities may be eligible based on income, AFI 

projects do not collect and report data on people with disabilities who 

participate in the program. Furthermore, some sources that provide matching 

funds target specific subpopulations, which create additional barriers for people 

with disabilities who do not meet these criteria. 

7. Disability organizations should actively participate in HUD’s 

Consolidated Plan process in order to help expand homeownership and 

affordable rental housing for people with disabilities.

State and local officials and Public Housing Agencies must create strategic 

plans that identify how the jurisdiction will use federal housing funding to meet 

the affordable housing needs of the community. The plans also identify which 

population groups will receive priority for federally subsidized housing units and 

housing vouchers. Disability community involvement is critical in order to 

ensure that the housing needs of people with disabilities are both considered 

and met. 

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8. Public and private entities such as HUD, State and local housing 

agencies, private foundations, and housing referral and advocacy 

organizations should form a partnership to establish and fund a new 

disability and housing technical assistance initiative.

In order to become more involved in the process of developing affordable 

housing for people with disabilities, disability organizations need access to 

information, technical assistance, and examples of successful strategies that 

will enhance their capacity to participate effectively in efforts to establish 

integrated, affordable, and accessible housing. They also need information that 

will enable them to become involved with State and local activities that promote 

affordable housing and to integrate the needs and interests of people with 

disabilities into well-established State and local fair housing networks. A 

national housing technical assistance center would fill this role. It could also 

undertake targeted research on topics including potential advantages and 

drawbacks of housing models, such as Limited-Equity Cooperatives and other 

co-ops, as housing alternatives to single-family homes, lifelong rentals, and 

congregate housing. 

9. Public and private entities (examples as named above) should form a 

partnership to establish and fund an active housing registry.

The need for affordable accessible housing is significant, yet people with 

disabilities do not have access to a coordinated, accurate, and up-to-date 

source of information about accessible and affordable rental units, units 

designated as rentals with options to purchase, and accessible and affordable 

homes for sale nationwide. Such a service would ensure that people seeking 

housing have the option to consider available units in their geographic area 

and to take appropriate steps to establish eligibility and gain access to these 

units. 

10. Public and private partners should draw on the experience of the Arc of 

the Central Chesapeake Region, Maryland, to create other lease-to-own 

projects for very low income people with disabilities.

This lease-to-own model appears to offer very low income individuals with 

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disabilities a unique homeownership option. The model provides a long-term 

lease, and a portion of the rent is applied toward the eventual purchase of the 

rented unit. People with disabilities are currently using this program to 

purchase homes. This model should be replicated by private and public 

partners in other States to determine if it will achieve effective outcomes in 

situations with different geographical and demographic characteristics. Federal 

incentives should be established to spur the evaluation and development of 

this model. 

11. Congress should increase funding for HUD’s Fair Housing Initiatives 

Program (FHIP) to ensure enforcement of the Fair Housing Act’s 

accessibility requirements.

Such funding will allow a significant increase in the presence and effectiveness 

of FHIP. By supporting organizations to partner with HUD in addressing 

housing discrimination complaints, the program can improve public awareness 

about fair housing rights and support increased fair housing enforcement. 

Disability-based complaints make up the largest percentage of fair housing 

complaints filed with HUD. Additional support for FHIP will help to bolster the 

currently inadequate enforcement of fair housing laws, thus alleviating some of 

the systemic difficulties people with disabilities face in finding homes of their 

own. 

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NCD Topical Brief #3 

Mental Health Issues— 

Housing for People with 

Psychiatric Disabilities 

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Contents 

Introduction ............................................................................................................... 299

Setting the Stage: Deinstitutionalization and Board and Care Homes................. 301

Olmstead and the Embrace of Recovery................................................................. 305

Supportive Housing .................................................................................................. 307

Housing for People with Psychiatric Disabilities Released from Correctional 

Facilities..................................................................................................................... 311

Examples of Supportive Housing Programs for People with Psychiatric 

Disabilities ................................................................................................................. 313

Pathways to Housing................................................................................ 314

Mental Health Association of Morris County, New Jersey: Residential 

Intensive Support Team (RIST)................................................................ 316

Main Street Housing................................................................................. 318

Recommendations .................................................................................................... 323

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Introduction 

Housing for people with psychiatric disabilities continues to be a largely unmet need in 

America, with tragic results. A national survey conducted in 1996 found that more than 

40 percent of homeless people reported mental health problems.573 Insufficient housing, 

in turn, contributes to the large number of incarcerated people with psychiatric 

disabilities.574 A report issued in 2006 by the Federal Bureau of Justice Statistics found 

that more than half the nation’s prison and jail inmates have a mental health problem.575

The lack of adequate housing for people with psychiatric disabilities is particularly 

compelling in the face of emerging consensus that recovery from mental illness is 

possible, and that stable housing provides a foundation for achieving it.576 This report 

will briefly trace the evolution of housing for people with psychiatric disabilities, describe 

some of the models of housing currently in use, highlight best practices, and 

recommend policy changes needed to provide the type of housing that is most 

conducive to recovery and that provides the greatest degree of dignity and integration 

for people with psychiatric disabilities.577

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300
Setting the Stage: Deinstitutionalization and Board 

and Care Homes 

Housing for people with psychiatric disabilities is a relatively recent public policy 

concern. Before the 1960s, people diagnosed with serious mental illness were 

considered incapable of living outside of institutions. Most residents in mental 

institutions lived there for many years, receiving custodial care rather than treatment. In 

1956, 559,000 people diagnosed with mental illness lived in public institutions.578 The 

development of psychotropic medications, a desire to save public funds, and growing 

concern about conditions in institutions led to a nationwide movement to 

deinstitutionalize hospital residents. 

By 1980, the number of people diagnosed with mental illness living in public institutions 

had been reduced to154,000.579 People released from mental institutions were 

supposed to receive treatment and support services in the community, but the promise 

of community-based treatment proved illusory, and the lack of support services coupled 

with the dearth of affordable housing swelled the ranks of people with mental illness 

living without shelter. Those who were unable to negotiate the streets often found 

themselves reinstitutionalized in nursing homes or correctional facilities. 

The need for housing for people with psychiatric disabilities sparked the development of 

a new type of institution called the board and care home.580 Board and care homes 

range in size from 2 to more than 200 residents, with the majority housing more than 50 

people. They provide 24-hour supervision and food to residents. 

Most board and care homes function as mini-institutions within the community. They 

provide very little privacy, a limited scope of services, and little opportunity to interact 

with people without disabilities in the community. In most board and care homes, 

residents have no opportunity to exercise choice in their day-to-day lives over 

roommates, meals, bedtimes, or other daily functions. Few board and care homes help 

residents develop independent living skills or move on to independent housing.581

Virtually all resident income goes directly to the home, making it impossible for residents 

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to save sufficient funds to consider moving to private housing.582 “In such settings, 

residents who receive only SSI [Supplemental Security Income] are typically required to 

turn over their entire monthly benefit check, and they get back a personal needs 

allowance of as little as $25 per month to cover all expenses beyond room and 

board.”583

Approximately 330,000 people with psychiatric disabilities live in board and care homes. 

There is little oversight, most homes are unlicensed, and there have been multiple press 

stories about abusive conditions in board and care homes.584 Board and care homes 

are not designed to lead to recovery—they simply filled the housing gap created by 

deinstitutionalization. 

The dearth of affordable alternatives also keeps people trapped in board and care 

homes. “In 2006—for the first time—national average rents for both one-bedroom and 

efficiency units were more than the entire monthly income of an individual relying solely 

on SSI income. As growth in the cost of modest rental housing continued to outpace 

cost-of-living increases in SSI payments, the national average rent for a one-bedroom 

apartment rose to 113.1 percent of monthly SSI—up from 109.6 percent in 2004.”585

It is important to note that providing rental subsidies for existing units rather than 

funding new construction is the fastest and most cost effective way to address the lack 

of affordable housing for people with psychiatric disabilities. As discussed below, rental 

subsidies also facilitate community integration and other benefits. However, the need for 

affordable housing is great, so all possible strategies should be used to create it. For 

example, the use of creative strategies, such as inclusionary zoning requirements for 

new construction, should be used alongside rental subsidies for existing housing to 

maximize the number of affordable housing units for people with psychiatric 

disabilities.586

Although most mental health housing is congregate, studies have repeatedly shown that 

people with psychiatric disabilities prefer to live in integrated housing where they can 

exercise choice over the type of supportive services they receive.587

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Participants wanted services that emphasized social interaction and the 

development of social networks. Survivors described a variety of supports such 

as peer supports, employment supports, family, friends, and professionals as 

essential components of a support network. Survivor organizations, peer 

support, and drop-in centers were all seen as examples of services that can 

specifically address the issues of isolation and loneliness.588

The exercise of choice over housing and support services and the quality of housing, in 

turn, lead to better outcomes, because they are “important contributors to the subjective 

quality of life and adaptation to community living of people with mental illness....”589 

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Olmstead and the Embrace of Recovery 

In 1999, the Supreme Court decided a case that upheld the right of people with 

disabilities to integrated housing. Olmstead v. L.C.590 involved two women with mental 

disabilities who had been voluntarily admitted to Georgia Regional Hospital in Atlanta. 

Although their doctors determined that the women were ready for release to community 

care, they were not offered community placements by the State, so they sought relief 

through the courts. When their case finally reached the Supreme Court, it ruled that 

unnecessary segregation constituted discrimination under the Americans with 

Disabilities Act. 

In reaching its decision, the Supreme Court noted that ADA explicitly identifies 

unjustified segregation as a form of discrimination,591 and that ADA’s implementing 

regulations state that “[A] public entity shall administer services, programs, and activities 

in the most integrated setting appropriate to the needs of qualified individuals with 

disabilities.”592 The Court stated that the regulations define such a setting as one that 

“enables individuals with disabilities to interact with non-disabled persons to the fullest 

extent possible.”593

Hence, in assessing whether housing for people with psychiatric disabilities meets 

ADA’s integration mandate, a key determination is whether the housing facilitates and 

maximizes the residents’ ability to interact with people without disabilities. The Court 

underscored the importance of integration by describing the harm caused by 

segregation: 

Recognition that unjustified institutional isolation of persons with disabilities is a 

form of discrimination reflects two evident judgments. First, institutional 

placement of persons who can handle and benefit from community settings 

perpetuates unwarranted assumptions that persons so isolated are incapable 

or unworthy of participating in community life. Second, confinement in an 

institution severely diminishes the everyday life activities of individuals, 

including family relations, social contacts, work options, economic 

independence, educational advancement, and cultural enrichment.594

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The Olmstead decision added support to a concept that emerged from the psychiatric 

survivor movement: that recovery from mental illness is possible, and that housing and 

support services should be designed to support it. The recovery concept was embraced 

by the President’s New Freedom Commission on Mental Health, which was charged by 

President George W. Bush in 2002 with recommending policies to help States embrace 

the goals of the Olmstead decision. The commission’s final report defined recovery as: 

“The process in which people are able to live, work, learn, and participate fully in their 

communities. For some individuals, recovery is the ability to live a fulfilling and 

productive life despite a disability. For others, recovery implies the reduction or 

complete remission of symptoms.”595 The commission went on to note that: 

After a year of study, and after reviewing research and testimony, the 

Commission finds that recovery from mental illness is now a real possibility. 

The promise of the New Freedom Initiative—a life in the community for 

everyone—can be realized. Yet, for too many Americans with mental illnesses, 

the mental health services and supports they need remain fragmented, 

disconnected and often inadequate, frustrating the opportunity for recovery.596

The Supreme Court’s recognition of ADA’s integration mandate and the growing 

acceptance that people can recover from mental illness reinforced the development of 

supportive housing for people with psychiatric disabilities. 

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Supportive Housing 

The term supportive housing has been used to describe a broad range of housing for 

people with disabilities. The common characteristic that runs across all types of 

supportive housing is the provision of support services meant to enable people with 

disabilities to live in the community. Supportive housing has been used to describe: 

● Transitional or permanent congregate housing with onsite support services 

● Group homes with onsite or offsite support services 

● Single-room occupancy buildings with onsite services that exclusively or 

partially house people with disabilities 

● Apartment buildings with onsite or offsite services that exclusively or partially 

house people with disabilities 

● Scattered-site apartments leased on the open market with offsite support 

services 

Some types of supportive housing require participation in services as a condition of 

obtaining or maintaining housing. This requirement is problematic for several reasons. It 

makes participation in support programs coercive rather than voluntary, which makes 

such programs less desirable and effective.597 Also, it forces tenants to adapt to 

preexisting programs rather than allows people with disabilities to choose the specific 

services they need. 

Requiring participation in support services also runs counter to the Fair Housing Act, by 

creating a burden based on disability that tenants without disabilities do not have to 

meet. Like all tenants, people with disabilities are expected to comply with a lease, but 

requirements that go beyond that, such as participation in specific programs and 

services, create special hurdles that make it more difficult for tenants with disabilities 

than those without to obtain and maintain housing. 

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The best types of supportive housing maximize tenant empowerment by unlinking 

housing from support services and allowing tenants to choose from a broad array of 

voluntary support services that can be provided onsite or offsite at the tenant’s option. 

Scattered-site supportive housing that is indistinguishable from private market housing 

provides tenants with fully integrated homes that encourage independence and allow 

tenants to avoid the stigma associated with housing set aside for people with psychiatric 

disabilities. One of the prerequisites for recovery is overcoming the stigma about mental 

illness that permeates society: “Simply by virtue of their diagnosis or label, people 

labeled with psychiatric disabilities are perceived as second-class citizens, murderers, 

people to be feared, people too incompetent to make their own decisions, malingerers, 

and many other stereotypes.”598

Segregated housing by its very nature invites stigma and makes recovery more difficult. 

People with psychiatric disabilities who experience more independence and less 

depersonalization have corresponding gains in social integration.599

Fully integrated scattered-site housing also avoids the “not in my backyard” reaction 

from neighbors who fear that housing for people with psychiatric disabilities will bring 

crime and lower property values, despite ample evidence to the contrary.600 

Scattered-site supportive housing can help foster a sense of community and support by 

offering an offsite clubhouse or building for tenants to participate in classes and other 

types of social activities. Such programs are particularly effective when run by 

psychiatric survivors who can help create an accepting, nonjudgmental atmosphere and 

serve as recovery role models. 

Support services can also facilitate recovery by offering help in the community. Aides 

offer assistance and companionship to tenants who need support with grocery 

shopping, cooking, errands, laundry, doctor visits, participating in recreational and social 

activities, attending classes and vocational training, accessing substance abuse 

treatment programs, and similar community-based tasks. Support services that are 

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flexible and allow tenants access 24 hours a day and 7 days a week, and permit tenants 

to pick from a broad array of services, offer the best chance for recovery and successful 

independent and integrated living. Just as the Americans with Disabilities Act and the 

Olmstead decision require housing integration, providing support and rehabilitation 

services in integrated settings rather than offices is also required, both because it is 

more effective to learn these skills where they are used, and also because it allows 

access to services in settings that maximize the opportunity to interact with people 

without disabilities.601

Another crucial characteristic of successful supportive housing is permanence. Timelimited housing makes it difficult for tenants to stabilize and focus on recovery. Tenants 

who time out of transitional housing often become homeless and experience a 

resurgence of psychiatric disability as a result of the stress from life on the streets. As 

one report noted, “Extensive consumer preference studies show a desire to live in one’s 

own house or apartment, a disregard for segregated settings, and greater housing and 

neighborhood satisfaction with the permanent supportive housing model.”602

Cost effectiveness is another hallmark of successful supportive housing. Well-designed 

supportive housing is far less expensive than the mix of shelters, psychiatric hospital 

beds, and jail cells that people with severe psychiatric disabilities often cycle through 

when stable housing with support services is not available.603

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Housing for People with Psychiatric Disabilities 

Released from Correctional Facilities 

As noted earlier, deinstitutionalization without adequate community-based support 

services and the lack of affordable housing have contributed to the dramatic increase in 

the number of prisoners with psychiatric disabilities over recent years. Without 

meaningful discharge planning and access to supportive housing, released prisoners 

with psychiatric disabilities face difficult challenges to remain in the community. Welfare 

and subsidized housing programs often exclude ex-inmates, the stigma of incarceration 

makes private landlords and employers reluctant to rent or hire, and parolees and 

probationers must meet the specific requirements of their respective programs to 

maintain their freedom. 

Given these reentry barriers, it is not surprising that returning prisoners consider 

housing to be perhaps the most crucial component to community reintegration.604 But 

although the need to link ex-inmates to stable housing may be obvious, meaningful 

discharge planning from correctional facilities is rare. In a precedent-setting case, the 

city of New York agreed to provide discharge planning for prisoners with serious mental 

illnesses to settle a lawsuit. The settlement agreement in Brad H. v. City of New York

was finalized in 2003. It requires individualized assessments and help obtaining 

services in several areas, including housing, public benefits, and mental health services. 

Before the lawsuit, the city had simply released jail inmates between 2 a.m. and 6 a.m. 

in Queens Plaza with $1.50 in cash and a $3 Metrocard. The New York Times had 

described the lead plaintiff in the case as: 

A 44-year-old homeless man with schizophrenia who grew up in a psychiatric 

hospital and has been treated for mental illness each of 26 times he has been 

jailed as an adult, most recently for jumping a subway turnstile. On none of 

these occasions, the lawsuit charges, did anyone plan for how the man would 

continue to receive medication and other mental health services on his release 

from jail, or how he would obtain Medicaid benefits, Social Security disability 

payments, or supportive housing.605

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Although there is insufficient research to evaluate the effectiveness of reentry housing 

programs,606 it makes sense to assume that the same characteristics that have been 

found to meet the housing needs of people with psychiatric disabilities will also serve 

the needs of returning prisoners with mental illness. Indeed, the Pathways to Housing 

Program profiled below accepts clients directly released from Rikers Island, New York 

City’s largest correctional facility. 

In conclusion, permanent supportive housing that is fully integrated and offers tenants 

with psychiatric disabilities a broad and flexible array of voluntary support services, a 

sense of community and acceptance, and role models through program staff who are 

psychiatric survivors offers the best chance for stable housing and support for recovery 

from mental illness. 

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Examples of Supportive Housing Programs for People 

with Psychiatric Disabilities 

The following offers a closer look at three types of permanent housing programs for 

people with psychiatric disabilities. Pathways to Housing is the nation’s oldest “housing 

first” program and has been heavily studied. It provides permanent, scattered-site 

supportive housing with voluntary, flexible, and individualized support services delivered 

by a staff that is heavily composed of peer providers. There are no requirements to use 

support services or abstain from substance abuse to either obtain or maintain housing, 

and tenants are accepted directly from the streets, homeless shelters, psychiatric 

wards, and correctional facilities. 

The Mental Health Association of New Jersey’s Residential Intensive Support Team 

(RIST) program is a modified housing first program because it requires agreement to 

continue psychiatric medications and participate in a treatment plan as a condition of 

obtaining housing, but not as a condition of maintaining it. Until 2009, all its tenants 

came from a psychiatric hospital through a discharge planning program. It provides 

individualized onsite support services in scattered-site housing delivered primarily 

through psychiatric survivors. 

Main Street Housing does not meet the definition of permanent supportive housing 

because it offers only housing. Rather than directly offering support services, it provides 

referrals to community-based support services upon request. It offers a mix of 

congregate and single-residency housing, and does not accept tenants with cooccurring substance abuse or who have committed violent crimes. Because it does not 

offer support services, it only accepts tenants who can demonstrate an acceptable 

degree of “wellness.” However, it is included here because it appears to be the nation’s 

only housing program for people with psychiatric disabilities that is entirely run by 

psychiatric survivors, and service provision by peers has been found to be an important 

predictor of housing success for people with psychiatric disabilities. 

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Pathways to Housing 

In 1992, Pathways to Housing (Pathways) pioneered a new way of housing people with 

psychiatric disabilities that has come to be known as the “housing first” model.607 Based 

in New York City, the program was founded by Dr. Sam Tsemberis, a clinical 

psychologist who had worked with homeless people with psychiatric disabilities. 

Tsemberis believes that housing is a basic human right, and should therefore be offered 

without any precondition, whether or not tenants agree to pursue treatment.608 

Pathways provides housing to homeless people with mental illness and co-occurring 

substance abuse—the population that other homeless prevention programs have found 

most difficult to place. Tenants are offered independent private housing in the 

community when they enter the program. The only requirements to obtain housing are 

to agree to participate in biweekly visits by a service coordinator, attend a money 

management program, agree to pay 30 percent of income toward rent, and abide by a 

standard lease. 

Pathways rents apartments via a network of landlords, and sublets the units to its 

tenants. By making timely rent payments and intervening quickly to solve tenancy 

problems, Pathways is able to maintain a stable number of units. Tenants are offered up 

to three units to choose from when they enter the program. 

To ensure full community integration, the program does not rent more than 10 to 

20 percent of the units in a building. Tenants are free to stay as long as they wish. 

There is no requirement to participate in mental health or substance abuse treatment. 

Tenants choose whatever support services, if any, they want. 

Services are delivered onsite and are available 24 hours a day, 7 days a week, via an 

Assertive Community Treatment (ACT) team or at Pathways offices. ACT teams consist 

of a case manager—typically a peer counselor or former consumer—and a nurse, 

psychiatrist, social worker, vocational rehabilitation counselor, drug counselor, and 

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administrative assistant. Approximately half of Pathways staff are in recovery from 

mental illness, substance abuse, or homelessness. 

Staff help tenants develop independent living skills by accompanying them on trips to 

buy groceries, visit doctors, and perform other activities in the community. Depending 

on what a client wants, case managers can work directly with the client or, as tenants 

proceed toward recovery, can provide referrals to community services. The intensity of 

services is adjusted relative to a client’s evolving abilities. 

Pathways offices offer a range of support services and opportunities for socializing and 

recreation. There are writing groups, photography groups, computer classes, science 

groups, and people go to the movies together and socialize. 

A person with a psychiatric disability’s need for housing is no different from anyone 

else’s. Housing is constant, while services vary as a function of disability. Unlike 

Supportive Housing Programs that preceded Pathways, tenants who refuse mental 

health and/or substance abuse treatment and those who continue to abuse drugs or 

alcohol are not threatened with loss of housing, so long as they continue to comply with 

their lease. 

Tsemberis believes that people with psychiatric disabilities have the capacity to 

immediately move into their own home in the community. He points out that homeless 

people have substantial survival skills that are masked by their disability. Homeless 

people know where to go for meals, where to collect SSI checks, where to seek medical 

care, the location and eligibility rules for shelters, where to sleep when shelters are full, 

and what parts of the town are relatively safe to travel through. Tsemberis also believes 

that relief from the daily stress of life on the streets allows tenants to begin to focus on 

addressing other needs and developing the skills that can foster recovery. 

Pathways to Housing provides people with an apartment of their own first, so 

that they may find a reprieve from the war zone that is homelessness. 

Assistance is provided every step of the way so that tenants have all the 

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support necessary to move and integrate into their community, and to begin 

the long journey through the recovery and rehabilitation process.609 

Research substantiates the effectiveness of the housing first approach. One study 

demonstrated a direct relationship between participating in a housing first program and 

decreased homelessness and increased perceived choice.610 This study also 

suggested that this approach may have a distal effect on decreased psychiatric 

symptoms. People in the housing first program obtained housing earlier, remained 

stably housed, and reported higher perceived choice.611 Living in their own apartment

through a housing first program and having choices also had a great impact on the 

psychological and social integration of people with mental illnesses.612

Pathways to Housing separates housing from treatment. It treats 

homelessness by providing people with individual apartments, and then treats 

mental illness by intensive and individualized programs that seek out and 

actively work with tenants as long as they need, in order to address their 

emotional, psychiatric, medical and human needs, and on a twenty-four-hour, 

seven-day-a-week basis.613 

Tsemberis believes the housing first approach is far superior to the status quo: “People 

with mental illness are in jail, or homeless, or in and out of psychiatric institutions. This 

is better, and far more cost-effective.... A housing first approach requires an agency to 

take the risk of putting people with mental illness and addiction into apartments and 

assume liability for that. Most programs want a containment/supervision model—that’s 

not based on data, but rather on prejudice about mental illness.”614

Finally, Pathways has an 80 percent tenant retention rate and is far more cost effective 

than emergency services used by homeless people with severe mental illness.615

Mental Health Association of Morris County, New Jersey: Residential 

Intensive Support Team (RIST) 

The Mental Health Association of Morris County, New Jersey, operates a permanent 

Supportive Housing Program for patients leaving Greystone Park Psychiatric 

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616 Hospital. It is known as the RIST program because it uses a Residential Intensive 

Support Team to provide support services. The program began housing 21 people in 

2004 and has grown slowly since. By the end of 2008, the program served 36 people, 

and a total of 49 people had been housed directly from hospital discharge since the 

program’s inception. 

RIST staff meet with potential tenants before they are discharged from Greystone. They 

help patients locate private, single-residency, scattered-site housing in the 

neighborhood of their choice. The patients are then discharged directly into their new 

homes. The lease is in the tenant’s name. 

RIST is a modified housing first program, in that it seeks to serve “recovery-oriented” 

patients deemed ready for discharge. Patients must agree to continue to take their 

medication and participate in a treatment plan to win acceptance into the program. 

However, patients—referred to as “customers” by RIST staff—are not removed from 

their housing or from the program if they refuse to take medication or adhere to their 

treatment plan. The only criterion for maintaining housing is lease compliance. 

Housing is permanent, with allowance for periods of absence from the unit of up to 

approximately 6 months, and sometimes longer on a case-by-case basis. If a customer 

cannot comply with the lease and is evicted, RIST staff will offer a new placement. 

Customers are allowed three housing placements before they are turned away from the 

program. 

RIST customers are offered a rich array of support services in their units, in the 

community, and at a RIST drop-in center/social club. Most services consist of 

developing independent living skills, such as cooking, housekeeping, hiking, and 

accompaniment to spiritual services. Services are delivered by nine community life 

coaches, all of whom are consumer providers. RIST staff also help customers access 

vocational rehabilitation programs and educational programs. One customer obtained a 

massage therapy license, another completed a program in heating and air conditioning 

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repair, and a third graduated from the RIST program and is pursuing a degree in 

pastoral counseling. Services are available 24 hours a day, 7 days a week. 

In addition to community life coaches, RIST staff include one master’s level residential 

coordinator, one full-time assistant coordinator, three full-time senior residence 

counselors (one of whom is a consumer provider), and a part-time nurse consultant. In 

addition, the program shares a bookkeeper, a housing development specialist, and a 

psychiatrist with other Mental Health Association of Morris County programs. 

The RIST program defines successful community integration by several measures, 

including avoidance of hospital and jail stays, positive relationships with friends and 

family, and involvement in educational or vocational training. RIST has a goal that 

80 percent or more of housed customers will participate in three or more different 

social/leisure activities each quarter. Social participation per quarter in 2008 ranged 

from 81 percent to 92 percent. 

RIST has a goal that 75 percent or more of housed customers will be involved in one or 

more prevocational or vocational activities. Vocational and prevocational participation 

per quarter in 2008 ranged from 79 percent to 82 percent. This included 12 customers 

who were employed either part-time or full-time during the year. 

RIST attributes much of its success to its use of consumer providers, who make up 

71 percent of its staff. The key component of the program is the relationship between 

life coaches and customers, who are matched carefully to foster trust and teamwork. 

Having experienced psychiatric disabilities as well as recovery, life coaches can offer 

more empathy, understanding, and tolerance, and can “meet their customers where 

they’re at,” while serving as role models. 

Main Street Housing 

Another emerging model of housing for people with psychiatric disabilities is Main Street 

Housing (MSH) in Maryland. A subsidiary of On Our Own of Maryland, an organization 

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of psychiatric survivors, MSH was incorporated in 2001 as a nonprofit and began 

offering housing the following year. It was formed to provide an alternative to board and 

care homes and residential settings tied to service provision.617 

MSH offers a consumer-run “housing only” model that differs from Pathways and RIST 

in several ways. It only offers housing, with no support services provided, although MSH 

staff are familiar with local services and will refer tenants to support services in their 

communities. 

Today, MSH owns 15 buildings in nine Maryland counties that contain a total of 27 units 

and house 53 adults and families. Approximately half the tenants live alone; the rest are 

families or adult roommates. Units include efficiencies, one- and two-bedroom units, 

and three-bedroom units for families. 

Unlike Pathways, MSH owns its homes and leases them directly to its tenants. MSH’s 

Executive Director, Ken Wineman, says homeownership enables his organization to 

build equity it can use to leverage the purchase of new homes, and to offer the 

opportunity for tenants to sign leases and experience the responsibilities and privileges 

of tenancy. 

MSH chooses its tenants carefully. Each applicant is screened by Ken Wineman, who is 

both a consumer and a social worker. Although treatment is not a prerequisite to obtain 

housing, applicants must demonstrate a “certain wellness level” to be accepted. Current 

substance abuse is not permitted, nor is a history of arrest for violent crimes. 

Tenants must agree to monthly inspections for safety and cleanliness. If the home is not 

kept well, staff offer, but do not force, referrals for support services. When adults live 

together, each tenant must agree to be responsible for the upkeep of a specific common 

area. Housemates are expected to work out any problems that come up, and house 

meetings are the usual method used to do so. Staff are available to informally mediate 

disputes upon request. When a new tenant first moves in, staff will visit more frequently 

to help ensure a smooth transition. Staff will sometimes contact a tenant’s case 

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manager or other support staff if needed. Alcohol and tobacco use is discouraged but 

not prohibited—however, in shared living situations a tenant can request that his or her 

roommate not use either in the home. 

Rent is kept low—typically it ranges from $200 to $275 per month. Section 8 vouchers 

are accepted, and MSH has adopted the housing authority rules of occupancy to ensure 

that Section 8 vouchers will be offered to its tenants. 

Wineman explained, “People in the mental health system see us as a model. We get 

referrals from State hospitals—and that enables workers there to see that it’s possible 

to offer housing separate from support services.”618

Housing is permanent—tenants can stay as long as they wish. Wineman is particularly 

proud that MSH was able to help a mother regain custody of her child by offering stable 

housing for both. 

MSH has successfully avoided “not in my backyard” (NIMBY) problems. When a home 

is purchased, no neighborhood notification occurs. If neighbors drop by while a home is 

being prepared for occupancy or when staff are doing repairs and maintenance, 

neighbors are welcomed and told that MSH is the landlord and will quickly respond to 

calls about any concerns neighbors may have. Wineman says that neighbors have 

responded well to this approach, which satisfies concerns without stigmatizing tenants 

by announcing the presence of mental health consumers. 

Although MSH has not yet conducted studies, Wineman states that his experience at 

MSH has convinced him that stable housing leads to employment and more stability 

and grounding in nonpatient roles. To avoid segregation, MSH purchases buildings that 

range from single-family homes to buildings that contain no more than four units. No 

more than six people reside per multiunit building. He explained, “I don’t buy anything I 

wouldn’t live in.”619 

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Finally, Wineman believes that the fact that MSH is completely consumer run provides 

significant advantages that contribute to the success of the program. Consumer staff 

provide role models and hope for tenants, and educate the broader mental health 

community that recovery is possible. Wineman also believes that a consumer-run 

program fosters a greater degree of tenant accountability, because staff have higher 

expectations of tenants to be self-sufficient. Tenants feel more comfortable interacting 

with staff who have faced similar mental health challenges. Tenants find the staff to be 

compassionate and nonjudgmental, and hence easier to approach for help. The 

presence of role models and the sense of acceptance help tenants develop their selfesteem. Research implies that peer support empowers people with psychiatric 

disabilities to make decisions relatively autonomous from professional staff.620

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Recommendations 

1. As required under the Fair Housing Amendments Act, the Americans with 

Disabilities Act, and Olmstead, people with psychiatric disabilities are entitled 

to and should be offered fully integrated housing in the community. Prospective 

tenants should participate in choosing their housing, and such choice should 

be preceded by a meaningful opportunity to observe and understand what is 

being offered and resolve any concerns they may have. People who prefer not 

to live in such housing should not be forced to do so. 

2. Housing must be offered without being tied to treatment or use of supports as a 

condition of obtaining or maintaining housing. Lease compliance should be the 

only criterion for maintaining housing. 

3. People with psychiatric disabilities are entitled to permanent housing, and to 

the legal protections offered all tenants. 

4. Brief absences should be tolerated without loss of housing, and program staff 

should stay in close touch with tenants and landlords to maximize the chances 

that tenants will return to their homes. 

5. Tenants should be offered individualized, flexible support services that are 

available 24 hours a day, 7 days a week. Tenants should be free to request the 

type of services they need, and when and how they want to receive them. 

6. Whenever possible, housing and support services should be staffed by people 

who have recovered from mental illness. For programs that serve tenants with 

both psychiatric disabilities and substance abuse problems, staff should 

include people who have recovered from drug and/or alcohol abuse. 

7. Program staff should be responsive to concerns from property managers, 

landlords, and neighbors, and intervene promptly to resolve tenancy problems 

to help tenants avoid eviction. 

8. Program staff, tenants, and landlords should be educated about fair housing 

rights and responsibilities, with emphasis on the right to reasonable 

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324

accommodation. Housing staff should have formal backup support from fair 

housing attorneys for training, advice, and help in resolving disputes. 

9. Government housing and treatment funds should be redirected from board and 

care homes, nursing facilities, and psychiatric hospitals to housing first 

programs that maximize client choice and community integration and that 

reflect the characteristics contained in these recommendations. 

10. Jails and prisons should be required to provide meaningful discharge planning 

that helps prisoners with psychiatric disabilities identify and apply for quality 

supportive housing prior to release, to minimize recidivism and maximize 

successful transition to independent living in the community. Similarly, 

probation services should help people with psychiatric disabilities obtain stable 

supportive housing and support services that foster independence and 

meaningful participation in community life. 
NCD Topical Brief #4 

Homeland Security and 

Emergency Housing Evaluation 

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326
Contents 

Introduction ............................................................................................................... 329

Need ........................................................................................................................... 331

Overview of Key Issues ............................................................................................ 333

Analysis ..................................................................................................................... 337

Emergency Shelter................................................................................... 337

Temporary Shelter.................................................................................... 337

Transitioning into Temporary or Permanent Housing ............................... 339

Attaining Temporary and Permanent Housing After a Disaster............................ 345

Direct Assistance...................................................................................... 348

FEMA Trailers .......................................................................................... 350

Rebuilding Permanent Housing............................................................................... 353

Congregate Care and Group Locations.................................................... 356

Risk Mitigation .......................................................................................... 356

Promising Practices.................................................................................................. 359

A Functional Model................................................................................... 359

U.S. Department of Justice Guidance for Emergency Shelters ................ 361

Search Tools ............................................................................................ 363

U.S. Department of Housing and Urban Development............................. 364

Mortgage and Rental Relief...................................................................... 365

FEMA Comprehensive Planning Guides .................................................. 366

National Disaster Housing Strategy.......................................................... 367

Concerns About Federal Guidance .......................................................... 369

Hurricane Ike Impact Report..................................................................... 369

FEMA Disability Coordinator(s) ................................................................ 371

Voluntary and Community Organizations and Advocates ........................ 372

Conclusion................................................................................................................. 375 

Recommendations .................................................................................................... 377

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328
Introduction 

The purpose of this brief is to present an overview and analysis of emergency housing 

issues of concern to people with disabilities. The report describes general needs and 

identifies key issues that influence the provision of emergency, post-disaster housing. 

Historically, few communities or organizations have made disabilities a key issue, either 

before or after a disaster. As a result, there are problems that begin with initial 

notification of an impending emergency or disaster, and then continue with evacuation, 

transportation to a shelter with trained staff ready to provide appropriate 

accommodations, providing temporary housing, and developing permanent housing. 

This report describes the process of securing emergency housing and includes the 

perspectives of people involved in providing and receiving this housing: people with 

disabilities, disability advocates, service providers, caregivers, and public officials. 

Observed problems include the lack of available accessible and affordable units 

lengthening shelter stays, lack of proximity to accessible transportation and key health 

and social services during a temporary relocation, challenges faced by caseworkers in 

assisting people with disabilities into temporary or permanent housing, and the failure of 

most communities to conduct pre-disaster recovery planning. 

The brief concludes with a review of evolving practices that are consistent with 

recommended practices for housing people with disabilities in an emergency context.

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330
Need 

Arguably the most regionally widespread disaster ever to face the United States, 

Hurricane Katrina revealed stark gaps in emergency housing for people with 

disabilities.621 This massive, widespread event stressed the abilities of agencies and 

organizations to provide accessible shelters and temporary and permanent housing 

solutions. Evacuees often had to leave behind critical resources during the evacuation, 

including durable medical equipment, assistive technologies, and prescriptions, and 

were separated from service animals, caregivers, and service providers. Those 

receiving evacuees struggled to respond to their needs. 

Hundreds of communities opened ad hoc shelters, but many were not equipped with 

specialized equipment or resources to assist people with disabilities.622 It is clear that 

people with disabilities were not accommodated well, and in a number of instances 

were sent inappropriately to special needs shelters.623 Some shelters also reportedly 

refused access to service animals. 

Caseworkers, who usually assist dislocated people in the recovery process, 

experienced difficulty with assisting people with disabilities to move from shelters into 

temporary or permanent housing.624 Issues included replacement of equipment and 

finding accessible housing close to key social and health services.625 People with 

disabilities appear to have stayed in temporary shelter or with family, friends, or others 

for longer periods of time than people without disabilities.626 Social service providers 

and advocacy organizations stepped in to assist, but often found that their efforts were 

constrained by a lack of available resources or knowledge. Transitioning to temporary 

housing became a stressful, lengthy ordeal. 

A study by the U.S. Government Accountability Office indicates that “special needs 

populations are often overlooked in planning for disaster housing assistance.”627 As 

subsequently demonstrated in Brou v. FEMA, there were neither sufficient numbers of 

accessible emergency housing units (e.g., trailers) nor a process for providing 

accessible units in place after Hurricane Katrina. In January 2009, the Federal 

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Emergency Management Agency (FEMA) issued its National Disaster Housing 

Strategy, with a recommendation to create national and State disaster housing task 

forces that include people with disabilities and representatives of disability organizations 

and agencies. 

There is reason to believe that Hurricane Katrina was not an exception in how people 

with disabilities experience emergency housing. Wildfires in California, floods in the 

Midwest, and September 11 all revealed considerable challenges across hazards and 

locations with finding and providing accessible housing in settings supportive of people 

with disabilities.628 In short, post-disaster emergency housing for people with disabilities 

is problematic. Efforts to address the need through policy, practice, and research are 

emerging, although most of those efforts remain to be assessed. A careful look at the 

issues associated with emergency housing is thus required. 

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Overview of Key Issues 

A number of reports published by the National Council on Disability, the National 

Organization on Disability, the U.S. Government Accountability Office, Congress, and 

independent researchers indicate that in disaster situations certain issues recur for 

people with disabilities. Problems start when officials notify the public of an impending 

emergency. Such notifications appear more likely to reach people who can see, hear, 

and are physically able to take protective action. To illustrate, people who are deaf and 

hard of hearing experience problems with receiving emergency notifications. For 

example, notifications concerning rapid onset of weather events (e.g., a tornado) often 

fail to reach people who are deaf,629 a situation described as a “hole” in the warning 

system. Closed captioning during emergencies is often not consistently available, 

despite Federal Communication Commission (FCC) policies requiring such 

dissemination of information. Even when interpreters are present, cameras cut away 

and coverage is lost.630

Accessible public transportation to reach areas of safety is limited and typically depends 

on advance knowledge prior to an event. Because disasters are not salient events for 

most people in general,631 and because disaster is just another challenge among many 

experienced daily by people with disabilities, personal planning tends to be insufficient 

for people with disabilities.632 In short, the process of informing and moving people with 

disabilities to safe shelter remains a significant problem in the United States. Once 

people are in the shelter, their stay can be lengthy and traumatic. 

People with disabilities appear to experience longer stays in shelters or other 

accommodations before moving into temporary housing because of a lack of accessible 

and affordable temporary units, including public housing, rental units, and governmentprovided trailers. Rental units are typically sought as a first strategy to solve housing 

needs. Those units may not be in a location convenient to people with disabilities and 

may have features different from what is familiar and/or needed. In some disasters, the 

Federal Government may authorize mobile homes or travel trailers, though such units 

are far from ideal. These units take time to transport and place, a particularly lengthy 

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process if an area requires the construction of roads and utilities. For Hurricane Katrina, 

the massive needs generated by the storm meant that everyone, regardless of 

disability, waited a long time to secure a unit. After Hurricane Katrina, the U.S. 

Department of Housing and Urban Development (HUD) created a National Housing 

Locator System that helps people search for accessible units. However, those units at 

times are located at a considerable distance from an individual’s workplace and social 

network. FEMA has also established a Housing Portal that indicates if a unit offers basic 

accessibility. 

Once people have been relocated into such temporary units, other problems tend to 

arise, including finding accessible public transportation from the new unit to and from 

work, social or health care services, veterinary services, grocery stores, and/or laundry 

facilities. Caregivers may not be able to live in the units or may now be at a further 

distance. Reliable and established relationships that may be critical to daily activities are 

disrupted. The new neighborhood and neighbors may be unfamiliar. Pets, a source of 

comfort, may not be allowed. Service animals may be disoriented and stressed. 

The process of permanent housing reconstruction can be time consuming. For 

homeowners, insurance must be claimed, federal assistance acquired, permits sought, 

contractors hired, and building materials purchased. In an area hard hit by disaster, 

such contractors and supplies may be difficult to secure—particularly contractors 

familiar with disability issues and supplies that are accessible. In Louisiana, 

reconstruction shortages and “scam artists” damaged local trust so badly that Louisiana 

State University established a Web site for construction contractors to list their licenses 

and skill levels. For renters, the displacement may be permanent. After the 1994 

Northridge earthquake in California, renters faced lengthy displacement because a 

regional recession and poor cash flow meant that apartment building owners could not 

afford reconstruction for some time. A combination of bank, State, and federal programs 

had to be initiated for rebuilding.633 For many families, rebuilding is cumbersome and 

exhausting. Without the assistance of voluntary and community organizations, many are 

not able to rebuild their homes or secure appropriate housing. This appears to be 

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especially true for people with disabilities, and even more prevalent among those 

marginalized further by lower incomes. 

More broadly, the community itself typically moves through a recovery planning 

process. The post-disaster housing recovery process requires that construction be 

authorized through a permitting process, although not all communities take advantage 

of this as an opportunity to increase access for people with disabilities. Recovery 

planning processes allow for the consideration of new philosophies, building codes, and 

designs to be integrated into the rebuilt homes and community. The U.S. Access Board 

has led an Emergency Transportable Housing Work Group that includes FEMA and 

representatives of the disability community and the manufactured housing businesses. 

Through the work of this group, substantial progress has been made. The U.S. 

Department of Justice, through Project Civic Access, provided technical assistance to 

Mississippi and Louisiana to enhance compliance with ADA requirements for postdisaster reconstruction.634

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Analysis 

This section examines the emergency housing process people are likely to follow to 

reestablish the continuity of their lives after a disaster. Overall, the emergency housing 

process involves four phases,635 starting with dislocation from one’s home into either 

emergency or temporary shelter, and then moving into either temporary housing or 

(eventually) some form of permanent housing. In the subsections below, the process of 

moving through these phases is defined and illustrated from the perspectives of 

individuals, agencies, and officials.

Emergency Shelter 

The first phase that an individual faced by disaster might experience is emergency 

shelter.636 This phase is typically ad hoc and short lived. People may seek out locations 

such as cars, tents, or lawns to stay for a short duration before moving to a more 

amenable location. For Hurricane Katrina, those emergency shelter locations included 

overpasses, rooftops, and places like the New Orleans convention center. Even for a 

smaller event like Hurricane Gustav, some people sheltered in their cars. Such locations 

typically vary in their access to food, water, medical assistance, and personal security. 

Such circumstances can range from being places of simple discomfort to acute and lifethreatening locales for anyone, and especially so for those who are medically fragile. 

Temporary Shelter 

Temporary shelter, the second phase, provides basic amenities that include, at a 

minimum, food, water, and a place to sleep that is free of exposure to the elements. 

General population shelters, such as those managed or supported by the American Red 

Cross, usually offer shower facilities, first aid, psychological support, case management, 

and more. Typically, less than 20 percent of the population goes to a public shelter, 

preferring instead to stay with family or friends, stay in a motel, or try and remain in their 

own homes.637 People who do go to a public shelter tend to be lower income. Because 

people with disabilities tend to have lower-than-average incomes, it seems more likely 

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they would go to public shelters. However, some research suggests that if people with 

disabilities do not believe shelters are ready for them, they will not evacuate and may 

remain in their homes at considerable personal risk.638 People with disabilities also may 

not use shelters if they cannot get there because evacuation, accessible transportation 

procedures, or buddy systems fail. Significant problems may then develop when people 

with disabilities remain at home and, for example, are unable to operate critically 

needed medical or mobility equipment because of power outages.639

For those who do make it to temporary shelter, two kinds may be available. Usually, 

emergency managers identify and announce predesignated general population (GP) 

shelter locations, which are most commonly managed by the American Red Cross. 

These locations must accept and accommodate people with disabilities and service 

animals. Some areas may choose an alternative system, where the Red Cross provides 

support. In Texas, for example, a shelter hub system is used under the State’s 

emergency response plan. This mass care system is managed by a designated liaison 

between voluntary organizations and the State, with support from a variety of health, 

medical, and voluntary organizations. 

Whether a shelter is run by the Red Cross or not, a triage system based on specific 

criteria is usually used to determine if an individual should go to a general population or 

to an advanced care facility, such as a medical/special needs shelter, a nursing home, 

or a hospital. At both general population and medical/special needs shelters, there is an 

intake or registration process, which can vary from minimal to extensive. Ideally, 

registration processes identify the specific needs of an individual, including those 

related to disabilities, language barriers, and health problems. Medical needs shelters, 

particularly those in areas of repetitive risks, have improved since Hurricane Katrina, but 

planning and implementation for such facilities are still inconsistent across the nation.

It is not unusual for organizations, communities, and officials other than the Red Cross 

to open their doors to displaced people. Such independent shelters can vary from a 

local place of worship that sets up cots and offers food provided by congregants, to the 

Katrina mega-shelters established by Texas officials in large facilities to host massive 

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numbers of evacuees. The abilities of ad hoc shelters to accommodate people with 

disabilities can vary widely. For Hurricane Katrina, ad hoc shelter providers often sought 

out local resources or used their personal networks to find sign language interpreters, 

medical supplies, nutritional services, wheelchairs and other devices, veterinarians, and 

health care providers. How well shelter staff understand disability issues can also vary. 

In general, many Katrina shelters lacked adequate training for their staff and volunteers 

for them to understand and support even basic needs.640 Some progress has been 

made in this area since Katrina, with general population shelters more likely to accept 

people with disabilities and service animals. States at higher risk for hurricanes have 

implemented plans for medical and/or special needs shelters.

Planning is vital to accommodating people with disabilities in shelters. The best strategy 

to accomplish effective planning is to actively include people with disabilities and/or 

disability organizations and advocates in the planning process. These experts can also 

participate as shelter staff and/or volunteers throughout the life of the shelter, from 

intake and registration through daily activities and discharge. Their insights can help 

shelter managers avoid misdirecting people with disabilities to inappropriate locations 

and can ease the discomfort associated with shelter life. By involving people with 

disabilities in shelter planning and management, the usual challenges associated with 

mobility, communication, nutrition, and facility use can be addressed and overcome. 

Incorporating disability organizations into the intake/registration and discharge planning 

process can expedite the movement of people with disabilities out of the shelter and into 

appropriate temporary or permanent housing post-disaster.

Transitioning into Temporary or Permanent Housing 

The ultimate goal of shelter managers, other than to provide basic relief to those 

displaced by disaster, is to move shelter residents back into their own homes or into 

temporary housing until permanent housing becomes available. Temporary housing is 

defined as housing that allows for reestablishing normal household routines that may 

include cooking, laundry, and sleeping in a safe, secure location.641 For people with 

disabilities, temporary housing may also require particular accommodations, such as 

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ramps, communication devices, or kitchen counters at an appropriate height. 

Permanent housing means that no more moves are necessary. It is not unusual for 

people to move many times before finding or rebuilding a permanent home. 

Moving people from the sheltering stage into temporary or permanent housing is a timeconsuming process that depends on several conditions. First, such units must be 

available in the community. Depending on the extent of the disaster, including impacts 

on critical infrastructure and services such as police, fire, ambulance, road clearance, 

power, water, and sewage, housing units may be in short supply. Many markets also 

experience seasonal or low availability outside of disasters, further reducing the 

temporary or permanent housing supply. For people with disabilities, available units 

must be accessible and provide an environment well suited to the individual’s particular 

type of disability. Insurance companies must provide settlements to those holding 

policies, a process that can take years depending on the type of disaster, the wording of 

the policy, and lawsuits that inevitably follow most denials. 

To move out of a temporary shelter into temporary or permanent housing also means 

that resources must be secured to offset expenses such as moving, storage, and the 

cost of a rental unit. To obtain government assistance, a Presidential Disaster 

Declaration must be issued. When that occurs, FEMA makes Individual Assistance 

payments to those affected. To qualify, individuals must first apply to the U.S. Small 

Business Administration for a loan. If rejected (usually because of income, credit history, 

or inability to repay), then applicants can then seek a federal grant. In 2009, the 

maximum grant amount was $33,300, an amount that changes with the fiscal year every 

October 1. Grants are provided to those who meet income requirements; FEMA must 

inspect the property in question to verify the claim, often with little to no recourse or 

appeal process for the homeowner if declined. 

Though FEMA opens Disaster Recovery Centers (DRCs) in many locations after an 

event, most applicants are encouraged to use the online application system at 

www.disasterassistance.gov or a national 1-800 number. The application process can 

result in a check from FEMA quickly, or the process may be lengthier. Federal 

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assistance may not cover all needs. After a 2008 ice storm in Oklahoma, for example, 

elderly families, including those with disabilities, had to rely heavily on local volunteers 

to remove debris. 

For individuals to return home, shelter discharge planners must make a final 

determination. When an earthquake strikes, homes damaged by the disaster must be 

cleared of interior debris so that people with mobility devices or people with visual 

limitations can move about. Utilities must be restored so that power is available for the 

devices, technologies, and resources used by people with disabilities. After Hurricane 

Andrew in 1992, utilities were down in southern Dade County for more than a month. 

After Hurricane Ike in 2008, Texas opened post-disaster shelters particularly for seniors 

and people with disabilities because of extended power outages. As noted by one 

Hurricane Ike survivor: 

In my naïveté about how the world works, I never realized that without 

electricity, gasoline pumps won’t work, air pumps won’t work, and water 

purification plants shut down. Generators only run about 10 hours before you 

have to put in more gas. No gasoline stations were open or functioning. The 

fact that our water was contaminated was the final straw, propelling us down 

the road to Austin. After visiting two abandoned gasoline stations, we finally 

figured out why the air pumps weren’t working, so we filled up our tires using 

an old-fashioned hand pump my neighbor had in her garage. We finally got to 

the hotel in Austin by midnight.642 

To help people with the transition from shelters into temporary or permanent housing, a 

discharge process identifies issues that can impede relocation and link the evacuee with 

appropriate support services, including public housing authorities, faith-based 

organizations, disability organizations, and home health care agencies. In some 

communities, a case management process may develop.

A professional case management process for disaster victims has only recently been 

developed. After Hurricane Katrina, the United Methodist Committee on Relief 

(UMCOR) developed case management materials and trained caseworkers. Known as 

Katrina Aid Today (KAT), the effort represents a critical advancement in helping disaster 

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victims. The case manager helps the evacuee work through a recovery plan, identify 

resources, and solve problems. However, even with help, transitioning into temporary 

housing can be difficult and even impossible for some. For example, through the KAT 

program, case managers served 1,713 individuals with disabilities and their families. Yet 

out of the total intakes, less than half (about 818 cases) have been closed. There are 

many reasons these cases have not been closed. For many, recovery plans could not 

be met because resources including affordable accessible housing were not available in 

Mississippi.643

In an assessment of the Katrina Aid Today case management process, Stough and 

Sharp found considerable value in a case manager approach for disaster survivors with 

disabilities. Case managers know and understand local social systems, which are often 

bureaucratic, confusing, and foreign, especially for survivors who are at a distance from 

their original communities and providers. Case managers thus serve as important 

conduits for those seeking recovery. In an assessment of focus groups with survivors, 

Stough and Smith found that: 

The largest majority of respondents reported housing or home repair as the 

primary need preventing their recovery. Most respondents had received FEMA 

housing assistance at some time during the previous two years. However, 

responses indicated that ongoing FEMA assistance was fraught with 

uncertainties, required complicated and excessive recordkeeping, and was 

maintained only through repeated and sometimes stressful interactions.644 

Case managers also reported that their clients required more specialized knowledge 

than did those without disabilities and they needed additional guidance on recovery 

issues. As another measure, the case managers had more frequent and longer contacts 

with clients with disabilities than those without disabilities. These client cases tended to 

be complex, as these clients often received State and federal entitlements that had to 

be restored or transferred along with finding new providers. Case managers also served 

as advocates for survivors with disabilities. Agencies in communities new to the 

survivors did not know the clients well. Case managers reported that they observed 

agencies (local and federal) that did not understand people with disabilities and they 

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believed that those agencies unfairly and inappropriately judged the clients as trying to 

abuse the system.645 

Case managers reported that clients with disabilities went through the recovery 

experience with far fewer resources than others, often a reflection of lower incomes or 

lack of employment. These clients were also less likely to be homeowners and indicated 

that some FEMA Individual Assistance Programs were not useful. For example, many 

clients could not qualify for loans because they were renters. Because of a lack of 

accessible trailers, both homeowners and renters had trouble securing temporary 

housing. The lower incomes also meant that clients experienced difficulties in 

establishing and paying utilities and buying replacement furniture. Case managers 

perceived that the recovery process was far more difficult for clients with disabilities and 

observed higher rates of depression and anxiety among these clients.646

The process of moving from warning/notification through emergency and temporary 

shelter is a trying time for anyone, and can be particularly so for people with disabilities. 

Unfortunately, arriving at a presumably more stable temporary housing unit may bring 

an additional set of challenges. As noted by the U.S. Department of Homeland Security 

Office of Civil Rights and Civil Liberties, after Hurricane Ike: 

NGO [nongovernmental organization] advocacy and service organizations 

reported that a number of elderly individuals and individuals with disabilities, 

who originally lived in community residences with supports, have been 

displaced into congregate living settings such as nursing homes. Experience 

following Katrina and Rita showed that individuals who were displaced in this 

manner were unable to return to their community living situations because they 

lacked the mobility or capacity to find new housing situations on their own. 

Following Katrina, foundation grant funding was obtained by advocacy 

organizations, enabling them to send personnel on visits to congregate living 

settings to locate displaced individuals and connect them with FEMA 

registration, and link them to case managers to obtain the supports needed to 

return to their communities. Similar strategies will be needed to identify, assist, 

and advocate on behalf of individuals displaced into congregate settings as a 

result of Hurricane Ike so that they can return to their communities.647

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Case managers appear to be helpful in assisting a survivor through the bureaucratic 

process of applying for aid, and particularly when they require advocacy with the aid 

application process. 

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Attaining Temporary and Permanent Housing After a 

Disaster 

Temporary housing allows an individual to leave a shelter or move from staying in a 

motel or with family or friends. Temporary housing means that people can reestablish a 

household routine, including activities like cooking, traveling to work, and doing laundry. 

A temporary housing situation, however, also means that the person has not yet 

returned to her or his original home or to a permanent alternative, and that another 

move will be required. Once in the permanent housing stage, a person does not have to 

move again.

As noted above, in most disasters people tend to leave shelters fairly quickly. However, 

doing so depends on a number of factors. The scope and magnitude of the disaster can 

influence a transition into temporary or permanent housing. A small-scale tornado that 

damages a portion of an urban area will probably not be a problem, as alternative 

temporary or permanent housing is likely available nearby. In a massive event, such as 

Hurricane Andrew in Florida (1992) or the Midwest floods (1994), housing availability 

can be compromised regionally, thus extending a shelter stay. Hurricane Katrina was a 

catastrophic regional event that required significant resources at all government levels 

and taxed relief agencies that were struggling to provide aid across a vast area. While 

Katrina should not be considered a representative event, it does reveal issues that 

appear to lesser degrees in other disasters. 

Other factors also influence the transition into temporary or permanent housing. For a 

renter, the availability of rental units is necessary. After the Northridge earthquake in 

1992, in which multistory apartment buildings suffered significant damage, southern 

Californians faced challenges in locating comparable rental units in proximity to their 

work, as well as to the important health and social services and networks that enhance 

their quality of life.648 The local market can also compromise availability. A tight rental 

market means that few apartments or houses can be found to rent. Concurrently, a tight 

market usually results in higher costs. In some areas, such as urban or coastal areas, 

the costs of rental units can be high even before disaster. Because people with 

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disabilities and senior citizens tend to have lower incomes than others, the affordability 

of rental units as a permanent housing solution becomes a significant barrier to 

relocation. It is not unusual for many people, particularly those at lower incomes or with 

insufficient insurance, to have to downsize their homes or move into inferior permanent 

housing as a post-disaster solution. When such choices must be made, a consequence 

is that the relocated individual or family may now be in an unfamiliar location, away from 

important social and health networks, and at risk for economic, medical, and even 

psychological trauma. In previous disasters, including Katrina, Rita, and Ike, people with 

disabilities reported considerable difficulty in finding appropriate housing. 

Although rental and homeowner units increasingly feature accessibility, the built 

environment contains many units that have not been upgraded, a particular problem in 

older neighborhoods or communities and especially in older rural areas. Locating 

accessible units or adding accessible features requires time, which extends the 

transition from shelter to housing. Searching for these units (or providing certification for 

federal payment) may require expertise and resources not readily available to some 

people with disabilities, especially those who are elderly, lack computer access, or 

remain isolated. 

The case management process, which may or may not be present in a stricken area, 

also requires some degree of expertise to assist with the transition. Local social 

services may be able to help, but may also experience damage from the disaster or be 

overwhelmed by a new caseload. A local housing authority can be of assistance to 

those who qualify, but may also be subject to the same demands as local social service 

agencies. Long-term recovery committees can help, if they have been established and 

are aware of and familiar with working with people with disabilities. In short, the 

transition from shelter to either temporary or permanent housing can be overwhelming, 

challenging, and certainly problematic.

Moving into temporary housing requires resources. Americans tend to be overly 

generous with donations at the time of disaster, so much so that the abundant 

donations are commonly referred to as the second disaster. Unfortunately, the majority 

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of the donations typically include used clothing, canned goods, and bottled water, which 

tend to go unused. When media attention wanes, so do public donations—just at the 

time when they are sorely needed for transition into either temporary or permanent 

housing. Few people donate bedroom furniture, kitchen appliances, washers, dryers, or 

other key households necessary to reestablishing a household routine. Few donations 

include those appropriate to replace items lost by people with disabilities and their 

service animals. Durable medical equipment, technological and assistive devices, and 

even service animals remain expensive to replace and may not be covered by 

insurance, federal programs, or voluntary organizations. Though disaster organizations 

can provide some funds and goods, many remain dependent on the generosity of 

monetary donations for individually specific needs. 

Funding is a particular problem for people with disabilities and those trying to help them. 

The National Council on Disability held its January 2008 Quarterly Meeting in New 

Orleans. One participant said:

While there was a lot of funding sent to Louisiana post-Katrina, there was not a 

lot of money specifically for assisting people with disabilities. The money was 

not distributed and prorated in terms of specific services for people with 

disabilities, except for some limited resources aimed toward housing. In terms 

of other resources, additional funding has gone to healthcare services, but 

again, not specific to serve those with disabilities. There was specific funding 

for people with mental health issues. However, because infrastructure was so 

devastated, it has made it difficult to provide these services. The infrastructure 

collapse has made it extremely difficult to utilize that money in an efficient 

manner.649

Finally, individual circumstances can influence the transition. Even though temporary or 

permanent options may be available, they may not be appropriate for each individual. 

Relocation, whether temporary or permanent, means that people may have to travel 

farther to work. It is also necessary to learn new routes to grocery stores, pharmacies, 

and places of worship and recreation. People may be dependent on nearby medical 

care or social services, which will need to be transferred or reestablished. A new 

neighborhood can be frightening, particularly to a senior with a disability. Service 

animals have to acclimate as well. In new locations, people do not know their neighbors. 

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They may have lost social relationships (neighbors, family, friends) important to them 

personally, financially, and perhaps even to their daily activities. Agencies may have 

been hard hit by the disaster and cannot reestablish services. One hopes that 

accessible transportation is available in the new location, new providers can be 

secured, and friends can be made. Relocation, however, is difficult for anyone. For 

people with disabilities, there are added layers that require additional sensitivity. It may 

be understandable, then, that people with disabilities may be reluctant to accept 

temporary or even permanent relocation options given the significant potential impact 

on their personal and professional lives. 

Direct Assistance 

Federal resources and assistance programs are vitally important in helping survivors 

transition into temporary or permanent housing. Several federal agencies provide direct 

assistance to disaster survivors to help them transition after disasters, including FEMA, 

the U.S. Small Business Administration (SBA), the U.S. Department of Housing and 

Urban Development (HUD), and the U.S. Department of Justice (DOJ). 

To secure FEMA assistance, disaster survivors must apply for assistance, be verified as 

a qualified applicant, and then be routed to the correct program. Housing assistance for 

survivors is made available through the Individual Assistance Program. FEMA 

covers:650

● Temporary housing (a place to live for a limited period of time), providing funds 

to help rent a place to live or a government-provided housing unit when rental 

properties are not available. 

● Repair assistance to help homeowners repair damage on their primary 

residence that is not covered by insurance, so that the home is safe, sanitary, 

and functional. 

● Funding to help homeowners replace their home destroyed in the disaster when 

it is not covered by insurance. 

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● Direct assistance for new home construction, though usually limited to insular 

areas or remote locations specified by FEMA where no other type of housing 

assistance is possible. 

FEMA provides additional funds to cover costs such as medical, dental, funeral, burial, 

clothing, household items, tools related to employment, some educational resources, 

fuel for heating a home, resources to clean a damaged home, vehicle damage from the 

disaster, moving and storage, and other “necessary expenses or serious needs as 

determined by FEMA” that are “authorized by law.” Many of these funds are necessary 

to reestablish a household routine, which serves as a measure of “housing recovery” 

and movement into either temporary or permanent housing. FEMA operates a special 

needs desk that responds to questions regarding disabilities. The FEMA Office of Equal 

Rights exists to promote equal access to programs and benefits, and provides technical 

assistance and complaint resolution through its civil rights program.651

The U.S. Small Business Administration makes disaster loans to homeowners or 

renters for repairs or replacement of “damaged real estate or personal property owned 

by the victim.” As observed by the case managers and noted earlier, “renters are 

eligible for their personal property losses, including automobiles.”652 SBA loans require 

that applicants have an acceptable credit history and demonstrate an ability to repay 

loans. They require collateral for loans over $14,000, and interest rates vary from 

2.187 percent to 4.375 percent, as of January 30, 2009. Home loans are limited to 

$200,000 for real estate repairs and $40,000 for personal property damage. Loan 

recipients are also required to carry insurance. 

After the 2008 Gulf hurricanes and flooding across Iowa, Indiana, and Wisconsin, HUD 

granted a 90-day moratorium on foreclosures of FHA-insured mortgages and 

encouraged that “loan services take such actions as special forbearance, loan 

modification, refinancing, and waiver of late charges.”653 Under a Presidential Disaster 

Declaration, HUD may allow States to use their Community Development Block Grant 

(CDBG) and HOME programs for housing victims. HUD also has the capacity to provide 

mortgage insurance under its Section 203(h) program for disaster victims and can give 

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local and State governments Section 108 loan guarantees for housing rehabilitation, 

economic development, and repair of public infrastructure. 

The U.S. Department of Justice offers support to communities damaged by disasters 

through its Project Civil Access,654 which provides technical assistance to communities 

to increase compliance with ADA and is not based on any complaints. Ultimately, the 

technical assistance can result in new codes and construction that is more accessible. 

Case examples after Hurricane Katrina (Mississippi and Louisiana) and a toolkit can be 

found at the Project Civil Access Web site. 

FEMA Trailers 

One option that may be made available is a FEMA trailer. In most disasters, FEMA is 

reluctant to provide trailers because they are not an ideal temporary solution, 

particularly for an individual with a disability. A number of issues exist with providing 

trailers. A location with appropriate utilities and roads must exist or be created, along 

with a means for access to basic services, such as accessible public transportation to 

work, laundry, grocery stores, faith locations, social services, and health care. Months 

can pass before such locations become available in even a small-scale disaster. 

Additional accommodations specific to a disability may also be needed. Safe, 

accessible trailers must then be located, transported, and connected to utilities. Either 

mobile homes or smaller travel trailers may be made available. The latter are 

particularly unpleasant, as such units provide cramped conditions not conducive to 

quality of life, let alone the ability to maintain independence with a disability. 

Such conditions existed after Hurricane Katrina, an event that challenged federal 

capacities to deliver accessible, temporary housing in a widespread, large-scale event. 

The Manufactured Housing Institute (MHI) issued a “Statement on Accessibility 

Guidelines for Emergency Transportable Housing.” The institute indicated that “it is 

unreasonable to require that 100 percent of the homes have accessibility features,” and 

preferred the 5 percent benchmark under the Uniform Federal Accessibility Standard. 

Further, it stated that the requirements “must allow for design flexibility and greater ease 

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in incorporating accessible features,” in part because of the challenge in securing 

resources to provide accommodations during disasters. The MHI produced more than 

23,000 units for FEMA in 2005, and noted that “accessibility was not a primary function 

of the home procurement effort.”655

In Brou v. FEMA, an advocacy group sued based on the claim that FEMA had not 

allotted sufficient numbers of accessible trailers that allowed for people with disabilities 

to use kitchens, bathrooms, bedrooms, or even enter the front door. The basis of the 

lawsuit was that FEMA had not provided such units and could not or would not in the 

foreseeable future. According to the Louisiana Advocacy Center, “FEMA’s published 

reports indicate that as of February 3, 2006, five months after the disaster, of the 34,808 

trailers FEMA has provided to Mississippi, only 417 units, or just over 1 percent of all 

trailers, comply with access guidelines.” Approximately 15 months later, the lawsuit was 

settled with a solution in place to address accessibility issues. That process included 

identifying needs and providing accessible units. FEMA established a toll-free number 

for people with disabilities and a complaint process. Advocacy groups were brought in 

to the process to provide insights. The Louisiana Advocacy Center indicates that 2,553 

people called, with 1,260 receiving accessible trailers and 256 awarded modifications 

close to 2 years after the disaster had occurred.656

Trailer units have also been critiqued as bearing health hazards. After Katrina and 

floods in Iowa, formaldehyde and mold emerged as concerns. The Centers for Disease 

Control and Prevention conducted a study regarding the formaldehyde, and found that 

levels were “higher than usual in indoor air in these trailers than in most homes in the 

United States” and recommended “that FEMA move residents of the Gulf Coast area 

displaced by Hurricanes Katrina and Rita out of travel trailers and mobile homes. We 

recommend that people with symptoms that could be linked to formaldehyde and 

vulnerable populations such as children, elderly, and individuals with chronic diseases 

be moved first.”657 The mold in Iowa trailers appeared to originate on water heaters, but 

may have moved to interior areas. FEMA’s response included working with the State on 

testing, informing trailer residents, relocating families, and removing the units. 

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Rebuilding Permanent Housing 

Even more challenges exist for those seeking to rebuild their homes. Depending on the 

extent of a disaster, it may be extremely difficult to secure the key resources needed to 

rebuild. From permission to rebuild through securing funding, contractors, 

subcontractors, labor, and supplies, the rebuilding process is cumbersome and 

exhausting for anyone. For a person with a disability, particularly a senior citizen, the 

rebuilding process may be too daunting. The loss of community, social networks, and 

home associated with a disaster, and having to face the rebuilding process, may mean 

that a person cannot return home. In this section, we examine some of the factors that 

can impede or expedite permanent housing reconstruction for people with disabilities. 

When a community experiences a disaster, local officials typically act to improve the 

quality and disaster resistance of local housing. Doing so takes planning and time to 

implement, which can delay the reconstruction process. In a large-scale disaster, the 

delays can be considerable, as local, State, and federal officials conduct assessments 

to determine recommendations. When people remain at a distance from their homes 

and cannot afford to return, reconstruction may not be an option at all. Contractors, 

subcontractors, voluntary organizations providing labor, and building inspectors all must 

become familiar with new codes and ordinances, and the local offices responsible for 

implementing and monitoring the new procedures must take on additional work. People 

must learn how this system works, which is often a new, confusing experience for those 

facing reconstruction. All factors interact to slow the reconstruction process—and not 

only for people with disabilities. Although the anticipated outcome is desirable, the time 

and personal cost to someone with a disability living in a temporary situation can be 

burdensome. 

Further, renters remain dependent on building owners to reconstruct their properties. 

After the 1994 Northridge earthquake, a local recession meant that owners faced 

difficulty with rebuilding.658 Local banks, State officials, and federal authorities all 

worked to create innovative funding or forgiveness programs to assist. Regardless, 

building a multistory unit takes considerably more time than a typical single-family unit. 

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People living in public housing may have several options. If availability exists, they can 

relocate to a new unit or another location can be approved by the local housing 

authority. After the California wildfires of 2005 and 2007 and Hurricane Katrina, people 

were given the option of relocating across the country, but unfortunately with the same 

problems mentioned earlier—moving away from familiar social, medical, and economic 

resources. All the public housing across multiple Louisiana parishes was condemned. 

Though it is being rebuilt, the new design style incorporates mixed-income units into the 

locations.659 Critics argue that such a design philosophy unduly reduces the number of 

low-income units and disproportionately affects low-income people with disabilities and 

seniors. 

For homeowners, insurance is the key to recovery. However, insurance remains 

expensive and in some areas, such as earthquake and hurricane zones, coverage may 

be prohibitively expensive, especially for those at low incomes. Some insurance 

companies will not cover all kinds of disasters or all expenses associated with the event. 

The cost of insurance may mean that policyholders carry coverage insufficient for the 

cost of rebuilding. Regardless, the first step for a homeowner to rebuild is usually to 

pursue an insurance claim. If a Presidential Disaster Declaration is issued, the 

homeowner may qualify for either an SBA loan or a grant from FEMA. State and local 

programs may also develop, although such efforts are not typical. Few programs 

specifically target the kinds of rebuilding needs associated with disabilities. For 

example, the maximum FEMA Individual Assistance of $33,300 is for rebuilding, 

although accessible design elements may add costs for ramps, accessible bathrooms, 

kitchen counters of certain heights, and other features that allow for appliances to be 

used. Some additional funds may be available for disability concerns, but survivors 

report they must pursue those funds aggressively. Regardless, the FEMA Individual 

Assistance amount is assumed to be supplemented by personal insurance and personal 

funds. These assumptions, coupled with the realities of living at lower incomes, mean 

that many people fall through the cracks of federal assistance and face considerable 

trouble in rebuilding. 

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To assist, a long-term recovery committee often forms in disaster-stricken communities. 

Such a committee can take the place of a formal planning unit with elected or appointed 

officials and/or representatives, or it may evolve from an interfaith group of faith-based 

organizations. Most such entities tend to bring in voluntary organizations and labor 

teams to rebuild homes. These voluntary organizations (e.g., Presbyterian Disaster 

Assistance, Mennonite Disaster Service, Lutheran Disaster Response) usually work 

within the case management system described earlier to target the homes of those with 

low incomes, senior citizens, single parents, and people with disabilities. Faith-based 

voluntary organizations are often the key to helping people return home, as they provide 

labor, expertise, and resources to rebuild cost effectively. Such organizations, though, 

may require some guidance and advice as they rebuild, so that they incorporate 

accessibility into the projects. Contractors and subcontractors may also need guidance. 

Some communities offer housing fairs to encourage various kinds of rebuilding, 

including green rebuilding and energy-efficient designs. However, such events typically 

fail to offer insight into universal design, ADA compliance, or accessibility features. 

Project Civil Access mentioned earlier, which links federal technical assistance to State 

and local government on access issues, can provide a means to do so. 

Further, local commitment to the permanent housing process can vary in regard to 

accessibility and affordability. Although affordable housing remains a concern across 

the nation, few communities specifically plan for post-disaster housing, let alone take 

into consideration issues of affordability or accessibility. However, the city of 

Watsonville, California, did so in 1989 after the Loma Prieta earthquake, by passing an 

ordinance that requires 25 percent of all new housing to meet standards for 

affordability.660 Communities facing disaster could do the same by adding elements to 

their recovery plans that emphasize accessibility and affordability. ADA standards 

beyond basic levels could be mandated, and universal design elements could be 

required as part of building codes. Disaster represents not only an unfortunate 

circumstance; it is also an opportunity for change. 

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Congregate Care and Group Locations 

Little is known about the reconstruction process for larger facilities, which tend to be 

privately owned and are usually covered by sufficient insurance. It is fairly clear that 

facilities owned by larger chains are more likely to be able to relocate their residents. 

Smaller, independent facilities face considerable challenges from evacuation to 

relocation. While many plan for evacuation, just as many fail to drill or to think through 

the consequences of long-term or permanent relocation.661 In one creative response for 

temporary housing, an effort in Santa Cruz, California, relocated residents who were low 

income, elderly, and/or with disabilities from a downtown, earthquake-damaged hotel 

into a vacant nursing home facility for nearly 2 years.662 A local day care provider for 

adults with dementia served as the facility administrator with support and funding from 

local social services and FEMA. Some permanent housing solutions for the population 

included moving back in with family or to an assisted living or nursing home facility. 

After Katrina, Louisiana and Mississippi social workers also reported a similar pattern. 

Individuals who could not return to their facilities or their homes moved into congregate 

care locations either by choice or not. 

Risk Mitigation 

Ideally, reconstruction allows for mitigation of the risk that prompted relocation. 

Mitigation may include either structural or nonstructural measures. Structural measures 

might allow for elevations, (re)building levees, hurricane lamps, shutters, or safe rooms. 

Nonstructural measures include building codes, insurance programs, and public 

education. Structural mitigation measures have not been assessed for their impact, 

positive or negative, on people with disabilities. Presumably, mitigation would reduce 

risk for them, too. However, some mitigation efforts, such as creating new standards for 

building elevations, have been critiqued as displacing people with disabilities 

permanently from their homes, if the new standards make it difficult to make housing 

accessible. Existing codes and plans for large-scale safe rooms usually fail to address 

accessibility issues.663 In Mississippi after Katrina, some social workers reported that 

some residents felt compelled to move into congregate care facilities, thus losing their 

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independence. A few elevations along the Louisiana coast after Hurricane Andrew 

(1992) included elevators so that people could return to their home communities. 

Ramps may also provide access, but organizations involved in rebuilding may require 

education and resources to provide these features. At present, federal programs do not 

provide funds specifically for disability mitigation needs. Some funds may be added to 

an SBA loan for mitigation purposes, although this information is not widely advertised. 

A nonstructural mitigation measure that has been attempted, particularly in areas of 

repetitive flooding, is relocation. In a relocation, also called a federal buyout, the Federal 

Government can offer fair market value for a home. Yet, relocation buyouts can still be 

difficult for the individual, because moves undermine established relationships, 

resources, and services that may be critical to independence. Relocation efforts must 

be worked out in the context of potential impacts such programs can have on people 

with disabilities. Successful relocation efforts integrate the needs of an individual with a 

disability in the relocation planning process. The individual, their advocates or 

representatives, and those providing the relocation must negotiate a new environment 

thoughtfully. Ideally, relocation will afford greater safety and allow the resident to remain 

in a set of social, economic, and health care relationships that allow that individual to 

retain or return to his or her original quality of life. 

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Promising Practices 

Clearly, a number of challenges exist with sheltering and housing people with 

disabilities after a disaster. Several principles should undergird efforts to strengthen 

emergency housing. First, forethought and planning for people with disabilities and 

special needs should serve as the main strategy for emergency housing. Second, 

including and actively involving people with disabilities, disability organizations, and 

advocates will provide planners and those involved in all aspects of emergency housing 

with a means to identify problems and address solutions. Third, resources must be 

made to support these recommendations. This section reviews a number of promising 

practices based on a majority of these principles.

Much of the progress made in the promising practices below derives from two sources. 

First, post-Katrina legislation drove changes in awareness and prompted the creation of 

guidance and planning materials. Second, community and organizational initiatives 

have served as agents of change. 

A Functional Model 

Historically, disabilities have been viewed as a limitation and have been “treated” with 

some type of remediation that is often medical in nature. This medical model can be 

observed when general population shelters refer people with disabilities to special 

needs or medical shelters rather than provide accommodations. An alternative model 

has emerged called the “functional” approach.664

The term special needs has historically been used to include a wide variety of people, 

which carries considerable challenges for planning. A functional approach to special 

needs looks at specific assistance that is required, centering on communication, 

medical needs, independence, supervision, and transportation, also called the C-MIST 

model.665 These groups may include people with disabilities, but also include people 

with morbid obesity, high-risk pregnancies, kidney problems requiring dialysis, and 

people lacking transportation. The diversity that exists across disabilities means that 

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while some may require C-MIST assistance, many others will not. As Kailes and Enders 

explain, “most people with disabilities and functional limitations are integrated into and 

actively involved in society,” because many have aged into disability.666 The 

implications for emergency housing are significant. To illustrate, a general popula

shelter manager would need to plan for a variety of communication needs across a 

diverse set of potential shelter residents. People with disabilities should not be 

automatically assumed to have medical needs and be sent to a special needs shelter. 

Intake, triage, registration, and discharge procedures can screen for functional 

independence needs. Staff and volunteers can be trained to supervise people with 

dementia, disorientation, and other conditions in either general population or special 

needs shelters as deemed appropriate. Transportation can be provided that is 

accessible and allows for people with mobility concerns to travel from their homes to the

safety of a shelter. Officials and organizations involved in securing temporary housing 

tion 

can attend to the same issues. 

vices need to 

e can 

tential 

acility? 

e 

Although the C-MIST approach is recommended for special needs planning, the ideas 

within the model can be applied to think through basic needs in emergency housing. For

example, what kind of communication needs exist? Do communication de

be replaced due to the disaster? Are special services required to support 

communication devices? Are any durable medical equipment or related services 

needed in either temporary or permanent housing locations? Are there medical risks in 

the dwelling unit and immediate environment? What is necessary to promote functional

independence? Has debris been removed from roads and interiors so that peopl

navigate? Is the replacement housing accessible so that people can return to a 

household routine? Does the housing provide for personal care attendants or family 

caregivers if needed? Is the housing located in a secure area that reduces the po

for crime, disasters, and other threats? Is it near to adult day care or is there an 

appropriate level of security within the assisted living, group, or congregate care f

Is the housing situated in a place that allows for people to move about, either by 

themselves, with service animals or personal mobility equipment, or through accessibl

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public transportation? Can people move easily to and from key points including work, 

grocery stores, worship, recreational areas, schools, health and medical services? 

The functional model serves as a means to identify and address issues associated with 

those at highest risk and provides a lens to think through what is truly needed in all 

types of emergency housing. 

●

●

●

U.S. Department of Justice Guidance for Emergency Shelters 

The U.S. Department of Justice (DOJ) has created a useful set of materials that provide 

guidance for shelters and rely implicitly on the functional model. The documents include 

why people with disabilities should be accommodated in general population shelters, 

descriptions of ways to provide such accommodations, and checklists for planning 

purposes. These documents can be used at the local, State, regional, and national 

levels by any entity involved in sheltering. It is not known, however, how influential these 

materials are or how extensively they are used. The ADA Best Practices Toolkit for 

State and Local Governments includes: 

Basic guidance on accessibility for shelters, social services, temporary lodging 

or housing, and other benefit programs (Chapter 7)667 

Title II Checklist, which walks the planning team through decisions about shelter 

and housing (Chapter 7, Addendum I)668

The ADA and Emergency Shelters: Access for All in Emergencies and 

Disasters (Chapter 7, Addendum II)669

● The ADA Checklist for Emergency Shelters 670

The DOJ materials guide users through an inclusive planning process. An example of 

one Addendum I checklist question for the planning team is: 

Do you have written procedures to ensure that you regularly seek and use 

input from persons with a variety of disabilities and organizations with expertise 

in disability issues in all phases of your emergency planning, such as those 

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addressing preparation, notification, evacuation, transportation, sheltering, 

medical and social services, temporary lodging and/or housing, clean-up, and 

remediation?671

As the user/team moves through the checklist, problems are identified and action steps 

are offered. The DOJ/ADA materials strongly advise involvement of a diverse set of 

people with disabilities and disability organizations in order to identify and manage all 

potential issues across the full spectrum of preparedness, planning, warning, 

evacuation, transportation, shelter, and housing. Addendum II advises readers on 

shelter practices that ensure equal access and accessibility, address shelter resident 

eligibility, offer modification suggestions, improve communications and shelter life, guide 

shelter managers on necessary services and supplies, and provide insight on 

transitioning out of a shelter. The ADA Checklist for Emergency Shelters walks the user 

through measuring or assessing specific areas including doorways, sideways, 

walkways, parking spaces, sloped surfaces, entrances, toilets, telephones, fountains, 

showers, sleeping areas, and related areas. 

The DOJ materials on temporary housing, though less comprehensive, also alert 

planners and managers to issues related to repairing and rebuilding. According to 

Chapter 7 in the manual, governments must comply with Title II of ADA. Title II allows 

for a choice between two construction standards: “either the Uniform Federal 

Accessibility Standards (UFAS) or the ADA Standards for Accessible Design (ADA 

Standards).” If a government location was constructed after 1992, alterations must 

comply with Title II of ADA. Otherwise, governments must allow a “path of travel...from 

the entrance to the altered area” that includes phones, restrooms, and fountains. 

Locations that are reconstructed with a “substantial alteration” must provide accessible 

routes, entrances, and restrooms. Substantial is defined by UFAS as “where the total 

cost of alterations in a 12-month period amounts to 50 percent or more of the value of 

the building.”672

The DOJ materials emphasize involvement of people with disabilities and a process that 

mobilizes an inclusive planning team to identify and address solutions collectively. The 

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guides walk the team through a series of assessments and corrective steps that are 

easy to follow and result in accessible emergency shelters. The materials also 

encourage critical thinking about disability issues, such as providing alternative means 

to communicate, inviting accessible social and psychological services to be present, 

and working through the implications of closing a shelter for people with disabilities. 

nal 

 disabilities.674 The NHLS 

includes a Housing Neighbors in Disaster option that allows a “neighbor to neighbor” 

Search Tools 

The U.S. Department of Housing and Urban Development (HUD) initiated a Natio

Housing Locator System as a result of Hurricane Katrina and implemented it after the 

2007 California wildfires.673 To help evacuees after Hurricane Ike, HUD’s National 

Housing Locator System (NHLS) was supplemented with government and local 

databases. The NHLS required those listing rentals to comply with the Fair Housing Act

and to make reasonable accommodations for people with

connection for “mom and pop” landlords willing to rent to people displaced by disaster, 

though they must also comply with the Fair Housing Act. 

Similarly, the U.S. Access Board initiatives include links and information for accessible 

housing after a disaster. A key link is to the National Network of ADA Centers, which 

was used after Hurricane Katrina.675 In a related vein, FEMA has created a National 

Housing Portal to assist people with finding suitable post-disaster homes.676 The portal 

allows for basic and advanced searches by State, county, city, ZIP code, number of 

bedrooms, and cost. The advanced search allows a user to look for accessible units, 

although detailed information on the nature of that accommodation may not be 

provided. These types of tools represent promising practices because they provide a 

resource for both individuals and case managers to search for suitable emergency 

housing.

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U.S. Department of Housing and Urban Development 

HUD’s participation in disaster relief has varied over the last 30 years. Generally, HUD’s 

participation in disaster housing primarily focuses on temporary and permanent 

housing. Specifically, the Department: 

● Administers two mortgage insurance programs (Section 203[h] and Section 

203[k]), which assist disaster survivors in purchasing, renovating, or rebuilding 

housing. 

Administers an insured housing rehabilitation loan program (Title I). 

Makes its foreclosed housing portfolio available for purchase by disaster 

survivors at a discount in areas affected by a declared disaster. 

●

●

 

● Provides annual grants (grants through supplemental appropriations may also 

be available) that may be reprogrammed post-disaster (Community 

Development Block Grant and HOME Investment Partnerships Program) to 

local, county, and State governments that would directly assist eligible 

recipients to purchase, rehabilitate, or construct housing. 

● Provides a 90-day moratorium on the repayment of FHA-insured mortgages for 

homes damaged in a declared disaster area. 

● Encourages private mortgage lenders to take special forbearance, loan 

modification, refinancing, and waivers of late charges on loans they hold. 

An example of HUD’s efforts in New Orleans post-Katrina: 

Approximately 123,000 homes were damaged or destroyed in New Orleans as 

a result of the hurricane. 82,000 of those were rental units [approximately 

55 percent of all rental units were lost]. The Road Home small landlord rental 

program brings federal community development block grant dollars for property 

restoration. A small percentage of these units will be designated as both 

affordable and accessible.... Section 8 rentals are also very limited. This has 

resulted in some tenants not being able to afford the increases as landlords 

have doubled their rents in some cases. Power bills have also increased. It 

was reported that some people have not been able to catch up on their utility 

bills following Katrina, especially those with disabilities who live on limited 

677

364

income.
The Road Home program used Community Development Block Grants (CDBGs) to 

provide landlord incentives. Those who rebuild using the funds must maintain units at 

affordable prices for up to 5 years, which qualifies the landlord for loan forgiveness. 

Approximately 10,000 units were estimated to result from this program. 

HUD also offers the Disaster Housing Assistance Program (DHAP), which provides for 

the public housing authority to pay landlords a Fair Market Rent (FMR) for 6 months. 

Thereafter, the tenant pays $50 of the rent, an amount that increases $50 monthly until 

the full rent is being paid or the renter leaves the program. For Hurricanes Ike and 

Gustav, FEMA identified 6,500 eligible families. The Ike program is designated to end 

on March 13, 2010.678 

The Disaster Voucher Program applies to families living in public housing, including 

seniors and people with disabilities. After a disaster, HUD transfers those in Section 8 or 

the Housing Choice Voucher (HCV) program to the Disaster Voucher Program. 

Approximately 7,600 families benefited from this program after Hurricane Katrina. HUD 

and public housing offices also worked to locate comparable housing across the nation 

for those who were displaced. People affected by Ike were able to transfer their Section 

8 housing voucher by working through the closest public housing authority that was 

mandated to assist with issues of accessibility and barriers.679 However, gaps existed in 

serving those entitled to public housing assistance: “a comprehensive tracking/counting 

system of individual accessible housing needs is currently not available to inform the 

public housing authorities (PHAs) and federal funders.”680 Mississippi, however, 

reported that such Section 8 rentals were “very limited.”681 Further, increases in rents 

and power bills increased, causing economic hardship particularly for “people with 

disabilities living on limited income.”682

Mortgage and Rental Relief 

The Mortgage and Rental Assistance Act of 2007 served to help people keep their 

homes under the duress of a disaster event. The intent of the legislation was to 

reinstate funding

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that had been lost after a revision of the Stafford Act dropped the 
program. Eligibility is income based, although exceptions can be made in areas with 

high costs of living.

683 In addition, FHA under Section 203(h) offers insurance that 

protects lenders of qualified disaster victims. The intent of the program is to support 

those with low and moderate incomes and is limited by HUD by amount, home type, 

and location.684

FEMA Comprehensive Planning Guides 

FEMA is creating a series of Comprehensive Planning Guides (CPGs) that includes 

CPG-301 (Emergency Management Planning Guide for Special Needs Populations) 

and CPG-302 (State, Territorial, Tribal, and Local Government Household Pets and 

Service Animals Plan). As of August 2009, both remain in interim versions. The current 

sheltering and mass care section describes basic guidelines for shelters and refers 

users to DOJ and FEMA Office of Equal Rights guidance materials. A shorter section 

indicates that jurisdictions should provide communication services to assist people with 

special needs through the disaster assistance application process and that “accessibility 

of both temporary and permanent housing is crucial. Timely allocation of adequate stock 

of accessible housing safeguards against individuals with disabilities (e.g., physical 

impairments) having to remain in a shelter environment longer than others or being 

685 inappropriately relocated to a congregate setting.” The document indicates that 

housing provided through government sources must comply with the Fair Housing Act 

and “meet physical accessibility requirements.”686 CPG-301 also recommends that 

recovery planners involve special needs populations and use the recovery as an 

opportunity to meet accessibility requirements. 

CPG-302 resulted from Katrina experiences, particularly the unwillingness of people to 

evacuate without their pets. This observation prompted Congress to pass the Pets 

Evacuation and Transportation Standards (PETS) Act in 2006. The intent of CPG-302 is 

to aid jurisdictions to plan for and evacuate pets and service animals, and was created 

through a joint effort of emergency managers, the Centers for Disease Control and 

Prevention, the Humane Society of the United States, the American Humane 

Association, the American Veterinary Medical Association, and others.687 A 

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predecisional draft was released in March 2009, but not to third parties and not for 

citation or quotation. A FEMA fact sheet indicates that the content will discuss 

integration with the National Incident Management System (NIMS), as well as planning 

principles and strategies for household pet and service animals. The content will include 

transportation, shelter options, veterinary care, search and rescue, and nutritional 

standards. Appendixes will include planning checklists, resources, and templates. 

Such guidance is key to motivating evacuation among people at risk and particularly 

important to sensitize first responders and emergency managers to the value and 

importance of service animals. The content of both documents will sensitize and guide 

planning teams and community groups as they address key issues, particularly those 

related to shelter. 

National Disaster Housing Strategy 

In January 2009, FEMA approved a National Disaster Housing Strategy.688 Sections 

specifically address disability issues, beginning with recommending that “local 

governments should build partnerships with disability groups/organizations and 

advocates [and the U.S. Access Board], as well as disabled persons in the affected 

community to assist in the evaluation and identification of those special needs.”689 It 

references Section 504 of the Rehabilitation Act of 1973 regarding shelter buildings and 

the requirement for ADA compliance for shelters. For interim housing, local groups and 

organizations are deemed particularly valuable because they know local populations 

and contexts best. A National Disaster Housing Joint Task Force is to be convened to 

enhance existing outreach programs by involving disability organizations. State-led 

Disaster Housing Task Forces should also be convened to do the same. 

Annex 3 of the National Disaster Housing Strategy offers a 23-page set of resources 

that acknowledge that “very few housing programs exist exclusively to assist these 

populations in disaster-specific instances, but a number of programs are relevant and 

could offer support if called upon. Well-coordinated housing assistance programs must 

be available to individuals with special needs, disabilities, and/or low incomes who are 

367
displaced by a disaster.” A number of legal requirements are noted, including 

compliance with the Architectural Barriers Act, ADA, UFAS, Section 504, the Fair 

Housing Amendments Act (FHAA), the Developmental Disabilities Assistance and Bill of 

Rights Act of 2000, Executive Order 13347, the Civil Rights Act of 1964 Title VI, the Age 

Discrimination Act of 1974, the Pets Evacuation and Transportation Act of 2006, and the 

Post-Katrina Emergency Management Reform Act of 2006. These policies promote 

several key principles: 

690

● Accessibility and nondiscrimination in all locations, particularly those supported 

by federal funding. This pertains not only to shelter and housing but also to 

application processes for assistance. 

● Housing initiatives must fit with the local community and its populations. 

● The flexibility of NGOs offers a broader array of options and less restrictive 

guidelines than can federally funded programs. Involving NGOs is key. 

● It is important to provide case management and for survivors to access it. 

Though federal programs exist to help people with disabilities, those noted in the Annex 

are admittedly limited due to the pre-disaster, existing waiting lists. Some allow for 

disaster victims to receive priority, such as Section 811 Supportive Housing for People 

with Disabilities and Section 202 Supportive Housing for the Elderly. The Older 

Americans Act also allows for some small awards to State agencies if a Presidential 

Disaster is declared. 

The National Disaster Housing Strategy and Annex 3 represent an important step 

forward in a national commitment to people with disabilities affected by disaster. The 

strategy emphasizes key principles important to any housing initiative, particularly the 

involvement of disability organizations and advocates. However, it is equally clear in 

Annex 3 that, although existing disaster assistance programs apply to everyone, there 

are no standalone disaster housing programs specifically for people with disabilities. As 

noted in a number of places throughout this topical brief, this appears to translate into a 

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small percentage of federal assistance that directly applies to those most likely to 

languish in shelters and have trouble finding temporary or permanent housing. 

Concerns About Federal Guidance 

le to 

tions 

At the January 2008 National Council on Disability Quarterly Meeting, participants 

raised public comments about the guidance materials and new criteria for special needs 

planning. The main concerns centered on a lack of funds or resources availab

implement the planning recommendations and that “the worry is that local jurisdic

are being set up to fail and not meet new criteria.” A related critique of the National 

Response Framework, which includes ESF#6 Mass Care (shelter) and ESF#14 

(recovery), did not “provide clear direction to the States and local jurisdictions about 

how to operationalize the concepts.”691 

Hurricane Ike Impact Report

One way in which ESF#14 is often operationalized is through consulting with 

communities on key issues. In October 2008, the U.S. Department of Homeland 

Security Office for Civil Rights and Civil Liberties issued a Special Needs Populations 

Impact Assessment Source document as an activity under the National Response 

Framework Emergency Support Function #14, Long Term Community Recovery. Such 

types of reports are rare, and this one provides important initial insights into the 

emergency housing challenges after Hurricane Ike (thus this report is commonly 

referred to as the Ike impact report). The report initiative involved local, State, and 

nongovernment officials in assessing C-MIST related functional needs. Observations 

related to housing included: 

●

geographic location, and single-family versus multifamily units. Housing choice 

nd 

Choice of housing units should be available, including renting, owning, 

also helps retain the “cultural integrity of communities.”692

● Affordability and accessibility are particularly important for senior citizens a

people with disabilities. Those living on fixed incomes are a special concern. 

369
● Community and faith-based organizations are crucial in helping people with 

disabilities to secure housing. 

● Realtors and others involved in finding accessible units, as well as those who

underwrite home modifications, are important partners in relocating housing. 

The Ike impact report also indicated that some individuals, including senior citizens and 

people with significant mental health needs, tended to stay in shelters longer than 

others. Individuals who had left retirement communities were reportedly having difficulty 

finding out if they could go home. Elderly residents also remained in their homes, even 

in inferior and health-threatening conditions. Both government and NGOs were said to 

be assisting with cleanup so that seniors could return to a safe environment. The report 

recommended that resources be applied to “rental assistance, debris removal, or 

emergency repairs...funding will also be needed to purchase appliances...bedding, 

furniture, food, clothing and prescription medication.”693

 to 

e report 

Similar to Katrina, “NGO advocacy and service organizations reported that a number of 

elderly individuals and individuals with disabilities, who originally lived in community 

residences with supports, have been displaced into congregate living settings such as 

nursing homes.”694 Advocates secured funding from foundations to assist Katrina and 

Rita evacuees, including helping evacuees in congregate care facilities to register for 

FEMA assistance and “link them to case managers.”695

Mitigation, particularly minimal flood elevations, was noted in the report as problematic, 

because of the potential to displace the elderly and people with disabilities: “there is a 

need for a strategy to reconcile minimum flood elevation requirements with housing 

accessibility requirements in locations such as Galveston.”696 The report recommended 

that community planners, building groups, and voluntary organizations work together

increase accessible and affordable housing through joint efforts, educational outreach to

the construction sector, and focused use of volunteer teams. Further, th

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recommended that housing be located close to public transportation, particularly 

paratransit options. 
The Ike impact report is consistent with observations after Katrina, as noted by 

participants at the NCD Quarterly Meeting held in New Orleans. Participants there 

encouraged that FEMA funds be used to increase accessibility in rebuilding streets, 

schools, civic centers, and even privately owned buildings.697 Such an approach would 

provide benefits to people with disabilities and the broader community. 

Formalizing this type of post-impact assessment, particularly if it involves disability 

organizations and is coupled with funding and other resources, represents a potentially 

promising practice. Funding the initiatives and providing resources is crucial. 

FEMA Disability Coordinator(s) 

The 2006 Post-Katrina Emergency Reform Act allowed for the appointment of a 

Disability Coordinator to assist with and provide support to address issues related to 

disabilities in disasters. The FEMA position was posted and filled in 2007. Since then, 

the Disability Coordinator has been onsite for multiple disasters and continues to 

provide guidance on disability issues. The Disability Coordinator position is situated in 

the FEMA Office of Equal Rights. In 2008, FEMA Director Paulison noted the value of 

the Disability Coordinator in speaking before the National Council on Disability in April 

2008: “we realized after Katrina that we needed a better way to reach out to these 

communities and also to have open channels of communication so we could better 

understand their needs.”698

For the 2007 California wildfires, the Disability Coordinator was able to put efforts into 

place in advance, including daily conference calls with the disability community, sending 

teams into shelters to assist with durable medical equipment and assistive devices, 

educating shelter staff, and supporting service animals. As of January 2008, FEMA had 

provided 400 people with such resources as “motorized wheelchairs, manual 

wheelchairs, raised toilet seats, grab bars, TTYs, hearing aids, and dentures.”699

In December 2008, the FEMA National Advisory Council (NAC) released a memo 

(dated August 18, 2008) to the FEMA Director recommending the creation of Regional

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Disability Coordinator positions for each of the 10 FEMA regional offices. The NAC 

noted that many States have officials or offices that deal with disability issues and 

indicated that regional-level coordinators would serve as useful liaisons between the 

State and federal levels. Further, the NAC believed that “regional disability coordinators 

would multiply FEMA personnel available to be present in Joint Field Offices to 

coordinate and support outreach to victims with special needs when disaster strikes.” 

On March 17, 2009, Executive Director Mary Troupe of the Mississippi Coalition of 

Citizens with Disabilities testified before the U.S. House Subcommittee on Emergency 

Communications, Preparedness, and Response. Troupe concurred with the 

recommendation to appoint Regional Disability Coordinators to help the National 

Disability Coordinator, assist with response, and provide liaison with voluntary agencies. 

Further, she recommended that “the Obama Administration should also encourage or 

mandate that each of the FEMA Region Administrators establish a Regional Advisory 

Council (RAC) to include a Special Needs Subcommittee as former Region II 

Administrator Steve Kempf, Jr., announced in August 2008. This would mirror the 

structure already established at the National Advisory Council (NAC) level.”700 The 

National Council on Disability issued a report in August 2009 recommending that FEMA 

“[h]ire regional disability coordinators for all ten regional FEMA offices” and “[e]stablish 

special needs subcommittees under regional advisory committees.”701

 NCD meeting, such advocates noted, “there is no 

The Disability Coordinators are a promising practice because of their ability to link 

survivors with resources, to advocate for specific needs, and to point out viable 

accommodations and solutions. 

Voluntary and Community Organizations and Advocates 

As noted at the January 2008 NCD Quarterly Meeting in New Orleans, housing 

emerged as and remained a significant problem after Katrina and Rita. A number of 

local, State, regional, and national organizations and advocates became involved in 

dealing with emergency housing. The Mississippi Protection and Advocacy Center, LIFE 

of Mississippi, and others shared information and participated in the Katrina Aid Today 

case management process. At the

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accessible affordable housing in Mississippi, so that makes a recovery plan addressing 

that issue impossible to achieve right now.”702 The National Disability Rights Network 

tried to assist clients from the Gulfport Armed Forces Retirement Home, which was 

severely damaged, and advocated for an expedited rebuilding of the original facility. The 

building, which housed more than 1,700 residents, is scheduled for completion in 2010, 

a full 5 years after the hurricane. 

Local organizations have also stepped in to advocate for disaster survivors with 

disabilities. After evacuees from Hurricane Katrina relocated to Texas, the Houston 

Independent Living Center began: 

...working with the housing committee to establish and provide accessible 

housing. The ILC developed a checklist based on the Uniform Federal 

Accessibility Standards (UFAS) so that people would have basic entry and 

ability to move around. There was a good organized effort to try to find 

accessible housing, but in the end, people with disabilities took it upon 

themselves to find housing and make modifications later.703

The Katrina Aid Today program served 1,713 clients by January of 2008 with about 800 

cases now closed. Case managers trying to close the remaining cases report that a lack 

704 of resources prevents resolution. The State of Louisiana Office for Citizens with 

Developmental Disabilities indicated that post-Katrina housing needs may include 

“retrofitting homes and accessibility issues as well as access to...dialysis centers, 

physicians, senior centers.” Notably, “what remain missing are the vouchers that allow 

for subsidies...[which] prevents people who receive SSI from actually obtaining the 

housing. This situation has made it difficult for some people with disabilities to 

return.”705 

Funds and resources often flow through long-term recovery committees or voluntary 

organizations, but those seeking to assist people with disabilities must compete with 

others seeking those funds. At the January 2008 NCD meeting, participants observed 

that while there was a significant amount of funding for Katrina, “there was not a lot of 

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money specifically for assisting people with disabilities...except for some limited 

resources aimed toward housing.”706

Voluntary and community organizations and advocates have proved critically important 

to assisting people with disabilities to regain housing. Particularly noteworthy are the 

faith-based organizations that often seek out and support those needing reconstruction 

assistance. Organizations like the Mennonite Disaster Service, Presbyterian Disaster 

Assistance, Lutheran Disaster Response, and others have worked diligently for decades 

to rebuild low-income housing. They often dedicate their efforts to the homes of people 

with disabilities and seniors. Without their free labor, construction expertise, and 

commitment, many people with disabilities would never be able to return home again. 

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Conclusion 

Post-disaster housing remains problematic across the nation. People with disabilities 

tend to stay longer in temporary shelter locations and to experience considerable 

challenges with finding suitable, accessible, and affordable temporary or permanent 

housing. Existing guidance tends to emphasize the inclusion and involvement of people 

with disabilities, disability organizations, and advocates. More specific guidance, 

coupled with adequate funding, needs to target the complete cycle of emergency 

housing that people experience from dislocation to finally never having to move again. 

To date, the process of helping people appears to be stop-gap and ad hoc. 

In order to better address the concerns of post-disaster housing, basic and applied 

research is required. Such empirical work should address at a minimum: 

● Enumerating how many people with disabilities are affected by disasters and 

what types of disabilities are most challenging for emergency housing. 

● Assessing the use of DOJ/ADA guidelines for shelters and identification of the 

conditions that block or expedite implementation. 

● Identifying the barriers to effective case management and ways to improve the 

success rate of recovery plans for people with disabilities. 

● Looking at the online search tools for post-disaster housing, how they are used, 

and their effectiveness. 

● Comparing and contrasting the various forms of temporary housing as 

experienced by people with disabilities, including rental units, mobile homes, 

trailers, and similar units. 

● Following people with disabilities through the process of finding or rebuilding 

housing in order to document the common challenges and identify strategies for 

relocation. Research should address the diversity of people with disabilities and 

their income levels. 

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● Examining building codes and local commitment to accessibility standards as 

well as identifying locations that exceed minimal commitment to ADA and other 

federal standards. 

● Studying the ways in which voluntary organizations commit to and work with 

people with disabilities in the housing reconstruction period. 

● Finding out the best strategies for relocating congregate care populations for 

temporary shelter, temporary housing, and permanent relocation. 

● Assessing the effects of relocations or buyouts on people with disabilities and 

identifying various means to ease the transition. 

● Understanding the effects of mitigation measures on people with disabilities and 

identifying alternatives that enhance safety but do not dislocate the individual. 

● Researching the ways in which inclusive housing and recovery planning efforts 

involve people with disabilities and address issues of accessibility. 

To complete a thorough study of post-disaster housing, it is essential to actively involve 

people with disabilities and disability organizations in the research process. Funding for 

this research needs to be expedited. 

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Recommendations 

The following follows the four-phase emergency housing model described in this 

chapter in order to identify appropriate recommendations for post-disaster housing.707

Several principles underlie these recommendations. First, inclusion of people with 

disabilities and their advocates in emergency programs and services is the single most 

important action to take. Planning programs and services with people with disabilities 

should also proceed holistically to link emergency housing with transportation, health 

and social services, employment opportunities, and other critical areas of the 

infrastructure. 

Emergency Shelter 

The use of emergency shelter, such as living in cars, on lawns, and under overpasses, 

is to be avoided. Doing so requires dedication from all levels: 

1. Getting people out of harm’s way is crucial to helping people to avoid using 

these emergency sheltering options. To provide guidance, FEMA should 

publish CPG-301 and CPG-302 as soon as possible and provide resources to 

publicize, train, and implement plan elements at the State and local levels. 

2. FEMA should create and fill the Regional Disability Coordinator positions in 

FEMA and add Regional Advisory Committees to support the positions as soon 

as possible. 

3. Emergency managers and social service agencies must encourage individuals 

to develop personal preparedness plans. The lowest-income individuals will 

require resources to develop emergency preparedness kits and transportation 

options. With resources, individuals can become increasingly accountable for 

their own safety. 

4. Warning systems must be accessible to alert the public to impending danger 

and activate networks that link to those at highest risk. Warning message 

content must include protective action directions specific for people with 

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disabilities. Academic and outreach programs must educate meteorologists 

and the media on the importance of providing clear and specific information on 

watches, warnings, and protective action for people with disabilities. Doing so 

is especially important in rapid onset events. 

5. Local and State governments need to provide (or continue to provide) 

accessible transportation that is preplanned vis-à-vis local population needs. 

Those at highest risk who lack transportation must be evacuated well in 

advance of impact when possible. 

6. Individuals and agencies must practice protective action, evacuation, and 

shelter plans. Drills and exercises must involve people with disabilities in 

planning, executing, and evaluating efforts. 

Temporary Shelter 

7. Shelter site selection teams must include and involve people with disabilities. 

8. The DOJ/ADA guidelines and checklists need to be more widely promoted, 

along with resources to implement key guidelines for accommodation of people 

with disabilities. Efforts should be made to publicize accessibility of shelters 

prior to an event to encourage evacuation. Co-located pet shelters should be 

added to motivate evacuation. 

9. Efforts to identify locations and organizations that have opened ad hoc shelters 

in previous disasters should be made. Those involved in coordinating shelter 

efforts should provide training and integrate ad hoc groups into shelter 

planning. 

10. Shelter coordinators can deepen a community’s shelter capacities by training 

staff and volunteers on disability sensitivity, including use of durable medical 

equipment, communication devices and strategies, assistive technologies and 

devices, and the support of service animals. 

11. All shelters under federal law must accept and support service animals. 

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12. Disability experts should be involved during intake, registration, triage, and 

discharge planning in shelters in order to identify and address specific needs. 

13. Shelter teams must be ready to open new shelters after an event for those who 

could not or did not evacuate or who are affected by storm effects, such as 

loss of power. 

14. Low-income populations generally use shelters and often arrive without 

sufficient funds to return home. Voluntary organizations and the faith 

community should be tapped to help with the transition from temporary shelter 

into temporary or permanent housing. Due to the recent recession, these 

organizations may require funds. 

15. Many agencies experience personnel turnover from disaster to disaster. It is 

thus imperative to provide continual training to those taking applications from 

people with disabilities. Those taking applications for aid should ask additional 

questions about disability-related needs to maximize the full potential of federal 

aid. 

Temporary Housing 

The following recommendations provide direction designed to renew dedication and 

expedite commitment to the provision of temporary emergency housing. 

16. Temporary housing search teams should locate and publicize accessible 

housing locations. Information about accessible housing should be 

disseminated widely through available search tools, social media, local media, 

and advocacy organizations. 

17. Local organizations and agencies can be useful in finding and transitioning 

those in temporary shelter into temporary or permanent housing. However, 

such organizations may have also suffered losses in the disaster. Thus, local 

and State efforts to transition people into temporary or permanent housing is 

best served through a coordinated team approach. Voluntary Organizations 

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Active in Disaster (VOADs) and similar organizations should be integrally 

involved. 

18. A transition team (that often emerges through a long-term recovery committee) 

based on case management planning should be created to help people move 

from temporary shelter into temporary housing. 

19. Teams or organizations that can quickly modify temporary units, such as 

adding ramps and other accessible features, should be contracted prior to a 

disaster. 

20. Those involved in transitioning people out of shelter into housing should seek a 

location and environment comparable to or geographically near the original 

location to restore social and health care relationships and access to 

employment. 

21. Additional federal funding beyond the Individual Assistance maximum is 

needed to replace disability-specific items like durable medical equipment, 

assistive technologies, service animal needs, and similar resources. 

22. Trailers and similar options must be made available in sufficient numbers for 

people with disabilities and must remain free of interior health hazards. 

23. Temporary locations such as trailer parks must include accessible 

transportation, so that people can travel to work, grocery stores, senior 

centers, Centers for Independent Living, medical facilities, and other locations. 

Evacuation planning and accessible transportation should be provided for 

trailer parks. 

24. Congregate facilities should be required by law to locate appropriate temporary 

locations in advance of disaster as part of their annual disaster planning. 

Facilities should plan to transfer residents and their caregivers, family, and 

medical records to reduce transfer trauma. 

25. Funding for creative solutions should be offered to local health and social 

service providers in order to secure safe temporary housing for congregate 

populations. 

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26. Renters often experience considerable problems finding housing after disaster. 

Local and State governments should commit to affordable and accessible 

rental housing, including multifamily, single-family, and public housing options. 

27. Programs such as Katrina Aid Today offered professional case managers. The 

Katrina Aid Today case management materials need to be placed on as many 

Web sites as possible, including FEMA and the national Voluntary Organizations 

Active in Disaster.708 Recovery case managers require funding and/or resources 

to help move clients into permanent housing. Providing such support will reduce 

longer stays in shelters and dependency on public assistance. 

Permanent Housing 

28. The new National Disability Housing Strategy needs to be integrated into State 

and local planning efforts. The strategy calls for the inclusion of disability 

organizations in State Disaster Housing Task Forces. Funding and training 

may be needed to help States plan and implement their strategy. 

29. In order to increase visibility of programs and efforts, FEMA may wish to 

consider establishing a standalone disaster housing program specifically for 

people with disabilities. 

30. After Hurricane Ike, FEMA funded an ESF #14–based long-term recovery 

report to identify special needs. These efforts should become institutionalized. 

Resources to implement recommendations need to be provided. 

31. Ideally, jurisdictions should design a recovery plan in advance of a future event 

that incorporates accessibility, affordability, and universal design elements. 

32. Planning for post-disaster recovery must involve people with disabilities in an 

active role. Increasing accessibility in rebuilt housing beyond minimal ADA 

levels is ideal. Using universal design philosophies for individual homes and 

public places means that a broad array of people with and without disabilities 

can benefit, including people who develop disabilities as they age. 

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33. Planning for post-disaster recovery must be encouraged to embrace a vision 

that enhances accessibility across all locations and sectors of a community 

and its infrastructure. A holistic philosophy that connects rebuilt housing to 

public, accessible transportation systems and features (e.g., audible traffic light 

alerts, curb cuts, and tactile signage) so that people can travel from home to 

work and other locations more easily is ideal. 

34. Outreach to people with disabilities should be offered to provide education and 

support on the process of rebuilding one’s home. Those offering assistance to 

people with disabilities need to publicize that assistance widely, frequently, and 

through networks linked to people with disabilities and disability organizations. 

35. Local government should commit a portion of rebuilding and reconstruction funds 

to increase accessible and affordable units. For example, the city of Watsonville, 

California, mandated that 25 percent of all post-disaster housing construction be 

built at affordable levels after the 1989 Loma Prieta earthquake. 

36. Those involved in disaster response and recovery should encourage monetary 

donations to pay for items that enhance accessibility and the transition into 

permanent housing, such as hearing aid batteries, wheelchair ramps, and 

personal motorized vehicles, as well as household items that require assistive 

technologies (e.g., telephones, televisions, cooking utensils). 

37. Federal funds are needed to support volunteer labor efforts and purchase 

resources dedicated to rebuilding accessible homes and congregate locations 

for people with disabilities. 

38. HUD must continue to expedite the certification of new Section 8 units and 

supplement these units with post-disaster funds that pay for increased utilities. 

39. States must expand UFAS minimum criteria for accessible units beyond the 

5 percent mark. 

40. Local and State governments should revise building codes to enhance 

accessibility, including use of universal design features, which also benefit the 

general population. 

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41. Federal, State, and local government should sponsor events like housing fairs 

that teach the public, construction companies, contractors, and voluntary labor 

organizations about accessibility and universal design. Government programs 

could offer incentives to homeowners, apartment owners, and construction 

companies to exceed federal standards for accessibility. 

42. Local and State governments can certify contractors on issues related to 

accessible construction so that people know whom to trust. 

43. Many homeowners and renters struggle to secure insurance for hazards in 

their area. Federal assistance can be helpful in this important mitigation 

measure. 

44. Local and State government can mitigate future risks by enhancing structural 

design to resist disasters and afford greater protection. For example, features 

could include earthquake retrofit of housing, elevations that remain accessible, 

hurricane clips, and the introduction of an accessible safe room in homes and 

public locations. Specific programs that fund these mitigation measures for 

low-income households of people with disabilities should be considered. 

45. Communities may opt to remove structures from hazardous areas through 

FEMA’s relocation/buyout program. Such relocations must be done carefully so 

as to minimize the impact on people with disabilities who rely on nearby work, 

transportation, and key social and health services. 

46. Programs like HUD’s DHAP should be continued, and HUD could ensure that a 

portion of funds are set aside for accessibility needs. 

47. A portion of mortgage relief funds could be set aside for people with 

disabilities, particularly those at the lowest income levels. 

48. Increase funding for and publicize SBA mitigation funds usable for enhancing 

accessibility in post-disaster housing more widely. Ultimately, mitigation can 

reduce the need for disaster assistance. 

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384
NCD Topical Brief #5 

State Evaluation 

385
386
Contents 

Introduction ............................................................................................................... 389

Background History, Legislation, and Policy ......................................................... 391

State and Local Housing History .............................................................. 391

State Long-Term Services and Supports and Least Restrictive 

Community Living: The History of “Real Choice”...................................... 398

Movement to Coordinate Housing and Community Living Supports 

and Systems............................................................................................. 399

Key Issues Influencing “Real Choice” .................................................................... 401

Differences in Definitions.......................................................................... 401

Defining Disability ......................................................................... 401

Defining Accessibility .................................................................... 402

Defining Affordable ....................................................................... 403

Defining Integration....................................................................... 404

Why Are Definitions Important? .................................................... 405

Differences in Qualifying and Eligibility Criteria ........................................ 405

Differences in Funding and Parity of Supports and Services.................... 406

Housing System Funding.............................................................. 406

Community Living and Long-Term Services and Supports 

Funding......................................................................................... 406

Differences in Information Access ............................................................ 408

Differences in Coordination of Supports and Services Across 

Systems and Quality Control, Monitoring, and Enforcement .................... 409

Housing and Community Living Promising Practices........................................... 411

Systems Change and Coordination.......................................................... 411

Cross-System Navigation......................................................................... 413

Promoting Integrated and Least Restrictive Choice ................................. 414

Increasing Information Access with Housing Locator Systems ................ 414

Socialserve.com ........................................................................... 415

Mass Access: The Accessible Housing Registry .......................... 415

Access Virginia: Virginia’s Accessible Housing Registry............... 415

National Accessible Apartment Clearinghouse............................. 416

Housing Connections.................................................................... 416

Legislative Promising Practices................................................................ 416

Recommendations .................................................................................................... 419 

387
388
Introduction 

This brief examines the wide range of issues shaping what States do to promote two 

closely related goals or outcomes, particularly for people with disabilities living on 

limited or low incomes: (1) accessible, affordable, and integrated housing; and (2) longterm supports and services to live in least restrictive situations of choice in the 

community and prevent institutionalization. Although interrelated, these goals have been 

shaped and governed by very different systems, policies, and funding sources at the 

federal and State levels. To address the first goal specific to housing, the focus has 

been on civil rights related to fair housing and the development and availability of 

equitable housing opportunities, with people with disabilities being one of many societal 

groups covered. In the second goal related to long-term community living supports, the 

focus has been on civil rights related to the Americans with Disabilities Act and 

equitable participation in society, including the right to have a choice over where one 

lives and access to supports to do so. In this case, community living and integration are 

disability specific and cut across federal and State legislation, case law, and systems 

change, particularly Medicaid initiatives to ensure choice and to rebalance funding to 

support community-based options. 

These two different but very interrelated and interdependent outcomes are realized, 

implemented, and enforced to varying degrees at the State, regional, and community 

levels. We can identify and examine existing housing and community integration needs, 

issues, and disparities experienced by people with disabilities within and across States, 

as well as the impact of advocacy to further realize civil rights and increase housing and 

community living opportunities. Of central concern is the need for people with disabilities 

to have to navigate many different systems, policies, and funding sources at the State 

and local levels, and the development of recent initiatives to coordinate across housing 

and community living systems to realize full participation, choice, and control by citizens 

with disabilities. 

This brief examines State-level statutes, issues, trends, and promising practices in 

developing, maintaining, and enforcing accessible, affordable, and integrated housing 

389
and community living supports for citizens with disabilities. Specific focus is placed upon 

the needs of and disparities faced by people with disabilities living on very low incomes 

or extremely low incomes, defined as below 50 percent and below 30 percent of the 

Area Median Income (AMI), respectively. This brief includes (1) a brief historical 

overview and comparison of housing and community integration legislation, policies, 

and systems most influencing “real choice”; (2) a detailed analysis of key issues related 

to equitable delivery and implementation of these polices within and between States; (3) 

promising practices emerging within States; and (4) summary recommendations for 

promoting future development, systems change, and legislation. 

390
Background History, Legislation, and Policy 

Housing systems do not operate in isolation, and State issues related to housing, longterm services and supports, and disability cut across multiple systems. Two primary, yet 

often uncoordinated and conflicting, State systems that people with disabilities need to 

navigate and negotiate are (1) State and local (e.g., city, town, county, metropolitan, 

and rural) housing systems, which manage resources such as housing subsidies, 

vouchers, development, and homeownership programs; and (2) long-term service and 

support systems, primarily State Medicaid agencies, that manage resources such as 

Home- and Community-Based (HCBS) Waivers to support least restrictive community 

options. We outline the history of these different systems and describe key State issues 

in implementing policy and systems change to more fully realize the housing rights of 

people with disabilities. 

State and Local Housing History 

Since the early part of the 20th century, the development and location of any type of 

housing in the United States have been primarily determined by building codes and 

zoning enacted through local and State government. The roots of current funding that 

can be used to help make housing affordable, accessible, and integrated can be traced 

to federal programs from around the same period, although many States also now 

manage their own Affordable Housing Trust Funds derived from different sources.709

Here we examine more closely how these two spheres—State and local regulation and 

federal funding—affect the location and availability of affordable, accessible, and 

integrated housing for people with disabilities, particularly for households with incomes 

at or below 50 percent of AMI who are eligible for virtually all federal affordable housing 

programs. 

Zoning primarily affects the location and density of housing and whether it is singlefamily or multifamily in design, as well as if it is integrated with or segregated from other 

land uses, such as open space, commercial uses, or industrial activities. While zoning 

has often been used to separate housing from “noxious” land uses, recent efforts to 

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redevelop and revitalize urban and suburban communities have introduced mixed-use 

zoning to integrate housing with spaces for work and play.710 Many communities 

employing mixed-use development often aim to house a mix of income and/or age 

groups, including retirees who are interested in downsizing but wish to stay in the 

community. These mixed-use areas are also offered as partial solutions to the negative 

impacts on the environment resulting from the need to drive to work, school, shop, and 

play. Broader efforts, including compact development, smart growth, and new urbanism, 

aim to reduce the distance between uses so that people can walk, bike, and use public 

transit rather than drive. These efforts obviously can benefit people with disabilities and 

an aging population, as long as modes of transit and paths accommodate different and 

diverse disability needs, including physical, sensory (hearing, vision, tactile), 

developmental, cognitive, psychological, social, and environmental sensitivity. 

Building codes aim to ensure housing meets health, safety, welfare, and property 

protection goals. However, as a 2001 U.S. Department of Housing and Urban 

Development (HUD) report points out, these “have been expanded in recent years to 

include other societal goals, including energy conservation, accessibility, disaster 

mitigation, historic preservation, and affordability.”711 

While building codes are locally controlled, communities have long adopted standard 

building codes. In 2000, the International Building Code (IBC) was developed by the 

International Code Council (ICC)712 to provide guidance for accessibility from the 

American National Standard Institute and the U.S. Access Board. In addition to building 

codes, local ordinances and State legislation also provide specific instructions for 

making housing visitable. However, these are often voluntary, although they frequently 

come with incentives to encourage visitability. 

Despite movement toward uniform building codes across the United States, regulatory 

barriers, including zoning, local politics, and planning practices, among other things, 

greatly affect where and if affordable, integrated, and accessible housing is built.713 To 

a certain extent, federal policy and subsequent funding streams that flow into States 

and local jurisdictions to produce affordable housing acknowledge these variations by 

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devolving to State and local government the ability to develop localized plans to expend 

federal funds. HUD requires each State to produce a Consolidated Plan, which outlines 

how federal funding will be allocated to address housing and community development 

needs in each State. This plan must also include an analysis of barriers to fair housing 

and plans to remove or reduce these barriers that are in line with the goals of the Fair 

Housing Act and its amendments (FHAA). 

The federally mandated Consolidated Plan identifies housing needs for different groups, 

including people with disabilities, and then outlines how funds will be used to meet 

those needs given current and near future housing conditions. Developed for a 5-year 

window, the purpose of the Consolidated Plan is to guide the use of all federal housing 

funds, including Community Development Block Grants (CDBGs), HOME, Section 202, 

Section 811, emergency shelter and homeless services grants, Neighborhood 

Stabilization Program (NSP), and other federal grants awarded either to or through the 

State. Each State and local jurisdiction receiving CDBG and HOME funds is required to 

develop the plan with citizen participation and public review prior to submission to HUD 

for approval. An annual plan report is used to monitor progress and also make 

adjustments, if needed, to the 5-year plan in order to respond to new conditions or 

opportunities. There are more than 500 Consolidated Plans in the United States. 

Typically, local plans have little to no relationship to the State’s Consolidated Plan, 

which means they can completely contradict one another. 

The Consolidated Plan uses census data provided by HUD to assess needs among 

people with disabilities.714 Appendix A, “Data Tables,” provides detailed data on the 

distribution of people with disabilities (defined on a limited basis by mobility limitations) 

that have “housing problems” by income, tenure, and age, for each State. A housing 

problem is identified as having one or more of substandard or poor-quality housing 

(lacking complete plumbing facilities or lacking complete kitchen facilities), living in 

overcrowded conditions (with 1.01 or more people per habitable room), or being cost 

burdened (paying more than 30% of income for housing). 

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Overall, the Consolidated Plan data shows that for all households with at least one 

person with a disability and some sort of housing problem, twice as many own their 

homes (12.8 million) than rent (6.3 million).715 Among renters, the largest number and 

proportion of renters of any income group with mobility impairments and housing 

problems in the United States is in California (13% of renters; 811,000 households), 

New York (10%; 645,000 households), Texas (6%; 391,000 households), Florida (5%; 

330,000 households), and Pennsylvania (4%; 258,000 households). The majority of 

these renters are very low income, so it is likely that the housing problem is due to 

housing cost burden. 

Consolidated Plan data also reveals that nearly 13 million homeowners in the United 

States with mobility impairments have a housing problem. Unlike renters, the majority of 

these homeowners are in the higher income bracket (6.9 million are above 80% of Area 

Median Income), which means they may not qualify for some or most public housing 

assistance (with the exception of some local programs for owners). 

A review of Consolidated Plans on HUD’s Web site illustrates the variety of approaches 

States take to meet their affordable housing needs.716 However, there is not always a 

clear connection made between need and the objectives/targets outlined in the plan 

when it comes to housing for people with disabilities, other than what is minimally 

required by law. In part, this may be due to the limited guidance HUD provides on using 

funds to meet the housing needs of people with disabilities and the aging population.717

Still, some of these Consolidated Plans demonstrate promise, at least in terms of 

initiatives that respond specifically to people with disabilities: 

● Maryland: Bridge Subsidy Demonstration Program. This 1-year pilot 

program for people with disabilities provides short-term rental assistance for up 

to 3 years. This program was funded by a reallocation of existing resources 

from the Maryland Department of Housing and Community Development and 

other State agencies. 

394
● Iowa: Money Follows the Person initiative. The State agency that 

administers the Consolidated Plan, the Iowa Department of Economic 

Development (IDED), is participating in a Statewide collaboration to address the 

needs of people with disabilities as defined by the Olmstead decision. A major 

focus of the State of Iowa Olmstead Task Force is adequate and appropriate 

housing. In addition, this task force is working on a film and toolkit to “educate 

elected officials, policy makers, advocates, and the general public on its overreliance on institutional-based care in Iowa.”718

HUD recently began an initiative to improve the Consolidated Plans, including providing 

examples from existing plans and research on planning, reporting, outcomes, and 

performance measures. As HUD describes this initiative, the goal is to reduce 

meaningless compliance burdens, streamline the plan into a concise, readable 

document that is easy to understand, make the plan more useful and results oriented by 

linking it to performance reporting, make better use of technology to decrease the 

reporting burden, and promote use of the plan as a management tool for tracking results 

over time.719

While these are good and necessary changes to the process, the Consolidated Plan 

content for the most part has not changed. This means that people with disabilities are 

still in the “special needs” category, which includes: 

...various subpopulations that are not homeless but may require housing or 

supportive services, including the elderly, frail elderly, persons with disabilities 

(mental, physical, developmental, persons with HIV/AIDS and their families), 

persons with alcohol or other drug addiction, victims of domestic violence, and 

any other categories the jurisdiction may specify and describe their supportive 

housing needs.720

As a means to ensure that planners take into consideration the housing needs of the 

aging population and people with disabilities, this catch-all category restricts housing 

options for this group to supportive housing, rather than opens up the possibility to 

include people with disabilities in other types of affordable housing. As stated in the 

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guide for developing Consolidated Plans, “If the jurisdiction plans to use HOME or other 

tenant-based rental assistance to assist one or more of these subpopulations, it must 

justify the need for such assistance in the plan.”721 People with disabilities do need 

specific housing features; however, not all need or want supportive services attached to 

their housing. The question remains as to why people with disabilities should have to 

justify the need or desire to live in other types of affordable and integrated housing. 

In conjunction with the Consolidated Plan, States also are required to produce an 

Analysis of Impediments to Fair Housing Choice and Fair Housing Action Plan. 

Guidance from HUD states that the purpose of these plans are to affirmatively further 

fair housing by (1) conducting an analysis to identify impediments to fair housing choice 

within the jurisdiction, (2) taking appropriate actions to overcome the effects of any 

impediments identified through the analysis, and (3) maintaining records reflecting the 

analysis and actions taken in this regard. HUD’s Fair Housing Planning Guide

recognizes that any ability to affirmatively further fair housing is challenged by the 

devolution of power down to State and local jurisdictions: 

Perhaps nowhere in the Department’s mission is the prospect of devolution 

more challenging than in fair housing. Since 1968 the Department has been 

under an obligation to affirmatively further fair housing in the programs it 

administers. Its failures to do so have come most dramatically when that policy 

is not embraced or is actively resisted by local communities. There are those 

who do not believe that “devolution” is compatible with strong and effective fair 

housing enforcement. They fear that without detailed and prescriptive 

directives, local communities will even more aggressively ignore the need for 

fairness and equal opportunity by individuals and groups who are covered by 

the Fair Housing Act. We all know that there is a basis for that concern.722

As part of the Consolidated Plan, States and localities should be identifying 

impediments, although not all States do so. A common impediment is the lack of 

resources to enforce fair housing rights, deal with complaints in a timely fashion, and 

engage in effective outreach and education. As with Consolidated Plans, States and 

localities respond to these impediments in a variety of ways. Nothing is uniform across 

States, in part because of the variation in local resources, but also because of the 

variation in the roles played by local government and fair housing advocates and the 

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extent to which each proactively furthers fair housing. Furthermore, enforcement and 

addressing complaints vary, since this also depends on resources. For example, some 

States have local entities that are HUD-certified fair housing enforcement agencies, 

while others rely on regional HUD offices, which can add time to the process of 

addressing complaints. Enforcement can be further complicated in that HUD deals with 

discrimination in State and local public housing and in housing assistance and referrals, 

while other forms of discrimination fall under ADA, which is the jurisdiction of the U.S. 

Department of Justice (DOJ). In other words, even though all States are required to 

uphold the same fair housing laws, this has not ensured consistency across States 

when it comes to efforts to affirmatively further fair housing. 

Another area where the Federal Government provides guidance to States is the 

Qualified Allocation Plan (QAP), which is used to allocate the Low Income Housing Tax 

Credits issued to States. States use these plans to evaluate development proposals 

from private and nonprofit developers building affordable housing. In other words, this is 

where States convey to developers what they are looking for in terms of housing 

development proposals via the points they award for different features or aspects of the 

proposed developments. While it is assumed that the QAP will be consistent with the 

State’s Consolidated Plan, the only federal guidance is that QAPs give priority to 

projects that serve the lowest-income families and are structured to remain affordable 

for the longest period of time. Federal law also requires that 10 percent of each State’s 

annual housing tax credit allocation be set aside for projects owned by nonprofit 

organizations.723 Beyond these requirements, QAPs establish a variety of different 

criteria for awarding points in the competition for tax credits. As a result, these plans can 

vary greatly across the States because they are often written to meet State priorities 

that often change from year to year. 

Since the tax credit program is not covered by Section 504, there is no mandatory 

inclusion of accessible housing units beyond what is required by the Fair Housing Act. 

The QAP could use priority points to incentivize development of more integrated, 

accessible housing; however, national data shows that this is not currently happening. 

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Based on HUD’s latest report, 12 percent of the tax credit developments built between 

2003 and 2005 were to target people with disabilities. Most are assumed to be 

supportive housing facilities for people who are homeless. Furthermore, most of these 

developments (87%) are larger facilities with 21 units or more, so these represent 

segregated rather than integrated housing, given the developments are for a targeted 

population.724

State Long-Term Services and Supports and Least Restrictive 

Community Living: The History of “Real Choice” 

The prior section of this brief focused on fair housing rights and planning processes. 

Housing rights are further expanded upon in the Americans with Disabilities Act (ADA) 

to include community integration and full participation of citizens with disabilities in 

society.725 In 1999, the application of this right to “least restrictive” community living 

choice was put to fore within the U.S. Supreme Court case Olmstead v. L.C. (98-536) 

527 U.S. 581,138 F.3d 893 (1999),726 referred to as the Olmstead decision. At the crux 

of this case was the issue of integration, that is, whether people with disabilities have a 

right to live in the least restrictive settings of choice, including community-based options, 

and whether States have responsibilities related to providing community living supports 

equitable to those given to people living in institutional and nursing home settings to 

realize this “real choice.” The Olmstead decision enforced this right and the State’s 

responsibilities, mandating each State to develop “comprehensive, effectively working 

plans,” referred to as Olmstead plans. The purpose of these plans is to show what 

States would do to support community reintegration (e.g., from nursing home to 

community) and long-term community living (e.g., maintaining choice and preventing 

institutionalization). However, States vary as to whether Olmstead plans exist, are 

available to people with disabilities in accessible formats, the level of detail in the plans 

in relation to proposed actions to rebalance funding and address institutional bias within 

the State, inclusion of methods to monitor and enforce plan implementation, outcomes 

realized, and actions taken to address continuing needs and gaps.727

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Movement to Coordinate Housing and Community Living Supports and 

Systems 

In addition to planning, the Olmstead decision also sparked disability advocacy and 

resulting systems changes within States to rebalance funding to address issues of 

institutional bias. Starting in 2000, the Centers for Medicare and Medicaid (CMS) was 

instrumental in coordinating Real Choice Systems Change Grants for Community Living 

to fund the needed infrastructure, systems change, and policy revisions to offer real 

choice related to community living with supports. This systems change was further 

reinforced within the New Freedom Initiative and President George W. Bush’s Executive 

Order 13217 titled Community-Based Alternatives for Individuals with Disabilities.728 

A number of significant changes were made to Medicaid’s coverage of long-term care 

services within the 2005 Deficit Reduction Act (DRA) to further support use of funds 

toward community living options. Through March 2008, CMS also awarded 

approximately $285 million (see CMS 2006, 2007) in Real Choice Grants that were 

used to support States in providing community reintegration supports (e.g., transition 

from nursing home or institution to community), cross-system coordination and 

infrastructure, and resource rebalancing to address institutional bias. For many States, 

this involved the creation and expansion of Home- and Community-Based Waivers 

(HCBSs) and long-term community living programs. For some States, such as Texas 

with its Rider 37, this systems change was also legislated. However, many States 

remained challenged in implementing real choice, with great disparities between States 

on implementation and resource rebalancing.729 

The concept of Money Follows the Person (MFP) then was proposed and advocated for 

as a mechanism for monies to follow the person into the community at levels equitable 

to those allocated for institutional/nursing home care. The MFP movement also brought 

to the fore the coordination of information, supports, services, and funding across 

systems, and the need for consumer direction and control throughout the process. CMS 

funded over $1.75 billion in MFP demonstration grants in 31 States, with States 

estimating to transition more than 27,000 people out of nursing homes and other 

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institutions to the community using these initiatives. Of note, States needed to also 

show a plan to maintain these MFP initiatives long term after the demonstration period. 

At the same time, disability activists rallied for accompanying MFP-related legislation 

that has since been enacted or is now pending in several States. This advocacy 

continues nationally with the Community Choice Act and other related legislation. 

Additionally, many class action lawsuits were brought against States in relation to 

violation of ADA civil rights and the Olmstead decision, further influencing systems 

change and funding rebalancing within specific States.730 In some cases, these resulted 

in the creation of promising practices from which other States can learn. 

From this brief historical overview, we can see how and why different systems and 

funding mechanisms exist, their differing foci and philosophies, and the complexity of 

housing and community living choice at the legislative and policy levels. 

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Key Issues Influencing “Real Choice” 

States, and citizens with disabilities living in them, are facing several key issues 

influencing “real choice” access to affordable, accessible, and integrated housing.731

These include differences in (1) definitions related to housing and community 

living/integration, (2) eligibility criteria, (3) system funding levels and disparities, (4) 

information access, (5) coordinated, consumer-directed system delivery, and (6) 

monitoring and enforcement across systems. 

Differences in Definitions 

One key issue facing States is the variation in definitions related to disability, housing 

features such as accessibility and affordability, and community integration. 

Defining Disability 

For States providing housing services through HUD and community living supports 

through CMS, how disability is defined determines who receives services. For CMS and 

State providers, a disability determination is criteria-based and complex. By law, 

disability is defined as “the inability to engage in any substantial gainful activity (SGA) 

by reason of any medically determinable physical or mental impairment(s) which can be 

expected to result in death or which has lasted or can be expected to last for a 

continuous period of not less than 12 months.”732 This definition centers on showing 

proof of long-term medical need and economic need related to productive 

employment/gainful activity. Additional criteria related to medical necessity, functional 

performance status, and age further influence specific CMS program eligibility. 

For HUD housing programs and providers, disability is defined at both the individual and 

household levels. A person with a disability is defined as an individual who “has a 

disability as defined in Section 223 of the Social Security Act; or is determined to have a 

physical, mental, or emotional impairment which is: expected to be of long, continued 

and indefinite duration; and substantially impedes his or her ability to live independently; 

and is of such a nature that such ability could be improved by more suitable housing 

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conditions; or has a developmental disability as defined in Section 102 of the 

Developmental Disabilities Assistance and Bill of Rights Act.”733 A disabled household 

is defined as a “family whose head, spouse, or sole member is an adult with a disability

Disabled households can be a single individual with a disability living alone; a related 

family in which the head of household or spouse is a disabled person; two or more 

related adults with disabilities living together; two or more unrelated adults with 

disabilities living together; or one or more unrelated adults with disabilities living with 

one or more live-in aides.”

. 

734

In comparison to these systems definitions, the Americans with Disabilities Act and 

ensuing systems change initiatives are based upon the civil rights framing of disability, 

which is “The term ‘disability’ means, with respect to an individual, a physical or mental 

impairment that substantially limits one or more of the major life activities of such 

individual; a record of such impairment; or being regarded as having such an 

impairment.”735 This definition was used in the Olmstead decision to assert the right to 

least restrictive choice; however, the systems involved in implementing those rights 

continue to use existing medical and economic-based definitions that shift the onus to 

the individual to demonstrate need, versus to society and the systems within it to 

support the civil rights of citizens with disabilities. 

Defining Accessibility 

The other side of the coin relates to how we then define the environment, as in housing 

and environmental modifications, at the federal, State, and local levels. This brings to 

the fore definitions related to accessibility, most often defined by the Architectural 

Barriers Act, the Federal Fair Housing Act of 1988 accessibility guidelines,736 and 

Section 504 of the Rehabilitation Act of 1973 as amended (29 U.S.C. 794). Additionally, 

many housing developers point to Uniform Building Code or the International Building 

Code standards of accessibility, as well as to State and local codes and regulations.737

Each of these offers differing versions of “accessibility,” which are further complicated 

by terms such as adaptable and visitable. Adaptable housing does not implement full 

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accessibility features and is built to allow for easier adaptation or addition of these 

features should the person need it in the future. For example, the housing may have a 

closet or storage space built in a way that could accommodate an elevator or lift 

addition if needed. “Visitability” focuses on building in a minimal set of access features 

so people with disabilities can visit others in the community and be able to move around 

and use the first-floor entrance and bathroom.738 Neither “adaptable” nor “visitable” 

corresponds to full accessibility, and many consumers are confused by the differences 

in these terms and the accessibility or lack thereof when they move in. Many also are 

not aware that it would be their responsibility to pay for such adaptations to make the 

housing accessible, even though it is their right to add it. Additionally, “accessible” 

primarily pertains to physical and sensory access, with far less coverage and 

consideration of diverse issues related to cognitive, social, psychological, and 

environmental sensitivity. 

Another area of confusion—and contention—is that many people believe that 

townhouses and single-family detached homes are not covered by these accessibility 

regulations, therefore excluding a large section of housing supply from scrutiny and 

requirements. While these regulations may not directly require that some types of 

housing include accessibility features when developed or rehabilitated, all housing is 

subject to requirements of reasonable accommodation. Furthermore, all public housing 

programs are subject to 504 requirements, so if this type of housing is produced with 

federal funds, it must comply with these laws. 

Defining Affordable 

Among the different State plans, private and nonprofit housing is expected to be built 

and/or made affordable through use of a diverse collection of public and private funds. 

Since the 1960s, the Federal Government has gauged affordability relative to 

assumptions about precisely how much all consumers should pay for housing as a 

portion of their incomes, which currently is 30 percent of income. For renters, this cost 

includes monthly contract rent plus utilities. For owners, it includes monthly mortgage 

payments, insurance, utilities, and taxes. For both renters and owners, regardless of 

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income level, housing is not affordable if a household has to use more than 30 percent 

of its income on it. 

Eligibility for housing that is built with or in any way made affordable by federal funds is 

determined by income limits regardless of age or disability status. Federal requirements 

provide specific guidance on what is included in determining eligibility, such as assets 

and other forms of income. Most HUD programs target “very low income” households, 

which means their income is at or below 50 percent of the family Area Median Income 

(AMI). The AMI is based on family size and adjusted annually using the annual 

American Community Survey (ACS).739 In addition, there are further subdivisions: 

households with an income below 30 percent of AMI are considered “extremely low 

income” (ELI), while an income below 50 percent of AMI is “very low income.” Still, in 

addition to these categories, other funding streams use other ranges of income when 

targeting assistance. For example, the Low Income Housing Tax Credit (LIHTC) 

program uses formulas that include people earning between 50 and 60 percent of AMI. 

The new Neighborhood Stabilization Program introduced “middle-income” (between 80 

and120% of AMI) and now refers to households with incomes below 120 percent of AMI 

as “mid-mod-low-income.”740 While all States can fund projects that target incomes 

below these marks, many affordable housing programs have benefitted people at the 

higher end of the eligible income group rather than the lower end. Furthermore, rents in 

LIHTC projects are based on what is affordable to a specific income level (e.g., 50% of 

AMI), so any family below that income cannot afford to live there using the 30 percent of 

income standard.741 All these different income targets and corresponding requirements 

make it difficult to develop affordable housing for people with disabilities. 

Defining Integration 

States have not specifically defined “integration,” but instead rely on ADA and Olmstead

decision terminology related to “least restrictive” choice to guide the provision of 

integrated housing, programs, and services. This framing focuses on what integrated 

choice is not—placement in nursing homes or other institutional settings without choice 

about community-based options—rather than describing what it is. More recently, MFP 

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legislation and policies have referred to specific numbers in which “community-based” 

options may not include more than four people with disabilities living together, such as a 

group home with 8 to10 people in it. However, these criteria and their enforcement differ 

by State. There is great variance within States, and particularly among housing 

developers and providers within them, in what “integrated” or “least restrictive” choice 

includes, often leading to class action lawsuits to put parameters around integration and 

enforcement related to it. 

Why Are Definitions Important? 

These different framings and multiple definitions make it very difficult not only to deliver 

coordinated housing and community living services, but also to show need versus 

supply disparities, to compare issues and outcomes across States, and to monitor 

enforcement and learn from promising practices. 

Differences in Qualifying and Eligibility Criteria 

For the most part, States defer to funding sources to set qualification and eligibility 

criteria, and different funding sources use different criteria.742 As an example, both CMS 

and HUD use income/asset criteria; however, each uses different thresholds to 

determine initial and continuing eligibility (e.g., HUD uses median income in relation to 

national poverty and income thresholds, while Medicaid uses income/asset thresholds 

determined via individual State statute). 

Qualifications are not just based on income. For those individuals who also need to 

obtain community living supports through Medicaid, States also use functional needs 

determination and risk management assessments to determine eligibility, criteria that 

may vary significantly among States. Additionally, type of disability (e.g., physical, 

psychiatric, developmental) or age may preclude people with disabilities from accessing 

specific State programs even if they have a need. For people who identify with multiple 

disabilities or acquire them as they age, access to housing and community living 

supports becomes much more complicated. They may lose access or be offered very 

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different services when transitioning between or among systems, again placing them at 

risk for premature or unwanted institutionalization or homelessness. 

Differences in Funding and Parity of Supports and Services 

States also face significant issues related to funding of housing and community living 

supports, as well as disparities among different disability and aging constituencies in 

accessing this funding. 

Housing System Funding 

As part of States’ Consolidated Plans, allocation of housing resources is to be guided by 

need; however, need far exceeds what is available. This is true also for the LIHTC 

program; while it is based on a per capita formula, the actual dollars it can generate per 

State are quite small relative to the cost of building new housing. In addition, as noted 

previously, the complexity of using multiple layers of financing makes it quite difficult for 

many affordable housing developers to juggle the different eligibility requirements of 

different funding streams, which can deter or derail efforts to produce quality integrated 

housing. Finally, while State plans provide counts of units for people with disabilities and 

seniors, it is very difficult to ascertain the number of people with disabilities who actually 

receive housing units, housing subsidies, or monies for eligible housing retrofitting, 

rehabilitation, and supportive services. Also, the data does not examine differences by 

different disability type. All these issues significantly influence whether people have “real 

choice” in deciding where they live, whether they are able to support or maintain that 

living over time, and the quality of their living situation. 

Community Living and Long-Term Services and Supports Funding 

To live in community-based housing options, many people with disabilities also need 

accompanying community living supports that are often funded by Home- and 

Community-Based or related Medicaid waiver programs, and/or other State long-term 

services and supports programs that fall outside waiver designations. One indicator of 

whether States have progressed in rebalancing funds to address institutional bias and 

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provide community-based living choice is to compare funds spent on institutional longterm care (including nursing homes, State institutions, ICFs, etc.) to those spent on 

Medicaid waiver programs to support community living and trends over time. Based on 

federal data, a recent analysis by Thomson Reuters743 shows that significant progress 

has been made nationally in this rebalancing, moving from institutional to community 

funding ratios of 85 percent institutional/15 percent community in 2000, to 58 percent 

institutional/42 percent community as of 2007, with an average growth of 10 percent a 

year in community-based funding from 2002 to 2007. However, this data is limiting and 

can be misleading. First, the data does not tell us about community-based housing 

funding needs and trends, as they only reflect long-term care system funding. The data 

also does not reflect the number of people who are on waiting lists for community-based 

services, or those who cannot find affordable and accessible housing and therefore 

remain in institutional settings. 

Additionally, this data is complex to interpret. Although we have made gains in 

rebalancing on a national level, the funding ratios vary significantly by State. As of 2007, 

only 11 States had rebalanced their spending to support community-based options at 

levels of 50 percent or more of their total long-term care budget (New Mexico, Oregon, 

Arizona, Minnesota, Alaska, Washington, Wyoming, California, Kansas, Colorado, and 

Maine). In comparison, the rest of the States spent less than 50 percent on communitybased services, with several reporting 30 percent or less (Mississippi, North Dakota, 

Pennsylvania, Alabama, New Jersey, Tennessee, Arkansas, Ohio, and Kentucky). 

Thus, the State in which you live influences real choice. 

Another example of State differences is how funds are allocated between different 

programs (e.g., aging, and physical, psychiatric, or developmental disability). The 

national ratio of 58 percent institution to 42 percent community across all disability 

groups shifts to 69 percent institution to 31 percent community when looking specifically 

at aging and physical disability group funding, with 16 States reporting less than 

20 percent allocated for community waivers for these groups. Thus, one’s age or 

disability designation as defined by each State also influences real choice. For example, 

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in some States, older adults with disabilities may be able to access funding for either 

personal attendant or homemaker supports depending on their level of need, while in 

other States, their choice is limited to homemakers who may not be trained or 

authorized to help with heavy lifting or personal care tasks such as bathing. In many 

States, waiver programs are not available to people with psychiatric disabilities, 

significantly limiting their choices. For people with developmental disabilities, some 

States offer funding for a full range of living options, including innovative family and 

least restrictive shared living options of four or less, while other States continue to 

primarily fund more segregated living options such as Intermediate Care Facilities or 

shared living situations of more than four people, thus also limiting real choice. 

Additionally, some States impose service limits, or caps, on individual funding that may 

further restrict community-based services, while other States using a more flexible 

Money Follows the Person (MFP) approach in which funds that would have been spent 

on institutional services follow the person to the community to be used more flexibly, as 

needed and as directed by the individual. In summary, although States have progressed 

in addressing institutional bias issues, significant disparities continue to exist among 

States in regard to real choice and long-term control in housing and community living. 

Differences in Information Access 

The need for accurate, accessible, and transparent information also is critical for people 

with disabilities to have “real choice,” so they can make informed decisions about where 

and how they live. Information access, quality, and coordination are key issues within 

States, especially for people with disabilities who may be trying to access information 

during times of housing or health crises or emergencies, or from within settings where 

information access is difficult, unavailable, or withheld. Additionally, information needs 

to be accessible via alternative formats if consumers and significant others in their lives 

are to actually use that information to make a “real choice.” Accessibility may also 

involve modifications in policies or strategies, such as increased time to process 

information before making decisions, or use of peer supports or other accommodations 

during the process. Accessibility also relates to information technology use, such as cell 

phones, computers, Internet, and email. In some States, emergency cell phones and 

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basic Internet access have been integrated into housing and community living support 

services and funding. 

Information about choices also needs to be accurate and consistent across different 

systems and providers, such as homeless shelters, emergency systems, information 

hotlines/centers, community organizations, medical and rehabilitation systems, nursing 

homes, and other long-term care settings. Disability advocates also point to problems 

providing this information in a way that is unbiased, highlighting the potential role of 

Centers for Independent Living, Senior Centers, and Disability and Aging Resource 

Centers to collaborate on offering access to information and to support consumers in 

navigating across different systems. Some States also have collaborated with these 

groups to implement housing locator systems that provide information on accessible 

and affordable housing; however, the availability, quality, accuracy, and level of 

accessibility detail vary widely among these systems.744 

Differences in Coordination of Supports and Services Across Systems 

and Quality Control, Monitoring, and Enforcement 

As referenced throughout this report, States have shifted toward coordination of housing 

and community living systems, particularly within Real Choice and MFP demonstration 

grants and related State initiatives. However, coordination of services and funding 

sources currently varies widely by State. In many States, housing systems have not 

been coordinated with community living and long-term services and supports systems, 

making it very difficult for people with disabilities to coordinate housing vouchers or 

subsidies with needed community living supports. As shown previously, many States 

continue to use silo systems, with services based on different disability or funding 

systems, such as those related to aging, physical disability, psychiatric disability, and 

developmental disability. In comparison, some States have used Real Choice and MFP 

grants to break down these silos and offer coordinated information and services, as well 

as equitable access to community living supports across systems. Coordination of 

services and funding is also an issue for people with disabilities who move to different 

communities within States, as well as those who relocate to another State. The 

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challenge is to provide “no wrong door,” that is, coordinated points of entry so that 

consumers can understand their rights and access housing and community living 

information and supports. This also means that States need to develop and fund 

infrastructure to coordinate policies and monitor access to and provision of coordinated 

services. This coordination is especially important to consistently and rigorously 

compare outcomes, impact, needs, and disparities across States and across the Nation. 

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Housing and Community Living Promising Practices 

In this section, we feature promising practices that have been or are being implemented 

by and within States in the areas of systems change, information access, legislation, 

monitoring and enforcement, and research related to housing and community living. 

Systems Change and Coordination 

One of the most promising trends at the State level has been the increasing crosscoordination of housing with community living and support systems, funding, and 

service delivery. These have been referred to as Single Access Points, One Stop Shop, 

No Wrong Door, and Comprehensive Entry Point systems. These systems enable 

consumers to enter through many different “doors,” or systems/programs, yet still 

receive coordinated, consistent, and quality information, counseling, housing, and 

community living supports and services. The Rutgers Center for State Health 

Policy/NASHP Community Living Exchange Collaborative reported 43 single entry 

points operating across Medicaid programs in 32 States.745 Many of these initiatives 

were developed with systems change demonstration grants from CMS and related 

national initiatives (e.g., Robert Wood Johnson’s self-determination and cash and 

counseling projects).746 

Although many States used these initiatives to streamline entry within specific Medicaid 

programs, some States have used them to break down silos created by categorizing 

people by disability type (e.g., developmental, physical) or age across all State 

programs, so no matter how or where people enter, they receive information about their 

choices and coordinated access housing and community living supports.747 Such 

commitment to long-term, cross-systems change has been especially useful to people 

who are transitioning between living situations (such as moving from a nursing home, 

institution, or ICF to community living) or people having to navigate multiple systems 

(such as people with disabilities as they age, people who identify with multiple 

disabilities, or families in which multiple people with disabilities are living and aging 

together and need supports across systems). They are also useful for maintaining 

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community living choices over a lifetime (including coordination of young child, adult, 

and older adult systems), and preventing or responding to institutional placements that 

are not of choice at any time. 

These initiatives offer valuable strategies to States to formally integrate consumer 

direction and control across systems.

748 They also offer infrastructure and strategies for 

States to document needs, service delivery, costs, and outcomes over time across 

systems,749 contributing to research that documents their impacts and cost 

effectiveness.750

Even more promising, several States are expanding to coordinate community living with 

housing systems and delivery. Many of these initiatives are based upon a Money 

Follows the Person framework to offer cross-system, consumer-directed choice. These 

involve development of new policies to enable States to fund and deliver this 

coordinated package across systems. Current promising practices include: 

● State initiatives to coordinate HCB waivers with housing vouchers or subsidies 

via innovative funding collaborations, including use of HOME funds for rental 

assistance during transition to the community (e.g., Kentucky’s Housing 

Finance Agency has allocated $50,000 in HOME funds to fund bridge 

subsidies, and Ohio’s Dayton Metropolitan Housing Authority announced the 

use of HOME funds to fund tenant-based assistance and Section 8 funds for 

project-based vouchers for people with mental illness who are homeless). 

● Development of Home Modification/Barrier Free Housing Trust Funds. 

● Reuse of funds from institutional downsizing and closures for expanded housing 

vouchers, rental assistance, and community support packages. 

As an example, Pennsylvania is implementing several of these practices in its Statewide 

systems change initiative, which coordinates between the Pennsylvania Department of 

Public Welfare and the Pennsylvania Housing Finance Agency (PHFA). 

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Two States, North Carolina and Louisiana, have been featured as examples for 

implementing Statewide, cross-systems change initiatives to coordinate mainstream 

affordable housing and community living systems for people with long-term disabilities, 

including people with disabilities who are homeless.751 These include a targeted 

collaboration of health and human services systems and housing authorities across the 

State, including the use of bonus points within Qualified Allocation Plans (QAPs) with 

housing developers to target 10 percent set-asides for people with disabilities with 

extremely low incomes (below 30% of AMI), and the use of Targeting Plans and Local 

Lead Agencies to ensure coordination among community service providers and property 

managers with tenants with disabilities, and the provision of reasonable 

accommodations and supports. Louisiana replicated North Carolina’s systems change 

to further target the needs of people with disabilities post-Katrina, adding the use of 

CDBG funds to support infrastructure and long-term support provision. 

Cross-System Navigation 

Several of these systems change coordination initiatives have formally incorporated 

coordination with regional Aging and Disability Resource Centers, Area Agencies on 

Aging, and Centers for Independent Living to provide information, case management, 

peer mentoring, legal assistance, and connections to related community living, 

transportation, social participation, and employment opportunities. Coordination also 

involves continuous education of staff across systems and delivery programs. Public 

Housing Agencies have used service coordinators to assist consumers with locating 

housing, employment, and social service information. Several States are using Centers 

for Independent Living (CILs) and peer mentors to support consumers in navigating 

complex housing and community living systems and programs. For example, 

Pennsylvania is funding regional housing coordinators whose role is to provide 

coordinated information and assistance to individuals and organizations that help 

people with disabilities transition from institutions to community living, to educate 

property managers and housing developers on how to develop and market least 

restrictive housing options to people with disabilities, and to monitor that the housing 

needs of people with disabilities are being addressed. 

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Another example of such an initiative has been facilitated by Access Living, a Center for 

Independent Living in Chicago, Illinois.752 Access Living has collaborated with the 

Chicago Housing Authority (CHA) to promote coordinated housing and community living 

information, increased access to and use of housing vouchers (Home Choice) by 

people with disabilities, and designated vouchers for people moving out of nursing 

homes and institutions to community-based options. This close collaboration has 

resulted in actions, such as the creation of an Office on Disability Policy within the CHA, 

a 504 self-evaluation, a 504 Voluntary Compliance Agreement, audits of accessibility of 

new housing by an architectural firm specializing in disability-related access, funding of 

a home modification fund for people receiving Home Choice Vouchers, time extensions 

and transportation support during the housing search, and creation of a targeted 

program and vouchers for people moving out of nursing homes to the community. Joint 

counseling sessions by Access Living and the CHA are conducted at Access Living to 

support people during this process and ensure the successful use of vouchers. 

Promoting Integrated and Least Restrictive Choice 

Several States have targeted initiatives to create and expand integrated housing 

choices. As an example, Washington is using federal demonstration grant funding to 

collaborate with local housing authorities throughout the State to develop more 

integrated and less restrictive (four or fewer) community living choice models and 

evaluate their impact. Oregon continues to expand community housing in small 

neighborhood homes, and is also developing individual apartment housing in which 

consumers can share support services with other consumers with developmental 

disabilities. Virginia is working to revise legislation and policies to enable people with 

developmental disabilities to share an apartment or single-family home with supports. 

Increasing Information Access with Housing Locator Systems 

Access to consistent, quality, and current information about affordable, accessible, and 

integrated housing choices and features is critical. A number of States have developed 

housing locator systems that allow online searches of affordable housing units.753

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These systems range from minimal databases of State-financed developments to

sophisticated sites with multiple search options, detailed accessibility information, 

updated vacancy and occupancy status, and links to local service agencies and 

resources. Following are some examples of housing locator promising practices. 

 more 

Socialserve.com 

Socialserve.com is a nonprofit agency and the largest database provider of multistate 

housing registry services. Registries include listings of affordable rental properties in 27 

States, and affordable housing for sale in 8 States and 1 county. Socialserve.com 

includes a toll-free call center with multilingual staff members who help landlords and 

tenants search the database. They can work with a particular State or community to 

customize a housing registry to meet specific needs. For example, registries can include 

a filter for searching for specific accessible features, such as bathrooms with grab bars 

and/or roll-in showers, kitchens with low counters, or entryways with flat or no-step 

entry.754

Mass Access: The Accessible Housing Registry 

Maintained by the Citizen’s Housing and Planning Association, Mass Access helps 

people with disabilities find barrier-free, accessible housing in Massachusetts. This 

housing locator includes information on the availability of affordable and accessible 

apartments, waiting list openings, information on homeownership opportunities, and 

links to housing locators in other States. Users can also search for specific 

accessible/adaptable features.755

Access Virginia: Virginia’s Accessible Housing Registry 

Access Virginia is sponsored by the Virginia Housing Development Authority and the 

Virginia Board for People with Disabilities. Access Virginia includes information on 

affordable and accessible apartments, as well as information about accessibility 

requirements and universal design. The site includes an Accessible Apartment Finder, 

an index of accessible housing resources, an interactive map to Centers for 

415
Independent Living (CILs) in Virginia, and links to related housing services and retailers 

of accessible appliances.756

National Accessible Apartment Clearinghouse 

This clearinghouse is a national database of more than 80,000 accessible apartments 

across 50 States. The clearinghouse is a public service program of the National 

Apartment Association, the Virginia Housing Development Authority, and other 

organizations. Information is available from the clearinghouse via the Web, fax, or a tollfree hotline.757

Housing Connections 

In Portland, Oregon, Housing Connections is an example of a city-sponsored site 

maintained by the city’s Bureau of Housing and Community Development, with data 

provided by landlords on rental, for-sale, and shared housing.758 

To link locators to long-term systems change, some States, such as Louisiana, have 

incorporated housing locators into housing developer contracts to make it easier for 

individuals to identify available housing options and to improve marketing of affordable 

and accessible units by developers to consumers. 

Legislative Promising Practices 

Many States have been hampered by current policies that restrict how monies can be 

used to provide services in a least restrictive, community-based setting. Given ongoing 

disability advocacy, some States have enacted legislation to rebalance Medicaid 

monies toward community-based options. Two examples are Texas and Vermont. 

Texas Rider 37 of the General Appropriations Act of the 77th Legislature enables the 

Texas Department of Human Services to allow money to follow the person (MFP) from 

a nursing facility to the community. Funds were transferred from nursing home 

appropriations to the HCBS waiver program to provide “real choice.” Texas was one of 

the first States to enact such State legislation and policy, and it estimates that as of 

2007, 13,300 people will have transitioned from nursing homes to the community via 

416
759 this initiative. Passed in 1996, Vermont Act 160 allows funds appropriated for nursing 

home care to be used for home- and community-based services, including for people 

who have the most significant support needs. In addition, the act created a Statewide 

system of Long-Term Care Community Coalitions to improve the infrastructure for 

Medicaid waivers and the long-term services and supports programs.760

417
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Recommendations 

Formally Linking State Plans to Actions 

1. States should be required and given resources to revisit Consolidated Plans 

and Olmstead plans to report on actual actions taken, impact/outcomes of 

actions, and specific action plans to address continuing or newly emerging 

needs and disparities. 

2. States should be encouraged to offer priority points within Qualified Allocation 

Plans (QAPs) that guide the local allocation of Low Income Housing Tax 

Credits for affordable housing for development that (1) produces more than the 

minimum number or percent of accessible housing, and (2) demonstrates 

integrated choice within projects and across communities. 

3. States should provide incentives to developers to use tax credits to build 

visitable and adaptable housing through QAP priority points. 

4. There should be an annual systematic review of QAPs to make sure that 

States are meeting the minimum requirements set by the Federal Government. 

Housing and Community Living Systems Change and Coordination 

5. In collaboration with the National Conference of State Legislatures and national 

disability and aging advocacy organizations, convene a task force to examine 

federal policies to support cross-system delivery of housing and community 

living supports within States and make it easier for States to provide these in a 

timely fashion. 

6. Expand cross-agency funding of Money Follows the Person and Community 

Choice Act systems change demonstration projects (across CMS and HUD) to 

focus on cross-system, coordinated delivery, and funding of housing and 

community living supports, especially in States that have not shown significant 

progress in rebalancing funding to address institutional bias. 

419
7. Similar to CMS’s promising practices resources, CMS and HUD together 

should collaborate with States to continually highlight and widely disseminate 

effective plans, policies, and practices for coordinating housing with community 

living/long-term care supports across State systems, using a consumerdirected approach. 

8. Provide resources for States that have effectively accomplished systems 

change and coordination to partner with States that have not, in order to share 

expertise, policies, data collection, financing, and monitoring systems. 

9. Provide resources for States to consistently monitor and enforce fair housing 

and least restrictive choice and control rights with resources to actively involve 

external parties, including community and disability-run organizations, in this 

enforcement. 

10. Across States, implement systems for periodic assessment with people with 

disabilities living in institutional and long-term care settings, such as nursing 

homes, to determine if least restrictive choice and options have been offered, 

and if chosen, how to efficiently and effectively support timely transitions and 

offer cross-systems support to transition. 

11. Jointly sponsor research (CMS and HUD) for States to evaluate the impact and 

cost effectiveness of these systems change initiatives and their long-term 

maintenance within States and nationally, and to document system- and policylevel barriers to doing so. 

Housing and Community Living Financing 

12. Expand housing vouchers and rental assistance subsidies within State and 

local housing authorities, targeting people with disabilities transitioning out of 

nursing homes/institutions/Intermediate Care Facilities (ICFs) to communitybased options. 

13. Sponsor and share innovative models of financing of least restrictive, 

community-based options, such as use of combined waiver and voucher 

420
funding, use of HOME funds toward rental assistance, bridge subsidies during 

transitions, and home modification trust funds and programs. 

Information Access 

14. Replicate and expand model housing locator information systems: 

● Using Socialserve.com and other housing registry examples, fund the 

development of a network of housing registry systems and infrastructure to 

use the same criteria for reporting accessibility and affordability across 

regions and States. 

● Provide incentives for housing developers to contribute to the funding of 

these systems as a method to market housing to people with disabilities. 

● Model the inclusion of diverse accessibility features within registries, such 

as features for people with sensory (vision, hearing, tactile), developmental, 

and psychiatric disabilities, autism, and environmental sensitivities. 

● Model the inclusion of universal design, visitability, and livability features for 

housing and surrounding communities/neighborhoods. 

15. Coordinate housing locator systems with least restrictive community living 

information resources and community-based navigator services: 

● Coordinate housing information with community living support and program 

information so consumers can have real choice and make informed 

decisions. 

● Fund mechanisms for community-based organizations, such as Centers for 

Independent Living, Area Agencies on Aging, and Aging and Disability 

Resource Centers, to coordinate and maintain these resources. 

● Fund mechanisms for Housing and Community Living Navigators from 

community-based organizations, including use of a pool of trained peer 

mentors, to support people with disabilities during this complex decisionmaking process. 

421
● Formally link supports and navigator services with legal protection and 

advocacy supports for consumers. 

State Legislation 

16. Advocate for State legislation related to Community Choice Act and Money 

Follows the Person to put policies and funding mechanisms in place at the 

State level to realize the civil rights of citizens with disabilities and address 

existing disparities. 

Education 

17. Fund quality education on housing and community living rights, policies, and 

system delivery for housing developers and agency staff across housing and 

community living systems at the State and local levels, particularly in 

collaboration with community organizations with such expertise, such as 

Centers for Independent Living. 

18. Increase and improve accessibility of outreach and education to people with 

disabilities and their families/supports, including at key entry points, such as 

emergency rooms, homeless shelters, medical and rehabilitation centers, and 

nursing homes. 

Data Collection and Continuous Quality Improvement Research 

19. Convene a consortium of stakeholders (consumers, federal agencies and 

funders, State policymakers, housing and community living organizations, 

developers) to develop a blueprint to: 

● Establish common definitions and criteria for assessing needs and 

disparities that people with disabilities face related to affordable, 

accessible, and integrated housing choice that can be used and compared 

nationally and within States. 

422
● Incorporate an ADA and Fair Housing Act civil rights framing of disability, 

integration, and accessibility within data collection systems and across 

federal housing, long-term care, and community living systems and 

policies. 

● Use findings to inform national data collection systems, such as Census 

Bureau and ACS, so data can be used to advocate for State systems 

change and to compare trends and outcomes over time. 

20. Conduct rigorous evaluations and future trend analyses of the need for and 

supply of affordable, accessible, and integrated housing nationally and within 

States that: 

● Include people who are homeless and living in institutional settings 

● Include children under age 5 and longitudinal data across the lifespan 

● Include targeted outreach to communities and people with disabilities who 

are not currently receiving services or supports 

● Include data on diverse disability constituencies 

● Include data at family and household levels, including families with multiple 

disability needs and those with aging caregivers 

● Present findings in accessible formats that can be used by different 

stakeholders (e.g., policymakers, State systems, advocates, consumers) 

21. Collect data on post-occupancy use of publicly funded, affordable, and 

accessible housing options by people with disabilities. 

22. Fund rigorous evaluations and periodic audits of fair housing and civil rights 

programs and practices at State and local levels. 

23. Fund cross-agency research (Interagency Committee on Disability Research, 

the National Institutes of Health, National Institute on Disability and 

Rehabilitation Research, Agency for Healthcare Research and Quality, Centers 

for Medicare and Medicaid Services, Administration on Aging, Department of 

Veterans Affairs, Substance Abuse and Mental Health Services Administration, 

423
424

Administration on Developmental Disabilities, etc.) to rigorously evaluate and 

compare outcomes and impact (costs, function, health, safety, quality of life, 

community participation, employment) of least restrictive, integrated housing 

options and programming with existing models, such as nursing 

home/institutions and Intermediate Care Facilities, to inform evidence-based 

State systems change and practice. 

24. Use a participatory action research approach to all data collection and 

research that actively involves people with disabilities in all aspects of this 

research, and provides funding to support this participation. 
APPENDIX A. Data Tables 

425
426
Contents 

Estimated Number and Percentage of People with Disabilities by State 

in 2007 

Table 1. Noninstitutionalized People with Disabilities: Number by States, 2007 ....... 429

Table 2. Noninstitutionalized People with Disabilities: Prevalence Rates by States, 

2007 ............................................................................................................ 430

Housing Need by State Based on 2000 U.S. Census 

Table 3. Housing Problems Among People with Mobility and Self-Care 

Limitations: All Households, 2000 ............................................................... 431

Table 4. Housing Problems Among People with Mobility and Self-Care 

Limitations: Low-Income, 2000.................................................................... 434

Table 5. Housing Problems Among People with Mobility and Self-Care 

Limitations: Very Low Income, 2000 ........................................................... 437

Table 6. Housing Problems Among People with Mobility and Self-Care 

Limitations: Extremely Low Income, 2000................................................... 440

Priced Out in 2008 

Table 7. People with Disabilities Receiving SSI; Monthly SSI Payment; Proportion 

of SSI Needed to Rent Average-Priced Studio and One-Bedroom Unit; 

and Estimated Housing Wage Needed to Afford Housing by State, 2008... 443

Units and People Assisted by HUD Programs 

Table 8. Disability Status of Households in Public Housing and Using Housing 

Choice Vouchers, 2008............................................................................... 446

Table 9. HUD Multifamily Housing Inventory Survey of Units for the Elderly and 

Disabled, 2008 ............................................................................................ 448

Visitability Laws and Programs 

Table 10. Existing State Visitability Laws and Programs............................................. 451

Table 11. U.S. City Visitability Ordinances.................................................................. 453

427
428
Table 1. Noninstitutionalized People with Disabilities: Number by States, 2007 

Location Estimate (#) 95% CI (#) * 

Base 

Population Location Estimate (#) 95% CI (#) *

Base 

Population 

Alabama 888,000 ± 23,100 4,256,000 Montana 143,000 ± 9,500 884,000 Alaska 96,000 ± 7,300 624,000 Nebraska 210,000 ± 11,700 1,617,000 Arizona 828,000 ± 23,200 5,779,000 Nevada 295,000 ± 13,900 2,350,000 Arkansas 541,000 ± 18,100 2,594,000 New Hampshire 163,000 ± 10,300 1,226,000 California 4,279,000 ± 53,100 33,452,000 New Jersey 957,000 ± 25,200 8,026,000 Colorado 543,000 ± 19,000 4,453,000 New Mexico 299,000 ± 13,800 1,808,000 Connecticut 414,000 ± 16,500 3,229,000 New York 2,533,000 ± 40,500 17,839,000 Delaware 116,000 ± 8,700 797,000 North Carolina 1,386,000 ± 29,600 8,316,000 D.C. 80,000 ± 7,200 542,000 North Dakota 80,000 ± 7,200 586,000 Florida 2,610,000 ± 40,800 16,850,000 Ohio 1,699,000 ± 32,800 10,554,000 Georgia 1,237,000 ± 28,300 8,682,000 Oklahoma 617,000 ± 19,500 3,289,000 Hawaii 163,000 ± 10,300 1,190,000 Oregon 568,000 ± 19,000 3,474,000 Idaho 192,000 ± 11,200 1,362,000 Pennsylvania 1,865,000 ± 34,400 11,471,000 Illinois 1,507,000 ± 31,500 11,787,000 Puerto Rico 963,000 ± 21,600 3,671,000 

Indiana 893,000 ± 23,900 5,804,000 Rhode Island 155,000 ± 9,900 984,000 Iowa 405,000 ± 16,200 2,742,000 South Carolina 677,000 ± 20,700 4,049,000Kansas 364,000 ± 15,400 2,535,000 South Dakota 106,000 ± 8,300 724,000 Kentucky 822,000 ± 22,200 3,892,000 Tennessee 1,054,000 ± 25,500 5,661,000 Louisiana 711,000 ± 21,000 3,918,000 Texas 3,050,000 44,500± 21,529,000

Maine 246,000 ± 12,200 1,232,000 Utah 281,000 ± 13,700 2,369,000 Maryland 677,000 ± 21,100 5,169,000 Vermont 92,000 ± 7,600 582,000 Massachusetts 830,000 ± 23,200 5,990,000 Virginia 952,000 ± 24,900 7,093,000 Michigan 1,523,000 ± 31,000 9,317,000 Washington 936,000 ± 24,400 5,988,000 Minnesota 591,000 ± 19,800 4,771,000 West Virginia 397,000 ± 14,100 1,680,000 Mississippi 548,000 ± 18,200 2,650,000 Wisconsin 699,000 ± 21,400 5,171,000 Missouri 911,000 ± 24,000 5,392,000 Wyoming 76,000 ± 6,400 478,000 

* CI = Confidence Interval. The 95% CI can be constructed by adding and subtracting the amount in the column from the estimate.Source: American Community Survey data tabulated by Cornell University, at http://www.ilr.cornell.edu/edi/DisabilityStatistics/acs.cfm. 

429
Table 2. Noninstitutionalized People with Disabilities: Prevalence Rates by States, 2007 

Location Estimate (%) 95% CI* (%) Location Estimate (%) 95% CI* (%)

Alabama 20.9 ±0.5 Montana 16.2 ±1.1 

Alaska 15.3 ±1.2 Nebraska 13.0 ±0.7 

Arizona 14.3 ±0.4 Nevada 12.5 ±0.6 

Arkansas 20.9 ±0.7 New Hampshire 13.3 ±0.8 

California 12.8 ±0.2 New Jersey 11.9 ±0.3 Colorado 12.2 ±0.4 New Mexico 16.6 ±0.8 Connecticut 12.8 ±0.5 New York 14.2 ±0.2 Delaware 14.6 ±1.1 North Carolina 16.7 ±0.4 D.C. 14.7 ±1.3 North Dakota 13.6 ±1.2 Florida 15.5 ±0.2 Ohio 16.1 ±0.3 Georgia 14.2 ±0.3 Oklahoma 18.8 ±0.6 

Hawaii 13.7 ±0.9 Oregon 16.4 ±0.5 

Idaho 14.1 ±0.8 Pennsylvania 16.3 ±0.3 

Illinois 12.8 ±0.3 Puerto Rico 26.2 ±0.6 Indiana 15.4 ±0.4 Rhode Island 15.7 ±1.0 Iowa 14.8 ±0.6 South Carolina 16.7 ±0.5 Kansas 14.4 ±0.6 South Dakota 14.7 ±1.1 Kentucky 21.1 ±0.6 Tennessee 18.6 ±0.5 Louisiana 18.2 ±0.5 Texas 14.2 ±0.2 

Maine 20.0 ±1.0 Utah 11.8 ±0.6 Maryland 13.1 ±0.4 Vermont 15.8 ±1.3 Massachusetts 13.9 ±0.4 Virginia 13.4 ±0.4 Michigan 16.4 ±0.3 Washington 15.6 ±0.4 Minnesota 12.4 ±0.4 West Virginia 23.6 ±0.8 Mississippi 20.7 ±0.7 Wisconsin 13.5 ±0.4 Missouri 16.9 ±0.4 Wyoming 15.8 ±1.3 

* CI = Confidence Interval. The 95% CI can be constructed by adding and subtracting the amount in the column from the estimate.Source: American Community Survey data tabulated by Cornell University, at http://www.ilr.cornell.edu/edi/DisabilityStatistics/acs.cfm. 

430
Table 3. Housing Problems Among People with Mobility and Self-Care Limitations: 

All Households, 2000

State 

Renters Owners Households

Number in 

State 

Percent of 

National 

Renters 

Percent of 

State Total 

Households

Number in 

State 

Percent of 

National 

Owners 

Percent of 

State Total 

Households

Number In 

State 

National 

Percent 

Alabama 102,665 1.6% 25.8% 295,460 2.3% 74.2% 398,125 2.1%

Alaska 11,449 0.2% 35.0% 21,220 0.2% 65.0% 32,669 0.2%Arizona 95,765 1.5% 28.0% 246,125 1.9% 72.0% 341,890 1.8%Arkansas 70,530 1.1% 28.1% 180,250 1.4% 71.9% 250,780 1.3%California 810,675 12.8% 41.0% 1,168,955 9.1% 59.0% 1,979,630 10.3%

Colorado 79,180 1.2% 33.1% 159,809 1.2% 66.9% 238,989 1.2%Connecticut 78,350 1.2% 39.2% 121,485 0.9% 60.8% 199,835 1.0%Connecticut 78,350 1.2% 39.2% 121,485 0.9% 60.8% 199,835 1.0%Delaware 14,030 0.2% 26.7% 38,550 0.3% 73.3% 52,580 0.3%District of Columbia 

22,455 0.4% 58.1% 16,178 0.1% 41.9% 38,633 0.2%

Florida 329,995 5.2% 26.1% 934,060 7.3% 73.9% 1,264,055 6.6%

Georgia 162,620 2.6% 30.0% 378,670 2.9% 70.0% 541,290 2.8%

Hawaii 25,955 0.4% 38.3% 41,819 0.3% 61.7% 67,774 0.4%Idaho 21,800 0.3% 26.5% 60,453 0.5% 73.5% 82,253 0.4%

Illinois 253,095 4.0% 33.8% 496,495 3.9% 66.2% 749,590 3.9%Indiana 124,220 2.0% 29.6% 295,860 2.3% 70.4% 420,080 2.2%Iowa 52,800 0.8% 29.1% 128,509 1.0% 70.9% 181,309 0.9%Kansas 54,940 0.9% 30.7% 123,795 1.0% 69.3% 178,735 0.9%

Kentucky 108,405 1.7% 27.8% 281,705 2.2% 72.2% 390,110 2.0%Louisiana 102,065 1.6% 28.9% 251,400 2.0% 71.1% 353,465 1.8%Maine 31,489 0.5% 31.5% 68,485 0.5% 68.5% 99,974 0.5%Maryland 103,015 1.6% 33.1% 208,030 1.6% 66.9% 311,045 1.6%Massachusetts 171,155 2.7% 44.5% 213,800 1.7% 55.5% 384,955 2.0%

431
Table 3. Housing Problems Among People with Mobility and Self-Care Limitations: 

All Households, 2000 (cont’d)

State 

Renters Owners Households

Number in 

State 

Percent of 

National 

Renters 

Percent of 

State Total 

Households

Number in 

State 

Percent of 

National 

Owners 

Percent of 

State Total 

Households

Number In 

State 

National 

Percent 

Michigan 186,105 2.9% 27.4% 493,300 3.8% 72.6% 679,405 3.5% Minnesota 80,465 1.3% 30.9% 179,860 1.4% 69.1% 260,325 1.4% Mississippi 62,285 1.0% 24.4% 192,840 1.5% 75.6% 255,125 1.3% Missouri 123,235 1.9% 29.6% 292,710 2.3% 70.4% 415,945 2.2% Montana 20,009 0.3% 31.6% 43,274 0.3% 68.4% 63,283 0.3% Nebraska 32,209 0.5% 32.3% 67,380 0.5% 67.7% 99,589 0.5% Nevada 46,790 0.7% 35.8% 84,020 0.7% 64.2% 130,810 0.7% New Hampshire 26,444 0.4% 34.9% 49,219 0.4% 65.1% 75,663 0.4% 

New Jersey 182,205 2.9% 36.6% 315,470 2.5% 63.4% 497,675 2.6% New Mexico 35,050 0.6% 26.4% 97,750 0.8% 73.6% 132,800 0.7% New York 645,265 10.2% 50.8% 625,455 4.9% 49.2% 1,270,720 6.6% North Carolina 170,960 2.7% 28.4% 432,040 3.4% 71.6% 603,000 3.1% 

North Dakota 13,295 0.2% 35.0% 24,718 0.2% 65.0% 38,013 0.2% 

Ohio 257,585 4.1% 32.4% 536,445 4.2% 67.6% 794,030 4.1% 

Oklahoma 83,455 1.3% 28.2% 212,355 1.7% 71.8% 295,810 1.5% Oregon 86,950 1.4% 35.9% 155,070 1.2% 64.1% 242,020 1.3% Pennsylvania 258,260 4.1% 30.2% 598,305 4.7% 69.8% 856,565 4.5% Rhode Island 31,489 0.5% 45.1% 38,258 0.3% 54.9% 69,747 0.4% 

South Carolina 79,155 1.2% 25.4% 232,295 1.8% 74.6% 311,450 1.6% South Dakota 16,515 0.3% 35.3% 30,268 0.2% 64.7% 46,783 0.2% 

Tennessee 138,430 2.2% 28.6% 345,970 2.7% 71.4% 484,400 2.5% Texas 391,105 6.2% 30.3% 898,240 7.0% 69.7% 1,289,345 6.7% 

432
Table 3. Housing Problems Among People with Mobility and Self-Care Limitations: 

All Households, 2000 (cont’d)

Renters Owners Households

Percent of Percent of Percent of Percent of 

Number in National State Total Number in National State Total Number In National 

State State Renters Households State Owners Households State Percent 

Utah 27,105 0.4% 25.5% 79,350 0.6% 74.5% 106,455 0.6%

Vermont 13,112 0.2% 33.1% 26,442 0.2% 66.9% 39,554 0.2%Virginia 132,350 2.1% 29.6% 315,350 2.5% 70.4% 447,700 2.3%Washington 140,685 2.2% 36.2% 248,465 1.9% 63.8% 389,150 2.0%

West Virginia 46,295 0.7% 23.8% 148,525 1.2% 76.2% 194,820 1.0%Wisconsin 108,605 1.7% 35.1% 200,595 1.6% 64.9% 309,200 1.6%Wyoming 9,150 0.1% 29.1% 22,272 0.2% 70.9% 31,422 0.2%

TOTAL 6,349,566 12,838,839 19,188,405 

Source: U.S. Department of Housing and Urban Development, Consolidated Plan/Comprehensive Housing Affordability Strategy 2000 Data, 

http://www.huduser.org/datasets/cp.html.

People with Disabilities = All people with Mobility and Self-Care Limitations identified in the 2000 U.S. Census. Housing Problems = Lacking complete plumbing facilities or lacking complete kitchen facilities (quality), or with 1.01 or more people per room (overcrowding), or with cost burden more than 30% (Note: Most are cost burdened). 

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Table 4. Housing Problems Among People with Mobility and Self-Care Limitations: 

Low-Income, 2000 

State 

Renters Owners Households

Number 

in State 

Percent of 

National 

Renters 

Percent of 

State Total 

Households

Number 

in State 

Percent of 

National 

Renters 

Percent of 

State Total 

Households

Number in 

State 

Percent of 

National 

Total 

Alabama 17,585 1.5% 23.6% 56,930 2.2% 76.4% 74,515 2.0% 

Alaska 2,265 0.2% 37.8% 3,725 0.1% 62.2% 5,990 0.2% 

Arizona 20,075 1.7% 28.8% 49,690 1.9% 71.2% 69,765 1.9% 

Arkansas 13,520 1.2% 27.3% 36,080 1.4% 72.7% 49,600 1.3% California 157,120 13.5% 42.9% 209,460 8.1% 57.1% 366,580 9.8% Colorado 16,135 1.4% 32.6% 33,315 1.3% 67.4% 49,450 1.3% Connecticut 12,465 1.1% 36.3% 21,880 0.8% 63.7% 34,345 0.9% 

Connecticut 12,465 1.1% 36.3% 21,880 0.8% 63.7% 34,345 0.9% 

Delaware 2,510 0.2% 23.8% 8,045 0.3% 76.2% 10,555 0.3% District of Columbia 

2,230 0.2% 49.3% 2,295 0.1% 50.7% 4,525 0.1% 

Florida 64,855 5.6% 25.6% 188,495 7.3% 74.4% 253,350 6.8% 

Georgia 30,170 2.6% 29.1% 73,365 2.8% 70.9% 103,535 2.8% Hawaii 4,930 0.4% 41.1% 7,060 0.3% 58.9% 11,990 0.3% Idaho 4,525 0.4% 25.7% 13,070 0.5% 74.3% 17,595 0.5% 

Illinois 44,835 3.8% 29.7% 106,220 4.1% 70.3% 151,055 4.0% Indiana 24,680 2.1% 26.9% 67,235 2.6% 73.1% 91,915 2.5% Iowa 10,220 0.9% 25.1% 30,545 1.2% 74.9% 40,765 1.1% Kansas 10,875 0.9% 28.5% 27,265 1.1% 71.5% 38,140 1.0% Kentucky 19,300 1.7% 24.8% 58,650 2.3% 75.2% 77,950 2.1% Louisiana 17,965 1.5% 27.0% 48,520 1.9% 73.0% 66,485 1.8% Maine 5,785 0.5% 28.4% 14,615 0.6% 71.6% 20,400 0.5% Maryland 16,545 1.4% 31.8% 35,415 1.4% 68.2% 51,960 1.4% Massachusetts 24,375 2.1% 37.5% 40,620 1.6% 62.5% 64,995 1.7% 

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Table 4. Housing Problems Among People with Mobility and Self-Care Limitations: 

Low-Income, 2000 (cont’d) 

State 

Renters Owners Households

Number 

in State 

Percent of 

National 

Renters 

Percent of 

State Total 

Households

Number 

in State 

Percent of 

National 

Renters 

Percent of 

State Total 

Households

Number in 

State 

Percent of 

National 

Total 

Michigan 32,945 2.8% 23.4% 107,905 4.2% 76.6% 140,850 3.8% 

Minnesota 14,165 1.2% 27.0% 38,320 1.5% 73.0% 52,485 1.4% 

Mississippi 10,890 0.9% 22.9% 36,620 1.4% 77.1% 47,510 1.3% 

Missouri 24,445 2.1% 27.8% 63,345 2.5% 72.2% 87,790 2.3% 

Montana 3,965 0.3% 29.5% 9,490 0.4% 70.5% 13,455 0.4% Nebraska 6,485 0.6% 30.0% 15,155 0.6% 70.0% 21,640 0.6% 

Nevada 10,130 0.9% 38.5% 16,190 0.6% 61.5% 26,320 0.7% 

New Hampshire 5,175 0.4% 32.6% 10,675 0.4% 67.4% 15,850 0.4% 

New Jersey 29,260 2.5% 36.0% 51,990 2.0% 64.0% 81,250 2.2% New Mexico 6,580 0.6% 26.1% 18,600 0.7% 73.9% 25,180 0.7% 

New York 103,035 8.8% 47.8% 112,410 4.4% 52.2% 215,445 5.8% 

North Carolina 32,165 2.8% 27.2% 85,970 3.3% 72.8% 118,135 3.2% North Dakota 2,665 0.2% 32.5% 5,540 0.2% 67.5% 8,205 0.2%Ohio 48,415 4.2% 28.6% 120,835 4.7% 71.4% 169,250 4.5% 

Oklahoma 16,830 1.4% 27.8% 43,685 1.7% 72.2% 60,515 1.6% 

Oregon 18,720 1.6% 36.9% 32,050 1.2% 63.1% 50,770 1.4% 

Pennsylvania 48,350 4.2% 26.6% 133,725 5.2% 73.4% 182,075 4.9% Rhode Island 5,070 0.4% 38.1% 8,235 0.3% 61.9% 13,305 0.4% South Carolina 14,030 1.2% 23.9% 44,620 1.7% 76.1% 58,650 1.6% 

South Dakota 3,225 0.3% 32.5% 6,700 0.3% 67.5% 9,925 0.3%Tennessee 24,830 2.1% 26.5% 68,815 2.7% 73.5% 93,645 2.5% 

Texas 75,270 6.5% 30.2% 174,065 6.8% 69.8% 249,335 6.7% Utah 5,890 0.5% 26.4% 16,450 0.6% 73.6% 22,340 0.6% Vermont 2,550 0.2% 29.6% 6,075 0.2% 70.4% 8,625 0.2% 

435
Table 4. Housing Problems Among People with Mobility and Self-Care Limitations: 

Low-Income, 2000 (cont’d) 

Renters Owners Households

Percent of Percent of Percent of Percent of Percent of 

Number National State Total Number National State Total Number in National 

State in State Renters Households in State Renters Households State Total 

Virginia 24,105 2.1% 29.1% 58,770 2.3% 70.9% 82,875 2.2% Washington 28,040 2.4% 35.7% 50,555 2.0% 64.3% 78,595 2.1% West Virginia 8,075 0.7% 19.9% 32,580 1.3% 80.1% 40,655 1.1% Wisconsin 22,115 1.9% 32.3% 46,335 1.8% 67.7% 68,450 1.8% Wyoming 1,895 0.2% 27.9% 4,900 0.2% 72.1% 6,795 0.2% TOTAL 1,164,745 2,574,980 3,739,725 

Source: U.S. Department of Housing and Urban Development, Consolidated Plan/CHAS 2000 Data, http://www.huduser.org/datasets/cp.html. People with Disabilities = All people with Mobility and Self-Care Limitations identified in the 2000 U.S. Census. Housing Problems = Lacking complete plumbing facilities or lacking complete kitchen facilities (quality), or with 1.01 or more people per room (overcrowding), or with cost burden more than 30% (Note: Most are cost burdened). 

436
Table 5. Housing Problems Among People with Mobility and Self-Care Limitations: 

Very Low Income, 2000

State 

Renters Owners Households

Number in 

State 

Percent of 

National 

Renters 

Percent of 

State Total 

Households

Number in 

State 

Percent of 

National 

Renters 

Percent of 

State Total 

Households 

Number 

in State 

Percent of 

National 

Total 

Alabama 22,895 1.7% 33.5% 45,500 2.5% 66.5% 68,395 2.2% Alaska 2,760 0.2% 50.1% 2,754 0.2% 49.9% 5,514 0.2% 

Arizona 19,840 1.5% 37.7% 32,720 1.8% 62.3% 52,560 1.7% 

Arkansas 16,150 1.2% 37.4% 27,000 1.5% 62.6% 43,150 1.4% California 172,765 12.8% 55.1% 140,980 7.7% 44.9% 313,745 9.9% Colorado 16,245 1.2% 41.8% 22,665 1.2% 58.2% 38,910 1.2% Connecticut 16,050 1.2% 48.4% 17,100 0.9% 51.6% 33,150 1.0% Connecticut 16,050 1.2% 48.4% 17,100 0.9% 51.6% 33,150 1.0% Delaware 3,010 0.2% 36.8% 5,175 0.3% 63.2% 8,185 0.3% 

District of Columbia 3,675 0.3% 63.4% 2,120 0.1% 36.6% 5,795 0.2%

Florida 67,290 5.0% 35.6% 121,940 6.7% 64.4% 189,230 6.0% Georgia 33,180 2.5% 37.5% 55,225 3.0% 62.5% 88,405 2.8% Hawaii 4,745 0.4% 54.6% 3,950 0.2% 45.4% 8,695 0.3% Idaho 5,175 0.4% 36.8% 8,905 0.5% 63.2% 14,080 0.4% 

Illinois 51,635 3.8% 41.3% 73,395 4.0% 58.7% 125,030 3.9% 

Indiana 29,030 2.2% 39.4% 44,625 2.4% 60.6% 73,655 2.3% 

Iowa 13,000 1.0% 38.6% 20,680 1.1% 61.4% 33,680 1.1% Kansas 12,290 0.9% 41.2% 17,560 1.0% 58.8% 29,850 0.9% 

Kentucky 24,705 1.8% 34.5% 46,995 2.6% 65.5% 71,700 2.3% 

Louisiana 21,500 1.6% 35.9% 38,350 2.1% 64.1% 59,850 1.9% Maine 8,085 0.6% 42.7% 10,860 0.6% 57.3% 18,945 0.6% Maryland 20,080 1.5% 43.3% 26,345 1.4% 56.7% 46,425 1.5% Massachusetts 35,025 2.6% 53.0% 31,035 1.7% 47.0% 66,060 2.1% Michigan 40,470 3.0% 35.1% 74,970 4.1% 64.9% 115,440 3.6% 

437
Table 5. Housing Problems Among People with Mobility and Self-Care Limitations: 

Very Low Income, 2000 (cont’d)

State 

Renters Owners Households

Number in 

State 

Percent of 

National 

Renters 

Percent of 

State Total 

Households

Number in 

State 

Percent of 

National 

Renters 

Percent of 

State Total 

Households 

Number 

in State 

Percent of 

National 

Total 

Minnesota 18,810 1.4% 40.9% 27,175 1.5% 59.1% 45,985 1.4% Mississippi 13,145 1.0% 30.5% 29,955 1.6% 69.5% 43,100 1.4% Missouri 28,695 2.1% 39.0% 44,950 2.5% 61.0% 73,645 2.3% Montana 5,010 0.4% 43.3% 6,570 0.4% 56.7% 11,580 0.4% Nebraska 7,305 0.5% 42.7% 9,790 0.5% 57.3% 17,095 0.5% Nevada 8,605 0.6% 48.7% 9,080 0.5% 51.3% 17,685 0.6% New Hampshire 5,855 0.4% 45.1% 7,130 0.4% 54.9% 12,985 0.4% New Jersey 37,215 2.8% 45.6% 44,470 2.4% 54.4% 81,685 2.6% New Mexico 7,285 0.5% 35.1% 13,485 0.7% 64.9% 20,770 0.7% 

New York 126,390 9.4% 61.0% 80,935 4.4% 39.0% 207,325 6.5% North Carolina 34,795 2.6% 35.3% 63,905 3.5% 64.7% 98,700 3.1% North Dakota 3,150 0.2% 45.7% 3,745 0.2% 54.3% 6,895 0.2% 

Ohio 56,120 4.2% 41.5% 79,020 4.3% 58.5% 135,140 4.3% Oklahoma 19,280 1.4% 37.6% 31,985 1.8% 62.4% 51,265 1.6% 

Oregon 18,525 1.4% 47.5% 20,440 1.1% 52.5% 38,965 1.2% 

Pennsylvania 59,635 4.4% 39.1% 92,990 5.1% 60.9% 152,625 4.8% 

Rhode Island 6,445 0.5% 54.6% 5,350 0.3% 45.4% 11,795 0.4% 

South Carolina 16,850 1.3% 32.7% 34,740 1.9% 67.3% 51,590 1.6% South Dakota 4,115 0.3% 47.8% 4,495 0.2% 52.2% 8,610 0.3% 

Tennessee 29,185 2.2% 35.8% 52,375 2.9% 64.2% 81,560 2.6% 

Texas 80,440 6.0% 38.1% 130,480 7.2% 61.9% 210,920 6.6% Utah 5,785 0.4% 36.2% 10,180 0.6% 63.8% 15,965 0.5% 

Vermont 3,195 0.2% 42.1% 4,390 0.2% 57.9% 7,585 0.2% Virginia 27,655 2.1% 39.1% 43,130 2.4% 60.9% 70,785 2.2% 

438
Table 5. Housing Problems Among People with Mobility and Self-Care Limitations: 

Very Low Income, 2000 (cont’d)

Renters Owners Households

Percent of Percent of Percent of Percent of Percent of 

Number in National State Total Number in National State Total Number National 

State State Renters Households State Renters Households in State Total 

Washington 28,700 2.1% 48.7% 30,215 1.7% 51.3% 58,915 1.9% West Virginia 11,735 0.9% 33.6% 23,170 1.3% 66.4% 34,905 1.1% Wisconsin 25,305 1.9% 46.4% 29,245 1.6% 53.6% 54,550 1.7% Wyoming 2,325 0.2% 40.9% 3,365 0.2% 59.1% 5,690 0.2% TOTAL 1,347,205 1,824,709 3,171,914

Source: U.S. Department of Housing and Urban Development, Consolidated Plan/CHAS 2000 Data, http://www.huduser.org/datasets/cp.html. People with Disabilities = All people with Mobility and Self-Care Limitations identified in the 2000 U.S. Census. Housing Problems = Lacking complete plumbing facilities or lacking complete kitchen facilities (quality), or with 1.01 or more people per room (overcrowding), or with cost burden more than 30% (Note: Most are cost burdened).

439
Table 6. Housing Problems Among People with Mobility and Self-Care Limitations: 

Extremely Low Income, 2000

State 

Renters Owners Households

Number 

in State 

Percent of 

National 

Renters 

Number

in State 

Percent of 

National 

Renters 

Percent of 

State Total 

Households

Number 

in State 

Percent of 

National 

Total 

Alabama 41,190 1.8% 46.9% 46,715 3.0% 53.1% 87,905 2.3% 

Alaska 3,295 0.1% 59.4% 2,253 0.1% 40.6% 5,548 0.1% Arizona 27,275 1.2% 51.1% 26,115 1.7% 48.9% 53,390 1.4% Arkansas 23,740 1.0% 51.2% 22,655 1.4% 48.8% 46,395 1.2% California 253,150 10.9% 68.7% 115,250 7.4% 31.3% 368,400 9.5% Colorado 28,300 1.2% 61.4% 17,810 1.1% 38.6% 46,110 1.2% 

Connecticut 34,565 1.5% 71.1% 14,040 0.9% 28.9% 48,605 1.3% 

Connecticut 34,565 1.5% 71.1% 14,040 0.9% 28.9% 48,605 1.3% 

Delaware 5,040 0.2% 53.0% 4,475 0.3% 47.0% 9,515 0.2% District of Columbia 12,645 0.5% 81.1% 2,944 0.2% 18.9% 15,589 0.4%

Florida 97,545 4.2% 49.3% 100,240 6.4% 50.7% 197,785 5.1% Georgia 61,350 2.6% 53.1% 54,150 3.5% 46.9% 115,500 3.0% Hawaii 8,840 0.4% 71.7% 3,494 0.2% 28.3% 12,334 0.3% Idaho 6,375 0.3% 50.6% 6,215 0.4% 49.4% 12,590 0.3% Illinois 106,130 4.6% 64.6% 58,035 3.7% 35.4% 164,165 4.2% 

Indiana 44,030 1.9% 57.5% 32,480 2.1% 42.5% 76,510 2.0% 

Iowa 18,755 0.8% 57.3% 13,985 0.9% 42.7% 32,740 0.8% 

Kansas 18,770 0.8% 58.5% 13,295 0.8% 41.5% 32,065 0.8% 

Kentucky 42,560 1.8% 48.9% 44,445 2.8% 51.1% 87,005 2.2% 

Louisiana 38,480 1.7% 49.6% 39,140 2.5% 50.4% 77,620 2.0% 

Maine 11,950 0.5% 57.5% 8,825 0.6% 42.5% 20,775 0.5% 

Maryland 40,960 1.8% 63.9% 23,140 1.5% 36.1% 64,100 1.6% 

Massachusetts 81,335 3.5% 75.4% 26,520 1.7% 24.6% 107,855 2.8% 

Michigan 75,530 3.3% 53.9% 64,505 4.1% 46.1% 140,035 3.6% 

440

Percent of 

State Total 

Households
Table 6. Housing Problems Among People with Mobility and Self-Care Limitations: 

Extremely Low Income, 2000 (cont’d)

State 

Renters Owners Households

Number 

in State 

Percent of 

National 

Renters 

Number 

in State 

Number

in State 

Percent of 

National 

Renters 

Percent of 

State Total 

Households

Number 

in State 

Percent of 

National 

Total 

Minnesota 32,415 1.4% 60.7% 20,985 1.3% 39.3% 53,400 1.4% Mississippi 23,350 1.0% 42.6% 31,460 2.0% 57.4% 54,810 1.4% Missouri 43,805 1.9% 55.9% 34,530 2.2% 44.1% 78,335 2.0% 

Montana 6,665 0.3% 58.6% 4,700 0.3% 41.4% 11,365 0.3% 

Nebraska 10,445 0.5% 59.1% 7,240 0.5% 40.9% 17,685 0.5% 

Nevada 11,815 0.5% 62.5% 7,095 0.5% 37.5% 18,910 0.5% New Hampshire 9,770 0.4% 64.4% 5,395 0.3% 35.6% 15,165 0.4% 

New Jersey 71,190 3.1% 65.7% 37,215 2.4% 34.3% 108,405 2.8% New Mexico 11,345 0.5% 47.5% 12,525 0.8% 52.5% 23,870 0.6% 

New York 265,155 11.4% 79.4% 68,890 4.4% 20.6% 334,045 8.6% 

North Carolina 64,005 2.8% 50.0% 64,035 4.1% 50.0% 128,040 3.3% North Dakota 4,510 0.2% 61.9% 2,774 0.2% 38.1% 7,284 0.2% Ohio 99,205 4.3% 61.3% 62,600 4.0% 38.7% 161,805 4.2% Oklahoma 26,655 1.1% 50.8% 25,860 1.7% 49.2% 52,515 1.4% 

Oregon 26,155 1.1% 64.7% 14,280 0.9% 35.3% 40,435 1.0% 

Pennsylvania 98,070 4.2% 55.9% 77,320 4.9% 44.1% 175,390 4.5% 

Rhode Island 15,050 0.6% 75.0% 5,024 0.3% 25.0% 20,074 0.5% 

South Carolina 30,065 1.3% 44.9% 36,925 2.4% 55.1% 66,990 1.7% 

South Dakota 5,530 0.2% 63.2% 3,224 0.2% 36.8% 8,754 0.2% 

Tennessee 52,855 2.3% 51.3% 50,250 3.2% 48.7% 103,105 2.7% 

Texas 131,495 5.7% 51.3% 124,855 8.0% 48.7% 256,350 6.6% Utah 8,510 0.4% 54.9% 7,005 0.4% 45.1% 15,515 0.4% Vermont 4,870 0.2% 63.0% 2,864 0.2% 37.0% 7,734 0.2% Virginia 45,620 2.0% 55.3% 36,875 2.4% 44.7% 82,495 2.1% 

441
Table 6. Housing Problems Among People with Mobility and Self-Care Limitations: 

Extremely Low Income, 2000 (cont’d)

Renters Owners Households

Percent of Percent of Percent of Percent of 

Number National Number Number National State Total Number National 

State in State Renters in State in State Renters Households in State Total 

Washington 47,485 2.0% 66.4% 24,015 1.5% 33.6% 71,500 1.8% 

West Virginia 17,055 0.7% 46.8% 19,420 1.2% 53.2% 36,475 0.9% 

Wisconsin 38,760 1.7% 65.1% 20,815 1.3% 34.9% 59,575 1.5% 

Wyoming 2,875 0.1% 52.1% 2,643 0.2% 47.9% 5,518 0.1% TOTAL 2,321,100 1,565,585 3,886,685

Source: U.S. Department of Housing and Urban Development, Consolidated Plan/CHAS 2000 Data, http://www.huduser.org/datasets/cp.html. People with Disabilities = All people with Mobility and Self-Care Limitations identified in the 2000 U.S. Census. Housing Problems = Lacking complete plumbing facilities or lacking complete kitchen facilities (quality), or with 1.01 or more people per room (overcrowding), or with cost burden more than 30% (Note: Most are cost burdened).

442
Table 7. People with Disabilities Receiving SSI; Monthly SSI Payment; 

Proportion of SSI Needed to Rent Average-Priced Studio and One-Bedroom Unit; 

and Estimated Housing Wage Needed to Afford Housing by State, 2008 

State 

Number of 

People with 

Disabilities 

Number of 

SSI 

Recipients

Percent with 

Disability 

Receiving 

SSI 

SSI 

Monthly

Payment 

Percent of 

SSI Needed 

to Rent 

Studio 

Percent of 

SSI Needed 

to Rent OneBedroom 

Estimated 

Hourly 

Housing 

Wage * 

Alabama 888,000 103,548 11.7% $637 75.4% 84.0% $9.85 

Alaska 96,000 7,242 7.5% $999 69.1% 80.6% $14.85 Arizona 828,000 58,263 7.0% $637 92.9% 107.5% $13.00 

Arkansas 541,000 56,803 10.5% $637 70.0% 77.7% $9.58 

California 4,279,000 601,744 14.1% $870 103.0% 119.8% $19.65 

Colorado 543,000 36,680 6.8% $662 89.9% 102.1% $12.83 Connecticut 414,000 34,289 8.3% $805 95.8% 116.3% $17.42 Delaware 116,000 8,555 7.4% $637 108.6% 122.3% $14.20 

District of Columbia 80,000 13,334 16.7% $637 157.3% 177.6% $22.46 Florida 2,610,000 205,086 7.9% $637 119.0% 133.1% $15.24 Georgia 1,237,000 121,421 9.8% $637 97.0% 104.9% $12.36 

Hawaii 163,000 13,186 8.1% $637 169.9% 198.1% $24.15 

Idaho 192,000 15,913 8.3% $669 72.3% 81.8% $9.99 

Illinois 1,507,000 158,219 10.5% $637 104.9% 119.6% $14.10 

Indiana 893,000 69,239 7.8% $637 78.6% 89.0% $10.64 Iowa 405,000 30,238 7.5% $637 68.0% 77.4% $9.43 

Kansas 364,000 26,245 7.2% $637 73.5% 83.0% $9.79 Kentucky 822,000 121,965 14.8% $637 69.5% 79.0% $9.65 

Louisiana 711,000 97,246 13.7% $637 91.5% 100.5% $12.21 

Maine 246,000 24,381 9.9% $647 83.5% 96.1% $12.03 Maryland 677,000 57,438 8.5% $637 131.2% 149.5% $18.11 

Massachusetts 830,000 109,847 13.2% $751 119.0% 131.5% $19.20 Michigan 1,523,000 152,184 10.0% $651 84.2% 94.0% $11.80 Minnesota 591,000 48,963 8.3% $718 75.3% 87.7% $11.99 

443
Table 7. People with Disabilities Receiving SSI; Monthly SSI Payment; 

Proportion of SSI Needed to Rent Average-Priced Studio and One-Bedroom Unit; 

and Estimated Housing Wage Needed to Afford Housing by State, 2008 (cont’d) 

State 

Number of 

People with 

Disabilities 

Number of 

SSI 

Recipients

Percent with 

Disability 

Receiving 

SSI 

SSI 

Monthly

Payment 

Percent of 

SSI Needed 

to Rent 

Studio 

Percent of 

SSI Needed 

to Rent OneBedroom 

Estimated 

Hourly 

Housing 

Wage * 

Mississippi 548,000 71,252 13.0% $637 77.4% 86.7% $10.15 

Missouri 911,000 81,421 8.9% $637 75.8% 85.1% $10.17 Montana 143,000 10,880 7.6% $637 68.6% 79.0% $9.50

Nebraska 210,000 15,395 7.3% $644 73.1% 80.7% $9.68 

Nevada 295,000 19,539 6.6% $637 109.3% 128.9% $15.52 

New Hampshire 163,000 11,236 6.9% $698 100.1% 117.3% $15.65 

New Jersey 957,000 81,012 8.5% $668 135.7% 153.2% $19.12 New Mexico 299,000 32,411 10.8% $637 74.6% 85.2% $10.37 New York 2,533,000 339,576 13.4% $724 129.4% 141.4% $20.30 

North Carolina 1,386,000 119,131 8.6% $637 83.8% 93.9% $11.44 

North Dakota 80,000 5,241 6.6% $637 61.7% 70.5% $8.38 

Ohio 1,699,000 175,657 10.3% $637 74.4% 85.4% $10.52 Oklahoma 617,000 54,624 8.9% $683 69.5% 76.6% $9.59 Oregon 568,000 41,913 7.4% $638 84.2% 98.2% $11.60 

Pennsylvania 1,865,000 208,600 11.2% $664 86.8% 99.0% $12.08 

Rhode Island 155,000 19,547 12.6% $694 107.7% 121.0% $16.88 

South Carolina 677,000 62,812 9.3% $637 83.4% 91.8% $11.36 

South Dakota 106,000 7,807 7.4% $652 64.4% 71.5% $8.75 Tennessee 1,054,000 105,618 10.0% $637 79.0% 87.4% $10.57 

Texas 3,050,000 275,695 9.0% $637 91.5% 101.1% $12.35Utah 281,000 15,722 5.6% $637 85.9% 95.4% $11.26 

Vermont 92,000 9,665 10.5% $689 93.8% 107.8% $13.12Virginia 952,000 82,629 8.7% $637 115.4% 126.7% $15.74 

Washington 936,000 77,872 8.3% $683 89.9% 102.9% $13.01 

444
Table 7. People with Disabilities Receiving SSI; Monthly SSI Payment; 

Proportion of SSI Needed to Rent Average-Priced Studio and One-Bedroom Unit; 

and Estimated Housing Wage Needed to Afford Housing by State, 2008 (cont’d) 

Percent with Percent of Percent of Estimated 

Number of Number of Disability SSI SSI Needed SSI Needed Hourly 

People with SSI Receiving Monthly to Rent to Rent One- Housing 

State Disabilities Recipients SSI Payment Studio Bedroom Wage * 

West Virginia 397,000 57,768 14.6% $637 68.6% 76.9% $9.00 Wisconsin 699,000 62,254 8.9% $720 70.9% 82.3% $11.31 

Wyoming 76,000 4,140 5.4% $662 74.8% 82.0% $9.67 National 41,305,000 4,221,920 10.2% $667 99.3% 112.1% $14.40 Source: Priced Out in 2008: The Housing Crisis for People with Disabilities, Technical Assistance Collaborative, Inc., Consortium for Citizens with Disabilities, Housing Task Force, April 2009. * The National Low Income Housing Coalition estimates the 2008 housing wage by determining how much a household must earn per hour (based on a 40-hour work week) to be able to afford the average rent for a one-bedroom rental unit based on HUD’s 2008 Fair Market Rents. Monthly SSI income is equivalent to an hourly wage of only $3.86—less than one-third of the national housing wage. 

445
Table 8. Disability Status of Households in Public Housing and Using Housing Choice Vouchers, 2008 

State Name 

Public Housing Voucher 

Elderly 

Family 

Disabled 

Family Neither Both 

Elderly 

Family 

Disabled 

Family Neither Both 

Alabama 5,283 7,763 18,586 2,485 1,334 6,349 18,179 1,291

Alaska 180 272 780 139 338 1,457 1,851 296Arizona 559 1,303 3,543 702 1,322 6,160 10,280 2,210 Arkansas 2,175 3,443 6,028 1,272 1,571 6,111 11,564 1,570

California 3,589 6,601 19,246 5,917 28,329 73,260 133,495 54,736 Colorado 1,488 1,751 3,562 965 2,283 10,231 13,125 2,783

Connecticut 3,083 2,312 4,567 1,353 1,908 6,955 17,511 2,356

Delaware 203 464 1,011 192 330 1,273 2,267 387Florida 5,211 6,059 15,141 4,975 7,227 17,932 47,339 8,952

Georgia 5,708 7,756 21,507 3,690 3,391 8,994 33,747 3,813Hawaii 1,121 981 2,210 479 750 2,882 4,912 1,033 Idaho 199 284 201 118 288 2,815 2,768 772

Illinois 9,236 9,023 16,565 6,730 3,674 17,359 45,845 7,718

Indiana 2,112 3,428 6,652 1,780 1,767 9,597 19,583 3,026

Iowa 1,534 886 1,006 399 2,374 7,372 9,385 1,784 Kansas 2,156 2,206 3,063 820 831 4,230 5,192 1,014 Kentucky 2,704 5,375 11,034 2,781 1,535 10,657 18,616 2,851

Louisiana 1,893 3,350 10,031 2,172 1,422 6,260 19,901 2,177

Maine 1,142 857 1,556 397 1,144 5,563 4,243 1,181 Maryland 2,072 2,987 5,058 1,982 3,140 8,599 18,555 4,338Massachusetts 7,027 8,099 9,463 5,570 4,020 27,144 32,721 7,250 Michigan 4,814 5,681 7,742 2,334 2,960 15,410 29,024 4,016Minnesota 4,399 5,985 6,936 2,573 2,233 10,371 14,463 2,644Mississippi 1,429 2,679 6,680 1,107 775 4,383 11,829 916 Missouri 3,082 4,408 6,681 1,876 1,940 11,074 22,908 2,751

Montana 142 500 1,157 174 267 2,155 2,380 688

Nebraska 1,925 1,497 2,625 643 836 3,134 6,303 836 

446
Table 8. Disability Status of Households in Public Housing and Using Housing Choice Vouchers, 2008 

(cont’d) 

State Name 

Public Housing Voucher 

Elderly 

Family 

Disabled 

Family Neither Both 

Elderly 

Family 

Disabled 

Family Neither Both 

Nevada 629 616 1,822 623 1,216 3,387 6,430 1,695 New Hampshire 1,573 1,222 941 473 1,087 4,086 3,202 877New Jersey 11,637 6,313 11,789 4,389 6,301 13,107 32,033 6,035 

New Mexico 460 888 1,949 567 657 3,818 6,241 1,527 New York 37,030 33,761 96,750 37,349 25,656 50,465 111,207 27,863 

North Carolina 3,051 7,094 19,851 3,656 2,980 14,551 29,145 5,871 

North Dakota 364 452 684 209 964 2,018 3,279 660

Ohio 3,891 10,243 23,233 5,226 3,174 27,710 49,000 8,066 Oklahoma 1,448 2,687 6,041 1,981 967 6,667 12,672 2,367Oregon 611 1,761 1,872 630 2,509 10,971 14,824 3,656 Pennsylvania 10,774 12,934 20,812 7,598 6,049 21,446 33,489 6,803 Rhode Island 3,669 2,020 2,500 1,133 513 2,697 4,319 621 

South Carolina 1,205 2,751 8,554 1,322 1,211 5,426 14,141 2,280 

South Dakota 588 382 392 176 660 1,658 2,603 474

Tennessee 3,318 8,063 16,875 3,892 1,064 8,745 19,618 2,520 

Texas 8,289 10,014 26,900 5,942 7,461 29,657 80,005 13,366 Utah 538 242 712 236 563 3,988 4,806 1,060Vermont 628 513 393 260 578 2,531 2,067 729Virginia 1,781 3,626 10,933 1,861 2,484 11,717 23,650 4,399 Washington 2,036 4,121 4,348 1,952 3,115 17,500 18,118 5,490 

West Virginia 1,048 1,582 2,821 708 454 4,808 7,478 1,148 

Wisconsin 3,384 3,352 4,034 1,370 2,318 8,417 13,386 2,430 Wyoming 145 170 319 37 316 746 854 197TOTAL 172,564 210,760 457,182 135,218 150,499 544,561 1,052,906 223,766 

Source: U.S. Department of Housing and Urban Development, Resident Characteristic report generated by HUD for this report. Resident data 

reflects tenants in public housing between January 1 and December 31, 2008. 

447
Table 9. HUD Multifamily Housing Inventory Survey of Units for the Elderly and Disabled, 2008 

Total Units 

State 

Total 

Units 

Total 

Assisted 

Units 

Total Units 

Designated 

for Elderly

Designated 

for People 

with 

Disabilities

Total 

Units with 

Accessible 

Features 

Percent 

Assisted

Percent 

Designated 

for Elderly

Designated 

for People 

with 

Disabilities

Percent 

Units with 

Accessible 

Features 

Alabama 19,646 16,057 5,675 1,371 1,659 81.7% 28.9% 7.0% 8.4% 

Alaska 2,408 1,660 248 133 257 68.9% 10.3% 5.5% 10.7% 

Arkansas 17,516 11,577 3,881 1,760 2,275 66.1% 22.2% 10.0% 13.0% 

Arizona 13,178 8,358 4,078 603 1,349 63.4% 30.9% 4.6% 10.2% California 98,583 81,949 39,257 5,073 12,241 83.1% 39.8% 5.1% 12.4% Colorado 22,650 16,172 6,194 1,019 2,376 71.4% 27.3% 4.5% 10.5% 

Connecticut 32,291 23,001 8,476 912 2,646 71.2% 26.2% 2.8% 8.2% 

District of 12,512 9,933 779 271 784 79.4% 6.2% 2.2% 6.3% 

Columbia Delaware 5,595 4,710 2,132 252 844 84.2% 38.1% 4.5% 15.1% 

Florida 53,929 43,899 23,115 3,157 5,920 81.4% 42.9% 5.9% 11.0% 

Georgia 41,108 28,020 10,302 1,500 4,439 68.2% 25.1% 3.6% 10.8% Hawaii 5,964 3,667 1,088 528 425 61.5% 18.2% 8.9% 7.1% 

Iowa 13,659 12,421 3,145 998 1,835 90.9% 23.0% 7.3% 13.4% 

Idaho 4,355 3,826 781 196 590 87.9% 17.9% 4.5% 13.5% 

Illinois 48,927 42,708 14,225 2,670 4,695 87.3% 29.1% 5.5% 9.6% 

Indiana 37,749 29,404 4,959 1,241 2,590 77.9% 13.1% 3.3% 6.9% Kansas 14,309 11,192 4,790 1,171 2,000 78.2% 33.5% 8.2% 14.0% 

Kentucky 28,688 23,595 7,690 1,449 2,751 82.2% 26.8% 5.1% 9.6% Louisiana 18,114 13,394 3,648 1,012 2,142 73.9% 20.1% 5.6% 11.8% Massachusetts 60,430 49,458 16,039 2,182 4,236 81.8% 26.5% 3.6% 7.0% Maryland 32,136 23,306 8,302 1,660 2,826 72.5% 25.8% 5.2% 8.8% Maine 7,962 7,142 1,860 397 767 89.7% 23.4% 5.0% 9.6% Michigan 66,918 50,559 22,394 2,797 5,054 75.6% 33.5% 4.2% 7.6% 

Percent 

448
Table 9. HUD Multifamily Housing Inventory Survey of Units for the Elderly and Disabled, 2008 

(cont’d) 

State 

Total 

Units 

Total 

Assisted 

Units 

Total Units 

Designated 

for Elderly

Total Units 

Designated 

for People 

with 

Disabilities

Total 

Units with 

Accessible 

Features 

Percent 

Assisted

Percent 

Designated 

for Elderly

Percent 

Designated 

for People 

with 

Disabilities

Percent 

Units with 

Accessible 

Features 

Minnesota 47,168 32,767 11,958 2,505 5,768 69.5% 25.4% 5.3% 12.2% Missouri 28,591 23,534 8,445 1,606 3,145 82.3% 29.5% 5.6% 11.0% 

Mississippi 17,332 14,276 2,598 626 862 82.4% 15.0% 3.6% 5.0% 

Montana 5,283 4,197 622 138 1,069 79.4% 11.8% 2.6% 20.2% 

North Carolina 38,007 8,045 8,031 3,229 4,745 73.8% 21.1% 8.5% 12.5% 

Nebraska 10,799 7,257 2,885 790 2,212 67.2% 26.7% 7.3% 20.5% 

New Hampshire 6,795 6,284 2,482 349 776 92.5% 36.5% 5.1% 11.4% 

New Jersey 25,157 3,476 9,741 1,257 3,383 93.3% 38.7% 5.0% 13.4% New Mexico 8,248 5,565 1,493 532 716 67.5% 18.1% 6.5% 8.7% Nevada 4,745 3,636 1,091 284 346 76.6% 23.0% 6.0% 7.3% New York 108,720 4,687 25,263 4,258 12,309 87.1% 23.2% 3.9% 11.3% 

Ohio 82,488 70,061 21,854 3,962 8,432 84.9% 26.5% 4.8% 10.2% Oklahoma 16,432 14,347 3,186 1,027 1,883 87.3% 19.4% 6.3% 11.5% Oregon 12,264 8,643 3,424 721 1,894 70.5% 27.9% 5.9% 15.4% 

Pennsylvania 69,730 60,120 25,431 3,931 6,842 86.2% 36.5% 5.6% 9.8% Puerto Rico 21,486 18,180 5,206 676 1,289 84.6% 24.2% 3.1% 6.0% 

Rhode Island 16,409 15,703 2,079 890 1,609 95.7% 12.7% 5.4% 9.8% South Carolina 20,003 17,777 2,756 634 1,142 88.9% 13.8% 3.2% 5.7% 

South Dakota 5,541 5,150 552 413 719 92.9% 10.0% 7.5% 13.0% Tennessee 44,798 32,540 10,591 2,553 5,384 72.6% 23.6% 5.7% 12.0% Texas 107,639 53,797 14,305 2,871 12,589 50.0% 13.3% 2.7% 11.7% Utah 5,012 4,155 1,152 327 1,022 82.9% 23.0% 6.5% 20.4% 

449
Table 9. HUD Multifamily Housing Inventory Survey of Units for the Elderly and Disabled, 2008 

(cont’d) 

Total Units Percent 

Designated Total Designated Percent 

Total Total Units for People Units with Percent for People Units with 

Total Assisted Designated with Accessible Percent Designated with Accessible 

State Units Units for Elderly Disabilities Features Assisted for Elderly Disabilities Features 

Virginia 41,541 30,730 7,860 2,041 4,753 74.0% 18.9% 4.9% 11.4% Virgin Islands 566 566 - 8 8 100.0% 0.0% 1.4% 1.4% 

Vermont 2,757 2,505 447 176 268 90.9% 16.2% 6.4% 9.7% 

Washington 13,834 12,011 6,353 863 2,138 86.8% 45.9% 6.2% 15.5% 

Wisconsin 34,654 31,618 10,258 2,541 4,428 91.2% 29.6% 7.3% 12.8% 

West Virginia 11,843 11,027 2,382 917 1,558 93.1% 20.1% 7.7% 13.2% 

Wyoming 2,546 2,178 409 205 216 85.5% 16.1% 8.1% 8.5% TOTAL 1,469,015 1,150,840 385,912 72,682 156,206 78.3% 26.3% 4.9% 10.6% 

Source: U.S. Department of Housing and Urban Development, at http://www.hud.gov/offices/hsg/mfh/hto/inventorysurvey.cfm. 

450
Table 10. Existing State Visitability Laws and Programs 

Date Location Name Types of Homes 

Subsidized/ 

Unsubsidized 

Mandatory/ 

Voluntary 

1989 Florida Florida Bathroom 

Law 

Subsidized and unsubsidized 

Mandatory 

1998 Georgia Tax Credit 

Incentive Program

New single-family homes that include all four accessibility features or 

retrofitting of an existing home that has one or more features 

Voluntary 

1999 Texas New single-family 

affordable housing 

Subsidized (State or federal funds) 

Mandatory 

1999 Virginia Tax Credit 

Incentive Program

Voluntary 

2000 Georgia New single-family 

affordable housing 

Subsidized (State or federal funds) 

Mandatory 

2000 Vermont New residential homes, one 

family or multifamily 

Unsubsidized and subsidized (State or federal funds) 

Mandatory 

2001 Minnesota New residential homes, one 

family or multifamily 

Applies only to projects financed in whole or in part by the Minnesota Housing Finance Agency 

Mandatory if 

MHFA funds are 

used 

2002 New Mexico “UD Package” All public and private homes Voluntary 2002 Kansas New single-family houses, 

duplexes, and triplexes 

Subsidized (State or federal funds) 

Mandatory 

2002 Georgia Easy Living Home 

Project 

Single-family homes, townhomes, and attached home of fewer than four units. 

Voluntary/ 

Certificate based 

451
Table 10. Existing State Visitability Laws and Programs (cont’d) 

Date Location Name Types of Homes 

Subsidized/ 

Unsubsidized 

Mandatory/ 

Voluntary 

2002–2004 Illinois Accessible 

Housing Demonstration Grant Program 

Spec homes—private single residence constructed by a builder or individual for sale on the open market 

Voluntary/ 

Incentive based 

2003 Oregon New rental housing Subsidized (State or 

federal funds) from the Oregon Housing and Community Services Department 

Mandatory 

2003 Kentucky KHC Universal 

Design Standards Policy 

Subsidized with Kentucky Housing Corporation (KHC) financing 

Subsidized with Kentucky Housing Corporation (KHC) financing 

Mandatory 

2005 New Jersey New Jersey’s 

Barrier Free Subcode 

Buildings with four or more dwelling units in a single structure 

Mandatory 

2006 Michigan Public Act 182 Newly constructed for 

residential purposes and intended for occupancy by a single family, two families, or three families 

Housing that uses Michigan State Housing Development Authority (MSHDA) funding 

Mandatory 

2006 Pennsylvania Residential Visitability Tax 

Credit Act (Senate Bill 1158) 

Voluntary 

2007 Ohio Newly constructed units in 

properties that receive tax credits 

Mandatory 

Source: University of Buffalo, School of Architecture and Planning and Concrete Change.

452
Table 11. U.S. City Visitability Ordinances 

Date Location Types of Homes 

Subsidized/ 

Unsubsidized 

Mandatory/ 

Voluntary 

1992 Atlanta, GA Single-family homes Any federal, State, or city 

financial benefits dispersed through the city 

Mandatory 

1997 Freehold Borough, 

NJ 

Public and private dwellings Voluntary/

Incentive 

1998 Austin, TX New single-family homes, 

duplexes, triplexes 

Subsidized (any public funds) Mandatory 

1999 Irvine, CA New single-family homes Voluntary 

2000 Urbana, IL New single-family dwellings or 

one to four units, duplexes and triplexes 

Subsidized (city funds) Mandatory 

2001 Visalia, CA New single-family homes Voluntary/ 

Certificate program

2001 San Mateo County, 

CA 

Consumer

awareness 

2001 Howard County, 

MD 

Consumer

awareness 

2001–2002 Albuquerque, NM All new homes Subsidized and unsubsidized Consumer 

awareness/ 

Voluntary 

2002 San Antonio,TX New single-family homes, 

duplexes, triplexes 

Subsidized (city, State, or federal funds) 

Mandatory 

2002 Onondaga County, 

NY 

New single-family homes and duplexes 

Subsidized (county assistance) 

Voluntary 

2002 Southampton, NY New one- and two-family detached housing Voluntary/Incentive 

based 

2002 Naperville, IL All new single-family homes All homes (subsidized and 

unsubsidized) 

Mandatory 

453
Table 11. U.S. City Visitability Ordinances (cont’d) 

Date Location Types of Homes 

Subsidized/ 

Unsubsidized 

Mandatory/ 

Voluntary 

2002 Pima County, AZ 

(Tucson) 

All new single-family homes All homes (subsidized and 

unsubsidized) 

Mandatory 

2002 Long Beach, CA All single-family or duplex 

dwelling units 

Subsidized (city funds) Mandatory 

2002 Iowa City, IA All dwelling units All subsidized Mandatory 

2003 Syracuse, NY New single-family homes Voluntary 2003 Bolingbrook, IL All new single detached 

dwelling units 

All homes (subsidized and unsubsidized) 

Mandatory 

2003 Escanaba, MI Property owners 

All homes Voluntary/Consumer 

incentive 

2003 Chicago, IL 20% single-family homes and 

townhomes in planned developments must be “adaptable” or “visitable” 

All homes Mandatory 

2003 St. Louis County, 

MO 

Any homes built with county funds 

All homes: New construction and substantial rehabilitation 

Mandatory 

2004 Houston, TX Affordable housing Voluntary/Incentives

to developers 

2004 Pittsburgh, PA Pittsburgh Visitability Ordinance Newly constructed or 

substantially renovated singlefamily dwellings, duplexes, triplexes, townhouses and row houses 

Tax incentive 

2004 St. Petersburg, FL All new one- to three-unit 

homes 

Subsidized (city funds) Mandatory 

2005 Toledo, OH All new one- to three-unit 

homes 

Subsidized (any government funds) and built within the city of Toledo 

Mandatory 

454
Table 11. U.S. City Visitability Ordinances (cont’d) 

Date Location Types of Homes 

Subsidized/ 

Unsubsidized 

Mandatory/ 

Voluntary 

2005 Auburn, NY All new one- to three-unit Subsidized (city funds)— Mandatory 

homes single-family homes, duplexes, 

and triplexes that are constructed with public funds 

2005 Prescott Valley, AZ Voluntary 

2005 Scranton, PA All new one- to three-unit Subsidized (city funds)— Mandatory 

homes single-family homes, duplexes, 

and triplexes that are constructed with public funds 

2005 Arvada, CO 15% of all new dwelling units must be visitable or visitable Mandatory 

adaptable; an additional 15% must include interior visitable features 

2006 Pittsburgh, PA Residential Visitability Tax Voluntary 

Credit Act (Senate Bill 1158) 

2006 Milwaukee, WI New/substantially rehabilitated Subsidized—Recipients of the Mandatory 

multifamily city’s Housing Trust Fund 

2007 Montgomery All new home building and renovation in single-family attached Voluntary 

County, MD and detached homes 

2007 Rockford, IL All new one- to three-unit Subsidized (city funds)—in Mandatory 

homes new residential structure(s) 

constructed with public funds or with financial assistance originating from or flowing through the city of Rockford 

455
Table 11. U.S. City Visitability Ordinances (cont’d) 

Date Location Types of Homes 

Subsidized/ 

Unsubsidized 

Mandatory/ 

Voluntary 

2007 Davis, CA 100% of all new market-rate 

and middle-income singlefamily residential units shall be developed with visitability and all new single-family affordable residential units shall be developed with first-floor accessibility (includes bedroom)

Target of 100% visitability Voluntary (facilitate 

inclusion of 

accessibility and 

visitability features to 

the greatest extent 

possible, including 

use of incentives) 

2007 Lafayette, CO All new housing The 25% requirement would 

apply regardless of whether the development consisted of single-family detached or multifamily units. Mixed-use developments that include a vertical mix of uses and have 

Mandatory 

greater than 75% of the units located above the ground floor

2007 Dublin City, CA All new housing The universal design 

ordinance requires developers building more than 20 houses in a given project to install UD features. The ordinance 

Mandatory 

requires the developer to offer a list of optional features to make homes more accessible, such as a zero-step entrance. 

2007 Birmingham, AL All new single-family homes Subsidized (city funds) Mandatory 

456
457

Table 11. U.S. City Visitability Ordinances (cont’d) 

Date Location Types of Homes 

Subsidized/ 

Unsubsidized 

Mandatory/ 

Voluntary 

2007 Tucson, AZ All new single-family homes All homes (subsidized and Mandatory 

(takes effect unsubsidized) Jan. 1, 2008) 2007 

Source: University of Buffalo, School of Architecture and Planning and Concrete Change. 
458
APPENDIX B. Mission of the National Council on 

Disability 

Overview and Purpose 

The National Council on Disability (NCD) is an independent federal agency, composed 

of 15 members appointed by the President, by and with the consent of the U.S. Senate. 

The purpose of NCD is to promote policies, programs, practices, and procedures that 

guarantee equal opportunity for all people with disabilities, and that empower people 

with disabilities to achieve economic self-sufficiency, independent living, and inclusion 

and integration into all aspects of society. 

To carry out this mandate we gather public and stakeholder input, including that 

received at our public meetings held around the country; review and evaluate federal 

programs and legislation; and provide the President, Congress, and federal agencies 

with advice and recommendations. 

Specific Duties 

The current statutory mandate of NCD includes the following: 

● Reviewing and evaluating, on a continuing basis, policies, programs, practices, 

and procedures concerning people with disabilities conducted or assisted by 

federal departments and agencies, including programs established or assisted 

under the Rehabilitation Act of 1973, as amended, or under the Developmental 

Disabilities Assistance and Bill of Rights Act, as well as all statutes and 

regulations pertaining to federal programs that assist such people with 

disabilities, to assess the effectiveness of such policies, programs, practices, 

procedures, statutes, and regulations in meeting the needs of people with 

disabilities. 

459
● Reviewing and evaluating, on a continuing basis, new and emerging disability 

policy issues affecting people with disabilities in the Federal Government, at the 

State and local government levels, and in the private sector, including the need 

for and coordination of adult services, access to personal assistance services, 

school reform efforts and the impact of such efforts on people with disabilities, 

access to health care, and policies that act as disincentives for individuals to 

seek and retain employment. 

● Making recommendations to the President, Congress, the Secretary of 

Education, the director of the National Institute on Disability and Rehabilitation 

Research, and other officials of federal agencies about ways to better promote 

equal opportunity, economic self-sufficiency, independent living, and inclusion 

and integration into all aspects of society for Americans with disabilities. 

● Providing Congress, on a continuing basis, with advice, recommendations, 

legislative proposals, and any additional information that NCD or Congress 

deems appropriate. 

● Gathering information about the implementation, effectiveness, and impact of 

the Americans with Disabilities Act of 1990 (ADA) (42 U.S.C. § 12101 et seq.). 

● Advising the President, Congress, the commissioner of the Rehabilitation 

Services Administration, the assistant secretary for Special Education and 

Rehabilitative Services within the Department of Education, and the director of 

the National Institute on Disability and Rehabilitation Research on the 

development of the programs to be carried out under the Rehabilitation Act of 

1973, as amended. 

● Providing advice to the commissioner of the Rehabilitation Services 

Administration with respect to the policies and conduct of the administration. 

● Making recommendations to the director of the National Institute on Disability 

and Rehabilitation Research on ways to improve research, service, 

administration, and the collection, dissemination, and implementation of 

research findings affecting people with disabilities. 

460
461

● Providing advice regarding priorities for the activities of the Interagency 

Disability Coordinating Council and reviewing the recommendations of this 

council for legislative and administrative changes to ensure that such 

recommendations are consistent with NCD’s purpose of promoting the full 

integration, independence, and productivity of people with disabilities. 

● Preparing and submitting to the President and Congress an annual report titled 

National Disability Policy: A Progress Report. 

Statutory History 

NCD was established in 1978 as an advisory board within the Department of Education 

(P.L. 95–602). The Rehabilitation Act Amendments of 1984 (P.L. 98–221) transformed 

NCD into an independent agency. 
462
463

Endnotes 

1

 National Council on Disability, Creating Livable Communities (Washington, DC: NCD, 

2006). 

2

 See, for example, the Housing and Urban Development PIC system data. 

3

 See, for example, www.socialserve.com, a nonprofit organization that has developed 

housing locator Web sites for at least 22 States. Most have search features that include 

some level of accessibility and affordability. 

4

 The research focuses on best practices in the United States and does not include 

specific international examples because given the local nature of housing development, 

it is difficult to translate housing programs and policy from other countries for use in the 

United States. 

5

 J. Smith, Housing Needs of People with Disability in the U.S. (Chicago: Nathalie P. 

Voorhees Center for Neighborhood and Community Improvement, University of Illinois 

at Chicago, 2009). Data was from the 2005 Survey of Income and Program Participation 

(SIPP) and the 2007 American Community Survey (ACS). This number is expected to 

be higher if data on institutionalized people was available to include. 

6

 M.W. Brault, J. Hootman, K.A. Theis, “Prevalence and Most Common Causes of 

Disability Among Adults—United States, 2005,” Morbidity and Mortality Weekly Report, 

Centers for Disease Control and Prevention (May 1, 2009), http://www.cdc.gov/mmwr/

preview/mmwrhtml/mm5816a2.htm. 

7 http://www.infouse.com/disabilitydata/workdisability/appendices_glossary.php. 

8

 In the SIPP, people ages 15 years and older were identified as having a severe 

disability if they were unable to perform one or more functional activities; needed 

personal assistance with an ADL or IADL; used a wheelchair; were a long-term user of 

a cane, crutches, or a walker; had a developmental disability or Alzheimer’s disease; 

were unable to do housework; were receiving federal disability benefits; or were 16 to 

67 years old and unable to work at a job or business. 

9

 Smith, Housing Needs. This is based on American Housing Survey data, which 

estimates 110.6 million households in 2007. The 2007 American Community Survey 

estimates 112.4 million households. 

10 Ibid. 

11 Smith, Housing Needs. Data is from the 2007 American Housing Survey. 

12 U.S. Census Bureau, Population in Group Quarters by Type, Sex and Age, for the 

United States: 1990 and 2000 (PHC-T-26), accessed January 30, 2009, from 

http://www.census.gov/population/www/cen2000/briefs/phc-t26/index.html. 

13 A. Pathania, “Nursing Homes in U.S. Register a 41% Increase in Occupancy,” March 

23, 2009. Data analysis done by the Associated Press, http://topnews.us/content/

24540-nursing-homes-us-register-41-increase-occupancy. 
464

14 U.S. Centers for Disease Control and Prevention, Fact Sheets, accessed January 27, 

2009, from http://www.cdc.gov/ncipc/factsheets/nursing.htm. 

15 U.S. Department of Housing and Urban Development, The 2008 Annual Homeless 

Assessment Report (Washington, DC: HUD, Office of Community Planning and 

Development, 2009). 

16 U.S. Department of Housing and Urban Development, Affordable Housing Needs 

2005: Report to Congress (Washington, DC: HUD, May 2007). 

17 K.P. Nelson, The Hidden Housing Crisis: Worst Case Housing Needs Among Adults 

with Disabilities, prepared for the Housing Task Force of the Consortium for Citizens 

with Disabilities, p. 2. http://www.tacinc.org/Docs/HH/HiddenHousingCrisis.pdf. 

18 Ibid. 

19 U.S. Department of Housing and Urban Development, Affordable Housing Needs 

2005. 

20 Ibid. 

21 Smith, Housing Needs. This number is expected to be higher if data on 

institutionalized people was available to include. 

22 E. Cooper, H. Korman, A. O’Hara, and A. Zovistoski, Priced Out in 2008: The 

Housing Crisis for People with Disabilities, Technical Assistance Collaborative, Inc., 

Consortium for Citizens with Disabilities, Housing Task Force, April 2009. 

23 National Low Income Housing Coalition, “Out of Reach 2009 U.S. Statistics,” 

http://www.nlihc.org/oor/oor2009/OOR_US-Fact-Sheet.pdf. 

24 Ibid. 

25 Based on data from a special one-time supplement on disability and housing 

modifications to the 1995 American Housing Survey. Summary tables from Michael 

Shae, Housing Choice Voucher Tenant Accessibility Study: 2001–2002, prepared for 

the U.S. Department of Housing and Urban Development, Office of Policy Development 

and Research, 2004. 

26 This includes people with chemical sensitivities and electromagnetic sensitivities. For 

more information, contact the National Center for Environmental Health Strategies 

(NCEHS), http://www.ncehs.org. 

27 Ibid. 

28 National Council on Disability, The State of 21st Century Long-Term Services and 

Supports: Financing and Systems Reform for Americans with Disabilities (Washington, 

DC: NCD, 2005). 

29 Ibid. 

30 S. Golant, “The Housing Problems of the Future Elderly Population,” Commission on 

Affordable Housing and Health Facility Needs for Seniors in the 21st Century, A Quiet 

Crisis in America: A Report to Congress, Appendix G-1 (Washington, DC: U.S. 

Government Printing Office, 2002), pp. 189–370; Federal Interagency Forum on Aging-
465

Related Statistics, Older Americans Update 2006: Key Indicators of Well-Being

(Washington, DC: U.S. Government Printing Office, 2006); and U.S. Department of 

Health and Human Services, A Profile of Older Americans 2002 (Washington, DC: 

Administration on Aging, 2002). 

31 C. Koyanagi, Learning from History: Deinstitutionalization of People with Mental 

Illness as Precursor to Long Term Care Reform: Kaiser Commission on Medicaid and 

the Uninsured, 2007). See also Ann Braden Johnson, Out of Bedlam: The Truth About 

Deinstitutionalization (New York: Basic Books, 1992). 

32 Board and care homes are also called “adult homes” and “halfway houses.” 

33 Substance Abuse and Mental Health Services Administration (SAMHSA), 

Transforming Housing for People with Psychiatric Disorders Report (Washington, DC: 

SAMHSA, 2006). 

34 Ibid. 

35 G. Nelson, H.G. Brent, and R. Walsh-Bowers, “Predictors of the Adaptation of People 

with Psychiatric Disabilities in Group Homes, Supportive Apartments, and Board-andCare Homes,” Psychiatric Rehabilitation Journal 22, no. 4 (1999): 381–390. 

36 National Council on Disability, Inclusive Livable Communities for People with 

Psychiatric Disabilities (Washington, DC: NCD, 2008). 

37 AARP, These Four Walls...Americans 45+ Talk About Home and Community 

(Washington, DC: AARP Public Policy Institute, 2003). 

38 M. Minkler, J. Hammel, et al., “Moving Out of the Nursing Home: Building Community 

Capacity and Fostering Public Policy Change Through Community Based Participatory 

Research,” Journal of Disability Policy Studies, forthcoming. 

39 S.H. Kaye, Is the Status of People with Disabilities Improving? (Washington, DC: U.S. 

Department of Education, 1998). 

40 T. Wilson, Survey of Nursing Home Placement and Community Living Options,

Access Living Report, Chicago: 2000); J. Charlton, Nothing About Us Without Us

(Berkeley, CA: University of California Press, 1998); J. Hammel, R. Jones, A. Gossett, 

and E. Morgan, “Examining Barriers and Supports to Community Living and 

Participation After a Stroke from a Participatory Action Research Approach,” Topics in 

Stroke Rehabilitation (2006): 43–58; S.H. Kaye, Disability and the Digital Divide

(Washington, DC: U.S. Department of Education, 2000). 

41 The U.S. Department of Housing and Urban Development is in the process of 

updating its ABA standards, which apply to federally funded residential facilities. 

42 See NCD Topical Brief #2: “Private and Nonprofit Sector Housing” and NCD Topical 

Brief #5: “State Evaluation.” 

43 2007American Housing Survey estimates of rental housing based on year built. 

44 Joint Statement of the U.S. Department of Housing and Urban Development and the 

U.S. Department of Justice, Reasonable Accommodations Under the Fair Housing Act, 

June 17, 2004. 
466

45 The Urban Institute, Discrimination Against Persons with Disabilities: Barriers at 

Every Step (Washington, DC: HUD, Office of Policy Development and Research, 2005). 

46 Ibid., p. 2. 

47 Ibid. 

48 National Fair Housing Alliance, The Future of Fair Housing: Report of the National 

Commission on Fair Housing and Equal Opportunity, December 2008 

http://www.nationalfairhousing.org/. 

49 http://www.hud.gov/offices/fheo/FHLaws/yourrights.cfm. 

50 http://www.hud.gov/offices/fheo/FHLaws/yourrights.cfm. 

51 National Fair Housing Alliance, The Future of Fair Housing, p. 15. 

52 A very thorough review of all the HUD programs for people with disabilities, including 

the history and evolution of each, can be found in Libby Perl, Section 811 and Other 

HUD Housing Programs for Persons with Disabilities (Washington, DC: Congressional 

Research Service, Domestic Social Policy Division, November 3, 2008), 

http://assets.opencrs.com/rpts/RL34728_20081103.pdf. 

53 Before the ACS, HUD would produce annually adjusted estimates of the decennial 

census. These calculations do not include tax credit properties covered under the 

Housing and Economic Recovery Act of 2008 (P.L. 110–289), which have special 

income limits. For those limits, see http://www.huduser.org/datasets/mtsp.html. 

54 For all income limits, go to HUD’s FY 2009 Income Limits Documentation System at 

http://www.huduser.org/datasets/il/il2009/select_Geography.odb. 

55 U.S. Department of Housing and Urban Development. Median in some cases is lower 

than the 80 percent of median value; the values are taken directly from HUD’s FY 2009 

Income Limit Calculation Documentation System at http://www.huduser.org/datasets/

il/index_il2009.html. Cities selected were included in HUD’s Affordable Housing Needs 

2005: Report to Congress. 

56 See HUD’s Admission and Occupancy FAQ at http://www.hud.gov/offices/pih/phr/

about/ao_faq2.cfm. 

57 U.S. Department of Housing and Urban Development Resident Characteristic report 

generated by HUD for this NCD report. Resident data reflects tenants in public housing 

between January 1 and December 31, 2008. 

58 B. Sard and W. Fischer, Preserving Safe, High Quality Public Housing Should Be a 

Priority of Federal Housing Policy (Washington, DC: Center for Budget and Policy 

Priorities, 2008), http://www.cbpp.org/cms/index.cfm?fa=view&id=655. 

59 Ibid. 

60 U.S. Department of Housing and Urban Development Resident Characteristic report 

generated by HUD for this NCD report. Resident data reflects tenants in public housing 

between January 1 and December 31, 2008. 
467

61 For an estimate by State and housing authority, see Steve Gold, “Recent HUD 

Section 504 Compliance Reviews,” Information Bulletin #185, December 2006, at 

http://www.stevegoldada.com/stevegoldada/archive.php?mode=A&id=186. 

62 See the U.S. Department of Housing and Urban Development’s Voluntary 

Compliance Agreements online via the Fair Housing and Equal Opportunity Library at 

http://www.hud.gov/offices/fheo/library/index.cfm#vca. 

63 This particular CVA came out of advocacy on the part of Access Living of 

Metropolitan Chicago. 

64 HUD Designated Housing Status Report, accessed August 18, 2009, from 

http://nhl.gov/offices/pih/programs/ph/dhp/designated.cfm. 

65 Ibid. 

66 Fair Market Rent is calculated by HUD and is based on annual estimates of median 

rent for a region based on U.S. Census Bureau data. See http://www.huduser.org/

datasets/fmr.html. 

67 M. Shae, Housing Choice Voucher Tenant Accessibility Study: 2001–2002, prepared 

for the U.S. Department of Housing and Urban Development, Office of Policy 

Development and Research, 2004. 

68 The survey, which included a random sample of 400 HCV recipients from six public 

housing authorities, is not meant to be representative of all HCV uses in the United 

States. 

69 We do not have data to compare this rate to all voucher holders. 

70 J. Khadduri, K. Burnett, and D. Rodda, Targeting Housing Production Subsidies 

Literature Review (Washington, DC: HUD, 2007). 

71 HUD, Affordable Housing Needs 2005. 

72 2008 IREMS reports for each State were downloaded from the HUD Web site at 

http://www.hud.gov/offices/hsg/hsgmulti.cfm, and totals by each category—elderly 

designated, disabled designated, and accessible—were tallied by the author to produce 

these totals. 

73 Ibid. 

74 U.S. Department of Housing and Urban Development, FY 2007 Performance and 

Accountability Report, November 15, 2007, p. 439, http://www.hud.gov/offices/cfo/

reports/2007/2007par.pdf. 

75 811 funds specify that no more than six individuals with disabilities may live in a group 

home. U.S. Department of Housing and Urban Development, FY2008 SuperNOFA for 

HUD’s Discretionary Programs, Federal Register, vol. 73, no. 92, May 12, 2008, p. 

27320. The NOFA is available on the HUD website with different pagination at 

http://www.hud.gov/offices/adm/grants/nofa08/811sec.pdf. 
468

76 G. Locke, C. Nagler, and K. Lam, Implications of Project Size in Section 811 and 

Section 202 Housing for People with Disabilities, prepared for the U.S. Department of 

Housing and Urban Development, Office of Policy Development and Research, 2004. 

77 HUD Community Development Allocations and Appropriations, accessed August 18, 

2009, from http://www.hud.gov/offices/cpd/communitydevelopment/budget/.

78 This has been consistent for the past 8 years based on HUD data going back to 

FY 2001. See http://www.hud.gov/offices/cpd/communitydevelopment/budget/

disbursementreports/index.cfm. 

79 The number of housing units “benefitting” is available in entitlement community 

reports but not in aggregated data in the national performance report. 

80 Data from the HUD Integrated Disbursement and Information System (IDIS), 

http://www.hud.gov/offices/cpd/systems/idis/index.cfm. 

81 HUD, HOME Program National Production Report as of 01/31/09, accessed March 

2009 from http://www.hud.gov/offices/cpd/affordablehousing/reports/#npr. 

82 Ibid. 

83 For more on the history preceding the 1986 act, see the National Coalition for the 

Homeless at http://www.nationalhomeless.org/index.html. 

84 http://www.hudhre.info/index.cfm?do=viewSupportiveHousingProgram. 

85 http://www.hudhre.info/index.cfm?do=viewShelterPlusCare. 

86 http://www.hud.gov/offices/cpd/affordablehousing/training/web/lihtc/basics/. Also see 

U.S. Government Accountability Office, Tax Credits: Opportunities to Improve Oversight 

of the Low Income Housing Program (GAO/T-GGD/RCED-97-149) (Washington, DC: 

GAO, 1997). 

87 In addition, the city of Chicago has its own allocation of tax credits outside the State 

of Illinois. No other city has its own allocation. 

88 For current distribution and analysis of LIHTC allocations per State, go to 

http://www.danter.com/taxcredit/. 

89 Allocating Housing Tax Credits, U.S. Department of Housing and Urban 

Development, Community Planning and Development, accessed January 11, 2009, 

from http://www.fhasecure.gov/offices/cpd/affordablehousing/training/web/lihtc/basics/

allocating.cfm. 

90 http://www.huduser.org/datasets/lihtc.html. 

91 Abt Associates, HUD National Low Income Housing Tax Credit (LIHTC) Database: 

Projects Placed in Service Through 2005, prepared for the U.S. Department of Housing 

and Urban Development, 2007, http://www.huduser.org/datasets/lihtc.html. 

92 See HUD USER http://www.huduser.org/datasets/lihtc.html. 

93 Rents cannot exceed local market rents, which in some cases then will be less than 

these maximum rent caps. 
469

94 According to HUD, “Certain rental assistance programs can be used to raise the total 

rent above the LIHTC rent limit. For example, project-based Section 8 contract rents 

can exceed the LIHTC limit, but tenant-based Section 8 contract rents cannot.” See 

http://www.hud.gov/offices/cpd/affordablehousing/training/web/lihtc/basics/eligibility.cfm. 

95 U.S. Government Accountability Office, Tax Credits Opportunities to Improve 

Oversight of the Low-Income Housing Program: Testimony Before the Subcommittee on 

Oversight, Committee on Ways and Means, U.S. House of Representatives, April 23, 

1997. 

96 The categories are not necessarily mutually exclusive, since developers can target 

more than one population. 

97 Abt Associates, HUD National Low Income Housing Tax Credit (LIHTC) Database. 

98 Ibid. 

99 It is not determined if these rates are statistically significant. 

100 A very good source of current and historical data for all rural housing programs and 

issues is the Housing Assistance Council, http://www.ruralhome.org

101 Housing Assistance Council data portal at http://www.ruralhome.org/dataportal/. 

102 The 2009 income limits can be found at http://www.rurdev.usda.gov/rhs/sfh/

DSFH_Income_Limits/IL%20Direct.pdf. 

103 http://www.rurdev.usda.gov/rhs/sfh/area%20loan%20limit%20pdf%20files/CA.pdf. 

104 Search for rural multifamily property at http://rdmfhrentals.sc.egov.usda.gov/

RDMFHRentals/select_state.jsp. 

105 L. George, L. Strauss, and M. Kudlowitz, Connecting the Dots: A Location Analysis 

of USDA’s Section 515 Rental Housing and Other Federally Subsidized Rental 

Properties in Rural America, Housing Assistance Council, May 2008 

http://www.huduser.org/search/Bibliography.asp?id=200849

106 Ibid. 

107 National Fair Housing Alliance, USDA Rural Rental Testing Project, prepared for 

USDA, October 12, 2004. Unpublished report was attained via Freedom of Information 

Act request by NCD; received April 2009. 

108 Ibid. 

109 Ibid., p. 3. 

110 Ibid., p. 3. 

111 ICF Consulting Team, Rural Rental Housing—Comprehensive Property Assessment 

and Portfolio Analysis, prepared for the U.S. Department of Agriculture, Rural 

Development, November 2004, http://peerta.acf.hhs.gov/uploadedFiles/Rural%20Rental

%20Housing_ICF.pdf. 

112 The Housing Assistance Council estimates about 7,300 properties with 195,000 units 

are eligible to prepay. 
470

113 See S. Crowley, “The Truth About the Housing Trust Fund,” 2008, at 

http://www.nlihc.org/detail/article.cfm?article_id=5552&id=48. 

114 See http://www.hud.gov/offices/pih/programs/hcv/vash/index.cfm. 

115 See K. Mulligan, “VA Excels in Reaching Homeless Mentally Ill Vets,” Psychiatric

News 39, no. 12 (June 18, 2004), http://pn.psychiatryonline.org/cgi/content/full/39/12/12. 

116 http://www.govtrack.us/congress/bill.xpd?bill=h111-1408. This bill was first 

introduced by Representative Schakowsky in 2002 (H.R. 5683). 

117 Center for Budget and Public Policy (CBPP), “House Bill Makes Significant 

Improvements in ‘HOPE VI’ Public Housing Revitalization Program,” 2008, 

http://www.cbpp.org/1-16-08hous.htm. 

118 Ibid. CBPP does raise concerns about the House bill’s not addressing the issue of 

employment/work requirements that can either prevent people from using housing or 

push them out if they do not comply. 

119 For more detail, see http://www.washingtonwatch.com/bills/show/111_SN_

118.html#toc1. 

120 U.S. Department of Housing and Urban Development, based on data entry screen 

shots from Integrated Real Estate Management System, HUD User’s Guide for PBCA’s 

Chapter 7: Occupancy, May 2008, to be completed by Performance Based Contract 

Administrators (PBCA), http://www.hud.gov/offices/hsg/mfh/rems/ug/7caoccu.pdf. 

121 http://www.clpha.org/uploads/10.24.08__Policy_Framework-_Final.pdf. 

122 See “HUD, DOT and EPA Partnership: Sustainable Communities,” June 16, 2009, 

http://www.hud.gov/content/releases/pr2009-06-16factsheet.pdf. 

123 Smart Codes in Your Community: A Guide to Building Rehabilitation Codes, U.S. 

Department of Housing and Urban Development, 2001, http://www.huduser.org/

Publications/pdf/smartcodes.pdf. 

124 For more information, go to http://www.iccsafe.org. 

125 See Regulatory Barriers Clearinghouse maintained by the U.S. Department of 

Housing and Urban Development, Policy Development and Research, at 

http://www.huduser.org/rbc/. Also see M. Lugar and K. Temkin, Red Tape and Housing 

Costs: How Regulation Affects New Residential Development (New Brunswick, NJ: 

CUPR Press, 2000). 

126 Consolidated Plan/CHAS 2000 Data available by State, accessed January 2009 

from http://www.huduser.org/datasets/cp.html. 

127 State and local Consolidated Plans available at http://www.hud.gov/offices/cpd/

about/conplan/local/index.cfm. 

128 See Guidelines for Preparing Consolidated Plan and Performance and Evaluation 

Report Submissions for Local Jurisdictions, U.S. Department of Housing and Urban 

Development, Office of Community Planning and Development, http://www.hud.gov/

offices/cpd/about/conplan/toolsandguidance/guidance/, accessed November 4, 2009. 
471

129 ADA defined discrimination as “a failure to make reasonable modifications in 

policies, practices, or procedures, when such modifications are necessary to afford such 

goods, services, facilities, privileges, advantages, or accommodations to individuals with 

disabilities, unless the entity can demonstrate that making such modifications would 

fundamentally alter the nature of such goods, services, facilities, privileges, advantages, 

or accommodations.” For more information, go to http://www.ada.gov/. 

130 As cited in Olmstead: “States are required to place persons with mental disabilities in 

community settings rather than in institutions when the State’s treatment professionals 

have determined that community placement is appropriate, the transfer from institutional 

care to a less restrictive setting is not opposed by the affected individual, and the 

placement can be reasonably accommodated, taking into account the resources 

available to the State and the needs of others with mental disabilities.” 

131 See W. Fox-Grage, B. Coleman, and D. Fleer, The States’ Response to the 

Olmstead Decision: A 2003 Update, National Conference of State Legislatures (NCSL) 

and AARP Public Policy Institute, 2004; Mathis, “Community Integration of Individuals 

with Disabilities: An Update on Olmstead Implementation,” Journal of Poverty Law and 

Policy (November–December 2001), http://www.bazelon.org/issues/disabilityrights/

resources/olmstead. 

132 The New Freedom Initiative was announced by President George W. Bush on 

February 1, 2001, followed up by the Executive Order 13217 on June 18, 2001. 

133 See Fox-Grage et al., The States’ Response to the Olmstead Decision. 

134 See M. Kitchener, M. Willmott, M. Alameida, A. Wong, and C. Harrington, 

Introduction to Olmstead Lawsuits and Olmstead Plans, 2008, http://pascenter.org/

olmstead/index.php; S. Rosenbaum, J. Teitelbaum, and A. Stewart, An Analysis of 

Olmstead Complaints: Implications for Policy and Long-Term Planning (Washington, 

DC: Center for Health Care Strategies, Inc., 2001), http://www.gwumc.edu/sphhs/

departments/healthpolicy/CHPR/downloads/olmsteadcomplaints.pdf

135 See W. Fox-Grage, B. Coleman, and D. Fleer, The States’ Response to the 

Olmstead Decision: A 2003 Update, National Conference of State Legislatures (NCSL) 

and AARP Public Policy Institute, 2004; Mathis, “Community Integration of Individuals 

with Disabilities: An Update on Olmstead Implementation,” Journal of Poverty Law and 

Policy (November–December 2001), http://www.bazelon.org/issues/disabilityrights/

resources/olmstead; National Council on Disability, Olmstead: Reclaiming 

Institutionalized Lives (abridged version), 2003, http://www.ncd.gov/newsroom/

publications/2003/reclaimabridged.htm. 

136 CMS definition, http://www.ssa.gov/disability/professionals/bluebook/

general-info.htm. For further information on how medical necessity can impact a person 

with disabilities trying to receive medical services (e.g., CMS-funded), see “Medical 

Necessity Determination in the Medicare Program: Are the Interests of Beneficiaries 

with Chronic Conditions Being Met?” http://www.partnershipforsolutions.org/DMS/files/

MedNec1202.pdf. 

137 P.L. 101–336. 
472

138 Seven broad architectural guidelines: (1) accessible entrance on an accessible 

route; (2) accessible public and common use areas; (3) usable doors; (4) accessible 

routes into and through a dwelling unit; (5) reinforced bathroom walls; (6) useable 

kitchens and bathrooms; and (7) accessible light switches, electrical outlets, and 

environmental controls. For further information, see http://www.hud.gov/offices/fheo/

disabilities/fhguidelines/fhefha5.cfm#sect5. 

139 For further information, see http://www.iccsafe.org/cs/codes/

140 See NCD Topical Brief #2 for more information. 

141 See NCD Topical Brief #1 for an overview. 

142 See T. Reuters, Medicaid Long-Term Care Expenditures in FY 2007 and Medicaid 

HCBS Waiver Expenditures FY 2002 Through FY 2006, 2008, at the Clearinghouse for 

Home- and Community-Based Services, http://www.hcbs.org/. 

143 See, for example, www.socialserve.com, a nonprofit organization that has developed 

housing locator Web sites for more than half the States (number is in flux as some are 

in development and not yet active), most of which have search features that include 

some level of accessibility and affordability. 

144 Rutgers Center for State Health Policy/NASHP, Community Living Exchange 

Collaborative, Single Entry Point Systems: State Survey Results, August 2003, 

http://www.nashp.org/Files/SEPReport11.7.03.pdf. 

145 See http://www.cms.hhs.gov/NewFreedomInitiative/01_Overview.asp#TopOfPage

for overview and State profiles featured in CMS Promising Practice resources. 

146 See 

http://www.cms.hhs.gov/PromisingPractices/HCBSPPR/list.asp?intNumPerPage=all&

submit=Go for specific State examples. 

147 See summary overview of effective policy and strategies: O’Keeffe, Crisp, Doty, 

Flanagan, Smith, et al., Developing and Implementing Self-Direction Programs and 

Policies: A Handbook, National Resource Center for Participant-Directed Services and 

Robert Wood Johnson Foundation, 2009, http://www.cashandcounseling.org/

resources/handbook.

148 See, for example, New Hampshire’s infrastructure to track participants and monitor 

provision of services and supports over time. The system is designed to improve 

funding and service coordination, as well as to provide check-in points for consumers so 

risks of community living can be proactively identified and managed to prevent future 

institutionalization. 

149 See http://www.hpm.umn.edu/ltcresourcecenter/research/rebalancing/

Rebalancing_state_ltc_systems.htm for long-term research of systems change 

initiatives. 

150 A. O’Hara, “Using Mainstream Affordable Housing and Service Systems Resources 

to Create Permanent Supportive Housing for Cross-Disability Homeless and At-Risk 

Populations,” in A New PSH Approach: The Louisiana and North Carolina PSA 

Initiatives (Boston: Technical Assistance Collaborative, Inc., 2009). 
473

151 Access Living was contracted to assist in writing this report. As one of the oldest 

Centers for Independent Living in the country, Access Living is a recognized leader in 

developing innovative programs aimed at improving system change and coordination. 

152 Few States have included housing locator information in their Consolidated Plans, 

while some States have housing locator services available. States that are 

implementing Money Follows the Person are using such services. 

153 Only cities that have 30 or more units listed on Socialserve.com receive a housing 

filter component, particularly regarding accessible features. 

154 See http://www.massaccesshousingregistry.org/. 

155 See http://www.accessva.org/. 

156 See http://www.accessibleapartments.org. 

157 See http://www.housingconnections.org. 

158 See http://www.dads.state.tx.us/providers/pi/mfp_demonstration/ for additional 

information and reports. 

159 See http://dail.vermont.gov/dail-publications; See also NCD Topical Brief #1 for 

overview of new 811 legislation, H.R. 1675. 

160 “About UCP Texas,” UCP Texas homepage, accessed January 12, 2009, from 

http://www.ucptexas.org/about_UCP_Texas.html. 

161 Naomi Hubert, Housing Coordinator, UCP Texas, interview, January 12, 2009. 

162 Ibid. 

163 Ibid. 

164 “Housing Opportunities,” UCP Texas homepage, accessed January 12, 2009, from 

http://www.ucptexas.org/housing.html. 

165 Hubert, interview. 

166 Ibid. 

167 Ibid. 

168 Ibid. 

169 Ibid. 

170 Royal Walker, Co-Director, Institute for Disability Studies, University of Southern 

Mississippi, interview, January 12, 2009. 

171 Alma Ellis, Project Coordinator, Institute for Disability Studies, University of Southern 

Mississippi, email, January 13, 2009. 

172 Cassie Hicks, Coordinator for Housing Initiatives, Institute for Disability Studies, 

University of Southern Mississippi, interview, January 12, 2009. 

173 Hicks, interview. 

174 Walker, interview. 
474

175 IDS Housing Fact Sheets, accessed January 11, 2009, from http://www.usm.edu/ids/

housing/housing_fact_sheets.pdf. 

176 Ellis, email. 

177 IDS Housing Fact Sheets. 

178 Ellis, email. 

179 Walker, interview. 

180 Ibid. 

181 Ellis, email. 

182 M. Morris, Coordination and Leveraging Long-Term Supports with Affordable and 

Accessible Housing for Persons with Disabilities: Maryland Case Study, February 2007, 

pp. 1–2. Rutgers Center for State Health Policy. 

183 Ibid., pp. 3–4. 

184 Ibid. 

185 Ibid. 

186 Ibid., p. 2. 

187 Ibid., pp. 1–2. 

188 Ibid., pp. 3–4. 

189 Ibid., p. 4. 

190 P. Walker and R. Cory, Shifting from Empowered Agencies to Empowered People: 

Neighbors, Inc. (Syracuse, NY: Center on Human Policy, School of Education, 

Syracuse University, November 2002), p. 2. 

191 Ibid., p. 1. 

192 Ibid., pp. 4–5. 

193 Ibid., p. 5. 

194 Ibid., pp. 20–21. 

195 Patti Scott, CEO, Neighbors, Inc., interview, January 16, 2009. 

196 Real Life Summary, Real Life Choice Support Coordination, accessed January 16, 

2009, from http://www.neighbours-inc.com/RealLifeChoices/RLC_summary.html. 

197 Mission, Onondaga Community Living Web site, accessed January 16, 2009, from 

http://www.oclinc.org/Mission/mission_index.htm. 

198 Patricia Fratangelo, Executive Director, Onondaga Community Living, interview, 

January 16, 2009. 

199 Ibid. 

200 Kim Turner, Executive Director, Options in Community Living, interview, January 15, 

2009. 
475

201 Ibid. 

202 Ibid. 

203 Ibid. 

204 Options in Community Living, Inc., 2006 Annual Report, accessed January 15, 2009, 

from http://www.optionsmadison.com/OptionsAnnualReport2006.pdf. 

205 S. Tsemberis, L. Gulcur, and M. Nakae, “Housing First, Consumer Choice, and Harm 

Reduction for Homeless Individuals with a Dual Diagnosis,” American Journal of Public 

Health 94, no. 4 (2004): 651–656. 

206 Description of Pathways program is based on author interview with Sam Tsemberis, 

and on studies of the Pathways program, http://www.pathwaystohousing.org. 

207 From Pathways Web site, http://www.pathwaystohousing.org/TopMenu/AboutUs/

Snapshot.html. 

208 R.M. Greenwood, N.J. Schaefer-McDaniel, G. Winkel, and S.J, Tsemberis, 

“Decreasing Psychiatric Symptoms by Increasing Choice in Services for Adults with 

Histories of Homelessness,” American Journal of Community Psychology 36, no. 3/4 

(2005): 223–238. 

209 S. Tsemberis et al., “Housing First.” 

210 L. Gulcur, S. Tsemberis, A. Stefancic, and R.M. Greenwood, “Community Integration of 

Adults with Psychiatric Disabilities and Histories of Homelessness,” Community Mental 

Health Journal 43, no. 3 (2007): 211–227. 

211 From Pathways Web site, http://www.pathwaystohousing.org/TopMenu/AboutUs/

Snapshot.html. 

212 Ibid. 

213 L. Gulcur, A. Stefancic, M. Shinn, S. Tsemberis, and S.N. Fisher, “Housing, 

Hospitalization, and Cost Outcomes for Homeless Individuals with Psychiatric 

Disabilities Participating in Continuum of Care and Housing First Programmes,” Journal 

of Community Applied Social Psychology 13 (2003): 171–186; A. Stefancic and S. 

Tsemberis, “Housing First for Long-Term Shelter Dwellers with Psychiatric Disabilities in 

a Suburban County: A Four Year Study of Housing Access and Retention,” Journal of 

Primary Prevention 28 (2007): 265–279. 

214 Information about the RIST program is based on interviews conducted with Deborah 

Taggart, who heads the program, and Anne Portine, the coordinator of residential 

services, January 2009. 

215 Information contained in this profile of Main Street Housing was obtained via an 

author interview with Executive Director Ken Wineman, February 2009. 

216 Ibid. 

217 Ibid. 

218 Research implies that peer support empowers people with psychiatric disabilities to 

make decisions relatively autonomous from professional staff. L. Johnson, “The 
476

Community/Privacy Trade-Off in Supportive Housing: Consumer/Survivor Preferences,” 

Canadian Journal of Community Mental Health 20, no. 1 (2001): 123–134; K. Haertl, 

“Factors Influencing Success in a Fair-Weather Model Mental Health Program,” 

Psychiatric Rehabilitation Journal 28, no. 4 (2005): 370–377. 

219 “Unique Partnership Produces Nation’s First Affordable, Universal Design Apartment 

Complex,” AIA Architect, Project Watch, August 2005, accessed January 11, 2009, 

http://www.ahainc.org/aha.php?loc=headlines&thisone=20&page=news. 

http://www.aia.org/aiarchitect/thisweek05/tw0729/tw0729pw_unineighborhood.htm. 

220 Ibid. 

221 City of Berkeley Housing Department, Berkeley, California, accessed January 17, 

2009, from http://www.ci.berkeley.ca.us/ContentDisplay.aspx?id=10502. 

222 S. Saegert and L. Benítez, “Limited Equity Housing Cooperatives: Defining a Niche 

in the Low-Income Housing Market,” Journal of Planning Literature 19 (2005). 

223 Douglas Klein, personal communication, March 18, 2004, cited in Saegert and 

Benítez, “Limited Equity Housing Cooperatives.” 

224 Saegert and Benítez, “Limited Equity Housing Cooperatives.” 

225 Ibid., p. 432. 

226 Ibid. 

227 Cathy Ludlum, interview, January 14, 2009. 

228 Ibid. 

229 About Us: Not Just Bricks & Mortar, Penn South homepage, accessed January 15, 

2009, from http://www.pennsouth.coop/PublicPages/about.html. 

230 Naomi Goldstein, Education Director, Mutual Redevelopment Houses, interview, 

January 14, 2009. 

231 The State of 50+ American 2006, AARP Public Policy Institute, p. 43, accessed April 

28, 2009, from http://assets.aarp.org/rgcenter/econ/fifty_plus_2006.pdf. 

232 NORC/Vladek Cares, Henry Street Settlement’s NORC (Naturally Occurring 

Retirement Community) homepage, accessed January 6, 2009, from 

http://www.henrystreet.org/site/PageServer?pagename=sns_norc. 

233 How Do Housing Tax Credits Work? U.S. Department of Housing and Urban 

Development, Community Planning and Development, accessed January 11, 2009, 

from http://www.fhasecure.gov/offices/cpd/affordablehousing/training/web/lihtc/basics/

work.cfm. 

234 Allocating Housing Tax Credits, U.S. Department of Housing and Urban 

Development, Community Planning and Development, accessed January 11, 2009, 

from http://www.fhasecure.gov/offices/cpd/affordablehousing/training/web/lihtc/basics/

allocating.cfm. 
477

235 National Council of State Housing Agencies (NCSHA), State HFA Factbook: 2006 

NCSHA Annual Survey Results, 2006. 

236 2009 Low Income Housing Tax Credit Qualified Allocation Plan for the State of North 

Carolina, accessed January 16, 2009, from 

http://www.nchfa.com/Rental/RD2009qap.aspx. 

237 Ibid. 

238 “North Carolina: An Innovative Supportive Housing Model,” Opening Doors: A 

Housing Publication for the Disability Community 29 (November 2006): 9. It should be 

noted, however, that the North Carolina program only targets a small number of very 

low income people, and it combines people with disabilities and very low income 

individuals together, thus reducing the targeting for both groups. 

239 Ibid. 

240 Donald Kahl, Executive Director, The Equal Rights Center, email, January 26, 2008. 

241 Ibid. 

242 “National Developer Agrees to Groundbreaking Effort to Provide Accessible 

Housing,” accessed January 26, 2009, from http://www.equalrightscenter.org/releases/

pr_2007_07_17.php. 

243 Urban Land Institute, Development Case Studies, accessed January 6, 2009, from 

http://casestudies.uli.org/CaseStudies/C036016.htm; “Minimum Universal Design 

Requirements for New Construction Using Affordable Housing Trust Funds from the 

City of St. Louis,” Dolan Media Newswires, September 2004, revised September 2008; 

H. Livingston, “Designing to Accommodate Everyone: Universally Designed Building 

Awarded for Socially Responsible Housing,” AIA Architect, February 8, 2008. 

244 RERC on Universal Design at Buffalo, updated January 2008, Rehabilitation 

Engineering Research Center on Universal Design, School of Architecture and 

Planning, State University of New York at Buffalo, accessed January 23, 2009, from 

www.ap.buffalo.edu/idea/visitability/reports/existingcitylaws.xls; J.L. Maisel, E. Smith, 

and E. Steinfeld, Increasing Home Access, Designing for Visitability (Washington, DC: 

AARP Public Policy Institute, August 2008). 

245 Maisel et al., Increasing Home Access, p. 9. 

246 E. Smith, “Early History of the Visitability Movement,” Concrete Change homepage 

accessed January 28, 2009, from http://www.concretechange.org/visitability_history.aspx. 

247 Maisel et al., Increasing Home Access, p. 20. 

248 “Atlanta City Ordinance of 1992,” Concrete Change homepage, accessed January 

28, 2009, from http://www.concretechange.org/policy_legislative_local_atlanta.pdf. 

249 “Construction Costs,” Concrete Change homepage, accessed January 28, 2009, 

from http://www.concretechange.org/construction_costs.aspx. 

250 “Minimum Universal Design Requirements for New Construction Using Affordable 

Housing Trust Funds from the City of St. Louis,” September 2004, revised September 
478

2008, accessed January 9, 2009, from http://www.stlouis.missouri.org/development/

otherprojects/rfp-rfq/UDCriteria.doc. 

251 U.S. Government Accountability Office, Disaster Assistance: Better Planning Needed 

for Housing Victims of Catastrophic Disasters (GAO-07-88 Report) (Washington, DC: 

GAO, 2007), p. 35. 

252 V.T. Wood and R.A. Weisman, “A Hole in the Weather Warning System,” Bulletin of 

the American Meteorological Society 84, no. 2 (2003): 187–194. 

253 B.D. Phillips and B.H. Morrow, “Social Science Research Needs: Focus on 

Vulnerable Populations, Forecasting, and Warnings,” Natural Hazards Review 8, no. 3 

(2007): 61–68. 

254 E.L. Quarantelli, Sheltering and Housing After Major Community Disasters (Newark, 

DE: University of Delaware Disaster Research Center, 1982). 

255 National Organization on Disability, Special Needs Assessment for Katrina Evacuees 

Project, 2005, accessed December 18, 2008, from www.nod.org/emergency. 

256 K.J. Tierney, M.K. Lindell, and R.W. Perry, Facing the Unexpected: Disaster 

Preparedness and Response in the United States (Washington, DC: Joseph Henry 

Press, 2001). 

257 M. van Willigen, T. Edwards, B. Edwards, and S. Hessee, “Riding Out the Storm: 

Experiences of the Physically Disabled During Hurricanes Bonnie, Dennis, and Floyd,” 

Natural Hazards Review 3, no. 3 (2002): 98–106. 

258 National Council on Disability, Effective Emergency Management: Making 

Improvements for Communities and People with Disabilities, 2009, http://www.ncd.gov. 

259 E.L. Quarantelli, Sheltering and Housing After Major Community Disasters.

260 http://www.fema.gov/oer/crp.shtm. 

261 Advocacy Center, Update on FEMA Lawsuit (no date), accessed July 20, 2009, from 

http://www.advocacyla.org/news/fema.php. 

262 U.S. Department of Housing and Urban Development, “HUD Announces Disaster 

Assistance for Three Midwest States,” 2008, accessed June 30, 2009, from 

http://www.hud.gov/news/release.cfm?content=pr08-083.cfm; U.S. Department of 

Housing and Urban Development, “HUD Readies Disaster Assistance for Gulf 

Hurricane Victims,” 2008, accessed June 30, 2009, from 

http://www.hud.gov/news/release.cfm?content=pr08-130.cfm. 

263 U.S. Department of Justice, Project Civil Access, accessed August 10, 2009, from 

http://www.ada.gov/civicac.htm. 

264 National Council on Disability, Effective Emergency Management: Making 

Improvements for Communities and People with Disabilities, 2009, accessed August 20, 

2009, from http://www.ncd.gov/newsroom/publications/2009/

NCD_EmergencyManagement_HTML/EffectiveEmergencyManagement.html. 
479

265 D. Saliba, J. Buchanan, and R.S. Kingston, “Function and Response of Nursing 

Facilities During Community Disaster,” American Journal of Public Health 94, no. 8 

(2004): 1436–1441. 

266 National Council on Disability, Effective Emergency Management. 

267 Ibid. 

268 J. Kailes and A. Enders, “Moving Beyond ‘Special Needs’: A Function Based 

Framework for Emergency Management and Planning,” Journal of Disability Policy 

Studies 17, no. 4 (2006): 230–237. 

269 http://portal.hud.gov/app_nhls/, accessed July 21, 2009. 

270 U.S. Department of Homeland Security, Office of Civil Rights and Civil Liberties, 

Special Needs Populations Impact Assessment White Paper, 2008, accessed June 30, 

2009, from http://www.disabilitypreparedness.gov/pdf/ike_snp.pdf. 

271 http://www.adata.org/resources/rebuilding/index.html, accessed July 23, 2009. 

272 https://asd.fema.gov/inter/hportal/home.htm, accessed July 23, 2009. 

273 CRC/Congressional Research Service (CRS), Mortgage and Rental Assistance as 

Disaster Relief: Legislation in the 100th Congress (CRC Report Order Code RS22828) 

(Washington, DC: CRS, 2008). 

274 Federal Emergency Management Agency (FEMA), “Disaster Assistance Available 

from FEMA,” 2009, accessed June 30, 2009, from http://www.fema.gov/assistance/

process/assistance.shtm. 

275 Ibid., Comprehensive Planning Guides, p. 43. 

276 Ibid., Comprehensive Planning Guides, p. 44. 

277 FEMA, National Disaster Housing Strategy, January 2009, http://www.fema.gov/

emergency/disasterhousing/. 

278 National Council on Disability, Quarterly Meeting: People with Disabilities and 

Emergency Management, New Orleans, January 2008, p. 20. 

279 It is recognized that HUD has developed the National Fair Housing Training 

Academy (NFHTA) and that HUD currently provides ongoing training, technical 

assistance, and guidance. This set of recommendations aims to reinforce the need for 

consistent and regular training of all involved with the enforcement of the Fair Housing 

Act to assure enforcement is as uniform as possible everywhere in the United States. 

280 J. Smith, Housing Needs of People with Disability in the U.S. (Chicago: Nathalie P. 

Voorhees Center for Neighborhood and Community Improvement, University of Illinois 

at Chicago, 2009). Data was from the 2005 Survey of Income and Program Participation 

(SIPP) and the 2007 American Community Survey (ACS). This number is expected to 

be higher if data on institutionalized people was available to include. 

281 M.W. Brault, J. Hootman, K.A. Theis, “Prevalence and Most Common Causes of 

Disability Among Adults—United States, 2005,” Morbidity and Mortality Weekly Report, 
480

Centers for Disease Control and Prevention (May 1, 2009), http://www.cdc.gov/mmwr/

preview/mmwrhtml/mm5816a2.htm. 

282 http://www.infouse.com/disabilitydata/workdisability/appendices_glossary.php. 

283 In the SIPP, people ages 15 years and older were identified as having a severe 

disability if they were unable to perform one or more functional activities; needed 

personal assistance with an ADL or IADL; used a wheelchair; were a long-term user of 

a cane, crutches, or a walker; had a developmental disability or Alzheimer’s disease; 

were unable to do housework; were receiving federal disability benefits; or were 16 to 

67 years old and unable to work at a job or business. 

284 Smith, Housing Needs. This is based on American Housing Survey data, which 

estimates 110.6 million households in 2007. The 2007 American Community Survey 

estimates 112.4 million households. 

285 Ibid. 

286 Smith, Housing Needs. 

287 U.S. Census Bureau, Population in Group Quarters by Type, Sex and Age, for the 

United States: 1990 and 2000 (PHC-T-26), accessed January 30, 2009, from 

http://www.census.gov/population/www/cen2000/briefs/phc-t26/index.html. 

288 A. Pathania, “Nursing Homes in U.S. Register a 41% Increase in Occupancy,” March 

23, 2009. Data analysis completed by the Associated Press, http://topnews.us/content/

24540-nursing-homes-us-register-41-increase-occupancy. 

289 Centers for Disease Control and Prevention, Fact Sheets, accessed January 27, 

2009, from http://www.cdc.gov/ncipc/factsheets/nursing.htm. 

290 M. Brault, Americans with Disabilities: 2005, Current Population Reports, December 

2008. 

291 U.S. Department of Housing and Urban Development, Affordable Housing Needs 

2005: Report to Congress (Washington, DC: HUD, May 2007). 

292 K.P. Nelson, The Hidden Housing Crisis: Worst Case Housing Needs Among Adults 

with Disabilities, prepared for the Housing Task Force of the Consortium for Citizens 

with Disabilities, p. 2. http://www.tacinc.org/Docs/HH/HiddenHousingCrisis.pdf

293 Ibid. 

294 U.S. Department of Housing and Urban Development, Affordable Housing Needs 

2005. 

295 Ibid. 

296 Smith, Housing Needs. This number is expected to be higher if data on 

institutionalized people was available to include. 

297 National Low Income Housing Coalition, “Out of Reach 2009 U.S. Statistics,” 

http://www.nlihc.org/oor/oor2009/OOR_US-Fact-Sheet.pdf. 

298 Ibid. 
481

299 Based on data from a special one-time supplement on disability and housing 

modifications to the 1995 American Housing Survey, U.S. Bureau of the Census. 

Summary tables from Michael Shae, Housing Choice Voucher Tenant Accessibility 

Study: 2001–2002, prepared for the U.S. Department of Housing and Urban 

Development, Office of Policy Development and Research, 2004. 

300 This includes people with chemical sensitivities and electromagnetic sensitivities. For 

more information, contact the National Center for Environmental Health Strategies 

(NCEHS), http://www.ncehs.org. 

301 Ibid. 

302 National Council on Disability, The State of 21st Century Long-Term Services and 

Supports: Financing and Systems Reform for Americans with Disabilities (Washington, 

DC: NCD, 2005). 

303 Ibid. 

304 S. Golant, “The Housing Problems of the Future Elderly Population,” Commission on 

Affordable Housing and Health Facility Needs for Seniors in the 21st Century, A Quiet 

Crisis in America: A Report to Congress, Appendix G-1 (Washington, DC: U.S. 

Government Printing Office, 2002), pp. 189–370; Federal Interagency Forum on AgingRelated Statistics, Older Americans Update 2006: Key Indicators of Well-Being

(Washington, DC: U.S. Government Printing Office, 2006); and U.S. Department of 

Health and Human Services, A Profile of Older Americans 2002 (Washington, DC: 

Administration on Aging, 2002). 

305 C. Koyanagi, Learning from History: Deinstitutionalization of People with Mental 

Illness as Precursor to Long Term Care Reform, Kaiser Commission on Medicaid and 

the Uninsured, 2007. 

306 Ibid. See also Ann Braden Johnson, Out of Bedlam: The Truth About 

Deinstitutionalization (New York: Basic Books, 1992). 

307 Board and care homes are also called “adult homes” and “halfway houses.” 

308 Substance Abuse and Mental Health Services Administration (SAMHSA), 

Transforming Housing for People with Psychiatric Disorders Report (Washington, DC: 

SAMHSA, 2006). 

309 Ibid. 

310 G. Nelson, H.G. Brent, and R. Walsh-Bowers, “Predictors of the Adaptation of 

People with Psychiatric Disabilities in Group Homes, Supportive Apartments, and 

Board-and-Care Homes,” Psychiatric Rehabilitation Journal 22, no. 4 (1999): 381–390. 

311 National Council on Disability, Inclusive Livable Communities for People with 

Psychiatric Disabilities (Washington, DC: NCD, 2008). 

312 See NCD Topical Brief #3: “Mental Health Issues—Housing for People with 

Psychiatric Disabilities.” 

313 AARP, These Four Walls...Americans 45+ Talk About Home and Community 

(Washington, DC: AARP Public Policy Institute, 2003). 
482

314 M. Minkler, J. Hammel, et al., “Moving Out of the Nursing Home: Building Community 

Capacity and Fostering Public Policy Change Through Community Based Participatory 

Research,” Journal of Disability Policy Studies, in press. 

315 S.H. Kaye, Is the Status of People with Disabilities Improving? (Washington, DC: 

U.S. Department of Education, 1998). 

316 T. Wilson, Survey of Nursing Home Placement and Community Living Options

(Chicago: Access Living Report, 2000); J. Charlton, Nothing About Us Without Us 

(Berkeley, CA: University of California Press, 1998); J. Hammel, R. Jones, A. Gossett, 

and E. Morgan, “Examining Barriers and Supports to Community Living and 

Participation After a Stroke from a Participatory Action Research Approach,” Topics In 

Stroke Rehabilitation (Summer 2006): 43–58; and S.H. Kaye, Disability and the Digital 

Divide (Washington, DC: U.S. Department of Education, 2000). 

317 Rehabilitation Act of 1973, Title V, Section 504, 24 C.F.R. 8.27(a). 

318 24 C.F.R. 8.26. 

319 24 C.F.R. 8.26-27. 

320 See NCD Topical Brief #2: “Private and Nonprofit Sector Housing,” and NCD Topical 

Brief #5: “State Evaluation.” 

321 2007American Housing Survey estimates of rental housing based on year built. 

322 Joint Statement of the U.S. Department of Housing and Urban Development and the 

U.S. Department of Justice, Reasonable Accommodations Under the Fair Housing Act, 

June 17, 2004. 

323 A very thorough review of all the HUD programs for people with disabilities, including 

the history and evolution of each, can be found in Perl, L., Section 811 and Other HUD 

Housing Programs for Persons with Disabilities (Washington, DC: Congressional 

Research Service, Domestic Social Policy Division, November 3, 2008). 

324 Before the ACS, HUD would produce annually adjusted estimates of the decennial 

census. These calculations do not include tax credit properties covered under the 

Housing and Economic Recovery Act of 2008 (P.L. 110-289), which have special 

income limits. For those limits, see http://www.huduser.org/datasets/mtsp.html. 

325 For all income limits, go to HUD’s FY 2009 Income Limits Documentation System at 

http://www.huduser.org/datasets/il/il2009/select_Geography.odb. 

326 U.S. Department of Housing and Urban Development. Median in some cases is 

lower than the 80 percent of median value; the values are taken directly from HUD’s 

FY 2009 Income Limit Calculation Documentation System at http://www.huduser.org/

datasets/il/index_il2009.html. Cities selected were included in HUD’s Affordable 

Housing Needs 2005: Report to Congress. 

327 See HUD’s Admission and Occupancy FAQ at http://www.hud.gov/offices/pih/phr/

about/ao_faq2.cfm. 

328 HUD, Affordable Housing Needs 2005.
483

329 U.S. Department of Housing and Urban Development Resident Characteristic report 

generated by HUD for this NCD report. Resident data reflects tenants in public housing 

between January 1 and December 31, 2008. 

330 B. Sard and W. Fischer, Preserving Safe, High Quality Public Housing Should Be a 

Priority of Federal Housing Policy (Washington, DC: Center for Budget and Policy 

Priorities, 2008), http://www.cbpp.org/cms/index.cfm?fa=view&id=655. 

331 Ibid. 

332 U.S. Department of Housing and Urban Development Resident Characteristic report 

generated by HUD for this NCD report. Resident data reflects tenants in public housing 

between January 1 and December 31, 2008. 

333 For an estimate by State and housing authority, see Steve Gold, “Recent HUD 

Section 504 Compliance Reviews,” Information Bulletin #185, December 2006, at 

http://www.stevegoldada.com/stevegoldada/archive.php?mode=A&id=186. 

334 See the U.S. Department of Housing and Urban Development’s Voluntary 

Compliance Agreements online via the Fair Housing and Equal Opportunity Library at 

http://www.hud.gov/offices/fheo/library/index.cfm#vca. 

335 This particular CVA came out of advocacy on the part of Access Living of 

Metropolitan Chicago. 

336 HUD Designated Housing Status Report, accessed August 18, 2009, from 

http://nhl.gov/offices/pih/programs/ph/dhp/designated.cfm. 

337 HUD Designated Housing Status Report, accessed August 18, 2009, from 

http://nhl.gov/offices/pih/programs/ph/dhp/designated.cfm. 

338 Fair Market Rent is calculated by HUD and is based on annual estimates of median 

rent for a region based on U.S. Census Bureau data. See http://www.huduser.org/

datasets/fmr.html. 

339 M. Shae, Housing Choice Voucher Tenant Accessibility Study: 2001–2002, prepared 

for the U.S. Department of Housing and Urban Development, Office of Policy 

Development and Research, 2004. 

340 The survey, which included a random sample of 400 HCV recipients from six public 

housing authorities, is not meant to be representative of all HCV uses in the United 

States. 

341 We do not have data to compare this rate to all voucher holders. 

342 HUD, Affordable Housing Needs 2005.

343 2008 IREMS reports for each State were downloaded from the HUD Web site at 

http://www.hud.gov/offices/hsg/hsgmulti.cfm, and totals by each category—elderly 

designated, disabled designated, and accessible—were tallied by the author to produce 

these totals. 

344 Ibid. 
484

345 See A. O’Hara, E. Miller, and M. Collins Versluys, “What’s Wrong with This Picture? 

An Update on the Impact of Elderly Only Housing Policies on People with Disabilities,” 

Opening Doors, no. 15 (September 2001). 

346 U.S. Department of Housing and Urban Development, FY 2007 Performance and 

Accountability Report, November 15, 2007, p. 439, http://www.hud.gov/offices/cfo/

reports/2007/2007par.pdf. 

347 811 funds specify that no more than six individuals with disabilities may live in a 

group home. FY 2008 HUD NOFA, p. 27325. 

348 G. Locke, C. Nagler, and K. Lam, Implications of Project Size in Section 811 and 

Section 202 Housing for People with Disabilities, prepared for the U.S. Department of 

Housing and Urban Development, Office of Policy Development and Research, 2004. 

349 U.S. Government Accountability Office (GAO), Elderly Housing: Federal Housing 

Programs that Offer Assistance for the Elderly (Washington, DC: GAO, 2005). 

350 Ibid. 

351 Beginning in 1992, HUD made Section 202 exclusively for elderly renters. Prior to 

that date, 202 developments may include nonelderly people with disabilities, though 

most of the occupants are elderly. 

352 U.S. GAO, Elderly Housing, 2005. 

353 HUD HOPE for Elderly Independence (HOPE IV), http://www.hud.gov/progdesc/

hope4fin.cfm. 

354 R. Ficke and S. Berkowitz, Evaluation of the HOPE for Elderly Independence 

Demonstration, prepared for U.S. Department of Housing and Urban Development, 

Office of Policy Development and Research, 1999. 

355 Ibid. 

356 For more information on Consolidated Plans, what they include and how they are 

made, go to HUD’s Web site “Consolidated Planning,” at http://www.hud.gov/offices/

cpd/about/conplan/. 

357 While public housing began in 1937, it is no longer funded for new development 

except through HOPE VI, which supports demolition and redevelopment of existing 

units and construction of new replacement units. In this sense, the net effect is not 

adding new units to the stock of public housing. 

358 Based on FY 2009 formula allocations available at http://www.hud.gov/offices/cpd/

about/budget/budget09/. 

359 This has been consistent for the past 8 years based on HUD data going back to 

FY 2001. See http://www.hud.gov/offices/cpd/communitydevelopment/budget/

disbursementreports/index.cfm. 

360 The number of housing “benefitting” is available in entitlement community reports but 

not in aggregated data in the national performance report. 

361 HUD IDIS, http://www.hud.gov/offices/cpd/systems/idis/index.cfm.
485

362 A Decent Place to Live: The Report of the National Housing Task Force, March 

1988, p. 24. 

363 HOME Community Housing Development Organization (CHDO) Guidance, 

http://www.hud.gov/offices/cpd/affordablehousing/programs/home/topical/chdo.cfm. 

364 HUD, HOME Program National Production Report as of 01/31/09, accessed March 

2009, from http://www.hud.gov/offices/cpd/affordablehousing/reports/#npr. 

365 Ibid. 

366 For more on the history preceding the 1986 act, see the National Coalition for the 

Homeless at http://www.nationalhomeless.org/index.html. 

367 U.S. Department of Housing and Urban Development, A Guide to Counting 

Sheltered Homeless People Revised (Washington, DC: HUD, January 15, 2008). 

368 U.S. Department of Housing and Urban Development, The 2008 Annual Homeless 

Assessment Report (Washington, DC: HUD, Office of Community Planning and 

Development, 2009). 

369 U.S. Department of Housing and Urban Development, A Guide to Counting 

Unsheltered Homeless People Second Revision (Washington, DC: HUD, January 15, 

2008). 

370 http://www.endhomelessness.org/section/policy/focusareas/veterans. 

371 Ibid. 

372 http://www.endhomelessness.org/section/policy/focusareas/health. 

373 The Department of Veterans Affairs currently estimates about 131,000 veterans are 

homeless on any given night. Nearly all are male (97%) and 45 percent were either 

African American or Latino. About 45 percent having a mental health condition and 

about 70 percent were dependent on drugs and/or alcohol. Overview of Homelessness. 

U.S. Department of Veterans Affairs, August 31, 2009, http://www1.va.gov/homeless/

page.cfm?pg=1. 

374 Dennis Culhane found that 20 percent of the people in shelters in New York use 

80 percent of resources. 

375 According to HUD, this definition is adopted from a federal standard that was arrived 

at through collective decision making by a team of federal agencies including HUD, the 

U.S. Department of Labor, the U.S. Department of Health and Human Services, the 

U.S. Department of Veterans Affairs, and the U.S. Interagency Council on 

Homelessness. 

376 U.S. Department of Housing and Urban Development, Defining Chronic 

Homelessness: A Technical Guide for HUD Programs (Washington, DC: HUD, 2007). 

377 National Alliance to End Homelessness. Currently, there are 213 completed plans 

and 130 more in progress in various cities, counties, and States in the United States, 

http://www.endhomelessness.org/section/tools/communityplans. 
486

378 J. McGuire, “Closing a Front Door to Homelessness Among Veterans,” Journal of 

Primary Prevention 28 (2007): 389–400; and U.S. Government Accountability Office, 

Homeless Veterans Programs: Improved Communications and Follow-up Could Further 

Enhance the Grant and Per Diem Program (Report GAO-06-859) (Washington, DC: 

GAO, 2006). 

379 D. Culhane and S. Metraux, “Rearranging the Deck Chairs or Reallocating the 

Lifeboats? Homeless Assistance and Its Alternatives,” Journal of the American Planning 

Association 74, no. 1 (Winter 2008). 

380 http://www.hudhre.info/index.cfm?do=viewShelterPlusCare. 

381 Centers for Disease Control and Prevention, http://www.cdc.gov/hiv/topics/

surveillance/resources/reports/2007report/table4.htm. 

382 This is the latest aggregate data HUD provides; latest available by grantee is 2007, 

but it is not complete. 

383 http://www.hud.gov/offices/cpd/affordablehousing/training/web/lihtc/basics/; also see 

Tax Credits: Opportunities to Improve Oversight of the Low Income Housing Program

(GAO/T-GGD/RCED-97-149) (Washington, DC: GAO, 1997). 

384 In addition, the city of Chicago has its own allocation of tax credits outside the State 

of Illinois. No other city has its own allocation. 

385 For current distribution and analysis of LIHTC allocations per State, go to 

http://www.danter.com/taxcredit/. 

386 Allocating Housing Tax Credits, U.S. Department of Housing and Urban 

Development, Community Planning and Development, accessed January 11, 2009, 

from http://www.fhasecure.gov/offices/cpd/affordablehousing/training/web/lihtc/

basics/allocating.cfm. 

387 See HUD USER http://www.huduser.org/datasets/lihtc.html. 

388 Rents cannot exceed local markets, which in some cases then will be less than 

these maximum rent caps. 

389 According to HUD, “Certain rental assistance programs can be used to raise the total 

rent above the LIHTC rent limit. For example, project-based Section 8 contract rents 

can exceed the LIHTC limit, but tenant-based Section 8 contract rents cannot.” 

390 U.S. Government Accountability Office, Tax Credits Opportunities to Improve 

Oversight of the Low-Income Housing Program: Testimony Before the Subcommittee on 

Oversight, Committee on Ways and Means, House of Representatives, April 23, 1997. 

391 http://www.huduser.org/datasets/lihtc.html. 

392 Abt Associates, HUD National Low Income Housing Tax Credit (LIHTC) Database: 

Projects Placed in Service Through 2005, prepared for the U.S. Department of Housing 

and Urban Development, 2007, http://www.huduser.org/datasets/lihtc.html. 

393 The categories are not necessarily mutually exclusive, since developers can target 

more than one population. 
487

394 Abt Associates, HUD National Low Income Housing Tax Credit (LIHTC) Database.

395 Ibid. 

396 It is not determined if these rates are statistically significant. 

397 Abt Associates, HUD National Low Income Housing Tax Credit (LIHTC) Database.

398 A very good source of current and historical data for all rural housing programs and 

issues is the Housing Assistance Council, http://www.ruralhome.org.

399 U.S. Department of Housing and Urban Development, Affordable Housing Needs 

2005. 

400 “Housing for Persons with Disabilities in Rural Areas” Information Sheet, Housing 

Assistance Council, January 2001, citing Mental Health and Rural America: 1980–1993

(Washington, DC: Federal Office of Rural Health Policy). http://www.ruralhome.org 

401 Ibid. 

402 Housing Assistance Council data portal at http://www.ruralhome.org. 

403 The 2009 income limits can be found at http://www.rurdev.usda.gov/rhs/sfh/

DSFH_Income_Limits/IL%20Direct.pdf. 

404 http://www.rurdev.usda.gov/rhs/sfh/area%20loan%20limit%20pdf%20files/CA.pdf. 

405 Search for rural multifamily property at http://rdmfhrentals.sc.egov.usda.gov/

RDMFHRentals/select_state.jsp. 

406 L. George, L. Strauss, and M. Kudlowitz, Connecting the Dots: A Location Analysis 

of USDA’s Section 515 Rental Housing and Other Federally Subsidized Rental 

Properties in Rural America, Housing Assistance Council, May 2008, 

http://www.huduser.org/search/Bibliography.asp?id=200849. 

407 George, Strauss, and Kudlowitz, Connecting the Dots. 

408 ICF Consulting Team, Rural Rental Housing—Comprehensive Property Assessment 

and Portfolio Analysis, prepared for the U.S. Department of Agriculture, Rural 

Development, November 2004. 

409 Housing Assistance Council estimates about 7,300 properties with 195,000 units are 

eligible to prepay. 

410 “USDA Rural Development Housing Vouchers: Answers for Property Owners,” 

USDA Rural Housing Fact Sheet, June 2006, http://www.rurdev.usda.gov/rd/pubs/

pa1872.pdf. 

411 HAC used as a proxy for “remote” any county that is not included in either a 

metropolitan or micropolitan statistical area as defined by the U.S. Census Bureau. 

412 George, Strauss, and Kudlowitz, Connecting the Dots, p. 1. 

413 Ibid., p. 2. 

414 Ibid. 

415 George, Strauss, and Kudlowitz, Connecting the Dots. 
488

416 National Fair Housing Alliance, USDA Rural Rental Testing Project, prepared for 

USDA, October 12, 2004. Report attained via Freedom of Information Act request; 

received April 2009. 

417 Ibid. 

418 Ibid., p. 3. 

419 Ibid., p. 3. 

420 U.S. Department of Housing and Urban Development, Affordable Housing Needs 

2005. 

421 D. Rice and B. Sard, The Effects of the Federal Budget Squeeze on Low-Income 

Housing Assistance (Washington, DC: Center for Budget and Policy Priorities, 2007). 

422 QHWRA permitted the demolition and replacement of units in developments of 250 

units or more based on criteria to determine viability of rehabilitating units versus giving 

tenants vouchers to relocate. 

423 Ibid. 

424 The evidence to support this concern is found in recent Voluntary Compliance 

Agreements including with the Boston Housing Authority and Chicago Housing 

Authority. 

425 U.S. Government Accountability Office, Public Housing: Distressed Conditions in 

Developments for the Elderly and Persons with Disabilities and Strategies Used for 

Improvement (Washington, DC: GAO, 2005). 

426 Ibid. 

427 B. Sard and W. Fischer, Preserving Safe, High Quality Public Housing Should Be a 

Priority of Federal Housing Policy (Washington, DC: Center for Budget and Policy 

Priorities, October 2008). 

428 U.S. Department of Housing and Urban Development, Multifamily Properties: Opting 

In, Opting Out and Remaining Affordable, January 2006, http://www.huduser.org/

publications/affhsg/opting_in.html.

429 Ibid. 

430 U.S. Government Accountability Office, Project-Based Rental Assistance: HUD 

Should Update Its Policies and Procedures to Keep Pace with the Changing Housing 

Market (GAO-07-290) (Washington, DC: GAO, April 2007). 

431 George, Strauss, and Kudlowitz, Connecting the Dots. 

432 Steve Gold recommends either asking for the review directly from the PHA or using 

the State open records law process to attain it. 

433 Steven Winter Associates, Inc., Multifamily Building Conformance with the Fair 

Housing Accessibility Guidelines, 2003. http://ideas.repec.org/p/hud/wpaper/39118.html. 
489

434 The exception was with elevators, which the authors attributed to most likely being 

due to elevator manufacturers’ using predetermined standards independent of builders’ 

plans. 

435 Units were estimated using the 2007 American Housing Survey. 

436 The strict enforcement of the statute of limitations rule is 2 years after the act of 

discrimination or, in the case of a new development, 2 years after the last occupancy 

permit is issued. For discussion of potential exceptions to this, see 

http://fairhousing.foxrothschild.com/2009/06/articles/disability/fha-and-the-statuteof-limitations/. 

437 J. Khadduri, K. Burnett, and D. Rodda, Targeting Housing Production Subsidies 

Literature Review (Washington, DC: U.S. Department of Housing and Urban 

Development, 2007). 

438 The Urban Institute, Discrimination Against Persons with Disabilities: Barriers at 

Every Step (Washington, DC: U.S. Department of Housing and Urban Development, 

Office of Policy Development and Research, 2005). 

439 Ibid., p. 2. 

440 Ibid.; see pp. 2–3, and entire report for detailed accounts of methodology and 

findings. 

441 National Fair Housing Alliance, The Future of Fair Housing: Report of the National 

Commission on Fair Housing and Equal Opportunity, December 2008, 

http://www.nationalfairhousing.org/. 

442 http://www.hud.gov/offices/fheo/FHLaws/yourrights.cfm. 

443 Ibid. 

444 National Fair Housing Alliance, The Future of Fair Housing, p. 25. 

445 See article in New Urbanism News regarding this matter at 

http://www.newurbannews.com/VisitabilityOct04.html. 

446 See, for example, “Accessibility and Visitability in New Urbanist Dwellings,” 

http://www.cnu.org/node/1708. 

447 See U.S. Department of Housing and Urban Development, at http://www.nls.gov/

offices/cpd/affordablehousing/training/web/crosscutting/equalaccess/accessprotected.cfm.

448 See NCD Topical Brief #2 for more information on Texas programs. 

449 HUD is currently funding the first study to look at green-built housing to determine 

health benefits. Grantee is the University of Illinois at Chicago (David Jacobs, Principal 

Investigator). 

450 See S. Crowley, “The Truth About the Housing Trust Fund,” 2008, at 

http://www.nlihc.org/detail/article.cfm?article_id=5552&id=48. 

451 See http://www.hud.gov/offices/pih/programs/hcv/vash/index.cfm. 
490

452 See K. Mulligan, “VA Excels in Reaching Homeless Mentally Ill Vets,” Psychiatric 

News 39, no. 12 (June 18, 2004), http://pn.psychiatryonline.org/cgi/content/full/39/12/12. 

453 http://www.govtrack.us/congress/bill.xpd?bill=h111-1408. This bill was first 

introduced by Representative Schakowsky in 2002 (H.R. 5683). 

454 Center for Budget and Public Policy (CBPP), “House Bill Makes Significant 

Improvements in ‘HOPE VI’ Public Housing Revitalization Program,” 2008, 

http://www.cbpp.org/1-16-08hous.htm. 

455 Ibid. CBPP does raise concerns about the House bill’s not addressing the issue of 

employment/work requirements that can either prevent people from using housing or 

push them out if they do not comply. 

456 For more detail, see http://www.washingtonwatch.com/bills/show/

111_SN_118.html#toc1. 

457 U.S. Department of Housing and Urban Development, based on data entry screen 

shots from Integrated Real Estate Management System, HUD User’s Guide for PBCA’s 

Chapter 7: Occupancy, May 2008, to be completed by Performance Based Contract 

Administrators (PBCA), http://www.hud.gov/offices/hsg/mfh/rems/ug/7caoccu.pdf. 

458 http://www.clpha.org/uploads/10.24.08__Policy_Framework-_Final.pdf. 

459 See “HUD, DOT and EPA Partnership: Sustainable Communities,” June 16, 2009, 

http://www.hud.gov/content/releases/pr2009-06-16factsheet.pdf. 

460 The Urban Institute, Discrimination Against Persons with Disabilities, p. 1. 

461 J. Smith, Housing Needs of People with Disability in the U.S. (Chicago: Nathalie P. 

Voorhees Center for Neighborhood and Community Improvement, University of Illinois 

at Chicago [UIC], 2009); estimates from SIPP data (2005) and ACS data (2007); this 

number is expected to be higher if data on institutionalized people was available to 

include. 

462 Ibid.; the ACS estimates 112.4 million households. 

463 U.S. Census Bureau, Population in Group Quarters by Type, Sex and Age, for the 

United States: 1990 and 2000 (PHC-T-26), accessed January 30, 2009, from 

http://www.census.gov/population/www/cen2000/briefs/phc-t26/index.html. 

464 U.S. Centers on Disease Control and Prevention, Fact Sheets, accessed January 

27, 2009, from http://www.cdc.gov/ncipc/factsheets/nursing.htm. 

465 Data from the 2007 American Housing Survey; estimates generated by J. Smith, 

Nathalie P. Voorhees Center, UIC, 2009. 

466 K. Nelson, The Hidden Crisis: Worst Case Housing Needs Among Adults with 

Disabilities, Housing Task Force of the Consortium for Citizens with Disabilities, p. 2, 

2008. http://www.tacinc.org/Docs/HH/HiddenHousingCrisis.pdf. 

467 U.S. Department of Housing and Urban Development, Affordable Housing Needs 

2005: Report to Congress (Washington, DC: HUD, May 2007). 
491

468 National Council on Disability, The State of 21st Century Long-Term Services and 

Supports: Financing and Systems Reform for Americans with Disabilities (Washington, 

DC: NCD, 2005). 

469 Ibid. 

470 S. Golant, “The Housing Problems of the Future Elderly Population,” Commission on 

Affordable Housing and Health Facility Needs for Seniors in the 21st Century, A Quiet 

Crisis in America: A Report to Congress, Appendix G-1 (Washington, DC: U.S. 

Government Printing Office, 2002), pp. 189–370; Federal Interagency Forum on AgingRelated Statistics, Older Americans Update 2006: Key Indicators of Well-Being

(Washington, DC: U.S. Government Printing Office, 2006); U.S. Department of Health 

and Human Services, A Profile of Older Americans 2002 (Washington, DC: 

Administration on Aging, 2002). 

471 Testimony of Ann O’Hara, Consortium for Citizens with Disabilities Housing Task 

Force Regarding the Frank Melville Supportive Housing Investment Act of 2008 (H.R. 

5772) Before the Committee on Financial Services Subcommittee on Housing and 

Community Opportunity, June 20, 2007. 

472 Ibid.; A. O’Hara, E. Cooper, A. Zovistoski, and J. Buttrick, “Priced Out in 2006: 

People with Disabilities Left Behind and Left Out of National Housing Policy,” Opening 

Doors 30 (July 2007). 

473 Introduction to the Housing Voucher Program, Center on Budget and Policy 

Priorities, July 6, 2007, accessed January 28, 2008, from http://www.cbpp.org/

5-15-03hous.htm. 

474 K. Bright, Section 202 Supportive Housing for the Elderly (Washington, DC: AARP 

Public Policy Institute, March 2006), accessed January 29, 2009, from: 

http://www.aarp.org/research/ppi/liv-com/housing/articles/fs65r_housing.html. 

475 O’Hara, Cooper, Zovistoski, and Buttrick, “Priced Out in 2006.” 

476 Steven Winter Associates, Multifamily Building Conformance with the Fair Housing 

Accessibility Guidelines, Noral, CT, for U.S. Department of Housing and Urban 

Development, Office of Policy Development and Research, 2003; in a study conducted 

between April 1, 1991, and March 31, 1997, and published in 2003, HUD reported that 

over 80 percent of 291 surveyed elements in 397 multifamily housing projects 

distributed across 10 HUD regions of the country were in conformance with Fair 

Housing Act accessibility guidelines. 

477 J.L. Maisel, E. Smith, and E. Steinfeld, Increasing Home Access, Designing for 

Visitability (Washington, DC: AARP Public Policy Institute, August 2008). 

478 The Urban Institute, Discrimination Against Persons with Disabilities. 

479 Disability Law Center, Disability Discrimination Audit of the Housing Market of 

Newton, Massachusetts, January 2006, accessed January 10, 2009, from 

http://www.dlc-ma.org/News/Newton%20Housing%20Report.pdf. 

480 Ibid., p. 3. 
492

481 National Fair Housing Alliance, The Future of Fair Housing. 

482 Ibid. 

483 Ibid. 

484 527 U.S. 581 (1999). 

485 A. O’Hara and S. Day, “Olmstead and Supportive Housing: A Vision for the Future,”

Center for Health Care Strategies, Consumer Action Series, December 2001. 

486 For a relevant discussion of housing in relation to people with psychiatric disabilities, 

see NCD’s findings in National Council on Disability, Inclusive Livable Communities for 

People with Psychiatric Disabilities, especially Chapter 3, March 17, 2008, accessed 

June 23, 2009, from http://www.ncd.gov/newsroom/publications/2008/Livable

Communities.html#ChapterThree. 

487 Housing for People with Disabilities: The Crisis Escalates, Fact Sheet, p. 1, The 

2008 Disability Policy Seminar, The ARC, AAIDD, AUCD, UCP, NACDD, February 19, 

2008; O’Hara and Day, “Olmstead and Supportive Housing.” 

488 O’Hara and Day, “Olmstead and Supportive Housing.” 

489 J. Klein, The History and Development of a National Homeowner Initiative: Institute 

on Disability, University of New Hampshire, 2000); American Homeownership and 

Economic Opportunity Act of 2000, P.L. 106–569, December 27, 2000, Title III—Section 

8 Homeownership Option. 

490 The 1977 Community Reinvestment Act (12 U.S.C. 2901) is intended to encourage 

depository institutions to help meet the credit needs of the communities in which they 

operate, including low- and moderate-income neighborhoods. Regulations implementing 

the act were amended in August 2005. 

491 Klein, The History and Development of a National Homeowner Initiative. 

492 “About UCP Texas,” UCP Texas homepage, accessed January 12, 2009, from 

http://www.ucptexas.org/about_UCP_Texas.html. 

493 Naomi Hubert, Housing Coordinator, UCP Texas, interview, January 12, 2009. 

494 Ibid. 

495 Ibid. 

496 “Housing Opportunities,” UCP Texas homepage, accessed January 12, 2009, from 

http://www.ucptexas.org/housing.html. 

497 Hubert, interview. 

498 Ibid. 

499 Ibid. 

500 Ibid. 

501 Ibid. 
493

502 Royal Walker, Co-Director, Institute for Disability Studies, University of Southern 

Mississippi, interview, January 12, 2009. 

503 Alma Ellis, Project Coordinator, Institute for Disability Studies, University of Southern 

Mississippi, email, January 13, 2009. 

504 Cassie Hicks, Coordinator for Housing Initiatives, Institute for Disability Studies, 

University of Southern Mississippi, interview, January 12, 2009. 

505 Hicks, interview. 

506 Walker, interview. 

507 IDS Housing Fact Sheets, accessed January 11, 2009, from http://www.usm.edu/ids/

housing/housing_fact_sheets.pdf. 

508 Ellis, email. 

509 IDS Housing Fact Sheets. 

510 Ellis, email. 

511 Walker, interview. 

512 Ibid.

513 Ellis, email. 

514 M. Morris, Coordination and Leveraging Long-Term Supports with Affordable and 

Accessible Housing for Persons with Disabilities: Maryland Case Study, February 2007, 

pp. 1–2, Rutgers Center for State Health Policy. 

515 Morris, pp. 3–4. 

516 Ibid. 

517 Ibid. 

518 Morris, p. 2. 

519 Morris, pp. 1–2. 

520 Morris, pp. 3–4. 

521 Morris, p. 4. 

522 P. Walker and R. Cory, Shifting from Empowered Agencies to Empowered People: 

Neighbors, Inc. (Syracuse, NY: Center on Human Policy, School of Education, 

Syracuse University, November 2002), p. 2. 

523 Ibid., p. 1. 

524 Ibid., pp. 4–5. 

525 Ibid., p. 5. 

526 Ibid., pp. 20–21. 

527 Patti Scott, CEO, Neighbors, Inc., interview, January 16, 2009. 
494

528 Real Life Summary, Real Life Choice Support Coordination, accessed January 16, 

2009, from http://www.neighbours-inc.com/RealLifeChoices/RLC_summary.html. 

529 Mission, Onondaga Community Living Web site, accessed January 16, 2009, from 

http://www.oclinc.org/Mission/mission_index.htm. 

530 Patricia Fratangelo, Executive Director, Onondaga Community Living, interview, 

January 16, 2009. 

531 Ibid. 

532 Kim Turner, Executive Director, Options in Community Living, interview, January 15, 

2009. 

533 Ibid. 

534 Ibid. 

535 Ibid. 

536 Options in Community Living, Inc., 2006 Annual Report. accessed January 15, 2009, 

from http://www.madisoncommunityfoundation.org/Document.Doc?id=42. 

537 “Unique Partnership Produces Nation’s First Affordable, Universal Design Apartment 

Complex,” AIA Architect, Project Watch, August 2005, accessed January 11, 2009, 

fromhttp://www.ahainc.org/aha.php?loc=headlines&thisone=20&page=news. 

538 Ibid. 

539 City of Berkeley Housing Department, Berkeley, California, accessed January 17, 

2009, from http://www.ci.berkeley.ca.us/ContentDisplay.aspx?id=10502. 

540 S. Saegert and L. Benítez, “Limited Equity Housing Cooperatives: Defining a Niche 

in the Low-Income Housing Market,” Journal of Planning Literature 19 (2005). 

541 Douglas Klein, personal communication, March 18, 2004, cited in Saegert and 

Benítez, “Limited Equity Housing Cooperatives.” 

542 Saegert and Benítez, “Limited Equity Housing Cooperatives.” 

543 Ibid., p. 432. 

544 Ibid. 

545 Cathy Ludlum, interview, January 14, 2009. 

546 Ibid. 

547 About Us: Not Just Bricks & Mortar, Penn South homepage, accessed January 15, 

2009, from http://www.pennsouth.coop/PublicPages/about.html. 

548 Naomi Goldstein, Education Director, Mutual Redevelopment Houses, interview, 

January 14, 2009. 

549 The State of 50+ American 2006, AARP Public Policy Institute, p. 43, accessed April 

28, 2009, from http://www.globalaging.org/elderrights/us/2006/fiftyplus.pdf. 
495

550 NORC/Vladek Cares, Henry Street Settlement’s NORC (Naturally Occurring 

Retirement Community) homepage, accessed January 6, 2009, from 

http://www.henrystreet.org/site/PageServer?pagename=sns_norc. 

551 How Do Housing Tax Credits Work? U.S. Department of Housing and Urban 

Development, Community Planning and Development, accessed January 11, 2009, 

from http://www.fhasecure.gov/offices/cpd/affordablehousing/training/web/lihtc/basics/

work.cfm. 

552 Allocating Housing Tax Credits, U.S. Department of Housing and Urban 

Development, Community Planning and Development, accessed January 11, 2009, 

from http://www.fhasecure.gov/offices/cpd/affordablehousing/training/web/lihtc/basics/

allocating.cfm. 

553 National Council of State Housing Agencies (NCSHA), State HFA Factbook: 2006 

NCSHA Annual Survey Results, 2006. 

554 2009 Low Income Housing Tax Credit Qualified Allocation Plan for the State of North 

Carolina, accessed January 16, 2009, from http://www.nchfa.com/Rental/RD2009qap.aspx. 

555 Ibid. 

556 “North Carolina: An Innovative Supportive Housing Model,” Opening Doors: A 

Housing Publication for the Disability Community 29 (November 2006): 9. It should be 

noted, however, that the North Carolina program only targets a small number of very 

low income people, and it combines people with disabilities and very low income 

individuals together, thus reducing the targeting for both groups. 

557 Ibid. 

558 Donald Kahl, Executive Director, The Equal Rights Center, email, January 26, 2008. 

559 Ibid. 

560 “National Developer Agrees to Groundbreaking Effort to Provide Accessible 

Housing,” accessed January 26, 2009, from http://www.equalrightscenter.org/releases/

pr_2007_07_17.php. 

561 Urban Land Institute, Development Case Studies, accessed January 6, 2009, from 

http://casestudies.uli.org/CaseStudies/C036016.htm; “Minimum Universal Design 

Requirements for New Construction Using Affordable Housing Trust Funds from the 

City of St. Louis,” Dolan Media Newswires, September 2004, revised September 2008; 

H. Livingston, “Designing to Accommodate Everyone: Universally Designed Building 

Awarded for Socially Responsible Housing,” AIA Architect (February 8, 2008). 

562 RERC on Universal Design at Buffalo, updated January 2008, Rehabilitation 

Engineering Research Center on Universal Design, School of Architecture and 

Planning, State University of New York at Buffalo, accessed January 23, 2009, from 

www.ap.buffalo.edu/idea/visitability/reports/existingcitylaws.xls; Maisel, Smith, and 

Steinfeld, Increasing Home Access. 

563 Maisel, Smith, and Steinfeld, Increasing Home Access, p. 9. 
496

564 E. Smith, “Early History of the Visitability Movement,” Concrete Change homepage, 

accessed January 28, 2009, from http://www.concretechange.org/visitability_history.aspx. 

565 Maisel, Smith, and Steinfeld, Increasing Home Access, p. 20. 

566 “Atlanta City Ordinance of 1992,” Concrete Change homepage, accessed January 

28, 2009, from http://www.concretechange.org/policy_legislative_local_atlanta.pdf. 

567 “Construction Costs,” Concrete Change homepage, accessed January 28, 2009, 

from http://www.concretechange.org/construction_costs.aspx. 

568 “Minimum Universal Design Requirements for New Construction Using Affordable 

Housing Trust Funds from the City of St. Louis,” September 2004, revised September 

2008, accessed January 9, 2009, from http://www.stlouis.missouri.org/development/

otherprojects/rfp-rfq/UDCriteria.doc. 

569 S. Lowe, “New Complex Welcomes Foster Youth Home,” Oakland Tribune, June 26, 

2008, accessed January 20, 2009, from http://www.ahainc.org/aha.php?loc=headlines&

thisone=6&page=news

570 RERC on Universal Design at Buffalo; Maisel, Smith, and Steinfeld, Increasing 

Home Access. 

571 S. Gold, “HOME Funds for Housing Vouchers: One Idea to Increase 

Deinstitutionalization,” Information Bulletin #209, May 2007, accessed January 14, 2009, 

from http://www.stevegoldada.com/stevegoldada/archive.php?mode=A&id=209;&sort=D. 

572 S. Gold, “Housing Vouchers Used for Home Ownership,” Information Bulletin #214, 

June 2007, accessed January 10, 2009, from http://www.stevegoldada.com/

stevegoldada/archive.php?mode=A&id=215;&sort=D. 

573 A. O’Hara, “Permanent Supportive Housing: A Proven Solution to Homelessness,” 

Opening Doors, Technical Assistance Collaborative, January 2003; see also R. M. 

Greenwood, N.J Shaefer-McDaniel, G. Winkel, and S.J. Tsemberis, “Decreasing 

Psychiatric Symptoms by Increasing Choice in Services for Adults with Histories of 

Homelessness,” American Journal of Community Psychology 36, no. 3/4 (December 

2005), which cites earlier studies that measure the percentage of persons with mental 

illness among the homeless population at 5 to 91 percent, with most findings ranging 

from 25 to 33 percent. 

574 S. Tsemberis and R.F. Eisenberg, “Pathways to Housing: Supported Housing for 

Street-Dwelling Homeless Individuals with Psychiatric Disabilities,” Psychiatric Services 

51, no. 4 (2000): 487–493. 

575 D.J. James and L. E. Glaze, Mental Health Problems of Prison and Jail Inmates

(Washington, DC: Bureau of Justice Statistics, September 2006). 

576 C. Forchuk, C. Ward-Griffin, R. Csiernik, and K. Turner, “Surviving the Tornado of 

Mental Illness: Psychiatric Survivors’ Experiences of Getting, Losing, and Keeping 

Housing,” Psychiatric Services 57, no. 4 (2006): 558–562. 

577 Although this paper is focused on the housing needs of people with psychiatric 

disabilities, it is important to note that many people with mental illness also have (or 
497

may prematurely acquire) physical disabilities for several reasons, including the side 

effects of psychiatric medications. For this reason, and also to enable people with 

psychiatric disabilities to “age in place,” it is important that housing for people with 

psychiatric disabilities be physically accessible whenever possible. 

578 C. Koyanagi, Learning from History: Deinstitutionalization of People with Mental 

Illness as Precursor to Long Term Care Reform: Kaiser Commission on Medicaid and 

the Uninsured, 2007). 

579 Ibid.; see also A. Braden Johnson, Out of Bedlam: The Truth About 

Deinstitutionalization (New York: Basic Books, 1992). 

580 Board and care homes are also called “adult homes” and “halfway houses.” 

581 H. Nelson, G. Brent, and R. Walsh-Bowers, “Predictors of the Adaptation of People 

with Psychiatric Disabilities in Group Homes, Supportive Apartments, and Board-andCare Homes,” Psychiatric Rehabilitation Journal 22, no. 4 (1999): 381–390. 

582 SAMHSA, Transforming Housing for People with Psychiatric Disorders Report. 

583 Ibid. 

584 Ibid. 

585 Technical Assistance Collaborative, Inc., and Consortium of Citizens with 

Disabilities, “Priced Out in 2006.” 

586 Inclusionary zoning requires builders and housing providers to offer a percentage of 

units at below-market rates. Some communities have made inclusionary zoning a 

requirement for all new construction, while others have permitted greater density as a 

reward for inclusionary zoning. 

587 National Council on Disability, Inclusive Livable Communities for People with 

Psychiatric Disabilities (Washington, DC: NCD, 2008); B. Tanzman, “An Overview of 

Surveys of Mental Health Consumers’ Preferences for Housing and Support Services,” 

Psychiatric Services 44 (1993): 450–455; C. Forchuk, G. Nelson, and G.B. Hall, “It’s 

Important to Be Proud of the Place You Live In: Housing Problems and Preferences of 

Psychiatric Survivors,” Perspectives in Psychiatric Care 42, no. 1 (2006): 42–52. 

588 C. Forchuk et al., “It’s Important to be Proud of the Place You Live In.” 

589 G. Nelson, J. Syvestre, T. Aubry, L. George, and J. Trainor, “Housing Choice and 

Control, Housing Quality, and Control over Professional Support as Contributors to the 

Subjective Quality of Life and Community Adaptation of People with Severe Mental 

Illness,” Administration and Policy in Mental Health 34 (2007): 89–100. 

590 527 U.S. 581 (1999). 

591 42 U.S.C. 12101(a)(2) and (a)(5). 

592 28 C.F.R. 35.130(d). 

593 28 C.F.R. 35, App. A, p. 450. 

594 Ibid. 
498

595 President’s New Freedom Commission on Mental Health’s Final Report, 2003. 

596 Ibid.

597 C. Forchuk et al., “It’s Important to be Proud of the Place You Live In”; research 

indicates that people with mental illness describe the dilemma of choosing between 

housing they want and the supports they need, since supports are most often 

connected with a less desirable housing situation. See also P.J. Carling, “Housing and 

Supports for People with Mental Illness: Emerging Approaches to Research and 

Practice,” Hospital and Community Psychiatry 44 (1993): 439–464; and Michael Allen, 

“Waking Rip van Winkle: Why Developments in the Last 20 Years Should Teach the 

Mental Health System Not to Use Housing as a Tool of Coercion,” Behavioral Sciences 

and the Law 21 (2003): 503–521. 

598 National Council on Disability, From Privileges to Rights: People Labeled with 

Psychiatric Disabilities Speak for Themselves (Washington, DC: NCD, January 20, 

2000), p. 32. 

599 L. Gulcur, S. Tsemberis, A. Stefancic, and R.M. Greenwood, “Community Integration 

of Adults with Psychiatric Disabilities and Histories of Homelessness,” Community 

Mental Health Journal 43, no. 3 (2007): 211–227. 

600 See Furman Center (NYU), The Impact of Supportive Housing on Surrounding 

Neighborhoods: Evidence from New York City, November 2008, at 

http://www.furmancenter.org/files/FurmanCenterPolicyBriefonSupportiveHousing_

LowRes.pdf 

601 Smith, Housing Needs. This number is expected to be higher if data on 

institutionalized people was available to include. 

602 A. O’Hara, “Housing for People with Mental Illness: Update of a Report to the 

President’s New Freedom Commission,” Psychiatric Services 58, no. 7 (2007): 907–

913. 

603 D. Culhane, S. Metraux, and T. Hadley, “The Impact of Supportive Housing for 

Homeless People with Severe Mental Illness on the Utilization of the Public Health, 

Corrections, and Emergency Shelter Systems: The New York-New York Initiative,” 

Housing Policy Debate 13, no. 1 (2002). 

604 C. Roman, E. McBride, and J. Osborne, Principles and Practice in Housing for Persons 

with Mental Illness Who Have Had Contact with the Justice System, The Center for Mental 

Health Services National GAINS Center, June 1, 2005, citing K. Mallik-Kane, Health and 

Prisoner Reentry: Returning Home Policy Brief (Washington, DC: The Urban Institute, 

2005), http://gainscenter.samhsa.gov/text/ebp/Papers/HousingPaper.asp. 

605 N. Bernstein, “Treatment Plan Is Sought After Inmates Are Freed,” New York Times,

Section B, p. 3, August 25, 1999. 

606 Ibid. 

607 S. Tsemberis, L. Gulcur, and M. Nakae, “Housing First, Consumer Choice, and Harm 

Reduction for Homeless Individuals with a Dual Diagnosis,” American Journal of Public 

Health 94, no. 4 (2004): 651–656. 
499

608 Description of Pathways program is based on author interview with Sam Tsemberis, 

and on studies of the Pathways program, http://www.pathwaystohousing.org/Articles/

Publications.html. 

609 From Pathways Web site, http://www.pathwaystohousing.org/TopMenu/AboutUs/

Snapshot.html. 

610 R.M. Greenwood, N.J. Schaefer-McDaniel, G. Winkel, and S.J. Tsemberis, 

“Decreasing Psychiatric Symptoms by Increasing Choice in Services for Adults with 

Histories of Homelessness,” American Journal of Community Psychology 36, no. 3/4 

(2005): 223–238. 

611 S. Tsemberis et al., “Housing First.” 

612 L. Gulcur, S. Tsemberis, A. Stefancic, and R.M. Greenwood, “Community Integration 

of Adults with Psychiatric Disabilities and Histories of Homelessness,” Community 

Mental Health Journal 43, no. 3 (2007): 211–227. 

613 From Pathways Web site, http://www.pathwaystohousing.org/TopMenu/AboutUs/

Snapshot.html. 

614 Ibid. 

615 L. Gulcur, A. Stefancic, M. Shinn, S. Tsemberis, and S.N. Fisher, “Housing, 

Hospitalization, and Cost Outcomes for Homeless Individuals with Psychiatric 

Disabilities Participating in Continuum of Care and Housing First Programmes,” Journal 

of Community Applied Social Psychology 13 (2003): 171–186; A. Stefancic and S. 

Tsemberis, “Housing First for Long-Term Shelter Dwellers with Psychiatric Disabilities in 

a Suburban County: A Four Year Study of Housing Access and Retention,” Journal of 

Primary Prevention 28 (2007): 265–279. 

616 Information about the RIST program is based on interviews conducted with Deborah 

Taggart, who heads the program, and Anne Portine, the coordinator of residential 

services, January 2009. 

617 Information contained in this profile of Main Street Housing was obtained via an 

author interview with Executive Director Ken Wineman, February 2009. 

618 Ibid. 

619 Ibid. 

620 Research implies that peer support empowers people with psychiatric disabilities to 

make decisions relatively autonomous from professional staff. L. Johnson, “The 

Community/Privacy Trade-Off in Supportive Housing: Consumer/Survivor Preferences,” 

Canadian Journal of Community Mental Health 20, no. 1 (2001): 123–134; K. Haertl, 

“Factors Influencing Success in a Fair-Weather Model Mental Health Program,” 

Psychiatric Rehabilitation Journal 28, no. 4 (2005): 370–377. 

621 National Council on Disability, Effective Emergency Management: Making 

Improvements for Communities and People with Disabilities, 2009, accessed August 12, 

2009, from http://www.ncd.gov/newsroom/publications/2009/NCD_Emergency

Management_HTML/EffectiveEmergencyManagement.html. 
500

622 National Organization on Disability, Special Needs Assessment for Katrina Evacuees 

Project, 2005, accessed December 18, 2008, from www.nod.org/emergency. 

623 U.S. Government Accountability Office, Disaster Assistance: Better Planning Needed 

for Housing Victims of Catastrophic Disasters (GAO-07-88 Report) (Washington, DC: 

GAO, 2007). 

624 L. Stough and A. Sharp, An Evaluation of the National Disability Rights Network 

Participation in the Katrina Today Project (Washington, DC: The National Disability 

Rights Network, 2008). 

625 National Council on Disability, Quarterly Meeting: People with Disabilities and 

Emergency Management, New Orleans, January 2008. 

626 Ibid. 

627 U.S. Government Accountability Office, Disaster Assistance: Better Planning Needed 

for Housing Victims of Catastrophic Disasters (GAO-07-88 Report) (Washington, DC: 

GAO, 2007). 

628 National Council on Disability, Effective Emergency Management: Making 

Improvements for Communities and People with Disabilities, 2009, accessed August 12, 

2009, from http://www.ncd.gov/newsroom/publications/2009/NCD_Emergency

Management_HTML/EffectiveEmergencyManagement.html

629 V.T. Wood and R.A. Weisman, “A Hole in the Weather Warning System,” Bulletin of 

the American Meteorological Society 84, no. 2 (2003): 187–194. 

630 B.D. Phillips and B. H Morrow, “Social Science Research Needs: Focus on 

Vulnerable Populations, Forecasting, and Warnings,” Natural Hazards Review 8, no. 3 

(2007): 61–68. 

631 D. Mileti, Disasters by Design: A Reassessment of Natural Disasters in the United 

States (Washington, DC: Joseph Henry Press, 2009). 

632 National Organization on Disability, People with Disabilities Unprepared for Terrorist, 

Other Crises at Home or at Work, New Poll Finds, 2007, accessed June 14, 2008, from 

http://www.nod.org/index.cfm?fuseaction=Feature.showFeature&FeatureID=507. 

633 M. Comerio, Disaster Hits Home: New Policy for Urban Housing Recovery (Berkeley: 

University of California Press, 1998). 

634 For an example from Harrison County, Mississippi, see http://www.ada.gov/

harrisoncomspca.htm. 

635 E.L. Quarantelli, Sheltering and Housing After Major Community Disasters (Newark, 

DE: University of Delaware Disaster Research Center, 1982). 

636 Ibid. 

637 K.J. Tierney, M.K. Lindell, and R.W. Perry, Facing the Unexpected: Disaster 

Preparedness and Response in the United States (Washington, DC: Joseph Henry 

Press, 2001). 
501

638 M. van Willigen, T. Edwards, B. Edwards, and S. Hessee, “Riding Out the Storm: 

Experiences of the Physically Disabled During Hurricanes Bonnie, Dennis, and Floyd,” 

Natural Hazards Review 3, no. 3 (2002): 98–106. 

639 M. Nosek, Riding Out Ike on a Vent: Testimony Before Select Committee on 

Hurricane Ike Storm Devastation to the Texas Gulf Coast, November 10, 2008. 

640 National Organization on Disability, Special Needs Assessment for Katrina Evacuees 

Project, 2005, accessed December 18, 2008, from http://www.nod.org/index.cfm?

fuseaction=Feature.showFeature&FeatureID=1588

641 E.L. Quarantelli, Sheltering and Housing After Major Community Disasters.

642 M. Nosek, Riding Out Ike on a Vent. 

643 National Council on Disability, Quarterly Meeting: People with Disabilities and 

Emergency Management, New Orleans, January 2008. 

644 L. Stough and A. Sharp, An Evaluation of the National Disability Rights Network 

Participation in the Katrina Today Project (Washington, DC: The National Disability 

Rights Network, 2008). 

645 Ibid. 

646 Ibid. 

647 U.S. Department of Homeland Security, Office of Civil Rights and Civil Liberties, 

Special Needs Populations Impact Assessment White Paper, 2008, accessed June 30, 

2009, from http://www.disabilitypreparedness.gov/pdf/ike_snp.pdf. 

648 M. Comerio, Disaster Hits Home: New Policy for Urban Housing Recovery (Berkeley: 

University of California Press, 1998). 

649 National Council on Disability, Quarterly Meeting: People with Disabilities and 

Emergency Management, January 2008. 

650 Federal Emergency Management Agency, Disaster Assistance Available from FEMA,

accessed June 30, 2009, http://www.fema.gov/assistance/process/assistance.shtm. 

651 See http://www.fema.gov/oer/crp.shtm. 

652 U.S. Small Business Administration, Fact Sheet About U.S. Small Business 

Administration (SBA) Disaster Loans, accessed June 30, 2009, from 

http://www.sba.gov/idc/groups/public/documents/sba_homepage/serv_da_disastr_

loan_factsht.pdf. 

653 U.S. Department of Housing and Urban Development, “HUD Announces Disaster 

Assistance for Three Midwest States,” 2008, accessed June 30, 2009, from 

http://www.hud.gov/news/release.cfm?content=pr08-083.cfm; U.S. Department of 

Housing and Urban Development, “HUD Readies Disaster Assistance for Gulf 

Hurricane Victims,” 2008, accessed June 30, 2009, from http://www.hud.gov/

news/release.cfm?content=pr08-130.cfm. 

654 U.S. Department of Justice, Project Civil Access, accessed August 10, 2009, from 

http://www.ada.gov/civicac.htm. 
502

655 Manufactured Housing Institute (MHI), MHI Statement on Accessibility Guidelines for 

Emergency Transportable Housing, 2009, accessed July 24, 2009, from 

http://www.manufacturedhousing.org/lib/showtemp_detail.asp?id=584&cat=whats_hot. 

656 Louisiana Advocacy Center, Update on FEMA Lawsuit, accessed July 20, 2009, 

from http://www.advocacyla.org/news/fema.php. 

657 Centers for Disease Control and Prevention, Final Report on Formaldehyde Levels 

in FEMA-Supplied Travel Trailers, Park Models, and Mobile Homes, 2008, accessed 

July 20, 2009, from http://www.cdc.gov/nceh/ehhe/trailerstudy/pdfs/FEMAFinalReport.pdf. 

658 M. Comerio, Disaster Hits Home.

659 J.S. Cowan, “Environmental Justice After Hurricane Katrina: A Delphi Approach to 

Determining the Ethics and Future of Public Housing Policies in New Orleans 

(Unpublished doctoral dissertation), Oklahoma State University, Stillwater, OK, 2009. 

660 National Council on Disability, Effective Emergency Management: Making 

Improvements for Communities and People with Disabilities, 2009, accessed August 20, 

2009, from http://www.ncd.gov/newsroom/publications/2009/NCD_Emergency

Management_HTML/EffectiveEmergencyManagement.html. 

661 D. Saliba, J. Buchanan, and R.S. Kingston, “Function and Response of Nursing 

Facilities During Community Disaster,” American Journal of Public Health 94, no. 8 

(2004): 1436–1441. 

662 National Council on Disability, Effective Emergency Management. 

663 Ibid. 

664 J. Kailes and A. Enders, “Moving Beyond ‘Special Needs’: A Function Based 

Framework for Emergency Management and Planning,” Journal of Disability Policy 

Studies 17, no. 4 (2006): 230–237. 

665 Ibid. 

666 Ibid., p. 233. 

667 Accessed July 20, 2009, from http://www.ada.gov/pcatoolkit/chap7emergencymgmt.pdf, 

pp. 5–8. 

668 Accessed July 20, 2009, from http://www.ada.gov/pcatoolkit/chap7emergencymgmt

add1.htm. 

669 Accessed July 20, 2009, from http://www.ada.gov/pcatoolkit/chap7shelterprog.htm. 

670 Accessed July 20, 2009, from http://www.ada.gov/pcatoolkit/chap7shelterchk.htm. 

671 Accessed July 20, 2009, from http://www.ada.gov/pcatoolkit/chap7emergencymgmt

add1.htm. 

672 U.S. Department of Justice, ADA Best Practices Toolkit for State and Local 

Governments, 2007, accessed July 20, 2009, http://www.ada.gov/pcatoolkit/

toolkitmain.htm. 

673 Accessed July 21, 2009, from http://portal.hud.gov/app_nhls/. 
503

674 U.S. Department of Homeland Security, Office of Civil Rights and Civil Liberties, 

Special Needs Populations Impact Assessment White Paper, 2008, accessed June 30, 

2009, from http://www.disabilitypreparedness.gov/pdf/ike_snp.pdf. 

675 Accessed July 23, 2009, from http://www.adata.org/resources/rebuilding/index.html. 

676 Accessed July 23, 2009, from https://asd.fema.gov/inter/hportal/home.htm. 

677 National Council on Disability, Quarterly Meeting: People with Disabilities and 

Emergency Management, New Orleans, January 2008. 

678 U.S. Department of Housing and Urban Development, FEMA Begins Referring 

Families to HUD for Temporary Disaster Housing Program, accessed June 30, 2009, 

from http://www.hud.gov/news/release.cfm?content=pr08-170.cfm. 

679 U.S. Department of Homeland Security, Office of Civil Rights and Civil Liberties, 

Special Needs Populations Impact Assessment White Paper, 2008, p. 15, accessed 

June 30, 2009, from http://www.disabilitypreparedness.gov/pdf/ike_snp.pdf. 

680 Ibid. 

681 National Council on Disability, Quarterly Meeting: People with Disabilities and 

Emergency Management, New Orleans, January 2008, p. 15. 

682 Ibid. 

683 CRC/Congressional Research Service (CRS), Mortgage and Rental Assistance as 

Disaster Relief: Legislation in the 100th Congress (CRC Report Order Code RS22828) 

(Washington, DC: CRS, 2008). 

684 Federal Emergency Management Agency, Disaster Assistance Available from 

FEMA, 2009, accessed June 30, 2009, from http://www.fema.gov/assistance/process/

assistance.shtm. 

685 Ibid., Comprehensive Planning Guides, p. 43. 

686 Ibid., Comprehensive Planning Guides, p. 44. 

687 Ibid., Comprehensive Planning Guides, p. 45. 

688 FEMA, National Disaster Housing Strategy, January 2009, http://www.fema.gov/

emergency/disasterhousing/. 

689 FEMA, 2009, p. 11. 

690 FEMA, 2009, p. 74. 

691 National Council on Disability, Quarterly Meeting: People with Disabilities and 

Emergency Management, New Orleans, January 2008, p. 20. 

692 Ibid., p. 13. 

693 U.S. Department of Homeland Security, Office of Civil Rights and Civil Liberties, 

Special Needs Populations Impact Assessment White Paper, 2008, p. 15, accessed 

June 30, 2009, from http://www.disabilitypreparedness.gov/pdf/ike_snp.pdf. 

694 Ibid. 
504

695 Ibid. 

696 Ibid. 

697 National Council on Disability, Quarterly Meeting: People with Disabilities and 

Emergency Management, New Orleans, January 2008, p. 11. 

698 David Paulison, Administrator, FEMA, speaking at a National Council on Disability 

Quarterly Meeting in Arlington, VA, April 23, 2008, http://www.fema.gov/about/paulison/

speeches/2008/042308.shtm. 

699 Ibid., p. 19. 

700 Mary Troupe, Executive Director of the Mississippi Coalition of Citizens with 

Disabilities, Testimony before the U.S. House Subcommittee on Emergency 

Communications, Preparedness, and Response, March 17, 2009. 

701 National Council on Disability, Effective Emergency Management, p. 285. 

702 National Council on Disability, Quarterly Meeting: People with Disabilities and 

Emergency Management, New Orleans, January 2008, p. 6. 

703 Ibid. 

704 L. Stough and A. Sharp, An Evaluation of the National Disability Rights Network 

Participation in the Katrina Today Project (Washington, DC: The National Disability 

Rights Network, 2008). 

705 National Council on Disability, Quarterly Meeting: People with Disabilities and 

Emergency Management, New Orleans, January 2008, p. 9. 

706 Ibid. 

707 Based on E.L. Quarantelli, Sheltering and Housing After Major Community Disasters

(Newark, DE: University of Delaware Disaster Research Center, 1982). 

708 For more information, visit the National Voluntary Organizations Active in Disaster at 

www.nvoad.org. 

709 The different federal funding programs are outlined in NCD Topical Brief #1: “Federal 

Evaluation”; and examples of how private and nonprofit developers use these funds are 

provided in NCD Topical Brief #2: “Private and Nonprofit Sector Housing.” 

710 The American Planning Association provides model zoning for commercial zoning 

that “permits” rather than requires housing in the mix, http://www.planning.org/research/

smartgrowth/pdf/section41.pdf; Smart Growth codes developed in conjunction with the 

Environmental Protection Agency, http://www.planning.org/research/smartgrowth/. 

711 U.S. Department of Housing and Urban Development, Smart Codes in Your 

Community: A Guide to Building Rehabilitation Codes, 2001, http://www.huduser.org/

Publications/pdf/smartcodes.pdf. 

712 For more information, go to http://www.iccsafe.org/. 

713 See Regulatory Barriers Clearinghouse maintained by the U.S. Department of 

Housing and Urban Development, Policy Development and Research, 
505

http://www.huduser.org/rbc/. Also see M. Luger and K. Temkin, Red Tape and Housing 

Costs: How Regulation Affects New Residential Development (New Brunswick, NJ: 

CUPR Press, 2000). 

714 Consolidated Plan/CHAS 2000 Data, U.S. Department of Housing and Urban 

Development, http://www.huduser.org/datasets/cp.html. 

715 Consolidated Plan/CHAS 2000 Data, U.S. Department of Housing and Urban 

Development, http://www.huduser.org/datasets/cp.html. We compiled all State-level 

data to produce the data tables in Appendix A; these numbers reflect only the CHAS 

2000 data that HUD makes available to State and local jurisdictions on the Internet. 

716 State and Local Consolidated Plans, U.S. Department of Housing and Urban 

Development, http://www.hud.gov/offices/cpd/about/conplan/local/index.cfm. 

717 See Guidelines for Preparing Consolidated Plan and Performance Report 

Submissions for Local Jurisdictions, U.S. Department of Housing and Urban 

Development Office of Community Planning and Development, 

http://www.hud.gov/offices/cpd/about/conplan/toolsandguidance/guidance/. 

718 The State of Iowa Consolidated Plan for Housing and Community Development 

Annual Action Plan: 2009, http://www.iowalifechanging.com/community/downloads/

2009ap.pdf. 

719 See http://www.hud.gov/offices/cpd/about/conplan/improvement/index.cfm. 

720 See Guidelines for Preparing Consolidated Plan and Performance Report. 

721 Ibid. 

722 Fair Housing Planning Guide, vol. 1 (Washington, DC: U.S. Department of Housing 

and Urban Development, Office of Fair Housing and Equal Opportunity, no date). 

723 Allocating Housing Tax Credits, U.S. Department of Housing and Urban 

Development Office of Community Planning and Development, accessed January 11, 

2009, from http://www.fhasecure.gov/offices/cpd/affordablehousing/training/web/lihtc/

basics/allocating.cfm. 

724 U.S. Department of Housing and Urban Development, The 2008 Annual Homeless 

Assessment Report (Washington, DC: HUD, Office of Community Planning and 

Development, 2009). 

725 ADA defines discrimination as “a failure to make reasonable modifications in policies, 

practices, or procedures, when such modifications are necessary to afford such goods, 

services, facilities, privileges, advantages, or accommodations to individuals with 

disabilities, unless the entity can demonstrate that making such modifications would 

fundamentally alter the nature of such goods, services, facilities, privileges, advantages, 

or accommodations.” 

726 As cited in Olmstead: “States are required to place persons with mental disabilities in 

community settings rather than in institutions when the State’s treatment professionals 

have determined that community placement is appropriate, the transfer from institutional 

care to a less restrictive setting is not opposed by the affected individual, and the 
506

placement can be reasonably accommodated, taking into account the resources 

available to the State and the needs of others with mental disabilities.” 

727 See W. Fox-Grage, B. Coleman, and D. Fleer, The States’ Response to the 

Olmstead Decision: A 2003 Update, National Conference of State Legislatures (NCSL) 

and AARP Public Policy Institute, 2004; Mathis, “Community Integration of Individuals 

with Disabilities: An Update on Olmstead Implementation,” Journal of Poverty Law and 

Policy (November–December 2001), http://www.bazelon.org/issues/disabilityrights/

resources/olmstead. 

728 The New Freedom Initiative was announced by President George W. Bush on 

February 1, 2001, followed up by the Executive Order 13217 on June 18, 2001. 

729 See Fox-Grage et al., The States’ Response to the Olmstead Decision. 

730 See M. Kitchener, M. Willmott, M. Alameida, A. Wong, and C. Harrington, 

Introduction to Olmstead Lawsuits and Olmstead Plans, 2008, 

http://pascenter.org/olmstead/index.php; S. Rosenbaum, J. Teitelbaum, and A. Stewart, 

An Analysis of Olmstead Complaints: Implications for Policy and Long-Term Planning

(Washington, DC: Center for Health Care Strategies, Inc., 2001), 

http://www.gwumc.edu/sphhs/departments/healthpolicy/CHPR/downloads/

olmsteadcomplaints.pdf

731National Council on Disability, Olmstead: Reclaiming Institutionalized Lives (abridged 

version), 2003, http://www.ncd.gov/newsroom/publications/2003/reclaimabridged.htm. 

732 CMS definition, http://www.ssa.gov/disability/professionals/bluebook/generalinfo.htm. For further information on how medical necessity can impact a person with 

disabilities trying to receive medical services (e.g., CMS-funded), see “Medical 

Necessity Determination in the Medicare Program: Are the Interests of Beneficiaries 

with Chronic Conditions Being Met?” http://www.partnershipforsolutions.org/DMS/files/

MedNec1202.pdf. 

733 http://www.ucp.org/ucp_channeldoc.cfm/1/13/12632/12632-12632/6184. 

734 Ibid. 

735 P.L. 101–336. 

736 Seven broad architectural guidelines: 1) accessible entrance on an accessible route; 

2) accessible public and common use areas; 3) usable doors; 4) accessible routes into 

and through a dwelling unit; 5) reinforced bathroom walls; 6) useable kitchens and 

bathrooms; and 7) accessible light switches, electrical outlets, and environmental 

controls. For further information, see http://www.hud.gov/offices/fheo/disabilities/

fhguidelines/fhefha5.cfm#sect5. 

737 For further information, see http://www.iccsafe.org/cs/codes/ 

738 See NCD Topical Brief #2 for more information. 

739 Before the ACS, HUD would produce annually adjusted estimates of the decennial 

census. 
507

740 NSP requires targeting for assistance a proportion (at least 25 percent) of individuals 

at or below 50 percent of AMI. 

741 See NCD Topical Brief #1 for more details and data on this point. 

742 See NCD Topical Brief #1 for an overview. 

743 See T. Reuters, Medicaid Long-Term Care Expenditures in FY 2007 and Medicaid 

HCBS Waiver Expenditures FY 2002 through FY 2006, 2008, at the Clearinghouse for 

Home- and Community-Based Services, http://www.hcbs.org/. 

744 See, for example, www.socialserve.com, a nonprofit organization that has developed 

housing locator Web sites for more than half the States (number is in flux as some are 

in development and not yet active), most of which have search features that include 

some level of accessibility and affordability. 

745 Rutgers Center for State Health Policy/NASHP, Community Living Exchange 

Collaborative, Single Entry Point Systems: State Survey Results, August 2003, 

http://www.nashp.org/Files/SEPReport11.7.03.pdf. 

746 See http://www.cms.hhs.gov/NewFreedomInitiative/01_Overview.asp#TopOfPage

for overview and State profiles featured in CMS Promising Practice resources. 

747 See http://www.cms.hhs.gov/PromisingPractices/HCBSPPR/list.asp?intNumPer

Page=all&submit=Go for specific State examples. 

748 See summary overview of effective policy and strategies: O’Keeffe, Crisp, Doty, 

Flanagan, Smith, et al., Developing and Implementing Self-Direction Programs and 

Policies: A Handbook, National Resource Center for Participant-Directed Services and 

Robert Wood Johnson Foundation, 2009, http://www.cashandcounseling.org/resources/

handbook.

749 See, for example, New Hampshire’s infrastructure to track participants and monitor 

provision of services and supports over time. The system is designed to improve 

funding and service coordination, as well as to provide check-in points for consumers so 

risks of community living can be proactively identified and managed to prevent future 

institutionalization. 

750 See http://www.hpm.umn.edu/ltcresourcecenter/research/rebalancing/

Rebalancing_state_ltc_systems.htm for long-term research of systems change 

initiatives. 

751 A. O’Hara, “Using Mainstream Affordable Housing and Service Systems Resources 

to Create Permanent Supportive Housing for Cross-Disability Homeless and At-Risk 

Populations,” in A New PSH Approach: The Louisiana and North Carolina PSA 

Initiatives (Boston: Technical Assistance Collaborative, Inc., 2009). 

752 Access Living was contracted to assist in writing this report. As one of the oldest 

Centers for Independent Living in the country, Access Living is a recognized leader in 

developing innovative programs aimed at improving system change and coordination. 
508

753 Few States have included housing locator information in their Consolidated Plans, 

while some States have housing locator services available. States that are 

implementing Money Follows the Person are using such services. 

754 Only cities that have 30 or more units listed on Socialserve.com receive a housing 

filter component, particularly regarding accessible features. 

755 See http://www.massaccesshousingregistry.org/. 

756 See http://www.accessva.org/. 

757 See http://www.accessibleapartments.org. 

758 See http://www.housingconnections.org. 

759 See http://dail.vermont.gov/dail-programs for additional information and reports. 

760 See http://dail.vermont.gov/dail-publications; See also NCD Topical Brief #1 for 

overview of new 811 legislation, H.R. 1675.